Abdomen Flashcards
Contents of the spermatic cord?
The spermatic cord has a number of important structures that run to and from the testis.
Blood vessels:
Testicular artery – branch of the aorta that arises just inferiorly to the renal arteries.
Cremasteric artery and vein – supplies the cremasteric fascia and muscle.
Artery to the vas deferens – branch of the inferior vesicle artery, which arises from the internal iliac.
Pampiniform plexus of testicular veins – drains venous blood from the testes into the testicular vein.
Nerves:
Genital branch of the genitofemoral nerve – supplies the cremaster muscle.
Autonomic nerves
Other structures:
Vas deferens – the duct that transports sperm from the epididymis to the ampulla (a dilated terminal part of the duct), ready for ejaculation.
Processus vaginalis – projection of peritoneum that forms the pathway of descent for the testes during embryonic development. In the adult, it is fused shut.
Lymph vessels – these drain into the para-aortic nodes, located in the lumbar region.
Hesselbach’s triangle borders?
The inguinal triangle is located within the inferomedial aspect of the abdominal wall. It has the following boundaries:
Medial – lateral border of the rectus abdominis muscle.
Lateral – inferior epigastric vessels.
Inferior – inguinal ligament.
the triangle does demarcate an area of potential weakness in the abdominal wall – through which herniation of the abdominal contents can occur
Borders of Inguinal canal?
Anterior wall – aponeurosis of the external oblique, reinforced by the internal oblique muscle laterally.
Posterior wall – transversalis fascia.
Roof – transversalis fascia, internal oblique, and transversus abdominis.
Floor – inguinal ligament (a ‘rolled up’ portion of the external oblique aponeurosis), thickened medially by the lacunar ligament.
contents of inguinal canal?
Spermatic cord (biological males only) – contains neurovascular and reproductive structures that supply and drain the testes. See here for more information.
Round ligament (biological females only) – originates from the uterine horn and travels through the inguinal canal to attach at the labia majora.
Ilioinguinal nerve – contributes towards the sensory innervation of the genitalia
Note: only travels through part of the inguinal canal, exiting via the superficial inguinal ring (it does not pass through the deep inguinal ring)
This is the nerve most at risk of damage during an inguinal hernia repair.
Genital branch of the genitofemoral nerve – supplies the cremaster muscle and anterior scrotal skin in males, and the skin of the mons pubis and labia majora in females.
The walls of the inguinal canal are usually collapsed around their contents, preventing other structures from potentially entering the canal and becoming stuck.
Retroperitoneal structures?
Hint: SAD PUCKER
S: suprarenal (adrenal) gland A: aorta/IVC D: duodenum (second and third part) P: pancreas (except tail) U: ureters C: colon (ascending and descending) K: kidneys E: (o)oesophagus R: rectum
Abdominal aorta terminates at?
L4
Branches of abdominal aorta?
In descending order:
Inferior phrenic arteries: Paired parietal arteries arising posteriorly at the level of T12. They supply the diaphragm.
Coeliac artery: A large, unpaired visceral artery arising anteriorly at the level of T12. It is also known as the celiac trunk and supplies the liver, stomach, abdominal oesophagus, spleen, the superior duodenum and the superior pancreas.
Superior mesenteric artery: A large, unpaired visceral artery arising anteriorly, just below the celiac artery. It supplies the distal duodenum, jejuno-ileum, ascending colon and part of the transverse colon. It arises at the lower level of L1.
Middle suprarenal arteries: Small paired visceral arteries that arise either side posteriorly at the level of L1 to supply the adrenal glands.
Renal arteries: Paired visceral arteries that arise laterally at the level between L1 and L2. They supply the kidneys.
Gonadal arteries: Paired visceral arteries that arise laterally at the level of L2. Note that the male gonadal artery is referred to as the testicular artery and in females, the ovarian artery.
Inferior mesenteric artery: A large, unpaired visceral artery that arises anteriorly at the level of L3. It supplies the large intestine from the splenic flexure to the upper part of the rectum.
Median sacral artery: An unpaired parietal artery that arises posteriorly at the level of L4 to supply the coccyx, lumbar vertebrae and the sacrum.
