Abdomen Flashcards

GI, inguinal canal

1
Q

Blood supply to each gut

A

(1. ) Foregut = coeliac trunk
(2. ) midgut (distal 1/2 duodenum to 2/3 T.colon) = superior mesenteric artery
(3. ) hindgut (1/3 t.colon to rectum) = inferior mesenteric artery

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2
Q

Sympathetic nerve supply to each gut structure and where would pain be referred to?

A

(1. ) Foregut = greater splanchic nerve (T5-9) referred to epigastrium
(2. ) Midgut = lesser splanchic nerve (T10-11) referred to umbilical
(3. ) Hindgut = least splanchic nerve (T12) referred to suprapubic

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3
Q

Venous drainage of each gut

A

(1. ) All gut structures ultimately drain into the hepatic portal vein (HPV)
(2. ) Midgut via superior mesenteric v –> HPV
(3. ) Hindgut via inferior mesenteric v –> splenic vein –> HPV

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4
Q

Name 5 parts of the gut that are retroperitoneal?

A

(1. ) Pancreas
(2. ) Ascending colon
(3. ) Descending colon
(4. ) 2nd part of duodenum
(5. ) 1st part of rectum

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5
Q

Where is start and end of midgut?

A

(1.) 1/2 of duodenum to 2/3 of transverse colon

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6
Q

Where is McBurney’s point

A
  • McBurney’s point located on the right side of the abdomen
  • One-third of the distance from the anterior superior iliac spine to the umbilicus.
  • Base of appendics is found here
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7
Q

Name of hernia that is lateral to inferior epigastric artery

A

Indirect hernia

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8
Q

What is a direct inguinal hernia

A
  • This is acquired (e.g. heavy lifting) and due to weakening of abdo muscles
  • Content (viscera, bowel) herniate through posterior wall of inguinal canal.
  • This is medial to the inferior epigastric a.
  • Protrusion/peritoneal bulge may be palpated over deep ring
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9
Q

What are the 9 regions of the abdomen and how is it formed?

A

Horizontal planes:

(1. ) Subcostal plane = lowest part of the costal margin
(2. ) Intertubucular plane = between iliac tubercle (most lateral aspects of iliac crest)

Vertical plane
(3.) Mid-clavicular to mid-inguinal

Regions:

  • R and L.hypochondrium (1, 3)
  • Epigastrium (2)
  • R and L.Flank (4, 6)
  • Umbilical (5)
  • R and L.Iliac fossa (7, 9)
  • Suprapubic (8)
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10
Q

What is the rectus abdominis? How does this form the 6-pack?

A

(1. ) Runs vertically from the pubis up to the costal margin
(2. ) Tendons cross its length (x3)
(3. ) During exercise the muscle hypertrophies whereas the tendon stays the same - this forms the 3 bulges on either side of the midline

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11
Q

What forms the rectus sheath?

A

It is formed by the aponeurosis of three flat muscles surrounding the rectus abdominis, the arrangement of layers differ above and below the arcuate line.

Upper 2/3 i.e. above arcuate

(1. ) IOA lies in front and behind the RA
(2. ) EOA lies in front of RA
(3. ) TA lies behind the RA

Lower 1/3 i.e. below the arcuate

(1. ) All three lie infront of the RA
(2. ) TF is in direct contact with RA

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12
Q

What muscles make up the abdominal anterior wall? Describe their fibres and action

A

(1. ) EO
- ‘hands in pockets’ fibres
- rotation of torso

(2. ) IO
- ‘hands on boobs’ fibres
- compress abdomen, rotation of torso

(3. ) TA
- runs horizontally
- compress abdomen

(4. ) RA
- Compress abdomen
- depress ribs
- stabilise pelvis during walking

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13
Q

What is an indirect hernia

A

(1. ) Failure of vaginalis to regress
(2. ) Content enters via the deep ring
(3. ) Lateral to the inferior epigastric a

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14
Q

What makes up the boundaries of the inguinal canal? (anterior, posterior, roof, floor, rings)

A

(1. ) Deep ring = TF
(2. ) Superficial ring = EOA

(3. ) Anterior wall = EOA
(4. ) Floor = EOA (curves under)
(5. ) Roof = IO + TA
(6. ) Posterior wall = Conjoint tendon (IO + TA)

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15
Q

What is content found in the inguinal canal? And what passes behind the canal?

