Week 1 Anatomy Flashcards
(215 cards)
1
Q
The abdomen is part of the trunk between the thorax and the what
A
The pelvis
2
Q
The abdomen has mainly muscular walls except from the posterior aspect which has
A
Inferior ribs, lumbar vertebrae, intervertebral discs
3
Q
Superior surface anatomy of the abdomen? (2)
A
Xiphoid process
Costal cartilages of 7th-10th ribs
4
Q
Inferior surface anatomy of the abdomen?
A
Inguinal ligament
Pubic crest and pubic symphysis
5
Q
Inferior limit of what tells us the superior aspect of what
A
Of sternum = superior aspect of the abdomen
6
Q
Where would you locate liver based on surface anatomy?
A
Under ribs like 7-10 and costal cartilages
7
Q
How many ribs do we have
A
12
8
Q
Where is the stomach based on surface anatomy
A
Left to centre. From height of inferior aspect of sternum to about 10/11th costal cartilage
9
Q
Stomach is continuous with what
A
The duodenum
10
Q
Where is the appendix based on surface anatomy
A
Lower right inguinal region
Though can be centre remember
Or really ‘McBurney’s point’.
11
Q
Kidneys location based on surface anatomy
A
Either side of the vertebral column, below spleen
12
Q
The appendix is located where on the large intestine
A
Cecum (start of large intestine)
13
Q
The liver has three lobes true or false
A
No literally 2
14
Q
Liver rises to what height surface anatomy, extends to what
A
Rib 5 to rib 12
15
Q
What’s kinda directly above the liver
A
The diaphragm
16
Q
Where’s McBurney’s point
A
A third from iliac spine when drawing a line to the umbilicus
17
Q
Liver is where meaning pain doesn’t usually radiate where
A
Underneath the ribs mainly, so pain doesn’t ever really radiate below the ribs
Unless enlarged livee
18
Q
How do we palpate the liver if it’s mainly below the ribs?
A
Find right costal margin, jutting out behind that. Ask patient to breathe in and out and you can feel it below your fingers.
19
Q
Pain for the liver would radiate from what side and relative to stomach above or below radiation? (Despite kinda being same level as stomach)
A
Liver= right side. Stomach pain radiates higher
20
Q
Stomach Vs liver innervation
A
Stomach = T8
Liver/ gall bladder = T8-T11
21
Q
Small intestine Vs large intestine innervation?
A
“Testine” = think ten
Small = t10 innervation whilst large intestine = t11
Small above large radiation of pain
22
Q
Kidney pain is radiated where and from what innervation
A
Kinda like inguinal groove area
But it’s t10 just like liver gallbladder and small intestine
23
Q
Why do abdominal organs refer pain to skin?
A
Because brain not used to sensation from them
24
Q
External oblique purpose
A
(2)
Support and compress abdominal viscera
Flex and rotate trunk
25
Internal oblique purpose (2)
Support and compress abdominal viscera, flex and rotate trunk
26
Transversus abdominis purpose (corset)
Compresses and supports abdominal viscera
27
Rectus abdominis action and where
Across lumbar vertebrae at the back
And
From Xiphoid process to the 5th/7th costal cartilages to pubic crest and symphysis
Flexes trunk on lumbar vertebrae and
Compresses abdominal viscera, and controls tilt of pelvis
28
What’s the rectus sheaf
A large area of connective tissue
Formed by interlaced aponeurosis of internal, external oblique and the transversus abdominis
29
What’s the actuate line
Curved line found posterior to the rectus abdominis and the pubic symphysis
30
Is the actuate line always present?
No
But if it was it’d usually be 1/3 distance from pubic crest to umbilicus
31
What happens at the arcuate muscle?
Aponeuroses of the internal oblique and transversus abdominis pass anteriorly and at level of the line- instead of actually surrounding the rectus abdominis muscle.
So the rectus abdominis has all three aponeurosis as the rectus sheaf, then below the arcuate line is only the transversus abdominis
32
Clinical significance of the arcuate line?
Site of weakness in the abdominal wall, where a ventral hernia may develop.
33
What does the rectus sheaf enclose?
The rectus abdominis
34
Which two muscles are enclosed in the recurs sheaf?
