ABDOMEN, PELVIS & PERINEUM Flashcards
Describe the identifying features of the lumbar vertebrae
Large size, kidney shaped body
short and broad (blunt, quadrilateral) spinous processes
Thin and long transverse processes (horizontal from L1-3, incline superiorly in L4 and 5)
Vertebral foramen = triangular shape (larger than thoracic, smaller than cervical)
Where are the mammillary and accessory processes found on the lumbar vertebrae?
Mammillary = end of superior articular process
Accessory = base of transverse processes
Describe the characteristics of the sacrum.
single triangular shaped bone made up of 5 fused sacral vertebrae
apex points inferiorly and articulates with the coccyx
2 large L shaped facets on each lateral side that articulate with the pelvic bones (sacroiliac joint)
four pairs of anterior and posterior sacral foramina for ventral and dorsal rami of spinal nerves S1-S4
what is the pubic arch formed by?
inferior pubic rami of the conjoined pubic bones as they diverge from the midline
What structure forms the posterior margin of the pelvic inlet?
sacral promontory (and portions of the ala)
Describe the iliolumbar ligament
ligament from transverse process of L5 to inner lip of posterior portion of the iliac spine - stabilises the articulation of L5 to S1
Describe the lumbosacral ligament
ligament from transverse process of L5 to ala of sacrum - stabilises the articulation of L5 to S1
what type of joints occur between adjacent inferior and superior articular processes of the vertebrae
zygapophysial joints
What type of joint is the sacroiliac joint?
Synovial
What 3 ligaments stabilise the sacro-iliac joint?
Anterior sacroiliac ligament - runs anteriorly and inferiorly to the joint
Interosseous sacro-iliac liagment (strongest) - runs posteriorsuperior to the joint
Posterior sacroiliac ligament - cover interosseous sacroiliac ligament
which 2 ligaments stabilise the pubic symphysis?
Superior pubic ligament - above the joint
Inferior pubic ligament - below the joint
What are the surfaces of the pubic symphysis joint covered with?
Hyaline cartilage
How would you sex a male vs female pelvic girdle?
Pelvic inlet round and larger in women, heart shaped in men
Subpubic angle - larger in women, smaller in men
where does the inguinal ligament run?
ASIS –> pubic tubercle
What does the inguinal canal contain in men?
Spermatic cord
Genitofemoral nerve
ilioinguinal nerve
What does the inguinal canal contain in women?
Round uterine ligament
Genitofemoral nerve
ilioinguinal nerve
Where is the deep inguinal ring located?
1 cm superior to the midpoint of the inguinal ligament (between ASIS and pubic tubercle)
1cm lateral to epigastric vessels
What structure makes up the deep inguinal ring
transversalis fascia
Where is the superficial inguinal ring located?
superior and medial to the pubic tubercle
What structure makes up the superficial inguinal ring?
evagination of the external oblique muscle
Where would an indirect hernia be felt in relation to the inferior epigastric vessels?
Indirect hernias protrude through the deep inguinal ring and follow through the canal and so would be felt lateral to the inferior epigastric vessels
Where would a direct hernia be felt in relation the the inferior epigastric vessels?
Direct hernia protrude through the posterior wall of the inguinal canal (not the deep inguinal ring) and would be felt medial to the inferior epigastric vessels
What is the difference between direct and indirect inguinal hernias?
Direct - peritoneal sac/bowel protrudes into the inguinal canal through the posterior wall (does not enter the scrotum) (acquired - usually due to weakness in abdominal wall)
Indirect - peritoneal sac enters the inguinal canal through the deep inguinal ring - can follow the canal and through the superficial ring into the scrotum (congenital)
What planes divide the quadrants of the abdomen?
transumbilical plane horixonatally, midline vertically
What planes divide the 9 regions of the abdomen?
subcostal plane and intertubercular plane horizontally, midclavicular planes vertically
Name the 9 regions of the abdomen
Left and right hypochondrium, epigastric, left and right lumbar, umbilical, left and right inguinal, suprapubic
At what vertebral level is the subcostal plane and what features are located here?
