Abdomen Flashcards
Muscle in lateral abdomen
External Oblique
Internal Oblique
Tranversus Abdomonis
Muscle on posterior wall
Psoas major- lumbar vertebrae to femur
Quadratus Lumborum- iliac crest to all lumbar veterbrae (outer)
Iliac Muscle/iliacus- iliac crest down to femur
Midline Structure arising from aponeurosis and where it attaches to
Linea alba and goes from xiphoid to pubic symphysis
External oblique origin and attachment, function and innervation
Originates from Lower 8 ribs
Attaches to ASIS, anterior half of iliac crest and lines alba
Compress abdominal contents
Bends trunk to same side contracting
And rotates trunk to opposite side contracting
T7-12
Internal oblique origin and attachments, function and innervation
Origin Lateral half of inguinal ligament, iliac crest
Attaches to inferior borders of cartilages of last 3-4 ribs, pubic crest and linea alba
Compress abdominal contents
Bends trunk to same side contracting
And rotates trunk to same side contracting
T7-12 and L1
Transversus Abdomonis attachments, function and innervation
Runs medially from costal margin at ribs 7-12
Iliac crest
Lateral third of inguinal ligament
Compresses abdominal contents
T7-12 and L1
Rectus abdomonis and rectus sheath
Muscle lies infront of transverses aponeurosis and internal’s splits it for upper 2/3 until arcuate line (at umbilicus) where all 3 run anteriorly
Between oblique muscles is
Fasica but under transversus is transveralis fascia which then has parietal peritoneum deep to it
Tendinous intersections of rectus abdominis
Xiphoid
umbilicus
inbetween
Blood supply rectus sheath
Epigastric vessel
Superior (descend from internal thoracic) and inferior (ascend from external iliac) anastomose
Formation of inguinal ligament
External aponeurosis extends from ASIS to pubic tubercle and fold back on itself to form this ligament
Canals
Femoral- carries femoral arteries and veins and inguinal from superficial to deep ring
Types of hernias
Femoral, inguinal, direct and indirect
Difference in indirect and direct
Indirect pass through the canal from one ring to another
Direct bypass one ring and enter the canal midway
Types of peritoneum
Parietal and visceral
Intra vs retro peritoneum and examples
Retro- between parietal and abdominal wall- kidneys and great vessels
Intra- suspended by mesentery- small intestine
Divisions of GI tract
Foregut- distal third of oesophagus to papilla of duodenum
Midgut- papilla to diastal third of transverse colon
Hindgut- distal third to rectum
Mesentery of liver
Falciform ligament Lesser omentum (between stomach and liver)
Splenic Ligaments
Gastrolienal (stomach)
Lineorenal (wall)
Greater omentum
Apron like peritoneal double fold from the stomach containing the omentum bursa separating it from the greater sac
Omentum bursa location
Posterior to liver and stomach
4 parts of duodenum
Superior
Descending- papilla
Inferior
Ascending
Blood supply of gut
Coeliac trunk- foregut and pancreas, spleen, liver
Superior mesenteric artery-midgut
Inferior mesenteric artery- hindgut
Coeliac trunk divisions
Common hepatic artery- gives rise to right gastric and gastroduodenal (which also supplies pancreas)
Left Gastric
Splenic- gives rise to short gastric
Branches of superior mesenteric artery
Middle
Right
Ileocolic
Branches of inferior mesenteric artery
Left
Sigmoid
Superior rectal
Portal vein forms from
Splenic-Inferior mesenteric branches onto this
Superior mesenteric
Lymphatic of gut
Drain into superior and inferior mesenteric nodes which go to cisterna chyli
Innervation of gut
Para- Vagus and pelvic splanchnic (S2-4)
Symp- Thoracic(greater and lesser) (T5-12) and Lumbar splanchnic (L1-2)
Secondary retroperitoneal structures
Duodenum parts 2-4
Pancreas expect tail
Colon not transverse
Parts of pancreas
Head, neck, uncinate process- lie in G of duodenum
Body
Tail- kidney to spleen
Liver, jejenum, stomach and spleen relations to kidneys
Liver is anterior to right superior part of kidney
Jejenum is anterior to left inferior part of kidney
Stomach and spleen anterior to upper part of left
Right lower than left
Liver lobes and area
Bare area at top to diaphragm
4 lobes- right left, caudate(lower), quadrate(upper)
Where liver is split
Gall bladder and IVC split from left to right
Porta of liver (carries hepatic artery, portal vein and common bile duct) serperates caudate and quadrate
Blood supply of liver
Hepatic artery from coeliac trunk
3 short hepatic veins to IVC
Biliary Tract
Right and left hepatic duct form common hepatic duct
This goes to either the cystic duct to the gall bladder or the bile duct to join the pancreatic duct to form the ampulla of vater with the sphincter of oddi controlling
Spleen location
Left side, posterior to ribs 9-11
