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Abdomen Flashcards

1
Q

surface landmarks of abdominal wall

A

-xiphoid stress
-xiphosternal joint
-costal margin- 7-10 (L3, rib 10, xiphoid process)- upper margin
-inguinal ligament and pelvic bones- lower margin
-iliac crest- across L4
-symphysis pubis
-inguinal canal
-linea alba- from pubic symphysis to xiphoid process- vertical fibrous band
-linea semilunaris- lateral borders of rectus abdominus (outer abs)
-tendinous intersections- defines 6 pac

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2
Q

iliac crest

A

-anterior superior iliac spine (ASIS)- iliac crest ends here anteriorly
-posterior superior iliac spine (PSIS)- ends here posteriorly
–> waist circumference

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3
Q

inguinal ligament

A

-rolled-under inferior margin of the aponeurosis of the external oblique muscle
-attached to the ASIS and pubic tubercle

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4
Q

superficial inguinal ring

A

-triangular aperture in the aponeurosis of the external oblique muscle
-situated above the medial to the pubic tubercle
-Inguinal hernia
-direct- directly through abdominal wall traverse superficial ring
-indirect- traverse deep and superficial inguinal rings
-if it is medial or lateral to inferior epigastric -> tell you if it is direct or indirect

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5
Q

vertical lines

A

-passes through the midpoint between the ASIS and symphysis pubis

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6
Q

transpyloric plane

A

-passes through the tips of the 9th costal cartilage @ L1
-pylorus of stomach, duodenum junction, neck of pancreas, and hilum of kidneys run through here

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7
Q

subcostal plane

A

-joins the 10th costal cartilage at level of L3

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8
Q

intertubercular plane

A

-joints the tubercles on the iliac crest at L5

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9
Q

contents of abdomen

A

-liver- under cover of lower ribs, most of it lies in RUQ (in thin adult, 2 fingerbreadth below costal margin)
-gallbladder- fundus lies opposite the tip of right 9th costal cartilage
-spleen- LUQ and lies under cover of 9-11 ribs (well protected)
-pancreas- lies across transpyloric plane (deep)
-kidneys- right is slightly lower than left (right palpable in right lumbar region at the end of deep inspiration
-duodenum- transpyloric plane about 4 fingerbreadths to right of midline (mostly retroperitoneal)
-cecum- RLQ
-appendix- RLQ, base is situated 1/3 up line, joining ASIS to umbilicus (McBurney’s point)
-ascending colon- extends upwards from cecum on lateral side of right vertical line (retroperitoneal)
-transverse colon- extends across abdomen, occupying umbilical region
-descending colon- extends downward from left costal margin on lateral side of left vertical line
-sigmoid colon- approx 10-15 inches and continuous with rectum in from of S3
-rectum- 5 inches and begins anterior to S3, pierces pelvic floor and becomes continuous with anal canal

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10
Q

stomach

A
  • cardioesophageal junction lies about 3 fingerbreadths below to left of xiphisternal junction, lesser curvature lies on curved lines joining the cardioesophageal junction and pylorus, greater curvature has extremely variable position in umbilical region or below
    -esophagus pierces the stomach at T10
    -pylorus lies in transpyloric plane
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11
Q

abdominal wall layers

A

-skin
-superficial fascia- campers -> yellowy/fatty (superficial), scarpa -> membranous (deep)
-investing fascia
-muscles
-extraperitoneal fat
-parietal peritoneum

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12
Q

paracolic gutters

A

-lateral and medial sides of ascending and descending colon
-site for fluid collection
-movement of infected peritoneal fluid

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13
Q

subphrenic space

A

-between the liver and diaphragm
-fluid can collect
-drain inferior to 12th rib

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14
Q

nerve supply- skin, muscles, and parietal peritoneum

A

-anterior rami of lower 6 thoracic and 1st lumbar nerves
-lower 5 intercostal and subcostal nerves
-iliohypogastric and ilioinguinal nerves
-run between internal oblique and transversus abdominus muscle
-lower 6 thoracic pierce rectus sheath
-iliohypogastric nerve pierces the external oblique aponeurosis above the superficial inguinal ring
-ilioinguinal nerve passes through the inguinal canal to emerge through the ring
-iliohypogastric and ilioinguinal-arise from anterior rami of L1

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15
Q

T7 dermatome

A

-epigastric around xiphoid process
-T10- umbilicus
-L1- just above inguinal ligament at the pubic symphysis
-T4 nipple