The rectus abdominis and of course the pyramidalis muscles
35
Where is the pyramidalis muscles ?
Pubic crest and pubic symphysis area
36
Purpose of pyramidalis muscles?
Tense the linea alba
37
In the centre of the rectus sheaf is what
A horizontal line of connective tissue called the linea alba
38
Where is the linea alba?
Sternum to the pubis
39
Each anterior intercostal space contains how many arteries
Two
40
Each posterior intercostal space has how many arteries
Two
41
2 main that give off
What superior abdominal arteries please
Internal thoracic artery (off subclavian)
= superior epigastric (goes straight down)
Musculophrenic (along costal margin)
Abdominal aorta
10th and 11th (floating ribs so continues down abdominal wall)
12th = subcostal arteey
42
2 main arteries inferior abdominal wall
External iliac artey = inferior epigastric and deep circumflex iliac
Fermoral artery a bit further down, gives off superficial circumflex along iguinal iliac
And superficial epigastric
43
What’s caput Medusa
Formation of dilated abdominal wall veins due to portal hypertension
44
Above the umbilicus the lymphatic drainage goes to the what nodes
Acillry
45
Below the umbilicus the lymphatic drainage goes to the what nodes
Iliac nodes
46
What’s the inguinal canal?
An oblique passage through the lower part of the abdominal wall approx 4cm long that provides a passage for structures from the abdomen to the genital region
47
What passes through the iguanal canal?
Spermatic cord or ligament to the uterus
48
Muscle layers featured in the inguinal canal?
Outer to inner:
External oblique to internal oblique to tranversus abdominis muscle
49
In the abdominal wall, (as featured in the inguinal passage) what’s the three layers deep to the transversus abdominis muscle?
Transversalis fascia
Extraperitoneal fat
Parietal peritoneum
50
Where are you if you’ve cut through the parietal peritoneum?
The peritoneal cavity
51
Where does the inguinal canal lie?
Just above and parallel to the inguinal ligament
52
What’s the ASIS
Anterior superior iliac spine
53
What’s the most pointy boy I can feel?
Pubic tubercle
54
The external oblique muscle and aponeurosis attaches to what inferiorly
The iliac spine until the Asis, then the Punic tubercle, (and then it has nothing to attach to so….)
55
The external oblique muscles, after iliac spine and asks and then pubic tubercle, has nothing to attach to, so what does it do?
The lower part of the aponeurosis of the external oblique curls around itself and forms the inguinal ligament
56
What is the inguinal ligament?
Nothing but the lower free margin if the external oblique aponeurosis
57
Layers of the anterior abdominal wall from the inguinal ligament go
External oblique
Internal oblique
Transversalis muscle
Transversalis fascia
Extra peritoneal fat
Peritoneum
58
Where abouts are the gonads
Pelvic cavity
59
Why do the testes pass through the anterior abdominal wall to pelvic cavity rather than abdominal cavity?
For spermatogenesis, need a temperature couple degrees lower than in the abdominal cavity
Therefore creates inguinal canal
60
Where is the testicular/ovarian artery given off?
Abdominal aorta at level of l1/l2
Therefore BEFORE iliac branches
Vaginal ones come off the internal iliac arteries
61
What does the spermatic cord consist of- in the inguinal canal?
Arteries
Veins
Lymphatics
All in a cord like structure
The first part of the ductus deferens as well is part of the inguinal canal but not sure when that is…
62
How does testes drop through abdominal wall into the scrotum embryologically?
The gubernaculum gets smaller (fibrous cord that connects testes to exterior
63
Processus vaginalis is like a sleeve/gap in the inguinal canal where the guvernaculum was (barrier so testes don’t actually have contact with the abdominal cabity) what’s the problem that may occur here then?
Inguinal hernias, if increased pressure in abdomen, then eg loops of intestines may go through the inguinal canal
64
Do females have a gubernaculum?
Yes
65
Why is there less chance of an inguinal hernia happening in females?
Because whilst the gubernaculum shortens and pulls the ovary down, the ovary remains in the pelvic cavity, not the inguinal canal
66
What’s in the inguinal canal of females then if the ovaries aren’t there?