9 regions of abdomen
R and L hypochrondrium Epigastric
R and L flank Umbilicus
R and L groin Pubic
Plexus and ganglia- superior to inferior
Coeliac Superior mesenteric ganglion Renal plexus and ganglion Inferior mesenteric ganglion Superior hypogastric ganglion and plexus Inferior hypogastric ganglion and plexus
Referred pain
Cerebral cortex doesn’t have a good visceral map
So if there is any pain from viscera it is referred to the dermatome of the same nerve that supplies it
Dermatome
Area supplied by a single spinal nerve(segment of that spinal nerve)
Referred pain- areas in abdomen
Foregut- epigastric region - T7/8 (stomach, proximal duodenum, pancreas, liver, gall bladder)
Midgut- Umbilical region- T10
Progress of pain in appendicitis- inflammation spreads to local peritoneum- localised to right inguinal
Hindgut- Suprapubic- T12/L1-2
Ligaments of hip bone
Sacrospinous- sacral vertebrae to ischial spine
Sacrotuberous- sacral vertebrae to ischial tuberosity
Tendinous arch- levator ani to obturator internus
Anococcygeal-attaches to coccyx and attaches levator ani of either sides
Spines of pelvis
On anterior ASIS AIIS Then on posterior PSIS PIIS Mirrors
Ischial Spine-below greater sciatic notch
Fossa that attaches to femur
Acetabulum- has part of all 3 bones
Bones of pelvis
Ilium
Ischium
Pubis
Foreamen of pelvis
Greater sciatic
Lesser sciatic - separate by sacrospinous ligament
Obturator- mostly covered by obturator membrane giving rise to obturator canal
Muscles on lateral wall of pelvic cavity
Piriformis (S1-2) and Obturator internus (L5 S1)
Both cause lateral rotation of hip
Pelvic floor- what it is, function and what is below it
Formed by pelvic diaphragm and in the anterior midline the perineum membrane
Supports the main pelvic viscera (bladder, uterus, rectum)
Below the diaphragm is the perineum (fascia), containing voluntary sphincters and external genitali
Pelvic diaphragm muscles
Levator ani- illiococcygeus (tendinous arch to coccyx) , pubococcygeus (anterior to coccyx) , puborectalis (around anal aperture)
Coccygeus muscle- ischial spine to sacral/coccyx
What enters and exits the bladder
Ureters enter- superior posterior angles
Urethra exit- inferior angle
Form trigone at posterior of bladder
-Two ureteral orifices and the internal urethral orifice form the trigone
Males pelvis viscera- where they sit
Bladder superior to prostate and they sit in a bowl shaped structured formed by levator ani
4 parts of human urethra and size
Preprostatic Prostatic Membranous Spongey 20cm
Female pelvis viscera- where they sit
Uterus superior to bladder
Urethra anterior to vagina and rectum
Urethral sphincter
Internal sphincter on neck of bladder- smooth muscle
Female’s isn’t as well defined
External sphincter-skeletal muscle surrounding the urethra in the deep perineal pouch
Female’s have 2 extra
Sphincter urethrovaginalis- surrounds vagina and urethra
Compressor urethrae- branches to urethra
Expansion of bladder
Tetrahedral when empty
Expands between transversals fascia and peritoneum
Sensation of rectum
Autonomic- filing
Somatic- pain- v sensitive
Muscle that causes sharp angle in recto-anal junction
Puborectalis
Arterial supply of pelvic organs
Common iliac artery branches into
External and internal iliac
Internal iliac- supplies viscera apart from ovaries, pelvic walls and buttocks
What plane is used to find position of kidneys
Transpyloric- at CC9
Runs through L1
Outline of kidney
Mark transpyloric plane
Both 4-5 cm from posterior midline
Superior pole- Covered by 12th rib
Inferior pole- 3-4cm above iliac crest
9-12cm long, 4-7 wide
Difference of male and female pelvises
Male- heart shaped inlet
Pubic angle 50-60 degrees
Ischial spine projects medially
X:Y <1- ratio beween pubic symphysis to acetabulum to acetabulum diameter
Female- oval inlet
Pubic angle- greater than 80degrees
Ischial spine doesn’t project medially
X:Y >1
Pathway of ductus deferens
From testis to inguinal canal-then anterior and over behind the ureter to enter the urethra via the prostate with the seminal vesicles (on back of bladder) opening into the deferens between ampulla (enlarged portion) and ejaculatory duct
Openings into urethra in prostate
Prostatic utricle
Ejaculatory ducts- from ductus deferens
Significance of internal urethra sphincter in males
Closes during ejaculation by sympathetic synthesis
Parasympathetic relaxes
Perineum
Diamond shape between pubic symphysis, ischial tuberosities and coccyx
Divided into anterior (urogenital) and posterior (anal) triangles
Urogenital is different in sexes, and anal is same
Perineum membrane
Thick triangular fascial structure attached to pubic arch. Posterioly free margin. Anteriorly a small gap.
