sp14_-_human_anatomy_exam_2_20141210195155 Flashcards
(272 cards)
1
Q
What are the 2 ways to divide the abdomen?
A
- 9 region- quadrants
2
Q
What are the layers of the anterior abdominal wall?
A
- skin (superficial)- camper fascia - superficial fatty layer of subcutaneous tissue- scarpa fascia - deep membranous layer of subcutaneous tissue- investing fascia - wraps around and between the following muscles: - external oblique muscle - internal oblique muscle - transversus abdominis muscle- endo-abdominal (transversalis) fascia- extraperitoneal fat- parietal peritoneum
3
Q
What are the muscles of the abdominal wall?
A
- external oblique muscle- internal oblique muscle- transversus abdominis muscle- rectus abdominis muscle- pyramidalis muscle
4
Q
What muscles form the aponeurosis in the anteriolateral abdominal wall?
A
external obliuqe, internal oblique, and transversus abdominus muscles
5
Q
What is the linea alba?
A
a midline raphe formed by the interweaving of the aponeuroses which extends from the xiphoid process to the pubic symphysis; between right and left sides as well as between superficial, intermediate, and deep layers
6
Q
What is the rectus sheath? What does it envelope? Name the layers.
A
- aponeurotic (tendinous) sheath- envelopes rectus abdominus and pyramidalis muscles- consists of anterior and posterior layers
7
Q
How does the composition of the ANTERIOR layer of the rectus sheath change from above the arcuate line to below the arcuate line?
A
- superior to arcuate line - formed by aponeuroses of external oblique and 1/2 inferior oblique muscles- inferior to arcuate line - formed by aponeuroses of external oblique, internal oblique and transversus abdominis muscles
8
Q
How does the composition of the POSTERIOR layer of the rectus sheath change from above the arcuate line to below the arcuate line?
A
- superior to arcuate line - formed by aponeuroses of transversus abdominis and 1/2 internal oblique muscles and transversalis fascia- inferior to arcuate line - formed by transversalis fascia
9
Q
What are the 3 infraumbilical peritoneal folds? How many of each are there? What do they each cover?
A
- median umbilical fold (1) - from urinary bladder to umbilicus; covers median umbilical ligament- medial umbilical folds (2) - covers medial umbilical ligaments; formed by the occluded portions of umbilical arteries- lateral umbilical folds (2) - covers inferior epigastric vessels
10
Q
What are the superficial vessels of the anterior abdominal region? Where do all of these vessels run (layer)?
A
- circumflex iliac artery- epigastric artery- circumflex iliac vein- epigastric vein- all of these vessels run in superficial fat and fascia
11
Q
What is the superficial circumflex iliac artery a branch of? What does it supply?
A
- branch of the femoral artery- supplies region of inguinal ligament
12
Q
What is the superficial epigastric artery a branch of? What does it supply?
A
- branch of the femoral artery- supplies abdomen inferior to umbilicus
13
Q
What is the superficial circumflex iliac vein drain to? What does it drain?
A
- drains to the femoral vein- drains region of inguinal ligament
14
Q
What is the superficial epigastric vein drain to? What does it drain?
A
- drains to femoral vein- drains abdomen inferior to umbilicus
15
Q
What is the deep circumflex artery a branch of? Where does it run? What does it supply? How does the vein of the same name differ?
A
- branch of external iliac artery- runs between internal oblique and transversus abdominis muscles- supplies inferior lateral abdominal muscles- all veins are similarly placed and drain to the external iliac vein
16
Q
What is the inferior epigastric artery a branch of? Where does it run? What does it supply? What does it anastamose with? How does the vein of the same name differ?
A
- branch of external iliac artery- enters posterior rectus sheath at arcuate line- supplies lower rectus abdominus muscles- anastamoses with superior epigastric artery- all veins are similarly placed and drain to external iliac vein
17
Q
What is the superior epigastric artery a branch of? Where does it run? What does it supply? What does it anastamose with? How does the vein of the same name differ?
A
- branch of internal thoracic artery (mammary)- enters posterior rectus sheath lateral to sternum- supplies upper rectus abdominus muscles- anastomoses with inferior epigastric artery- all veins are similarly placed and drain to internal thoracic vein
18
Q
What are the nerves of the abdominal wall? Where do they run?
A
- ventral rami of T7-L1 spinal nerves- run between internal oblique and transversus abdominis muscles
19
Q
What do each of the nerves of the abdominal wall supply?
A
- T7, T8, & T9 - supply region above umbilicus- T10 - supplies umbilical region- T11, T12, & L1 - supply region below umbilicus
20
Q
What can occur if there is an injury to the ventral rami of spinal nerves T11, T12, and L1?
A
injury to these nerves weakens muscles in inguinal region; predisposes the person to developing direct inguinal hernias
21
Q
Where is the inguinal region located?
A
superior to thigh, medial to ilium, and lateral to pubic bone
22
Q
What does the inguinal region extend between?
A
area extends between the anterior superior iliac spine (ASIS) and the pubic tubercle
23
Q
What are the contents of the inguinal region?
A
- inguinal ligament- inguinal canal (male and female)- superficial and deep rings of the inguinal canal- walls of the inguinal canal
24
Q
What is the inguinal ligament? What does it extend between? What does it supply?
A
- folded inferior border of the external oblique aponeurosis- extends from ASIS to pubic tubercle- supplies upper abdominal muscles and diaphragm
25
What is the inguinal canal? What does it transverse? What other structure does it run by?
- obliquely set tunnel 3-5 cm long- transverses anterior abdominal wall- runs parallel and superior to inguinal ligament
26
What are the contents of the MALE inguinal canal?
- spermatic cord and its contents (vas deferens, testicular nerves and vessels, cremasteric muscle and fascia)- ilioinguinal nerve (L1)
27
What are the contents of the FEMALE inguinal canal?
- round ligament of uterus- ilioinguinal nerve (L1)
28
What are the 2 rings of the inguinal canal? Where do they each open?
- superficial ring - opening in external oblique aponeurosis; obvious triangular opening lateral to pubic tubercle- deep ring - opening in transversalis fascia; subtle piercing just lateral to inferior epigastric vessels
29
How do the 2 inguinal rings define the inguinal canal?
the canal extends between the superficial and deep inguinal rings
30
What are the walls of the inguinal canal?
