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
how does the shape of the stomach change depending on body type
shorter, wider people tend to have a stomach sitting higher in their abdomen that is more rounded
taller, thinner people tend to have a lower hanging stomach that is j-shaped
structures anterior to the stomach
transverse colon
structures posterior to the stomach
pancreas spleen top pole of left kidney 1st part of duodenum left suprarenal gland
branches of the coeliac axis
left gastric
common hepatic
splenic artery
structures supplied by left gastric a.
lesser curvature of stomach
structures supplied by the common hepatic a.
liver, gall bladder, parts of stomach
structures supplied by the splenic a.
spleen
parts of stomach
pancreas
duodenum
arterial supply to the lesser curvature of the stomach
right gastric (branch of hepatic artery) left gastric (branch of coeliac axis) <>
arterial supply to fundus of stomach
short gastric artery (branch of splenic)
arterial supply to greater curvature of stomach
right gastroepiploic (gastroduodenal from common hepatic artery) left gastroepiploic (from splenic artery)
venous drainage of lesser curvature of stomach
gastric veins to hepatic portal vein
venous drainage of greater curvature of stomach
left gastroepiploic into splenic vein, then portal vein
right gastroepiploic vein to superior mesenteric vein, then portal vein
venous drainage of fundus of stomach
short gastric vein, to splenic vein, to portal ven
lymphatic drainage of stomach
small nodes:
cardiac ring around entrance to oesophagus, gastro-mental, gastric, pyloric, pancreaticosplenic and pancreaticoduodenal nodes
important nodes: coeliac nodes (pre-aortic T12)
autonomic innervation of the stomach
coeliac plexus
parasympathetic innervation of stomach
anterior and posterior vagal trunks
sympathetic innervation of stomach
greater splanchnic nerve to coeliac plexus
which parts of the duodenum are intra-peritoneal and why
the first part
- attaches to the stomach so needs to be able to move with it as it contracts
the last (4th) part
- attaches to the small intestine which is attached to a mesentery so needs more movement
describe the 4 parts of the duodenum
1st part duodenal cap, intraperitoneal
2nd part descending, retroperitoneal
3rd part, transverse, retroperitoneal
4th part, ascending, intraperitoneal
in which part of the duodenum is the entrance of the bile and pancreatic ducts
2nd part (descending)
what are the folds of the duodenum called
plicae circularis
what is the name given to the union of the common bile duct and main pancreatic duct
hepatopancreatic ampulla (of Vater)
what is the name of the structure that controls the flow of pancreatic and bile fluids onto the duodenum
sphincter of Oddi
at which level is the start of the duodenum located
transpyloric plane (L1/2)
what is the approximate location of the duodenal jejunal junction
3 cm to left of midline
structures related to the 1st part of the duodenum
liver gall bladder bile duct portal vein IVC
structures related to the 2nd part of the duodenum
transverse colon
right kidney and ureter
pancreas
structures related to the 3rd part of the duodenum
superior mesenteric vessels jejunum right ureter right poses IVC aorta pancreas
structures related to the 4th part of the duodenum
root of mesentery
jejunum
aorta
left psoas
arterial supply of duodenum
proximal:
superior pancreaticoduodenal artery (branch of gastroduodenal –> common hepatic)
distal:
inferior pancreaticoduodenal artery (branch of SMA)
venous drainage of duodenum
proximal:
superior pancreaticoduodenal vein to portal vein
distal:
inferior pancreaticoduodenal vein to superior mesenteric vein then portal vein
innervation to duodenum
sympathetic: greater and lesser splanchnic nerves
parasympathetic: vagal trunks
where is pain from the duodenum referred to
epigastric region
describe lymph drainage from the duodenum
proximal:
pre-aortic coeliac axis nodes at T12
distal:
pre-aortic superior mesenteric nodes at L1
lobes of the liver
anteriorly: right and left lobe posteriorly: quadrate lobe caudate lobe
which ligaments are visible anteriorly on the liver
