Abdomen Flashcards
which planes divide the abdomen into quadrants
median plane
trans umbilical plane
which planes divide the abdomen into regions
mid-clavicular lines vertically
subcostal and trans tubercular lines horizontally
what are the abdominal regions
right and left hypochondrium epigastric right and left lumbar umbilical right and left inguinal suprapubic
what are the layers of the abdominal wall
skin superficial fascia muscle deep fascia extraperitoneal fascia parietal peritoneum
what are the two layers of superficial fascia below the umbilicus
campers fascia
scarpas fascia
what are the characteristics of campers/scarpas fascia
campers = fatty scarpas = membranous
________ fascia is continuous over inguinal ligament and into fascia of thigh and peritoneum
campers fascia
which structure continuous with the fascia of the penis in males and fascia of the labia majora in females
campers fascia
describe campers fascia as a structure contributing to the male external genitalia
loses the fatty layer and fuses with deeper later of superficial fascia to become the dartos muscle of the scrotum
what are the attachments of scarpas fascia
pubic symphysis and linea alba
what does scarpas fascia fuse with below the inguinal ligament
fuses with the fascia of the thigh to form fascia late
which male genital structures does the scarpas fascia contribute to
fascia of penis
dartos fascia of scrotum
fungiform ligament of penis
which female genital structures does the scarpas fascia contribute to
labia majora
where do the fibres of external oblique run from and to
from ribs 5-12 to iliac crest and linea alba
which direction to the fibres of external oblique travel
inferomedially
hands in pockets
attachments of the aponeurosis of external oblique
linea alba from xiphoid to pubic symphysis
which structure is formed by the inferior border of external oblique
inguinal ligament
action of external oblique
bilateral contraction = flexion of trunk
unilateral contraction = lateral flexion of trunk
external oblique forms which aspect of the rectus sheath
anterior wall
innervation of external oblique
anterior rami T7-12
where do fibres of internal oblique run from and to
from thoracolumbar fascia, inguinal ligament and iliac crest to ribs 9-12
direction of fibres of internal oblique
superomedial
action of internal oblique
bilateral contraction = flexion of trunk
unilateral contraction = lateral flexion of trunk
innervation of internal oblique
T7-12 and L1
direction of fibres of transversus abdominis
transverse
attachments of transversus abdomens
thoracolumbar fascia, iliac crest, inguinal ligament, costal cartilages of ribs 7-12 to linea alba, pubic crest and pectineal line
innervation of transversus abdominis
T7-12, L1
attachments of rectus abdominis
pubic tubercle, crest and symphysis to diploid process and costal cartilages of ribs 5-7
action of rectus abdominis
flexion of trunk
support/compression of abdominal wall
innervation of rectus abdominis
T7-12
which blood vessels travel on posterior of rectus sheath
inferior epigastric
which muscle is part of the abdominal wall but is often absent
pyramidalis
attachments of pyramidalis
pubis to linea alba
action of pyramidalis
tenses linea alba
innervation of linea alba
anterior rams T12
which structures form the anterior wall of rectus sheath above the umbilicus
external oblique aponeurosis
superficial layer of internal oblique aponeurosis
which structures form the posterior wall of rectus sheath above the umbilicus
deep later of internal oblique aponeurosis
transversus abdominis fascia
which structures form the anterior wall of the rectus sheath below the umbilicus
all of the aponeuroses
internal oblique, and both layers of internal oblique
which structures form the posterior wall of the rectus sheath below the umbilicus
transversalis fascia
which structure marks the transition of the structures of the anterior wall of rectus sheath
arcuate line
what is the median umbilical ligament
urachus remnant
what is the medial umbilical ligament
umbilical artery remnant
what is contained in the lateral umbilical fold
inferior epigastric vessels
where do superficial epigastric veins drain
femoral vein
thoracoepigastric vein drains where
axillary vein superiorly and femoral vein inferiorly
the musculophrenic artery is a branch of which artery
internal thoracic
the superficial epigastric artery and superficial circumflex iliac artery are branches of which artery
femoral artery
which nerves provide innervation to superficial abdominal wall
lateral cutaneous branches 6-12 intercostal nerve and iliohypogastric (L1)
anterior cutaneous branches of 6-12 intercostal nerves
where do the lumbar arteries arise from
abdominal aorta
where does the deep circumflex iliac artery arise from
femoral artery
where does they inferior epigastric artery arise from
external iliac artery, just before it turns into femoral artery
which nerves supply the deep aspect of abdominal wall
iliohypogastric nerve
