Abdomen, Pelvis and Perineum Part 1 Flashcards by Notis Tzionis

What are the superior & inferior boundaries of the abdominal cavity?

Superior limit: Diaphragm
Inferior limit: No inferior limit - continues with the pelvic cavity

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The abdominal can be divided in to 4 quadrants. Name them starting from the most superolateral point and going clockwise.

Right upper quadrant
Left upper quadrant
Left lower quadrant
Right lower quadrant

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What lines divide the abdomen into 4 quadrants?

Transumbilical plane
Median plane

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The abdominal can be divided in to 9 regions. Name them starting from the most superolateral point and going S - shaped.

Right hypochondrium
Epigastric
Left hypochondrium
Left lumbar
Umbilical
Right lumbar
Right inguinal
Pubic
Left inguinal

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What lines divide the abdomen into 9 regions?

Left & Right Midclavicular line
Subcostal plane
Intertubercular plane

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What are the main characteristics of Lumbar Vertebra (5)?

Large size
Lack facets for articulation with ribs
The transverse processes are generally thin and long, with the exception of those on vertebra L5, which are massive and somewhat cone shaped for the attachment ofiliolumbar ligamentsto connect the transverse processes to the pelvic bones.
The vertebral body of a typical lumbar vertebra is cylindrical
The vertebral foramen is triangular in shape and larger than in the thoracic vertebrae

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Name the ligament

Inguinal ligament

Strong band of tendonous tissue that joins the anterior superior iliac spine to the pubic tubercule

Lowest part of the external oblique aponeurosis

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What are the 2 rings found on the ends of the inguinal canal?

Superficial inguinal ring
Deep inguinal ring

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What structures go through the inguinal canal (5)?

Spermatic cord (males)
Testicular artery (males)
Testicular vein (males)
Round ligament (females)
Genitofemoral nerve (both)

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Which muscles make up the posterior wall of the abdomen? (Posterior to Anterior)

Erector spinae muscles
Quadratus lumborum muscle
Psoas major
Psoas minor

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Name the muscle

Quadratus lumborum muscle

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What is the origin of the quadratus lumborum muscle muscle?

Iliac crest
Iliolumbar ligament

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What is the insertion of the quadratus lumborum muscle?

Inferior border of the 12th rib
Transverse processes of L1 - L4

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What is the action of the quadratus lumborum muscle?

Extends & laterally flexes trunk
Stabilises 12th rib during inspiration

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What is the innervation of the quadratus lumborum muscle?

Anterior rami of T12
Spinal nerves L1 - L4

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What is the arterial blood supply of the quadratus lumborum muscle?

Lumbar artery
Subcostal artery
Lumbar branch of iliolumbar arteries

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Name the muscle

Psoas major muscle

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What is the origin of the psoas major muscle muscle?

Transverse processes of L1 - L5
Vertebral bodies of T12 - L5

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What is the insertion of the psoas major muscle?

Lesser trochanter of femur

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What is the action of the psoas major muscle?

Flexes thigh at hip joint
Flexes trunk

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What is the innervation of the psoas major muscle?

Anterior rami of spinal nerves L1 - L3

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What is the arterial blood supply of the psoas major muscle?

Lumbar artery
Lumbar branch of iliolumbar arteries
Obturator artery
External iliac artery
Femoral artery

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Name the muscle

Iliopsoas muscle

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How is the iliopsoas muscle formed?

The medial fibres of the iliacus and the lateral fibres of the psoas major join forming the iliopsoas

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Where does the iliopsoas major muscle insert?

Passes under the inguinal ligament and backwards to insert at the lesser trochanter of the femur

What structure covers the iliopsoas muscle?

Ilio-psoas fascia

Name the muscle

Iliacus muscle

What is the origin of the iliacus muscle?

* Iliac crest * Iliac fossa * Ala of sacrum * Anterior sacroiliac ligaments

What is the insertion of the iliacus muscle?

Lesser trochanter of femur

What is the action of the iliacus muscle?

* Flexes thigh at hip joint * Flexes trunk

What is the innervation of the iliacus muscle?

Femoral nerve L2 - L3

What is the arterial blood supply of the iliacus muscle?

* Iliac branch of iliolumbar arteries * Deep circumflex iliac artery * Obturator artery * Femoral arteryc

Name the muscle

Psoas minor muscle

What is the origin of the psoas minor muscle muscle?

Vertebral bodies of T12 - L1

What is the insertion of the psoas minor muscle?

