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Maksim > Abdomen > Flashcards

Abdomen Flashcards

1
Q

What are the laters of the abdomen lateral to rectus sheath?

A

Skin
Camper fascia (fatty layer)
Scarper Fascia (membranous layer)
Thin layer of deep fascia
External obliue muscle
Internal obliue muscle
Transversus abdominus
Fascia Transversalis
Extraperitoneal tissue
Parietal peritoneum

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2
Q

What are the abdominal wall layers anterior to the rectus sheath above arcuate line?

A

Skin
Campers fascia
Scarpas fascia
Thin later deep fascia
Anterior wall of rectus sheath
Rectus abdominus muscle
Posterior wall rectus sheath
Fascia transversalis
Extraperitoneal connective tissue
Parietal peritoneum

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3
Q

Abdominal wall layers in midline

A

Skin
Scarpers fascia
Campers fascia
Thin layer deep fascia
Linea alba
Transversalis fascia
Extraperitoneal connective tissue
Parietal peritoneum

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4
Q

Why is the membranous layer of superficial fascia important in the extravasation of urine?

A

Important as closed space that does not open into the thigh

Membranous rupture of the urethra may be followed by extravasation of urine into scrotum, perineum, penis and lower part of ant. abdominal wall deep to membranous layer of fascia

Urine excluded from thigh due to attachment of fascia to fascia lata

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5
Q

External oblique

A

origin: ribs 5-12
insertion: iliac crest and pubic tubercle
innervation: thoracoabdominal nerves

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6
Q

Internal oblique

A

origin: inguinal ligament, iliac crest, lumbodorsal fascia

insertion: ribs 10-12

innervation: thoracoabdominal nerve

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7
Q

Transversus abdominis

A

origin: inguinal ligament, costal cartilage, iliac crest and thoracolumbar fascia

insertion: conjoint tendon, xiphoid process, linea alba and pubic crest

innervation: thoracoabdominal muscles, subcostal

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8
Q

Rectus abdominis

A

origin: Crest of pubis

insertion: xiphoid process and sternum and costal cartilage 5-7

innervation: thoracoabdominal nerves

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9
Q

Pyramidalis

A

origin: pubic crest, pubic symphysis

insertion: linea alba

innervation: subcostal nerves

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10
Q

Rectus sheath

A

Formed by the aponeurosis of three flat muscles

Anterior wall - aponeurosis of external oblique and internal oblique

posterior wall - aponeurosis of internal oblique and transversus abdominis

ARCUATE LINE - midway from umbilicus to pubic symphysis where the posterior wall also lies anterior to the rectus sheath

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11
Q

What occurs at the arcuate line?

A

Inferior epigastric vessels pierce rectus abdominus and pass upward to anastamose with the superior epigastric vessels

\Post and ant rectus sheath passes anterior to rectus abdominus muscle below Arcuate line

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12
Q

Posterior abdominal wall

A

Quadratus lumborum

Psoas major

psoas minor

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13
Q

Quadratus lumborum

A

origin: iliac crest and iliolumbar ligament

insertion: transverse process of L1-L4

innervation: T12- L4

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14
Q

Psoas major

A

origin: T12-L5
insertion: Lesser trochanter
innervation: L1-L3

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15
Q

Psoas minor

A

origin: T12, L1

insertion: superior ramus of pubis

innervation: L1 action: flexion fo vertebral column

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16
Q

Fascia of the posterior wall

A

Psoas fascia - encloses psoas major & minor thoracolumbar fascia - divided into 3 layers, anterior, middle and posterior layer

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17
Q

Peritoneum

A

Continous layer divided into parietal and visceral peritoneum

Squamous epithelial cells from mesothelium

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18
Q

Parietal peritoneum

A

Somatic sensation thus well localised sensitive pain, laceration, temperature

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19
Q

Visceral peritoneum

A

Splanchnic mesoderm origin poorly localises, referred to pain in dermatomes

Sensitive to chemical and stretch

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20
Q

Retroperitoneal organ

A

SAD PUCKOR. Can be primary or secondary. Primary if developed and remain outside of parietal peritoneum.

