Abdomen 1 Flashcards

1
Q

Bone Boundaries of Abdomen

A
  • Lumbar vert
  • Pelvic Bones/Inlet
  • Inf Thoracic Wall (costal margin, Rib XI-XII, xiphoid process)
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2
Q

Arcuate Ligs

A
  • Median Arcuate Lig - midline, crosses aorta, joins R/L crus to make opening, at L3
  • Medial Arcuate Lig - at L1, goes over psoas major
  • Lateral Arcuate lig - at L1 -> rib XII, over quadratus lumborum
  • all 3 form tight seal btwn abdomen = thorax
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3
Q

Pelvic Inlet Margins

A

Posteriorly: sacrum
Anteriorly: pubic symphysis
bilaterally: bony rim on pelvic bone

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4
Q

4 quadrant Pattern

A
  • draw line thru umbilicus + midline
  • McBruney’s point = 2/3 away from umbilicus to ASIS (sign of appendicitis)
  • upper R = liver, gall bladder, diaphragm, right costal margin
  • lower R = cecum + appendix, R ASIS/Inguinal lig/pubic tubercle
  • lower L = descending + sigmoid colon, L ASIS/Inguinal lig/pubic tubercle
  • upper L = spleen + stomach
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5
Q

Iliac Crest

A
  • inf bony boundary

- separates post ab wall from glutes

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6
Q

Inguinal Lig

A
  • btwn ASIS + tubercle

- separates ant ab wall from thigh

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7
Q

Muscular Wall

A
  • Psoas major + iliacus -> thigh, hip join flexors
  • Rectus abdominis -> inf thoracic wall to pelvis, 6 pack muscles
  • continuity in ab wall from thick fascia + aponeuroses
  • fascial wall separates ab wall from peritoneum
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8
Q

Foregut

A
  • omental bursa/lesser sac = ventral mesentery mem, connects liver to stomach
  • greater omentum/greater sac
  • omental foramen/epipoic foramen - connects greater to lesser sac
  • development of these + connection important to prevent infection spread
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9
Q

Midgut

A
  • 270 degree CCW rotation, develops quickly, runs out of space = herniates, pushes out where umbilicus will be
  • superior mesenteric artery = midline, separates small intestine from large intestine
  • after herniating, draws intestines back to abdomen
  • midgut pt -> cecum = iliocecal junction -> inf R cavity (upper R -> lower R quadrant)
  • large intestine flipped over small intestine
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10
Q

Hindgut

A

majority of colon + superior rectum

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11
Q

Appendix

A

retrocecal -> as it descends, gets tucked up behind cecum

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12
Q

Groin in anterior wall

A
  • Gubernaculum -> processus vaginalis (becomes scrotum or labia majora)
  • males: inguinal canal (spermatic cord cnxn of testes to ab) + spermatic cord (has structures from ab -> testes)
  • females: gubernaculum becomes round lig of uterus, ends in labia majora
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13
Q

Transpyloric Plane

A
  • horizontal plane, transect body at L1 (pancreas also at L1)
  • midway btwn jugular notch/pubic symphysis
  • crosses opening of stomach into duodenum = pyloric opening
  • shows position of kidney hila (L higher than R -> crosses thru inf L hilum, sup R hilum)
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14
Q

Hepatic Portal Sys

A
art -> cap bed 1 -> vein -> cap bed 2 -> vein
venous blood (GI, panc, gall, spleen) -> inf liver via portal vein -> cap bed liver -> short hepatic veins -> IVC
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15
Q

Portacaval Anastomoses Locations

A
  • inf end of esophagus, inf rectum, umbilicus

- liver contacts diap (bare liver), GI conacts post ab wall (retro GI), post panc

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16
Q

Innervation of ab viscera by pre-vert plexus

A
  • branches -> to target tissues w/vessels from aorta
  • has symp (T5-L2), parasymp (vagus + S2-S4), + sensory parts (parallel motor paths)
  • vagus (CN X) = foregut + midgut, S2-S4 = hindgut
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17
Q

Superficial fascia of ab wall

A
  • subcutaneous fatty CT
  • in lower region of ant ab wall, below umbilicus, forms 2 layers:
  • superficial fatty layer (camper’s fascia) + deep membranous layer (Scarpa’s fascia)
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18
Q

Camper’s Fascia

A
  • Cont. over inguinal lig w/thigh superficial fascia
  • Male - cont. over penis to scrotum = Dartos fascia
  • Female - superficial fat layer, part of labia majora
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19
Q

Scarpa’s Fascia

A
  • deep thin mem layer w/no fat
  • Inferiorly: Continues to thigh below inguinal lig, becomes fascia lata
  • Midline: attached to linea alba + pubic symphysis
  • Continues to ant perineum = Superficial perineal fascia
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20
Q

Fundiform ligament

A
  • Extensions of scarpa’s fascia attached to pubic symphysis pass inferiorly to sides of penis /clitoris to form fundiform lig
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21
Q

External Oblique Attachments/Innervation

A
  • Attachment = outer lower 8 ribs (ribs V-XII)
  • Lateral iliac crest -> aponeurosis ending in midline (linea alba)
  • Innervation = ant. rami of T7 to T12
22
Q

Assoc ligs of External Oblique

A
  • Inguinal lig – inf border of aponeurosis of external oblique
  • Lacunar lig – extension off inguinal ligament, medial side, attaches to pubic bone at pectin pubis
  • Pectineal lig - on top of pectineal line
23
Q

