Abdomen/ Pelvis & Perioneum Flashcards
What bony structure ends anteriorly as the ASIS?
Iliac crest
What bony structure serves as attachment for rectus femoris muscle?
AIIS
Where does the ilium and pubis come together?
Iliopubic eminence
What bony structure leads into the pubic crest?
Pubic tubercle
What bony structure ends medially at the pubis symphysis?
Pubic crest
What five body planes serve as the boundries of the quadrants and regions of the abdomen? (x5)
Midclavicular Subcostal Median (Midsagittal) Transumbilical Transtubercular
What body plane occurs at the L4 level? What is a good bony landmark feature for this plane?
Transumbliclal plane–it lies through the superiro border of the iliac crests
What body plane lies at midway between the iliac crest and ASIS? What vertebral level does it occur at?
Transtubercular plane–L5 level
How many abdominal regions are there? What are they?
9–epigastric (with R and L hypochondriac)
umbilical (with R and L lumbar)
hypogastric (with R and L inguinal)
How many abdominal quadrants are there?
4–R and L upper and R and L lower
What planes form the regions of the abdomen?
Midclavicular, subcostal, and transtubercular planes
What planes form the abdominal quadrants?
Median and transumbilical planes
What organ is found in all four quadrants?
Colon
What is found in the RUQ (right upper quadrant)? (x10)
Right lobe of liver Gallbladder Stomach (pylorus) Duodenum (parts 1-3) Head of pancreas Right suprarenal gland Right lidney Right colic (hepatic) flexure Ascending colon (superior part) Transverse colon (right half)
What is found in the LUQ? (x10)
Left lobe of liver Spleen Stomach Jejunum and proximal ileum Pancreas (body and tail) Left kidney Left suprarenal gland Left colic (splenic) fissure Transverse colon (left half) Descending colon (superior part)
What is found in the RLQ? (x10)
Cecum Veriform appendix Most of ileum Ascending colon (inferior part) Right ovary Right uterine tube Right ureter (abdominal part) Right spermatic cord (abdominal part) Uterus (if enlarged) Bladder (if very full)
What is found in the LLQ? (x8)
Sigmoid colon Descending colon (inferior part) Left ovary Left uterine tube Left ureter (abdominal part) Left spermatic cord (left part) Uterus (if enlarged) Bladder (if very full)
What are the nine layers of the abdominal wall (superficial to deep)? (x11)
Skin Campers fascia Scarpa's fascia External oblique muscle (deep fascia) Internal oblique muscle (deep fascia) Transversalis muscle (transversalis fascia) Endoabdominal (extrapertioneal) fat Parietal peritoneum
What is the superficial layer of fascia (and fat) that lies just deep to the skin of the abdomin?
Camper’s fascia
What is the deep membranous layer of superficial fascia?
Scarpa’s fascia
What type of fascia sits around all the muscles?
Deep investing fascia of the muscles
What are the five muscles of the anterior abdominal wall?
Transverse abdominus Internal abdominal oblique External abdominal oblique Rectus abdominalis Pyramidalis
How do the fibers of the external oblique run?
Superiomedial (makes a “v” shape)
How do the fibers of the internal oblique run (as compared to the external oblique)?
Almost perpendicular to the external oblique
What is important about the fiber orientation of the internal and external oblique muscles?
Their overlapping creates a strong layer of muscle.
True or false:
The pyramidalis is not present in everyone.
True
Where is the pyramidalis found?
It’s found along the midline right above the groin and at the end of the rectus abdominalis; its a very small muscle
What is the origin, insertion, action, and innervation of the external oblique?
O: external surfaces of 5th-12th ribs
I: Linea alba, pubic tubercle, & ant. half of iliac crest
A: Compress & support abdominal viscera; flex and rotate trunk
N: thoracoabdominal nerves (T6-subcostal)
What is the origin, insertion, action, and innervation of the internal oblique muscle?
O: thoracolumbar fascia, anterior 2/3 of iliac crest, & lateral half of inguinal ligament
I: inferior borders of 10-12th ribs, linea alba, and pecten pubis via conjoint tendon
A: compress & support abdominal viscera; flex and rotate the trunk
N: thoracoabdominal (ventral rami of inferior 6 thoracic nerves) & L1
What is the origin, insertion, action, and innervation of the transverse abdominal muscle?
O: internal surfaces of 7-12th costal cartilages, thoracolumbar fascia, iliac crest, & lateral 1/3 of inguinal ligament
I: linea alba with aponeurosis of internal oblique, pubic crest, and pecten pubis via conjoint tendon
A: compress & support abdominal viscera
N: thoracoabdominal (ventral rami of inferior 6 thoracic nerves) & L1
What is the origin, insertion, action, and innvervation of the rectus abdominalis muscle?