- anterior wall: external oblique aponeurosis- posterior wall: transversalis fascia and conjoint tendon (fusion of internal oblique and transversus abdominis aponeuroses medially)- roof: internal oblique and transversus abdominis muscles- floor: inguinal ligament
31
What is an abdominal hernia? Where do most hernias occur?
- outpouching of abdominal viscera within a sac- 90% of hernias occur in inguinal region
32
What are the 3 layers that comprise the hernial sac?
- peritoneum- extraperitoneal fat- transversalis fascia
33
Where does an indirect inguinal hernia occur?
extends through entire inguinal canal; LATERAL to inferior epigastric vessels; commonly enters scrotum or labia majora
34
What is the most common type of hernia? Is it more prevalent in males or females?
- indirect inguinal hernia- more prevalent in males than females
35
In males, what does an indirect inguinal hernia usually result from?
usually from persistent processus vaginalis in males (connects peritoneum with descended testis)
36
What is an indirect inguinal hernia usually referred to in a female?
canal of Nuck
37
Where does a direct inguinal hernia occur?
through the inguinal triangle (Hesselbach's) (inferior epigastric artery, rectus abdominus muscle and inguinal ligament); emerges through conjoint tendon by or at superficial ring; MEDIAL to inferior epigastric vessels; usually does NOT enter scrotum or labia majora
38
Is a direct inguinal hernia more common in males or females?
males
39
What is a direct inguinal hernia usually associated with?
usually associated with a weakened abdominal wall
40
Other than inguinal hernias, what are the 3 other types of abdominal hernias covered in lecture?
- femoral hernia- umbilical hernia- epigastric hernia
41
What is the most common type of hernia in females?
indirect inguinal hernia
42
Describe a femoral hernia.
- through the femoral ring and canal- medial compartment of sheath- more common in females than males (femoral ring is wider in females)
43
Describe an umbilical hernia.
- through the umbilical ring- most common in newborns- more common in females and obese individuals
44
Describe an epigastric hernia.
- through the linea alba- most common in over 40- usually associated with obesity
45
What is the inferior epigastric artery a branch of? Where does it run? What does it supply? What does it anastamose with? How does the vein of the same name differ?
- branch of external iliac artery- enters posterior rectus sheath at arcuate line- supplies lower rectus abdominus muscles- anastamoses with superior epigastric artery- all veins are similarly placed and drain to external iliac vein
46
What is the superior epigastric artery a branch of? Where does it run? What does it supply? What does it anastamose with? How does the vein of the same name differ?
- branch of internal thoracic artery (mammary)- enters posterior rectus sheath lateral to sternum- supplies upper rectus abdominus muscles- anastomoses with inferior epigastric artery- all veins are similarly placed and drain to internal thoracic vein
47
What is a peritoneum?
thin, translucent, serous membrane
48
What are the two types of peritoneum? What does each cover?
- parietal peritoneum - lines the inner abdominal wall- visceral peritoneum - covers organs
49
What does the term retroperitoneal imply?
that the organs are behind the peritoneum
50
Where do vessels travel with respect to the peritoneum?
vessels travel between the peritoneal layers
51
What is the peritoneal sac?
all viscera and parietal peritoneal membranes
52
What is the peritoneal cavity? What does it contain? What is its purpose?
- a potential space within the peritoneal sac- contains only a small amount of serous fluid- allows organs to move freely without friction (ex. peristalsis)
53
Explain the clinical significance of the peritoneal cavity.
- the potential space (peritoneal cavity) can become an actual space- may contain up to several liters of fluid (ascites)- disease, injury, or infection can lead to pooling of fluids (blood, bile, pus, feces)
54
Name the 7 double-layered peritoneal folds and ligaments.
- greater omentum- lesser omentum- mesentery proper- suspensory ligament of Treitz- mesocolon- falciform ligament- coronary ligament
55
What does the greater omentum attach to? What does it cover?
- attaches to the greater curvature of stomach and the transverse colon- drapes over the small intestines like an "apron"
56
What is another name for the "apron" that drapes over the small intestines and is a part of the greater omentum? How many layers does it have?
- gastrocolic ligament- 4 layers (the double layer goes down and then comes back up to total 4 layers)
57
What are the three parts of the greater omentum?
- gastrophrenic ligament- gastrosplenic ligament- gastrocolic ligament
58
What is the clinical significance of the greater omentum?
- functionally, it can wall off infections and inflammation sites- results in formation of adhesions (limit mobility and limit how food can be processed)
59
What does the lesser omentum attach to?
attaches the lesser curvature of the stomach and duodenum to the liver via 2 ligaments
60
What are the 2 portions of the lesser omentum? What does each connect?
- hepatogastric ligament - connects liver to stomach- hepatoduodenal ligament - connects liver to duodenum
61
What is the portal triad? What peritoneal fold/ligament contains this structure?
- hepatic artery, portal vein, and bile duct- hepatoduodenal ligament of the lesser omentum
62
What does the mesentery proper connect to?
- anchors most of the small intestine to the posterior abdominal wall- runs diagonally from duodenojejunal junction to the ileocecal junction (distance = 15-20 cm in adults)**NOTE: duodenum anchored by the suspensory ligament of Treitz
63
What is the suspensory ligament of Treitz? What does it connect to? What is its function?
- fibromuscular ligament descends form R. crus of the diaphragm and crosses over L. crus to hold the distal duodenum in place- prevents the duodenojejunal junction from sagging
64
What is the function of the mesocolon?
anchors portions of the colon to the posterior abdominal wall
65
Which of the sections of the colon are supported by a mesocolon?
- transverse colon is anchored by transverse mesocolon- sigmoid colon is anchored by sigmoid mesocolon- ascending and descending colon have no mesentery; they attach directly to the posterior wall- rectum is only partially covered with peritoneum
66
What is the function of the falciform ligament? What does it contain at its inferior border?
- divides liver into right and left lobes; anchors liver to diaphragm and anterior body wall- round ligament of the liver (the obliterated umbilical vein)
67
What is the coronary ligament? What is its function?