Deep perineal space
Above PM and below pelvic diaphragm
Superficial perineal space
Below PM above superficial fascia
Median erectile tissue
Corpus spongiosum- contains urethra
Lateral erectile tissue
Corpora Cavernosae
Meet to form shaft and head of penis or clitoris
Rectum blood supply
Inferior mesenteric artery provides the superior rectal artery
The internal iliac artery provides middle and inferior rectal arteries
All provided in pairs
Testis
Where is sperm produced and where it passes to
Produced in seminiferous tubules
Goes to epididymis then vas deferens
Parts of the penis
Crus of penis- attached part of corpus cavernosum
Bulb of penis- attached part of corpus spongiosum
Bulbourethral gland within pouch
Glans penis- head
Parts of of clitoris
Bulb of vestibule with greater vestibular gland inferior
Crus of clitoris- attached part of corpus cavernosum
Muscle underlying genital muscle and innervation
Ischiocavernosus- underlies crus of penis/clitoris
Bulbospongiosus- underlies bulb of penis/ bulb of vestibule
Superficial transverse perineal- run transversely from ischial tuberosities
All supplied by pudendal nerve
Blood supply of penis
From internal pudendal artery
Deep artery of penis- corpora cavernosa
Dorsal artery of penis- skin
Artery of bulb- bulb, corpus spongiosum
Pelvic content innervation
Sympathetic from lower thoracic and upper lumbar (T10 - L2) segments via hypogastric plexus
Parasympathetic from S2-4 outflow
Nerves of perineum
Somatic nerve- arise from lumbosacral plexus- pudendal - arrise from S2-4
Sensory to penile headvestibule, labia minora and part of labia majora, lower vagina, clitoris, lower anal canal
Motor to perineal muscles bulbospongiosus and ischicavernosus -causing ejaculation and external urethral sphincter, anal sphincters and levator ani
Peritoneum in the female pelvic region
Continues into pelvic cavity but does not reach floor
Completely covers uterine/fallopian tubes forming broad ligament
Ovaries are suspended by
Mesovarium- portion of broad ligament
Parts of female genetalia
Vagina
Cervix
Uterus
Uterine tube
Ligaments of female genitals
Ligament of ovaries- joins ovaries to uterus
Round ligaments- 2 anterolateral attachments of uterus to inguinal canal and to labia majora (part of female genitals anterior to pubic symphysis)
Broad ligament- double fold of peritoneum from lateral pelvic wall to uterus
Suspensory ligaments- ovaries to L2 level in retroperitoneum covering ovary vessel
Segments of uterus
Fundus
Body
Lower segment
Cervix
Parts of Fallopian tube
Infundibulim and fimbrae
Ampulla
Isthmus
Structure formed between vagina and cervix
Fornix
Posterior fornix- clinically relevant as it is very close to pouch of Douglas and rectum
Arteries of female pelvis viscera
Internal iliac artery
Anterior division provides - superior vesicubules, uterine and medial rectal arteries
Uterine Artery
Runs medially towards cervix
Crosses ureter around 1cm before uterus
Ascending supplies ovaries and uterine tubes
Descending supples vagina
Contents of superficial perineal pouch
Median erectile tissue masses
Lateral erectile tissue masses
Lymphatic drainage of pelvis
Pelvic organs drain mainly to external and internal iliac nodes (around the arteries)
Ovary and testis drain to para-aortic nodes
Perineum (including anal canal) and external genitalia drain to superficial inguinal nodes
Pelvic brim and girdle
Brim is the edge of the inlet
Girdle is two hip bones joined together to sacral vertebrae
True and false pelvis
False pelvis is above the pelvic brim
True is below the pelvic brim
Parts of broad ligament
Mesosalpinx- most superior, suspends uterine tube
Mesovarium- posterior extension, attaches the ovary
Mesometrium- largest part, extends from lateral pelvic wall to the body of the uterus
Inferior epigastric arrises from
Internal iliac artery
Testicular/ovarian artery arrises from
Abdominal aorta just inferior to superior mesenteric artery
Testicular then passes down through the inguinal canal to the testes
Ovarian pass in suspensory ligaments of ovary
Contents of spermatic cord
Cremasteric muscle
Testicular artery and pampiniform plexus
Ligaments between sacral vertebrae and pelvis
Anterior sacro-iliaca ligament Lumbosacral ligament Iliolumbar ligament Interosseous Sacro iliac ligament Posterior sacro iliac overlying
Ligaments at pubic symphysis
Superior and inferior pubic ligament
Divisions of pubococcygeus
Puboprostaticus
Pubovaginalis
Puboanalis
Ligaments of bladder
Women- pubovesical
Men- Puboprostatic
Spaces in peritoneum in pelvis
Recto-uterine pouch- on either side in women
Rectovesical pouch in men
Somatic plexus
Sacral-sciatic, pudendal, superior and inferior glutaneal, obturator
Coccygeal- anococcygeal
Autonomic plexuses in pelvis
Superior hypogastric plexus forms 2 hypogastric nerves
Which combine with pelvic splanchnic nerves to form 2 inferior hypogastric plexuses- this goes to rectal, uterovaginal, porstatic and vesicle plexuses
Branches of internal iliac artery
Umbilical Obturator Superior vesical Inferior vesical /Vaginal Middle rectal Uterine
Veins in pelvis
Prostatic plexus Vesical plexus Middle rectal Obturator Go to internal iliac
Rectal plexus and its veins
Pudendal vein
Glands of females and male
Vestibular
Bulbourethral- in deep perineum pouch
