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Anatomy 1 - MD > Week 4 - Abdomen > Flashcards

Week 4 - Abdomen Flashcards

1
Q

Which area of the body is the largest for malpractice?

A

the abdomen

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2
Q

Boundariers of the Abdomen

A

-superior: Diaphragm (seprates thoracic from abd cavity)
-inferior: Pelvis (continuous w/ pelvic cavity)
-posterior: veterbreal column + posterior/inferior ribs (lower part of thoracic cage)
-lateral: flank muscles
-anterior: abdominal muscles (rectus abdominus, external oblique, internal oblique, transversus abdominus + fasciae)

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3
Q

Peritoneal Space

A

organs covered by peritoneal (abdominal) lining

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4
Q

Retroperitoneal Space

A

organs posterior to the peritoneal lining
-most problematic for injuries (uncovered) + misdiagnosis
-major organ = kidneys (not well protected)

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5
Q

Pelvic Space

A

organs within the pelvis

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6
Q

Abdominal Wall is made of…

A

-skin
-superficial fasciae
-deep fascia
-extraperitional fascia
-parietal peritoneum

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7
Q

Abdominal Wall is lined with…

A

fascial envelope + parietal peritoneum

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8
Q

Rectus Abdominus

(origin, insertion, bloody supply, innervation)

Abd Wall Muscles

A

joins to 5th rib and sternum (above xiphoid)
-attached by 2 tendons
-origin: pubic symphysis + pubic crest
-insertion: xiphoid process of sternum + costal cartilage of 5, 6, 7th ribs
-bloody supply: inferior + superior epigastric
-innervation: thoracoabdominal nerves (anterior divisoons of 7th-11th lower intercostal nerves)

vertical midline of abdominal wall

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9
Q

External Oblique

(origin, insertion, action)

Abd Wall Muscles

A

-origin: external surfaces of ribs 5-12
-insertion: anterior iliac crest + fan shaped distribution to abdominal aponeurosis to Linea alba
-action: flexion of vertebral column (draws thorax down), rotates vertebral column, laterally flexes vertebral column

“hands in pocket” superior abd wall muscle

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10
Q

Internal Oblique

(origin, insertion)

Abd Wall Muscles

A

fibers perpendicular to external oblique
-origin: anterior iliac crest, lateral half of inguinal ligament, thoracocolumbar fascia
-insertion: costal cartilages of ribs 8-12, abdominal aponeurosis to Linea alba

intermediate abd wall muscle

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11
Q

Transversus Abdominus

(origin, insertion, trauma)

Abd Wall Muscles

A

deepest layer of abdominal muscle
-origins: costal cartilages/ribs 7-12, thoracolumbar fascia, front 2/3 of iliac crest (top border of pelvic bone), lateral 1/3 of inguinal ligament
-insertions: Linea alba, pubic symphysis, xiphoid process
-trauma: rigidity, fractured xiphoid/sternum, internal bleeding

sits below internal/external obliques + rectus abdominus

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12
Q

Origin

A

proximal attachment

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13
Q

Insertion

A

distal attachment

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14
Q

Thoracolumbar Fasciae

A

large diamond shaped sheet of connective tissue located at lower back

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15
Q

Inguinal Ligament

A

band of connective tissue extends diagnoally down from pelvis

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16
Q

Linea Alba

A

fibrous band of connective tissue runs down the front of abdominal wall

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17
Q

Pubic Symphysis

A

connective tissue joining R + L sides of lower pubic bone

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18
Q

Innervation of Transversus Abdominus

A

-lower 5 intercostal nerves: originate from T1-T11 nerves of spinal cord
-subcostal nerve: originate from T12 nerves of spinal cord
-Iliohypogastric nerve (lumbar plexus in lower back): originate from L1 of spinal cord
-Ilioinguinal nerve: lumbar plexus branch originating from L1 of spinal cord

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19
Q

Blood Supply of Skin Near the Midline:

A

-superior epigastric artery (branch of internal thoracic artery)
-inferior epigastric artery (branch of external iliac artery)

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20
Q

Blood Supply of Skin of the Flanks:

A

branches of intercostal, lumbar + deep circumflex arteries

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21
Q

Muscles of Lower Posterior Abdomen

(starting at 12th rib)

A

-quadratus lumborum
-psoas minor
-iliopsoas (psoas major + iliacus)
-tensor fasciae latae
-sartorius
-pectineus
-adductor longus
-gracilis
-adductor magnus
-quadriceps femoris (rectus femoris, vastus lateralis, vastus medialis)

