Abdomen, Pelvis and Perineum Flashcards
What structure forms the deep inguinal ring?
Outpouching of Transversal fascia
What muscle of the 3 layers of the anterior abdominal wall does not contribute to spermatic fascia/cord?
Transversus abdominis
What structures forms the external, middle and internal spermatic fascia of the spermatic cord?
- external abdominal oblique (external)
- internal abdominal oblique (middle)
- transversalis fascia
What structure form the femoral canal?
Transversalis fascia ▶️ inferior extension ▶️ femoral sheath
Contents of inguinal canal in female
- round ligament of the uterus
- ilioinguinal nerve (L1)
Contents of inguinal canal in male
- Ilioinguinal nerve (L1),
- espermatic cord: testicular artery, pampiniform venous plexus, vas deferens (ductus deferens and its artery), autonomic nerves, lymphatics
What is the fibrous gubernaculum during descent of testes?
Fibrous tissue that guides the testis descending to the deep inguinal ring
Where does penis and scrotum cancer metastasize, and the testicular cancer?
- penis and scrotum: superficial inguinal lymph nodes
- testicular: aortic (lumbar) lymph nodes
What nerves are the responsible of the sensitive and motor response of the cremasteric reflex?
- ilioinguinal nerve: sensory fibers (lightly touch of thigh)
- genitofemoral nerve: motor fibers
What structure forms the superficial inguinal ring?
External abdominal oblique fascia
What is the result of a persistent process vaginalis?
Congenital indirect inguinal hernia
What happen if serous fluid collects in the tunica vaginalis?
Hydrocele ▶️ enlarged scrotum (doesn’t reduce in size when lying down)
Which the boundaries of inguinal “hasselbach’s” triangle? And what is its importance?
Lateral: inferior epigastric vessels
Medial: rectus abdominis muscle
Inferior: inguinal ligament
- site of direct inguinal hernia
Which layers cover the sac where bulges the indirect inguinal hernia?
The 3 layers of spermatic fascia
What is the difference or boundary between femoral and inguinal hernia?
- femoral: pass below inguinal ligament
- inguinal: pass above inguinal ligament
What is the epiploic foramen (of Winslow) and its boundaries?
The only communication between the lesser sac and the greater sac of peritoneal cavity
- Anteriorly: Hepatoduodenal ligament and the hepatic portal vein.
- Posteriorly: Inferior vena cava.
- Superiorly: Caudate lobe of the liver.
- Inferiorly: First part of the duodenum
What structures undergo to secondary retroperitonealization? Why does it occur?
Duodenum, 2nd and 3rd parts Head, neck, and body of pancreas Ascending colon Descending colon Upper rectum - they fuse with the body wall by way of fusion of visceral peritoneum with parietal peritoneum
What is annular pancreas and its mean feature?
Defect in rotation and fusion of ventral and dorsal buds of pancreas ▶️ constrict or obstruct duodenum ▶️ polyhydramnios
Where is located the portal triad, what is it?
- hepatoduodenal ligament
- portal vein, hepatic artery, common bile duct
What clinical presentation commonly occur in head cancer pancreas?
Constrict main pancreatic duct and common bile duct, obstruction of it ▶️ jaundice
Innervation and function of internal anal sphincter
- circular smooth muscle surround anal canal
- sympathetic: lumbar splanchnic ⬆️ tone
- parasympathetic: pelvic splanchnic ⬇️ tone relaxes (defecation)
Innervation and function of external anal sphincter
- circular voluntary skeletal muscle surrounding the canal
- inferior rectal branch of pudendal nerve, relaxes during defecation
What is the cause of hirschsprung disease?
Mutations affect the migration of neural crest cells into the Gut ▶️ deficiency of terminal ganglion cells in Auberbach’s plexus
What is the cause of pain in gastrointestinal tract?
Excessive contraction and or distention of smooth muscle
What alteration in gastrointestinal motility results in Hirschsprung disease?
Particularly in rectum ▶️ peristalsis is not effective ▶️ constipation
What results in Vit B12 deficiency?
- pernicious anemia
- disruption of peripheral and central nervous system myelin (subacute combined degeneration)
How does histamine increases the HCl secretion by parietal cells?
- H2 receptor ⬆️ potentiate gastrin and Ach
* inhibitor: cimetidine and H2 antagonist
How can you differentiate the three portions of the small intestine?
- duodenum: brunner’s glands in submucosa
- jejunum: no brunner’s or peyer’s patch
- ileum: peyer’s patch in lamina propia
In case of constipation what system would you like to activate?
Parasympathetic system ▶️ 🔛 peristalsis
*dopaminergic of cholinergic agents (metoclopramide)
What is the function of a paneth cell?
- apical acidophilic granules ▶️ lysozymes and defensins (cryptins) ▶️ protect against pathogens
Main functions of salivary glands
- initial triglycerides digestion (lipases)
- initial starch digestion (amylases)
- lubrication
What is the effect of parasympathetic and sympathetic innervation on salivary glands?
- sympathetic: ⬆️ serous production by B-adrenergic receptors
- parasympathetic: ⬆️ mucous production by muscarinic receptor (anticholinergic ▶️ dry mouth)
What is the function of Ito cells? Where are they?
- contain fat, storage of fat-soluble vitamins, Vit A mainly
- space of Disse
What zone of the hepatic acinus is more susceptible to hypoxia and ischemia?
zone 3
What induce the contraction and empty of the gallbladder? Where is it produced?