The guvernaculum persists as a ligament- main content of the inguinal canal in females
67
Where is the opening of the inguinal canal
A gap in the transversalis fascia called the deep inguinal ring
68
The transversalis muscle and the internal oblique muscle form what at pubic tubercle
They merge together and form a conjoined tendon
69
The transversalis muscle and the internal oblique muscle form a conjoined tendon and this does what
Arches over spermatic cord and goes through the deep inguinal ring to form walls and roof of inguinal canal
70
Superficial inguinal ring Vs deep inguinal ring
Deep inguinal ring = gap in the transversalis fascia
Superficial inguinal ring = gap in the external oblique aponeurosis (at pubic tubercle)
71
What are the walls and roof of the inguinal canal formed by?
The conjoined tendon of the internal oblique and the transversalis abdominals
72
What’s the floor of the inguinal canal?
The inguinal ligament - aponeurosis of external oblique muscle layer
73
The inguinal ligament extends from what to what
Asis to the pubic tubercle
74
What forms the posterior wall of the inguinal canal?
The transversalis fascia
75
Where is the deep inguinal ring located? (At femoral pulse)
Halfway between pubic symphysis the the ASIS
76
During periods of increased intra abdominal pressure, Herniation May occur into the inguinal canal, which walks of the canal contract
Muscles of anterior and posterior wall
77
Borders of the inguinal canal?
Top and post = transversalis fascia
Ant = aponeurois of external oblique
Floor = inguinal ligament
78
Contents of the inguinal canal make Vs female (as well as blood and lymphatics)
Male = spermatic cord
Ilioinguinal nerve
Genital branch of the Genitofemoral nerve
Female = round ligament
Ilioinguinal nerve
Genital branch of the genitofemoral nerve
79
Does the Ilioinguinal nerve, that passes through the inguinal canal, goes through both the deep and superficial ring?
No just the superficial, doesn’t go through the deep therefore only travels through part of the inguinal canal
80
Layer of spermatic cords
Internal spermatic fascia
Cremasteric fascia
Cremaster muscle
External spermatic fascia
81
Which is the most common type of hernia?
Inguinal hernias
82
Definition of hernia
Protrusion of a hernia into an abdominal space
83
Two causes of hernias (kinda go together)
Weakened/damaged tissue and increased intra-abdominal pressure
84
Inguinal hernia definition
Abnormal protrusion of abdominopelvic contents through the superficial inguinal ring, into the groin
85
Deep inguinal ring location?
Just above the mid-point of the inguinal ligament
86
Superficial ring location?
Just above and lateral to the pubic tubercle
87
In an inguinal hernia, where does the hernia enter the canal?
Medial to the deep ring
88
Direct inguinal hernia is caused by weakness in which wall of the inguinal canal?
Posterior
89
Ironically, where would an indirect hernia enter the inguinal canal?
Enters the deep ring
90
What
91
Where do femoral hernias occur
Below the inguinal ligament
At posterior wall of the femoral canal. (This is a potential space below the inguinal ligament. Medial to the femoral vein)
92
What separates the left and right sides of the recurs abdominis
Linea Alba- sternum to pubic bone
93
Posterior muscles deepest thing abdominal wall?
Aponeurosis of transverslais muscle (corset)
Quadratics lumborum
94
The psoas muscle combines with what muscle to form what muscle?
Iliacus muscle to form the iliopsoas muscle
95
Quadratics lumborum action? (3)
Stabilises diaphragm
Flexes vertebral column
Extends lumbar vertebrae
96
Iliopsoas muscle action
Hip flexor, rotation of hip joint
97
Psoas minor muscle location relative to psoas major/ iliapsoas muscle?
Anterior to it but insertion is different. Major extends to inguinal ligament, but minor only to pecten pubis
98
Psoas minor action
Minor Flexion of the lumbar spine
99
Which sits more anteriorly, the aorta or the inferior vena cava?
The aorta
Think ‘a’ = anterior
100
When does a hiatus hernia occur?
When the upper part of your stomach bulges through the diaphragm
101
Foregut runs from what to what
Oesophagus to duodenum
102
Midgut goes from what to what?
