Week 1 GI workbook part 1 Flashcards
1
Q
what are the four different quadrants of the abdomen?
A
right upper quadrant
left upper quadrant
right lower quadrant
left lower quadrant
2
Q
what is the horizontal line dividing the quadrants?
A
linea alba
3
Q
name the 9 regions of the abdomen
A
right and left hypochondrium
epigastric
right and left lateral abdominal
umbilical
right and left inguinal
pubic
4
Q
what are the two horizontal planes that divide the 9 regions
A
subcostal
transtubercular
5
Q
what organs are found in the right hypocondriac region?
A
The liver
The gallbladder
The small intestine
The ascending colon
The transverse colon
The right kidney
6
Q
what organs are found in epigastric region?
A
The esophagus
The stomach
The liver
The spleen
The pancreas
The right and left kidneys
The right and left ureters
The right and left suprarenal glands
The small intestine
The transverse colon
7
Q
what organs are found in the left hypochondriac region?
A
The stomach
The top of the left lobe of the liver
The left kidney
The spleen
The tail of the pancreas
Parts of the small intestine
The transverse colon
The descending colon
8
Q
what organs are found in the right abdominal region?
A
The tip of the liver
The gallbladder
The small intestine
The ascending colon
The right kidney
9
Q
what are the organs found in the left abdominal region?
A
A portion of the small intestine
A part of the descending colon
The tip of the left kidney
10
Q
what organs are found in the umbilical region?
A
The stomach
The pancreas
The small intestine
The transverse colon
The medial extremities of right and left kidneys
The right and left ureters
The cisterna chyli
11
Q
what organs are found in the right inguinal region?
A
The small intestine
The appendix
The cecum
The ascending colon
The right ovary and right fallopian tube in females.
12
Q
what organs are found in the left inguinal region?
A
Part of the small intestine
The descending colon
The sigmoid colon
The left ovary and the left fallopian tube in females.
13
Q
what organs are found in the pubic region?
A
The small intestine
The sigmoid colon
The rectum
The urinary bladder
The right and left ureters
The uterus, the right and left ovaries and the fallopian tubes can be found in females
The ductus deferens, seminal vesicles and prostate in males
14
Q
what is a dermatome?
A
Dermatomes are defined as the area of skin supplied by a single spinal nerve.
15
Q
what dermatome is the umbilicus in?
A
T10
16
Q
what is the vertebral level of the umbilicus?
A
Between L4 and L5
17
Q
in relation to your pockets what direction to the external obliques run?
A
in the direction of you putting your hands in your jacket pocket
18
Q
what is the orientation of external oblique muscle fibres?
A
inferomedially and interdigit with slips of the serratus anterior
19
Q
what is the action of external obliques?
A
compress and support abdominal viscera flex and rotate trunk
20
Q
what is the innervation of external obliques?
A
thoraco-abdominal and subcostal nerves (anterior rami of T7-T12 spinal nerves)
21
Q
what is the orientation of internal oblique muscle fibres?
A
fibres fan out so upper fibres are perpendicular and its lower fibres are parrallel to those of external obliques
22
Q
what is the action of internal obliques?
A
compress and support abdominal viscera flex and rotate trunk
23
Q
what is the innervation of internal obliques?
A
thoracoabdominal nerves (anterior rami of T7-T11), subcostal and first lumbar nerve
24
Q
what is the orientation of transversus abdominus muscle fibres?
A
fibres exept for the most inferior run horizontally
25
what is the action of transversus abdominus?
compress and supports abdominal viscera
26
what is the innervation of transversus abdominus?
thoracoabdominal nerves (anterior rami of T7-T11), subcostal and first lumbar nerve
27
what is the orientation of rectus abdominus muscle fibres?
mostly enclosed in rectus sheath, do not run legnth of muscle, they run between three or more tendinous intersections - each firmyl attached to anterior layer of rectus sheath
28
what is the action of rectus abdominus?
flexes trunk (lumbar vertebrae) and compresses abdominal viscera stabilizes and controls tilt of the pelvis (anti lordosis)
29
what is the innervation of rectus abdominus?