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22
Q

Abdominal Venous Drainage

A

collected into a network of veins that radiate from the umbilicus

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23
Q

Drained above via axillary vein via…

Venous Drainage

A

lateral thoracic vein

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24
Q

Drained below via femoral vein via…

Venous Drainage

A

superficial epigastric + great sapphenous vein

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25
Paraumbilicus Veins ## Footnote Venous Drainage
form clincially important portal system venous anastomosis
26
Caput Medusae
**superficial veins aorund umbilicus + paraumbilical veins connecting them to portal vein become distended** -portal vein obstruction -distended veins radiate out from umbilicus -**occurs with**: any blockage, liver problems, alcoholism, difficulty defecating, cancer -leads to backup -> compression -> distension (could be a tumor)
27
Abdominal Nerves
**supply skin, muscles + parietal peritoneum** -**derived from**: anterior rami of lower 6 thoracic nerves + L1 nerves
28
Inflammation of Parietal Peritoneum
causes pain in overlying skin + increase reflex in tone of abdominal musculature of the same area
29
Lymphatic drainage of skin above the umbilicus:
drains upwards to anterior axillary nodes (pectoral group of nodes)
30
Lymphatic drainage of skin below the umbilicus:
drains downward/laterally to superficial inguinal nodes
31
Swelling of groin possibly due to:
enlarged superificial inguinal node
32
Rectus Sheath
**formed by aponeurosis of 3 lateral abdominal muslces (internal oblique, external oblique, transverse abdominus)** -long fibrous sheath enclosing the rectus abdominus + pyramidalis -contains anterior rami of lower 6 thoracic nerves -contains superior/inferior epigastric + lymphatic vessels
33
Anterior Wall of Rectus Sheath ## Footnote Rectus Sheath
**formed by aponeurosis of external oblique (in front of the muscle)** -firmly attached to rectus abdominus by tendinous intersections
34
Posterior Wall of Rectus Sheath ## Footnote Rectus Sheath
**formed by thoracic wall of 5th, 6th, 7th costal cartilages + intercostal spaces** -is NOT attached to rectus abdominus
35
Transversus Abdominus Aponeurosis ## Footnote Rectus Sheath
behind the muscle
36
Esophagus
carries food + liquid to the stomach
37
Small Intestine
duodenum, jejunum, ileum
38
Large Intestine
cecum, ascending colon, transverse colon, descending colon sigmoid colon
39
Abdominal Cavity
**separated form the throax by the diaphragm** -lined with peritoneum
40
Pelvic Cavity
**lower portional of abdominal cavity** -"pelvic region" -pelvis, vertebrae, sacrum
41
Cholecystitis
**inflammation of gallbladder** -common in young women especially after pregnancy
42
Pelvic Inflammation
**diffused tenderness** -may be ectopic pregnancy or ovarian cyst
43
Referred Pain: RUQ Organs
-**liver**: cholecystitis or liver lac -kidney -**gallbladder**: pain w/o trauma = gallbladder disease -pancreas -lung
44
Referred Pain: LUQ Organs
-heart -lung -**spleen**: rigidity under lower ribs -kidney -stomach
45
Referred Pain: RLQ Organs
-**appendix**: rebound tenderness = appendicitis -ureter -bladder -**colon**: colitis or diverticulitis -gonads
46
Referred Pain: LLQ Organs
-ureter -bladder -**colon**: colitis or diverticulitis -gonads
47
RUQ Pain + Associated Conditions
-acute cholcystitis -acute hepatitis -hepatic abscess -hepatomegaly -perforated duodenal ulcer -acute pancreatitis -retrocecal appendicitis -herpes zoster -myocardial ischemia -RLL pneumonia
48
RLQ Pain + Associated Conditions
-appendicitis -regional enteritis -diverticulitis -leaking aneurysm -abd. wall hematoma -ruptured ectopic pregnancy -ovarian cyst -PID -endometriosis -kidney stones -groin hernia
49
LUQ Pain + Associated Conditions
-gastritis -acute pancreatitis -splenic enlargement, rupture, aneurysm -myocardial ischemia -LLL pneumonia
50
LLQ Pain + Associated Conditions
-sigmoid diverticulitis -leaking aneurysm -ruptured ectopic pregnancy -PID -endometriosis -seminal vesiculitis -enteritis
51
Diffused Mid-Abdominal Pain + Associated Conditions
-peritonitis -acute pancreatitis -early appendicitis -gastroenteritis -dissecting/rupturing aneurysm -intestinal obstruction -diabetes mellitus
