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Anatomy > Abdomen > Flashcards

Abdomen Flashcards

1
Q

Name layers of the Anterior Abdomen Wall

A 
• Skin
• Superficial fascia
– Camper (fatty)
– Scarpa (fibrous)
• External oblique
• Internal oblique
• Transversus abdominis
• Transversalis fascia
• Extraperitoneal connective tissue
• Parietal peritoneum
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2
Q

What is femoral sheath?

A

Extension of the transversalis fascia deep
to the inguinal ligament into the thigh containing the femoral artery
and vein and the femoral canal (site of femoral hernia)

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3
Q

Which nerves innervate abdominal wall?

A
  • lower 6 Thoracic spinal nerves

- L1 (ilioinguinal and iliohypogastric branches)

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4
Q

Which arteries supply abdominal wall?

A
  • superior epigastric a. (branch of internal thoracic a.)

- inferior epigastric a. and circumflex iliac a. (branches of external iliac a.)

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5
Q

Which veins drainage abdominal wall?

A
  • superficial epigastric v.
  • lateral thoracic v.
  • great saphenous v.
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6
Q

To which lymph nodes does abdominal lymph drainage?

A
  • axillary nodes

- inguinal nodes

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7
Q

Name the contents of inguinal canal

A

Male:

  • testicular artery
  • pampiniform venous plexus
  • ductus (vas) deferens and its artery
  • autonomic nerves
  • lymphatic duct (to aortic nodes)
  • ilioinguinal nerve (L2)

Female:

  • round ligament of uterus
  • ilioinguinal nerve (L2)
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8
Q

Name the walls of inguinal canal

A
  • superior: int. oblique muscle, transversus muscle
  • inferior: inguinal ligament, lacunar ligament
  • anterior: ext. oblique muscle
  • posterior:
    v Lateral (weak): transversalis fascia
    v Medial: conjoint tendon
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9
Q

Name borders of the inguinal (Hesselbach’s) triangle

A

1) inguinal ligament
2) rectus abdominis m.
3) inferior epigastric artery

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10
Q

Name layers of spermatic cord:

A
  • external spermatic fascia (from external oblique fascia)
  • m. cremaster and fascia (from internal oblique fascia)
  • internal spermatic fascia (from transversalis fascia)
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11
Q

What is the purpose of gubernaculum?

A

It leads testicle to scrotum during its descent

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12
Q

Which nerves maintain cremasteric reflex?

A
  • sensory fibers from ilioinguinal n. (L1)

- motor fibers from genitofemoral n.

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13
Q

Where do cancers of male genitals will metastasize?

A

Testicle cancer will metastasize to aortic nodes; penis and scrotum cancers will metastasize to inguinal nodes

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14
Q

What is processus vaginalis?

A

An evagination of the parietal peritoneum and the peritoneal cavity
extends into the inguinal canal

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15
Q

What is tunica vaginalis?

A

A portion of the processus vaginalis remains patent in the scrotum and
surrounds the testis

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16
Q

What is a reason of congenital inguinal

hernia?

A

Failure of processus vaginalis to fuse. It’s always indirect

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17
Q

What is hydrocele?

A

A collection of serous fluid in the
tunica vaginalis. Doesn’t reduce in size when patient is lying. Is a result of incomplete fusion of processesus vaginalis

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18
Q

What is the site of indirect inguinal hernia?

A

Deep inguinal ring

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19
Q

What is the site of direct inguinal hernia?

A

Weak part of posterior inguinal canal wall

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20
Q

How to distinguish direct and indirect inguinal hernias?

A

1) by inferior epigastric a. (it’s medial to indirect hernia and lateral to direct hernia)
2) compressing superficial ring -> cough -> compressing (blocking) deep ring (if there still is a push under superficial ring it means that hernia can’t go to it site (deep ring) and it’s indirect; if there is no push under superficial ring it means that hernia goes to another location (not deep ring) and it’s direct)

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21
Q

When does varicocele occur?

