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Anatomy > Abdomen (SEM 2) > Flashcards

Abdomen (SEM 2) Flashcards

1
Q

2 layers of subcutaneous tissue of anterior abdominal wall

A

superficial = fatty (camper’s) fascia

membranous (scarpa’s) fascia
-continues as collet’ fascia over penis/scrotum/labia major

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2
Q

external oblique

internal oblique

transversus abdominis

A

EO -most superficial

  • origin = outer 5-12th ribs
  • lower costal nerves/subcostal nerve
  • contralateral rotation

IO

  • origin = inguinal lig/iliac crest
  • inserts = lower margin of 10-12th ribs / lateral inguinal ligament
  • ipsiolateral rotation
  • lower costal nerves/subcostal/L1 spinal

TA

  • inner surface of 7-12th cartilage ribs
  • same nerve supply as IO
  • compresses abdominal contents
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3
Q

L1 spinal nerve gives rise to

A

iliohypogastric
ilioinguinal nerves

supplies internal oblique and transverses abdominis

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4
Q

surgical importance of linea alba

A

no important nerves/vessels - common place for incision

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5
Q

rectus sheath

A

made up of external oblique, internal oblique and transversus abdominis

contains rectus abdominis muscle

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6
Q

rectus abdominis

A

linea alba down middle
semilunaris on lateral side

vertical muscle fibre orientation

origin: pubis/pubic symphysis
insertion: xiphoid/cartilage processes 5-7

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7
Q

arcuate line

what is present above but not below

A

line found L1 below umbilicus

posterior rectus sheath only above arcuate line (anterior still present below)

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8
Q

what arteries supply the anterior abdominal wall above/below umbilicus

A

above = superior epigastric (branch of internal thoracic)

below = superficial epigastric (branch of femoral artery after inguinal ligament)

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9
Q

what is the inferior epigastric artery a branch of

A

external iliac artery

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10
Q

transversus abdominis plane (TAP) blocks

A

Anesthetists are commonly insert TAP under ultrasound guidance to provide post-operative anesthesia to nerves of the anterior abdominal wall

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11
Q

inguinal ligament -where

what is it formed by

A

ASIS - pubic tubercle

formed by aponeurosis of external oblique

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12
Q

boundaries of inguinal canal

A

found in the half of the inguinal ligament closest to pubis

floor = inguinal ligament

anterior wall = external oblique aponeurosis (+ internal oblique, laterally)

posterior wall = conjoint tendon and transversalis fascia

roof = overarching fibres of internal oblique and transversus abdominis

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13
Q

when does inguinal canal close

A

contraction of internal oblique/ transversus abdominis (roof)

these are innervated by L1 fibres (iliohypogastric and ilioinguinal)

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14
Q

structures which enter the deep/internal inguinal ring of canal

A

spermatic cord

  • vas deferens
  • testicular artery
  • lymphatics
  • veins of pampiniform plexus

-genital branch of genitofemoral nerve

(ilioinguinal nerve does not enter via deep ring)

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15
Q

structures that exit out of the superficial/external inguinal ring of canal

A

ilioinguinal nerve

genital branch of genitofemoral nerve

spermatic cord/ round ligament

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16
Q

spermatic cord:

3 x CANT

A

3 coverings from muscle:

  • external oblique
  • cremasteric muscle
  • internal oblique

3 arteries from internal iliac artery:

  • testicular
  • artery to vas deferens (from superior vesicle artery -internal iliac)
  • cremasteric (branch of inferior epigastric- external iliac)

3 nerves:

  • genital branch of genitofemoral (cremasteric)
  • parasympathetic (point)
  • sympathetic (shoot)

3 tubes:

  • vas deferens
  • pampiniform plexus of veins
  • lymphatics
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17
Q

where does spermatic cord end

A

testis

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18
Q

direct and indirect inguinal hernia

A

inferior epigastric artery marks medial border of deep inguinal ring

if hernia is

  • medial to the artery = direct
  • lateral = indirect

direct (acquired)

  • does not transverse the entire inguinal canal (usually only its medial part)
  • almost never enters scrotum
  • less likely to strangulate blood supply

indirect (congenital)

  • transverse the entire inguinal canal
  • exits through superficial inguinal canal–> scrotum = inguino-scrotal
  • strangulation –> bowel ischaemia
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19
Q

difference between femoral and inguinal hernia

A

inguinal hernia sac is ABOVE pubic tubercle and through the inguinal canal

femoral hernia is BELOW pubic tubercle (not through inguinal canal)

inguinal hernias more common

women more likely to get femoral

men more likely to get inguinal (testis descend through inguinal canal)

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20
Q

conjoint tendon

A

Combined fibres from lower internal oblique and aponeurosis of transversus abdominis muscles to the pubic crest

nerve supply = ilioinguinal nerve (L1)

forms medial/roof part of posterior wall of inguinal canal

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21
Q

falciform ligament

A

double fold of peritoneum

Attaches anterior surface of liver to anterior abdominal wall

derived from ventral mesentery (foetal)

lower end wraps around the round ligament of liver (remnant of foetal umbilical vein)

22
Q

difference between intraperitoneal and retroperitoneal

A

retroperitoneal = only parietal covering ANTERIOR surface
(primary and secondary)

intraperitoneal structures = enveloped posterior and anterior by visceral peritoneum

23
Q

retroperitoneal structures

A

SADPUCKER

S- uprarenal (adrenal) glands
A- orta/IVC
D- uodenum (except proximal 2cm)
P- ancreas (except tail)
U- reters
C- olon (only ascending and descending)
K- idneys
E- (o)esophagus
R- ectum (only lateral 2/3rds)
24
Q

omentum and mesentery

A

omentum = SHEETS of visceral peritoneum

greater(4): greater curvature–> transverse colon (policeman)

lesser(2): lesser curvature–> liver

mesentery = double layer of visceral connecting intraperitoneal organs to POSTERIOR abdominal wall