falciform ligament (between left and right lobes) ligamentum teres (remnant of umbilical vein)
what is the porta hepatis
point where structures enter the liver
which structures are present in the porta hepatis
right and left hepatic ducts hepatic arteries portal vein ANS fibres lymph nodes
which structures are carried to the porta hepatis in the lesser edge of the lesser omentum
common bile duct
hepatic artery
portal vein
where are the hepatic veins
within the liver
drain into the IVC
which structures are associated with the anterior surface of liver
ribs and costal cartilages
which structures are associated with the posterior surface of the liver
oesophagus stomach duodenum right colic flexure right kidney right suprarenal gland gall bladder
which structures are associated with the superior surface of the liver
diaphragm
what are the surface markings of the gall bladder
9th costal cartilage, right midclavicular line
what are the surface markings of the superior border of the liver
between ribs 5-6
why is there a bare area on the liver
the part of the liver in contact with the diaphragm is not covered in peritoneum
what are the falciform, right and left triangular ligaments made of
folds of peritoneum
arterial blood supply to liver
hepatic artery
describe blood flow through liver
blood supplied to liver by hepatic artery and portal vein
arterial and venous blood conducted to central vein of each liver lobule by sinusoids
central veins drain into right and left hepatic veins (often up to four)
hepatic veins drain into IVC
lymph drainage of liver
nodes at porta hepatis –> coeliac nodes (T12)
small amount passes through diaphragm to posterior mediastinum
autonomic innervation of liver
coeliac plexus
sympathetic: greater splanchnic
parasympathetic: vagal trunks
where is pain from the liver referred to
epigastric region
right shoulder if diaphragmatic irritation
what is another name for the sphincter of Oddi
major duodenal papilla
parts of the gall bladder
superior neck (connected to cystic duct)
body (in contact with posterior surface of liver)
fundus (hangs below level of liver)
how does bile and the gallbladder aid in digestion
fat in the duodenum causes release of cholecystokinin from the small intestine mucosa
causes gall bladder to contract
smooth muscle in distal bile duct and ampulla relaxes to allow bile to enter the duodenum
bile emulsifies fat
arterial supply of gall bladder
cystic artery (branch of right hepatic artery)
venous drainage of gallbladder
cystic vein drains to portal vein
lymph drainage of gallbladder
cystic nodes –> hepatic nodes –> coeliac nodes
innervation of gallbladder
coeliac plexus
where is pain from the gall bladder referred to
epigastric region
parts of the pancreas
head (uncinate process posteriorly)
neck
body
tail
where is the head of the pancreas located
in the curvature of the duodenum
which vessel is posterior to the neck of the pancreas
superior mesenteric artery
in which ligament is the tail of the pancreas located
leinorenal ligament
which artery runs along the superior border of the pancreas
splenic
which structures are anterior to the pancreas
transverse colon
stomach
which structures are posterior to the pancreas
bile duct portal vein splenic vein IVC aorta SMA left posts left suprarenal gland left kidney spleen
what is the course of the main pancreatic duct
from the tail to the ampulla of vater
if present, what is the course of the accessory pancreatic duct
drains into the upper part of the head and into the duodenum (superior to ampulla of vater)
arterial supply of pancreas
right side:
superior pancreaticoduodenal artery (common hepatic, CA)
inferior pancreaticoduodenal artery (SMA)
left side:
dorsal pancreatic artery (splenic, CA)
venous drainage of pancreas
splenic or superior mesenteric veins –> portal system
lymphatic drainage of pancreas
coeliac (T12) and superior mesenteric (L1) pre-aortic nodes
innervation of pancreas
coeliac and superior mesenteric plexuses
surface markings of spleen
deep to ribs 9-11 in left hypochondrium
which vessels are carried in the gastrosplenic ligament
short gastric
L. gastro-epiploic
arterial supply to spleen
