Abdomen Flashcards
Origin and termination of abdominal aorta?
T12-L4
Posterior relations of abdominal aorta?
L1-L4 Vertebral bodies
Anterior relations of abdominal aorta?
Lesser omentum
Liver
Left renal vein
Inferior mesenteric vein
Third part of duodenum
Pancreas
Parietal peritoneum
Peritoneal cavity
which structures accompany the aorta as it traverses aortic hiatus?
thoracic duct
azygous vein
Posterior relations of caecum?
Psoas
Iliacus
Femoral nerve
Genitofemoral nerve
Gonadal vessels
Anterior relations of the caecum?
greater omentum
Arterial supply of the caecum?
ileocolic artery
Which are the main structures at risk in a right hemicolectomy?
gonadal vessels and ureter are important posterior relations that are at risk during a right hemicolectomy.
Floor of the inguinal canal?
External oblique aponeurosis
Inguinal ligament
Lacunar ligament
Roof of the inguinal canal?
Internal oblique
Transversus abdominis
Anterior wall of the inguinal canal?
External oblique aponeurosis
Posterior wall of the inguinal canal?
Transversalis fascia
Conjoint tendon
Lateral to the inguinal canal?
Internal ring
Transversalis fascia
Fibres of internal oblique
Medial to the inguinal canal?
External ring
Conjoint tendon
Contents of the inguinal canal in males?
Spermatic cord and ilioinguinal nerve
genital branch of genitofemoral nerve
Contents of the inguinal canal in females?
Round ligament of uterus and ilioinguinal nerve
genital branch of genitofemoral nerve
Coverings of the spermatic cord?
As it passes through the canal the spermatic cord has 3 coverings:
External spermatic fascia from external oblique aponeurosis
Cremasteric fascia
Internal spermatic fascia
Where is the superficial ring located?
anterior to the pubic tubercle
Where is the deep ring located?
approximately 1.5-2cm above the half way point between the anterior superior iliac spine and the pubic tubercle
Borders of hesselbachs triangle?
medial boundary: rectus abdominis muscle;
lateral boundary: inferior epigastric vessels
inferior: inguinal ligament
Abdominal aortic branches?
Phrenic [inferior]
Celiac
Superior mesenteric
Suprarenal [middle]
Renal
Testicular
Lumbars
Inferior mesenteric
Sacral
What is the midgut?
Second part of duodenum to 2/3 transverse colon
What is the hindgut?
Distal 1/3 transverse colon to anus
Relations of the left kidney?
Anterior- left renal vein, the tail of the pancreas
Anterior relations of the right kidney?
Anterior- IVC, right renal vein, the head of the pancreas, and the descending part of the duodenum
Where do the renal arteries branch off the aorta?
upper border of L2- right side and L1 - left side
Posterior relations of both kidneys?
Quadratus lumborum, diaphragm, psoas major, transversus abdominis
Superior relations of right kidney?
Liver, adrenal gland
Superior relations of left kidney?
Spleen, adrenal gland
What does the renal sinus contain?
- Branches of the renal artery
- Tributaries of the renal vein
- Major and minor calyces’s
- Fat
What structures are divided for midline incision?
linea alba, transversalis fascia, extraperitoneal fat, peritoneum (avoid falciform ligament above the umbilicus)
what structures are divided for a paramedian incision?
anterior rectus sheath, rectus (retracted), posterior rectus sheath, transversalis fascia, extraperitoneal fat, peritoneum
What is the origin of the external oblique muscle?
Outer surfaces of the lowest eight ribs
Insertion of the external oblique?
Anterior two thirds of the outer lip of the iliac crest.
The remainder becomes the aponeurosis that fuses with the linea alba in the midline.
Nerve supply of the external oblique?
Ventral rami of the lower six thoracic nerves
Actions of external oblique?
Contains the abdominal viscera, may contract to raise intra abdominal pressure. Moves trunk to one side.
What structures are found at the transpyloric plane?
L1
Pylorus stomach
Left kidney hilum (L1- left one!)
Right hilum of the kidney (1.5cm lower than the left)
Fundus of the gallbladder
Neck of pancreas
Duodenojejunal flexure
Superior mesenteric artery
Portal vein
Left and right colic flexure
Root of the transverse mesocolon
2nd part of the duodenum
Upper part of conus medullaris
Spleen
anterior relations of gallbladder?
liver
posterior relations of gallbladder?
Covered by peritoneum
Transverse colon
1st part of the duodenum
lateral relations of gallbladder?
Right lobe of liver
medial relations of gallbladder?
Quadrate lobe of liver
arterial supply and venous drainage of gallbladder?
Cystic artery (branch of Right hepatic artery)
Directly to the liver
Nerve supply of gallbladder?
Sympathetic- mid thoracic spinal cord, Parasympathetic- anterior vagal trunk
Borders of the hepatobiliary triangle?
