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MBBCh 2- ANAT2020A > Abdomen Week 1 (B) > Flashcards

Abdomen Week 1 (B) Flashcards

1
Q

What is the arterial supply of the abdomen? (9)

A
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2
Q

STUDY

A
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3
Q

Arterial supply on a cadaver:

A
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4
Q

What is the venous drainage in the abdomen?

A

▪ Intricate subcutaneous venous plexus

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5
Q

What are the main veins? (2)

A

▪Para-umbilical veins→hepatic portal vein laterally:thorax tabdom en
▪Thoraco-epigastric vein (not always present)

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6
Q

Venous drainage
Superiorly: (2)

A
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7
Q

Venous drainage
Inferiorly: (2)

A
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8
Q

Venous drainage
▪Deep veins follow _____
▪Deeper _______ may exist

A

arteries
anastomoses

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9
Q

Nervous supply of the abdomen: (5)

A
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10
Q

Lymphatics:

▪Superficial lymphatic vessels→ superficial veins
▪NB! Transumbilical line
▪ Superior :
▪ Inferior :

A

axillary nodes (parasternal
nodes)

superficial inguinal nodes

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11
Q

▪Deep lymphatic vessels→ deep veins
▪ Drain into….

A

external iliac, common iliac,
right and left lumbar nodes.

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12
Q

Clinical Significance: Fascia and Spaces

▪ Membranous layer of fascia:

A

▪ Included in suturing below umbilicus (therefore tough layer of fascia; keeps wound closed + attached)

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13
Q

Clinical Significance: Fascia and Spaces

▪ Between membranous and deep fascia: (2)

A

▪ Fluid can accumulate
▪ Cannot spread into thigh (Scarpa’s terminates above thigh - continuous in perineum but not thigh)

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13
Q

Clinical Significance: Fascia and Spaces

▪ Between membranous and deep fascia:

A

▪ Fluid can accumulate
▪ Cannot spread into thigh

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14
Q

Clinical Significance: Fascia and Spaces

▪ Endoabdominal fascia

A

▪ Surgical plane of opening ≠ abdominal cavity
- For incisions

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15
Q

Clinical Significance: Abdomen Protrusion

Common causes: (6)

A

▪Food
▪ Fluid
▪ Flatus ~gas build up in GIT
▪ Faeces
▪Fat
▪ Foetus

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16
Q

Clinical Significance: Abdomen Protrusion

▪Umbilicus eversion→ ______ or large mass
▪ In underdeveloped or weak muscles→
abdomen can become _______ (abdomen wall can’t maintain viscera posteriorly)

A

ascites
protruded

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17
Q

Neurovasculature

Dermatomes:

A
  • Anterior rami of T7-T12 and L1
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18
Q

Thoraco-abdominal

Dermatomes:
Origin:

A

T7-T11
Continuation of 7th – 11th intercostal nerves distal to the costal margin

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19
Q

7th – 9th lateral cutaneous br.

Dermatomes:
Origin:

A

T7-T9
Anterior divisions of 7th - 9th intercostal nerves

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20
Q

Subcostal nerve

Dermatomes:
Origin:

A

T12
Anterior ramus of T12

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21
Q

Iliohypogastric nerve

Dermatomes:
Origin:

A

L1
Superior terminal branch of anterior ramus of L1

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22
Q

Ilio-inguinal nerve

Dermatomes:
Origin:

A

L1
Inferior terminal branch of anterior ramus of L1

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23
Q

Superficial veins:

A
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24
Q

T7 - T9:

A

skin superior to umbilicus

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25
Q

T10:

A

skin around umbilicus

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26
Q

T11-L1:

A

skin inferior to umbilicus

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27
Q

L1:

A

inguinal fold

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28
Q

Referred pain:

A

T10 from appendix

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29
Q

Which veins make up the subcutaneous venous plexus?

A
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30
Q

Lymph drainage
* Superficial vessels above transumbilical plane: (2)

A

o Axillary lymph nodes
o Parasternal lymph nodes

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31
Q

Lymph drainage:
* Superficial vessels below transumbilical plane

A

o Superficial inguinal lymph nodes

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32
Q

Lymph drainage:
Deep vessels (4)

A
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33
Q

Lymph drainage:
Deep vessels (4)

A
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34
Q

Musculophrenic

Origin:
Course:
Supply:

A

Internal thoracic

Descends along costal margin

Hypochondrium
Anterolateral diaphragm

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35
Q

Superior epigastric

Origin:
Course:
Supply:

A

Internal thoracic

Descends in rectus sheath deep to rectus abdominis

Rectus abdominis m.
Epigastric and upper umbilical regions

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36
Q

10th & 11th posterior intercostal

Origin:
Course:
Supply:

A

Aorta

Descends between internal oblique and transversus abdominis

Lateral (lumbar) region

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37
Q

Subcostal

Origin:
Course:
Supply:

A

Aorta

Descends between internal oblique and transversus abdominis

Lateral (lumbar) region

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38
Q

Inferior epigastric

Origin:
Course:
Supply:

A

External iliac

Ascends in rectus sheath deep to rectus abdominis

Rectus abdominis m.
Deep pubic & lower umbilical regions

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39
Q

Deep circumflex iliac

Origin:
Course:
Supply:

A

External iliac

Runs parallel to inguinal ligament deep in anterior abdominal wall

Iliacus m.
Deep inguinal region & iliac fossa

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40
Q

Superficial circumflex iliac

Origin:
Course:
Supply:

A

Femoral

Runs in subcutaneous tissue along the inguinal ligament

Superficial inguinal region
Adjacent anterior thigh

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41
Q

Superficial epigastric

Origin:
Course:
Supply:

A

Femoral

Runs in subcutaneous tissue toward umbilicus

Superficial pubic & lower umbilical regions

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42
Q

What is the Internal Anterolateral Abdominal Wall?

A
  • Covered with transversalis fascia, extraperitoneal fat and parietal peritoneum
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43
Q

What are * Umbilical peritoneal folds? (2)

A

o Folds on the infra-umbilical part of the internal surface of the anterolateral abdominal wall
o 2 on each side and 1 in the median plane

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44
Q

What is the o Median umbilical fold? (2)

A
  • Apex of bladder to umbilicus
  • Covers median umbilical ligament
  • Remnant of urachus
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45
Q

What are the o Medial umbilical folds? (2)

A
  • Lateral to the median umbilical fold
  • Cover medial umbilical ligaments
  • Obliterated umbilical aa.
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46
Q

What are the o Lateral umbilical folds? (2)

A
  • Lateral to the medial umbilical folds
  • Cover the inferior epigastric vessels
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47
Q

What are the * peritoneal fossae? (2)

A

o Depressions lateral to umbilical folds
o Potential sites for hernia

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48
Q

o Supravesical fossa- (2)

A
  • Between median and medial umbilical folds
  • Level rises and falls with filling of bladder
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49
Q

o Medial inguinal fossa- (3)

A
  • Between medial and lateral
    umbilical folds
  • AKA inguinal triangle
  • Potential site for direct
    inguinal hernias
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50
Q

o Lateral inguinal fossa- (3)

A
  • Lateral to the lateral umbilical folds
  • Include the deep inguinal ring
  • Potential sites for indirect
    inguinal hernia
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51
Q

What is the inguinal region?

A

From anterior superior iliac spine to pubic tubercle

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52
Q

What is the anatomical importance of the inguinal region?

A

Many structures enter/exit abdominal cavity through this area

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53
Q

What is the clinical importance of the inguinal region?

A

Hernias

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54
Q

Inguinal region

  • Inguinal canal
    Pathway for testes _____
A

descent

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55
Q

What is the iliopubic tract?

A

Thickened tranverse fascia

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56
Q

What is the inguinal ligament?

A

Originates from thickened external oblique aponeurosis.

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57
Q

Where is the iliopubic tract located?

A

▪From anterior superior iliac spine
to pubic tubercle

58
Q

How is the flexor retinaculum formed?

A

Formed by 2x structures

59
Q

What is the function of the flexor retinaculum?

A

Maintains structure against skeleton while joints move

60
Q

What is contained in the subinguinal space? (2)

A
  • Flexors of the hip
  • Neurovasculature
61
Q

What are the flexors of the hip? (3)

A
  • iliacus
  • psoas major
  • pectineus
62
Q

Neurovasculature in the subinguinal space: (2)

A
  • femoral n.a.v
  • lat cut n. of thigh
63
Q

Neurovasculature in the subinguinal space: (2)

A
  • femoral n.a.v
  • lat cut n. of thigh
64
Q

Where does the inguinal ligament attach?

A

▪Attach on pubic tubercle mostly

65
Q

Inguinal ligament:

Deep fibres –> ____ ligament = medial boundary of _____ space

A

lacunar
subinguinal

66
Q

Inguinal ligament

Superior fibres –> ______ inguinal ligament

A

reflected

67
Q

What is the iliopubic tract? (3)

A

▪Fibrous band parallel to inguinal ligament
▪Posterior to inguinal ligament
▪Thickened transversalis fascia

68
Q

Where can the iliopubic tract be seen?

A

▪ Can be seen following inguinal ligament internally

69
Q

What is the function of the iliopubic tract?

A

▪Reinforce posterior wall and floor of inguinal canal

70
Q

▪ With the inguinal ligament protect myopectinal orifice→

A

site for hernias

71
Q

When does the inguinal canal form?

A

▪ Forms during development for the descent of the testis

72
Q

How long is the inguinal canal?

A

▪Oblique passage ≈ 4cm long

73
Q

What does the inguinal canal lie parallel to?

A

▪ Parallel to inguinal ligament

74
Q

What are the main contents of the inguinal canal? (2)

A

▪ Spermatic cord (males)
▪ Round ligament of the uterus (females)

75
Q

Inguinal canal

▪ Also contains ________
▪ Delimited by _____ and deep inguinal rings

A

neurovasculature
superficial

76
Q

What are inguinal rings? (2)

A

▪ Deep inguinal ring
▪ Superficial inguinal ring

77
Q

What is the deep inguinal ring?

