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1-Anatomy Flashcards

1
Q

What are the planes that make up the 9 abdominal regions?

A

Horizontal: Transpyloric: Halfway between xiphoid process and umbilicus, passes through pylorus of stomach
Intertubercular: Horizontal line that joins the iliac crest
Vertical: Midclavicular

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2
Q

What are the planes that make up the 4 quadrants of the abdominal cavity?

A

Transumbilical: Passes between umbilicus and IV disc between L3 and L4 vertebrae
Median: Passes through middle of pubic symphysis, splits abdomen into left and right

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3
Q

What are the layers from the skin to the parietal peritoneum?

A 
Skin
Superficial fascia (beneath umbilicus - fat- camper, then membranous layer - Scarpa)
Investing fascia 
External oblique 
Investing fascia 
Internal oblique
Investing fascia 
Transverse abdominus 
Transversalis fascia
Extraperitoneal fat
Parietal peritoneum
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4
Q

What is the inguinal ligament formed by?

A

Inferior margin of the external oblique and a fibrous band

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5
Q

Where does the inguinal ligament span between?

A

Anterior superior iliac spine and the pubic tubercle

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6
Q

What direction do the fibres of external oblique run in?

A

Inferomedially - HANDS IN POCKETS

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7
Q

What direction do fibres of internal oblique run in?

A

Superiomedially

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8
Q

What direction do fibres of transverse abdominis run?

A

Horizontally

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9
Q

What does the different direction of the flat muscle fibres do?

A

Strengthen abdominal wall

Decrease risk of herniation

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10
Q

What is the rectus sheath?

A

An aponeurosis of the medial parts of the flat muscles, enclosing the rectus abdominus, the pyramidalis muscles

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11
Q

What are the divisions of the rectus sheath?

A

Posterior wall: Aponeuroses of internal oblique and transverse abdominis
Midway between umbilicus and pubic symphysis, all aponeuroses move to anterior wall
Anterior wall: Aponeuroses of external and internal obliques

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12
Q

What is the arcuate line?

A

The transition between the rectus abdominus having a posterior wall and not, so is in direct contact with the transversalis fascia. Located midway between the umbilicus and pubic symphysis.

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13
Q

What is the linea alba?

A

Where the aponeuroses of the flat muscles entwine in the midline, splitting rectus abdominus in two. Extends from xiphoid process to pubic symphysis

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14
Q

What are the flat muscles?

A

External oblique
Internal oblique
Transverse abdominus

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15
Q

What are the vertical muscles?

A

Rectus abdominis

Pyramidalis

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16
Q

What are the attachments and innervation of external oblique?

A

Origin: Ribs 5-12
Insertion: Iliac crest and pubic tubercle
Innervation: Intercostals (T7-11) and subcostal (T12)

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17
Q

What are the attachments and innervation of internal oblique?

A

Origin: Inguinal ligament, iliac crest and thoracolumbar fascia
Insertion: Ribs 10-12
Innervation: Intercostals (T7-11), subcostal (T12) and L1 - iliohypogastric and ilio-inguinal

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18
Q

What are the attachments and innervation of transversus abdominus?

A

Origin: Inguinal ligament, costal cartilages 7-12, iliac crest and thoracolumbar fascia
Insertion: Conjoint tendon, xiphoid process, pubic crest
Innervation: Intercostals (T6-11), subcostal (T12) and L1 - iliohypogastric and ilioinguinal

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19
Q

What is the function of external oblique?

A

Compress the abdominal viscera (aids in expiration, micturition, defecation)
Bilateral contraction: Flexion of vertebral column
Unilateral contraction: Lateral rotation of vertebral column, ipsilateral shoulder moves anteriorly

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20
Q

What is the function of the internal oblique?

A

Compresses the abdominal viscera (aids in expiration, micturition, defecation)
Bilateral contraction: Flexion of vertebral column
Unilateral contraction: Lateral rotation of vertebral column, contralateral shoulder moves anteriorly

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21
Q

What is the function of transversus abdominus?

A

Compresses the abdominal viscera (aids in expiration, micturition, defecation)

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22
Q

What is the linea semilunaris?

A

The lateral border of the paired rectus abdominus muscles, runs from 9th rib to pubic tubercle

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23
Q

What are tendinous intersections?

A

3 Fibrous strips that intersect the rectus abdominis muscle to create the six pack

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24
Q

What are the attachments and innervation of rectus abdominis?

A

Origin: Pubic crest and symphysis
Insertion: Xiphoid process and costal cartilages 5-7
Innervation: Intercostals (T7-11) and subcostal (T12)

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25
Q

What is the function of rectus abdmoninis?

