Abdomen anatomy Flashcards
Blood supply to ureter
Segmental supply
Abdominal supply
1. Renal arteries
2. Gonadal arteries
3. Ureteric branches from aorta
Pelvic supply
-Superior and inferior vesical arteries (from internal iliac anterior division)
Borders of lesser sac
Anterior: quadrate lobe of liver, lesser omentum, stomach, gastrocolic ligament
Posterior: Pancreas, left kidney, left adrenal gland
Superior: Superior recess lesser sac lies behind caudate lobe of liver
Inferior: Inferior recess of lesser sac lies between layers of greater omentum (superior part)
To the left: gastrosplenic, lienorenal ligament
To the right: Epiploic foramen (of wilmslow)
Boundaries of epiploic foramen
Superior: caudate lobe of liver
Anterior: common hepatic artery, portal vein and common bile duct in free edge of lesser omentum
Posterior: IVC and crus of right diaphragm
Inferior: 1st part of duodenum
What are the differences between the ileum and the jejunum?
jejunum: redder in colour, more prominent vasa recta, located in LUQ, thicker intestinal wall, less arcades
Ileum: pink, more arterial arcades and shorter vasa recta, located in RLQ
Borders of inguinal canal
Roof: arching fibres of internal oblique and transversus abdominis
Anterior: aponeurosis of external oblique reinforced in lateral 1/3rd by fibres of internal oblique
Posterior: transversalis fascia, conjoint tendon medial 1/3rd
Floor: inguinal ligament reinforced in medial 1/3rd by lacunar ligament
What is the conjoint tendon?
–> sheath of connective tissue
–> formed by lower part of common aponeurosis of internal oblique/transversus abdominis
–> forms posterior wall of inguinal canal medially
The conjoint tendon (previously known as the inguinal aponeurotic falx) is a sheath of connective tissue formed from the lower part of the common aponeurosis of the abdominal internal oblique muscle and the transversus abdominis muscle
Forms posterior wall inguinal canal medially
Borders femoral ring
Anterior: inguinal ligament
Medial: lacunar ligament
Lateral: femoral vein
Posterior: pectineal ligament overlying superior ramus of pubis
Blood supply to pancreas:
Neck, body and tail:
-Splenic artery- runs along superior margin and supplies neck, body and tail via its pancreatic branches
Head:
-Superior pancreaticoduodenal artery from gastroduodenal
-Inferior pancreaticoduodenal from SMA
At what vertebral level does sma arise?
Lower border L1
Name branches of SMA
Inferior pancreaticoduodenal
ileal and jejunal branches
middle colic
right colic
ileocolic
Name branches of IMA
Left colic
Sigmoidal
Superior rectal
Name the boundaries of hasselbach’s triangle
Medial: lateral border rectus abdominis
Lateral: inferior epigastric artery
Inferior: inguinal ligament
Describe blood supply of rectum
Superior 1/3rd: superior rectal artery (IMA)
Middle 1/3rd: middle rectal artery (internal iliac anterior division)
Bottom 1/3rd: inferior rectal artery (from internal pudendal from internal iliac)
Paired branches abdominal aorta
Inferior phrenic (T12)
Middle suprarenal (T12)
Lumbar arteries (L1-L4)
Renal (L1-L2)
Gonadal (L2)
Name some anatomical sites of porto-systemic anastomoses, state the vessels
Rectal
–> Portal: superior rectal vein –> IMV
–> Systemic: Middle and inferior rectal veins
Oesophageal
-Portal: Oesophageal branches left gastric vein –> splenic vein
-Systemic: Oesophageal branches left azygous
Retroperitoneal:
–> Portal: colic veins
–> Systemic: retroperitoneal veins
Paraumbilical
–> Portal: portal veins of liver
–> Systemic: Veins of anterior abdominal wall
Branches anterior division of internal iliac
3 urinary (umbilical, superior vesical, inferior vesical)
3 parietal (obturator, internal pudendal, inferior gluteal)
3 visceral (middle rectal, uterine, vaginal)
Branches posterior division internal iliac
PILS
-Iliolumbar
-Lateral sacral
-Superior gluteal
Where is superficial ring located?
Superior to pubic tubercle. V shaped defect in external oblique
Where is deep ring located? What forms it?