A

(1. ) Spermatic cord (male)
(2. ) Round ligament (female)
(3. ) Ilioinguinal N.
(4. ) Genitofemoral N.

Femoral vessels are found under the canal: NAVy fronts

  • Nerve
  • Artery
  • Vein
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16
Q

Where is the femoral pulse palpated?

A
  • Between pubic symphysis + anterior iliac spine

- This is the mid-inguinal point (NOT the same as mid inguinal ligament point)

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17
Q

Where is the deep ring of the inguinal canal palpated?

A
  • At the mid inguinal ligament point

- This is the midpoint between the pubic tubercle and anterior iliac spine

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18
Q

What makes up the peritoneal cavity?

A

(1. ) The peritoneum is a serous membrane made up of visceral and parietal layers.
- visceral = lines organs + forms the mesentery
- parietal = abdominal wall

(2.) The peritoneal cavity is a potential space between the visceral and parietal peritoneum

(3. ) Potential space comprises of greater sac, lesser sac + peritoneal fluid.
- greater sac = spans from the diaphragm all the way to pelvic cavity. This is the main and larger part of the peritoneal cavity
- lesser sac = lies posterior to stomach, anterior to pancreas, inferior to liver
- peritoneal fluid = inc volume will lead to ascites and distended abdomen

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19
Q

What is mesentery? What types are there?

A

Double layer of peritoneum that contains lymphatics, vessels, adipose tissues. Allows organs to move freely.

Types

(1. ) Proper Mesentery
- Attaches to posterior abdo wall from dueodenal-jejunal flexure to ileo-caecal junction
- allows for bowel to be mobile
- can become twisted (volvulus)
- involved in hernia

(2. ) Transverse mesocolon
- T.colon + posterior abdo wall

(3. ) Sigmoid mesocolon
- sigmoid + pelvic cavity

(4. ) Mesoappendix
- appendix + ileum

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20
Q

What is meant by retro-peritoneal? List organs that are retroperitoneal

A
  • They are outside the peritoneal cavity
  • SO only the anterior surface has got parietal peritoneum
  • They are fixed in position
Retroperitoneal Organs (SAD PUCKER)
- Suprarenal, aorta + IVC, duodenum 2nd part, pancreas, ureters, colon ascending + descending, kidneys, esophagus, rectum first 1/3
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21
Q

What is meant by intraperitoneal? List organs that are intraperitoneal

A
  • Covered in visceral peritoneum
  • Organs are mobile in mesentery
  • If organs are inflammed, pain can be felt on movement + breathing
  • Stomach, spleen, 1st part duodenum, jejenum, ileum, caecum, appendix, t.colon, sigmoid
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22
Q

What parts of the bowels are intraperitoneal?

A

(1. ) 1st part of duodenum
(2. ) Jejunum
(3. ) Ileum
(4. ) Appendix
(5. ) T.Colon
(6. ) S.Colon

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23
Q

What is Omentum ?

A

(1.) Double layered extension of peritoneum containing vessels + lymphs + nerves

(2. ) Greater Omentum
- From greater curvature of stomach and proximal duodenum to posterior abdominal wall
- This can fold on itself to form 4 layers

(3. ) Lesser Omentum
- From lesser curvature + proximal duodenum to liver

24
Q

What is the epiploic foramen

A

(1. ) Opening to lesser sac from greater sac

(2. ) Hepatic duodenal ligament runs along the free edge of the lesser omentum. This contains the portal triad

25
Q

What is a peritoneal dialysis?