Suprarenal glands

Aorta

Duodenum (except 1st part)

Pancreas (except the tail)

Ureters

Colon (ascending & descending)

Kidneys

Oesophagus

Rectum

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21
Q

Peritoneal reflections

A

Mesentery

Greater omentum

Lesser omentum

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22
Q

Mesentery

A

Double layer of the visceral peritoneum

Connects the organs to the posterior abdominal wall

Small bowel

Transverse colon

Sigmoid mesocolon

Mesoappendix

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23
Q

Greater omentum

A

Greater curvature of stomach and proximal part of duodenum to anterior surface of transverse colon

Act as immunological barrier

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24
Q

Lesser omentum

A

Lesser curvature of stomach & proximal part of duodenum to liver

Hepatogastric ligament & hepatoduodenal ligament

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25
Q

Greater sac

A

Divided by transverse mesocolon

Supracolic - stomach, liver and spleen

Infracolic - small intestine, colon

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26
Q

Lesser sac

A

posterior to stomach and lesser omentum

connected to greater sac via EPIPLOIC FORAMEN

situated posterior to the free edge of the hepatoduodenal ligament

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27
Q

Boundaries of epiploic foramen?

A

Greater and lesser sac are in communication with each other through epiploic foramen

Boundaries:

  • *Anteriorly**: Portal vein, hepatic artery & common bile duct
  • *Posteriorly**: IVC
  • *Superiorly**: Caudate lobe of liver
  • *Inferiorly**: first part duodenum
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28
Q

What is the Pringle manouvere?

A

Clamping of the hepatoduodenal ligament (ant boundary of the epiploic foramen)

This will include clamping:

  • hepatic artery proper
  • portal vein
  • common bile duct
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29
Q

Peritoneum in pelvis

A

Male - rectovesical pouch - CLOSED

female - vesicouterine pouch and rectouterine pouch (pouch of douglas)

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30
Q

Inguinal canal - borders

A

MALT: (2M, 2A, 2L, 2T)

Starting from superior, moving anticlockwise in order to posterior:

Superior wall (roof): 2 Muscles
internal oblique Muscle
transverse abdominus Muscle

Anterior wall: 2 Aponeuroses:
Aponeurosis of external oblique
Aponeurosis of internal oblique

Lower wall (floor): 2 Ligaments
inguinal Ligament·
lacunar Ligament

Posterior wall: 2 Ts
Transversalis fascia
conjoint Tendon

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31
Q

Inguinal canal content

A

Spermatic cord (men)

Round ligament (women)

Ilioinguinal nerve

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32
Q

Spermatic cord content

A

3 fascia - external spermatic (external oblique aponeurosis), cremaster muscle & fascia (internal oblique aponeurosis) and internal spermatic fascia (transversalis fascia)

3 arteries - testicular, cremaster, vas

2 nerves - autonomic, genital branch of genitofemoral nerve

4 others - pampiliform, lymphatics, vas deferens, tunica vaginalis

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33
Q

Formation of inguinal canal

A

GUBERNACULUM guides the descend of gonad (testis/ovaries) from posterior abdominal wall to scrotum

Inguinal canal is the pathway by which the testes leave the abdominal cavity and enter the scrotum

Processus vaginalis (part of peritoneum) degenerates but if not - leads to indirect hernia

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34
Q

GI Tract - oesophagus

A

approx 25cm in length

C6 to T11

pierces diaphragm at T10

attached to the phrenoesophageal ligament

consists of internal circular and external longitudinal muscles

Upper oesophageal sphincter - cricopharyngeus muscle, striated muscle
Lower oesophageal sphincter - PHYSIOLOGICAL (acute angle of entry, gets compressed with raised IAP, folds of mucosa and right crus of diaphragm

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35
Q

What is the arterial supply of the oesophagus?

A

Split into 1/3s

Upper 1/3: Inferior Thyroid artery

Middle 1/3: Direct branches from descending aorta

Lower 1/3: Branches from L gastric. Splenic artery dorsally

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36
Q

What is the venous drainage of the oesophagus?

A

Blood supply split into 1/3s

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37
Q

What is the lymphatic drainage of the oesophagus?

A
  • *Lymph drainage:**
  • *Proximal third:** deep cervical lymph nodes, and subsequently into the thoracic duct.
  • *Middle third:** superior and posterior mediastinal nodes.
  • *Distal third:** follow the left gastric artery to the gastric and celiac lymph nodes.
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38
Q

What cell type is found in the oesophagus?

A

Stratified squamous epithelium - prolonged exposure to acid causes metaplasia to stomach’s columnar epithelium.

AKA Barrett’s oesophagus - type of metaplasia

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39
Q

What are the points of narrowing of the oesophagus?