O: pubic symphysis and pubic crest
I: xiphoid process and 5-7th costal cartilages
A: flexes trunk (lumbar vertebrae) and compresses abdominal viscera
N: thoracoabdominal nerves (ventral rami of inferior 6 nerves)
What two arteries run in the rectus sheath?
Superior and inferior epigastric arteries
What is the superior epigastric artery a continuation of?
Internal thoracic (mamillary) artery
When does the internal thoracic (mamillary) artery become the superior epigastric artery?
When it reaches the subcostal region (right under the ribs)
Where can the superior epigastric artery be found?
Deep to the rectus abdominalis muscle
Where does the inferior epigastric artery enter the rectus sheath?
Arcuate line
What is the arcuate line? Where is it located?
The inferior edge of the posterior rectus sheath (located about halfway between the umbilicus and the pubic crest)
What does the arcuate line represent?
The end of the posterior rectus sheath–below the arcuate line, there is a transition so that all but the transversalis fascia pass anterior to rectus abdominis.
What do the folds of the parietal peritoneum form? (x3)
Umbilical ligaments (median, medial, and lateral)
What is the median umbilical ligament formed by?
Urachus (reminent of tissue that joined the fetal bladder to the umbilicus)
What is the medial umbilical ligament formed by?
Occulded part of umbilical arteries
What is the laterla umbilical ligament formed by?
Covering of the inferior epigastric vessels
List the umbilical ligaments form most medial to lateral.
Median Umbilicus -> Medial Umbilicus -> Lateral Umbilicus
True or false:
There are depressions formed by the umbilical ligaments in between them.
True–there are 3.
What are the three depressions formed by the umbilical ligaments?
Supravesicular fossa
Medial inguinal fossa
Lateral inguinal fossa
Where does the supravesicular fossa lie? What is located here?
Between the median and medial umbilicus ligaments. The bladder is located here.
Where does the medial inguinal fossa lie? What can occur here?
Between the medial and lateral umbilical ligaments; direct hernia
Where does the lateral inguinal fossa lie? What can happen here?
Lateral to the lateral umbilical ligament; indirect hernia
What is the urachus?
The remnant of the tissue that once joined the fetal bladder to the umbilicus
Above the arcuate line, what forms the anterior layer of the rectus sheath? Posterior layer?
Anterior= membrane of external & internal oblique muscles Posterior= membrane of the internal oblique and the transvers abdominus muscles
Below the arcuate line, what forms the posterior layer of the rectus sheath?
Anterior= membrane of the external oblique, internal oblique, and transverse abdominus muscles Posterior= there is no posterior layer of rectus sheath below the arcuate line
Where do the external and internal obliques cross over to continue as the opposite muscle?
In the linea alba (above the arcuate line)
How do the external and internal oblique muscles produce rotation?
The external oblique on one side hits the aponeurosis and dives deep to continue as the oppostie internal oblique…so the internal oblique rotates the body to the same side and the external oblique rotates the body to the opposite side
What is the inguinal canal?
A canal (passageway) through the anterior abdominal wall. It is the most inferior border of the abdominal wall.
What is the inguinal canal formed by? What is it’s starting and end points?
The “rolling” or arching of fibers of the abdominal wall and muscles. It begins as the deep inguinal ring (where is begins internally) and ends as the superficial inguinal ring (where it ends externally)
What does the inguinal canal transmit? (x3) What does it do for males vs females?
It trasmits the spermatic cord, round ligament of the uterus, and the ilioinguinal nerve (L1);
For males, it allows a passageway for the spermatic cord
For females, it connects the uterus to the labia major
What constitutes the forgut?
Alimentary canal (digestive tract) up to the proximal 1/3 of the duodenum
What constitutes the midgut?
From the 1/3 of the duodenum to the 2/3 of the transverse colon
What constitutes the hindgut?
2/3 of the transverse colon through the rectum (it begins just before the colon flecture
List all the structures of the foregut. (x8)
Pharynx, Esophagus Stomach Proximal 1/3 of duodenum Accessory organs (liver, gallbladder, pancreas, & spleen)
List all the structures of the midgut. (x6)
Distal 2/3 of the duodenum, jejunum, ileum, ascending colon, appendix, proximal 2/3 of the transverse colon
List all the structures of the hindgut. (x4)
Distal 1/3 of the transverse colon
Descending colon
Sigmoid colon
Rectal canal
What are all the forgut structures below the diaphragm supplied arterially by?
Celiac afrtery
How does the foregut receive its sympathetic and parasympathetic innervation?
Sympathetic= greater thoracic splanchnic nerve (T5-T9) Parasympathetic= vagus nerve
What supplies the midgut arterially?
Superior mesenteric artery
How does the midgut receive its sympathetic and parasympathetic innervation?
Sympathetic= Lesser (T10-T11) and least thoracic splanchnic nerves (T12) Parasympathetic= vagus nerve
What supplies the hindgut arterially?
