Abdomen - Pelvic Flashcards by Marielle Sison

region of trunk lies inferior to abdomen
transmits body weight from vertebral column to femur

pelvis

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Post: lumbar vertebrae
Lateral: iliac fossa and iliacus
Ant: lower part of abdominal wall

false pelvis

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pelvic inlet, pelvic outlet, pelvic cavity

true pelvis

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aka pelvic brim
Boundaries:
Post: sacral promontory
Lat: iliopectineal lines
Ant: symphysis pubis

Pelvic Inlet

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Boundaries:
Post: coccyx
Lat: ischial tuberosities
Ant: pubic arch

Pelvic Outlet

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lies between the pelvic inlet & outlet

pelvic cavity

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bones of the pelvis

Sacrum
Coccyx
Hip Bones (2)
3 bones joined at acetabulum

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upper flattened part of hip bone

ilium

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Iliac fossa
Iliac crest
Iliac tubercle
ASIS
AIIS
PSIS

ilium

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bulge where ilium and pubis meets

iliopubic eminence

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runs downward & forward on the inner surface of ilium; divides true and false pelvis

symphysis pubis

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inferior and posterior bone
● Ischial tuberosity
● Ischial spine

ischium

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● Greater sciatic notch
● Lesser sciatic notch

ischial spine

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anterior part
pubic rami, symphysis pubis, body of pubis

pubis

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● Pubic tubercle
● Pubic crest

body of pubis

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superior and inferior

pubic rami

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post; limited movement
Fxn: transmit weight from spine to pelvis

sacroiliac joint

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ant, post and interosseous

sacroilliac ligament

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strong; from lateral of sacrum, coccyx and PSIS to ischial tube

sacrotuberous ligament

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triangular; base from lateral of sacrum & coccyx; apex – ischial spine

sacrospinous ligament

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ant; cartilaginous joint
(+) fibrocartilaginous disc bet. 2 pubic bones
fixed

symphysis pubis

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Filled in by obturator membrane, a fibrous sheet, leaving only a small gap

obturator foramen

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obturator nerve & vessels

oburator canal

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Tendon: OI
Nerve: pudendal & n. to OI

lesser sciatric foramen

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Muscle: piriformis ● Nerves: ● Sciatic ● IGN ● SGN ● Pudendal ● nerve to OI and QF ● Vessels: ● Sup & Inf gluteal a. & v. ● Internal pudendal a. & v.

greater sciatric foramen

Difference of pelvis in males & females false pelvis: males

deep

Difference of pelvis in males & females false pelvis: females

shallow

Difference of pelvis in males & females pelvic inlet: females

transverse oval

Difference of pelvis in males & females pelvic cavity: males

smaller

Difference of pelvis in males & females pelvic cavity: females

larger

Difference of pelvis in males & females pelvic outlet: males

smaller

Difference of pelvis in males & females ischial tuberosity: females

everted

Difference of pelvis in males & females ischial tuberosity: males

inverted

Difference of pelvis in males & females sacrum: males

longer

Difference of pelvis in males & females pubic arch: females

round

Difference of pelvis in males & females pelvic inlet: males

heart

Difference of pelvis in males & females pelvic outlet: females

larger

Difference of pelvis in males & females sacrum: females

shorter

Difference of pelvis in males & females pubic arch: males

triangular

pubic bone, pubic rami, symphysis pubis

pelvic walls: anterior

sacrum, coccyx, piriformis muscle

pelvic walls: posterior

pubic bone, ilium, sacrotuberous & sacrospinous ligament, oburator internus ms

pelvic walls: lateral

supports pelvic viscera; divides pelvic cavity and perineum - Formed by pelvic diaphragm

pelvic walls: inferior

Obturator membrane & adjoining part of hip bone

obturator internus

Pubic body obturator fascia

levator ani

Ischial spine

coccygeus

Greater troch. (femur)

piriformis & obturator internus

Lower end of sacrum & coccyx

coccygeus

Hip ER

piriformis

Supports pelvic viscera, sphincter to vagina & anorectal jxn

levator ani

Assists levator ani, Flexes coccyx

coccygeus

n. to piriformis

piriformis

n. to OI

obturator internus

S4, pudendal n.

