Abdomen Flashcards
What is the abdomen in relation to the trunk?
The part between thorax and pelvis
True/False: The abdomen is a flexible, dynamic container housing most of the organs of the alimentary system and part of the urogenital system.
True
Through what type of contraction is the muscular roof, anterolateral wallsm and floor that raises internal pressure to aid air expulsion or substances?
Voluntary, reflexive contraction
What covers the anterolateral wall and organs against the posterior wall?
Periotneum
What is formed between the viscera and the abdominpelvic cavity?
Peritoneal cavity
What structure “separates” the abdominal and pelvic cavities?
Pelvic inlet
What is the name of the two sagittal planes?
Midclavicular to midinguinal
What does the transverse plane cross through?
The coastal cartilages of 10th row (also called subcostal plane)
What is the plane that passes through the iliac tubercles and L5?
Transtubercular
What plane passes through the ASIS on each side?
Interspinous
What plane passes halfway between the manibrium and pubic symphysis?
Transpyloric
What are the nine region used to describe the location of organs, pains, and pathologies?
Right Hypochondriac, Right Flank , Right Inguinal, Epigastric, Umbilical, Hypogastric, Left Hypochondriac, Left Flank, Left Inguinal
What planes intersect to create the Right Hypogastric region?
R MCL x transtubercular
What planes intersect to create the epigastric region?
Transtubercular and MCLs
What planes intersect to create the Left Hypochondriac region?
L MCL x transtubercular
What planes intersect to create the Left flank region?
R MCL x interspinous x subcostal
What planes intersect to create the umbilical region?
MCLs x subcostal x Interspinous
What planes intersect to create the left flank region?
L MCL x subcostal x interspinous
What planes intersect to create the right inguinal region?
L MCL x interspinous
What planes intersect to create the hypogastric region?
MCLs x interspinous
What planes intersect to create the Left Inguinal region?
Interspinous x L MCL
What are the four quadrants that are created by the median plane and transumbilical plain?
RUQ, LUQ, RLQ, LLQ
What are the organs of the RUQ?
R lobe liver, Gallbladder, Pylorus of stomach, Duodenum, Head of pancreas, R suprarenal gland, R kidney, R colic flexure, ascending colon sup, 1/2 Transverse colon
What are the organs of the LUQ?
L lobe liver, Spleen, stomach, jejunum, proximal ileum, body and tail of pancreas, L kidney, L suprarenal gland, L colic flexure, Half transverse colon, Descending colon sup
What are the organs of the RLQ?
Cecum, appendix, ileum, ascending colon inf, R ovary, R uterine tube, R ureter, R spermatic cord
What are the organs of the LLQ?
Sigmoid colon, Descending colon inf, L ovary, L uterine tube, L spermatic cord
To what structures does the anterolateral abdominal wall extend to?
Thoracic cage -> pelvis
What are the components of the anterolateral abdominal wall?
Skin, SubQ tissue: Camper -> scarpa, deep fascia, muscles, extraperitoneal fat, parietal peritoneum
What are the muscles of the anterolateral wall?
External oblique, internal oblique, Rectus Abdominus, Transverse Abdominus, Pyramidalis
What structure forms between the aponeuroses of the anterolateral abdominal muscles?
Rectus sheath
What structure runs down the midline of the abdomen wall?
Linea alba
Between what two structure does the linea alba run between?
Xiphoid process and pubic symphysis
What is the arcuate line?
demarcates the transition between the aponeurotic posterior wall of the sheath covering the superior three quarters of the rectus and trasversalis fascia covering the inferior quarter
What structures are also found in the rectus sheath?
Superior and inferior epigastric arteries and veins, lymphatic vessels, and distal portions of thoraco-abdominal nerves
All the layers of the rectus sheath fuse to what structure?
Umbilicus
What is the OINA of the external oblique?
O: ribs 5-12
I: Linea alba, pubic tubercle, anterior 1/2 of iliac crest
N: Thoraco-abdominal nerve (T7-11) and subcostal nerve (T12)
A: Compress and support viscera, Flexion of trunk, Rotation of trunk
Where do the fibers of the EO become aponeurotic?
MCL and spino-umbilical line
What is the OINA of the internal oblique?
O: thoracolumbar fascia, ant 2/3s of iliac crest, connective tissue of lateral 1.3 of inguinal ligament
I: Inf borders of 10-12 ribs, linea alba, pecten pubis
N: T6-12 and L1 ant rami
A: compress and rotate viscera, Flexion of trunk, Rotation of trunk
What is the OINA of the tranverse abdominus?
