Abdomen & Pelvis anatomy Flashcards
Lymphatic drainage of abdominal wall above umbilicus
Anterior axillary lymph nodes
Lymphatic drainage of abdominal wall below umbilicus
Superficial inguinal lymph nodes
Lymphatic drainage below dentate line/scrotum/labia majora
Medial superficial inguinal lymph nodes
Level of arcuate line
2cm below umbilicus
Layers of abdominal wall medially above arcuate line
Skin
Campers
Scarpas
Anterior rectus sheath
Rectus Abdominis
Posterior rectus sheath
Transversalis fascia
Parietal peritoneum
Layers of abdominal wall laterally above arcuate line
Skin
Campers
Scarpas
External oblique
Internal oblique
Transversus abdominis
Transversalis fascia
Parietal peritoneum
Layers of abdominal wall
medially below arcuate line
Skin
Campers
Scarpas
Anterior abdominal aponeurosis
Rectus abdominis
Transversalis fascia
Parietal peritoneum
Layers of abdominal wall
laterally below arcuate line
Skin
Campers
Scarpas
External oblique
Internal oblique
Transversus abdominis
Transversalis fascia
Parietal peritoneum
Spigelian hernia
Weakness in semilunaris
L1 surface markings
Half way between suprasternal and symphysis pubis - 2 Ss
L3
3 things
- IMA
- 3rd pharyngeal pouch
- Inferior parathyroid
Surface marking of fundus of gallbladder
Intersection of R mid clavicular line & transpyloric plane
Spinal cord termination
Children are inferior to adults
L1 in adults
L3 in children
Transpyloric plane
Bones - L1, 9th costal cartilage
Nerve - conus medullaris
Lymph - cisterna chyli
Vessels - SMA, portal vein
Organs - fundus of gallbladder, pylorus of stomach, 2nd part of duodenum (sphincter of Oddi), colon (hepatic and splenic flexure), renal hilum, NECK of pancreas
Location of lumbar hernia
Posterior abdominal wall
IQ 12 (of examiners)
Internal oblique
Quadratus lumborum/erector spinae
Lower border of 12th rib
Ligaments formed by lesser omentum
Hepatoduodenal ligament
Hepatogastric ligament
Attachments of greater omentum
Attaches to greater curve of stomach and then transverse colon
Pancreatic pseudocysts
Smooth elevation in POSTERIOR wall of stomach
Portal triad
Portal vein
Hepatic artery proper
CBD
What makes a cyst a PSEUDO cyst?
No epithelial lining
Pancreatic HEAD pathology
Cancer
Location of pancreatic NECK
L1
Pancreatic BODY pathology
Pseudocysts
Pancreas TAIL pathology
Diabetes - 90% of islets in tail
Borders of epiploic foramen
IVC - posterior
D1 - inferior
Caudate lobe of liver - superior
Free edge of lesser omentum - anterior
Branches of celiac trunk
C is 3rd letter of alphabet
L gastric
Splenic
Common hepatitic
Why is splenic artery tortuous?
To compensate for difference in pressure between aorta and spleen
Anastomosis of L gastric vein
L gastric anastomoses to azygous –> portosystemic shunt
Relation of splenic vein and portal vein to pancreas
POSTERIOR
Which parts of GI tract are intraperitoneal?
D1 and pancreatic TAIL
Splenic artery
Bulge in posterior stomach
Border of Calot’s triangle
Inferior margin of liver
Common hepatic duct
Cystic duct
Contents of Calot’s
R hepatic artery - supplies R lobe of lover, if damaged can result in deranged LFTs following cholecystectomy
Cystic artery
Lymphatics - node of Lund
Most common location of gallstone
Ampulla –> narrowest
Mirizzi syndrome
Compression of common hepatic duct leading to jaundice
Gallstone ileus
Within 60cm of ileocaecal valve
Most common causative organism for cholecystitis
E coli
Signs of ascending cholangitis
Gas in biliary tree
Fever, pain, jaundice
Unwell
Cancer most often caused by chronic inflammation
Squamous cell
Cancer caused by gallbladder inflammation & Barrett’s oesophagus
Adenocarcinoma
Organism causing porcelain gallbladder
Salmonella Typhi
Blue colour - calcification
Structure posterior to 1st part of duodenum
Gastroduodenal artery
Structures relating to 2nd part of duodenum
TRANSPYLORIC PLANE
Post - right renal hilar vessels
Kocker maneouvre
Structures relating to 3rd part of duodenum
Post - aorta and IVC
Ant - SMA, SMV and ureter
Structures relating to 4th part of duodenum
Post - L renal hilar vessels
Jejunum
Long vasa rectae
Less arterial arcades
Thicker wall
More plicae circulares
Ileum
THINK CROHNS –> HOLE –> NEEDS MORE VESSELS TO HEAL
Short vasa rectae
More arterial arcades
Thinner wall
Peyers patches
Blood supply of pancreas
Splenic artery - pancreatic branches
Head also supplied by:
superior pancreaticoduodenal (branch of gastroduodenal)
inferior pancreaticoduodenal (branch of SMA)
SMA syndrome
Intermittent bowel obstruction
Thin patient
Post-prandial - 3rd part of duodenum
Which part of duodenum affected in SMA syndrome?