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16
Q

blood supply to abdominal wall

A

-midline- branches of superior (comes off internal thoracic) and inferior epigastric (comes off external iliac)
-flanks- intercostal, lumbar (come off aorta), and deep circumflex iliac (external iliac) arteries
-inguinal region- superficial epigastric, superficial circumflex iliac, superficial external pudendal (all originate from femoral artery

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17
Q

venous drainage

A

-same names as arteries
-drain into internal thoracic and external iliac veins, azygos, and inferior vena cava
-paraumbilical vein drains into porta vein

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18
Q

lymph drainage

A

-above umbilicus drains- anterior axillary lymph nodes
-below umbilicus- superficial inguinal nodes

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19
Q

caput medusae

A

-paraumbilical veins drain into porta veins
-if backup in portal system
-pressure increased
-veins distend in umbilical region
-stomach, esophagus, anal area -> same effect

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20
Q

superficial fasica

A

-superficial fatty layer (fascia of camper)- continuous

-deep membranous layer (scarpas fascia)- fades out laterally and above:
-inferiorly- fuse with deep fascia of the thigh (fascia lata)
-midline- forms tubular sheath for penis (clitoris)
-perineum- attached on each side to margins of the pubic arch (colles fascia)
-posteriorly- fuses with perineal body and posterior margin of the perineal membrane

-investing (deep) fascia- thin layer of areolar tissue covering the muscles

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21
Q

arcuate line

A

-marks the transition of the 3 abdominal muscles (sheath) running anteriorly to rectus abdominus at and below ASIS and the transversalis fascia covering the inferior quarter
-where arcuate line meet semilunaris -> area of herniation -> lateral ventral wall hernia -> spigelian hernia***
-hematomas can collect there post op bc there is no strong posterior fascia
-below arcuate line is weaker -> subpubic incision

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22
Q

rectus sheath

A

-formed by the aponeroses of the 3 lateral abdominal wall muscles: external and internal oblique and transversus
-above the ASIS- external oblique is above rectus, internal is above and below, and transversus runs below
-ASIS and below- all three run anterior to rectus abdominus -> no support below rectus other than the transversalis fascia
-rectus sheath looks thicker below ASIS

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23
Q

peritoneum and peritoneal cavity

A

-peritoneum is serous membrane that lines abdominal and pelvic cavities and that covers the viscera
-parietal layer lines the walls of abdominal and pelvic cavities
-visceral layer covers the organs
-potential space- peritoneal cavity
-peritoneum secretes fluid for lubrication of organs

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24
Q

2 parts of peritoneal cavity

A

-greater and lesser sac
-greater sac is main compartment- extends from diaphragm down into pelvis
-lesser sac- smaller and lies behind the stomach-> allows for stomach expansion with eating
-sacs are in free communication with one another through the epiploic foramen