- reflections of peritoneum around the bare area of the liver- attach liver to inferior surface of the diaphragm
68
Where is the bare area of the liver located?
upper posterior liver
69
What are the single-layered peritoneal folds? How many of each are there? What does each cover?
- 1 median umbilical fold: covers fetal urachus- 2 medial umbilical folds: covers fetal umbilical arteries- 2 lateral umbilical folds: covers inferior epigastric vessels
70
What are peritoneal pouches?
potential peritoneal spaces in standing patients; becomes actual spaces in recumbent (horizontally-lying) patents
71
What are the two peritoneal pouches?
- hepatorenal pouch- rectovesical or rectouterine pouch
72
What is the clinical significance of peritoneal pouches?
pathological fluids can accumulate in these recesses
73
What structures surround the hepatorenal pouch?
bounded by liver, right kidney, colon, and duodenum
74
What is the lowest part of the peritoneal cavity when patient is recumbent (horizontal)?
hepatorenal pouch; fluids may move down to rectovesical/rectouterine pouch when in reclining position or sitting up
75
What is another name for the hepatorenal pouch?
Pouch of Morrison
76
In what gender can the rectovesical pouch be found?
male
77
Where is the rectovesical pouch found? How can fluids move from this pouch to the hepatorenal pouch?
- between the bladder and rectum- fluids here may move up to hepatorenal pouch when in Trendelenburg position (laying down where the feet are higher than the head)
78
Where is the rectouterine pouch found? How can fluids move from this pouch to the hepatorenal pouch?
- between the rectum and uterus- fluids here may move up to hepatorenal pouch when in Trendelenburg position (laying down where the feet are higher than the head)
79
What is the function of the liver?
detoxifies chemical products and produces bile
80
What is the function of the gallbladder?
stores bile for emulsification of fats
81
What is the function of the pancreas?
produces enzymes for digestion
82
What is the function of the spleen?
produces lymphocytes and filters blood
83
What is the porta hepatis?
transverse fissure in the middle visceral surface of the liver that gives passage to the hepatic portal vein, hepatic artery, hepatic nerve plexus, hepatic ducts, and lymphatic vessels
84
Where is the gall bladder attached? What does it connect to?
- attached to inferior surface of liver- contacts duodenum, colon, and anterior abdominal wall
85
What occurs within the gallbladder?
receives bile produced by liver via bile ducts; bile then drains into duodenum through these ducts
86
Name the bile ducts. Where does each receive it's bile?
- right and left hepatic ducts: receives bile from right and left lobes of liver- common hepatic duct: receives right and left hepatic ducts- cystic duct: connected to gallbladder- common bile duct: receives cystic and common hepatic ducts
87
Describe the drainage of the bile ducts.
- right/left hepatic duct drain into common hepatic duct- common hepatic duct and cystic duct drain into common bile duct- common bile duct and main pancreatic duct drain into the major duodenal papilla in descending duodenum
88
Name the parts of the pancreas.
- head- neck- body- tail- uncinate process (posterior to superior mesenteric artery)
89
True or false: The pancreas is retroperitoneal.
true
90
What surrounds the pancreas?
surrounded by C-shaped duodenum on the right and spleen on the left
91
Describe the drainage of the pancreatic ducts.
- main pancreatic duct: enters duodenum with bile duct at major duodenal papilla- accessory pancreatic duct: may enter duodenum as well 2 cm superior to major papilla (minor papilla)*pattern of pancreatic drainage is variable
92
What is the hilum?
area of the spleen which is not surrounded by peritoneum where the splenic branches of the splenic artery and vein enter and leave
93
Where does the spleen contact the diaphragm?
contacts diaphragm along ribs 9-11
94
What are the 3 areas of the spleen?
- gastric area- renal area- colic area
95
What are the paired visceral branches of the abdominal aorta?
- suprarenal arteries- renal arteries- gonadal (ovarian or testicular) arteries
96
What are the unpaired visceral branches of the abdominal aorta?
- celiac trunk- superior mesenteric artery- inferior mesenteric artery
97
What are the paired parietal branches of the abdominal aorta?
- inferior phrenic arteries- lumbar arteries
98
What is the unpaired parietal branch of the abdominal aorta?
median sacral artery
99
What does the celiac trunk branch off of? What does it supply?
- 1st major branch of the abdominal aorta- supplies liver, gallbladder, esophagus, stomach, pancreas, and spleen
100
What are the 3 branches of the celiac trunk?
- common hepatic artery- left gastric artery- splenic artery
101
What does the common hepatic artery branch off of? Where does it run?
- right branch of the celiac trunk- runs toward liver and gallbladder
102
What are the 2 branches of the common hepatic artery?
- proper hepatic artery- gastroduodenal artery
103
What is the proper hepatic artery a branch of? Where does it run?
- superior branch of common hepatic artery- runs toward the liver medial to the common bile duct and superficial to the portal vein
104
What does the proper hepatic artery split into?
splits into the right and left hepatic arteries which supply the right and left lobes of the liver
105
What is the gastroduodenal artery a branch of? Where does it run?
- inferior branch of the common hepatic artery- runs toward the junction of the stomach and duodenum
106
What are the branches of the gastroduodenal artery?
- superior pancreaticduodenal artery to pancreas/duodenum- right gastroepiploic artery to the greater curvature of the stomach- sends supraduodenal artery to the superior duodenum
107
What is the left gastric artery a branch of? Where does it run? What does it supply?
- superior branch of the celiac trunk- runs left toward the lesser curvature of the stomach- supplies stomach and esophagus (via esophageal branches)
108
What is the splenic artery a branch of? Where does it run? What does it supply?
- left branch of celiac trunk- runs toward the spleen- supplies pancreas and spleen
109
What are the branches of the splenic artery?
- short gastric artery- left gastroepiploic artery*both supply the greater curvature of the stomach
110
Explain the variability in the cystic artery.
