07-05 GIT Gx Abdominal Wall, Inguinal Canal and the Peritoneal Flashcards
1
Q
boundaries of the abdominal wall
A
- costal margins & xiphoid process,
- diaphragm,
- plane of the pelvic inlet,
- inguinal ligament and bones of the pelvis (iliac crest, pubic crest, and pubic syphysis)
2
Q
surface anatomy
A
- umbilicus
- linea alba
- linea transversae
- linea semilunaris
3
Q
!!! transpyloric plane traverses the…
A
- pylorus (in recumbent position)
- fundus of the gallbladder
- neck of the pancreas
- origins of SMA and hepatic portal vein
- root of the transverse mesocolon
- duodenojejunal junction
- hila of the kidneys
4
Q
plane that passes through the easily palpated ASIS on each side
A
interspinous plane
5
Q
plane that passes through the iliac tubercles and the body of the L5 vertebra
A
transtubercular plane
6
Q
plane that passes through the inferior border of the 10th costal cartilage on each side
A
subcostal plane
7
Q
planes that pass from the midpoint of the clavicles to the midinguinal points
A
midclavicular planes
8
Q
abdominal regions
A
(left to right/up to down)
right hypochondrium epigastric left hypochondrium right flank (lateral region) umbilical left flank (lateral region) right inguinal (groin) pubic left inguinal (groin)
9
Q
cleavage lines of the skin
used in surgical incisions
A
Langer Lines
10
Q
inferior to the umbilicus. 2 layers of subcutaneous tissue
A
1) superficial fatty layer (Camper fascia)
2) deep membranous layer (Scarpa fascia)
11
Q
superficial fatty layer
A
Camper fascia
12
Q
deep membranous layer
A
Scarpa fascia
13
Q
membranous layer continues inferiorly into the perineal region as the ____, but nor into the thighs
A
superficial perineal fascia (Colles fascia)
14
Q
the glistening lining of the abdominal cavity that is formed by a single layer of epithelial cells and supporting connective tissue
A
parietal peritoneum
15
Q
parietal peritoneum is separated to the transversalis fascia by…
A
extraperitoneal fat
16
Q
layers of the anteroabdominal wall
A
- skin
- camper fascia (superficial fatty layer of subcutaneous tissue)
- Scarpa fascia (deep membraneous layer of subcutaneous tissue
- superficial investing fascia
- external oblique
- intermediate investing fascia
- internal oblique
- deep investing fascia
- transversus abdominis
- transversalis (endoabdominal) fascia
- extraperitoneal fat
- parietal peritoneum (the glistening lining)
17
Q
derivatives of External Oblique
A
inguinal ligament, superficial inguinal ring,
lacunar ligament
18
Q
derivatives of Internal Oblique
A
conjoint tendon, cremasteric muscle
19
Q
derivatives of Transversus Abdominis
A
conjoint tendon
20
Q
largest among the 3 flat anterolateral abdominal muscles
A
external oblique
also the most superficial
21
Q
muscle - same direction as the fingers do when the hands are in one’s side pockets
(with the most anterior and superior approaching a horizontal course
A
external oblique
22
Q
the contralateral external and internal oblique form a two-bellied muscle sharing a common central tendon. what is this called?
A
digastric muscle
23
Q
origin of external oblique
A
external surfaces of 5th-12th ribs
24
Q
insertion of external oblique
A
linea alba, pubic tubercle, and anterior half of iliac crest
25
innervation of external oblique
thoraco-abdominal nerves (T7-T11 spinal nerves) and subcostal nerves
26
main action of external oblique & internal oblique
compresses and supports abdominal viscera; flexes and rotates trunk
27
muscle - like your fingers when the hand is placed over your chest
internal oblique
28
2 flat abdominal muscle that originates from thoracolumbar fascia
internal oblique, and
| transversus abdominis
29
origin of internal oblique
thoracolumbar fascia,
anterior 2/3 of iliac crest,
connective tissue deep to lateral third of inguinal ligament
30
insertion of internal oblique
inferior borders of 10th-12th ribs,
linea alba, and
pecten pubis via conjoint tendon
31
innervation of internal oblique
(same with transversus abdominis)
thoraco-abdominal nerves (anterior rami of T6-T12 spinal nerves) and
first lumbar nerves
32
main action of internal oblique
same with external oblique.