A

(1. ) Used in pt with renal failure
(2. ) Peritoneum is semi-permeable to small molecules
(3. ) Sterile dialysis soln introduced into cavity
(4. ) Soln absorbs waste products from blood
(5. ) This is then drained out the cavity

26
Q

Where are the lowest places in the body when in a supine + upright position?

A

Bacteria and tumours gravitate to these areas

1. ) Behind the right lobe of liver (supine
(2. ) Pelvic cavity (upright)

27
Q

Describe the structure of the stomach

A

(1. ) It is a J shaped intraperitoneal organ found in LUQ
(2. ) It contains rugae (mucosa folds) that inc SA
(3. ) Comprises of: cardia, fundus, body, antrum, pylorus
(4. ) Inferior-oesophageal sphincter is not under voluntary control
(5. ) Pyloric sphincter = controls exit of chyme (food + gastric acid)

28
Q

Describe the structure of the duodenum

A

(1. ) 1st part = smooth wall, intraperitoneal
(2. ) 2nd, 3rd, 4th part = plicae circularis, retroperitoneal
(3. ) Papillae is found halfway the 2nd part, this allows for the opening of pancreatic secretion + bile from ampulla of Vatar

29
Q

How may a peptic ulcer cause brisk bleeding?

A

(1. ) Gastroduodenal artery is found behind the 1st part duodenum
(2. ) Peptic ulcer will erode the duodenum mucosa + erode the GDA -> brisk bleeding
(3. ) Causes = chronic NSAID therapy, h.pylori infection

30
Q

Describe the nerve supply (PNS and SNS), blood supply and venous drainage of the stomach

A

Nerve Supply

(1. ) CNX (PNS)
(2. ) T5-9 (SNS)

Blood Supply

(1. ) Short gastric + R + L gastric a. = lesser curvature
(2. ) R + L gastricepiploic a = greater curvature

Venous drainage

(3. ) R + L gastric vein - drains into HPV
(4. ) Short gastric v., L+R gastricepiploic v. drains into SMV

31
Q

What branches come off the coeliac trunk

A

(1. ) Common hepatic A
- gives rise to R.Gastric A. + GDA (which gives rise to R.gastroepiploic a.)
- Hepatic artery proper is a continuation of the artery

(2.) L.Gastric A.

(3. ) Splenic A.
- gives rise to short gastric a. + L.gastroepiploic A

32
Q

Where would you palpate the liver

A

(1. ) R.hypochondrium + epigastrium area
(2. ) L.lobe is above the costal margin so can’t be palpated
(3. ) R.lobe may be palpated on inspiration

33
Q

Describe the microscopic structure of the liver + portal triad

A

(1. ) Hepatocytes arrange in lobules
(2. ) Drained by a central hepatic vein
(3. ) Portal triad found on the periphery
(4. ) Porta hepatitis comprises of: HPV, Hepatic A, Bile duct, lymphatic vessels, CNX parasymp fibres

34
Q

Describe the blood supply to the liver + where does it get its oxygen from ?

A

(1. ) Hepatic artery proper
- comes from common hepatic artery of CT
- branches into left and right hepatic A, cystic a comes of the r. hepatic a.
- supplies 25% of liver’s oxygen via arterial blood

(2. ) HPV
- Liver receives most of its blood from HPV.
- This is poorly oxygenated venous blood from the bowel that need to be detoxified but still carries 75% of livers oxygen supply

(3. ) Hepatic vein
- venous blood from hepatocytes drained in to IVC

35
Q

What is hepatic encephalopathy?