Iliopectineal eminence & pecten pubis of hip bone

What is the action of the psoas minor muscle?

Assists flexion of trunk

What is the innervation of the psoas minor muscle?

Anterior ramus of spinal nerve L1

What is the arterial blood supply of the psoas minor muscle?

Lumbar artery

Which muscles make up the lateral & anterior wall of the abdomen? (Anterior to Posterior)

* Rectus abdominis muscle * External abdominal oblique muscle * Internal abdominal oblique muscle * Transversus abdominal oblique muscle

Name the muscle.

Rectus abdominis muscle

What is the origin of the rectus abdominis muscle?

* Pubic crest * Pubic symphysis

What is the insertion of the rectus abdominis muscle?

* Xiphoid process * Costal cartilage of 5th to 7th ribs

What is the action of the rectus abdominis muscle?

* Flexes trunk * Compresses & provides structural support to adjacent abdominal structures

What is the innervation of the rectus abdominis muscle?

Anterior rami of T6 - T12

What is the arterial blood supply of the rectus abdominis muscle?

Superior & Inferior epigastric arteries

Name the structure

Anterior rectus sheath ## Footnote Firmly attached to the tendonous intersections of the rectus abdominis muscle. The anterior rectus sheath & the posterior rectus sheath both meat at the linea alba (the midline).

Name the muscle

External abdominal oblique muscle

What is the origin of the external abdominal oblique muscle?

External surfaces and inferior borders of 5th - 12th ribs

What is the insertion of the external abdominal oblique muscle?

* Anterior superior iliac spine * Anterior half of iliac crest * Pubic crest * Pubic tubercule * Linea alba

What is the action of the external abdominal oblique muscle?

* Flexes, laterally flexes & rotates trunk * Compresses & provides structural support to adjacent abdominal structures

What is the innervation of the external abdominal oblique muscle?

Anterior rami of T7 - T12

What is the arterial blood supply of the external abdominal oblique muscle?

* Lower posterior intercostal artery * Subcostal artery * Circumflex artery * Superior & Inferior epigastric arteries

Where does the external abdominal oblique muscle end?

At the external oblique aponeurosis tendon

Name the muscle.

Internal abdominal oblique muscle

What is the origin of the internal abdominal oblique muscle?

* Thoracolumbar fascia * Iliac crest * Inguinal ligament

What is the insertion of the internal abdominal oblique muscle?

* Inferior margins of 10th - 12th ribs * Linea alba * Pecten pubis

What is the action of the internal abdominal oblique muscle?

* Flexes, laterally flexes & rotates trunk * Compresses & provides structural support to adjacent abdominal structures

What is the innervation of the internal abdominal oblique muscle?

* Anterior rami of T7 - T12 * Iliohypogastric nerve * Ilioinguinal nerve

What is the arterial blood supply of the internal abdominal oblique muscle?

* Lower posterior intercostal artery * Subcostal artery * Deep circumflex artery * Superior & Inferior epigastric arteries

Where does the internal abdominal oblique muscle end?

At the internal oblique aponeurosis tendon

Name the muscle.

Transversus abdominal oblique muscle

What is the origin of the transversus abdominal oblique muscle?

* Costal cartilages of 7th - 12th ribs * Thoracolumbar fascia * Iliac crest * Inguinal ligament

What is the insertion of the transversus abdominal oblique muscle?

* Linea alba * Pubic crest * Pecten pubis

What is the action of the transversus abdominal oblique muscle?

Compresses & provides structural support to adjacent abdominal structures

What is the innervation of the transversus abdominal oblique muscle?

* Anterior rami of T7 - T12 * Iliohypogastric nerve * Ilioinguinal nerve

What is the arterial blood supply of the transversus abdominal oblique muscle?

* Lower posterior intercostal artery * Superficial & Deep circumflex artery * Superior & Inferior epigastric arteries

Where does the transversus abdominal oblique muscle end?

At the transversus aponeurosis tendon

What is the inner lining of the abdominal cavity?

Parietal peritoneum

What are the two main arteries of the anterior abdominal wall?

* Inferior epigastric vessels * Superior epigastric vessels

What is the innervation of the anterolateral abdominal wall?

Intercostal nerves from T7 - T12 (mixed)

What is the innervation of the posterior abdominal wall?

* Subcostal nerve (Sensory) * Ilio-hypogastric nerve (Mixed) * Ili-inguinal nerve (Sensory) * Lateral cutaneous nerve of the thigh (Sensory) * Genito-femoral nerve (Sensory) * Femoral nerve (Motor) * Obturator nerve (Motor) * Sympathetic trunk (Sensory) * Sympathetic ganglion (Sensory) * Right vagus nerve (Sensory)

Outline the gastrointestinal tract.