A

When blood collects in the pampiniform venous

plexus. It enlarges when patient is standing and reduces in size when patient is lying

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22
Q

Name structures, blood supply and innervation of the foregut

A

Structures:

1) Esophagus
2) Stomach
3) Liver
4) Gallbladder
5) Pancreas
6) Duodenum (1 and 2 parts)

Blood supply: celiac trunk

Innervation:

1) Parasympathetic: n. vagus
2) Sympathetic: preganglionic - T5-T9, postganglionic - celiac ganglion

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23
Q

Name structures, blood supply and innervation of the midgut

A

Structures:

1) Duodenum (2, 3, 4 parts)
2) Jejunum
3) Ileum
4) Ceacum
5) Appendix
6) Ascending colon
7) Transverse colon (2/3)

Blood supply: Superior mesenteric artery

Innervation:

1) Parasympathetic: n. Vagus
2) Sympathetic: preganglionic - T9-T12, postganglionic - superior mesenteric ganglion

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24
Q

Name structures, blood supply and innervation of the hindgut

A

Structures:

1) Transverse colon (1/3)
2) Descending colon
3) Sigmoid colon
4) Rectum
5) Anal canal

Blood supply: Inferior mesenteric artery

Innervation:

1) Parasympathetic: pelvic nerves
2) Sympathetic: preganglionic - L1 - L2, postganglionic - inferior mesenteric ganglion

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25
Q

Name Major intraperitoneal organs

A

1) Stomach
2) Liver and gallbladder
3) Pancreas (tail)
4) Duodenum (1st part)
5) Jejunum
6) Ileum
7) Ceacum
8) Appendix
9) Transverse colon
10) Sigmoid colon

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26
Q

Name Major secondary retroperitoneal organs

A

1) Duodenum (2, 3, 4 parts)
2) Pancreas (head, neck and body)
3) Ascending colon
4) Descending colon
5) Rectum (upper part)

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27
Q

Name Major primary retroperitoneal organs

A

1) Kidneys
2) Adrenal glands
3) Ureters
4) Aorta
5) Inferior vena cava
6) Rectum (lower part)
7) Anal canal

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28
Q

How does foregut rotation occur?

A
  • along long axis of gut tube

- 90° (ventral (liver) to the right, dorsal (spleen) to the left

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29
Q

How does midgut rotation occur?

A
  • along superior mesenteric artery

- 270° counterclockwise

30
Q

Name the borders of the epiploic foramen

A
  • Anteriorly: hepatoduodenal ligament and the hepatic portal vein
  • Posteriorly: inferior vena cava
  • Superiorly: caudate lobe of the liver
  • Inferiorly: first part of the duodenum
31
Q

Name congenital abnormalities of the gut tube

A
  • hypertrophic pyloric stenosis (polyhydramnios)
  • extrahepatic biliary atresia
  • annular pancreas (polyhydramnios)
  • duodenal atresia (polyhydramnios)
  • omphalocele (midgut loop doesn’t return to abdominal cavity => stays in umbilical stalk + multiple anomalies => high mortality)
  • Ileal (Meckel’s) diverticulum (from vitelline duct)
  • Vitelline fistula (persistence of vitelline duct)
  • Malrotation of midgut
  • Colonic agangliosis (Hirschsprung)
32
Q

Name the liver lobes

A
  • Left

- Right ( +caudate, +quadrate)

33
Q

Which lacerated ribs could damage the spleen?

A

9, 10, 11 on left side

34
Q

How does pancreas receive blood supply?

A
  • Head of pancreas receives blood supply from superior pancreaticoduodenal artery (from common hepatic artery (branch of celiac trunk)) and from inferior pancreaticoduodenal artery (from superior mesenteric artery)
  • Neck, body and tail of pancreas receive blood supply from splenic artery
35
Q

Name branches of Celiac Trunk

A
  • left gastric artery (supplies lesser curvature of stomach)
  • splenic artery (gives left gastroepiploic artery to greater curvature of stomach, supplies neck, body and tail of pancreas and spleen)
  • common hepatic artery (proper hepatic artery and gastroduodenal artery (head of pancreas, duodenum) -> right gastroepiploic artery (supplies greater curvature)
36
Q

Name branches of Superior Mesenteric Artery

A

1) Inferior pancreaticoduodenal artery (to head of pancreas and duodenum)
2) intestinal arteries
3) ileocolic aretery
4) right colic artery
5) middle colic artery

37
Q

Name branches of Inferior Mesenteric Artery

A

1) Left colic artery
2) Sigmoid artery
3) Superior rectal artery

38
Q

How does venous drainage from abdominal organs occur?