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25
folds
-on parietal peritoneum -5 folds below umbilicus on anterior wall of greater sacs -peritoneal fossa between the folds -median umbilical fold- urachus- contains urinary bladder and fetus- extends from urinary bladder to umbilicus -medial umbilical folds on both sides of median umbilical fold- contain a obliterated umbilical artery- extends from sides of bladder to umbilicus -lateral umbilical folds- contain inferior epigastric artery- extends from deep inguinal ring to arcuate line -hasselbalch (inguinal) triangle in the fossa between the medial and lateral folds -> rectus abdomnis (lateral), inferior epigastric (medial), and iliopubic tract (inferiorly) -inguinal rings in the lateral fossa (most outer) -> potential sites of hernias
26
lesser sac
-lies behind the stomach and lesser omentum -dips into the omentum layers -extends upwards as far as the diaphragm and downward between the layers of the greater omentum -left margin- spleen, gastrosplenic omentum, splenicorenal ligament -right margin opens into greater sac (main part of peritoneal cavity) through the epiploic foramen -formed due to 90 degree clockwise rotation of the stomach during development -allows for stomach to expand after eating -superior border is posterior to stomach on lesser omentum and less border is at the tip of greater omentum
27
boundaries of epiploic foramen
-the communication of the greater and lesser sac -anteriorly- free border of lesser omentum, bile duct, hepatic artery, and portal vein -> portal triad -posteriorly- inferior vena cava -superiorly- caudate process of caudate lobe of liver -inferiorly- first part of duodenum
28
peritoneal ligaments, omenta, and mesenteries
-permit blood, lymph vessels, and nerves to reach the viscera -peritoneal ligaments: -2 layers folds of peritoneum that connect solid viscera with the anterior abdominal wall (mesenteries is posterior) -ie. falciform ligament (liver), coronary ligament (peritoneum/diaphragm), and right and left triangular ligaments -round ligament- tethers liver to abdominal wall as well- contains ligamentum teres (obliterated umbilical vein) -> goes straight to umbilical
29
omenta
-viscera to viscera -2 layered folds of peritoneum that connect the stomach with another viscus -greater omentum- greater curvature of stomach *with the transverse colon*, spleen, and diaphragm, -> gastro-phrenic, gastro-splenic portion-colic portions -lesser omentum- lesser curvature to the fissure for the ligamentum venosum and the porta hepatis of the liver -> hepato-gastric, duodenal -ligamentum venosum- cord like lies within hepato-gastro ligament to liver -> between caudate lobe and left lobe of liver
30
liver
-bare side of liver without peritoneum -allows for infection -can spread to abdomen to thoracic cavity
31
porta hepatis
-on the underside of viscera of liver -where hepatic veins enter and leave -equivalent of a root of lung
32
mesenteries
-2 layered fold of peritoneum connecting parts of the intestines with the posterior abdominal wall -mesentery of small intestine -transverse mesocolon -sigmoid mesocolon
33
nerve supply of peritoneum
-parietal peritoneum- very sensitive to pain, temp, touch, pressure -> lower 6 thoracic and 1st lumbar nerves -parietal peritoneum- supplied by vicerator nerve -visceral peritoneum- stretch, chemical irritation (ischemia) -> autonomic nerves that supply the viscera of that are traveling in mesenteries -visceral is poorly localized -ex. appendicitis- midline pain at first visceral pain fibers are unmyelinated, lateral, enter spinal cord at various levels -> as it worsens parietal peritoneum sharpens pain (somatic)
34
retroperitoneal space
-not in the paritenal cavity -lies on posterior abdominal wall behind parietal peritoneum -extends from 12th thoracic vertebra and 12th rib to sacrum and iliac crests -floor or posterior wall: -formed medial to lateral by the psoas and quadratus lumborum muscles and the origin of the transversus abdominis muscle
35
contents of retroperitoneal space
-variable amount of fatty connective tissue -muscles are covered by fascia -suprarenal glands -kidneys -ascending and descending colon -duodenum- first inch is not -pancreas -ureters -renal and gonadal blood vessels
36
esophagus
-muscular tube about 10 in (25) long -pharynx to stomach -level of the cricoid cartilage in the neck and descend in midline behind trachea -through mediastinum and enters the abdominal cavity by piercing the diaphragm at T10 -right and left vagus nerves come with it -upper 1/3- skeletal muscle -middle 1/3- skeletal and smooth -distal 1/3- smooth -constrictions- 5 sites: cricoid, aortic arch, carina, LA, esophageal hiatus
37
sphincters of esophagus
-UES: -skeletal -opening: thyrohyoid and geniohyoid -closing: inferior pharyngeal constrictor, cricophyrangeus (dont memorize) -LES- smooth muscle
38
esophageal fistula
-left principal bronchus crosses the anterior surface of the esophagus -a fistula can form here (connection) -occurs with lung cancer
39
arterial/venous supply of esophagus