Duodenum to the proximal 2/3 of the transverse colon
(1/3 is the curvature)
103
Hind gut extends from where to where
The distal 1/3 of the transverse colon to the anal canal
104
What are the three major vessels that come off of the abdominal aorta anteriorly to supply the abdomen?
Celiac trunk
Superior mesenteric artery
Inferior mesenteric artery
C SI = sissy for being too scared to learn the arterial supply of the abdomen
105
the organs with the same embryological origin share the same what
Arterial supply
106
What level is the celiac trunk
T12
107
What supplies the mid gut
Superior mesentery artery at L1
108
What supplies the hindgut
Inferior mesentery artery at L3
109
The celiac trunk arises from aorta at height of what hiatus
The aortic (T12)
110
What are the first two branches of the (specifically!) abdominal aorta?
The inferior phrenic arteries (pair)
Celiac arteries
111
Branches of the coeliac artery
Comhep Splegas
Common hepatic
Splenic
Left gastric
112
Which artery (arising from the celiac branch) is the only one to supply the liver?
Common hepatic
Remember at level of t12 (caeliac)
113
(Aorta) What’s directly inferior to the superior mesenteric branch , which is at l1
Pair of renal arteries
114
How many superior mesenteric arteries are there?
Just one, not a pair
115
Where does the abdominal aorta divide into 2 common iliac arteries?
L4
116
When do the common iliac veins become the inferior vena cava?
Anterior to the body of L5
117
The IVC is left or right of the abdominal aorta?
Right
118
What happens to the IVC when it reaches the liver?
Passes in a deep groove on the posterior surface of the liver, to pierce the diaphragm at the level of T8
119
For patients at high risk for pulmonary embolisation, where can a vena caval filter be placed?
In IVC, inferior to the renal veins
120
For patients at high risk for pulmonary embolisation, a vena caval filter can be placed (inferior to the renal veins. ) Why?
If patients have failed anticoagulation with heparin, or in whom heparin is contra-indicated
121
Which kidney is higher?
Left, right lower due to liver
122
The renal veins arise from where and which one is longer
Hills of kidneys
Left vein is three times longer
123
Where does the left and right renal veins pass?
Left = over left renal artery, behind body of the pancreas
Right = behind descending duodenum
124
Name 6 important veins of the abdominal region?
Common iliac vein
External iliac vein
IVC (obvs)
Renal veins
Testicular vein
Hepatic veins
125
What vein passes beneath the inguinal ligament ?
Femoral vein
126
Above the inguinal ligament, the femoral vein becomes what
The external iliac vein
127
Renal veins join IVC at what level
L2
128
IVC touches/follows what vertebrae in the abdomen?
L4-T12
129
Which is more anterior, iliac artery or the iliac vein
Obvs the iliac artery
130
Are there any veins that correspond to the Celiac trunk/mesenteric arteries?
No
131
Where does the external iliac vein (used to be femoral) join the internal vein
At bifurcation of the aorta
132
Veins that drain the abdomen either join the IVC or what
The hepatic portal vein
133
Waste products from liver go where
Well basically bile carries away waste products from the liver, is stored and concentrated by the gallbladder and then that goes to the duodenum
134
GI tract, spleen, pancreas and liver - are these supplied by veins that arise from the IVC?
No- hepatic portal vein, BEFORE being processed and detoxified through the liver and THEN to the IVC
135
Where is the portal being formed?
Behind the pancreas
136
What is the pancreas connected to
The duodenum
137
What does the common bile duct connect
Liver via branch of common hepatic duct, gall bladder via branch of cystic duct, to the duodenum
138
What does the pancreatic duct connect
The duodenum and the pancreas
139
Are the pancreas and liver and gall bladder connected?
No
But all connect to the duodenum
140
We know that the superior mesentery and the inferior mesentry veins and splenic join to become portal vein, where do they join
Behind head of the pancreas
141
Portal vein (mesentry x2, and splenic vein) gotta go to liver, so what big thing do they go behind?
The duodenum
142
The portal vein is anterior to the lesser what
The lesser omentum
143
The common bile duct is right next to the portal vein
Yah
144
The portal vein divides into how many branches as it enters the liver
Teo
145
Iliac arteries arise when
L4
146
Where does the inferior mesenteric vein drain into?