compresses and supports abdominal viscera;
flexes and rotates trunk
33
transversus abdominis run more or less transverssally, except for inferior part which runs parallel to those of the
internal oblique
34
origin of the transversus abdominis
thoracolumbar fascia,
internal surfaces of 7th-12th costal cartilages,
iliac crest,
connective tissue deep to lateral third of inguinal ligament
35
insertion of transversus abdominis
linea alba with aponeurosis of internal oblique,
pubic crest,
pecten pubis via conjoint tendon
36
innervation of transversus abdominis
same with internal oblique.
thoraco-abdominal nerves (anterior rami of T6-T12 spinal nerves) and
first lumbar nerves
37
main action of transversus abdominis
compresses and supports abdominal viscera;
38
principal vertical muscle of the abdominal wall; long, broad, and strap-like
rectus abdominis
39
paried rectus abdominis is, separated by _____, lie close together inferiorly .
linea alba
40
rectus abdominis enclosed in the
rectus sheath
41
the rectus muscle is anchored transversely by attachment to the anterior layer of the rectus sheath at 3 or more ___
tendinous intersections
| bulge outward when tensed
42
origin of rectus abdominis
pubic symphysis and
| pubic crest
43
insertion of rectus abdominis
xiphoid process and
| 5th-7th costal cartilages
44
innervation of rectus abdominis
thoraco-abdominal nerves (anterior rami of T6-T12 spinal nerves)
45
small, insignificant triangular muscle that is absent in app. 20% of people. lies anteriorly to the inferior part of the rectus abdominis.
pyramidalis
46
when present, it is used as a landmark for median abdominal incision
pyramidalis
47
formed by the weaving of the aponeuroses of the flat abdominal muscles
rectus sheath
48
inside the rectus sheath:
rectus abdominis,
pyramidalis,
also:
superior and inferior epigastric arteries and veins,
lymphatic vessels,
distal portions of the thoraco-abdominal nerves (abdominal portions of the anterior rami of spinal nerves T7-T12)
49
demarcates the transition between the aponeurotic posterior wall of rectus sheath covering the superior 3/4 of the rectus, and the
transversalis fascia covering the inferior quarter
arcuate line
50
a defect in the linea alba through which the fetal umbilical vessels passed to and from the umbilical cord and placenta.
umbilical ring
51
All layers of the anterolateral abdominal wall fuse here
umbilicus
52
dermatome L1 includes
inguinal fold
53
dermatome T10 includes
umbilicus
54
blood supply of rectus abdominis
superior and inferior epigastric arteries
55
superior epigastric arteries anastomose with the inferior epigatric arteries app. at the level of
the umbilical region
56
origin of superior epigastric artery
internal thoracic artery
57
origin of inferior epigastric artery
external iliac artery
58
other arteries of anterolateral abdominal wall - refer to Moore's page 196
memorize next time
59
superior epigatric vessels and branches of the musculophrenic vessels are from
internal thoracic vessels
60
inferior epigastric and deep circumflex iliac vessels are from
external iliac vessels
61
superficial circumflex and superficial epigastric vessels are from...