ilioinguinal nerve
which areas of abdominal wall drain into superficial inguinal lymph nodes
bit of thigh
bit of anterolateral wall below umbilicus
which areas of abdominal wall drain into axillary nodes
above umbilicus (superficial)
describe the flow of lymph in the deep aspects of abdominal wall
via abdominal aorta to lumbar nodes
or via external iliac artery to external iliac nodes
then via internal thoracic to parasternal nodes
which nerves supply the skin, muscle and parietal peritoneum of the anterolateral abdominal wall
T7-11 (intercostal), T12 (subcostal) L1 (iliohypogastric and ilioinguinal)
all anterior rami
which structures are present in the inguinal canal in males
spermatic cord
ilioinguinal nerve
which structures are present in the inguinal canal of females
round ligament of uterus
ilioinguinal nerve
which structure in the inguinal canal passes through the superficial ring but not the deep ring
ilioinguinal nerve
pierces the internal oblique to enter the canal
describe the superficial ring of the inguinal canal
triangular shaped defect in the aponeurosis of external oblique
what are the margins of the superficial ring of inguinal canal
medial and lateral crura
describe the deep ring of inguinal canal
oval opening in the transversalis fascia
halfway between the ASIS and pubic symphysis
which vessels lie medially to deep ring
inferior epigastric vessels
which structure gives origin of the internal spermatic fascia
deep ring (transversalis fascia)
what forms the anterior wall of inguinal canal
aponeurosis of external oblique
internal oblique in lateral third
why does internal oblique contribute to the anterior wall of inguinal in the lateral third
to give further protection anterior to the weakening as the opening of the deep ring
what forms the floor of the inguinal canal
inferior rolled edge of external oblique aponeurosis and medially the lacunar ligament
what forms the roof of the inguinal canal
fibres of internal oblique and transversus abdominis
which nerves pierce through internal oblique to enter the inguinal canal
ilioinguinal and iliohypogastric
what forms the posterior wall of the inguinal canal
transversalis fascia plus conjoint tendon in medial third
what is the conjoint tendon and what is its function in the posterior wall of the inguinal canal
common insertion of internal oblique and transversus abominis to pubic crest and pectineal line
strengthens the canal behind the opening of superficial ring in anterior wall
which ligament extends from the medial end of the inguinal ligament
lacunar ligament
describe the lacunar ligament
extends superiorly and posteriorly from medial end of inguinal ligament
attaches to pectineal line n superior pubic rams
the free edge of the lacunar ligament forms which structure
medial margin of femoral ring
how is the weakness in the abdominal wall created by the inguinal canal protected
oblique passage makes it harder of abdominal cavity contents to pass through it
strengthened areas corresponding to deep and superficial rings
increased abdominal pressure causes muscles to contract and flatten the canal
squatting position in defecation closes the canal as thighs press into abdominal wall
indirect vs direct hernia
indirect = inguinal canal entered via the deep ring (normally due to congenital weakness) direct = pushed through weak spot directly out of superficial ring
what are the three layers of spermatic cord fibres and the structures they originate from
internal spermatic fascia (transversalis fascia) cremasteric fascia (internal oblique) external spermatic fascia (external oblique aponeurosis)
where does the spermatic cord originate
deep inguinal ring
what is contained in the sporadic cord
vas deferens testicular artery testicular veins lymph vessels autonomic nerves cremasteric artery artery of vas deferens genital branch of genitofemoral nerve
at which level do the gonadal arteries branch from the abdominal aorta
L2
where do the testicular veins drain
Right to IVC
left to left renal vein
where does lymph from the testes drain
paraaortic nodes
where does the cremasteric artery arise from
inferior epigastric
what does the cremasteric artery supply
cremasteric fascia
where does the artery of vas deferens arise
inferior vesical artery
what does the genital bench of genitofemoral nerve supply in the spermatic cord
cremaster muscle
how does the superficial fascia of the scrotum differ from the abdominal wall
fat replaced with dartos muscle
what is scarpas fascia called in the scrotum
colles’
what are the attachment of colles’ fascia in the scrotum
perineal body and membrane
ischiopubic rami
what is the function o the cremaster muscle
raises testes and scrotum to control temperature
what is the tunica vaginalis the remains of
processus vaginalis
the seminiferous tubules open into which structure
rete testes
how are the retentions testes connected to the epididymis
efferent ductules
testes and epididymis drain lymph to
para-aortic nodes
