Abdomen - Pelvic Flashcards
- region of trunk lies inferior to abdomen
- transmits body weight from vertebral column to femur
pelvis
Post: lumbar vertebrae
Lateral: iliac fossa and iliacus
Ant: lower part of abdominal wall
false pelvis
pelvic inlet, pelvic outlet, pelvic cavity
true pelvis
aka pelvic brim
Boundaries:
Post: sacral promontory
Lat: iliopectineal lines
Ant: symphysis pubis
Pelvic Inlet
Boundaries:
Post: coccyx
Lat: ischial tuberosities
Ant: pubic arch
Pelvic Outlet
lies between the pelvic inlet & outlet
pelvic cavity
bones of the pelvis
Sacrum
Coccyx
Hip Bones (2)
3 bones joined at acetabulum
upper flattened part of hip bone
ilium
- Iliac fossa
- Iliac crest
- Iliac tubercle
- ASIS
- AIIS
- PSIS
ilium
bulge where ilium and pubis meets
iliopubic eminence
runs downward & forward on the inner surface of ilium; divides true and false pelvis
symphysis pubis
inferior and posterior bone
● Ischial tuberosity
● Ischial spine
ischium
● Greater sciatic notch
● Lesser sciatic notch
ischial spine
- anterior part
- pubic rami, symphysis pubis, body of pubis
pubis
● Pubic tubercle
● Pubic crest
body of pubis
superior and inferior
pubic rami
post; limited movement
Fxn: transmit weight from spine to pelvis
sacroiliac joint
ant, post and interosseous
sacroilliac ligament
strong; from lateral of sacrum, coccyx and PSIS to ischial tube
sacrotuberous ligament
triangular; base from lateral of sacrum & coccyx; apex – ischial spine
sacrospinous ligament
- ant; cartilaginous joint
- (+) fibrocartilaginous disc bet. 2 pubic bones
- fixed
symphysis pubis
Filled in by obturator membrane, a fibrous sheet, leaving only a small gap
obturator foramen
obturator nerve & vessels
oburator canal
Tendon: OI
Nerve: pudendal & n. to OI
lesser sciatric foramen
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