A

Depresses the ribs, flexes vertebral column, tenses anterior abdominal wall

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26
Q

Between which layers of the abdominal wall will fluid from the perineal region spread?

A

Between fatty fascia (Scarpa’s) and the investing fascia of external oblique

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27
Q

Where is pyramidalis in relation to rectus abdominis?

A

Superficial and inferior to it

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28
Q

Which of the abdominal wall muscles is missing in 20% of people?

A

Pyramidalis

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29
Q

What are the attachments and innervation of pyramidalis?

A

Origin: Pubic crest and symphysis
Insertion: Linea alba
Innervation: Subcostal (T12)

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30
Q

What is the function of pyramidalis?

A

Tenses linea alba

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31
Q

What is the action of the abdominal muscles during inspiration?

A

When diaphragm contracts, abdominal muscles relax to make room for the abdominal viscera that are pushed inferiorly

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32
Q

What is the action of the abdominal muscles during expiration?

A

Contract to increase intra-abdominal pressure, elevating the diaphragm so air can be expelled

33
Q

What type of cell makes up the peritoneum?

A

Mesothelium - Simple squamous epithelial cells

34
Q

What does the parietal peritoneum do?

A

Lines internal surface of abdominopelvic wall

35
Q

Where does the parietal peritoneum derive from and how does this affect its innervation?

A

Derived from somatic mesoderm
Innervated by the same somatic nerves as the abdominal wall it lines so pain is well localised and sensitive to pain, pressure and temperature

36
Q

What does the visceral peritoneum do?

A

Invaginates to cover abdominal viscera

37
Q

Where does visceral peritoneum derive from and how does this affect its innervation?

A

Derived from splanchnic mesoderm
Innervated by same nerves as the viscera it invests, so pain is poorly localised and referred to dermatomes that are supplied by same ganglia as nerves innervating the viscera. Sensitive only to stretch and chemical irritation

38
Q

Define and give examples of intraperitoneal organs

A

Organs completely covered by visceral peritoneum

Eg Stomach, liver, jejunum and spleen

39
Q

Define retroperitoneal organs

A

Organs covered in peritoneum only on their anterior surface

40
Q

Define and give examples of primarily retroperitoneal organs

A

Organs that develop and remain outside the parietal peritoneum eg oesophagus, rectum and kidneys

41
Q

Define and give examples of secondarily retroperitoneal organs

A

Organs that were initially intraperitoneal, suspended by mesentery. Become retroperitoneal, mesentery fuse with posterior abdominal wall, so peritoneum only covers anterior surface
E.g. Ascending and descending colon

42
Q

Which abdominal viscera are retroperitoneal?

A 
SAD PUCKER
Suprarenal (adrenal) glands
Aorta/IVC
Duodenum - except duodenal cap 
Pancreas - except tail 
Ureters 
Colon - ascending and descending 
Kidneys 
Esophagus 
Rectum
43
Q

Define mesentery

A

A double layer of visceral peritoneum, connecting an intraperitoneal organ to the (posterior) abdominal wall. Develops from splanchnic mesoderm

44
Q

How is mesentery named?

A

Small intestine - the mesentery

Everywhere else named according to viscera it connects to

45
Q

What is the omentum?

A

Double layer of peritoneum that extends from stomach and proximal duodenum

46
Q

What are the attachments of the greater omentum?

A

Descends from greater curvature of stomach and proximal duodenum passing in front of small intestines
Then fold back up to attach to the anterior surface of transverse colon

47
Q

What are the functions of the greater omentum?

A

Physically limit spread of intraperitoneal infection as wraps around affected area
Fat deposition

48
Q

What does the greater omentum develop from?

A

Develops from dorsal mesentery that connects stomach to posterior abdominal wall

49
Q

What does the lesser omentum develop from?

A

Ventral mesentery

50
Q

What are the attachments of the lesser omentum?

A

Attaches from the lesser curvature of the stomach and proximal duodenum to liver via hepatogastric and hepatoduodenal ligaments

51
Q

Define peritoneal ligament

A

Double fold of peritoneum that connects viscera together or to abdominal wall

52
Q

Where are is the pain from the embryological regions referred to?

A

Foregut to Epigastric
Midgut to umbilical
Hindgut to pubic

53
Q

What does the foregut develop to?

A 
Oesophagus 
Stomach
Pancreas
Liver 
Gallbladder
Duodenum (proximal to common bile duct)
54
Q

What does the midgut develop to?

A 
Duodenum (distal to common bile duct)
Jejunum
Ileum 
Cecum 
Ascending colon 
Proximal 2/3rds transverse colon
55
Q

What does the hindgut develop into?