femoral artery and
greater saphenous vein,
respectively
62
lymphatic drainage of those above the umbilicus
anterior axillary lymph
| nodes
63
lymphatic drainage of those below the umbilicus
superficial inguinal lymph nodes
64
this umbilical fold extends from tha apex of the urinary bladder to the umbilicus and covers the "median umbilical ligament", a fibrous remnant of the URACHUS that joined the apex of the fetal bladder to the umbilicus
median umbilical fold
65
these umbilical fold (paired) are lateral to the median umbilical folds. these cover the "medial umbilical ligaments", formed by OCCLUDED PARTS OF THE UMBILICAL ARTERIES (OBLITERATED UMBILICAL ARTERIES)
medial umbilical folds
66
these umbilical folds are lateral to the medial umbilical folds. these cover the INFERIOR EPIGASTRIC ARTERIES (vessels) and therefore bleed if cut
lateral umbilical folds
67
depressions lateral to the umbilical folds; potential sires for hernia
peritoneal fossae
68
the depression between the median and the medial umbilical cords; rises and falls with filling and emptying of the bladder
supravesical fossae
69
depressions between the medial and the lateral umbilical folds are commonly known as _____. these are potential sites for the less common direct inguinal hernias
medial inguinal fossae – inguinal triangles (Hesselbach triangles)
70
depressions lateral to the lateral umbilical folds, include the ______ and are potential sites for the most common type of hernia in the lower abdominal wall, the indirect inguinal hernia
lateral inguinal fossae – deep inguinal ring
71
fibrous remnant of the umbilical vein which is passed from the umbilicus to the liver prenatally
round ligament
72
encloses the round ligament of the liver (L. ligamentum teres hepatis) and para-umbilical veins in the inferior free edge
falciform ligament
73
oblique passageway through the anterior abdominal wall for the spermatic cord/ round ligament & ilioinguinal nerve
INGUINAL CANAL
74
region where structures enter/exit the abdominal cavity
INGUINAL CANAL
75
dense ligament consisting the inferiormost part of the external oblique
inguinal ligament
76
thickened inferior margin of the transversalis fascia
iliopubic tract
77
site of direct and indirect inguinal and femoral hernias; weakness in the body wall in the inguinal canal
myopectineal orifice
78
entrance to the inguinal canal; where extraperitoneal ductus (vas deferens) and testicular vessels in males (or round ligament of the uterus in females) pass to enter the inguinal canal
deep (internal) inguinal ring
79
ext by which the spermatic cord in males, or the round ligament in females, emerges from the inguinal canal
superficial (external) inguinal ring
80
Anterior wall of the inguinal canal
External oblique aponeurosis
81
Posterior wall of the inguinal canal
Transversalis fascia & the conjoint tendon
82
Roof of the inguinal canal
Internal oblique & transversus abdominis muscle
83
Floor of the inguinal canal
Inguinal & lacunar ligament
84
a fibrous tract connecting the primordial testis to the anterolateral abdominal wall
male gubernaculum
85
a fibrous cord connecting the ovary and primordial uterus to the developing labium majus - represented postnatally by the ovarian ligament (between the ovary and uterus) and round ligament (between the uterus and labia majus
female gubernaculum
86
(surface anatomy) pit of the stomach; slight depression in the epigastric region, just inferior to the xiphoid process
epigastric fossa
87
serous membrane that lines the abdominal wall
PARIETAL peritoneum
88
serous membrane that covers the organs
VISCERAL peritoneum
89
both parietal and visceral peritoneum consist of
mesothelium and connective tissue
90
Loss of mesothelial layer in peritoneum leads to
adherence of underlying tissues & interferes with visceral function
91
organs completely covered with VISCERAL peritoneum (e.g. stomach and spleen)
INTRAPERITONEAL organs
92
organs external to the PARIETAL peritoneum
| e.g. kidneys - retroperitoneal, urinary bladder - subperitoneal
EXTRAPERITONEAL organs
93
potential space between the parietal and visceral layers of peritoneum
peritoneal cavity
94
peritoneal cavity contains no organs, but only
peritoneal fluid (app. 100mL of fluid, but can hold up to 5 liters)
95
blood & nerve supply of the PARIETAL peritoneum comes from
the region of the wall it
| lines
96
blood & nerve supply of the VISCERAL peritoneum comes from
the organ it covers
97
cavity is completely CLOSED in males. in females,
there is communication to the exterior by way of uterine tubes, uterine cavity and vagina
98
peritoneal reflection from the BODY WALL to the small intestine
Mesentery
99
peritoneal reflection from the STOMACH to other abdominal organs
Omenta/ Omentum
100
double layer of peritoneum that connects an ORGAN TO ANOTHER ORGAN or to the abdominal wall
Peritoneal ligament
101
the LIVER is connected to the ANTERIOR ABDOMINAL WALL by the