levator ani

Ant: sling around prostate or vagina; inserted to perineal body Levator prostate - M Sphincter vaginae- F

levator ani muscles

sling bet rectum and anal canal

puborectalis

inserts to anococcygeal body

pubococcygeus

inserts to anococcygeal body & coccyx

iliococcygeus

small triangular muscle

Coccygeus / Ischiococcygeus

Formed by connective tissue Continuous with fascia lining abdominal wall and perinuem 2 layers: parietal & visceral

pelvic fascia

lines walls of pelvis, named accdg to muscle it overlies

parietal pelvic fascia

covers and supports the pelvic visera

visceral pelvic fascia

term used to refer to pelvic fascia in the region of the uterine cervix

parametrium

Lies on post pelvic wall ● Relations: NERVE SUPPLY ● Ant: internal iliac vessel and their branches ● Post: piriformis

sacral plexus

sciatic nerve

(L4-S3)

superior gluteal nerve

(L4-S1 post)

inferior gluteal nerve

(L5-S2 post)

quadratus femoris

(L4-S1 ant)

obturator internus

(L5-S2 ant)

cutaneous of the thigh

(S1-S3)

piriformis

(S1-S2 post)

- ends at pelvic inlet infront of SI jt - divides into external and internal iliac a.

common iliac artery

- follows the pelvic brim - gives off branches: inferior epigastric & deep circumflex iliac a. - passes under inguinal ligament to become femoral a.

external iliac artery

- passes down to pelvis to upper margin of greater sciatic foramen - divides into ant and post division

internal iliac artery

Superior vesical a. - upper part of bladder

umbilical

- base of bladder, prostate & seminal vesicles * Artery to vas deferens

obturator

- lower rectum

middle rectal artery

muscles of anal canal, skin and muscles of perineum

internal pudendal a

takes place of inf. vesical a. in males

vaginal a

supplies gluteal region

superior gluteal a

joins (L) common iliac vein

median sacral veins

Sigmoid colon ● Rectum

pelvic cavity: posterior

Ureter ● Urinary Bladder

anterior pelvic cavity

Continuation of descending colon 10 to 15.75 in level of 3rd sacral vertebra (continues as rectum) Attached to post pelvic wall by sigmoid mesocolon

sigmoid colon

Arteries: sigmoid branches of inf. mesenteric a. Veins: tributaries of inferior mesenteric vein NERVE SUPPLY: inf. hypogastric plexus

sigmoid colon

5 inches long * Begins: level of S3 vertebra * Course: Goes downward, following curve of sacrum & coccyx * Ends: tip of coccyx * pierce pelvic diaphragm -> anal canal

rectum

dilated lower part

rectal ampulla

covers the ff: first 1/3 middle 1/3 last 1/3

peritoneum

ant & lat surfaces

first 1/3

ant only

middle 1/3

none

last 1/3

outer longitudinal & inner circular layers of smooth muscles

muscular coat

3 permanent folds; formed by mucous membrane and circular muscle layers

transverse folds

BLOOD SUPPLY: Arteries: superior, middle and inferior rectal a. Veins: superior, middle and inferior rectal v. NERVE SUPPLY: inferior hypogastric plexus

rectum

● a pair of muscular tubes extending from kidney to posterior surface of bladder ● crosses pelvic inlet anterior to bifurcation of common iliac a. CONSTRICTIONS: ● renal pelvis joins ureter in abdomen ● as it crosses the pelvic brim to enter pelvis ● where it pierces the bladder wall

ureter

found behind symphysis pubis ● stores urine (max capacity: 500 ml of urine in women and 700 ml in men) ● Empty: pyramidal-shaped; lies within pelvis ● Full: ovoid- shaped; superior wall rises to hypogastric region

urinary bladder

points anteriorly ● connected to symphysis pubis by median umbilical ligament

apex urinary bladder

posterior surface; triangular (trigone)

base urinary bladder

covered by peritoneum

superior surface: urinary bladder

related to retropubic fat pad

inferolateral surface urinary bladder

continues as urethra Male: rests directly on top of prostate Female: rests on top of urogenital diaphragm