- usually arises from the right hepatic artery- 75% run posterior to common hepatic duct- 24% run anterior to common hepatic duct- 1% are double cystic arteries- supplies gallbladder and cystic duct*complications may arise when the artery passes anterior because of a risk for strangulation of blood flow
111
What is the function of the stomach?
stores food prior to entering duodenum
112
What is the function of the small intestine?
first for chemical digestion
113
What is the function of the large intestine?
second for chemical digestion
114
What is the function of the kidneys?
filter waste products out of blood
115
What is the function of the adrenal glands?
cortices produce steroid hormones and medulla act as a sympathetic ganglia (release epinephrine and norepinephrine)
116
What is the cardiac orifice?
entrance to the stomach from the esophagus
117
What is the pyloric sphincter?
exit of the stomach to the duodenum
118
What lines the stomach?
rugae (temporary folds within the body of the stomach)
119
What is the mixture called that is made by the stomach?
chyme
120
What are the 3 sections of the small intestine? Which are fixed and which are mobile?
- duodenum: fixed and relatively immobile- jejunum: tethered but very mobile- ileum: tethered but very mobile
121
What is the name of the permanent folds within the small intestine? Do they become more or less numerous distally?
- plicae circularis- become more diffuse distally
122
Where does the ileum empty into the cecum?
at the ileocecal junction
123
What are the four parts of the duodenum? Describe the location of each.
- superior (first) part: mostly horizontal; lies anterolateral to the body of the L1 vertebrae- descending (second) part: runs inferiorly along the right sides of the L2 and L3 vertebrae curving around the head of the pancreas; the bile duct and main pancreatic duct enter here- inferior (horizontal or third) part: crosses anterior to the IVC and aorta and posterior to the superior mesenteric artery and superior mesenteric vein at the level of L3 vertebrae- ascending (fourth) part: begins at the left of the L3 vertebrae and rises superiorly as far as the superior border of L2; it passes the aorta to reach the inferior border of the pancreas to join the jejunum
124
What are some ways the jejunum and ileum can be differentiated between?
- plicae circularis are abundant in jejunum- the arterial arcades (arteries that unite to form loops or arches) in the ileum are broader and flatter than in the jejunum
125
What is Meckel's (ileal) diverticulum? Why is it clinically significant?
- remnant of the embryonic yolk stalk; appears as a finger-like pouch; located approx. 1 m proximal to the ileocecal valve- may become inflamed and mimic appendicitis
126
Where is the veriform appendix located? What is it supplied by?
- opens into cecum inferior to ileocecal orifice; commonly retrocecal but varies considerably- triangular mesentary called the mesoappendix
127
Describe the progression of pain during appendicitis.
- vague pain begins in the periumbilical region (from afferent pain referred to T10 dermatone level)- severe pain later from the right lower quadrant (from irritation of the peritoneum of the posterior abdominal wall)- pain most severe over spinoumbilical point between the ASIS and umbilicus (McBurney point)
128
What are the 5 segments of the large intestine?
- cecum- ascending colon- transverse colon- descending colon- sigmoid colon
129
What are the 2 flexures of the large intestine?
- right colic (hepatic) flexure- left colic (splenic) flexure
130
What are the 3 specializations of the colon? Describe them.
- teniae coli: 3 smooth muscle bands paralleling the length of the colon- haustra coli: outpouchings produced by teniae coli- epiploic appendages: fat tags found along the colon
131
What is the superior mesenteric artery a branch of? What does it supply?
- 2nd major branch of the abdominal aorta approx. 1 cm inferior to the celiac trunk- sends 15-18 intestinal arteries to the small intestine; supplies up to proximal 2/3 of the transverse colon (via ileocolic, right colic, and middle colic arteries)
132
What is the inferior mesenteric artery a branch of? What does it supply?
- 3rd major branch of the abdominal aorta approx. 5 cm superior to aortic bifurcation- supplies colon from distal 1/3 of transverse colon (via left colic, sigmoid, and superior rectal arteries)
133
What are the intestinal branches of the superior mesenteric artery?
- jejunal and ileal branches- ileocolic artery- right colic artery- middle colic artery
134
What are the branches of the inferior mesenteric artery?
- left colic artery- sigmoid artery- superior rectal artery
135
True or false: There is no anastomoses for the colic branches of the superior and inferior mesenteric arteries.
FALSE; anastomoses exist between colic branches for collateral circulation
136
What artery helps the colic branches of the SMA and IMA to form a consistent vascular arc around the colon?
the marginal artery of Drummond
137
What arteries supply the pancreas?
- gastroduodenal artery gives off the superior pancreaticduodenal artery- SMA gives off the inferior pancreaticduodenal artery (anastomose and supply the head of the pancreas and duodenum)- splenic artery supplies the rest of the pancreas with additional branches*example of an anastomose between the 1st and 2nd unpaired branches of the abdominal aorta
138
What do the renal arteries branch off of? What do they supply?
- lateral branches of the abdominal aorta (lateral to the SMA)- enter hilum of each kidney to supply it; sends off branches to adrenal glands and ureters (*other adrenal branches come from inferior phrenic arteries and aorta)
139
What do the ovarian arteries branch off of? What is their course? What do they supply?
- lateral branches of the abdominal aorta (inferior to the renal arteries)- crosses over ureters and iliac vessels- descends to pelvis to supply ovaries*even though they are paired, they are not always right next to one another; often the left is slightly superior to the right
140
What do the testicular arteries branch off of? What is their course? What do they supply?
- lateral branches of the abdominal aorta (inferior to the renal arteries)- crosses over ureters and enters the inguinal canal- descends into scrotum to supply testes*even though they are paired, they are not always right next to one another; often the left is slightly superior to the right
141
Where does the inferior vena cava begin? What does it drain and where does it drain it to?
- begins at approx L5 level at the union of the common iliac veins- returns poorly oxygenated blood from the lower limb, most of the back, abdominal wall, and abdominopelvic viscera- drains to the right atrium of the heart
142
What is the purpose of the portal venous system?
collects poorly oxygenated but nutrient-rich blood from the abdominal part of the alimentary tract and carries it to the liver
143
What are the 4 portal-caval anastomoses?
- gastric veins and esophageal veins- paraumbilical veins and epigastric veins- superior rectal veins and middle/inferior rectal veins- colic veins and retroperitoneal veins
144
What is the clinical significance of the portal-caval anastomoses?
- portal venous system has no valves- reversal of blood flow into the caval veins is possible if portal hypertension restricts blood flow of the portal vein- causes caval veins to become engorged which then may become dilated and varicose
145
What types of clinical conditions can arise from dilated caval veins due to portal-caval anastomoses?