52
Visceral Pain
**stretching of hollow organs or capsule of solid viscus, leading to poorly localized/characterized pain** -dull, cramping, aching -can be localized to sensory cortex to an approximate spinal cord level (determined by embryologic origin of organ involved) | lining of the organ; deep pain
53
Foregut Organs ## Footnote Visceral Pain
**produce pain in epigastric region** -stomach, duodenum, biliary tract
54
Midgut organs ## Footnote Visceral Pain
**produce periumbilical pain** -small bowel, appendix, cecum
55
Hindgut Organs ## Footnote Visceral Pain
**produce suprapubic or hypogastric pain** -colon (including sigmoid), intraperitoneal portions of genitourinary tract
56
Parietal Pain
**caused by irritation of fibers that innervate the parietal peritoneum** -can be localized to dermatome superficial to site of painful stimulus
57
With any disease progression, viseceral pain will lead to
parietal pain, causing tenderness
58
Localized peritonitis leads to:
rigidity and rebound tenderness
59
Referred Pain
pain or discomfort perceived at a site distant from affected organ because of overlapping transmission pathways
60
Rebound Tenderness
press slowly + let go quickly; produces pain once pressure is removed
61
Sub-diaphragmatic Irritation ## Footnote Referred Pain
ipsilateral supraclavicular or shoulder pain
62
Gynecologic pathology ## Footnote Referred Pain
back or lower extremity pain
63
Biliary Tract Disease ## Footnote Referred Pain
R infrascapular pain
64
Myocardia Ischemia ## Footnote Referred Pain
mid-epigastric, neck, jaw or L extremity pain
65
Ureteral Obstruction ## Footnote Referred Pain
ipsilateral testicular pain
66
Hollow Organs
**allow materials to pass through; act as "holding tanks"** -decreased risk of injury when organ is empty -air is present (soft, resonant sound - same sound as solid organ when it's full ex. fluid in abdomen or pneumonia) -full = increased pressure = increased chance of rupture | stomach, large intestine, small intestine pancreas
67
Solid Organs
**significant blood supply; no air present + hard/echo sound** -increased risk of injury (bruising, tearing - hematuria) | liver, spleen, pancreas, kidney, ovaries, testes
68
Spleen ## Footnote Palpation
**palpate for enlarged spleen under L ribcage** -have pt raise arms above head
69
Liver ## Footnote Palpation
**press firmly below costal margin** -ask pt to take a deep breath -may feel liver slide against your hand -normal liver is not tender
70
Kidneys ## Footnote Palpation
**under posterolateral portion of ribcage** -R kidney rests more inferior than L -bruising, pooling of blood, swelling
71
Abdominal Rigidity ## Footnote Palpation
**occurs secondary to muscle guarding or blood accumulation (indication of internal injury)** -check for rebound tenderness -**normal percussion findings**: solid organs have dull thump resonant sound -**positive/abnormal finding**: hard, solid echo over area that should sound shallow
72
Hernia
protrusion of organ through defect in the wall of the cavity
73
Classifications of Hernias
-**reducible**: easily manipulated back in place -**irreducible/incarcerated**: cannot be reduced due to adhesions in hernia sac -**strangulated**: herniated intestine becomes twisted or edematous
74
Inguinal Hernia
**pressure in the abdominal wall finds a weak spot, intestine passes through** -bilateral in 20% of cases -R side more frequent than L side
75
Direct Hernia ## Footnote Inguinal Hernia
**herniation through muscle weakness in inguinal canal** -acquired -25% common -increased abdominal pressure weakens fascia -can be caused by constipation, coughing, straining, heavy lifting, prostate enlargement
76
Indirect Hernia ## Footnote Inguinal Hernia
**herniation through inguinal ring** -congenital -75% common, 3x more likely in males -can develop at any age but prevalent in infants less than 1 y/old
77
Femoral Hernia
**through femoral canal** -4% incidence -common in elderly women -female prediposition (3:1) -increased abd pressure -hernia sac bulges into femoral canal (medial to femoral vein)
78
Bilateral Hernia
**R + L inguinal hernia (simultaneous)** -L hernia present = 25% risk of occult R inguinal hernia -common in children + elderly men -L hernia present -> check for R side
79