Inferior mesentaric artery
How does the hindgut receive its sympathetic and parasympathetic innervation?
Sympathetic= lumbar and sacral splanchnic nerves Parasympathetic= pelvic splanchnic nerves
What is the celiac trunk a branch of? What are its three branches?
The descending aorta;
1- left gastric artery
2-splenic artery
3- common hepatic artery
Off the celiac trunk, where does the left gastric artery go and do?
Heads towards the lesser curvature of the stomach where it anastomoses with the right gastric artery on the lesser curvature of the stomach
Where does the splenic artery pass in relationship to the stomach? Where is it heading?
Posterior to the stomach as it heads to the spleen
What does the common hepatic artery terminate as?
Hepatic proper artery and the gastroduodenal artery
Where does the hepatic proper artery head to?
The liver
Where does the gastroduodenual artery head? What does it supply?
Inferiorly…it supplies the stomach and duodenum
What does the superior mesenteric artery supply?
Midgut
What does the inferior mesenteric artery supply?
Hindgut
What two arteries form an anastomosis around the large intestine? What is this anastomosis called?
Superior and inferior mesenteric arteries…its called the “marginal artery of drummen”
What nerve synapses in the celiac ganglia?
Greater thoracic splanchnic nerve
What nerve synapses in the superior mesenteric ganglia?
Lesser thoracic splanchnic nerve
What nerve synapses in the aorticorenal ganglia?
Least thoracic splanchnic nerve
True or false:
Sympathetic fibers hitchhike on the vasculature of the abdomen.
True
Where does the vagus nerve synapse?
In the walls of the organs–it doesn’t synapse in the ganglia
What is the name of the ganglia and sympathetic fibers that are found between the two mesenteric arteries on the aorta?
Intermesenteric Ganglia and fibers
Is there an inferior mesenteric ganglia
Yes–just like the celiac and superior mesenteric arteries
Where can the hypogastric plexus be found?
Where the aorta splits into the left and right iliac arteries
What does the aorta split into?
Left and right iliac arteries
What is the name of the splanchnics that leave the chain ganglia in the lumbar region?
Lumbar splanchnic nerves
Are the celiac, superior mesenteric, intermesenteric, and inferior mesenteric ganglias considered prevertebral or paravertebral?
Prevertebral
What is the greater omentum?
A fatty-like double, double layer of periotenum
What does the greater omentum hang off of?
The curvature off the stomach (like an apron–hence “Omental apron”)
What does the greater omentum cover?
Most of the intestines
Since the greater omentum is a double, double layer, where does the two double layers hang off of?
- Lesser curvature of the stomach
- Transverse colon
What suspends the digestive tract to the walls of the body?
Dorsal and ventral mesentaries–they help anchor the digestive tract to the wall of the body
Where is the abdominal cavity truly located?
Between the visceral peritoneum and the digestive tract
Where is the peritoneal cavity located?
Between the parietal peritoneum and the visceral peritoneum
What condition occurs when there is a collection fluid in the peritoneal cavity?
Ascites
What does the dorsal bud of the foregut during embryology become eventually?
Dorsal pancreas
What does the ventral bud of the foregut during embryology become eventually?
Liver, galbladder, and ventral pancreas
What do the differential growth and rotations of the digestive tract cause the dorsal and ventral mesentaries to do? What does this form?
Reflect back upon themselves forming the double peritoneal layers (called ligaments or folds)
How are the peritoneal ligaments and folds named?
For the visceral organs in which they span across (i.e. lienogastric (spleen & stomach), lienorenal, gastrophrenic, gastrocolic, phrenicocolic ligaments)
Describe the way in which the greater and lesser and “J” curve of the stomach is formed.
As the GI tract begins to outcrop, the foregut takes a 90 degree turn and the stomach turns in 90 degrees. Then the dorsal end of the stomach curves upward (creating the “J” shape). As the stomach is curving up, it drags the ventral mesentary up with it, creating that double, double layer of the omentum
What is the omental sac? How can you get into this space?
The space formed when the stomach curves up to make the greater ommentum–you can get here through the foramen of Winslow
What does the lesser omentum run between?
The liver and the stomach
What helps suspend the small intestine (looks like little fatty pouches on it)?
Mesentary (mesentary proper)
What from embryology becomes the lesser omentum?
Ventral mesentary
What from embryology becomes the greater omentum?
Dorsal mesentary
What helps to suspend the transverse colon?
Transverse mesocolon
What does the greater omentum run between?
Stomach and transverse colon
Since the greater omentum is a double, double layer, what does the anterior layer of the omentum cover? The posterior layer?
Anterior= stomach Posterior= transverse colon
What is the potential space between the parietal and visceral peritoneum that contains a film of fluid?
Peritoneal cavity
Is the peritoneal cavity closed or open in males? Females?