3rd part
Position of L renal vein
BEHIND SMA
IN FRONT OF aorta
Nutcracker syndrome
Compression of L renal vein between SMA and aorta –> loin pain and haematuria
Surface marking of spleen
Mid axillary line
9, 10, 11th rib
Embryonic derivative of spleen
MESODERM
Location of pancreatic TAIL
Intraperitoneal
Drug given to treat pancreatic fistula
Ocreotide (somatostatin) stops secretions
Structures close to R of liver
Gallbladder
IVC
Structures close to L of liver
2 x Ls
Ligamentum venosus
Round ligament
Watershed areas of large bowel
2/3rds of transverse colon
Sigmoid colon
How much of transverse colon does SMA supply?
2/3rd
Sites of portocaval anastomoses
Gut, butt then caput
L gastric - via azygous - oesophageal veins
Superficial epigastric veins - umbilical vein
Superior rectal - IMV
Middle rectal - internal iliac
Inferior rectal - internal iliac
Venous drainage of rectum
Superior rectal —– Inferior mesenteric vein (PORTAL VENOUS)
Middle rectal —— Internal iliac vein
Inferior rectal —— Internal iliac vein (pudendal) (SYSTEMIC)
Blood supply of rectum
Superior rectal artery – terminal continuation of the inferior mesenteric artery
Middle rectal artery – branch of the internal iliac artery
Inferior rectal artery – branch of the internal pudendal artery
Submucosal wall
Weakness causes oesophageal varies and haemorrhoids
Embryological relevance of dentate line
Separates ectoderm and endoderm
Anal canal above dentate line
Endoderm
Columnar epithelium
Insensate
Internal iliac nodes
Anal canal below dentate line
Ectoderm
Squamous epithelium
Sensate
Superficial inguinal nodes
Lymphatic drainage of ovary, fundus and fallopian tube
Para aortic
Lymphatic drainage of uterine body
External iliac
Lymphatic drainage of cervix
Internal iliac
Lymphatic drainage of scrotum
Superficial inguinal
Lymphatic drainage of glans penis
Deep inguinal
Order of structures at renal hilum
A–>P VAU
Renal vein
Renal artery
Ureter
Location of R adrenal gland
Posterior to IVC
Location of L adrenal gland
Next to aorta
Gold standard imaging for venous clot
MRI
Blood supply of ureter
Supplied by all branches it passes EXCEPT for:
Inferior rectal artery
Median sacral artery
Location of upper abdominal collection when supine
Hepatorenal pouch (Morrison)
Location of lower abdominal collection when supine
Rectouterine/vesicle (Douglas)
Most dependent part when sitting/standing
Rectouterine/vesical (Douglas)
Location of deep inguinal ring
Mid-point of inguinal ligament
INGUINAL LIGAMENT –> THINK HERNIA
Location of femoral artery
Mid-inguinal point
Significance of mid clavicular line
Fundus of gallbladder, femoral artery, nipple
Inguinal canal
Muscles superior
Aponeurosis anterior
Muscle - TA, IO
Aponeurosis - IO, EO
Ligament - inguinal, lacunar
Tendon - conjoint tendon, transversals fascia
Inguinal canal
ICE
TIE
Bottom line gives rise to top line
Internal spermatic fascia, cremasteric fascia, external spermatic fascia
Transversalis fascia, internal oblique, external oblique
Borders of Hesselbach’s triangle
Inguinal ligament - lateral
Inferior epigastric - superior
Rectus abdominis - medial
Role of inf epigastric in inguinal hernia
Lateral to IE –> indirect
Medial to IE –> direct
Femoral hernia
More common in females
Borders for femoral hernia
P for posterior - pectineal
Anterior - inguinal
Medial - lacunar
Lateral - femoral vein
Which nerve pierces psoas major?
Gentiofemoral (can be mistaken for psoas minor)
Location of femoral nerve in relation to obturator canal
EXTERNAL to obturator canal
Genital regional dermatomes
THINK FIG
F - anterior thigh - femoral
I - thigh and scrotum - ilioinguinal
G - scrotum - genitofemoral
Sensory part of cremasteric reflex
General somatic afferent - ilioinguinal & femoral branch of genitofemoral nerve
Motor part of cremasteric reflex
General somatic efferent - genital branch of genitofemoral nerve
Structures felt in male DRE
Anterior - prostate
Posterior - coccyx
Lateral - puborectalis
Pudendal canal syndrome - Alcocks
Perianal pain on sitting
Most important ligament supporting uterus
Uterosacral - pulling dog on leash
Sensory supply of pudendal nerve
Posterior scrotum and posterior labia majora
Surface landmark for pudendal nerve
Ischial spine
Water under the bridge
Urine goes under uterine artery