Incisional Hernia
**type of ventral hernia; develops in scar of prior laparotomy or drain site** -**risks include**: 1. vertical scar 2. wound infection (wound opens up) 3. wound dehiscence (getting surgical site wet) 4. malnutrition 5. obesity 6. tobacco use (decreased vascularization) | bacteria degrades sutures -> infection
80
Complications of Hernia
-**bowel incarceration**: trapping abdominal contents within hernia -**strangulation**: pressure compromises blood supply (decreased venous pressure), ischemia, necrosis (gangrene) -**small bowel obstruction**
81
HIDA Scan
hepatobiliary iminodiacetic acid scan of liver function
82
Cholecystitis | (Manifestation)
stone in cystic duct -> bile still produced -> flow is blocked -> inflamed gallbladder (cholecystitis)
83
Pancreatic Cancer | (Manifestation)
tumor compresses CHD -> backup of bile + buildup of bilirubin -> jaundice + pain from swelling | (painless jaundice)
84
R Hepatic Artery
branches off to cystic artery, supplies gallbladder
85
Gallbladder
**responsible for concentrating + storing bile** -sits under the liver in RUQ -hollow organ of smooth muscle (does not relax or empty well) -lies in shallow depression on interiro ruface of the liver -**capacity** = 30-50 mL of bile -connected to CHD by cystic duct -**blood supply** = cystic artery (originating from RHA)
86
Bile
**responsible for helping the body to digest fats** -golden color -1/4 -1 1/4 L bile produced daily
87
Bile Composition
-water -electrolytes (Na+, K+, Ca2+, Cl-, HCO3) -fatty acids -cholesterol -bilirubin -bile salts
88
Increased production of bile leads to...
production of gallstones when gallbladder is non-functional
89
Factors associated w/ increased risk of gallstone development
-obesity (increased abd pressure) -pregnancy (very common, increased pressure) -Crohn's Disease -terminal ileal resection -gastric surgery -Sickle Cell Disease
90
Murphy's Sign
**RUQ pain upon palpation causes cessation of breathing** -indicates cholecystitis
91
Gallstone Disease
**revealed by ultrasound** -3 stages: 1. cholesterol supersaturation in bile 2. crystal nucleation 3. stone growth
92
Symptomatic Cholelithiasis
**pain occurs due to stone obstructing cystic duct** -increased wall tension -pain resolves when stone passes -pain 1-5 hours (rarely >24 hours) -can cause acute/chronic cholecystitis -epigastric/RUQ pain, no fever/WBC
93
Acute Cholecystitis
**acute GB inflammation due to cystic duct obstruction** -persistent RUQ pain -incr. WBC - + Murphy's sign
94
Chronic Cholecystitis
**recurrent bouts of cholecystitis leading to chronic GB wall inflammation/fibrosis** -no fever/WBC
95
Chronic Calculous Cholecystitis ## Footnote Symptomatic Cholelithiasis
**recurrent inflammatory process due to recurrent cystic duct obstruction** -90% lead to gallstones -leads to scarring/wall thickening -scar tissue does not function well -**treatment**: laparotic cholecystectomy
96
Acute Calculous Cholecystitis ## Footnote Symptomatic Cholelithiasis
**persistent cystuc duct obstruction** -GB distension, edema -pain persists >24 hours -palpable tender RUQ mass -sonography for inital imaging
97
Acute Acalculous Cholecystitis
**caused by GB / biliary stasis from lack of enteral stimulation by cholecystokinin** -5-10% of acute cholecystitis cases -seen in critically ill pts or prolonged TPN -likely to progress to gangrene
98
Cholangitis
**infection of bile ducts due to CBD obstruction secondary to stones/strictures** -Charcot's triad + Raynaud's Pentad -may lead to life threatening sepsis
99
Charcot's Triad ## Footnote Cholangitis
**jaundice, fever + RUQ pain** -70% of pts
100
Raynaud's Pentad ## Footnote Cholangitis
**collection of signs + symptoms suggesting obstructive ascending cholangitis** -combination of Charcot's Traid w/ shock + AMS
101
Complications of Acute Cholecystitis
-**empyema of GB**: pus filled GB due to bacterial proliferation in obstructed GB (high fever) -**emphysematous cholecystitis**: severe RUQ pain + sepsis (common in men + diabetics, air in GB wall) -**perforated GB**: contained abscess in RUQ occuring in 10% of pts

Anatomy 1 - MD (6 decks)

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