GI , Snell Flashcards by CM L

Cutaneous supply to the anterior abdominal wall is derived from (2)

1) Anterior rami of lower six thoracic nerves (lower 5 intercostals and subcostal)
2) Anterior rami of first lumbar nerve

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First lumbar nerve is represented by (2)

1) Iliohypogastric nerve

2) Ilioinguinal nerve

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Dermatome of T7

Xiphoid process

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Dermatome of T10

Umbilicus

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Dermatome of L1

Just above the inguinal ligament and symphysis pubis

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Arterial supply of abdominal skin: Midline

Superior and inferior epigastric

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Arterial supply of abdominal skin: Flanks (3)

1) Intercostal
2) Lumbar
3) Deep circumflex iliac

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Venous drainage of abdominal skin (2)

1) Axillary vein via lateral thoracic vein

2) Femoral vein via superficial epigastric and greater saphenous veins

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Lymphatic drainage of abdominal skin: Above umbilicus

Anterior axillary LN

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Lymphatic drainage of abdominal skin: Below umbilicus

Superficial inguinal LN

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Superficial fascia of abdomen is divided into

1) Camper fascia (fatty)

2) Scarpa fascia (membranous)

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Camper fascia is continuous with

Superficial fascia of the rest of the body

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Scarpa fascia fades at

1) Lateral

2) Superior

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Scarpa fascia continues inferiorly over the inguinal ligament to fuse with

Deep fascia of the thigh (fascia kata) ~1 finger breadth below the inguinal ligament

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Scarpa fascia continues in the midline to form

A tubular sheath for the penis/clitoris

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Scarpa fascia continues in the perineum to attach at the

Margins of the pubic arch to form the Colles’ fascia

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Strongest layer of the anterior abdominal wall

Deep fascia

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The cremaster muscle is derived from

Lower fibers of the internal oblique

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The rectus sheath is formed by

Aponeurosis of the 3 lateral abdominal muscles

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Arrangement of abdominal aponeurosis at the level of the ASIS

All 3 aponeuroses pass anteriorly to the rectus muscle, leaving the sheath deficient posteriorly

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All 3 aponeuroses fuse with each other and with their fellows of the opposite side in the midline between the recti muscles to form the

Linea alba

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Linea alba extends from

Xiphoid process above to symphysis pubis below

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The transverse tendinous intersections that divide the rectus abdomens into segments are usually ___ in number

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Abdominal tendinous intersections levels

1) Level of the xiphoid
2) Level of the umbilicus
3) Between the the xiphoid and umbilicus

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Muscle fibers that form the conjoint tendon

Internal oblique and transversus abdominis

The lower free border of the internal oblique arches over the spermatic cord/round ligament of uterus, descends behind and attaches to

Pubic crest and pectineal line

Role of the conjoint tendon

Strengthens the medial half of the posterior wall of the inguinal canal

The inguinal ligament is formed by

Lower border of the aponeurosis of external oblique

Lower border of the inguinal ligament is attached to

Deep fascia of thigh (fascia lata)

The fascia transversalis lines the

Transversus abdominis

The fascia transversalis is continuous with (2)

1) Lining of the diaphragm | 2) Lining of the iliacus

Fascia transversalis forms part of what sheath

Femoral sheath

Femoral sheath is formed by (2)

1) Fascia transversalis | 2) Fascia iliaca

Content of inguinal canal in females

Round ligament

Content of inguinal canal in males

Spermatic cord

Inguinal canal leads to ___ in males

Testis

Inguinal canal leads to ___ in females

Labium majus

Inguinal canal: Length

4 cm

Inguinal canal: Extends from

Deep/internal inguinal ring laterally to superficial/external inguinal ring obliquely and medially

Inguinal canal: Lies parallel and immediately above the

Inguinal ligament

Deep inguinal ring: Oval opening in the

Fascia transversalis

Deep inguinal ring: Lies approximately ___ above the inguinal ligament

1.3 cm

Deep inguinal ring: Margins give attachment to

Internal spermatic fascia

Superficial inguinal ring: Shape

Triangular

Superficial inguinal ring: Aponeurosis of

External oblique

Superficial inguinal ring: Lies immediately above and medial to

Pubic tubercle

Superficial inguinal ring: Margins give attachment to

External spermatic fascia

Inguinal canal walls: Anterior

EOM aponeurosis

Inguinal canal walls: Posterior

Conjoint tendon medially, fascia transversalis laterally

Inguinal canal walls: Superior wall (roof)

IO and TA

Inguinal canal walls: Inferior wall (floor)

Inguinal and lacunar ligaments

Inguinal ligament is aka

Poupart's ligament

Structure that passes through the inguinal canal in both males and females

Ilioinguinal nerve

Hernia that occurs above the inguinal ligament

Inguinal hernia

Hernia that occurs below the inguinal ligament

Femoral hernia

Hernial sac of an indirect inguinal hernia

Processus vaginalis

More common: Indirect vs direct inguinal hernia

Indirect

Indirect inguinal hernia: More common in the left vs right

Right

Indirect inguinal hernia: Neck of sac, wide vs narrow

Narrow

Femoral vs inguinal hernia: Sac above and medial to the pubic tubercle

Inguinal

Femoral vs inguinal hernia: Sac below and lateral to the pubic tubercle

Femoral

Direct inguinal hernia: Males vs females

Males

Direct inguinal hernia: Neck of hernial sac, wide vs narrow

Wide

Contents of spermatic cord (7)