neck urinary bladder

thrown into folds, disappear when bladder is full

mucous membrane

3 layers of bundled smooth muscles

detrussor muscles

small elevation behind urethral orifice

uvula vesicae

thickened circular component at neck of bladder

sphicter vesicae

Stretch receptors in bladder signal desire to urinate ● Smooth muscle of bladder wall contracts and internal sphincter of urethra relaxes ● Voluntary relaxation of external sphincter ● Abdominal muscles contract to increase pressure and force urine out

micturition

connect rete testis to epididymis

efferent ductules

firm, mobile organ lying within the scrotum ● (L) is lower than (R) ● surrounded by tunic albuginea - a tough fibrous capsule ● divided into lobules ● within each lobule are 3 coiled seminiferous tubules ● tubules open to network of channels called rete testis

testes

lies post to testis, with vas deferens lying on its medial side ● coiled tube nearly 20ft long ● has a head, body and tail ● from tail,it emerges as ___as it enters spermatic cord

epididymis

Arteries: testicular artery Veins: testicular veins -> pampiniform plexus

testes & epididymis

● ● thick-walled tube; 18 inches long ● ● ● ● Fxn: conveys mature sperm from epidydimis to the ejaculatory duct and the urethra Begins: tail of epididymis Course: passes inguinal canal to post of bladder Ends: joins seminal vesicle to form ejaculatory duct

vas derens

dilated terminal part of vas deferens

ampulla of vas deferens

2 lobulated organs; 2 inches long ● lie on posterior surface of the bladder ● joins the vas deferens to form ejaculatory duct BLOOD SUPPLY: inferior vesicle and middle rectal a.

seminal vesicles

formed by union of vas deferens and duct of seminal vesicle ● pierce post. surface of prostate ● Fxn: drain the seminal fluid into prostatic urethra

ejaculatory ducts

- fibromuscular glandular organ that surrounds the prostatic urethra - 5 lobes - lies between the neck of bladder above and urogenital diaphragm - Fxn: produces a thin, milky fluid containing citric acid and acid phophatase that is added to seminal fluid * Secretion is alkaline-neutralize the acidity in the vagina

PROSTATE

Blood Supply: Arteries: inferior vesical and middle rectal a. Veins: prostatic venous plexus Nerve Supply: inferior hypogastric plexus

prostate

3 parts of urethra

prostatic, membranous, spongy urethra

1 1/4 inches long ● Begins: neck of bladder ● Course: passes through prostate, continuous with membranous urethra ● widest and most dilatable urethral portion

prostatic urethra

rethral crest ● prostatic sinus ● prostatic utricle

prostatic urethra

- openings on each side of crest

prostatic sinus

- analog of uterus and vagina in females

prostatic utricle

thin, fibrous capsule surrounding ovary

tunica albuginea

covers capsule of ovary

germinal epithelium

attaches ovaries to back of broad ligament

mesovarium

(Round ligament of ovary) – Attaches the ovaries to the lateral wall of uterus

ovarian ligament

Attaches the ovary to the pelvic wall and contains the main blood vessels which enter the ovary at the hilum

suspensory ligament

oval-shaped, found on either side of uterus position: variable but often found hanging down the rectouterine pouch (pouch of Douglas) lie on the ovarian fossa - a depression on lateral pelvic cavity Fxn: production of ova and female sex hormones (estrogen and progesterone)

OVARY

BLOOD SUPPLY: Artery: Ovarian a. Veins: Ovarian v. NERVE SUPPLY: derived from aortic plexus and accompanies ovarian artery

ovary

● 4 inches long ● connects ovary to uterus ● Fxn: ● receives ovum from ovary and transports it to uterus ● site where fertilization can take place (usually ampulla) ● nourishment of ovum ● conduit where sperm can travel to meet the ovum

uterine tubes

funnel-shaped lateral end

infundibulum

finger-like processes at end of funnel

fimbriae

widest part

ampulla

narrowest part

isthmus

segment that pierces uterine wall

intramural part

BLOOD SUPPLY: uterine and ovarian a. and v. NERVE SUPPLY: inferior hypogastric plexus