T7-T12 spinal nerves
30
The rectus sheath is formed from the aponeuroses of three muscles.
List them in order from superficial to deep
external obliques
internal oblique layer
transversus abdominus
31
what are the two muscles that lie within the rectus sheath?
rectus abdominus
pyramidalis
32
In the centre of the rectus sheath is a horizontal line of connective tissue known as?
linea alba
33
what is the function of pyramidalis?
Pyramidalis muscle tenses the linea alba. The muscle usually contracts together with the other abdominal muscles, contributing to contracting the abdominal wall and increasing the positive abdominal pressure
34
The line where the posterior layer of the rectus sheath ends is known as what?
arcuate line
35
list the order of abdominal muscles from superficial to deep to the abdominal cavity?
external obliques
internal obliques
rectus abdominis muscle
transversus abdominis muscle
transversalis fascia
extraperitoneal fat
parietal peritoneum
36
what is the superficial vasculature of the anterior abdominal wall?
superior epigastric vein
inferior epigastric vein
superior epigastric artery
inferior epigastric artery
37
where do the superior epigastric arteries arise from?
internal thoracic artery
38
where do the superior epigastric veins drain to?
internal thoracic vein
39
where do inferior epigastric arteries arise from?
external iliac artery
40
where do inferior epigastric veins drain to?
external iliac vein
41
what may happen to superficial veins secondary to portal hypertension?
they may become dialated in severe cases, leading to caput medusa (formation of dilated abdominal wall veins which extend from the umbilicus)
42
where does lymphatic drainage go to above the umbilicus?
axillary nodes
43
where does lymphatic drainage go to below the umbilicus?
superficial inguinal nodes
44
why does the inguinal canal form?
forms due to descent of the testis and its passage through the anterior abdominal wall to reach the scrotum
has to be pulled down to its level in the adults, in the female.
It remains in the pelvic cavity. But in the male, the testis has to pass through the layers of the anterior abdominal wall to enter into the scrotum.
And it is doing this because for Spermatogenesis, you need a temperature about a couple of degrees lower than in the abdominal cavity.
So as the testes passes through the anterior abdominal wall, it makes this canal called as the inguinal canal.
And as the testes moves down, it pulls its blood supply along with that.
45
where are both female and male gonads formed in the abdomen?
L1 L2 - level to the lower thoracic upper lumbar region is where the testes and the ovary first form.
46
what is the gubernaculum
A gelatinous tissue, the gubernaculum, pulls the testes through the abdomen, through the inguinal canal in the groin, and down into the scrotum. The pulling action occurs as the gubernaculum is stimulated first to grow and then to shrink
47
how long is the inguinal canal?
4cm
48
where does the inguinal ligament originate?
anterior superior iliac crest of the ilium
49
where does the inguinal ligament attach?
pubic tubercle of the pubic bone
50
The inguinal ligament is formed from the aponeurosis of which muscle?
The inguinal ligament is formed by the thickened, reinforced free inferior edge of the aponeurosis of the external oblique muscle as this attaches to the bones of the pelvis
51
The superficial inguinal ring is a break in the aponeurosis of what muscle layer?
The superficial ring is an opening in the external oblique aponeurosis, lying above and medial to the pubic tubercle.
52
What anatomical point is used surgically to determine the location of the superficial inguinal ring?
pubic tubercule
53
Where is the deep inguinal ring positioned in relation to the pubic tubercle?
The deep ring is a defect in the transversalis fascia. Found above the midpoint of the inguinal ligament (lateral to the epigastric vessels).
54
The deep inguinal ring is an oval shaped opening in which muscle layer’s fascia?
transversalis fascia
54
what are the four borders of the inguinal canal?
anterior, posterior, superior (roof) and inferior (floor) walls
55
what is the anterior wall of the inguinal canal?
aponeurosis of the external oblique, reinforced by the internal oblique muscle laterally.