- dilated esophageal veins produce esophageal varices- dilated epigastric veins produce caput medusae- dilated inferior and middle rectal veins produce hemorrhoids*NOTE: these can lead to vascular rupture and severe hemorrhaging
146
What innervates the abdominal viscera?
autonomic nerve plexuses
147
Where do the sympathetic fibers of the abdominal cavity originate? Where do the parasympathetic fibers originate?
- sympathetic fibers originate T5-L2(3) (thoracolumbar)- parasympathetic fibers originate from CN X and S2-S4 (craniosacral)
148
Describe the course of the sympathetic nerves of the abdomen.
- originates T5-L2/3- abdominopelvic splanchnic nerves exit the vertebral column through the PARAvertebral ganglia (sympathetic trunk) and some join to become the greater, lesser, and least splanchnic nereves and lumbar splanchnic nerve (preganglionic)- preganglionic splanchnic nerves synapse in the collateral ganglia (PREvertebral ganglia)- postganglionic fibers leave the ganglia to reach effector organs by traveling on all main arterial branches (celiac trunk, SMA, renal arteries, IMA, and all their branches)
149
What is the exception in the course of the sympathetic nerves of the abdomen?
the sympathetic nerve supplying the adrenal gland goes directly without synapsing to the adrenal gland so that the postganglionic cell bodies are IN the adrenal gland rather than in a PREvertebral ganglia
150
Describe the course of the parasympathetic nerves of the abdomen.
- preganglionic nerves from CN X travel on the upper arterial branches (celiac trunk, SMA, renal arteries and all their branches)- preganglionic nerves from S2-S4 travel on lower arterial branches (IMA and branches)- synapses occur within effector organs
151
What are the 4 major autonomic ganglia and plexuses of the abdomen? With what arterial vessels does each travel?
- celiac ganglion: plexus travels with celiac trunk branches- superior mesenteric ganglion: plexus travels with SMA branches- aorticorenal ganglion: plexus travels with renal branches- inferior mesenteric ganglion: plexus travels with IMA branches
152
Which autonomic ganglia receives thoracic splanchnic nerves and CN X branches? Which receives lumbar splanchnic nerves and S2-S4 branches?
- thoracic splanchnic nerves and CN X branches: celiac ganglion, superior mesenteric ganglion, and aorticorenal ganglion- lumbar splanchnic nerves and S2-S4 branches: inferior mesenteric ganglion
153
What is the diaphragm?
dome-shaped muscle that separates the thoracic and abdominal cavities; principal muscle of respiration
154
What are the 2 nerves of the diaphragm? What does each supply?
- phrenic nerves: supplies right and left hemidiaphragms- intercostal nerves: supplies lateral borders and some sensory (*take note that there is a sensory portion)
155
What nerves contribute to form the phrenic nerve?
C3-C5
156
What is the clinical significance of the phrenic nerve?
- nerve originates from C3-C5 spinal segments- paralysis of diaphragmatic respiration can result from cervical cord injuries- paralyzed hemidiaphragm cannot contract (descend) so it remains high in thorax and is recognizable on radiographic chest films
157
When the diaphragm contracts, does it ascend or descend?
descend
158
What are the 3 openings found in the diaphragm and at what vertebral body level are they found? What passes through each?
- vena cava foramen (T8): IVC- esophageal hiatus (T10): esophagus- aortic hiatus (T12): aorta
159
Name the arcuate ligaments or lumbocostal arches. How many of each are there? What does each arch over?
- median arcuate ligament (1): arches over aorta- medial arcuate ligaments (2): arch over psoas muscles- lateral arcuate ligaments (2): arch over quadratus lumborum muscles
160
What vessels supply the diaphragm? Which part of the diaphragm does each supply?
- pericardiacophrenic and superior phrenic arteries: supply superior surface (via internal thoracic and thoracic aorta)- inferior phrenic arteries: supply inferior surface (via abdominal aorta)- musculophrenic arteries: supply periphery of diaphragm (via internal thoracic artery)*NOTE: venous drainage is via accompanying veins to the IVC
161
Where are the kidneys located? How does the location of the kidneys vary between the left and right?
- located lateral to vertebral column T12-L3- superior pole of left kidney is at 11th rib while the superior pole of the right kidney is at the 12th rib
162
What surrounds the kidneys?
perirenal fat surrounds the kidneys and adrenal glands and is continuous with the fat in the renal sinus; the kidneys, adrenal glands, and perirenal fat is surrounded by a membranous layer of renal fascia
163
What structures exit the renal hilum?
- renal artery- renal vein- renal pelvis (becomes ureter)
164
What structure is located just superior to the kidney?
suprarenal (adrenal) gland
165
What are the gross features of the internal kidney?
- fibrous capsule: surrounds the kidney- renal cortex: outer 1/3 of kidney- renal medulla: inner 2/3 of kidney containing the renal pyramids- renal papillae: receive tips of pyramids- minor calyces- major calyces- renal pelvis- ureter
166
Which of the renal arteries is longer? Does it pass posterior or anterior to the IVC?
- right renal artery is longer- right renal artery passes posterior to IVC
167
How do the renal arteries terminate?
each divides at the hilum into 5 segmental end arteries
168
Which of the renal veins is longer? Does it pass posterior or anterior to the aorta?
- left renal vein is longer- left renal vein passes anterior to the aorta
169
Describe the drainage of the kidney.
renal papillae (receive the tips of the renal pyramids = urine) -> minor calyces -> major calyces -> renal pelvis -> ureter -> urinary bladder -> urethra
170
Describe the course of the ureters.
crosses psoas major muscles, run obliquely posterior to gonadal vessels, runs anterior to external iliac artery, enters bladder
171
True or false: Bifid renal pelvis and ureters is fairly common.
true
172
What is the clinical significance of retrocaval ureters?
ureter passes behind the IVC so there may be compression from the vessel so the ureter may be inhibited; increases potential for kidney stones
173
What arteries supply the ureter?
- renal artery- testicular or ovarian artery- abdominal aorta*NOTE: veins of ureters drain into similarly named veins
174
What is the clinical significance of kidney stones? What procedure is used to remove large kidney stones?
