Abdomen Flashcards
where is the posterior abdominal wall located? (2)
- behind abdominal organs
- extends from vertebral volumn to posterior aspects of abdominal cavity
what are the muscles included in the PAW? (4)
- psoas major
- psoas minor
- iliacus
- quadratus lumborum
what are the main parts of the PAW? (5)
- muscles
- vertebrae
- thoracloumbar fascia
- blood vessels
- nerves
what is thoracolumbar fascia? (2)
- strong connective tissues structure that covers the muscles of the lower back and forms a sheet
- provides stability
retroperitoneal organs (2) vs intraperitoneal organs (2)
retroperitoneal:
* anchored to PAW
* lies behind parietal peritoneum
Intraperitoneal:
* anterior to PAW
* suspended within peritoneal cavity by mesentery
the two types of extraperitoneal organs:
- rertoperitoneal
- sub periotteal
what is a sub peritoneal organ?
- an organ beneath the peritoneum of the abominal cavity
types of mesentery’s of the abdomen: (4)
- SI mesentery = the mesentery
- transverse colon mesentery = mesa colon
- sigmoid colon mesentery = sigmoid colon
- stomach mesentery = greater and lesser omentum
what is a secondary retroperitoneal organ? (3)
- an organ that originally had a mesentery
- was intrapertioneal
- due to enlarging of other organs in evolution (e.g. the SI), has become pushed against the PAW
examples of secondary retroperitoneal organs: (3)
- ascending colon
- descending colon
- duodenum
what is the lesser sac of the abdominal peritoneum also known as?
- omental bursa
what are the 2 main parts of the lesser sac?
- superior recess
- inferior recess
what are the 3 divisions of the gut?
- foregut
- midgut
- hindgut
what does the foregut contain? (6)
- oeseophagus
- stomach
- liver
- gallbladder
- pancreas
- first part of duodenum
what does the midgut contain? (7)
- second part of duodenum
- jejuunum
- ileum
- cecum
- appedix
- ascending colon
- first 2-thirds of transverse colon
what does the hindgut contain? (5)
- last 1/3 of transverse colon
- descending colon
- sigmoid colon
- rectum
- upper part of anal canal
what is the trunk that supplys to the foregut?
- coeliac trunk
what are the branches of the coeliac trunk? (3)
- left gastric artery
- splenic artery
- common hepatic artery
what does the left gastric artery supply? (2)
- the lesser curvature of the stomach
- lower part of oesophagus
what does the splenic artery supply? (3)
- spleen
- part of stomach
- part of pancreas
what does the common hepatic artery divide into and supply? (2)
- proper hepatic artery - liver
- gastroduodenal artery - first part of duodenum
where vertebral evel is the coeliac trunk found?
T12
what does the proper hepatic artery further split into, and supply (4)?
- right gastric artery - lesser curvature of stomach
- cystic artery - gall bladder
- left hepatic artery - liver
- right heptic artery - liver
what does the gstroduodenal artery further split into and supply (3)?
- supra duodenal artery - superior aspect of duodenum
- right gastroepiploic artery - inferior greater curvature of stomach
- superior pancreatic duodenal artery - duodenum and pancreas
what boundary does the pelvid brim/pelvic inlet mark?
- boundary between abdominal and pelvic cavities
what is the omentum? (2)
- two folds of peritoneum, that line the abdominal cavity and abdominal organs
- plats role in supporting and protecting abdominal organs
the greater omentum: (origin, location and role)
- hangs down from greater curavture of stomach
- drapes over abominal organs
- contains lymph nodes and immune cells to respond to infections and inflammation
why is the greater omentum known as the policeman of the abdomen?
- it can migrate to areas of inflammation to help contain infections or seal off injured areas
what ligaments are there in the greater omentum, and what they connect: (3)
- gastrocolic ligament - greater curvature of stomach and transverse colon
- gastrosplenic ligament - stomach to spleen
- gastrophrenic ligament - stomach to diaphragm
what does the gastrocolic ligament contain?
- blood vessels, nerves and lymphatic vessels to stomach and transverse colon
the lesser omentum location (2)
- extends from lesser curvature of stomach and proximal duodenum
- to the liver
the two ligaments of the lesser omentum:
- hepatogastric ligament - liver and lesser curvature of stomach
- hepatoduodenal ligament - liver to first part of duodenum
what important structure does the lesser omentum contain?
- the portal triad
how is the foregut attachment different from the rest of the GI tract?
- attached at the back and front to abdominal wall by 2 double folds of peritoneum
what are the attachments that connect the foregut to the abdominal wall called?