A

3 points:

Behind the cricoid cartilage of the larynx

Left bronchus & arch of aorta cross the front of the oesophagus

Right Crus of the diaphragam where oesophagus crosses

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40
Q

What is acalasia of the cardia?

A

Assoc with degeneration of the parasympathetic plexus (Auerbach’s plexus) in the wall of the oesophagus

Primary site of disorder may be innervation of the cardioesophageal sphincter by vagus nerves

Common symptoms:
Dysphagia & regurgiation
Later accompanied by proximal dilatation and distal narrowing of the oesophagus

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41
Q

What structures are found at the transpyloric plane?

A
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42
Q

GI tract - Stomach

A

Cardia - fundus - body - pylorus (ANATOMICAL SPHINCTER)

Greater curvature - reaches the pyloric antrums

Lesser curvature: has the angular notch which divives the body and pylorus

Drains to Left and & right gastric - hepatic portal vein

Gastro omental into SMV

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43
Q

Where does the left gastric originate from and what does it supply?

A

Arteries are derived from branches of the coeliac trunk

Left gastric (direct branch of coeliac artery) passes upwards and left to reach oesophagus and then descends on lesser curve of stomach - supplies upper right part stomach & lower 1/3 oesophagus

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44
Q

Where does the right gastric originate from and where does it supply?

A

Right Gastric: (CHA at upper border of pylorus) and runs to the left along the lesser curvature. Supplies lower right part stomach

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45
Q

Where do the short gastric arteries originate from and where do they supply?

A

Short Gastric arteries (arise from the splenic artery at the hilum of spleen) and pass forward to supply stomach along upper part of greater curvature

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46
Q

Where does the left gastroepiploic artery arise from and what does it supply?

A

Left gastroepiploic: Arises from splenic artery at the hilum of the spleen and pass forward in the gastrosplenic omentum to supply stomach along the upper part of greater curvature

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47
Q

Where does the right gastroepiploic artery arise from and what does it supply?

A

Right gastroepiploic: (gastroduodenal branch of hepatic artery) supplies stomach along the lower part of greater curvature

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48
Q

What is the venous drainage of the stomach?

A

Drains into portal circulation

Left & Right gastric veins drain directly into portal vein

Short gastric & gastroepiploic veins join the splenic vein

Right gastroepiploic vein joins the SMV

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49
Q

GI tract - Small interstine

A

Duodenum

Jejunum

Ileum

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50
Q

Duodenum

A

4 parts

1st - intraperitoneal, attached to liver by hepatoduodenal ligament, common area for ulcers

2nd - retroperitoneal, major duodenal papilla (posteromedial wall)

3rd - crosses over IVC and aorta, posterior to SMA

4th - duodenojejunal flexure, suspensory muscle of the duodenum supplied by gastroduodenal artery and inferior pancreaticoduodenal artery (SMA)

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51
Q

What is the arterial supply of the duodenum
& venous drainage?

A

Upper 1/2 supplied by superior pancreatoduodenal artery a branch of the gastroduodenal artery

Venous drainage - Sup. pancreatoduodenal vein drains into portal vein

Lower 1/2 supplied by inferior pancreatoduodenal artery which is a branch of Superior mesenteric artery

Venous drainage - Inf. pancreatoduodenal vein drains into IVC

52
Q

What is the lymphatic drainage of duodenum?

A

Lymph vessels follow the arteries and drain upward via pancreaticoduodenal nodes to the gastroduodenal nodes and then to coeliac nodes

53
Q

Jejunum and Ileum

A

attached the posterior wall by mesentery starts at the duodenojejunal flexure and ends at ileocaecal junction

Jejunum - thicker wall, longer vasa recta, less arcadesm red

ileum - thinner wall, shorter vasa recta, more arcades and pink

54
Q

What is the lymphatic drainage of the Jejunum and Ileum?

A

Superior mesenteric nodes

55
Q

Caecum

A

Surrounded by peritoneum

Muscle - is 3 longitudinal flat bands called teniae coli which converge at the base of the appendix

Ileocecal sphincter controls flow of contents from ileum into colon.

Gastrin leads to relaxation of the ileocecal sphincter

56
Q

Appendix

A

Vermiform shaped blind end tube located posteromedial to caecum, at the end of tinea coli (longitudinal muscle). Form the base of the appendix

Found at McBurneys point. 2/3 between umbilicus and ASIS

Pre ileal - 1 (anterior)
Post ileal - 2 (posterior)
sub ileal - 3 (alond)
pelvic - 4
subcaecal - 5 (below caecum)
para caecal - 6 (lateral to caecum)
retro caecal - 7 (posteiror to caecum)

57
Q

What is the blood supply of the appendix?