- form in kidney and progress to renal pelvis- may spontaneously pass through ureter into bladder (best case scenario)- usually associated with considerable pain- larger stones may have to be surgically removed- may be subjected to ultrasonic crushing via lithotripsy- usually due to dehydration or a side effect of medication
175
What is the clinical significance of calculi referred pain?
- waves of contraction force stone down through ureter- rhythmic pain occurs and is referred with descent of the stone; region of referred pain changes with the level of obstruction- pain gradually moves inferoanteriorly toward groin (from side and back between ribs to pelvis and inguinal)- pain is referred to the cutaneous areas innervated by the spinal cord segments which supply the ureter (T11-12)
176
What is the difference in the shape and location of the right adrenal gland and left adrenal gland?
- RIGHT gland is roughly triangular while LEFT gland is more semilunar- RIGHT gland lies superior to right kidney posterior to IVC and LEFT gland lies superomedial to left kidney near hilum
177
What are the gross internal features of the adrenal gland?
- fibrous capsule- adrenal cortex: outer part that produces adrenal steroids- adrenal medulla: inner portion that acts as sympathetic ganglion
178
What are the 3 sources of the suprarenal arteries?
- superior suprarenal arteries (6-8) supplied by inferior phrenic artery- middle suprarenal arteries (1+) supplied by abdominal arteries- inferior suprarenal arteries (1+) supplied by renal arteries
179
What muscles make up the posterior abdominal wall?
- transversus abdominus muscle- quadratus lumborum muscle- psoas major muscle- iliacus muscle- psoas minor muscle- diaphragm
180
What vessels supply the posterior abdominal wall?
lumbar arteries (4 pairs of arteries that branch off of the abdominal aorta superior to bifurcation)
181
At what vertebral level does the aorta bifurcate?
L4
182
What are the nerves of the posterior abdominal wall? Where are they located?
- ventral rami of T12-L4 (lumbar plexus of nerves)- located beneath fascia of posterior abdominal muscles*NOTE: sympathetic trunk is posterior as well and continuous with the thoracic portions
183
What is the spinal origin of the subcostal nerve? What does it supply?
- anterior rami of T12, approx 1 cm inferior to the 12th rib- supplies sensory to the anterior/lateral abdominal wall- supplies motor to abdominal muscles (external oblique, internal oblique, transversus abdominis, pyramidalis, rectus abdominis, and quadratus lumborum)
184
What is the spinal cord origin of the iliohypogastric and ilioinguinal nerves? What does each supply?
- both nerves arise from a common trunk of L1 and descend anterior to the quadratus lumborum- iliohypogastric nerve supplies skin of suprapubic region- ilioinguinal nerve runs through inguinal canal to supply it- both also supply abdominal muscles
185
What is the spinal cord origin of the genitofemoral nerve? Describe its course. What does it supply?
- spinal cord origin of L1-L2- pierces psoas major muscle, descends along anterior surface, splits to femoral branches and genital branches- supplies skin inferior and medial to inguinal ligament; supplies cremaster muscle (of spermatic cord)
186
What is the spinal cord origin of the lateral femoral cutaneous nerve (L2-L3)? Describe its course. What does it supply?
- spinal cord origin of L2-L3- descends anterior to iliacus muscle, passes deep to inguinal ring inferior to ASIS- supplies anterior/lateral skin of thigh
187
What is the spinal cord origin of the femoral nerve? Describe its course. What does it supply?
- spinal cord origin of L2-L4- runs between iliacus and psoas major muscles, passes deep to inguinal ligament inferior to ASIS- supplies sensory and motor to anterior thigh
188
What is the spinal cord origin of the obturator nerve? Describe its course. What does it supply?
- spinal cord origin L2-L4- runs medial to psoas major muscle, passes through obturator foramen- supplies sensory and motor to medial thigh
189
What is the spinal cord origin of the lumbosacral trunk? Describe its course. What does it do?
- spinal cord origin L4-L5- large nerve trunk that crosses over the ala of the sacrum, descends into pelvis to help form the sacral plexus- provides general contributions to both plexuses
190
What are the two regions of the pelvis? What separates them?
- false pelvis (greater pelvis): above the pelvic brim; pelvic inlet continuous with abdominal cavity- true pelvis: below the pelvic brim; pelvic outlet closed off below by muscular pelvic floor- pelvic brim separates them
191
What bones make up the pelvic girdle? What are the fused sections of each bone?
- sacrum (1): 5 fused sacral vertebrae- os coxae (2): ilium, ishium, and pubis
192
Where does the femur articulate with the os coxae? What bones make up this articular surface?
- at the acetabulum- ilium, ishium, and pubis
193
What is the most medial extent of the pubic bone?
pubic symphysis
194
How does the shape of the pelvic brim differ in males and females?
oval pelvic brim in females and heart-shaped in males
195
How does the size of the pubic symphysis differ in males and females?
shorter pubic symphysis in females
196
How does the width of the pubic arch differ in males and females?
much wider pubic arch in females
197
How do the iliac wings (alae) differ in males and females?
more flared iliac wings (alae) in females
198
How do the ischial tuberosities differ in males and females?
ischial tuberosities are farther apart in females
199
How does the sacrum differ in males and females?
sacrum is shorter and less curved in femlaes
200
Why does the pelvis differ for males and females?
female pelvis is accommodated for childbirth
201
How does the obturator foramen differ in males and females?
females have a more oval obturator foramen while the males have a more round obturator foramen
202
How does the subpubic angle or pubic arch differ in males and females?
males have a sharper and narrower angle that is less than 80 degrees
203
Name the ligaments of the pelvic girdle. What does each connect?
- pubic symphysis: connects 2 pubic bones- anterior sacroiliac ligament: connects sacrum and ilium anteriorly- posterior sacroiliac ligament: connects sacrum and ilium posteriorly- sacrotuberous ligament: connects sacrum to ischial tuberosity (lower border of lesser sciatic foramen)- sacrospinous ligament: connects sacrum/coccyx to ischial spine (lower boundary of greater sciatic foramen)- obturator membrane: closes off obturator foramen (lower border of obturator canal)
204
What ligament creates the lower boundary of the greater sciatic foramen?
sacrospinous ligament
205
What forms the lower border of the obturator canal?
obturator membrane
206
What ligament creates the lower border of the lesser sciatic foramen?
sacrotuberous ligament
207
What are the 2 triangles of the pelvis? What does each contain?