External Oblique Function

A

• Fn = compress ab contents, both muscles- flex trunk
○ Each site - bend trunk, turn ant part to opp side
• Fibers run lat sup to med inf (hands in pocket)

24
Q

Internal Oblique Attachments

A
  • Thoracolumbar fascia
  • Iliac crests
  • lateral 2/3 of inguinal lig
  • Inferior border of lower 3 or 4 ribs
  • Aponeurosis ending in linea alba
  • Inferiorly to pubic crest and pectineal line
25
Internal oblique Innervation/Function
* Innervation = ant rami of T7-L1 * Fn = compression of abdominal contents, both muscles - flex trunk, each site - bend trunk and turn ant part to same side
26
Transversus Abdominis Attachments
``` ○ Thoracolumbar fascia ○ Medial lip of iliac crest ○ Lateral 1/3 of inguinal ligament ○ Costal cartilage of lower 6 ribs (ribs VII to XII) ○ Aponeurosis ends in linea alba Pubic crest and pectineal line ```
27
Transversus Abdominis Innervation + Fn
Ant rami of T7-L1 | compresses ab contents
28
Rectus Abdominis
• Attachments ○ Pubic crest, Pubic tubercle, Pubic symphysis (all part of anterior pubic bone) ○ Costal cartilage or rib V to VII ○ Xiphoid process • Innervation = anterior rami of T6~ T7 to T12 • Fn = compress ab contents, flex VC, tense ab wall (stabilizes back)
29
Pyramidalis
- Attachments = front of pubis, pubic symphysis, linea alba - Innervation = ant ramus of T12 - Function = tenses linea alba -> pubic bone not moving
30
Rectus Sheath
- aponeurotic fusion of external/internal obliques and transversus abdominis muscle - upper 3 Qs - surrounds rectus abdominis - lower 1 Q - entirely in front of rectus abdominis - Arcuate Line (image above) = transition from half internal oblique aponeuroses (and others) going behind to going in front
31
Internal thoracic artery
- off subclavian after 6th intercostal space - splits to 2 branches: - Musculophreic a. (follows costal margin) - Superior epigastric a. (straight down, deep to rectus abdominis)
32
Aorta
- branches at T7-T12 follow nerves -> - Lower intercostal aa. - Subcostal a. (T12) - External + internal iliac artery
33
External Iliac Artery
- Inf epigastric a. (anastomoses w/sup epigastric a., also deep to rectus abdominis, near inguinallig) - Landmark for inguinal hernias - Deep circumflex iliac a. (supports iliacus and all attached to iliac crest)
34
Femoral Artery
- from external iliac, superficial, supplies muscles at iliac crest -> - Superficial circumflex iliac a. - Superficial epigastric a. - superficial up abdomen
35
Superficial Vein Drainage
- Above umbilicus → axillary v. - Below umbilicus → femoral v. - Paraumbilical vein (have portal cnxns -> caput medusa)
36
Superficial Lymph vessel drainage
- above umbilicus → anterior axillary nodes | - Below umbilicus → superficial inguinal nodes
37
Groin
* Layers go w/processus vaginalis, pulled down, become part of spermatic cord = cnxn from ab to scrotum * Don’t want ab contents going down to scrotum = potential for inguinal hernia
38
Deep Inguinal Ring
- lateral to epigastric vessels like inf. epigastric art - Transversalis fascia → internal spermatid fascia (male) + Inner layer (female) - Superficial to CT layer (extra peritoneal fat) + peritoneum
39
Superficial (External) Inguinal Ring
• Ext. oblique aponeurosis (spermatic cord thru it) ○ Lateral crus – lateral to superficial ring ○ Medial crus – medial to superficial ring • Forms ext. spermatic fascia of spermatic cord/round ligament
40
Boundaries of Inguinal Rings
- Ant wall = external oblique aponeurosis - lateral wall = internal oblique - Forms cremaster fascia + muscle/fascia of spermatic cord/round lig.   • Post wall = Transversalis fascia – full length, Conjoint tendon – medial 1/3 (brings it all together) • Roof = from arching fibers of transversus abdominis and internal oblique muscles • Floor = Inguinal ligament
41
M/F derived from External Oblique Aboneurosis
Male spermatic cord: External spermatic fascia | Female round ligament: outer layer
42
M/F derived from Internal Oblique Muscle
Male spermatic cord: Cremaster fascia and muscle | Female round ligament: diminishes from prox to dist
43
M/F derived from Transversalis fascia
Male spermatic cord: Internal spermatic fascia | Female round ligament: inner layer
44
M/F derived from superior vesical a.
Male spermatic cord: Artery of ductus deferens
45
M/F derived from aorta
Male spermatic cord: Testicular a. | Female round lig: Ovarian a.
46
M/F derived from R IVC + L renal vein
Male spermatic cord: Pampiniform plexus | Female round ligament: Ovarian vein
47
M/F derived from L1 + L2
Male spermatic cord: Genitofemoral n. | Female round ligament: Genitofemoral n.
48
M/F derived from genital branch in inguinal canal
Male spermatic cord: Cremasteric muscle innervation | Female round ligament: Supplies round lig
49
M/F derived from femoral branch
Male spermatic cord: Sensory medial thigh | Female round ligament: same
50
M/F derived from ilioinguinal nerve from L1
Male spermatic cord: Prosimomedial aspect of thigh + perineal region Female round ligament: same
51
Portcaval Anastomses Function
- block of hepatic portal vein = portal hypertension - anastomoses dilate = blood from tributaries bypass liver, enter caval sys, return to heart - portal hypertension = hemorrhoids, caput medusa, ascites + bloating