A

Appendicular artery which is a branch of posterior cecal artery

58
Q

Colon

A

It has omentum appendices, teniae coli, haustra

Ascending - retroperitoneal up to hepatic flexure

Transverse - mesocolon up to splenic flexure

Descending - retroperineal up to sigmoid flexure

Sigmoid - intraperitoneal up to rectosigmoid junction

Supplied by SMA (right colic, middle colic) and IMA (left colic, sigmoid)

Lymphatic drainage follows blood supply eg Caecum, ascending colon and 1/3 of transverse colon drain to SM nodes.

Watershed area - marginal artery of Drummond

59
Q

Rectum

A

Stores faeces, 15cm long begins at S3 superior third covered by peritoneum from 3 sides and middle third covered on anterior side

sympathetic - lumbar splanchnic - inferior hypogastric plexus parasympathetic - S2-S4

60
Q

What is the blood supply of the rectum?

A

Supplied by Superior rectal (IMA), middle rectal (IIA) anastamoses with sup rectal and inf recta;, inferior rectal (pudendal)

Drains into superior/middle/inferior rectal veins where superior one drains into IMV thus postal system

61
Q

Sup and Inf

What is the lymphatic drainage of the rectum?

A

Superior rectum drain into the pararectal nodes (which further drain into IM nodes)

Lower rectum drains into internal iliac nodes following the middle rectal artery

62
Q

Anal canal

A

located at the anal triangle, right and left ischioanal fossainternal sphincter - involuntary external sphincter - voluntary puborectalis muscles

63
Q

What are the features of the anal canal above pectinate line?

A

ABOVE pectinate line:

Endoderm origin (hindgut origin)
Columnar epithelium
organised into anal column and anal valve
supplied by SRA (branch from IMA)

64
Q

What are the features of anal canl below pectinate line?

A

BELOW pectinate line

ectoderm origin
non keratinised stratified squamous epithelium until intersphincteric groove -

supplied by IRA (branch from the pudenal artery)

65
Q

What is the lymphatic drainage of the lower half of the anal canal?

A

Drains into medial group of superficial inguinal nodes

66
Q

What is the nerve supply of the anal sphincters?

A

Involuntary internal sphincter: sympathetic fibres from the hypogastric plexus

Voluntary external sphincter: Inferior rectal nerve (branch of pudenal nerve)

67
Q

What is the rectal veins contribution to the porto-venous anastamosis

A

Superior rectal vein drains into IMV which drains into splenic vein into portal vein

Inferior rectal vein drains into systemic system

68
Q

Liver - surface

A

Intraperitoneal organ

4 ligaments - falciform ligament (ligamentunm teres - umbilical vein), coronary ligaments, triangular ligaments, lesser omentunm (hepatoduodenal/hepatogastric)

3 recesses - subphrenic, subhepatic and morison’s pouch

2 supply - hepatic portal and systemic

69
Q

Liver lobal anatomy

A

2 lobes divided by falciform ligament: Large right lobe and small left lobe

  • *Right lobe is further divided into 2 lobes:**
  • *Caudate** - separated by IVC and ligamentum venosum (remnant of ductus venosus)

Quadrate - separated by ligamentum teres (umbilical vein) and lies with the gall bladder anatomically part of right but functionally part of left lobe

Can also be divided in 8 hepatic segments

70
Q

What is the anatomy of portal canals?

A

Lie in between the lobules of the liver

Contains branches of hepatic artery, portal vein and a tributory of a bile duct

71
Q

Gall bladder

A

Located at L1

Stores bile, connected through the cystic duct and joins the CBD

Fundus - body - neck - Hartmann’s pouch - cystic duct

Body lies in contact with visceral surface of the liver

Supplied by cystic artery (branch of hepatic artery)

Vagus nerve stimulates as well but main stimulant is Cholecystokinin

72
Q

Biliary tree

A

Right and left hepatic duct

Common hepatic duct (+ cystic duct )

Common biliary duct (+ pancreatic duct)

Ampulla of Vater

73
Q

What is the ampulla of Vater?

A

Combination of the Bile duct and pancreatic duct

74
Q

What is the function of the gallbladder?