A

Normal:
- Liver reconfigures proteins (absorbed into the blood in bowel) + ensures they are safe

Liver Disease

  • Above process fails
  • Short AA chains are toxic and may bypass liver through porto-systemic shunt
  • Toxic protein enters brains -> neurological disease
36
Q

Describe the surface of the liver

A

Surface

(1. ) Diaphragmatic, concave smooth surface = anterior and superior aspects
(2. ) Visceral surface = posterior-inferior surface

Lobes

(1. ) Porta hepatis separates the CAUDATE and QUADRATE (inferior) lobes. Neurovascular structures enter and leave here except for HV
(2. ) RIGHT and LEFT lobes separated by falciform ligament

Bare area

(1. ) Under central tendon of diaphragm
(2. ) Within anterior and posterior folds of the coronary ligament

37
Q

Describe the ligaments of the liver

A

(1. ) Coronary ligament
- comprises of anterior and posterior folds
- attaches superior surface of liver to inferior surface of diaphragm

(2. ) Triangular ligaments
- continuation of coronary ligaments

(3. ) Falciform ligament
- Divides R+L lobes
- Attaches liver to abdominal wall
- Free border has ligament teres

(4. ) Ligament venosum
- Remnant of the ductus venosum

(5. ) Ligament teres
- Remnants of umbilical vein
- makes up inferior aspect of falciform ligament

38
Q

What cause hepatomegaly

A

(1. ) Cirrhosis
(2. ) Congestive heart failure
(3. ) Viral infection (hepatitis)

These impedes blood flow

39
Q

What is a porto-systemic shunt?

A

(1. ) It is where the portal system (HPV) anastomoses/communicates with the systemic venous system
(2. ) An example is where the oesophagus vein drains into the azygous vein (systemic system) instead of left gastric vein (portal system). This bypasses the liver
(3. ) Liver bypass means detoxification can’t take place and this will enter the circulation and may enter the brain -> disease
(4. ) Cirrhosis can cause portosystemic shunts and oesophageal varices formation

40
Q

Describe the PNS and SNS to all of the gut structures

A

PNS

(1. ) Foregut + Midgut = CNX
(2. ) Hindgut = S2,3,4

SNS

(1. ) Foregut = T5-9
(2. ) Midgut = T10-T11
(3. ) Hindgut = T12

41
Q

why may you get small bowel obstruction?

A

(1. ) Jejunum and ileum are in mesentery (attached to posterior abdo wall)
(2. ) This allows them to be very mobil so can become volvulus and involved in hernias

42
Q

How do the the jejunum and ileum allow for nutrient absorption?

A

They have high SA due to the following:

(1. ) Long length
(2. ) Plicae circularis (mucosal folds)
(3. ) Villi on mucosal folds
(4. ) Microvilli on epithelial cells

43
Q

List 4 differences between the jejunum and ileum

A

Jejunum

  • Left upper quadrant
  • Plicae circularis is more pronounced
  • Longer vasa recta
  • Less arcades

Ileum

  • Lower right quadrant
  • Shorter vasa recta
  • More arcades
  • Payer patch
44
Q

Describe three features of the large intestines

A

The large bowel starts in the r.iliac fossa at the ileo-caecal valve.

(1. ) Haustrations = circular inner layer bulges
(2. ) Epiploic appendages = fat filled pouches of peritoneum that hang from the tenia coli
(3. ) Tenai coli = longitudinal muscular strips that run from appendix to rectum -> there is only 3 of these

45
Q

List 5 difference between the small and large intestines

A

(1. ) Location
- SI = central
- LI = edges

(2. ) External Structure
- SI = smooth, muscular, cylinder tube
- LI = variable diameter, haustrations, tenai coli

(3. ) Mesentery
- SI = neat + tidy mesentery
- LI = epiploic appendages, t.mesocolon, s.mesocolon

(4. ) Blood supply
- SI = SMA, very high blood supply via vasa rectas
- LI = SMA + IMA, low blood supply

(5. ) Internal structures
- SI = villi, payers patch in ileum, plicae circularis

46
Q

Describe the biliary tree

A

(1. ) Liver synthesis and secretes bile
(2. ) This drains into the left and right hepatic ducts that merge into the common hepatic duct.