  • transverse mesocolon
  • mesentery of small intestine
  • sigmoid mesocolon
25
Q

divisions of peritoneal cavity

A

transverse mesocolon:
infra colic and supracolic

mesentery of small intestine subdivides infracolic into left/right

26
Q

differences of mesentery of jejunum and ileum

A

jejunum

  • less fat
  • thicker diameter
  • longer vasa recta
  • fewer arcades

ileum

  • more fat
  • thinner diameter
  • shorter vasa recta
  • more arcades
27
Q

Sigmoid volvulus

A

sigmoid colon twists on mesentery —> cant pass wind —> distended stomach

28
Q

how is the position of duodenojejunal junction maintained

A

by a suspensory ligament (the suspensory ligament of Trietz)

peritoneal fold attached to underside of diaphragm

bleeding in GIT is divided into

  • upper (proximal to ligament)
  • lower (distal to ligament)
29
Q

What is a gridiron (McBurney’s incision)

A

For appendectomy

Begins 2/5cm above ASIS —> lateral 1/3rd way to umbilicus

30
Q

what is found on the free border of lesser omentum

A

Hepatodudenal ligament

3 structure found in this free edge

  • common bile duct (cystic duct+common hepatic duct)
  • portal vein
  • hepatic artery

pringle’s manoeuvre = clamping this

31
Q

what level is coeliac trunk

superior and inferior mesenteric arteries

A

coeliac - T12

SMA- L1

IMA - L3

32
Q

venous drainage of stomach

A

mainly by splenic vein–> hepatic portal vein

33
Q

Incisura angularis

A

angle on lesser curvature side of pyloric part of stomach

34
Q

how many parts of duodenum and how many parts are derived from foregut

A

2 out of 4 total parts

1st part = intraperitoneum

35
Q

what part of duodenum = peptic ulceration occur mostly in

what is Kocherisation

A

1st part

this can perforate into peritoneal cavity (because intraperitoneal)—> peritonitis

anterior ulcers tend to perforate

posterior ulcers tend to bleed

Mobilising duodenum before performing other procedures

36
Q

sliding and para-oesophageal(rolling) hiatal hernia

A

sliding = cardia and fundus of stomach—> hiatus (T10)
-common regurgitation–>Barretts

rolling = cardia remains in place, pouch of peritoneum containing fundus extends through the hiatus anterior to oesophagus
-rare regurgitation
(More hazardous)

37
Q

branches of SMA

A

Jejunal and ileal arteries

Ileocolic artery

Right colic artery

Middle colic artery

38
Q

branches of IMA

A

marginal artery of drummound : Connects the IMA and SMA –> arc of Riolan

Left colic artery

Sigmoidal arteries

Superior rectal artery (continuation of IMA)

39
Q

what ligaments do the peritoneal reflections that pass from the surface of the liver onto the underside of the diaphragm form

A

coronary ligament

left and right triangular ligaments

40
Q

What causes the colonic wall to have a sacculated appearance

A

sacculated appearance = haustra

tone of Taeniae coli = Longitudinal muscle of colon is confined to 3 thin bands

41
Q

Anorectal junction

derived from what above and below

A

pectinate line

Above: derived from embyronic hindgut

Below: from ectoderm of proctodeum
lined by non-keratinised stratifeid squamous epithelium (anal pecten) smooth

42
Q

Anal lymphatic drainage

A

pararectal lymph nodes –> inferior mesenteric nodes

Lymph from lower aspect of rectum drains directly into internal iliac lymph nodes

43
Q

where is a vertebral fracture common

A

between T12 and L1 because of the pressure on L1

44
Q

trapezius

A 
Origin = occipital + C7-T12
insert = spine of scapula

accessory nerve

45
Q

latissimus dorsi

A

spinous processes T12-L5/iliac crest —> floor of inter tubercular groove of humerus

thoracodorsal nerve (C6-8)from posterior cord of brachial plexus

shoulder adduction/extension
internal rotation of arms

46
Q

erector spinae

A

iliocostalis

longissimus

spinalis

47
Q

Quadratus lumborum

A

origin: posterior iliac crest
insertion: inferior border of 12th rib + transverse process L1-4

stabilises 12th rib/lateral flexion/ depression of 12 the ib and diaphragm for expiration

lateral to psoas major

lateral arcuate ligament over it in diaphragm

lumbar arteries from aorta

48
Q

psoas major

psoas minor

A

major
-origin: T12-L5
-insertion: lesser trochanter
(is one of the iliopsoas muscle with iliacus)

minor (anterior to major)

  • origin:T12/L1 vertebrae
  • insertion: iliopectineal arch on pelvis
49
Q

what could be mistaken as AAA

A

abdominal aorta is posterior to stomach/pancreas

if there is a tumour on these organs it will transmit the pulse from the aorta and easily mistaken as abdominal aortic aneurysm (bulge caused by weakness of blood vessel)

pulsations of a large aneurysm would be felt left from midline and easily moved side to side

AAA rupture mortality rate = 90%

50
Q

branches of coeliac trunk

A

splenic
left gastric
hepatic

51
Q

For renal transplantation which artery is preferred for anastomosis with the renal artery of the donor’s kidney

A

external iliac artery because it is more superficial

52
Q

at what lumbar vertebrae do the common iliac veins join –> IVC

A

L5

posterior to aorta, to the right

Anatomy (12 decks)

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