uterine tubes

hollow, pear-shaped organ with thick muscular walls

uterus

lies above entrance of uterine tubes

fundus

below entrance of uterine tubes

body

inferior part which extends to vagina

cervix

cavity

cervical canal

normal; uterus is bent over bladder

anteversion

- uterus is bent forward at level of internal os

anteflexion

body of uterus is bent backward

retroverted

bent backward on cervix

retroflexed

migrates downward

prolapsed

maintains the anterverted position of uterus; from superlateral angle of uterus, passes through the deep inguinal ring and inguinal canal to labia majora

round ligament of uterus

In child: small until puberty In pregnancy: enlarged, becomes a part of abdominal cavity After menopause: atrophies; less vascular

uterus

serous membrane that lines the abdominopelvic cavity

peritoneum

- aka pouch of Douglas - most inferior part of peritoneum in females

rectouterine pouch

two-layered fold of peritoneum; from lateral margin of uterus to lateral pelvic wall

broad ligament

region of the trunk which lies in the diaphragm above and the inlet below

abdomen

* Skin * Superficial fascia * Deep fascia * Muscles * Extraperitoneal fascia * Parietal peritoneum

abdominal wall: anterior

Lumbar vertebra and their IV discs * 12th rib and upper part of pelvis * Muscles and aponeurosis

abdominal wall: posterior

4 Quadrants of abdomen

* Right upper * Left upper * Right lower * Left lower

9 regions of abdomen

- right hypochondriac region - epigastric region - left hypochondriac region - right lumbar region - umbilical region - left lumbar region - right iliac region - hypogastric region - left iliac region

Loosely attached to the underlying structures * Lines of cleavage – run downward and forward

skin

depression along the linea alba * site of attachment of umbilical cord of the fetus

umbilicus

lateral edge of the rectus abdominis muscle & crosses the costal at the tip of 9th costal cartilage

linea semilunaris

consist of superficial fatty layer and deep membranous layer

superficial fascia

Camper’s fascia * Scarpa’s fascia * Colle’s fascia

superficial fascia

thin layer of CT covering the muscles * lies immediately deep to the membranous layer of the superficial fascia

deep fascia

3 sheets of muscles that are aponeurotic in front

* External oblique * Internal oblique * Transversus

covered by rectus sheath

rectus abdominis

lower part of the rectus sheath

pyramidalis

Lateral flexion of trunk, rotates the trunk towards the opposite side, assist diaphragm during inspiration, assist in force expiration, supports and protects the abdominal viscera, abdominal straining

external oblique

defect in the aponeurosis, where the spermatic cord passes

superficial inguinal ring

Fibers run at right angles to those of the external oblique A – same as EO except rotation

internal oblique

insertion joined by similar fibers from the transversus abdominis

conjoint tendon

A – compresses the abdomen * Conjoint tendon

transversus abdominis

fascia that lines the transversus abdominis * Continuous with the layer lining the diaphragm and iliacus * Deep inguinal ring

fascia transversalis

Long strap muscle, separated by the linea alba * A – compress abdomen, trunk flexor, muscle of expiration * Covered by the rectus sheath

rectus abdominis

lateral margins

linea semilunaris

* A- tenses the linea alba * Often absent

pyramidalis

* Aponeurosis of the IO, EO and transversus * Encloses rectus abdominis and pyramidalis * Contains nerves and vessels

rectus sheath

* terminal branch of Internal thoracic artery * enters the rectus, supplying the upper central part of anterior abdominal wall * anastomose with inferior epigastric artery

superior epigastric artery

* branch of external iliac artery * pierces fascia transversalis to enter the rectus sheath * ascends behind rectus muscle supplying lower central part of anterior abdominal wall * anastomose with superior epigastric artery

inferior epigastric artery

* branch of External iliac artery * supplies lateral lower part of the abdominal wall

deep circumflex artery

level above umbilicus

anterior thoracic axillary node

level under umbilicus

superficial inguinal node

* oblique passage through the lower part of the anterior abdominal wall * allows structures to pass to & from the testis to the abdomen in males * permits passage of the round ligament of the uterus from the labia majora of the uterus, in females * transmit the ilioinguinal nerve for both sexes * lies above and parallel to the inguinal ligament