- urogenital triangle: passage of urinary and genital systems; contains deep transverse perineal muscles or urogenital diaphragm- anal triangle: passage of rectum and anus; contains pelvic floor muscles or pelvic diaphragm
208
What 2 muscles make up the pelvic diaphragm (pelvic floor)? What muscles assist them?
- levator ani muscle (3 bands: iliococcygeus, pubococcygeus, and puborectalis)- coccygeus muscle- assisted by piriformis and obturator internus muscles
209
What 3 muscle bands make up the levator ani muscle?
- iliococcygeus- pubococcygeus- puborectalis
210
What is the origin and insertion of the piriformis muscle? What does this muscle do structurally?
- anterior sacrum to greater trochanter- passes behind the greater sciatic notch and closes off posterior/superior pelvic outlet
211
What is the origin and insertion of the obturator internus muscle? What muscle does it attach to?
- obturator foramen to greater trochanter- covered with thick fascia and attaches to levator ani as tendinous arch
212
Where is the urogenital diaphragm located? What is it composed of?
- anterior/inferior to the pelvic diaphragm; extends between the 2 pubic arches; attaches posteriorly to perineal body- composed of deep transvers perineal muscles; blends with the sphincter muscles of the urethra (and vagina in females)
213
Describe the course of the ureters.
from the kidney, they cross the external iliac vessels and descend into pelvis; insert into the posterolateral aspect of the urinary bladder
214
What is the function of the urinary bladder? What is the bladder made of?
- stores urine prior to expulsion through the urethra- consists of smooth muscles (detrusor urinae muscle); covereed by peritoneum and supported by the pelvic floor
215
What is the muscle that makes up the walls of the bladder?
detrusor urinae muscle
216
Describe the course of the ureter in the female.
exits bladder, pierces anterior portion of the urogenital diaphragm, exits via external urethral orifice
217
What are the 4 regions of the male urethra?
- preprostatic urethra- prostatic urethra- membranous urethra- spongy urethra
218
Where is the rectum located? How is it normally constricted?
- located in true pelvis superior to the pelvic floor- normally constricted by puborectal sling (U-shaped puborectalis muscle)
219
Where is the anal canal located? What role does the puborectal sling play in the anal canal?
- emerges in the anal triangle inferior to the pelvic floor and is continuous with the rectum at the anorectal junction (at puborectal sling)- puborectal sling produces a curvature at the anorectal junction that marks the end of the rectum and beginning of the anal canal; functionally, the puborectal sling must be relaxed for defecation
220
What are the 3 reproductive glands in the male pelvic viscera? Describe each (size, location, etc.).
- seminal vesicles: joins vas deferens as the ejaculatory duct; empties into prostatic urethra- prostate gland: walnut-sized gland between the bladder and urogenital diaphragm- bulbourethral (Cowper's) gland: 2 pea-sized glands within the urogenital diaphragm; empties into penile urethra
221
What are the male external reproductive organs and structures?
- penis- testes: primary male reproductive organ; housed in scrotum- spermatic cord: fascial sheath derived from anterior abdominal wall; extends from inguinal canal into scrotum; surrounds ductus deferens and testicular vessels/nerves
222
What are the ovaries? What is their function? Where are they located?
- primary female reproductive organs- produces ova and female hormones (1 ovum released per menstrual cycle)- encapsulated and housed in true pelvis
223
What are the uterine (Fallopian) tubes?
muscular tubes for transport of ovum to uterus; they are open channels from peritoneal cavity to uterus
224
What are the 4 portions of the uterine tubes (in order from the ovaries to the uterus)?
closest to the ovaries- fimbriae- infundibulum- ampulla- isthmusclosest to the uterus
225
True or false: The vagina is open to the peritoneal cavity.
true; fimbriae are open to the peritoneal cavity and since they are all connected, the uterine tubes, uterus, and vagina are all open to the peritoneal cavity
226
What is the typical size of the uterus? At what angle is it usually found?
- approx 7 cm long (may enlarge up to 20x during pregnancy)- usually anteverted and at a right angle to the vaginal canal, but position changes with full bladder and pregnancy
227
What is the uterine cervix?
inferior neck of the uterus protruding into the vaginal canal
228
What is the external os? What is the internal os?
- external os: the opening of the cervix into the vaginal canal- internal os: the opening of the cervix into the uterus
229
What is the vaginal fornix? Which portion of the fornix is deeper?
- circular gutter surrounding the cervix in the vaginal canal- deeper posteriorly than anteriorly
230
Name the 4 uterine ligaments. What is the function of each?
- suspensory ligament: peritoneum covering ovarian vessels and nerves- broad ligament: peritoneum covering uterus and adnexa- ovarian ligament: anchors ovary to uterus- round ligament of uterus: continuation of the ovarian ligament; passes through inguinal canal to fuse with labia majora*NOTE: not to be confused with round ligament of liver
231
Describe the major arteries that are a continuation of the abdominal aorta. Which mainly supply the pelvis?
- abdominal aorta: splits to common iliac arteries- common iliac arteries: split into internal and external arteries- external iliac arteries: exits pelvis as femoral arteries- internal iliac arteries: enter true pelvis and branches (5 posterior and 3-4 anterior); supplies pelvic organs and gluteal region
232
What artery is found at the very end of the abdominal aorta where it bifurcates into 2 common iliac arteries?
median sacral artery
233
What is the iliolumbar artery a branch of? What does it supply?
- branch of the internal iliac artery between iliac crest and L5- supplies medial ilium and L5
234
What is the lateral sacral artery a branch of? What does it supply?
- branch of the internal iliac artery that enters the ventral sacral foramina- supplies sacrum and ventral sacral nerves
235
What is the superior gluteal artery a branch of? Where does it travel to? What does it supply?
- branch of the internal iliac artery between L5 and S1- enters the gluteal region superior to the piriformis muscle via the greater sciatic foramen- supplies gluteal muscles with superior gluteal nerves
236
What is the inferior gluteal artery a branch of? Where does it travel to? What does it supply?