A

When digestion not taking place sphincter of oddi remains closed and bile accumulates in gallbladder

Entrance of fat into duodenum causes release of cholecystokinin from mucous membrane - this causes gallbladder to contract

Sphincter of oddi is then relaxed

75
Q

Pancreas

A

Retroperitoneal

Exocrine and endocrine organ

Endocrine: insulin & glucagon
Exocrine: Secretions which hydrolyse protein, fats and carbohydrates

Lies posterior to SMA/SMV

Tail is closely related to spleen via splenic artery and splenorenal ligament

76
Q

Where does the pancreatic duct drain?

A

Pancreatic secretions begin in the tail and run the length of the gland - opens into second part of the duodenum at the middle with the bile duct on the major duodenal papillae

Accessory duct when present drains the upper part of the head - opens into minor duodenal papillae (sup to maj. papillae)

77
Q

What is the blood supply of the pancreas?

A

Blood supply is pancreatic branch of splenic artery.

Blood supply to head is from Sup. pancreatoduodenal (coeliac trunk) and Inf. pancreatoduodenal (SMA)

Venous drainage is via SMA branches into hepatic portal vein

78
Q

Spleen

A

Immunological & haematological organ

Intraperitoneal Ligaments - splenorenal ligament, gastrosplenic ligament

7 ounces (200g), ribs 9-11

Splenic artery has segmental supply thus subtotal resection is possible - branch of coeliac trunk

79
Q

Adrenal glands

A

Retroperitoneal organ, endocrine organ

Cortex:
zona glomerulosa (mineralocorticoid),
zona fasciculata (glucocorticoid),
zona reticularis (sex hormones)

Medulla - chromaffin cells - adrenaline

80
Q

Blood supply of adrenal glands

A

Supply - 3 arteries:
Superior adrenal - inferior phrenic artery
Middle adrenal - aorta
Inferior adrenal - renal artery

81
Q

What is the venous drainage of the adrenal glands?

A

Right side: IVC

Left side: Renal vein

82
Q

Kidneys

A

Retroperitoneal organ - T12-L3

Clear toxin from circulation & maintain circulatory homeostasis (volume & electrolyte)

Right kidney lies slightly lower than left kidney because large size right lobe of liver.

Medulla - renal pyramids - calyx - pelvis - ureter

Supply - renal artery - interlobar - arcuate

Drains into renal veins (left side drains adrenal & gonadal as well)

83
Q

What is the structure of the coverings of the kidney and the kidney?

A

Coverings:
Fibrous capsule

Perirenal fat

Renal fascia

Pararenal fat

Renal structure:
Cortex

Medulla

84
Q

What level do the kidneys lie at?

A

Left kidney: T12 - L3

Right kidney: slightly lower

85
Q

Blood supply of the kidneys?

A

Renal artery arises from the aorta at the level of L2

Renal vein anterior to artery at the hilum.

86
Q

What is the blood supply of the ureter?

A

Blood supply is split into three sections:

Upper end: Renal artery

Middle portion: Testicular / ovarian artery

Pelvis: Superior vesical artery

87
Q

What is the course of the ureter and points of constriction?

A

Leaves the hilum posterior to vessels

Runs down on psoas muscle - adjacent to transverse tips of lumbar vertebrae

  • *3 constrictions along course:**
  • *Renal pelvis**

Crosses pelvic brim (crosses over CIA)

Pierces the bladder wall

88
Q

What is the lymph drainage of the ureter?

A

Lateral aortic nodes and the iliac nodes

89
Q

Aorta - Abdominal branches

A

In Case My Students Really Love Games I‘m Monopoly

Inferior phrenic

Coeliac(T12)

Middle adrenal

SMA(L1)

Renal

Lumbar

Gonadal (L2),

IMA(L3),

Median sacral (L4),

90
Q

Coeliac trunk

A

T12

Left gastric (oesophageal branches)

Splenic (L gastroepiploic (greater curve stomach), short gastric arteries

Common hepatic artery : gives rise to R gastric, R + L hepatic, cystic and sup. gastroduodenal (head of panc.)