Medial: common hepatic duct
Inferior: cystic duct
Superior: inferior edge of liver
arterial supply of common bile duct?
Branches of hepatic artery and retroduodenal branches of gastroduodenal artery
Which veins can be found at the level of T8?
hepatic vein, inferior phrenic vein, ivc pierces diaphragm
Which veins can be found at the level of L1?
Right suprarenal vein, renal vein
Which vein can be found at the level of L2?
Gonadal vein
Which veins is at the level of L1-L5?
Lumbar veins
which veins are at L5?
Common iliac vein, formation of IVC
what is a common nerve injury with anterior resection of rectum?
hypogastric autonomic nerves.
What is a common nerve injury with inguinal hernia surgery?
ilioinguinal nerve.
Structures contained within the rectus sheath?
Pyramidalis
Superior epigastic artery
Inferior epigastric vein
Rectus Abdominis
What level is the transpyloric plane?
L1
What level is the subcostal plane?
L3
What level is the supracristal plane?
L4
What level is the inter tubercular plane?
L5
Where does the foregut begin and end?
where oesophagus pierces diaphragm -> after 2nd part duodenum (duodenal papilla)
Where does the midgut begin and end?
inferior to major duodenal papilla -> 2/3 through transverse colon
Where does the handgun begin and end?
2/3 through transverse colon –> midway through anal canal
Layers of abdominal wall superficial to deep?
SSS ExITT
1.Skin
2.Superficial fascia fatty layer (Campers)
3.Superficial fascia membraneous layer (Scarpas facia)
4. External oblique
5. Internal oblique
6. Transversus abdominis
7. Transverssalis fascia
Which muscles make up the posterior aspect of the abdominal wall?
The “erector spinae group”
-Iliocostalis
-Longissimus
-Spinalis muscles
PSOAS
Quadratus lumborum
Iliacus muscles
Internal oblique origin?
Thoracolumbar fascia
Iliac crest
Lateral 2/3s of the inguinal ligament
Internal oblique insertion?
Inferior border of the lower three of four ribs
Xiphoid process
Aponeurosis ends at linea alba
Also attached to pubic crest (just medial to the pubic tubercle)
External oblique origin?
The outer surfaces of the lower eight ribs (so from ribs 5 to 12
External oblique insertion?
Later lip of the iliac crest
Transversus abdominis origin?
Thoracolumbar fascia
Iliac crest
Lateral 1/3 of inguinal ligament
Costal cartilages of the lower six ribs (so ribs 7 to 12)
Transversus abdominis insertion?
Aponeurosis ends in linea alba
Pubic crest
What is the blood supply to the head of the pancreas?
pancreaticoduodenal artery
What is the blood supply to the tail of the artery?
branches of the splenic artery
Structures posterior to the pancreatic head?
Inferior vena cava
Common bile duct
Right and left renal veins
Superior mesenteric vein and artery
Structures posterior to the pancreatic neck?
Superior mesenteric vein, portal vein
Structures posterior to the pancreatic body?
Left renal vein
Crus of diaphragm
Psoas muscle
Adrenal gland
Kidney
Aorta
Structures posterior to the pancreatic tail?
Left kidney
Venous drainage of the pancreas?
Head: superior mesenteric vein
Body and tail: splenic vein
What are the main branches of the coeliac axis?
Left gastric
Hepatic
Splenic
What are the branches of the hepatic artery?
Right Gastric, Gastroduodenal,
Superior Pancreaticoduodenal,
Cystic (occasionally).
What are the branches of the splenic artery?
Pancreatic, Short Gastric, Left Gastroepiploic
secondary retroperitoneal organs?
2-4th parts of duodenum
Pancreas (tail is INTRAperitoneal)
Ascending colon
Descending colon
primary retroperitoneal organs?
Kidneys & ureters
Suprarenal glands
Aorta/Inferior vena cava
Nerves: lumbar plexus, sympathetic trunk
Oesophagus
Rectum
What are the two ligaments that help form the lesser omentum?
Hepatogastric
Hepatoduodenal
what is found at the inferior end of the lesser omentum?
portal triad
Common bile duct
Portal vein
Hepatic artery
What are the 4 parts of the stomach?
Fundus
Body
Pyloric antrum
Pyloric canal
What are the branches of the SMA?
jejunal arteries
Ileal arteries
Ileocolic artery
Right colic artery
Middle colic artery
Branches of the IMA?
Left colic artery
Superior rectal artery
Sigmoid arteries
Which veins are found at the site of oesophageal varices?
Oesophageal and left gastric veins
Which veins are found at the site of haemorrhoids?
Superior and inferior rectal veins
Which veins are at the site of caput medusa?
Paraumbilical and epigastric veins
venous drainage of the foregut?
Portal vein and splenic vein
venous drainage of the midgut?