falciform ligament
102
the LIVER is connected to the STOMACH by the
hepatogastric ligament
103
the LIVER is connected to the DUODENUM by the
hepatoduodenal ligament
104
the STOMACH is connected to the INFERIOR SURFACE OF THE DIAPHRAGM by the
gastrophrenic ligament
105
the STOMACH is connected to the SPLEEN by the
gastrosplenic ligament
106
the STOMACH is connected to the TRANSVERSE COLON by the
gastrocolic ligament
107
(Subdivisions of the Peritoneal Cavity)
| the main and larger part of the peritoneal cavity
greater sac
108
(Subdivisions of the Peritoneal Cavity)
| lies posterior to the stomach and lesser omentum
omental bursa (lesser sac)
109
(Subdivisions of the Peritoneal Cavity)
| contains the stomach liver and spleen
Supracolic compartment
110
(Subdivisions of the Peritoneal Cavity)
| contains the small intestine and ascending and descending colon
Infracolic compartment
111
the ____ divides the abdominal cavity into ___ and ___
Supracolic compartment and
| Infracolic compartment
112
free communication occurs between the Supracolic compartment and
Infracolic compartment through the
paracolic gutters
113
omental bursa communicates with the greater sac through
omental foramen
114
ANTERIOR boundary of Foramen of Winslow (Epiploic/Omental foramen)
Portal vein, hepatic artery, bile duct
115
POSTERIOR boundary of Foramen of Winslow (Epiploic/Omental foramen)
IVC, right crus of diaphragm
116
SUPERIOR boundary of Foramen of Winslow (Epiploic/Omental foramen)
Caudate lobe of liver
117
INFERIOR boundary of Foramen of Winslow (Epiploic/Omental foramen)
1st part of duodenum
118
main paired muscles of the posterior abdominal wall
- psoas major
- iliacus
- quadratus lumborum
119
psoas etymology
psoas = Greek = muscle of the loin
120
superior attachment of psoas major
T12-L5
121
inferior attachment of psoas major
lesser trochanter of femur
| merges inferiorly with iliacus
122
main action of iliopsoas muscle
flexes the thigh at hip joint
123
only ___ can produce movement (flexion or lateral bending) of the lumbar vertebrae
psoas major
124
psoas major and ilacus muscle merge inferiorly forming the
iliopsoas muscle
125
superior attachment of ilacus
iliac fossa;
sacroiliac/iliolumbar ligaments;
sacrum
126
inferior attachment of iliacus
lesser trochanter
127
innervation of psoas major
anterior rami of lumbar nerves (L1, L2, L3)
128
innervation of iliacus
femoral nerve (L2-L4)
129
superior attachment of quadratus lumborum
12th rib;
| L1-L5
130
inferior attachment of quadratus lumborum
L1-L5;
iliolumbar ligament;
iliac crest
131
innervation of quadratus lumborum
anterior rami of T12 and L1-L4 nerves
132
main action of quadratus lumborum
lateral bending of the trunk
133
abdominal aorta begins at __ and ends at ___
begins at the aortic hiatus in the diaphragm at the level of the T12 vertebra
and ends at the level of the L4 vertebra by dividing into the right and left common iliac arteries
134
terminal brand of the abdominal aorta
common iliac arteries
135
common iliac arteries divide into __ And ___
internal and external iliac arteries
136
internal iliac artery enters the
pelvis
137
external iliac artery follows the
iliopsoas muscle
138
just before leaving the abdomen, the external iliac artery gives rise to the ___ and ___ , which will supply the anterolateral abdominal wall
inferir epigastric and
| deep circumflex iliac arteries
139
paired parietal branches of the aorta serve the ___ and ___
diaphragm and posterior abdominal wall
140
anterior branches of the abdominal aorta and the parts they supply
- Celiac trunk (abdominal foregut)
- Superior mesenteric (abdominal midgut)
- Inferior mesenteric (abdominal hindgut)
141
lateral branches of the aorta and the parts they supply
- Middle suprarenal (suprarenal glands)
| - Renal arteries (kidneys)
142
paired branches of the abdominal aorta
- Testicular/ ovarian (Testes (male); ovaries (female))
| - Inferior phrenic (diaphragm)
143
posterior branches of the abdominal aorta
- lumbar arteries (Posterior abdominal wall & spinal cord)
| - median sacral
144
left testicular or ovarian veins will enter the ____ instead of entering the IVC
left renal vein
145
inferior vena cava (IVC) begins at ___
anterior to the L5 vertebra by the union of the common iliac veins
146
the IVC leaves the abdomen by ___ and enters the thorax at the ___
leaves the abdomen by passing through the "caval opening" in the diaphragm and
enters the thorax at the T8 vertebral level
147
tributaries to the inferior vena cava
* external iliac veins
* lumbar veins
* right testicular/ovarian vein
* renal veins
* right suprarenal vein
* inferior phrenic veins
* hepatic veins
148
blood from the abdominal viscera passes through the "portal venous system" and the liver before entering the IVC via the __-
hepatic veins
149
Which of the following structures are found on the same plane as the transplyloric plane?