inguinal canal

* half an inch above the inguinal ligament * oval opening in fascia transversalis

deep inguinal ring

* triangular in the aponeurosis of external oblique; attached laterally to ASIS and curves downward medially to be attached to the pubic tubercle, sometimes called CRURA

superficial inguinal ring

* 5 lumbar vertebra and IV discs * 12th rib * Pelvic bones - ilium * Muscles * Psoas * Quadratus lumborum * Transversus abdominis * Iliacus

posterior abdominal wall

* O – transverse process, sides of vertebral bodies and IVD of T12 – L5 * I – lesser trochanter of the femur * Covered by a sheath from the lumbar fascia * Thickened to form the medial arcuate ligament * N – lumbar plexus * A – hip flexion or trunk flexion

psoas major

* Small muscle that lies anterior to psoas major * Unimportant and often absent

psoas minor

* Flat, quadrilateral-shaped muscle * O – iliolumbar ligament, iliac crest, transverse process of lower lumbar vertebra * I – 12th rib, transverse process of upper 4 lumbar vertebra * Covered by lumbar fascia * Thickened to form the lateral arcuate ligament * N – lumbar plexus * A – depresses the 12th rib, lateral flexion to same side

quadratus lumborum

* Fan-shaped * O – upper part of iliac fossa * I – joins the psoas major to insert in the lesser trochanter of the femur * N – femoral nerve * A – hip flexion or trunk flexion

iliacus

CT between the parietal peritoneum and the fascial lining of the abdominal and pelvic wall

extraperitoneal tissue

space between parietal and visceral layer

peritoneal cavity

serous membrane lining the walls of the abdominal and pelvic cavity * clothing of the abdominal and pelvic viscera

peritoneum

* between greater and lesser sac * oval window * serves as communication between two sacs

epiploic foramen

almost totally covered with visceral peritoneum

intraperitoneal organ

- partially covered by visceral peritoneum

retroperitoneal

* Two-layered folds that connect solid viscera to the abdominal walls * Falciform ligament

peritoneal ligaments

* Two-layered fold of peritoneum that connect the stomach to another viscera * Greater omentum * Lesser omentum

omenta

* Two-layered folds of peritoneum connecting parts of the intestines to the posterior abdominal wall

mesenteries

* Muscular, collapsible tube that joins the pharynx to the stomach * Greater part lies within the thorax * Pierces diaphragm and enters the stomach(right side) * Conducts food from pharynx to stomach * Wave-like contractions of the smooth muscles called

esophagus

* Dilated portion of the alimentary canal * Storage of food * Mixes food with gastric juices to form chyme * Controls amount of chyme for digestion * Situated in the left upper part of the abdomen * J shape

stomach

from celiac artery

left gastric artery

arises from the hepatic artery

right gastric artery

arises from the splenic artery

short gastric artery & left gastroepiploic artery

arises from the gastroduodenal branch of the hepatic artery

Right gastroepiploic artery

drain into the splenic vein

Short gastric and left gastroepiploic vein

drain or joins the superior mesenteric vein

Right gastroepiploic vein

drain directly into the portal vein

left and right gastric veins

* Longest part of the alimentary canal, extends from the pylorus to the iliocecal junction * Greater part of digestion and food absorption

small intestine

* C-shaped tube * Joins the stomach to the jejunum * Curves around the head of the pancreas * Situated in the epigastric and umbilical regions

duodenum

begins at pylorus and runs upward and backward on the right side of L1 Vertebra

1st part

runs vertically downward in front of the hilum of the right kidney

2nd part

runs horizontally to the left

3rd part

runs upward and to the left to the duodenojejunal flexure

4th part

* 20 ft long * Upper 2/5 – jejunum * Lower 3/5 – ileum

jejunum and ileum

supplies the lower part of the ileum

iliocolic artery

* Extends from the ileum to the anus * Parts: cecum, appendix, ascending colon, transverse colon, descending colon and sigmoid colon * Rectum and anal canal are in the pelvic region * Absorption of water and electrolytes * Storage of undigested material until it can be expelled from the body as feces

large intestine

* Lies below the level of the junction of the ileum * The ileum enters the large intestine at the junction of the cecum with the ascending colon * The opening is provided with two-folds which forms the ILIOCECAL VALVE