- Dorsal mesogastrium = back
- ventral mesogatrium front
what is the epiploic foramen? (2)
- the only opening in the peritoneum that connects the greater and lesser sac
- located posterior to free edge of lesser omentum - the bit that connects the liver to lesser curvature of stomach
how does the epiploic foramen form? (2)
- duodenum is stuck against liver
- leaves small section of lower free boarder of lesser omentum
what are the 3 arteries that supply the GI tract, and which part:
- foregut - coeliac artery
- midgut - superior mesenteric artery
- hindgut - inferior mesenteric artery
what are the peritoneal attachments of the liver also referred to as?
ligaments
what are the peritoneal attachments of the liver? (4)
- falciform ligament
- coronary ligament
- right triangular ligament
- left triangular ligament
origin, insertion, anterior boarder, posterior boarder, what it contains
the falciform ligament: (5)
- origin - diaphragm
- insertion - highest part of liver, down to hepatic notch
- anterior boarder attaches to abdominal wall
- posterior boarder hangs free
- contains ligamentum teres
what does the falciform ligament line of attachment do?
- divide the liver into the left (smaller) and right (larger) lobes
what is the ligamentum teres
- a remnant of the foetal umbilical vein
the coronary ligament: (2)
- located on superior posterior part of liver
- surrounds front of inferior vena cava
the right and left triangular ligaments: (2)
- formed where the anterior and posterior layers of the coronary ligament meet on the left and right side
- attaches to the right/left lobe of liver
the stomach position relative to the costal margin:
- more than half of stomach lies above level of costal margin
the junctions of the stomach: (2)
- gastro-esophageal junction - where oesophageus meets stomach
- pyloric junction - where stomach meets duodenum
what is the most superior part of the somach called?
- the fundus
what is the narrow part of the stomach called?
- the pyloric antrum
the walls of the GI tract: (2)
- outer layer of smooth muscle
- inner layer of mucosa
difference between mucosa in the fundus and pyloric antrum of the stomach: (2)
- fundus = smooth
- pyloric antrum = prominent longitudinal folds known as ruggae
which of the two sphincters of the stomach is more effective?
- pyloric sphincter
what is the biliary system?
- a network of ducts and structures (organs) that play a crucial role in production, storage and transportation of bile
what does the biliary system include? (7)
- lliver
- gallbladder
- common bile duct
- pancreatic duct
- amupulla of Vater
- Hepatic ducts
- Cystic ducts
what are ampulla of Vater? (3)
- smal opening
- where the common bile duct and pancreatic duct
- enter the duodenum
what do hepatic ducts do?
- carry bile away from liver
what do cystic ducts do? (2)
- connect gallbladder to common hepatic duct
- allows flow of bile from gallbladder to common bile duct
where does the common bile duct end up? (2)
- duodenum
- enters at the duodenal papilla
what 2 structures enter the duodenum at the duodenal papilla?
- common bile duct
- pancreatic duct
main functions of the spleen? (2)
- blood filtration - removees old/damaged RBCs from blood stream and also debris
- immune response - contains WBCs, lymphocytes and macrophages
ligaments
what are the two folds of peritoneum that connect to the spleen?
- gastrosplenic ligament - at the front, connects to stomach
- Lienorenal ligament - at the back, loose connection to left kidney
what vessels supplies the spleen, and where they enter the spleen?
- splenic blood vessels
- hilum of spleen
what is the hilum of the spleen?
- refers where the blood vessels, nerves and lymphatic vessels enter ane exit organs (spleen in this case)
the superior and inferior boundary of the abdominal cavity:
- superior - diaphragm
- inferior - pelvic inlet
what is peritonitis?
- inflammation of the peritoneum
the three components of the portal triad and their position:
- bile duct - anterior right
- hepatic duct - anterior left
- portal vein - posterior
the boundaries of the epiploic foramen: (4)
- anterior - hepatoduodenal ligament
- posterior = IVC
- superior = liver
- inferior = 1st part of duodenum
what is splenomegaly?
- enlargement of the spleen
what is the large intestine mesentery called?
- mesacolon
divisions of the splenic artery that supply the stomach: (2)
- short gastric artery - fundus of stomach
- left gastro-epiploic artery - greater curvature of stomach
the common hepatic artery branches that supply the stomach: (2)
gastroduodenal artery
* right gastroduodenal artery - greater curvature of stomach
hepatic artery proper:
* right gastric artery - lesser curvature of the stomach
what are the specific branches of the coeliac truk that supply the stomach: (5)
- left gastric artery
- right gastric artery
- left gastro-epiploic artery
- right gastro-epiploic artery
- short gastric artery
what level does the bifurcation of the aorta occur?
T12
the steps of hepatic circulation: (11)
- heart
- arteries
- arterioles
- capillary 1 - lamina propria
- venules
- veins (hepatic portal system)
- venules
- capillary 2 - hepatic sinusoids
- venules
- veins
- heart
3 the features tha distinguish the large from small intestine, and what are they?