Superior mesenteric vein
venous drainage of the hindgut?
Inferior mesenteric vein
Where is the cisterna chyli located?
cisterna chyli is an elongated lymphatic sac located in front of the L1 & L2 bodies
which lymph nodes do foregut, midgut and hindgut drain to?
Foregut: Coeliac nodes
Midgut: Superior mesenteric nodes
Hindgut: Inferior mesenteric nodes
Which sympathetic nerves innervate the abdomen?
Thoracic splanchnic nerves (T5-T12)
- Greater splanchnic nerves (T5-T9)
- Lesser splanchnic nerves (T10-T11)
- Least splanchnic nerves (T12)
Lumbar splanchnic nerves (L1-L2)
Which parasympathetic nerves innervate the abdomen?
Vagus nerve
Pelvic splanchnic nerves (S2-4)
Main source of blood supply for the omentum?
gastroepiploic artery
Retroperitoneal structures?
SAD PUCKER
Suprarenal glands (adrenals)
Aorta (and IVC)*
Duodenum (2nd and 3rd parts)
Pancreas (except tail)
Ureters
Colon (ascending and descending)
Kidneys
Oesophagus
Rectum
- = contact with the posterior abdominal wall
Primary retroperitoneal structures?
Kidneys and Ureters
Suprarenal glands
Aorta and IVC
Oesophagus
Rectum
Secondary retroperitoneal structures?
Duodenum (2nd and 3rd)
Pancreas (not tail)
Colon (ascending and descending)
Where does the thoracic aorta originate and terminate?
T4 to T12
Where does the right upper quadrant of the lymph in body drain to?
RUQ -> Subclavian vein
Where does rest of body lymphatics(other than RUQ) drain to?
thoracic duct then subclavian vein
what two vessels does the thoracic duct ascend between?
azygous vein and descending aorta
what does the cisterna chyli drain?
drains abdomen, pelvis, perineum and lower limbs
Which vessel travels over the uncinate process of the pancreas?
SMA/v
How can the pancreas be accessed surgically?
It may be accessed surgically by dividing the peritoneal reflection that connects the greater omentum to the transverse colon.
How is the ampulla of water formed?
merge of pancreatic duct and common bile duct
What is the ampulla of vater a landmark for?
- halfway along the second part of the duodenum
2.marks the anatomical transition from foregut to midgut - the site of transition between regions supplied by coeliac trunk and SMA).
which incision is traditionally used to approach incarcerated femoral hernias?
Mcevedy
in radical gastrectomy which structure will need to be divided to gain access to coeliac axis?
lesser omentum
Which structures are found anterior to the epiploic foramen?
Bile duct to the right, portal vein behind and hepatic artery to the left. (in free edge of lesser omentum)
which structures are found posterior to the epiploic foramen
inferior vena cava
inferior boundary of epiploic foramen?
1st part of the duodenum
anterior boundary of epiploic foramen?
caudate process of liver
what is a pringles manoeuvre?
Control liver bleeding in surgery by placing vascular clamp across the anterior aspect of the epiploic foramen. Thereby occluding:
Common bile duct
Hepatic artery
Portal vein
In children what is the best incision for laparotomy ?
transverse supra umbilical incision
Main anatomical relations of the ureter?
-25-35 cm long
-Muscular tube lined by transitional epithelium
-Surrounded by thick muscular coat. Becomes 3 muscular layers as it crosses the bony pelvis
-Retroperitoneal structure overlying transverse processes L2-L5
-Lies anterior to bifurcation of iliac vessels
-Blood supply is segmental; renal artery, aortic branches, gonadal branches, common iliac and internal iliac
-Lies beneath the uterine artery
-related to broad ligaments
What sort of tissue is the spleen derived from?
Mesenchymal tissue (derived from mesoderm)
The rest of the gut is derived endodermally
How does the spleen remain connected to the posterior abdominal wall/stomach?
by two folds of peritoneum; the lienorenal ligament and gastrosplenic ligament
Contents of the the spleen?
White pulp: Immune function. Contains central trabecular artery. The germinal centres are supplied by arterioles called penicilliary radicles.
Red pulp: Filters abnormal red blood cells.
Contents of the the spleen?
White pulp: Immune function. Contains central trabecular artery. The germinal centres are supplied by arterioles called penicilliary radicles.
Red pulp: Filters abnormal red blood cells.
Functions of the spleen?
- Filtration of abnormal blood cells and foreign bodies such as bacteria.
- Immunity: IgM. Production of properdin, and tuftsin which help target fungi and bacteria for phagocytosis.
- Haematopoiesis: up to 5th month gestation or in haematological disorders.
- Pooling: storage of 40% platelets.
- Iron reutilisation
- Storage monocytes
Branches of the posterior division of the internal iliac?
Lateral sacral
superior gluteal
iliolumbar artery
Branches of the