* Mouth * Oesophagus (through the oesophageal hiatus of the diaphragm) * Stomach * Duodenum * Jejunum * Ileum * Cecum * Ascending colon * Transverse colon * Descending colon * Sigmoid colon * Rectum * Anal canal

What are the 3 main sections of the gastrointestinal tract?

* Foregut * Midgut * Hindgut

Outline the development of the midgut.

1. As the midgut develops, it protrudes into the yolk stalk forming a loop, with the superior mesenteric artery forming the axis of the loop. 1. As it protrudes the midgut loop makes a quarter turn counter - clockwise, so its distal part is to the the left & its proximal part is to the right. 1. The distal part of the loop develops a bulge that will become the cecum and the proximal part of the loop become quite convoluted 1. During this time the body grows and allows the midgut to return into the abdomen. The proximal part of the loop returns first. It passes under the distal part, and over to the left. The distal part passes in front of the proximal part and ends up over to the right

Name the structure.

Stomach

Where do the oesophagus & the stomach connect (1)?

Oesphago - gastric junction

Where do the oesophagus & the duodenum (2)?

Pylorus

What is the part of the stomach leading to the pylorus (3)?

Pyloric antrum

What are the two curves of the stomach called?

* Greater curve (Yellow) * Lesser curve (Green)

What is the upward & backward bulge of the stomach called?

Fundus (4)

Outline the structure of the stomach going from superficial layer to inner layer.

* Smooth muscle layer: * Forms a highly effective sphincter in the pylorus * Mucosa: * Form a party effective sphincter in the oesophagogastric junction * Prominent longitudinal folds in the pyloric antrum

What structure is attached on the greater curve of the stomach?

Greater omentum

Where does the greater omentum attach?

* Greater curve of the stomach * Transverse colon

What is the part of the greater omentum between the stomach and the transverse colon?

Gastrocolic Ligament

What structure is attached on the lesser curve?

Lesser omentum

Where does the lesser omentum end?

* On the underside of the liver and the diaphragm * Forms a bag-like structure called omental bursa / lesser sac

What is the opening of the lesser sac called?

Epiploic foramen

Name this part of the small intestine.

Duodenum

Where does the duodenum end?

Duodeno-jejunal flexure

How many parts does the duodenum have?

What structure does the duodenum surround?

The head of the pancreas

What structures empty into the duodenum?

* Pancreatic duct * Common bile duct

What are the two peritoneal attachments of the duodenum (proximally & distally)?

* Proximally: Distal part of the lesser omentum * Distally: Suspensory ligament

What part of the small intestine follows the duodenum?

Jejuno - ileum (6m length)

What structure acts as superior & lateral boundary of the jejuno - ileum?

* Ascending colon * Transverse colon * Descending colon

What peritoneal structure attaches the jejuno - ileum to the posterior abdominal wall?

* Mesentery * Blood supply traveling through the mesentery is arranged in arcades (Single arch is an arcade) * Attached all the way from the last part of the duodenum to the cecum

Describe the mucosa of the jejuno - ileum.

* Thrown into folds that project into the lumen * More pronounced in the jejunum than the ileum * Carpet of minute projections called villi (increase the absorptive surface area of the jejuno - ileum)

Where does the ileum end?

When it attached to the cecum at the ileocecal valve

What is the first part of the large intestine?

Caecum

What is the name of the valve between the large and small intestine?

Ileo - cecal valve ## Footnote Not an effective one way valve

What structure is attached to the cecum?

Appendix

What are the four parts of the the colon?

* Ascending colon (Yellow) * Transverse colon (Green) * Descending colon (Blue) * Sigmoid colon (Pink)

Where does the ascending colon end & the transverse colon start?

Right colic (hepatic) flexure

Where does the transverse colon end & the descending colon start?

Left colic (splenic) flexure

Where does the sigmoid colon end?

S3 level, where it merges with the rectum

What is the parietal peritoneum that attaches the the colon to the abdominal walls called?

Mesocolon

What are the differences between the small & large intestine?

* The longitudinal muscle is continuous in the small intestine, not in the large intestine. It’s gathered into strips called Tenia(e) coli (Green parts) * The large intestine is divided into haustra (outward bulges divided by mucosal folds), whereas the small intestine is not. * There are no villi in the large intestine, unlike the small intestine.

Where does the rectum end?