A

From intraperitoneal organs and secondary retroperitoneal organs - by portal system
From primary retroperitoneal organs - by caval system

39
Q

Name chief portocaval anastomosis

A

1) Esophageal (azygos and portal)
2) Rectal (Superior (portal) and inferior (caval) rectal veins)
3) Caput Medusae (paraumbilical veins (portal) and superficial abdominal veins (caval)

40
Q

How to distinguish duodenum, jejunum and ileum (histologically)

A

Duodenum has Brunner’s glands (bicarbonates)
Ileum has Peyer’s patches
Jejunum has nothing

41
Q

Name 3 major salivary glands and their function

A

1) Parotid (serous, opens through Stensen’s duct near 2nd upper molar)
2) Submandibular (serous! + mucous, opens through Warton’s duct near the base of tongue)
3) Sublingual (mucous, opens by many small ducts)

42
Q

How does autonomic nervous system affect salivary glands?

A

1) Parasympathetic: make saliva watery by muscarinic receptors (=> anticholinergic -> dry mouth)
2) Sympathetic: make saliva viscous by beta-adrenergic receptors

43
Q

How many zones does hepatic acinus have? Name their functions

A

Zone 1: closer to triad, most O2, synthesis
Zone 2: between 1 and 3
Zone 3: closer to central vein, susceptible to injury, detoxification

44
Q

From which parts does renal system of embryo consist?

A
  • pronephros (involutes)
  • mesonephros (duct, future ductus defernens in males)
  • metanephros (future kidney)
45
Q

How does kidney develop?

A

Ureteric bud (mesonephric bud’s diverticulum) penetrates the mesonephric mass). They induct each other to grow

46
Q

Which way does urine pass in embryo?

A

mesonephric duct -> cloaca -> allantois -> amniotic fluid -> swallowing -> gut absorption -> passing toxins to mommy

47
Q

How does urinary bladder and urethra develop?

A

Urorectal septum divides hindgut to anorectal canal and urogenital sinus (future urinary bladder and urethra)

48
Q

Which cells produce erythropoietin?

A

Cortex and medullar fibroblasts

49
Q

From which parts does urinary bladder trigone consist?

A

2 ureter, 1 urethra (internal urethral sphincter) and trigone muscle in between

50
Q

How does urinary bladder get blood supply?

A
  • from internal iliac artery and umbilical artery

- to internal iliac vein

51
Q

How does urinary bladder innervate?

A

Parasympathetic: to detrusor m. (in the bladder wall) => stimulation of micturition
Sympathetic: to internal urethral sphincter => suppress micturition
Pudendal nerve to external urethral sphincter

52
Q

What is spastic bladder?

A

lesions above sacral spinal cord level -> loss of inhibition of parasympathetic sacral system by CNS -> detrusor muscle is contracted

53
Q

What is atonic bladder?

A

lesion to sacral spinal cord segments -> loss of parasympathetic innervation -> loss of contraction of detrusor muscle

54
Q

How does ureter pass near the uterus?

A

It passes under uterine artery (“water under the bridge”)

55
Q

From which parts does Pelvic Diaphragm consist?

A
  • m. levator ani

- m. coccyges

56
Q

From which parts does Urogenital Diaphragm consist?

A
  • external urethral sphincter

- transverse perineum muscle

57
Q

Name Perineal Pouches

A
  • superficial PP (between superficial fascia and urogenital diaphragm, consists part of penis and clitoris, Bartholini glands)
  • deep PP (formed by urogenital diaphragm, consists Bulbourethral glands)
58
Q

What are the consequences of injury to the bulb of penis?

A

Extravasation of the urine into superficial perineal space: scrotum, penis, anterior abdominal wall

59
Q

What are the principles of the Embryology of the Reproductive System?