56
what is the posterior wall of the inguinal canal?
transversalis fascia.
57
what is the roof of the inguinal canal?
transversalis fascia, internal oblique, and transversus abdominis.
58
what makes up the floor of the inguinal canal?
inguinal ligament (a ‘rolled up’ portion of the external oblique aponeurosis), thickened medially by the lacunar ligament.
59
During periods of increased intra-abdominal pressure, the abdominal viscera are pushed into the posterior wall of the inguinal canal. What occurs to prevent herniation of viscera into the canal?
the muscles of the anterior and posterior wall contract, and ‘clamp down’ on the canal.
60
what are the male contents of the inguinal canal
Spermatic cord – contains neurovascular and reproductive structures that supply and drain the testes
Ilioinguinal nerve – contributes towards the sensory innervation of the genitalia
Note: only travels through part of the inguinal canal, exiting via the superficial inguinal ring (it does not pass through the deep inguinal ring)
This is the nerve most at risk of damage during an inguinal hernia repair.
Genital branch of the genitofemoral nerve – supplies the cremaster muscle and anterior scrotal skin in males
61
what are the female contents of the inguinal canal
Round ligament (biological females only) – originates from the uterine horn and travels through the inguinal canal to attach at the labia majora.
Ilioinguinal nerve – contributes towards the sensory innervation of the genitalia
Note: only travels through part of the inguinal canal, exiting via the superficial inguinal ring (it does not pass through the deep inguinal ring)
This is the nerve most at risk of damage during an inguinal hernia repair.
Genital branch of the genitofemoral nerve – supplies the skin of the mons pubis and labia majora in females.
62
how do the walls of the inguinal canal ussually appear and why?
collapsed around their contents, preventing other structures from potentially entering the canal and becoming stuck.
63
what are the layers of the spermatic cord?
external spermatic fascia
cremaster muscle
cremasteric fascia
internal spermatic fascia
64
where is the internal spermatic fascia derived from?
derived from the transversalis fascia at deep inguinal ring
65
where is the cremasteric fascia derived from?
derived from fascia of bth the superficial and deep surfaces of internal oblique muscle
66
where is the cremaster muscle derived from
continuation of lowest fascicles of internal oblique muscles
67
where is the external spermatic fascia derived from?
derived from external oblique aponeurosis and investing fascia
68
what are the two different classifications of inguinal hernias?
direct or indirect
69
what is an indirect hernia?
most common type of hernia
results from congenital weakness in deep inguinal ring, allowing abdominal contents to enter into the inguinal canal lateral to the inferior epigastric vessels and even out of the deep inguinal ring.
70
what is a direct hernia
direct hernias account for 1/3 of inguinal hernias
abdominal contents do not pass through deep inguinal ring but simply push though a weak spot in muscles making up the posterior wall of inguinal canal allowing contents to enter the canal and even pass through the superficial inguinal ring
71
what is a femoral hernia?
occur below the inguinal ligament
when abdominal contents pass into the weak area at the posterior wall of the femoral canal medial to the inferior epigastric vessels
more common in females
risk of strangulation is high
72
what is an umbilical hernia
occur when abdominal contents pass through weakness at the site of the passage of the umbilical cord through the abdominal wall
more aquired in adults than congenital
abnormal fibres at the linea alba may contribute to weakness of the wall
73
what are the five muscles of the posterior abdominal wall?
iliacus, psoas major, psoas minor, quadratus lumborum and the diaphragm
74
what is the quadratus lumborum?
The quadratus lumborum muscle is located laterally in the posterior abdominal wall. It is a thick muscular sheet which is quadrilateral in shape. The muscle is positioned superficially to the psoas major.
75
what are the attachments of the quadratus lumborum?