Splenic veins
147
Portal system is special how
It’s valveless, responsible for all blood from abdominal viscera, apart from kidneys and adrenal glands.
Has to pass through hepatic sinusoids
148
Foregut is what
Esophagus, liver, stomach, pancreas, gall bladder, duodenum
149
4 parts of the stomach?
Cardia- where esophagus is
Fundus- top part above cardia
Body- main
Pyloric- into the duodenum
150
Artery of the gallbladder?
Cystic artery
151
What duct is a continuation of the bile duct that attaches the gall bladder to what
The duodenum of the small intestine
152
The pancreas is an accessory digestive gland that releases what
Exocrine = pancreatic juice
Endocrine = insulin and glucagon
153
Where’s the transpyloric plane?
L1/L2
154
Portal vein goes to liver, goes behind what organ
Neck of the pancreas
155
If you get gall stones within the gall bladder, and the gall bladder is infected/inflamed, then what?
Cut off blood supply and remove gallbladder: If the pain is mild and infrequent, you may be prescribed painkillers to control further episodes and be given advice about eating a healthy diet to help control the pain.
If your symptoms are more severe and frequent, surgery to remove the gallbladder is usually recommended.
Also: ERCP can remove gallstones, whilst meds can also be given to dissolve them (tho not very effective and need to be given for up to 2 years)
156
What is mesentery?
Double layer of visceral peritoneum
157
What’s located at the tail end of the pancreas
Tge splewn
158
The pancreas is attached to what
The duodenum
159
Where does the jejunum begin
Like just after the duodenum stops touching the head of the pancreas, so quite quickly really
160
3 arteries of the GI tract
Coeliac trunk
Superior mesenteric artery
Inferior mesenteric artery
161
Which branch of the celiac trunk supplies the stomach
Left gastric artery
162
The midgut includes most of the duodenum and goes to what
The first 2/3 of the transverse colon
163
Which is the most fixed part of the small intestine?
Duodenum
164
Difference between jejunum and ileum?
Jejunum is deeper red in colour (remember this because it’s like deeper into the body)
And a few large loops/ arcades
165
Where does the superior mesenteric artery for the midgut come out, what level?
L1
166
If the superior mesenteric artery supplies the midgut, which is the later 2/3 of the duodenum until the transverse colon 2/3, that’s basically all the intestines. It must have branches: what are the two main ones?
Jejunal and ileal arteries
167
Artery that supplied the appendix is called what
The appendicular artery
168
What are omental appendices? (Of colon)
Small, fatty peritoneal like projections.
The raisins of the colon
169
What’s the haustra/ sacculations of the colon?
Basically the bumps
170
What’s the tensor coming of the colon? (Not small intestine)
Bands of smooth muscle that the bumps of haustra stick to… kinda like the ribbon it follows, ribbon through the middle
171
The appendix has few lymphatic nodules
False
Loads
172
McBurney’s point is where
Imagine line from ASIS to the umbilicus- go 2/3 up
173
Where does the superior rectal artery branch off from
The inferior mesenteric artery from l3 level
174
3 branches of the inferior mesenteric artery of the Hindgut
Left colic, sigmoid arteries, and superior rectal artery
175
Parasympathetic of abdominal organs =
Vagus and pelvic splanchnic nerves (S2,3,4)
176
Does the portal vein collect from the renal arteries?
No of course not
177
The portal vein divides into what
Splenchnic veins and I and s mesenteric veins
And gastric veins
178
The inferior mesenteric vein joins what
The splenchnic vein
179
4 sites of portal anastomoses made simple
Anotectal
Oesophageal (lower oesophagus)
Stomach
Umbilicus
180
Vomiting blood could be what
Oesophageal varies in the portal anastomoses
181
The lumbar nodes include what three groups?
1) pre-aortic eg coeliac, superior and inferior mesenteric nodes
2) lateral aortic - drains organs supplied by lateral aortic branches
3) retro-aortic - drains the posterior abdominal wall
182
What’s the greater and lesser omentum?
The peritoneal folds that attach the abdominal organs with one another
183
Which omenta attach to the stomach?
Both the greater and lesser
184
Greater Vs lease omentum attached to which part of the stomach?