-Above mid point of inguinal ligament (lateral to inferior epigastric vessels)
-Formed by transversalis fascia which invaginates to cover contents of inguinal canal.
Where is the mid-inguinal point and what is the clinical significance?
Midway between pubic symphysis and asis. Femoral pulse palpated here
What are the retroperitoneal organs?
Primarily:
-Kidneys
-Adrenal glands
-Rectum
-IVC
-Aorta
-Oesophagus
Secondarily
-2nd and 3rd parts duodenum
-Ascending and descending colon
-Pancreas (exceept tail)
Which muscles form pelvic floor?
2 pubes + the others
Iliococcygeus, pubococcygeus, puborectalis (levator ani)
Coccygeus
Innvervation to the pevlic floor
-Levator ani + coccygeus: S3 and S4 nerve roots
-Perianal muscles, external urethral sphincter + external anal sphincter: pudendal nerve
-Anal canal inferior to dentate line: inferior rectal nerves + pudendal nerve
Layers abdominal wall midline laparotomy
Skin
Subcut fat
camper’s fascia
Scarpa’s fasica
linea alba
preperitoneal fat
parietal peritoneum
Describe arterial supply to anterolateral abdominal wall
- internal thoracic—> superior epigastric
- External iliac —> inferior epigastric, deep circuflex iliac
- Femoral
—> superficial circumflex iliac
—> superficial epigastric
At what vertebral level does abdominal aorta bifurcate?
Lower border L4
Name anterior unpaired branches of abdominal aorta
Coeliac trunk
sma
ima
At what vertebral level does coeliac trunk arise?
Lower border T12
Name branches of coeliac trunk
Left gastric artery
–> oesophageal branches
Common hepatic
–> Gastroduodenal (right gastroepiploic, superior pancreaticoduodenal)
–> Hepatic artery proper (right gastric, right–>cystic and left hepatic)
Splenic
–> Left gastroepiploic (greater curvature of stomach)
–> Short + posterior gastrics (Fundus and posterior stomach)
–> Pancreatic branches (body and tail of pancreas)
Where to left and right testicular veins drain?
Left: left renal vein
right: directly into IVC
Therefore left sided varicoceles are more common
Constrictions of the ureter
Pelviureteric junction
As it crosses iliac vessels at pelvic brim
Vesicoureteric junction
Describe blood supply to the stomach
Lesser curvature: left (coeliac trunk) and right gastric (hepatic artery proper)
Greater curvature: left (splenic) and right (gastroduodenal) gastro-epiploic
fundus and posterior: posterior and short gastric
Structures at the transpyloric plane
Upper pole right kidney
Right and left colic flexures
Fundus of gallbladder
Head of pancreas
Pylorus of stomach
2nd Part of duodenum
Formation of portal vein (joining smv and sv)
D-J flexure
SMA origin from aorta
End of spinal cord in adults
Hilum of spleen
Hilum of kidney
What are conents of spermatic cord?
Fascial coverings: External spermatic fascia, internal spermatic fascia, cremasteric fascia
Arteries: Testicular artery, artery to vas deferens, cremasteric artery
Nerves: Genital branch genitofemoral nerve, sympathetic nerve fibres, ilioinguinal nerve (lies outside spermatic cord)
Other structures: pampiniform plexus, ductus deferens, lymphatics
Abdominal wall layers: appendicectomy
Skin
Subcut fat
Campers
Scarpas
External oblique
Internal oblique
Transversus abdominis
Transversalis fascia
Preperitoneal fat
Peritoneum
Contents of inguinal canal in males and females
Round ligament in females
Spermatic cord in males
Ilioinguinal nerve both sexes
What is the conjoint tendon?
-Formed from aponeurosis of internal oblique and transversus abdominis.
-Forms medial part posterior wall inguinal canal
The conjoint tendon (previously known as the inguinal aponeurotic falx) is a sheath of connective tissue formed from the lower part of the common aponeurosis of the abdominal internal oblique muscle and the transversus abdominis muscle
What do the branches of proper hepatic artery supply??
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
What do branches of gastroduodenal supply?
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.
Describe blood supply to adrenal gland
Superior adrenal artery – arises from the inferior phrenic artery
Middle adrenal artery – arises from the abdominal aorta.
Inferior adrenal artery – arises from the renal arteries.