1) Vas deferens 2) Artery of vas deferens 3) Remains of processes vaginalis 4) Testicular artery, vein (pampiniform plexus), and lymph vessels 5) Cremasteric artery 6) Genital branch of genitofemoral nerve, which supplies the cremaster muscle) 7) Autonomic nerves

External spermatic fascia is derived from

External oblique muscle

Internal spermatic fascia is derived from

Fascia transversalis

Cremasteric fascia is derived from

Internal oblique muscle

Lower expanded part of the processes vaginalis

Tunica vaginalis

T/F Direct inguinal hernia never enters the scrotum

Indirect inguinal hernia is covered by

1) Peritoneum | 2) 3 layers of spermatic cord

Musculoligamentous cord that connects the fetal testis with the floor of the developing scrotum

Gubernaculum testis

Gubernaculum testis is homologous with

Female round ligament of the ovary and round ligament of the uterus

Layers of the scrotum

1) Skin 2) Superficial fascia (Dartos muscle) 3) External spermatic fascia 4) Cremasteric fascia 5) Internal spermatic fascia 6) Tunica vaginalis

Derivatives: Superficial fascia of the abdomen

Dartos muscle

Derivatives: External oblique muscle

External spermatic fascia

Derivatives: Internal oblique muscle

Cremaster muscle

Derivatives: Fascia transversalis

Internal spermatic fascia

Derivatives: Peritoneum

Tunica vaginalis

Outer fibrous capsule of the testes

Tunica albuginea

Structure that lies posterior to the testis that has a head, body, and tail

Epididymis

Epididymis: Length

Emerges from the tail of the epididymis

Vas deferens

Arterial supply to the testis

Testicular artery from the abdominal aorta

Venous drainage of the testis (2)

1) IVC via the right testicular vein | 2) Left renal vein via the left testicular vein

Varicocele: Left vs right

Left

Why varicocele more commonly forms on the left testicle

Drains into the renal vein where the pressure is higher

Lymph drainage of the testis

Paraaortic LN at the level of L1

Nerves of the anterior abdominal wall run downward and forward between

Internal oblique and transversus abdominis

Nerve/s that enter the rectus sheath

Lower 6 thoracic nerves

Nerve/s that does/do NOT enter the rectus sheath

Inguinal triangle is aka

Hesselbach's triangle

Boundaries of the inguinal triangle: Superior and lateral

Inferior epigastric artery

Boundaries of the inguinal triangle: Inferior and lateral

Inguinal ligament

Boundaries of the inguinal triangle: Medial

Rectus abdominis

Reflex elicited by stroking the skin of the superior and medial thigh

Cremasteric reflex

Cremasteric reflex: Utilizes sensory and motor fibers in the

Ventral rams of L1

Cremasteric reflex: Sensory arm

Ilioinguinal nerve

Cremasteric reflex: Motor arm

Genital branch of the genitofemoral nerve

Superior epigastric artery arises from

Internal thoracic artery

Inferior epigastric artery arises from

External iliac artery

Deep circumflex iliac artery is a branch of

External iliac artery

Blood supply of the anterior abdominal wall

1) Superior epigastric 2) Inferior epogastric 3) Deep circumflex iliac 4) Lower 2 posterior intercostal (descending thoracic aorta) 5) Four lumbar (abdominal aorta) 6) Superficial epigastric, Superficial circumflex iliac, Superficial external pudendal (femoral artery)

T/F The peritoneal cavity in males is a closed cavity

T/F The peritoneal cavity in females is a closed cavity

F, communicates with exterior through uterine tubes, uterus, and vagina

Main compartment of the peritoneal cavity that extends from the diaphragm to the pelvis

Greater sac

Compartment of the peritoneal cavity that lies behind the stomach

Lesser sac

Greater and lesser sac of peritoneum are in free communication with each other at the

Epiploic foramen

The liver is connected to the diaphragm by (4)

1) Falciform ligament 2) Coronary ligament 3) Right triangular ligament 4) Left triangular ligament

Two-layered ford of peritoneum that connect the stomach with another viscus

Omenta

Connects the greater curvature of stomach with transverse colon

Greater omentum

Suspends the lesser curvature of the stomach to the fissure for the ligemantum venosum and port hepatic of the liver

Lesser omentum

Connects the stomach to the hilus of the spleen

Gastrosplenic omentum/ligament

Two-layered folds of peritoneum connecting parts of the intestines with the posterior abdominal wall

Mesenteries

Boundaries of the epiploic foramen: Anterior (2)

1) Lesser omentum | 2) Portal triad

Boundaries of the epiploic foramen: Posterior

IVC

Boundaries of the epiploic foramen: Superior

Caudate lobe of liver

Boundaries of the epiploic foramen: Inferiorly

First part of duodenum

Parietal peritoneum in the pelvis is mainly supplied by

Obturator nerve

Somatic vs autonomic: Parietal peritoneum

Somatic

Somatic vs autonomic: Visceral peritoneum

Autonomic

Somatic vs autonomic: Pain precisely localized

Somatic

Somatic vs autonomic: Pain poorly localized

Autonomic

Stimulus for visceral/autonomic pain

Stretching or pulling

Visceral vs parietal peritoneum: Sensitive to pressure, pain, heat and cold

Parietal

Visceral vs parietal peritoneum: Insensitive to touch heat and cold

Visceral

Sac of peritoneum that lies posterior to the stomach and lesser omentum

Lesser sac

2 recesses of lesser sac

Superior recess and inferior recess

GI , Snell Flashcards

(127 cards)