Originates from the iliac crest and iliolumbar ligament. The fibres travel superomedially, inserting onto the transverse processes of L1 – L4 and the inferior border of the 12th rib.
76
what are the actions of quadratus lumborum?
Extension and lateral flexion of the vertebral column. It also fixes the 12th rib during inspiration, so that the contraction of diaphragm is more efficient.
77
what is the innervation of the quadratus lumborum?
Anterior rami of T12 – L4 nerves.
78
what is the psoas major?
The psoas major is located near the midline of the posterior abdominal wall, immediately lateral to the lumbar vertebrae
79
what are the attachments of the psoas major?
Originates from the transverse processes and vertebral bodies of T12 – L5. It then moves inferiorly and laterally, running deep to the inguinal ligament, and attaching to the lesser trochanter of the femur.
80
what are the actions of psoas major?
Flexion of the thigh at the hip and lateral flexion of the vertebral column.
81
what is the innervations of psoas major?
Anterior rami of L1 – L3 nerve
82
what is the psoas minor
The psoas minor muscle is only present in 60% of the population. It is located anterior to the psoas major.
83
what are the attachments of the psoas minor?
Originates from the vertebral bodies of T12 and L1 and attaches to a ridge on the superior ramus of the pubic bone, known as the pectineal line.
84
what is the action of the psoas minor?
Flexion of the vertebral column.
85
what is the innervation of the psoas minor?
Anterior rami of the L1 spinal nerve.
86
what is the iliacus?
The iliacus muscle is a fan-shaped muscle that is situated inferiorly on the posterior abdominal wall. It combines with the psoas major to form the iliopsoas – the major flexor of the thigh.
87
what are the attachments of the iliacus?
Originates from the surface of the iliac fossa and anterior inferior iliac spine. Its fibres combine with the tendon of the psoas major, inserting into the lesser trochanter of the femur.
88
what is the action of the iliacus?
Flexion and lateral rotation of the thigh at the hip joint.
89
what is the innervation of the iliacus?
Femoral nerve (L2 – L4)
90
what are the three main openings in the diaphragm?
Caval Hiatus (T8)
Oesophageal Hiatus (T10)
Aortic Hiatus (T12)
91
what passes through the caval hiatus?
Inferior vena cava
Terminal branches of right phrenic nerve
92
what passes through the oesophageal hiatus?
Oesophagus
Right and left vagus nerves
Oesophageal branches of left gastric artery/vein
93
what passes through the aortic hiatus?
Aorta
Thoracic duct
Azygous vein
94
what is the position of the aorta and the IVC in relation to one another?
The aorta is situated anterior to the vertebral bodies and left of midline, whereas the IVC lies to the right of midline.
95
where does the foregut run from and to?
The foregut runs from the distal osophagous to the first half of the duodenum (including liver, gall bladder, spleen and pancreas)
96
where does the midgut run from and to?
The midgut runs from the foregut duodenum (distal to bile duct) to the Proximal 2/3 transverse colon
97
where does the hindgut run from and to?
The hindgut runs from the Distal 1/3 transverse colon to the Upper anal canal
98
There are three major vessels which come off of the abdominal aorta anteriorly to supply different regions of the abdomen what are they?
coeliac trunk
superior mesenteric artery
inferior mesenteric artery
99
what does the coeliac trunk supply?
what level does it come off the abdominal aorta?
foregut
T12/L1
100
what does the superior mesenteric artery supply?
what level does it come off the aorta?
midgut
L1
101
what does the inferior mesenteric artery supply?
what level does it come off the aorta?
hindgut
L3
102
what are the three branches of the celiac trunk
left gastric artery
splenic artery
common hepatic arteries
103
At what vertebral level does the abdominal aorta divide into 2 common iliac arteries?
L4
104
what is the left gastric artery?
The left gastric artery is the smallest of the three branches. It ascends across the diaphragm, giving rise to oesophageal branches, before continuing anteriorly along the lesser curvature of the stomach. Here, it anastomoses with the right gastric artery.