splenic artery –> CA
venous drainage of spleen
inferior mesenteric vein –> splenic vein –> superior mesenteric vein –> portal vein
innervation of spleen
coeliac plexus
which structures are classed as midgut
distal 1/2 duodenum jejunum ileum caecum appendix ascending colon proximal 2/3 of transverse colon (not including splenic flexure)
what is the arterial supply of midgut structures
superior mesenteric artery
which structures are classed as hindgut
distal 2/3 transverse colon descending colon sigmoid colon rectum anal canal
what is the arterial supply of hindgut structures
inferior mesenteric artery
difference in appearance between jejunum and ileum
jejunum = upper, red ileum = lower, pale
difference in wall of jejunum and ileum
jejunum = thicker, more plicae circularis ileum = thinner, less plicae
difference in bore of jejunum and ileum
jejunum = wider ileum = narrower
difference in mesenteric vessels of jejunum and ileum
jejunum = 1 or 2 arcades, long branches to wall ileum = 3 or 4 arcades, many short branches to wall
difference in adipose tissue of jejunum and ileum
jejunum = most near root of mesentery ileum = all through mesentery
difference in lymphoid tissue in jejunum and ileum
jejunum = small amount ileum = numerous Peter's patches
arterial supply of small intestine
mostly jejunal and ill branches from SMA
lower parts of ileum by ileocolic arteries
venous drainage of small intestine
to superior mesenteric veins
lymph drainage of small intestine
mesenteric nodes –> pre-aortic nodes at superior mesenteric artery (L1)
innervation of small intestine
superior mesenteric ganglion
pain from small intestine is referred where
umbilical region
features unique to large intestine
haustra = sacculation of body wall
appendices epiploicae = fatty tags
teniae coli = longitudinal muscles collected into 3 bands
structures related to caecum
small intestine
psoas
iliacus
arterial supply of caecum
caecal arteries from ileocolic artery (SMA)
anterior and posterior caecal arteries
venous drainage of caecum
SMV
lymphatic drainage of caecum
mesenteric –> superior mesenteric nodes
innervation of caecum
superior mesenteric plexus
how is the appendix attached to the body wall
small mesoappendix mesentery
where is MacBurney’s point
1/3 along line from ASIS to umbilicus
blood supply to appendix
appendicular artery (from either caecal artery or directly from ileocolic artery)
venous drainage of appendix
posterior caecal vein
where is pain from appendix referred to
umbilicus
until inflammation reaches body wall –> MacBurney’s point
the ascending colon is intraperitoneal/retropertioneal
retroperitoneal
structures related to ascending colon
small intestine greater omentum iliacus iliac crest quadratus lumborum right kidney ilioinguinal and iliohypogastric nerves
blood supply to ascending colon
ileocoloc and right colic branches of SMA
venous drainage of ascending colon
superior mesenteric vein via ileocolic and right colic veins
lymph drainage of ascending colon
superior mesenteric nodes (L1)
nerve supply of ascending colon
ANS from superior mesenteric plexus
how is transverse colon attached to body wall
transverse mesocolon
relations of transverse colon
greater omentum
pancreas
small intestine
blood supply of transverse colon
proximal: middle colic artery (SMA)
distal: left colic (IMA)
<>
venous drainage of transverse colon
proximal: superior mesenteric veins
distal: inferior mesenteric veins
lymph drainage of transverse colon
proximal: superior mesenteric nodes
distal: inferior mesenteric nodes
innervation of transverse colon
ANS: superior and inferior mesenteric plexuses
parasympathetic: vagus (proximal) and pelvis (distal)
relations of descending colon
small intestine greater omentum left kidney Quadratus lumborum psoas femoral, ilioinguinal and iliohypogastric nerves
blood supply of descending colon
left colic and sigmoid arteries (IMA)
venous drainage of descending colon
inferior mesenteric –> splenic vein –> portal vein
innervation of descending colon
sympathetic = inferior mesenteric plexus parasympathetic = pelvis
how is sigmoid colon attached to body wall
pelvic mesocolon
relations of sigmoid colon