L3 - 3rd part of duodenum, inferior mesenteric artery origin from aorta
At what vertebral level is the transpyloric plane located and what features are located here?
L1 posteriorly (9th rib at MCL anteriorly) pyloris of the stomach 1st part of duodenum attatchment of transverse mesocolon superior mesenteric artery origin gallbladder portal vein pancreatic neck kidney hila
At what vertebral level is the transtubercular plane located and what features are located here?
L5
formation of inferior vena cava close to midline
At what vertebral level is the supracristal plane located and what features are located here?
L4
aortic bifurcation
(L4 spinous process for lumbar puncture)
At what vertebral level is the transumbilical plane located?
L3/5
What viscera can be found in the upper right quadrant?
Liver, ascending and hepatic flexure of the colon, first 3 parts of the duodenum, gallbladder, biliary tree, inferior vena cava, head and neck of the pancreas, pyloris of the stomach, right kidney, ureter and adrenal gland
What viscera can be found in the upper left quadrant?
Splenic flexure and descending colon, last 4th of the duodenum, left kidney, ureter and adrenal gland, body and tail of the pancreas, spleen, stomach, jejunum and ileum
What viscera can be found in the lower left quadrant?
descending and sigmoid colon, left ductus deferens, left ovary, uterine tube, ureter, jejenum and ileum
What viscera can be found in the lower right quadrant?
ascending colon, ceacum, appendix, IVC, right ductus deferens, ovary, uterine tube, ureter and ileum
In what abdominal region is the stomach located?
Epigastric region (borders = midclav and subcostal plane) and left hypochondrium
In what abdominal region is the duodenum located?
epigastric region
In what abdominal region is the appendix located?
right inguinal region
In what abdominal region is the ceacum located?
right inguinal region
In what abdominal region is the ascending colon located?
right lumbar region (hepatic flexure in right hypochondrium)
In what abdominal region is the descending colon located?
left lumbar region (splenic flexure in left hypochondrium)
In what abdominal region is the urinary bladder located?
suprapubic region (posterior to the pubic symphisis)
What covers the superior surface of the urinary bladder?
Peritoneum
What does the posterior surface of the urinary bladder come in contact with in males vs. females?
Males - seminal vesicles and rectum
Females - superior surface of vagina
Describe the surface markings of the liver.
Occupies most of right hypochondrium and epigastrium.
Upper border - right 5th rib at MCL and left 5th ICS at MCL
Lower oblique border - from left 5 ICS to right 8th costal cartilage at the costal margin to the right 9th costal cartilage at MCL and 10th rib at right MAL
Describe the surface markings of the gall bladder.
9th costal cartilage at right MCL
Describe the surface markings of the spleen.
located in the left hypochondrium, posteriorly it is covered by ribs 9, 10 and 11 with its lateral border at the midaxillary line and medial boder at lateral border of erector spinae muscle
Describe the surface markings of the kidneys
Kidneys extend from T11 - L2/3 (9-12 cm long, 5-7cm wide)
Hilum - L1 (transpyloric plane) 4-5cm from midline
right kidney covered by rib 12, left kidney covered by ribs 11 and 12
Posterior poles are 3-4 cm superior to supracristal plane (L4)
Describe the surface markings of the ureters
ureters are at 5cm lateral to midline at L1 (hilum of kidney) and descend vertically anterior to tips of transverse processes of lumbar vertebrae to the PSIS
position of patient in abdo exam
supine with bed flat
Retroperitoneal structures
“S.A.D. P.U.C.K.E.R”
Supradrenal glands Aorta/IVC Duodenum (second and third part) Pancreas (neck and body) Ureters Colon (Ascending and descending) Kidneys Esophagus Rectum