Males= closed Females= open via the fallopian tubes
What is the peritoneal cavity divided into?
The greater sac and lesser sac
What is the greater sac of the peritoneal cavity?
From the diaphragm to the pelvic floor
What is the lesser sac? What does it contain?
THE OMENTAL BURSA
It is the space behind the stomach, liver, and lesser omentum…it contains the superior recess, the inferior recess, the splenic reess, and the opening to the greater sac via the epiploic foramen of winslow
What are the intraperitoneal structures? (x9)
Stomach Part of Duodenum Jejuneum Ilieum Appendix Transverse colon Sigmoid colon Spleen Liver
What lines the posterior wall of the peritoneum?
The mesocolon
What does it mean if an organ is considered retropertioneal?
It lies behind the peritoneum
What does it mean if an organ is considered secondarily retropertinoneal structure?
That is began as a intraperitoneal structure during embryonic development but then became retroperitonteal
When do the secondarily retroperitoneal organs transition from intraperitoneal to retroperitoneal?
When the viscera’s posterior (visceal) layer fuses with the parietal peritoneum
What organs are considered retroperitoneal? (x5)
Kidney Ureters, Adrenal Glands Inferior vena cava Aorta and its arterial branches
What does it mean if an organ is considered retroperitoneal?
They have always been located between the peritoeum–and they have never had a double layer of peritoneum
What organs are considered secondarily retroperitoneal? (x6)
Pancreas, Distal portion of duodenum Cecum Ascending and descending colons Rectum
True or false:
Secondarily retroperitoneal organs only have layers of peritoneal coverings on their anterior and posterior aspects.
False–they only have it on the anterior and later aspects–they lie behind the peritoneal cavity and thereore they do not have any peritoneal coverings on the backside surfaces
At about what vertebral level is the superior hypogastric plexus located? Anteriorly where is it located?
L3/L4; at the bifurcation of the aorta.
What does the superior hypogastric plexus give rise to?
Left and right hypogastric nerves
What does the left and right hypogastric nerves give rise to?
Inferior hypogastric plexus
From what levels does the pelvic splanchnics arrise from?
S2-S4
What are the functions of the liver? (x3)
Detox blood
Storage glycogen, vitamins, and iron
Produce and secrete bile
What ligament is found in the falciform ligament?
Ligamentum teres hepaticus (round ligament of the liver)
What is the round ligament of the liver (ligamentum teres hepaticus)?
The obliterated umbilical vein that ran through the falciform ligament
What are the components of the portal triad?
Portal vein
Hepatic artery
Bile duct
What is the coronary ligament?
The coronary ligament of the liver is the reflection of peritoneum that attaches the liver to the diaphragm
What is the bare area of the liver?
The area that does not have any visceral peritoneum…this is because the coronary ligament reflects upward to the diaphragm
What are the four portions of the liver?
Right lobe
Left lobe
Caudate lobe (posterior)
Quadrate lobe (anterior)
What is the caudate lobe of the liver adjacent to? The quadrate lobe?
Inferior vena cave; gall bladder
What does the falicform ligament do?
Helps anchor the liver to the abdominal wall
In relationship to the liver regions, where does the IVC run?
Between the caudate and right lobes
What is the general shape the fissures of the liver make? What makes up this shape?
“H”
- ligementum teres hepaticus
- ligamentum venosum
- fossa for the gallbladder
- inferior vena cava fissure
- porta hepatis
What does the ligamentum teres hepaticus run between?
Left and quadrate lobes
What does the ligamentum venosum run between? What is significant about this ligament?
Left and caudate lobes…it is interesting that it is the remnant of the ductus venosum in the fetus (used to shunt blood away from the liver)
Where is the fossa for the gall bladder on the liver?
Between the right and quadrate lobes
Where is the fissure for the IVC on the liver?
Between the right and caudate lobes
Where is the porta hepatis?
The horizontal portion of the liver fissures
What is the innervation to the liver?
Sympathetic= celiac & superior mesenteric ganglia Parasympathetic= vagal trunks
What is the blood supply to the liver?
Common hepatic artery (from the celiac trunk off the descending aorta) -> hepatic proper -> right and left hepatic arteries
True or false:
The spleen is found dorsal to the stomach.
True…the spleen is also a intraperitoneal structure
What are the functions of the spleen? (x4)
**Part of lymphatic system Produces blood cells early in life Destructs blood cells later in life Filters blood Also produces lymphocytes and antibodies
What two ligaments supports the spleen in the peritoneal cavity?
The lienogastic and lineorenal ligaments
What is the sympathetic innervation to the spleen? Parasympathetic?
Sympathetic= celiac and superior mesenteric ganglia Parasympathetic= vagal trunks
What is the blood supply to the spleen?
Splenic artery (comes off celiac trunk) via the hepatic artery?