urinary bladder (M)
uterus/vagina (F)
rectum, sacrum (both)
arterial supply to sigmoid colon
sigmoidal branches of L colic artery (IMA)
innervation of sigmoid colon
ANS from inferior hypogastric plexus
arterial supply of rectum
superior rectal artery (IMA)
middle rectal artery (internal iliac)
inferior rectal artery (internal pudendal)
venous drainage of rectum
superior to portal system via IMV
middle and inferior veins to internal iliac and internal pudendal veins
lymph drainage of rectum
upper to inferior mesenteric nodes
lower to nternal iliac nodes
innervation of rectum
inferior hypogastric plexus
define retroperitoneal
lies posterior to parietal peritoneum
what is the difference between primary and secondary retroperitoneal structures
primary: develops behind the peritoneum, has always been attached to body wall
secondary: develops within the body wall totally covered by peritoneum and moves to body wall by end of development
primary retroperitoneal structures
4
kidneys
suprarenal glands
vessels
nerves
secondary retroperitoneal structures
5
2nd/3rd parts of duodenum pancreas ascending colon descending colon upper 2/3 rectum
which ribs protect the kidneys
left kidney: 11/12
right kidney: 12
anterior relations of right kidney
4
suprarenal gland
liver
2nd part of duodenum
right colic (hepatic) flexure
posterior relations of right kidney
6
diaphragm rib 12 psoas Quadratus lumborum transversus abdominis subcostal nerve
anterior relations of left kidney
6
suprarenal gland spleen stomach pancreas left colic (splenic) flexure jejunum
posterior relations of left kidney
6
diaphragm ribs 11/12 psoas Quadratus lumborum transversus abdominis subcostal nerve
structures in the renal hilum
renal vein renal artery renal pelvis (and ureter) lymph sympathetic fibres
in which renal vein is variation more common and why
left renal vein
longer and more communications
where do the renal arteries branch from the aorta
L1
bilateral
how do the renal arteries branch when they reach the kidney
anterior and posterior branches, then segmental branches
what are the segmental branches of the renal arteries
anterior: apical, upper, middle, lower
posterior
describe the course of the right renal artery
longer than left
passes posterior to IVC
describe the course of the right renal vein
shorter than left
passes behind the descending duodenum
describe the course of the left renal vein
longer than right
travels over aorta and under SMA
passes behind splenic vein and body of pancreas
which veins drain into the left renal vein
left gonadal
left suprarenal
where do the kidney receive their nerve supply from
renal sympathetic plexus
lesser and least splanchnic nerves
where do afferent fibres from the kidney meet the spinal cord
T10-12
where does lymph from the kidneys drain
lateral aortic nodes at origin of renal artery (L1)
describe the course of the ureters
runs vertically from hilum on surface of psoas
crosses bifurcation of common iliac anterior to SI joint
runs on lateral wall of pelvis towards ischial spine
enters inferior surface of bladder at trigone
where are the three natural constrictions of the ureters
at junction with renal pelvis
as it crosses pelvis brim
as they enter bladder
describe the arterial supply of the ureters
superior: renal artery
middle: gonadal artery (l2)
inferior: superior vesical artery (one in pelvis)
describe venous drainage of ureters
superior: renal veins
middle: gonadal veins
inferior: vesical veins
where does lymph from the ureters drain
lateral aortic (L1) nodes iliac nodes
what is the nerve supply of the ureters
renal, gonadal and hypogastric plexuses
where does pain from the ureters refer
groin pain
what shapes are the suprarenal glands
right = pyramidal left = crescentic
arterial supply of suprarenal glands
superior = suprarenal branch of inferior phrenic artery middle = suprarenal artery (branch of aorta) inferior = suprarenal branch of renal artery
venous drainage of suprarenal glands
single vein on each side
right to IVC
left to renal vein
how is the fascia of the posterior abdominal wall named
after the muscles is covers
eg fascia over Quadratus lumborum
the fascia below the arcuate line is called…