O: Internal surfaces of 7-12 costal cartilages, thoracolumbar fascia, iliac crest, connective tissue deep to lateral 1/3 of inguinal ligament
I: linea alba, pubic crest, pecten pubis
N: T6-12 and L1 anterior rami
A: compress and support the viscera
What is the OINA of the rectus abdominus?
O: pubis symphysis, pubic crest
I: Xiphoid process and 5-7 costal cartilages
N: T6-12 anterior rami
A: flexes trunk, Compresses viscera, Stabilizes and controls tilt of pelvis (antilordosis)
What are the paired rectus muscles separates by?
Linea abla
What structure exists within the rectus abdominus?
Tendinous intersections
What is the pyramidalis muscle?
abest in 20% of people, small, insignificant triangular muscle. Lies anterior to the inferior part of RA and attaches to anterior surface of pubis and anterior pubic ligament
What supplies the majority of the abdominal wall?
Anterior rami of T7-T12
What are they and what structures do the thoraco-abdominal nerves supply?
anterior rami of T7-11, supply the abdominal skin @ and IO, TA muscles
What are they and what structures do the lateral cutaneous branches of nerves supply?
T7-9 or t10, supply skin supply the skin of the L and R hypochondriac regions
What are they and what structures do the anterior cutaneous branches of nerves supply?
T7-9, supply the skin abobe umbilicus, T10, supplies the skin around umbilicus, T11+T12+ iliohypogastric + Ilioinguinal, supply the skin below umbilicus
What is the subcostal nerve and what does it supply?
Anterior ramus of T12, supplies muscles of the anterolateral abdominal wall and overlying skin superior to iliac crest but inf to umbilicus
What is the Iliohypogastric nerve and what does it supply?
Anterior ramus of L1, supplies skin over iliac crest, upper inguinal, hypogastric regions, IO and TA muscles
What is the ilioinguinal nerver and what does it supply?
Anterior ramus of L1, supplies skin of lower inguinal region, mons pubis, anterior scrotum/labium, medial thigh, inferiormost IO and TA
What is the origin, course, and distribution of the musculophrenic artery?
O: Internal thoracic artery
C: descends along costal margin
D: hypochondriac region, anterolateral diaphragm
What is the origin, course, and distribution of the superior epigastric artery?
O: Internal Thoracic artery
C: Descends in rectus sheath deep to RA
D: RA, epigastric and upper umbilical regions
What is the origin, course, and distribution of the intercostal arteries?
O: Aorta
C: beyond ribs to descend abd. wall between IO and TA
D: Lumbar/Flank region
What is the origin, course, and distribution of the subcostal artery?
O: Aorta
C: beyond ribs to descend abd. wall between IO and TA
D: Lumbar/Flank region
What is the origin, course, and distribution of the inferior epigastric artery?
O: External Iliac artery
I: runs superiorly and enters rectus sheath, runs deep to RA
D: RA, pubic and umbilical regions
What is the origin, course, and distribution of the deep circumflex iliac artery?
O: Exteral Iliac artery
C: runs Deep aspect of abd. wall, parallel to inguinal ligament
D: Iliacus, inguinal region, iliac fossa
What is the origin, course, and distribution of the Superficial circumflex artery?
O: Femoral Artery
C: Runs in subQ tissue along inguinal ligament
D: Superifcial wall of inguinal regions and adj. anterior thigh
What is the origin, course, and distribution of the superificial epigastric artery?
O: femoral artery
C: Runs in subQ tissue toward umbilicus
D: Superficial wall of pubic and inferior umbilic region
What is a surgical method for removing unwanted subcutaneous fat using a suction tube and high vacuum pressure?
Liposuction
Which fascia provides a plane that can be opened, enabling a surgeon to approach structures without entering the peritoneal sac?
Endoabdominal fascia
Describe an abdominal protrusion.
Anything that causes the abdomen to protrude, can be food, feces, fetus, flatus, fat, fluid, ascites (serous fluid), Large mass (tumor, enlarged organ)
What is an umbilical hernia?
A hernia in umbilical ring due to failure to normally close, common in neonates
What is an epigastric hernia?
A hernia through the linea alba. typicall just lobules of fat
What is a Spligelian hernia?
Occur along semilunar line.
Describe a longtiduinal incision.
Midline/ paramedian incisions, good for exploratory operations due to best exposure to viscera, can extend as necessary with minimal complications
Describe a median incision.
Any part of the linea alba, won’t cut any major muscles, BVs, or nerves.
Describe an oblique incision.
(McBurney) 2.5 cm superomedial to the ASIS on the spino-umbilical line
Describe a suprapubic incision.
Horizontal with a slight convexity along pubic hairline (c-section)
Describe a subcostal incision.
parallel but at least 2.5 cm inf to costal margins to avoid the 7th and 8th spinal nerves, access to gallbladder and biliary ducts on R side and spleen on the :
What is a pararectus incision?
