Lect 3: Anterior Abdominal Wall, Inguinal Region, and Peritoneum Flashcards Preview

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Flashcards in Lect 3: Anterior Abdominal Wall, Inguinal Region, and Peritoneum Deck (61):
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Lesser vs. Greater curvature of stomach

Lesser - faces right Greater - faces left

1

Transumbilical Plane (Location)

@ L3/L4 separates 4 quadrants of abdomen (along with median plane - vertical)

2

Subcostal Plane (Location)

L3

3

Transtubercular plane (location)

L5

4

Transpyloric plane (location, intersections)

@ L1 and 9th costal cartilage *Intersects: - pyloric sphincter of stomach - funds of gallbladder - duodenojejunal junction - neck of pancreas - hiatus of kidneys

5

Umbilicus (location)

L3-L4

6

Linea semilunaris

depression at lateral edge of each rectus abdominus muscle

7

Lowest level of costal margin

L3

8

Iliac crest (location)

L4

9

2 types of superficial fascia of abdomen

1. Camper's 2. Scarpa's

10

Camper's fascia

- fatty, superficial fascia - continuous with tunica dartos in the scrotum (muscle that contracts when cold)

11

Scarpa's fascia

- membranous, superficial fascia - blends with fascia of thigh (although can be separated) - continuous with Colles' fascia of perineum

12

Superficial Arteries of Abdomen

1. Anterior perforating arteries (from superior and inferior epigastric A. - inferior epigastric from the external iliac A) 2. Lateral cutaneous arteries (from lower intercostal, subcostal, and lumbar A)

13

Superficial Arteries of Inguinal Region

From femoral A: 1. superficial epigastric (to lower abdomen) 2. superficial circumflex iliac (to lower abdomen above inguinal ligament) 3. superficial external pudendal (to pubic region)

14

Anterior perforating veins drain to the

superior and inferior epigastric VV

15

Lateral cutaneous veins drain to the

thoracoepigastric V (then will travel up to axillary vein or down to femoral vein)

16

Superficial inguinal vein drain to the

femoral V

17

Paraumbilical vein drain to the

portal V --> umbilical V (along the falciform ligament)

18

Caput medusae

portal drainage obstructed --> build-up of pressure --> drainage to tributaries of umbilical vein (distinctive pattern of visible superficial veins results)

19

Superficial lymphatics of abdomen

- above umbilicus --> anterior axillary nodes - below umbilicus --> superficial inguinal nodes

20

Deep lymphatics of abdomen

- parasternal (follows internal thoracic A) - lumbar (follows abdominal aorta) - external iliac nodes (follows external iliac A)

21

Cutaneous Nerves to abdomen (lateral, anterior, and pubic)

1. lateral and anterior --> from T7 - T12 2. L1: - iliohypogastric N (lower hypogastric region) - ilioinguinal N (inguinal region)

22

Key features at T7, T10, and L1 dermatomes

T7 - just below xiphoid process T10 - umbilicus L1 - inguinal ligament and pubic symphysis

23

External spermatic fascia

- from external oblique aponeurosis and fascia - outermost fascia of spermatic cord

24

Inguinal canal (deep and superficial rings and contents)

*deep *ring: evagination of transversalis fascia - lateral to inferior epigastric A and V *superficial *ring: b/w lateral and medial crura of external oblique Contains: 1. ilioinguinal N 2. (males) - spermatic cord (females) - round ligament of uterus

25

Cremaster fascia (and muscle)

- from internal oblique - middle layer of fascia for spermatic cord

26

Internal spermatic fascia

- from transversalis fascia - innermost fascia of spermatic cord

27

Tunica vaginalis

- serous sac that covers testis - parietal and visceral layers

28

Scrotum (contents)

- end of spermatic cord - epididymis - testis

29

Scrotum (layers)

1. skin 2. tunica dartos (smooth muscle that is a continuation of camper's fascia of lower anterior abdomen)

30

Epididymis

- stores sperm - receives sperm from seminiferous tubules of testis via efferent ductules - epididymus --> vas deferens (begins at tail of epididymus)

31

Vas deferens

- thick-walled muscular tube - conveys spermatozoa - passes with spermatic cord and externally to peritoneum in the pelvic cavity - expands to form ampulla which forms an ejaculatory duct with the seminal vesicle

32

3 arteries of scrotum

1. testicular A - supplies testis and epididymis (from abdominal aorta) 2. artery of vas deferens - from inferior vesical artery 3. cremasteric artery - from inferior epigastric artery

33

Pampiniform plexus

- venous drainage of testis and epididymis - surround testicular artery to allow for cooling (needed for spermatogenesis) - combines into 1 testicular vein at inguinal canal - *varicocele - due to obstruction of vein

34

Testicular veins terminates as

(right) - IVC (left) - left renal V.