A

1) Gonads develop to:
- male (by TDF): testes, seminiferous tubules, rete testes,
- female: ovary, follicles, rete ovarii

2) Paramesonephric duct:
- male (inhibited by MIF): appendix of testes
- female: uterine tubes, uterus, cervix, upper vagina

3) Mesonephric duct:
- male (by testosterone): epididymis, ductus deferens, seminal vesicle, ejaculatory duct
- female: Duct of Gartner

4) Genital Tubercle:
- male (by DHT): glans and body of penis
- female: clitoris

5) Urogenital folds:
- male (by DHT): ventral part of penis
- female: labia minora

6) Labioscrotal folds:
- male (by DHT): scrotum
- female: labia majora

60
Q

Where are stones in the ureters probably situated?

A 
• Where the renal pelvis joins the
ureter
• Where the ureter crosses the
pelvic inlet
• Where the ureter enters the wall
of the urinary bladder
61
Q

Name congenital Reproductive Anomalies

A

1) Female Pseudointersexuality
- 46, XX
- +ovarian tissue, -testicular
- masculinization of female genitalia
- cause is Congenital Adrenal Hyperplasia

2) Male Pseudointersexuality
- 46, XY
- +testicular tissue, - ovarian tissue
- stunted development of male external genitalia (no DHT)
- cause: 5a-reductase deficiency (gene mutation): it converts testosterone to DHT, which is responsible for development of external male genitalia

3) Complete androgen insensivity
- 46, XY
- testes (in labia majora) + external female genitalia
- female psychosocial orientation
- cause: androgen receptor gene mutation

62
Q

Which way does spermatozoa pass?

A

seminiferous tubules -> ductile efferent -> epididymis -> ductus (vas) deferens -> ejaculatory duct -> urethra

63
Q

How does Erection and Ejaculation occur?

A

Erection: by parasympathetic -> NO releasing -> relaxation of corpus spongiosum and cavernous -> blood accumulation

Ejaculation:

  • sympathetic stimulation of spermatozoa to move from epididymis into the ejaculatory tract
  • pudendal nerve stimulates bulbospongiosus and ischiocavernous muscles to semen ejection
64
Q

What makes follicle ovulate?

A

Luteinizing hormone

65
Q

Which hormone does corpus luteum produce? What does it do?

A

Progesterone; prevents ovulation of next follicle

66
Q

When should physiologic herniation of midgut to umbilical ring occur? When should it return?

A

herniation - 6th week

return - 10th week

67
Q

What’s sliding hiatal hernia and paraesophageal hiatal hernia?

A

Sliding hiatal hernia—gastroesophageal
junction is displaced upward as gastric cardia
slides into hiatus; “hourglass stomach.” Most
common type.
Paraesophageal hiatal hernia—
gastroesophageal junction is usually normal
but gastric fundus protrudes into the thorax

68
Q

What is Potter sequence?

A

Babies who can’t “Pee” in utero develop Potter
sequence.

POTTER sequence associated with:
Pulmonary hypoplasia
Oligohydramnios (trigger)
Twisted face
Twisted skin
Extremity defects
Renal failure (in utero)
69
Q

How does twinning occur?

A

Dizygotic (“fraternal”) twins arise from 2 eggs that are separately fertilized by 2 different sperm
(always 2 zygotes) and will have 2 separate amniotic sacs and 2 separate placentas (chorions).
Monozygotic (“identical”) twins arise from 1 fertilized egg (1 egg + 1 sperm) that splits in early
pregnancy. The timing of cleavage determines chorionicity (number of chorions) and amnionicity
(number of amnions) (SCAB):
ƒ Cleavage 0–4 days: Separate chorion and amnion
ƒ Cleavage 4–8 days: shared Chorion
ƒ Cleavage 8–12 days: shared Amnion
ƒ Cleavage 13+ days: shared Body (conjoined)

70
Q

What are the clinical presentations of anterior and posterior urethral injuries?

A

anterior: blood in scrotum
posterior: blood in abdomen, HIGH-RIDING PROSTATE

Anatomy (6 decks)

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