cecum

* Horizontal folds of mucous membranes that project around the orifice of the ileum * Plays little or no part in preventing reflux

illiocecal valve

* Narrow muscular tube containing large amount of lymphoid tissue * Attached to the posteromedial surface of the cecum below the ileocecal junction * Located in the McBurney’s point

appendix

Lies at right lower quadrant * extends upward from cecum to the inferior surface of the R lobe of the liver * Turn sharply to L forming R colic flexure/ hepatic flexure * Blood supply: ileocolic and R colic arteries, branches of the superior mesenteric artery * Vein: superior mesenteric vein

ascending colon

* Located in the umbilical region * begins at the R colic/hepatic flexure and ascends to the L colic flexure

transverse colon

suspends the transverse colon from the anterior border of the pancreas

transverse mesocolon

supplied by middle colic artery, branch of the superior mesenteric artery

proximal 2/3

supplied by L colic artery, branch of the inferior mesenteric artery

Distal 1/3

* Lies on L upper & lower quadrants * extends from L colic flexure to the pelvic brim * Blood supply: L colic artery & sigmoid branch of inferior mesenteric artery * Veins: drain towards the inferior mesenteric vein

descending colon

begins at the pelvic inlet, continuation of the descending colon, joins the rectum in front of the sacrum

sigmoid colon

occupies the posterior part of the pelvis cavity, descends in the part in front of the sacrum to leave the pelvis by piercing the pelvic floor

rectum

* Largest organ in the body * Production and secretion of bile * Involvement in many metabolic activities * Filtration of blood

liver

large * Quadrate lobe * Caudate lobe

right lobe

hilum of the liver that is found on the posteroinferior surface and lies between the quadrate lobe and caudate lobe (figure 5.7) * Blood supply – hepatic artery * Veins – hepatic veins

liver

secreted by liver at a constant rate * If digestion is not taking place, bile is stored in the gall bladder * Delivered to the duodenum during digestion

bile ducts

* Pear-shaped sac undersurface of the liver * Parts; * fundus * body * neck * serves as reservoir for bile which contains bile salts assists in digestion and absorption * Blood supply- cystic artery, branch of R hepatic artery * Veins- portal vein

gall bladder

* Both exocrine & endocrine gland

pancreas

secretes enzymes capable of hydrolyzing proteins, fats and carbohydrates

exocrine

islets of Langerhans produces insulin and glucagon

endocrine

head- lies within the concavity of the duodenum * neck- more constricted portion * body- runs upward and to the L across the midline * tail- passes upward in the splenicorenal ligament and in contact with hilum of the spleen

pancreas

begins at the tail and runs the length of the gland * opens into the 2nd part of the duodenum

pancreatic duct

drains at the upper part of the head

accesory duct

* reddish, largest single mass of lymphoid tissue * oval in shape, has a notch on the anterior border * surrounded by peritoneum by gastrosplenic omentum from the hilus down to greater curvature of the stomach

spleen

connects from the spleen to the L kidney

splenicorenal ligament

* Excretion of waste product * major role in controlling water & electrolyte balance into the body & maintaining the acid-base balance of the blood * R kidney: slightly lower than L kidney * median border has a hilus; passage for renal vein, 2 branches of renal artery, ureters, 3rd branch of renal artery

kidney

* convey urine from the kidney to urinary bladder

ureters

funnel shaped, expanded upper end of the ureter that lies within hilus of kidney

renal pelvis

renal calculus or nephrolith

kidney stones

lies at upper poles of the kidney

suprarenal glands

secretes hormones such as mineral corticoids and glucocorticoids and sex hormones

cortex

epinephrine and norepinephrine

medulla

pyramidal, located at the upper pole of the R kidney

right suprarenal gland

crescentic in shape @medial border of the L kidney

left suprarenal gland

* drains blood from abdominal part of the g.i tract * drainsbloodfromspleen,pancreas,7gallbladder * enters liver & breaks up into sinusoids, which blood passes into the hepatic veins that join the inferior vena cava * runs upward in front of the opening into the lesser sac to the porta hepatis, where it divides into R & L terminal branches

portal vein