36

3 Inguinal nerves

1. Genitofemoral N (L 1 and 2) - 2 branches: genital - enters spermatic cord via deep inguinal ring; motor to cremaster muscle femoral - enters thigh; sensory to thigh 2. Ilioinguinal N (L1): bw internal oblique and transversus abdominus, through inguinal canal but does NOT pierce deep inguinal ring - sensory to anterior scrotum/labia majora and to thigh 3. Iliohypogastric N (L1) - b/w I.O. and T.A. muscles - NOT within inguinal canal

37

Descent of gonads by

processus vaginalis (guided by gubernaculum) - obliterated in females; becomes tunica vaginalis in males

38

Gubernaculum remnants become

- males: scrotal ligament - females: superior - ligament of ovary, inferior - round ligament of the uterus

39

Hydrocele and Hematocele

- accumulation of fluid or blood (respectively) in the tunica vaginalis via distention - can lead to inguinal hernias

39

Femoral hernias

- more common in females - pass posterior to inguinal ligament in thigh

40

Direct vs. Indirect Hernias

- DIRECT: push out though the Hesselbach's (inguinal) triangle (usually don't reach testis) - INDIRECT: pass through deep inguinal ring (and the entire inguinal canal); may reach scrotum ** BOTH pass through superficial inguinal ring

41

Lymph drainage of scrotum

superficial inguinal --> deep inguinal --> external iliac nodes

42

Lymph drainage of testis

along testicular arteries --> lumbar (para-aortic) nodes posteriorly

43

Ligament (peritoneal reflection)

suspends/supports abdominal organ

44

Mesentery (peritoneal reflection)

encloses an organ AND conveys blood and nerves and stores fat

45

Falciform ligament

b/w diaphragm and anterior abdominal wall & liver

46

Coronary ligament and R/L triangular ligaments

b/w diaphragm and liver

47

Mesentery proper

b/w posterior abdominal wall and coils of jejunum/ileum

48

Sigmoid mesocolon

b/w posterior abdominal wall and sigmoid colon

49

transverse mesocolon

b/w pancreas and transverse colon

50

ligament of Treitz

suspensory ligament of duodenum (made from right crus of diaphragm) junction of retroperitoneal duodenum and intraperitoneal jejunum

51

Retroperitoneal organs

1. Kidneys (ureters, adrenal glands) 2. Aorta and IVC 3. Duodenum (except 1st part) 4. Colon (except transverse) 5. Pancreas (except tail)

52

Median umbilical fold covers

fetal urachus (median umbilical ligament)

53

Medial umbilical fold covers

obliterated umbilical artery

54

Lateral umbilical fold covers

inferior epigastric vessels

55

Omental bursa (lesser peritoneal sac)

- posterior to stomach and lesser omentum - hepatogastic and hepatoduodenal ligaments

56

Epiploic foramen

- communication b/w greater and lesser peritoneal sacs - extends to hilum of spleen (gastrosplenic and lienorenal ligaments) - anteriorly: portal vein, hepatic artery, and bile duct - posteriorly: IVC

58

Greater omentum

- hangs from greater curvature of stomach - can move - prevents spread of fluid and infection - fusion with omental bursa = gastrocolic ligament

58

Hepatogastric ligament

- prat of the lesser omentum - at lesser curvature of stomach - fuses with liver

59

Hepatoduodenal ligament

- Part of lesser peritoneal sac - from upper border of duodenum and porta hepatis

60

Paracolic gutters

- pathways that allow flow of fluid/infection - helps prevent spread into other areas - four of them: R lateral, R medial, L medial, and L lateral