91
Q

Superior mesenteric artery

A

L1

Major branches:
Inferior pancreaticoduodenal artery

Jejunal & ileal arteries (forms the anastamotic arcades)

Right & middle colic

Ileocolic (gives rise to branches supply illeum, caecum, colon and appendix) - can ligate appendicular artery in appendix

92
Q

Inferior mesenteric artery

A

L3, supplies the hindgut, retroperitoneal main branches:

Left colic (from distal 1/3 of transverse colon)

Sigmoid

Superior rectal

Anastomosis with middle colic - Marginal artery of Drummond

93
Q

Inferior vena cava

A

Formed by CIV at L5

Drains - Lumbar veins, right gonadal, right adrenal, right and left renal, inferior phrenic and hepatic veins

94
Q

Portal venous system

A

Drains the GIT content and supplied to liver

At L1 Formed by SMV & Splenic

Drains R&L gastric, cystic, para-umbilical veins

Splenic - short gastric, left gastroomental, pancreatic, IMV

SMV - right gastroomental, anterior and posterior inferior pancreaticoduodenal, jejunal, ileal, ileocolic, right & middle colic

95
Q

Portosystemic anastomosis

A

Oesophageal - left gastric and azygous

Rectal - superior rectal and inferior rectal

Retroperitoneal - mesenteric to reperitoneal

Paraumbilical - portal vein to anterior abdominal wall

96
Q

What is the nerve root blood supply at the

Xiphoid process

Umbilicus

Pubis

A

Xiphoid process: T7

Umbilicus: T10

Pubis: L1

97
Q

Where does the superior epigastric artery run and what does it supply?

A

Superior epigastric artery:
terminal branch of int. thoracic artery
Enters upper part of rectus sheath between sternal and costal edges of the diaphragm

98
Q

Where does the inferior epigastric artery run, what is its origin and what does it supply?

A

Inferior epigastric artery:
Branch of external iliac artery just above inguinal ligament
Runs upward and medial along medial side of deep inguinal ring
Pierces fascia transversalis to enter rectus sheath ant to arcuate line

Supplies:
Lower central part of abdominal wall

99
Q

Where does the deep circumflex iliac artery supply, what is it a branch of and where does it run

A

Deep circumflex iliac artery:
Branch of ext. iliac above inguinal ligament
Runs upward and laterally to ASIS
Supplies lower lat. part of abdo wall

100
Q

What is the lymphatic drainage of the superficial abdominal wall

101
Q

What is the lymphatic drainage of the testes?

A

Testicular lymph vessels ascend through the inguinal canal and pass posterior abdominal wall to reach para-aortic lymph nodes

102
Q

Common facts indirect inguinal hernia?

A

Remains of patent processus vaginalis therefore congenital in origin

More common than direct inguinal hernia

M>F
R>L

103
Q

Common facts direct inguinal hernia

A

Rarer than indirect hernias

Common in old men with weak abdominal muscles

Hernial sac bulges through posterior wall of inguinal canal medial to inferior epigastric vessels

Neck of hernial sac is wide

Lies above and medial to pubic tubercle

104
Q

What is a spigelian hernia?

A

Hernia of linea semilunaris

Occurs through aponeurosis of the transversus abdominus just lateral to lateral edge of rectus sheath

Occurs just below level of umbilicus

105
Q

What is a Lumbar hernia and where does it occur?

A

Rare

Occurs through weakness in Lumbar triangle in posterior part of abdominal wall

106
Q

What is a paramedian incision?
Advantages and disadvantages

107
Q

What is a pararectus incision?

Advantages & Disadvantages

A

Anterior wall of rectus sheath incised lateral margin of rectus muscle

Rectus retracted medially - exposing segmental nerves entering its posterior surface

Posterior wall of the sheath is then incised

Disadvantage:
Opening is small
Any longitudinal extension will cause post operative rectus muscle weakness

108
Q

What is a midline incision?

Advantages and disadvantages?

A

Made through Linea Alba

Rapid method of gaining access to the abdomen.

Does not damage blood vessels or nerve supply

Can be extended into T shape incision

109
Q

Pfannestial incision

A

Obstetric access

Rectus muscle should be retracted

If sufficient access not gained from retraction

If the muscle is to be transected, the inferior epigastric artery and vein on the lateral border of the muscle must be clamped, incised, and ligated prior to cutting the muscle.

110
Q

What is McBurney’s incision?

A

Obliue skin incision 5cm above and medial to ASIS

External & internal obliue and transversalis muscles are incised or split in the line of their fibres

Disadvantages
poor vision - should only typically be used when there is no doubt as to diagnosis

111
Q

How does the greater omentum help with localising infections?

A

Inflammatory exudate causes the omentum to adhere to the appendix and wrap itself around the organ

112
Q

How does peritoneal fluid move around the abdomen particuarly in infection?