- branch of the internal iliac artery between S1 and S2 or S2 and S3- enters gluteal region inferior to piriformis muscle via the greater sciatic foramen- supplies gluteal muscles with inferior gluteal nerves
237
What foramen do the superior and inferior gluteal arteries pass through?
greater sciatic foramen
238
What is the internal pudendal artery a branch of? Describe its course. What does it supply?
- branch of the internal iliac artery- runs with the pudendal nerve; exits pelvis through greater sciatic foramen and enters gluteal region inferomedial to piriformis; crosses over the sacrospinous ligamen and re-enters pelvis through lesser sciatic foramen- supplies urogenital and anal triangles
239
What are the contents of the pudendal canal? What forms the canal?
- contains internal pudendal artery and pudendal nerve back in pelvis- formed by fascia of obturator internus muscle
240
Where does the pudendal canal run? What does the canal supply?
- runs anteriorly along ischiopubic ramus (toward urogenital triangle)- supplies urogenital and anal triangles
241
What is the umbilical artery a branch of? Where does it run?
- anterior branch of the internal iliac artery- runs toward anterior abdominal wall
242
What branches come off of the umbilical artery and what do they supply? Describe the termination of the umbilical artery.
- sends off 3-4 superior vesical arteries that supply the bladder- terminates as the medial umbilical ligament
243
What is the obturator artery a branch of? Where does it run? What does it supply?
- anterior branch of the internal iliac artery- runs through the obturator canal- supplies medial thigh with obturator nerve
244
What is the clinical significance of the obturator anastomoses?
- corona mortis ("crown of death")- obturator artery anastomoses with the inferior epigastric vessels (could be arterial, venous, or both) so damage to the artery opens both the internal and external iliac systems and death can be caused in minutes
245
What is the uterine artery a branch of? What does it anastomose with? What does it supply?
- third anterior branch of the internal iliac artery in females- anastomoses with the ovarian artery (from aorta)- supplies uterus, cervix, and superior vaginal canal
246
True or false: The uterine artery runs below the ureter.
FALSE: the ureter runs immediately below the uterine artery
247
In males, what arteries are comperable to the uterine artery?
inferior vesical artery and artery of ductus deferens
248
What is the vaginal artery a branch of? What does it supply? Does the ureter run above or below it?
- branch of the internal iliac artery (uterine artery and vaginal artery split)- supplies inferior vaginal canal and posterior inferior bladder- ureter runs above this artery
249
What is the middle rectal artery a branch of? What does it supply?
- third or fourth anterior branch of the internal iliac artery- supplies rectum*NOTE: inferior vesicle artery may branch off of the middle rectal artery
250
What is the clinical significance regarding the location of the uterine artery and ureter?
uterine artery is tied off and cut during a hysterectomy; the ureter can be cut accidentally which could cause serious complications
251
True or false: Most of the venous return from the pelvis ultimately leads to the IVC.
true
252
What organs do the pelvic venous plexuses surround?
bladder, prostate/uterus, and rectum
253
What is the clinical significance of the pelvic venous plexuses?
plexuses intercommunicate prior to forming named veins; this intercommunication has clinical consequences because it could allow for the transportation of tumor cells or venous hypertension*NOTE: venous plexuses are valveless
254
True or false: Venous plexuses are valveless.
true
255
What spinal cord levels are involved in the sacral plexus?
L4-S4
256
What is formed by L4 and L5 spinal nerves? What does it cross?
- lumbosacral trunk- crosses over sacral ala
257
Where does S1 spinal nerve emerge? Where does S2 and S3 emerge?
- S1 emerges above piriformis muscle- S2 and S3 emerge through piriformis muscle
258
What is formed by S2-S4 spinal nerves?
pudendal nerve
259
What is formed by L4-S3 spinal nerves?
sciatic and gluteal nerves
260
From what spinal cord levels do the sympathetic fibers of the pelvis arise? What are the sympathetic nerve fibers called?
- T10-L2(L3)- sacral splanchnic nerves*NOTE: rememeber Sacral Splanchnic and Pelvic Parasympathetic
261
From what spinal cord levels do the parasympathetic fibers of the pelvis arise? What are the parasympathetic nerve fibers called?
- S2-S4- pelvic splanchnic nerves*NOTE: rememeber Sacral-Splanchnic and Pelvic-Parasympathetic
262
What type of nerve fibers are contained in the superior hypogastric plexus? Where is this plexus located? What is formed by this plexus?
- contains mostly sympathetic fibers- covers bifurcation of aorta and upper sacrum- condenses to form 2 hypogastric nerves which diverge and curve outward bilateral to rectum and then expand to form the inferior hypogastric plexus
263
What type of nerve fibers are contained in the inferior hypogastric plexus? Where is this plexus located? What is the purpose of this plexus?
- contains both sympathetic and parasympathetic fibers- found covering pelvic viscera bilaterally- serves as the main autonomic plexus of the pelvis
264
How does the sympathetic chains differ between the thorax and pelvis?
in the thorax, chains are lateral to the vertebrae, but in the pelvis, chains are medial to sacral foramen
265
The pelvic sympathetic chains converge and terminate anterior to the coccyx as the ________.
ganglion impar
266
What nerve fibers enter the inferior hypogastric plexus (other than the hypogastric nerves)?
sacral splanchnic nerves (sympathetic) and pelvic splanchnic (parasympathetic)
267
How do nerves get from the inferior hypogastric plexus to the organs?
fibers travel on arterial branches to the pelvic organs
268
What is the clinical significance of the sacral and pelvic splanchnic nerves?
- splanchnic nerves are closely related to lateral rectum and uterus- the nerves are easily injured during rectal sugery or radical hysterectomy- results in impaired bladder control or sexual functions
269
Where do the abdominopelvic lymphatic vessels and nodes lie?
along the aorta, IVC, and iliac vessels
270
Describe the order of the drainage of the abdominopelvic lymphatics.
superficial to deep and superiorly(superficial lymph below the umbilicus moves inferiorly to inguinal and then deep and then superiorly)
271
Through what structures does abdominopelvic lymph move?
through vessels, nodes and cisterna
272
True or false: Each organ has its own lymphatic drainage.
true