105
what is the splenic artery?
The splenic artery arises from the coeliac trunk just inferior to the left gastric artery. It then travels left towards the spleen, running posterior to the stomach and along the superior margin of the pancreas. During its course, it is contained within the splenorenal ligament. It terminates into five branches which supply the segments of the spleen.
106
In addition to supplying the spleen, the splenic artery also gives rise to several important vessels, what are they known as?
Left gastroepiploic
Short gastrics
Pancreatic branches
107
Left gastroepiploic
supplies the greater curvature of the stomach. Anastomoses with the right gastroepiploic artery.
108
Short gastrics
5-7 small branches supplying the fundus of the stomach
109
Pancreatic branches
supply the body and tail of the pancreas
110
what is the common hepatic artery?
The common hepatic artery is the sole arterial supply to the liver and the only branch of the coeliac artery to pass to the right.
As it travels past the superior aspect of the duodenum, it divides into its two terminal branches – the proper hepatic and gastroduodenal arteries. Each of these arteries has multiple branches and variation in the arrangement of these branches is common.
111
proper hepatic artery
The proper hepatic artery ascends through the lesser omentum towards the liver. It gives rise to:
Right gastric
Right and left hepatic
Cystic
112
right gastric artery
supplies the pylorus and lesser curvature of the stomach.
113
right and left hepatic artery
divide inferior to the porta hepatis and supply their respective lobes of the liver.
114
cystic artery
branch of the right hepatic artery – supplies the gall bladder
115
gastroduodenal artery
The gastroduodenal artery descends posterior to the superior portion of the duodenum. Its branches are:
Right gastroepiploic
Superior pancreaticoduodenal
116
right gastroepiploioc
supplies the greater curvature of the stomach. Found between the layers of the greater omentum, which it also supplies.
117
superior pancreaticduodenal
divides into an anterior and posterior branch, which supplies the head of the pancreas.
118
What vessels merge to form the IVC?
left and right common iliac veins
119
at what vertebral level do the left and right common iliac veins merge to form the IVC?
L5
120
what 2 major veins form the portal vein?
splenic vein
superior mesenteric vein
121
Where does the inferior mesenteric vein drain into?
The inferior mesenteric vein, a continuation of the superior rectal vein, accompanies the inferior mesenteric artery and usually drains into the splenic vein.
122
what are the two drainage systems of the body?
portal system and systemic system
123
what is the portal system?
Blood from the abdominopelvic gastrointestinal tract drains via the portal system to the liver.
124
what is the systemic venous system?
Blood from the gut tube superior to the diaphragm and inferior to the pelvic floor drains via the systemic venous system.
125
Where are the four sites of the portal-systemic anastomoses?
lower oesophagous
upper part of anal canal
umbilicus
area of liver
126
What is the clinical relevance of these sites of anastomoses?
The importance of portosystemic anastomoses is to provide alternative routes of circulation when there is a blockage in the liver or portal vein. These routes ensure that venous blood from the gastrointestinal tract still reaches the heart through the inferior vena cava without going through the liver.
127
The foregut is supplied by the celiac trunk which come off the aorta anteriorly at T12 therefore which lymph nodes drain?
all lymph for foregut structures will drain to the pre-aortic nodes at T12.
128
which lymph nodes drain the midgut?
prevertebral superior mesenteric nodes located at the origin of the superior mesenteric artery from the aorta.
129
which lymph nodes drain the hindgut?
The inferior mesenteric lymph nodes drain structures related to the hindgut; they receive lymph from the descending colon, sigmoid colon, and proximal part of the rectum
130
what is the sympathetic visceral nerve supply?
Abdominopelvic splanchnic nerves (greater, lesser and least)
Prevertebral sympathetic ganglia
Abdominal aortic plexuses
131
what is the parasympathetic visceral nerve supply?