scrotal wall and fascia drain lymph to
superficial inguinal nodes
what is the mesentery
double fold of peritoneum
which modalities is parietal peritoneum sensitive to
pain
touch
temperature
pressure
which nerves supply the parietal peritoneum
lateral and anterior walls by the lower 6 thoracic nerve
central part by phrenic nerves
pelvic part by obturator
what is the visceral peritoneum sensitive to
stretch
which type of nerve fibres are present in the visceral peritoneum
ANS afferent fibres
what does intraperitoneal mean
organ is totally surrounded by visceral peritoneum and attached to body wall via a mesentery
examples of intraperitoneal organs
stomach gall bladder small intestine (only 1st part of duodenum) spleen liver caecum transverse colon sigmoid colon
what does retroperitoneal mean
partially covered in peritoneum
what is the difference between primary and secondary retro-peritoneal organs
primary = no mesentery
ever
secondary = mesentery lost in development
examples of primary retroperitoneal organs
kidneys
suprarenal glands
examples of secondary retroperitoneal organs
2, 3, 4th parts of duodenum
pancreas
ascending and descending colon
upper 2/3rd rectum
what does infraperitoneal mean
below the peritoneum
in the pelvic cavity
what are the attachments of the greater omentum
greater curvature of the stomach
anterior surface of transverse colon
describe how the greater omentum functions as the ‘policeman of the abdomen’
the omentum is usually spread out across the anterior surface of the intestines by the movement of the intestine underneath
if part of the intestine is unhealthy, it is less motile so the omentum tends to gather over this area, as it is not moved away
if it remains static, over time it will form adhesions, which block off the area from the rest of the cavity, preventing spread of infection etc
how many layers are present in the omentum
4 layers
double layer of peritoneum
how is the transverse colon attached to the body wall
transverse mesocolon
which two compartments does the transverse mesocolon split the abdominal cavity into
supracolic (liver, gall bladder, stomach) infra colic (intestines)
which vessels are found in the superior border of the greater omentum and which structure do they supply
left and right gastro-epiploic arteries (and veins)
supply the greater curvature of the stomach
where do the gastro-epiploic arteries originate
right = hepatic artery
left = splenic artery
both branches of coeliac axis
what is the lesser sac also known as
omental bursa
what is the lesser sac
portion of the peritoneal cavity behind the lesser omentum and stomach
where does the lesser omentum extend from
lesser curvature of stomach
how many layers in the lesser omentum
2
what is the function of the lesser omentum
communication between stomach and porto-hepatic
what is located at the free edge of the lesser omentum
omental/epiploic foramen
what structures are contained within the free edge of the lesser omentum
hepatic artery (left, anterior) bile duct (right, anterior) portal vein (posterior)
what are the boundaries of the epiploic foramen
anterior = lesser omentum and its contained structures posterior = inferior vena cava superior = liver
what is contained in the mesentery
blood vessels
autonomic nerve
lymphatics
fat
which blood vessels supply the mesentery proper
superior mesenteric artery/vein
what is the function of the mesentery proper
allows movement of small intestine required for peristalsis
examples of mesenteries in the abdominal cavities
transverse mesocolon
sigmoid colon mesentery
vermiform appendix mesentery
blood supply of transverse colon (within the transverse mesocolon)
marginal artery
which structures are included in the foregut
6
distal oesophagus stomach liver spleen proximal duodenum part of pancreas
arterial supply of foregut structures
coeliac axis (aorta T12)
venous drainage of foregut structures
portal vein
lymphatic drainage of foregut structures
pre-aortic nodes at T12 (coeliac nodes)
the stomach is retro-peritoneal/intra-peritoneal
intra-peritoneal
which structure extends from the lesser curvature of the stomach
lesser omentum
which structure extends from the greater curvature of the stomach
greater omentum
what are the layers of the stomach wall
serosa
muscularis externa
submucosa
mucosa
what are the layers of the muscularis externa of the stomach
outer longitudinal layer
middle circular layer
inner oblique layer
what is the function of the differently orientated muscle fibres of the stomach
to allow the stomach to contract in all directions to churn food up with acid n whatnot
what are the main areas of the stomach
oesophageal region fundus body pyloric antrum pyloric valve
what are the two notches located in the stomach and where are they located
cardiac notch
- located between the oesophageal opening and fundus
angular notch
- in the lesser curvature of stomach
what is the name given to the fold on the internal surface of the stomach
rugae