- appendices epiploicae - fatty projections
- taenia coli - 3 bands of longitudinal layers of smooth muscles of the wall
- haustria - sacculations of the wall between the taenia coli
what are the jejunum and ileum?
- jejunum - middle section of SI
- ileum - final section of SI
differences of jejunum compared to ileum: (3)
jejunum is:
* wider
* thicker wall
* large, tall and closely packed pilcae circulares
what are pilcae circulares, and 2 major functions?
- folds of mucous membrane found in the SI
- slows down movement of chyme (food)
- increases SA
at what vertebral level does the superior mesenteric artery branch off?
L1
what does the superior mesenteric artery give rise to to the SI? (2)
- the jejunal and ileal branches
what do the jejunal and ileal branches give rise to? (2)
- vasa recta - short striaght arteries
- arterial arcades
which branch has more arterial arcades, the jejunum or ileal branch?
- ileum
in which branch are the vasa recta shorter, jejunum or ileum?
- ileum
blood supply from the superior mesenteric artery to the LI: (3)
- middle colic
- right colic
- ilio colic
the branches of the superior mesenteric artery: (6)
- inferior pancreatic duodenal artery
- jejunal branches
- ileal branches
- middle colic
- right colic
- ileocolic
4 for iliocolic
what do the right, middle and ilio-colic artery supply?
- right - ascending colon
- middle - transverse colon
- iliocolic - terminal ileum, appendix, cecum and part of ascending colon
where does the inferior mesenteric artery arise, vertebral level?
L3
what does the inferior mesenteric artery give rise to? (3)
- left colic artery
- sigmoid arteries
- superior rectal artery
two branches
what does the left colic artery supply? (3)
- ascending branch - distal transverse colon & upper ascending colon
- descending branch - lower descending colon
what do the branches of the left colic artery anastomose with?
- ascending branch - middle colic artery
- descending branch - sigmoid artery
how many sigmoid arteries are there?
- varies from 2-4
what do the sigmoid arteries supply? (1)
- sigmoid colon
what do the branches of the sigmoid arteries anastomose with? (2)
- left colic artery
- superior rectal artery
what does ths superior rectal artery supply?
upper rectum
what does the superior rectal artery anastomose with? (2)
- middle and inferior rectal arteries
what is the first branch of the inferior mesenteric artery?
- the superior rectal artery
where do the gastroc veins drain blood from and to?
- lesser curvature of the stomach
- portal vein
where do the gastroepiploic veins drain blood to? (2)
- portal and splenic vein
what vein drains all the midgut organs?
- superior mesenteric vein
the 3 primary tissues where blood drains to both hepatic portal system and caval veins?
- oesophagus
- rectum
- anterior abdominal wall
the primary portal and caval vein of the oesophageal region:
- portal - left gastric vein to HPV
- cval - oesophageal vein to azygous vein
4 for each - pathway
the primary portal and caval vein of the rectum region:
portal:
* superior rectal vein
* to inferior mesenteric vein
* into splenic vein
* into HPV
caval:
* middle/inferior veins
* into internal iliac vein
* into common iliac vein
* into IVC
the primary portal (1) and caval vein (4) of the anterior abdominal wall
Portal:
* periumbilical veins to HPV
Caval:
* superficial epigastric vein
* into femoral vein
* into external iliac vein
* into common iliac vein
where do the sympathetic nerves supplying the abdomen originate at the vertebral level: (2)
- T5-T12
- L1-L3
what is the parasympathetic supply to the abdomen?
- the vagus nerve
where does the aorta bificate?
- L4
what is the aortic plexus that surrounds the coeliac trunk?
- the coeliac plexus
what aortic plexus surrounds the superior mesenteric artery:
- superior mesenteric plexus
what aortic plexus surrounds he inferior mesenteric artery?
- the inferior mesenteric plexus
what aortic plexus surrounds the bifurcation of the aorta?
- the superior hypogastric plexus
what aortic plexus surrounds the internal iliac artery?
- the inferior hypogastric plexus (2 of them)
what two of the plexuses are connected and how?
- superior and inferior hypogastric plexus
- by hypogastric nerves
what are the 3 pre aortic ganglia where the abdominal nerves from the sympathetic chain go? and which thoracic nerves from which vertebrae go to which:
- the coeliac ganglia - T5-T9
- the superior mesenteric ganglia - T19-T12
- the inferior mesenteric ganglia - L1-L3
what are the main sympathetic nerves of the abdomen? (4)
- the greater, lesser, least & lumbar splanchnic nerves
the main parasympathetic nerves of the abdomen: (2)
- vagus nerve
- pelvic splanchnic nerves
where do the pelvic splanchnic nerves arise?