A 
Distal 1/3rd transverse colon 
Descending colon
Sigmoid colon
Rectum
Upper anal canal 
Internal lining of bladder and urethra
56
Q

Where is pain from retroperitoneal organs referred to?

A

The back

57
Q

Where does irritation of bladder present?

A

As shoulder tip pain

58
Q

Describe how appendicitis pain is referred

A

Initially pain from the appendix and visceral peritoneum is referred to the umbilical region as appendix is a midgut structure.
As inflammed appendix irritates the parietal peritoneum, pain becomes localised to the right lower quadrant

59
Q

What is a volvus?

A

When the intestine becomes twisted around an adhesion, causing bowel obstruction

60
Q

What is a peritoneal adhesion?

A

Inflammation of peritoneum leads to fibrous scar tissue forming, which cause abnormal attachments between visceral and parietal peritoneum

61
Q

How does the embryo fold in the 4th week?

A

Laterally: Creates ventral body wall and primitive gut becomes tubular
Craniocaudally: Creates cranial and caudal pockets from yolk sac endoderm, beginning primitive gut development

62
Q

Describe the primitive gut tube

A

Endoderm lined tube (future epithelial lining) Runs between stomatodeum (mouth) and proctodeum (anus)
Opening at umbilicus
Covered in splanchnic mesoderm (future muscules and visceral peritoneum)
Suspended in intraembryonic colem by a double layer of splanchnic mesoderm

63
Q

Describe how the stomach develops

A

Mid week 4, dilation of distal foregut indicates final position of stomach
Faster growth of dorsal border creates greater curvature
Stomach rotates, changing position of dorsal and ventral mesenteries, forming omental bursa and displacing lesser sac posteriorly from the right

64
Q

Describe the arterial supply to each segment of the gut tube

A

Foregut - celiac trunk
Midgut - superior mesenteric (upper) and abdominal aorta (lower)
Hindgut - inferior mesenteric artery

65
Q

What are the exceptions to the normal arterial supply of the gut?

A

Viscera close to the junction between foregut and midgut, have mixed supply
Duodenum: Proximal to bile duct = Gastroduodenal and superior pancreaticoduodenal - branches of celiac trunk
Distal to bile duct = inferior pancreaticoduodenal - superior mesenteric
Pancreas: Head supplied by superior pancreaticoduodenal (CT) and inferior pancreaticoduodenal (SMA)

66
Q

What is the intraembryonic coelom?

A

Cavity formed as embryo folds in week 4, that later will be divided into thoracic and abdominal by diaphragm

67
Q

What is the function of the mesenteries?

A

Allow a conduit for blood/nerves

Allow mobility so gut can move food

68
Q

How is the embryonic gut suspended?

A

All segments suspended by dorsal mesentery from dorsal body wall
Foregut also suspended anteriorly by ventral mesentery

69
Q

Where do the greater and lesser sacs develop from?

A

The foregut, split into right and left sacs by the dorsal and ventral mesenteries. Left becomes greater sac, right becomes lesser.

70
Q

Describe how the stomach develops

A

Week 4 - foregut proliferates
Week 5 - dorsal wall grows rapidly to form the greater curvature, bends tube ventrally (90 degrees)
Week 7- dorsal mesentery grows, rotating 90 degrees laterally, pushes greater curvature left, lesser right.

71
Q

Define a peritoneal reflection

A

A change in direction, lined by a single membrane

72
Q

What seperates the developing GI and respiratory tracts?

A

Tracheoesophageal septum

73
Q

Describe the development of the respiratory tract

A

Week 4, respiratory diverticulum forms in ventral wall of foregut, forming the respiratory primordium (ventrally) and oesophagus (dorsally)

74
Q

What are the abnormalities in the tracheosophageal septum?

A

Proximal blind end- oesophagus

Tracheoesophageal fistula

75
Q

What are the consequences of abnormal tracheoesophageal septum?

A

Food passing into lungs causing cyanosis and pneumonitis (lung inflammation)
Air passing into stomach

76
Q

What glands are foregut derived?

A

Liver and billary system - from ventral mesentery
Pancreas - unicate process and inferior head from ventral
Superior head, body and tail from dorsal

77
Q

What are the peritoneal reflections of the liver?

A

Visceral peritoneum covers the visceral surface and anterior diaphragmatic surface.
Posterior diaphragmatic surface has no peritoneal covering, in direct contact with diaphragm.

78
Q

What are subphrenic recesses and where are they found?

A

Superior extensions of the peritoneal cavity between anterior and superior liver and diaphragm. Split into left and right recesses by falciform ligament, connecting liver to anterior abdominal wall

79
Q

How does the development of the stomach cause the duodenum to become secondarily retroperitoneal?

A

Rotation of stomach

GI (12 decks)

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