A. Tail of the pancreas
B. Upper pole of the left kidney C. Inferior mesenteric artery
D. 9th costal cartilage
D. 9th costal cartilage
150
Visceral pain located in the umbilical region may emanate from which of the following abdominal viscera?
Ileum
151
The transpyloric plane is the horizontal plane between which of the following landmarks
Jugular notch and pubic symphysis
152
derivative of the internal oblique muscle
Cremasteric muscle
153
derivative of the Scarpa’s fascia
Superficial fascia/ Dartos muscle
154
derivative of the External Oblique
External spermatic fascia
155
derivative of the Transversalis fascia
Internal Spermatic fascia
156
derivative of the Peritoneum
Tunica vaginalis
157
signify the transition of the rectus sheath’s position exclusively anterior to the rectus abdominis muscle
Arcuate line
158
Which of the following zones of the anterior abdominal wall is supplied by the deep inferior epigastric artery?
Zone II
159
The lymphatic drainage of the anterior abdominal wall structures is dependent on their position relative to which of the following structures?
Umbilicus
160
Which of the following spinal nerves is being assessed when one strokes the area of the skin in the area just below the xiphoid process with light touch using the blunt end of a neurologic hammer?
T 7
161
Hesselbach’s triangle is located in which peritoneal fossae
Medial inguinal
162
located lateral to the inferior epigastric vessels
deep inguinal ring
163
A swollen gall bladder that stretches its visceral peritoneum shall manifest as a vague, waxing and waning pain in which of the following regions of the abdomen?
Epigastric
164
divide the peritoneal cavity into supracolic and infracolic compartments?
Transverse mesocolon
165
peritoneal fossae where direct inguinal hernias herniate
Medial inguinal
166
peritoneal fossa where indirect inguinal hernias herniate
Lateral inguinal
167
In a case of a ruptured urethra, urine is prevented from leaking into the thigh because of the attachment of which of the following structures?
Scarpa’s fascia
168
The origin of the renal artery is approximately at the level of which of the following vertebra?
L 2
169
In the ligation of which of the following arteries should you be wary about the ureter in respect to its relationship?
Testicular/Ovarian
170
transpyloric plane hits what vertebral level
L 1
171
this structure extends from Anterior Superior Iliac Spine to the pubic tubercle
inguinal ligament
172
above or below arcuate line?
rectus abdominis is covered directly by leaves of internal oblique aponeurosis
above
173
above or below arcuate line?
aponeuroses of external oblique runs anterior to rectus abdominis
both above and below
174
above or below arcuate line?
rectus abdominis is directly covered by transversalis fascia
below
175
dermatome of the pubis, just above the inguinal ligament and symphysis pubis
L1
176
dermatome of xiphoid process
T7
177
dermatome of the umbilicus
T10
178
dermatome of most parts of the epigastrium
T8
179
dermatome of most parts of hypogastric area
T12
180
origin of external oblique muscle
lower 8th ribs
181
fundus of the gallbladder lies opposite of what anatomical structure
tip of right 9th costal cartilage