(3. ) GB stores bile and excretes it (i.e. contract in response to fatty food) into the cystic duct
(4. ) The duct joins the common hepatic duct to form the common bile duct.

(5. ) Common bile duct joins with the pancreatic duct to form the ampulla of vatar
(6. ) Secretion is controlled by the sphincter of oddi and contractions of the papilla muscle - this empties into the 2nd part of the duodenum.

47
Q

Where is the gallbladder in the abdomen

A

(1. ) Right hypochondrium region within the midclavicular line at the 9th costal cartilage.
(2. ) It is close to the inferior surface of the liver

48
Q

Describe where pain may be felt in inflammation of gallbladder (cholecystitis)?

A

Pain is felt in the epigastrium region (T5-9) and may spread to the shoulder (phrenic nerve) if rubbing under diaphragm. It may also localise to RUQ (dermatome)

49
Q

pancreas - Surrounding organs/vessels? pancreas function?

A
  • posterior to stomach and SMA (behind uncinate process)
  • tail is in contact with spleen’s hilum
  • head sits within the ‘C’ of the duodenum
  • HPV and abdominal aorta lies behind [head] neck and uncinate process

It is a retroperitoneal organ except for the tail

It is a glandular organ with exocrine and endocrine functions

50
Q

Blood supply and venous drainage of pancreas

A

(1. ) Splenic a, pancreatic-duodenal a., SMA

(2. ) HPV

51
Q

What would you seen in a blockage of the following:

  • Sphincter of Oddi
  • Pancreatic Duct
A

(1. ) SoO = Stones may be too large to pas and causes a build up of pigment in blood -> jaundice + liver failure
(2. ) P.Duct = build of pancreatic juice digestive enzymes + high pressure causes it to leak out -> digestion of pancreas (acute pancreatitis)

52
Q

Where is the spleen and can it be palpated? Function?

A

(1. ) It is an intraperitoneal organ found in the upper left quadrant
(2. ) It is under the diaphragm and ribcage so can’t be palpated
(3. ) H/e if enlarged it can be palpated at the edge of the left costal margin -> superior border moves inferiormedially and its notches can be palpated

(4.) Function is to filter blood and remove old RBC. It plays a role in both cell mediated + humoral response

53
Q

Structures that surround the spleen

A

(1. ) Anterior = stomach
(2. ) Posterior = diaphragm, ribs 9-11
(3. ) Inferior = left colic/splenic flexure
(4. ) Medial = Left kidney, tail of pancreas

54
Q

why may a splenectomy be performed and will this effect life expectancy?

A
  • Splenectomy may be performed due to ruptured spleen (due to trauma), haematological condition, proliferative disorders
  • Liver and bone marrow can take over spleen function h/e pt is at increase infection risk so require life-long Abx.
55
Q

Describe what you’d find in the 9 regions of the abdomen

A

(1. ) Epigastric region = some of the pancreas, liver, spleen, stomach
(2. ) Right hypochondriac region = liver, gallbladder and right kidney.
(3. ) Left hypochondriac region = spleen, splenic flexure of the colon, left kidney.
(4. ) Umbilical region = small intestine.
(5. ) Suprapubic region = urinary bladder, sigmoid colon, uterus.

(6.) R and L.Flank
R = A.Colon, right kidney, small intestines
L = D.Colon, left kidney, small intestines

(7.) R and L.Iliac fossa
R = Appendix, caecum, a.colon
L = D.Colon, sigmoid

56
Q

What is the mediaN and mediaL umbilical ligament?

A

(1. ) MEDIAN umbilical ligament
- remnant of allantois/urachus
- allantoic duct connected to fetus bladder to umbilical

(2. ) MEDIAL umbilical ligament
- Two of these
- remnant of umbilical a.
- deoxygenated blood from fetus to placenta