transversals fascia
attachments of Quadratus lumborum
iliac crest to 12th rib and L1-4 transverse processes
action of quad lumborum
unilateral = lateral flexion bilateral = pressure, forced expiration, support of 12th rib
innervation of quad lumborum
anterior rami T12-L4
attachments of iliacus
iliac fossa (joins with posts to form Iliopsoas) to lesser trochanter
action of iliacus
hip flexion
innervation of iliacus
femoral nerve
attachments of psoas
T12-L4 bodies and IV disc (superficial) and L1-5 (deep) to lesser trochanter (joins iliacus)
innervation of psoas
lumbar plexus direct branches from L2-4
muscles within the abdominal cavity are innervated by anterior/posterior rami
anterior rami
posterior rami for muscles of the back
what is the lateral accurate ligament
thickening of fascia over Quadratus lumborum
what are he two divisions of psoas
minor (superficial, long tendon)
major (deep)
what is the medial arcuate ligament
thickening of the fascia over psoas
which levels does the right crus attach
L1-3
which levels does the left crus of diaphragm attach
L1-2
which branch of the abdominal aorta supplies the diaphragm
inferior phrenic
at which level does the aorta bifurcate
L4
what are the anterior branches of the abdominal aorta
coeliac axis
SMA
IMA
lateral branches of the abdominal aorta
real arteries
gonadal arteries
middle suprarenal artery
posterior branches of abdominal aorta
lumbar arteries
which structures drain into the IVC
body wall
diaphragm
suprarenal glands
right gonadal vein
where do the digestive organs drain blood to
portal vein NOT IVC
at which level is the IVC formed, and by the union of which vessels
L5
union of common iliac veins
where do the ascending lumbar veins arise, and what is their course/purpose
from external iliac
run upwards to join the azygous system, sometimes communicating with the renal veins
provides collateral venous drainage
where do the lumbar veins normally drain
L1/2 into ascending lumbar vein (superiorly)
L3/4 into IVC
L5 into iliolumbar vein (then common iliac) or ascending lumbar (inferiorly)
what are the main ganglia in the abdomen
coeliac
superior mesenteric
inferior mesenteric
superior/inferior hypogastric
describe the parasympathetic innervation of the abdominal ganglia
posterior vagal trunks to coeliac plexus and superior mesenteric ganglia
pelvic parasympathetic fibres (S2-3/4) to inferior mesenteric and superior/inferior hypogastric ganglia
where does lymph from the pelvis drain
iliac nodes
lymph from which structures drains to para-aortic (lateral) nodes
body wall
kidneys
testes/ovaries
lymph from which structures drain to pre-aortic nodes
digestive tract
includes coeliac, superior mesenteric and inferior mesenteric nodes
which level is the cisterns chill at
L1/2
the cistern chill is the start of which structure
thoracic duct
the lumbar plexus is made up of which nerve roots
L1-4
the branches of the lumbar plexus can all be identified in relation to which muscle
psoas
roots of iliohypogastric nerve
L1
sensory innervation of iliohypogastric nerve
lateral gluteal skin
pubic skin
motor innervation of iliohypogastric nerve
internal oblique
transversus abdominis
nerve roots of ilioinguinal nerve
L1
sensory innervation of ilioinguinal nerve
medial thigh
root of penis/scortum or mons pubis/labium magus
nerve roots of genitofemoral nerve
L1/2
sensory innervation of genitofemoral nerve
scrotum or mons pubis
upper anterior thigh
motor innervation of genitofemoral nerve
cremasteric muscle
where does the genitofemoral nerve lie in relation to psoas
runs on the surface of psoas
roots of lateral cutaneous nerve of thigh
L2/3
sensory innervation of lateral cutaneous nerve of thigh
skin on anterior and lateral thigh
roots of femoral nerve
L2-4
motor innervation of femoral nerve
pectineus
iliacus
anterior compartment of thigh
which branch of femoral nerve supplies the leg
saphenous nerve
sensory innervation of femoral nerve
skin on anterior thigh and medial leg
roots of obturator
L2-4
sensory innervation of obturator
medial thigh
motor innervation of obturator nerve
obturator externus
medial compartment of thigh
sometimes pectineus