- cholecystokinin
- enteroendocrine cells of the duodenum when meal (lipid) arrive
Besides excretion and aid to absorption of fat, what is the other function of the bile?
Transport of IgA
What pathological process does the Ito cell contribute?
Scarring of the liver
*stimulated during liver injury ▶️ release collagen type I and other matrix components into space of Disse (cirrhosis due to etanol)
Which are the three branches that can suffer erosion by penetrating ulcer of the wall of the stomach?
- splenic
- left gastric
- gastroduodenal
Where is the most common site of bowel ischemia?
The splenic flexure
What anastomoses represents the junction between foregut and midgut, midgut and hindgut?
- pancreoticoduodenal, superior (foregut) and inferior (midgut) arteries, branches from celiac and SMA respectively
- marginal artery interconnection of the branches of SMA and IMA to the colon (midgut and hindgut)
What structure most commonly be compressed by an aneurism of the superior mesenteric artery? What symptoms or signs can you get?
- left renal vein when crosses anterior to the aorta
- renal and adrenal hypertension on left, in males ▶️ varicocele on the left
Which are the sites where portal system anastomoses with caval system?
- esophageal veins
- rectal veins
- thoracoepigastric veins
- if portal hypertension exists (obstruction) these veins may enlarge (retrograde blood flow) ▶️ esophageal varices, internal hemorrhoids, and a caput medusae
What is the cause of spastic bladder?
Lesion of spinal cord above the sacral spinal cord levels
*loss inhibition of the parasympathetic nerve that innervates detrusor muscle during filling stage ▶️ urge incontinence (activate destructor with minimum stretch)
Atonic bladder is the result of what lesion?
Lesions to the sacral spinal cord segments or sacral espinal nerve roots
*loss pelvic splanchnic motor innervation ▶️ loss contraction of detrusor ▶️ full bladder with continuos dribble
What situation allows the filtration in the glomerulus?
pressure remains high inside
What protein is associated with complex protein between the diaphragm formed by foot processes of podocytes?
Actin
What cells produces erythropoietin?
Fibroblast in cortex and medulla
What is the role of MIF in embryology of reproductive system?
Inhibit paramesonephric duct (Müllerian duct) - lead in uterine tubes, uterus, cervix, upper vagina
*male - appendix of testes once inhibited
What structures would you expect to find normal in 5-Alfa reductase deficiency?
Prostate gland, epididymis, ductus deferens, seminal vesicle, ejaculatory duct (need just testosterone)
*Those that don’t need DHT to develop
What is the cause of complete androgen insensitivity? What is its presentation?
- mutation in androgen receptor gene
- testes develop but external female genitalia (46XY)
What structures form the pelvic diaphragm?
- levator ani
- coccygeus
What structures form the Urogenital diaphragm?
- urethral sphincter
- deep transverse perineus
What is the role of the internal urethral sphincter muscle during ejaculation reflex? What system mediates this reflex?
- contract to avoid retrograde flow and urine pass
* sympathetic control - contraction others smooth muscles to impulse seminal fluid (ex, of the ductus deferens)
What is call the “water under the bridge” and for what is it important?
- Ureter passes inferior to the uterine artery, or uterine artery within cardinal ligament crosses over anterior surface of ureter
- Must be identified during surgical procedures→avoid ureter injury
Which are the contents of the superficial perineal pouch?
- women: great vestibular (Bartholin) glands
- crura of penis or clitoris
- bulb of penis (contain urethra) and of vestibule in women
- ischiocavernosus muscle: covers crura
- bulbospongiosus muscle: covers bulb
- crura continues as corpora cavernosa in penis and clitoris
- bulb continues as corpus spongiosum in penis
What is the blood-testis barrier? And its function.
- network of Sertoli cells formed by their tight junctions which divides the seminiferous tubules into a basal and an adlumental compartment
- basal receive material from blood, the adlumental doesn’t
What can cause accumulation of fluid in the scrotum, penis, and anterolateral abdominal wall?
Laceration membranous or penile urethra (deep to scarpa fascia)
- trauma perineal region (saddle injury)
- laceration of the urethra during catheterization
What structure could have been injured to cause extravasation of urine from urethra to superficial perineal space?
Injury to the bulb of the penis
Where is the corpus luteum come from and its function?
- wall of follicles collapses and infold once the oocyte has been delivered
- granulosa and theca lutein cells ▶️ estrogen and progesterone, androstenedione and progesterone (prevent development of new follicles)
Why women with kartagener syndrome (immotile cilia syndrome) have normal transport of the ovum at the oviduct?
Ciliary action is not essential, contraction of muscle layer transport the ovum or fertilized egg (zygote) to the uterus
A woman develops a stenosis of the superior mesenteric artery at its origin from the aorta, which part of colon results in decreased blood supply? Which vessel provides collateral circulation to the affected part?
- 2/3 proximal colon
- Left colic (normally 1/3 proximal colon)
What level does the inferior mesenteric artery arise?
From the aorta at L3 between the gonadal arteries and the bifurcation of the aorta.
What can cause a failure in fusion of the buds of the pancreas?
Polyhydramnios
*defect in the rotation and fusion of the ventral and dorsal buds ▶️ annular pancreas ▶️ constrict or obstruct the duodenum