S2-S4
which parasympathetic nerve supplies which part of the abdomen:
- vagus nerve - foregut and midgut
- pelvic splanchnic nerves - hindgut
what is the cecum? (2)
- the side passage at the beginning of the alrge intestine
- hangs downward in right iliac fossa
what are the 2 branches of the portal vein?
- superior mesenteric
- splenic
boarders of the spleen: (5)
- anterior - stomach
- posterior - diaphragm
- inferior - left colic flexure
- superior - diaphragm
- medially - left kidney
the 4 main sections of the aorta:
- ascending aorta
- aortic arch
- thoracic aorta
- abdominal aorta
the abdominal aorta: where it begins, ends, position to IVC,
- begins at T12
- ends at L4
- lies to left of IVC
what does the superior mesenteric artery supply (the region)? (2)
- intestine - from duodenum up to first 2/3s of colon
- head of pancreas
the inferior mesenteric artery supply: (2)
- rest of colon, last 1/3
- rectum
the 3 large paired lateralbranches of the abdominal aorta:
- suprarenal
- renal
- gonadal
what is the biggest branch of the paired branches of the abdominal aorta?
- the renal
what are the 5 paired abdominal wall branches of the aorta?
- inferior phrenic branch
- 4 lumbar branches
nmeumonic to remeber the 6 branches of the lumbar plexus:
- **I **(twice)
- Get
- Laid
- On
- Fridays
what are the 6 nerves of the lumbar plexus:
- Iliohypogastric
- Ilioinguinal
- Gentiofemoral
- Lateral femoralcutaneous
- Obturator
- Femoral nerve
within what muscle does the lumbar plexus form?
- the psoas major muscle
where the nerves leave the psoas major muscle
- Anterior - genitofemoral nerve
- medial - obturator nerve
- Laterally - the other 4
what are the two parts of the diaphragm?
- aponeurotic part
- muscular part
what is the aponeurotic part of the diaphragm? (2)
- the central part
- the ligament part
what is the 3 sections of the muscular part of the diaphragm, and there specific attachments?
- sternal part - xiphoid process
- costal part - inferior 6 costal cartilages and ribs (6-12)
- lumbar part - L1-L3
what are the arcuate ligaments of the diaphragm? (3)
- median arcuate ligament
- medial arcuate ligament
- lateral arcuate ligament
what nerves innervate the peripheral part of the diaphragm?
- the lower 6/7 intercostal nerves and subcostal nerves
the blood supply of the adrenal glands: superior, middle, and inferior
- Superior - the inferior phrenic artery
- Middle - aorta
- Inferior - renal artery
difference in the shapes of the adrenal glands:
- right - pyramidal shaped
- left - crescentic shaped
which kidney lies slightly superior and why?
- left
- due to presence of liver
what vertebral level are the kidneys located?
- T12-L3
what are ureters? (4)
- muscular ducts
- transport urine from kidney to urinary bladder
- retroperiotneal structures
- pass over pelvic brim at bifurcation of common iliac arteries
what are the narrowing sites along the ureters?
- constriction potential sites
how many constriction potential sites are there along the ureters, and where are they:
Three
1. junction of ureters and renal pelvis
2. where ureter crosses pelvic brim
3. during passage through wall of urinary bladder
what does the iliohypogastric nerve innervate? (2)
- muscles of anterior abdominal wall
- skin of suprapubic region
what does the ilioinguinal nerve innervate? (4)
- muscles of anterior abdominal wall
- skin of anteriormedial part of thigh
- skin of scrotum and root of penis
- skin of labia and root of clitoris
what does the lateral femoral cutaneous nerve supply? (1)
- anterolateral part of thigh
the branches of the genitofemoral nerve: (2)
- genial branch
- femoral branch
what does the genial branch supply (3)
- cremaster muscle
- skin of anterior scrotum
- skin of labia majora
what does the femoral branch of the genitofemoral nerve supply?
- skin of upper and anterior thigh
lymphatic drainage from the alientary tract, liver, spleen & pancreas: (2)
- pre-aortic lymph nodes: coeliac, superior & inferior mesenteric nodes
- intestinal lymphatic trunk
lymphatic drainage from the PAW, kidneys, ureters & testes (2)
- lumbar lymph nodes
- lumbar lymphatic trunks
what are the layers of the anterior abdominal wall from superficial to deep? (6)
- skin
- superficial fascia
- muscles
- transversalis fascia
- extraperitoneal fat
- parietal peritoneum
what can the superficial fascia be divided into? (2)
- campers fascia - fatty layer
- Sarcpa.s fascia - membranous layer
origin and insertion of the inguinal ligament
- origin - ASIS
- insertion - pubic tubercle
function of the inguinal ligament (2)
- forms base of inguinal canal
- supports abdominal wall
what is the deep fascia of the anterior abdominal wall:
the transversalis fascia
what is the transversalis fascia function: (2)
- structural support
- forms part of inguinal canal