Lumbar arteries: There are four pairs of parietal lumbar arteries that arise posterolaterally between the levels of L1 and L4 to supply the abdominal wall and spinal cord.
Branches of coeliac trunk?
left gastric, splenic and common hepatic arteries.
Branches from Left gastric artery?
oesophageal branches, before continuing anteriorly along the lesser curvature of the stomach. Here, it anastomoses with the right gastric artery.
Branches from splenic artery?
In addition to supplying the spleen, the splenic artery also gives rise to several important vessels:
Left gastroepiploic: supplies the greater curvature of the stomach. Anastomoses with the right gastroepiploic artery.
Short gastrics: 5-7 small branches supplying the fundus of the stomach.
Pancreatic branches: supply the body and tail of the pancreas.
The splenic artery has a tortuous appearance (similar to the facial branch of the external carotid artery) and thus is easily identifiable from other nearby vessels.
Branches from common hepatic artery?
The common hepatic artery is the sole arterial supply to the liver and the only branch of the coeliac artery to pass to the right.
As it travels past the superior aspect of the duodenum, it divides into its two terminal branches – the proper hepatic and gastroduodenal arteries. Each of these arteries has multiple branches and variation in the arrangement of these branches is common.
Proper Hepatic
The proper hepatic artery ascends through the lesser omentum towards the liver. It gives rise to:
Right gastric: supplies the pylorus and lesser curvature of the stomach.
Right and left hepatic: divide inferior to the porta hepatis and supply their respective lobes of the liver.
Cystic: branch of the right hepatic artery – supplies the gall bladder.
Gastroduodenal
The gastroduodenal artery descends posterior to the superior portion of the duodenum. Its branches are:
Right gastroepiploic: supplies the greater curvature of the stomach. Found between the layers of the greater omentum, which it also supplies.
Superior pancreaticoduodenal: divides into an anterior and posterior branch, which supplies the head of the pancreas
Branches of SMA
Inferior Pancreaticoduodenal Artery
The inferior pancreaticoduodenal artery is the first branch of the SMA. It forms anterior and posterior vessels, which anastomose with branches of the superior pancreaticoduodenal artery (derived from the coeliac trunk). This network supplies the inferior region of the head of the pancreas, the uncinate process, and the duodenum.
The superior mesenteric artery gives rise to numerous arteries that supply the jejunum and ileum.
The arteries pass between the layers of the mesentery and form anastomotic arcades – from which smaller, straight arteries (known as the “vasa recta”) arise to supply the organs (fig 2).
The jejunal blood supply is characterised by a smaller number of arterial arcades, but longer vasa recta. In contrast, the ileal blood supply is marked by more arterial arcades with shorter vasa recta.
Middle and Right Colic Arteries
The right and middle colic arteries arise from the right side of the superior mesenteric artery to supply the colon:
Middle colic artery – supplies the transverse colon.
Right colic artery – supplies the ascending colon.
Ileocolic Artery
The ileocolic artery is the final major branch of the superior mesenteric artery. It passes inferiorly and to the right, giving rise to branches to the ascending colon, appendix, cecum, and ileum. In cases of appendectomy, the appendicular artery is ligated.
what is pringles manuevre?
clamping the hepatoduodenal ligament (free border of the lesser omentum) interrupting the flow of blood through the hepatic artery and the portal vein
Borders of epiloic foramen
anterior: the free border of the lesser omentum, known as the hepatoduodenal ligament. This has two layers and within these layers are the common bile duct, hepatic artery, and hepatic portal vein. A useful mnemonic to remember these is DAVE: Duct, Artery, Vein, Epiploic foramen.
posterior: the peritoneum covering the inferior vena cava
superior: the peritoneum covering the caudate lobe of the liver
inferior: the peritoneum covering the commencement of the first part of the duodenum and the hepatic artery, the latter passing forward below the foramen before ascending between the two layers of the lesser omentum.
left lateral: gastrosplenic ligament and splenorenal ligament
Borders of Calot’s triangle
Medial – common hepatic duct.
Inferior – cystic duct.
Superior – inferior surface of the liver