A

Peritoneal cavity is divided into upper part within the abdomen and lower part in the pelvis

Abdominal part is further subdivided by spaces and reccess

Attachment of transverse mesocolon and mesentery of the small intestine hinders the movement of infected peritoneal fluid from upper part to lower part of peritoneal cavity

Infection can spread from the peritoneum to the lung pleura via the diaphramatic lymph vessels.

113
Q

What drains to the preaortic lymph nodes?

A

Preaortic lymph nodes:
Celiac
Superior Mesenteric
Infeior Mesenteric

Drains lymph from GI tract
From lower 1/3 oesophagus to halfway down anal canal
From spleen, pancreas, gallbladder and greater part of liver

114
Q

What drains to the para-aortic lymph nodes

A

Lymph from kidneys and supraadrenals

From testes in males and from the ovaries, uterine tubes and fundus of uterus in females.

115
Q

What is in the lumbar plexus & what nerves originate there?

A

Formed in the psoas muscle from the anterior rami of upper 4 lumbar nerves

I (twice) get laid on friday
All lateral other than genitofemoral (ant) and obturator (medial)

Iliohypogastric

Ilioinguinal

Genitofemoral nerve (anterior)

Lateral cutaneous nerve of thigh

Obturator nerve (medial)

Femoral nerve

116
Q

What are the nerve root values of the lumbar plexus?

A

I (twice) Get Laid On Fridays - nerves

2 from 1, 2 from 2, 2 from 3

Iliohypogastric (L1)
Ilioinguinal (L1)
Genitofemoral (L1, L2)
Lateral cutaneous nerve of thigh (L2, L3)
Obturator (L2, 3, 4)
Femoral (L2 , 3, 4)

117
Q

What is the sacral plexus formed from?

A

L4, 5 S1, 2, 3, 4

On anterior surface of piriformis muscle

  • *superior gluteal nerve** L4/5 S1
  • *Inferior gluteal** L5 S1/2
  • *Posterior femoral cutaneous** S1/2/3
  • *Pudendal** S2/3/4
  • *Sciatic** L4, 5, S1, S2, S3
118
Q

What is the route of the superior gluteal nerve?

A

L4, 5, S1

Passes superior to the piriformis via the greater sciatic foramen

Accompanied bu sup. gluteal vein and artery

119
Q

What is the course of the inferior gluteal nerve?

A

L5, S1, S2

Leaves pelvis via greater sciatic foramen inferior to piriformis muscle

Motor function - gluteus maximus

120
Q

What is the route of sciatic nerve

A

L4 - S3

2 components:

  • *Fibular** (dorsal division L4 - S2)
  • *Tibial** (ventral divisions L4 - S3)

Formed on anterior aspect of piriformis muscle

121
Q

What muscles are innervated by the tibial componenet of the sciatic nerve?

A

Muscles in:
Posterior compartment of thigh (other than SH of Biceps femoris - innervated by fibular portion of sciatic nerve)
Hamstring component of adductor magnus
Posterior compartment of leg
Muscles in sole of foot

122
Q

What muscles are innervated by fibular portion of sciatic nerve?

A

Short head of biceps femoris
Anterior and lateral compartments of the leg & extensor digitorum brevis muscle

123
Q

What is the origin / route of the posterior cutaneous nerve of the thigh?

A

S1, 2, 3

Leaves pelvis via greater sciatic foramen. Enters inferiorly to piriformis muscle

Runs down back thigh to knee

Innervates skin of perineum, posterior surface thigh and leg.

124
Q

Origin of the pudenal nerve & root?

A

S2, 3, 4

Leaves via greater sciatic foramen and then loops around sacrospinus ligament to enter pelvis via lesser sciatic foramen

Motor: Innervates EUS, EAS, levator ani muscle

Sensory: Innervates penis, clitorus and nerves of skin

125
Q

What is Hesselbachs triangle?

A

The inguinal triangle is located within the inferomedial aspect of the abdominal wall. It has the following boundaries:

  • *Medial** – lateral border of the rectus abdominis muscle.
  • *Lateral** – inferior epigastric vessels.
  • *Inferior** – inguinal ligament.
126
Q

What are the borders of Calots triangle?

A

Inferiorly: Cystic duct

Medially: Common Hepatic duct

Superiorly: Inferior surface of the Liver

Cystic artery runs through Calots triangle

Maksim (4 decks)

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