Anterior and posterior vagal trunks (vagus nerve – 10th Cranial nerve)
Pelvic splanchnic nerves (S2, S3 and S4)
132
what effect does parasympathetic stimulation have on GI secretion, peristalsis and blood vessels?
Increased GI secretion
Increased peristalsis
Vasodialation
133
what effect does sympathetic stimulation have on GI secretion, peristalsis and blood vessels?
decreased GI secretion
decresed peristalsis
vasoconstriction
134
what is a vagotomy?
A vagotomy is a medical intervention to interrupt signals carried by your vagus nerve. Your vagus nerve communicates with many organs in your body. In current medical practice, a vagotomy usually means cutting the branch of the vagus nerve that tells your stomach to secrete gastric acid
135
what is the effect of a vagotomy on gastric secretion?
Cutting the nerve here reduces gastric acid secretion, but also reduces functions of your other organs that respond to the nerve. It can reduce bile and enzyme secretions from your liver, gallbladder and pancreas.
136
why would a patient recieve a vagotomy?
This extreme intervention is reserved for especially severe cases of peptic ulcer disease
137
is visceral pain localised?
no
138
The foregut tends to refer to the ______________. The midgut tends to refer to the _______________ and the hindgut tends to refer to the ________ ________
epigastric region
umbilical region
subrapubic region
139
why is appendicitis pain initially described as an epigastric/umbilical pain?
referred pain
140
what is the lumbar plexus?
This nerve plexus originates from ventral rami of L1-L4. The plexus is formed within the psoas major muscle and its main branches emerge either lateral to, on the surface of or medial to the psoas major muscle.
141
what are the different branches of the lumbar plexus?
Iliohypogastric Nerve
Ilioinguinal Nerve
Genitofemoral Nerve
Lateral Cutaneous Nerve of the Thigh
Obturator Nerve
Femoral Nerve
142
what are the roots of the iliohypogastric Nerve
L1 (with contributions from T12)
143
what are the motor functions of the iliohypogastric nerve
Innervates the internal oblique and transversus abdominis
144
what are the sensory functions of the iliohypogastric nerve
Innervates the posterolateral gluteal skin in the pubic region.
145
what are the motor functions of the ilioinguinal nerve?
Innervates the internal oblique and transversus abdominis.
146
what are the sensory functions of the ilioinguinal nerve?
Innervates the skin on the superior antero-medial thigh.
In males, it also supplies the skin over the root of the penis and anterior scrotum.
In females, it supplies the skin over mons pubis and labia majora.
147
what are the motor functions of the genitofemoral nerve?
The genital branch innervates the cremasteric muscle.
148
what are the sensory functions of the genitofemoral nerve
The genital branch innervates the skin of the anterior scrotum (in males) or the skin over mons pubis and labia majora (in females).
The femoral branch innervates the skin on the upper anterior thigh.
149
what are the roots of the genitofemoral nerve
L1 and L2
150
what are the roots of the ilioinguinal nerve?
L1
151
what are the roots of the lateral cutaneous nerve of the thigh
L2 and L3
152
what are the motor functions of the lateral cutaneous nerve of the thigh?
none
153
what are the sensory functions of lateral cutaneous nerve of the thigh?
Innervates the anterior and lateral thigh down to the level of the knee.
154
what are the roots of the obturator nerve
L2, L3 and L4
155
what are the motor functions of the obturator nerve?
Innervates the muscles of the medial thigh – the obturator externus, adductor longus, adductor brevis, adductor magnus and gracilis.
156
what are the sensory functions of the obturator nerve?
Innervates the skin over the medial thigh
157
what are the roots of the femoral nerve
L2,L3,L4
158
what are the motor functions of the femoral nerve?
Innervates the muscles of the anterior thigh – the illiacus, pectineus, sartorius and quadriceps femoris.
159
what are the sensory functions of the femoral nerve?
Innervates the skin on the anterior thigh and the medial leg