Greater = greatest curvature of stomach.
Vice versa
185
The femoral nerve travels down fibres of what muscle
Psoas major
186
What two planes separate the abdomen into quadrants?
Transpyloric
Median plane
187
Planes that divide abdomen into 9 quadrants?
2 x midclavicular
Subcostal (just below costal margin)
Intertubercular
188
Name the 9 regions
In the middle: epigastric, umbilical, hypogastric
Hypochondriac , lumbar, iliac
189
Is there any pancreas in the umbilical region of the 9 regions?
Yea
190
Dermatome Vs vertebral level of the umbilicus?
T10 dermatome
L3/4 vertebral level
191
Action of the e and i oblique muscles?
Support abdominal viscera.
For I, it’s support abdominal viscera located just inside the hipbones
192
Deepest muscle layer of the anterior abdomen?
Transversus abdominis - like a corset. Fibres run horizontally apart from inferior ones which reach down to insert with linea alba with aponeurosis of internal oblique, pubic crest, and pubis vis conjoined tendon
193
What’s the linea alba
The linea alba is a thin band of connective tissue that runs down the front of your abdomen. It separates the left and right sides of your rectus abdominis.
194
What’s only just deep to the rectus abdominis?
Rectus sheaf - aponeurosis of all those other anterolateral abdominal muscles
195
The anterolateral muscles of the abdominal wall are innervated by
Anterior rami if nerves T7-T11. Which muscles are also innervates by T12?
The two outermost ones- external oblique, and rectus abdominis
196
The arcuate line shows where the aponeurosis of which muscle disappears?
Transversalis fascia
197
Above arcuate line, aponeurosis of which muscles ant and post?
Ant = internal and external
Post = internal and transversus
198
Above and below the umbilicus = lymphatic drainage goes where?
Axillary
Iliac
199
The inguinal ligament is formed from the aponeurosis of which muscle?
Transversalis fascia
200
The superficial inguinal ring is a break in the aponeurosis of what muscle layer?
External oblique
201
Inguinal ligament originates at the asis and attached to
the pubic tubercle
202
The inguinal canal is basically a passage/hole through what
The abdominal wall
203
The inguinal canal is formed from folds of which aponeurosis?
External oblique
204
Semen is made in the pelvic cavity. But sperm is in the scrotum (external). How do they mix?
Sperm moves up through spermatic cord, through inguinal canal, mixes with dementia from other glands, then finally out through urethra
205
The deep inguinal ring is between which two layers
Transversus abdominis muscle and fascia transversalis
206
Branches of superior mesentery artery?
Right colic
Middle colic
Jejuneal artery leading to ileal arteries (look like net)
207
Portal vein is formed by the Union of which 2 major veins of the abdominal cavity?
Splenic vein
Superior mesenteric vein
208
Foregut Vs midgut Vs Hindgut referring to what region?
Foregut = epigastric
Midgut = umbilical
Hindgut = suprapubic
209
The lumbar plexus forms within which muscle?
Psoas major muscle
210
What enters the Hilum of the kidney
Renal artery
Renal vein
Ureter (which carry urine from the kidneys to the urinary bladder).
211
Anterior - posterior arrangement of Hilum to kidneys ?
Ureter inferior
Then the vein is inferior yet also anterior to the renal artery
212
Describe the course of the ureters?
From kidneys to the urinary bladder.
Adhere closely to the parietal peritoneum and all run retroperitoneal.
They run anteriorly to the psoas major and the transverse processes of the lumbar vertebrae.
They cross the external iliac artery just beyond the bifurcation of the common iliac artery.
Then run along the lateral wall of the pelvis to enter the urinary bladder.
213
Surface anatomy of transpyloric plane and subcostal plane? (NB for the 9 regions, it’s the subcostal)
Transpyloric = T8/9
Subcostal = T10
214
What surface level anatomy is the trans tubercular plane?
Kinda like mid iliac spine
215
The ureter is constricted at 3 locations during its course from the kidneys to the urinary bladder. Name these points and explain why it’s important to know clinically.
Location where kidney stones could lodge.
At junction of ureters and renal pelvis
At pelvic inlet
Entrance to bladder