-cervical esophagus- inferior thyroid arteries and veins (not important) -thoracic arterial- upper 2/3- descending thoracic aorta and lower*** 1/3- L gastric artery -thoracic venous- upper 2/3- azygos and lower 1/3 L gastric vein** -abdominal- left gastric artery and vein -L gastric vein- drain into portal system if you have cirrhosis of liver -> back up of blood-> esophageal varices -> can hemorrhage* -> catastrophe
40
diabetes / vagus nerve
-gastroparesis -vagus nerve- parasympathetic -diabetes can affect vagus nerve -> slows -food sits long enough -> vomit or reflux
41
nerve supply esophagus
-cervical- recurrent laryngeal (branch of vagus) and sympathetic trunk -thoracic- vagus nerve and sympathetic trunk -abdominal- vagus nerve and sympathetic trunk -auerbachs (motility) and meissners plexus (mucus)
42
stomach
-dilated portion of the GI tract -situated in the upper part of abdomen -J shaped -2 openings, 2 curvatures, 2 surfaces -lesser curvature- right border of stomach, connected to the liver by the lesser omentum -greater curvature- left border, gastrosplenic omentum (ligament) connects to the spleen, greater omentum to the transverse colon -cardiac orifice (physiologic- just a thickening) and pyloric sphincter (anatomic -> circular muscle and physiologic) -cardiac orifice is aka lower esophageal sphincter
43
stomach anatomy
-from top to bottom -fundus -body -antrum -pylorus -longitudinal muscle coat, circular muscle coat, oblique muscle coat (allowed for churning) -rugae- ridges-> allows for expansion
44
arterial supply to stoamch
-celiac trunk gives off left gastric, hepatic, splenic arteries -hepatic gives off right gastric (supplies lesser curvature) and anastomoses with left gastric artery -splenic artery- gives off short gastric arteries and left gastroepiploic artery ( gastro-omental artery) anastomoses with right gastroepiploic artery which comes off of gastroduodenal artery -gastroduodenal artery is a branch of hepatic -left and right gastroepipiloic arteries -> give rise to gastro-omental which supply greater omentum
45
venous drainage of stomach
-veins drain into portal circulation -right/left gastric veins drain into portal vein -short gastric and left gastroepiploic veins drain into splenic vein -right gastroepiploic vein drains into superior mesenteric vein -superior mesenteric and splenic vein -> portal vein
46
stomach lymph
all lymph from stomach passes to celiac nodes
47
nerve supply of stomach
-sympathetic -> T6-T9- sympathetic trunk from celiac plexus and greater splanchnic nerves -parasympathetic -> vagus
48
small intestine
-extends from pylorus of stomach to ileocecal junction -divided into 3 parts- duodenum, jejunum, ileum
49
duodenum
-C-shaped tube approx 10 in in length that curves around the head of pancreas -begins at pyloric sphincter of stomach and it ends by becoming continuous with jejunum -first inch of duodenum has lesser omentum attached (intraperitoneal) to upper border and greater omentum attached to lower border -remained of duodenum is retroperitoneal
50
part of duodenum
-1st- runs upward/backward on transpyloric plane at L1 -2nd part- runs vertically downward (bile and pancreatic ducts pierce medial wall) -3rd part- passes horizontally in front of vertebral column -4th- runs upward to left to duodenojejunal flexure -flexure is held in position by ligament of treitz -> attached to right crus of diaphragm -ligament of treitz separates upper and lower GI tract
51
duodenum ducts
-major duodenal papilla receiving bile duct and main pancreatic duct sphincter of oddi -ducts pierce medially
52
duodenum arterial supply
-upper half superior pancreaticoduodenal artery (branch of gastroduodenal artery) -lower half- inferior pancreaticoduodenal artery (branch of superior mesenteric artery) -veins- superior pancreaticoduodenal vein joins the portal vein /// inferior pancreaticoduodenal vein joins the superior mesenteric vein -everything drains into portal system
53
nerve supply duodenum
-sympathetic (greater and lesser splanchnic nerves) and vagus nerves via celiac and superior mesenteric plexuses
54
jejunum
-8ft long -begins at the duodenojejunal flexure in the upper part of the abdominal cavity and to the left of the midline -wider, thicker, redder (more vascular) than ileum -very strong mesentery attaches both to posterior abdominal wall
55
ileum
-12 ft -coils of the ileum occupy the lower right part of the abdominal cavity -ends at ileocecal junction -very strong mesentery attaches both to posterior abdominal wall
56
arterial and venous supply from jejunum and ileum
-very rich arterial supply -arteries- branches of superior mesenteric artery -veins- drain into superior mesenteric vein -lymph- intermediate nodes to SMA nodes -longer (less arterial arcades) vasa recta in jejunum -shorter (more arterial arcades) vasa recta in ileum -vasa recta are in circular muscles of bowel
57
large intestine
-ileocecal valve to the anus -divided into cecum, appendix, ascending colon, transverse colon, descending colon, sigmoid colon, rectum, and anal canal
58
cecum