Along the lateral border of the rectus sheath
Why is the pararectus incision so high risk?
Risk to cutting nerve supply to RA
Describe an endoscopic procedure.
Minimally invasive, tony perforations, allow entry of instruments (laparoscope)
What makes up the internal surface of the anterolateral abdominal wall?
Transversalis fascia, extraperitoneal fat, parietal peritoneum
What “structure(s)” are exhibited in the infra-umbilical part of the internal surface?
Umbilical folds
How many umbilical fold are there?
- Two median, two lateral, one medial
What are the depressions lateral to the umbilical folds?
Peritoneal fosse
What supra-umbilical structure extends between the superior anterior abdominal wall and liver?
Falciform ligament
What is another term for the inguinal region?
Groin
The inguinal region is a passage from what cavity?
Abdominal
What is the dense band constituting the inferiormost part of the EO aponeurosis?
Inquinal ligament
What structure forms the medial boundary of the subinguinal space, between the superior pubic ramus to tubercle?
Lacunar ligament
What structure runs along the pectin pubis?
Pectineal ligament
What structure is formed by the bypassing of the pubic tubercle and crossing the linea alba to blend with the lower fibers of the EO aponeurosis?
Reflected inguinal ligament
What structure is the thickened inferior margin of the transversalis fascia, appearing as a fibrous band running parallel to posterior to inguinal ligament?
Iliopubic tract
What is the weak area in the inguinal region that is the site of direct and indirect hernias?
Myopectineal orifice
Describe the difference between direct and indirect hernias.
Direct hernias form in the abdominal canal, indirect ones do not
What is formed in relation to the relication of the testis during fetal development?
Inguinal canal
What is the main occupant of the inguinal canal?
Spermatic cord/round ligament of uterus
What muscle aponeourosis forms the inguinal canal?
EO
What are the superficial inguinal rings?
exit by the spermatic cord/round ligament
What are the deep inguinal rings?
Entrance to inguinal canal
What other structures does the inguinal canal contain?
Inguinal nerve, blood and lymphatic vessels
What is a hydrocele in the inguinal region?
Excess fluid in a persistent processus vaginialis, testis, spermatic cord - detection by transillumination
What is a hermatocele of the testis?
Collection of blood in the tunica vaginalis that results from trauma
What is a spermatocele?
Retention cyst in the epidymis
What is an epidymal cyst?
Collection of fluid anywhere in the epidymis
What is a variocele?
varicose vein plexus
What is a thoraco-epigastric vein?
Formed between superior epigastric vein and lateral thoracic vein
What are the two layers of the peritoneum?
Parietal and visceral
What does the parietal peritoneal line?
Abdominal wall
What does the visceral peritoneal line?
Visceral organs
True/False: The peritoneum has separate neurovasculature than the wall lining it.
False, same
What is created in the potential space between the peritoneal layers?
Peritoneal cavity
What surrounds the peritoneal cavity?
peritoneal fluid
What is the double layer of peritoneum that encloses the abdominal organs?
Mesentery
What does the mesentery function to connect?
Organs and body wall
What is the double layer extension/fold of peritoneum that passes from stomach and proximal duodenum to organs in the abdominal cavity?
Omentum
What is the greater omentum?
Prominent, four layered peritoneal fold that connects the stomach to transverse colon
What is the lesser omentum?
Much smaller, double layered peritoneal fold that connect the lesser curvature of the stomach and proximal part of duodenum to the liver
What is the double layer of peritoneum that connect an organs with another to the abdominal wall?
Peritoneal ligament
What connects the liver to the anterior abdominal wall?
Falciform ligament
What connects the liver to the stomach?
Hepatogastric ligament
What connects the liver to the duodenum?
Hepatoduodental ligament
What connects the stomach to the inferior surface of the diaphragm?
Gastrophrenic ligament
What connects the stomach to the spleen?
Gastrosplenic ligament
What connects the stomach to the transverse colon?
Gastrocolic ligament
What is the inflammation of peritoneum?
Peritonitis
Describe peritoneal adhesions.
damage or infection fill with fibrin which changes to fibrous tissue
What is the surgical separation of peritoneal separations?
Adhesiolysis
What is the surgical puncture of the peritoneal cavity for the aspiration or drainage of fluid?
Paracentesis
What is the removal of soluble substances and excess water by the transfer across the peritoneum?
peritoneal dialysis
What is a circumscribed collection of pus in the subphrenic recess?
Abscess
How does an abscess form?
From a perforation of a duodenal ulcer, rupture of gallbladder, or perforation of appendix
What results from an inflamed/injured pancreas in the passage of pancreatic fluid into the bursa?
Pancreatic pseudocyst