-blind ended pouch within the right iliac fossa -no mesentary -completely covered with peritoneum -at junction of cecum and ascending colon -> joined on left side by terminal part of ileum -> ileocecal valves enters -appendix attached to posteromedial surface
59
teniae coli
-longitudinal
60
cecum arterial and venous supply
-anterior and posterior cecal arteries from ileocolic artery- branch of SMA -veins- ileocolic vein -lymph- mesenteric and superior mesenteric nodes -nerve- sympathetic and vagus via superior mesenteric plexus
61
appendix
-narrow -muscular tube -attached to posteromedial surface of cecum -complete peritoneal covering which is attached to the mesentery of small intestine by short mesentery -mesoappendix contains appendicular vessels and nerves -appendicular artery and vein -lymph- nodes of mesoappendix -> superior mesenteric nodes -nerve- sympathetic and vagus nerves from superior mesenteric plexus
62
ascending colon
-5 inch -peritoneum covers front and sides and bind it to posterior abdominal wall -lies posteriorly on iliacus, quadratus lumborum, and lower pole of the right kidney
63
ascending colon arterial and venous
-artery- ileocolic and right colic branches of SMA -veins- ileocolic and right colic branches of SMV -lymph- colic and superior mesenteric -nerve- sympathetic and vagus from superior mesenteric plexus
64
transverse colon
-approx 15 inch -occupies umbilical and hypogastric regions -contains transverse mesocolon -phrenocolic ligament on left -> fold of peritoneum -> tethers onto diaphragm -most mobile
65
transverse colon artery and venous
-artery: -proximal 2/3- middle colic artery -distal 1/3- left colic artery -marginal artery anastomoses inferior and superior mesenteric supply -vein: -proximal 2/3- middle colic vein -distal 1/3- left colic vein -lymph- prox- superior mesenteric nodes; distal inferior mesenteric nodes -nerve supply- prox 2/3- sympathetic and vagus; distal 1/3- sympathetic and parasympathetic pelvic splanchnic nerves through the inferior mesenteric plexus***
66
descending colon
-approx 10 inch -peritoneum covers front and sides and also binds it to posterior abdominal wall -lies posteriorly on left kidney the quadratus lumborum, and iliacus muscles
67
descending colon arteries and veins
-arteries- left colic and sigmoid artery -veins- left colic and sigmoid vein -lymph- colic and inferior mesenteric nodes -nerve- sympathetic and parasympathetic pelvic splanchnic nerves via inferior mesenteric plexus
68
sigmiod colon
-approx 10-15 in -continuous with rectum in front of S3 vertebra -attached to posterior pelvic wall by fanshaped sigmoid mesocolon -supplied by sigmoid artery and veins -lymph- colic and inferior mesenteric nodes -nerve- sympathetic and parasympathetic nerves -> pelvic splanchnic nerves
69
rectum
-about 5 inch long and begins anterior to 3rd sacral vertebrae -pierces the pelvic floor and becomes continuous with anal canal -peritoneum covers portion of upper 2/3rds of rectum -teniae coli form longitudinal broad band on anterior and posterior surface of rectum (covers the whole thing bc increased pressure)
70
incontinence
-anal rectal flexor- maintained by contraction of puborectalis muscle -weakening -> 80 angle changes -> incontinence -valves of Houston (transverse folds)- hold stool up -internal (involuntary) and external (voluntary) sphincter
71
arterial and venous supply to rectum
-arteries: -superior rectal artery (branch of IMA) -middle rectal arteries (branch of internal iliac artery) -inferior rectal artery (internal pudendal artery) -veins: -superior rectal vein (IMV) -> into portal circulation** -> back up in portal > dilated veins in rectum -> not hemorrhoids* -> can bleed -middle-> internal iliac vein -inferior rectal vein -> internal pudendal vein -nerve- sympathetic and parasympathetic pelvic splanchnic nerves
72
anal canal
-about 1 1/2 in -pectinate line*- divides into lower/upper halves -above line- involuntary internal sphincter -> parasymp and symp -> only sensitive to stretch (No pain) bc its part of visceral system -below- voluntary external sphincter -> somatic motor (pain, temp, pressure,) -blood supply- superior/inferior rectal artery and vein
73
liver developmental ligaments
-ligamentum venosum is remnant of ductus venosus- shunted blood from umbilical vein to IVC -> short circuiting the liver -round ligament - remnant of obliterated umbilical vein which carried oxygenated blood from placenta to fetus -fetal blood bypass liver via ductus venosus and enter IVC -ductus arteriosum-> ligamentum arteriosum
74
abdomen supply
-foregut- above ligament of treitz - celiac trunk -midgut- before transverse colon - superior mesenteric -hindgut- after transverse colon- inferior mesenteric
75
absorbtion
-duodenum- iron -ileum- B12, bile salts
76
3 anterior visceral branches
-celiac artery-> left gastric, splenic, hepatic arteries -splenic artery-> short gastric (6), splenic (6), left gastroepiploic -hepatic artery-> cystic, right gastric, gastroduodenal, right hepatic, left hepatic -refer to slide/image
77

Anatomy (34 decks)

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