A

Entrance into canal

78
Q

What is the location of the deep inguinal ring? (2)

A

▪ Superior to inguinal ligament midpoint
▪ Lateral to inferior epigastric artery

79
Q

▪ Deep inguinal ring:
▪ Evagination of the transversalis fascia →

A

inner covering of canal

80
Q

▪ Deep inguinal ring:
▪ Passage of _____ cord contents or round ligament of uterus

A

spermatic

81
Q

What is the superficial inguinal ring? (2)

A

▪ Exit for canal contents
▪ Separation of parallel fibres of external oblique aponeurosis

82
Q

Where is the superficial inguinal ring located?

A

▪ Superolateral to pubic tubercle

83
Q

Inguinal ring

▪ Aponeurosis parts form the crura
▪ Lateral crus →
▪ Medial crus →

A

pubic tubercle
pubic crest

84
Q

Pubic crest + pubic tubercle =

A

Intercrural fibres

85
Q

What are the boundaries of the inguinal canal? (4)

A
  • Anterior wall
  • Posterior wall
  • Roof
  • Floor
86
Q

Inguinal canal
Anterior wall: (2)

A

▪ External oblique aponeurosis
▪ Internal oblique muscle fibres (lateral)

87
Q

Inguinal canal
Posterior wall: (3)

A

▪ Transversalis fascia
▪ Pubic attachment of internal oblique and transversus abdominis aponeuroses = inguinal falx (medial)
▪ Inguinal ligament (reflection)

88
Q

Inguinal canal
Roof: (3)

A

▪ Transversalis fascia (lateral)
▪ Transversus abdominis and internal oblique (central)
▪ Medial crus of external oblique (medial)

89
Q

Inguinal canal:
Floor (3)

A

▪ Iliopubic tract (lateral)
▪ Inguinal ligament (central)
▪ Lacunar ligament (medial)

90
Q

READ

A
91
Q

Inguinal canal: Contents

Male (9)

A
92
Q

Inguinal canal: Contents

Female (2)

A
92
Q

Inguinal canal: Contents

Female (2)

A
93
Q

Inguinal canal: Contents

All sexes (2)

A

▪ Blood and lymphatic vessels
▪ Ilio-inguinal nerve

94
Q

How does the inguinal canal develop in males? (2)

A

▪ Testes on posterior abdominal wall week 28 embryo (7th month) inwayof peitanium
▪ Processus vaginalis of peritoneum passes through transversalis fascia to form inguinal canal

94
Q

How does the inguinal canal develop? (2)

A

▪ Testes on posterior abdominal wall week 28 embryo (7th month) inwayof peitanium
▪ Processus vaginalis of peritoneum passes through transversalis fascia to form inguinal cana

95
Q

What is

A
96
Q

What is the gubernaculum?

A

▪ Gubernaculum pulls testis inferiorly into scrotum
→ ligament

97
Q

Inguinal canal: development (male)

  • Testis posterior to processus ____
  • Processus vaginalis forms ____ vaginalis
A

vaginalis
tunica

98
Q

How does the inguinal canal develop in females? (2)

A

▪ Ovaries on superior ______ region (post
abdominal wall)
▪ Processus vaginalis forms inguinal canal

99
Q

What is the function of the gubernaculum in females?

A

▪ Gubernaculum connects ovary to uterus to anterior abdominal wall→ovarian ligament and round ligament of uterus

100
Q

Male contents:

  • Ductus deferens (vas deferens) =
  • Testicular artery =
  • Artery of ductus deferens =
  • Cremasteric artery =
  • Pampiniform venous plexus =
  • Sympathetic nerve fibres =
  • Genital branch of genitofemoral nerve =
  • Lymphatic vessels =
  • Vestige of processus vaginalis =
A
101
Q

What happens to the processus vaginalis at 15 weeks?

A

At 15 weeks, the ovaries have descended into the greater pelvis. The processus vaginalis (not shown) passes through the abdominal wall, forming the inguinal canal on each side as in the male fetus. The round ligament passes through the canal and attaches to the subcutaneous tissue of the labium majus.

102
Q

What is the pressure of intrabdominal pressure? (7)

A
103
Q

How is the canal constricted?

A

Contraction of musculature that forms the lateral part
of the arcades of the internal oblique and transversus abdominis muscles makes the roof of the canal descend, constricting the canal.

104
Q

What are the problems associated with the inguinal canal and intrabdominal pressure? (2)

A
105
Q

Where do majority of hernias occur?

A

The majority of abdominal hernias occur in the inguinal region. Inguinal hernias account for 75% of abdominal hernias. These herniations occur in both sexes, but most inguinal hernias (approximately 86%) occur in males because of the passage of the spermatic cord through the inguinal canal.

106
Q

What is an inguinal hernia?

A

An inguinal hernia is a protrusion of parietal peritoneum and viscera, such as the small intestine, through a normal or abnormal opening from the cavity in which they belong. Most hernias are reducible, meaning they can be returned to their normal place in the peritoneal cavity by appropriate manipulation. The two types of inguinal hernia are direct and indirect inguinal hernias. More than two thirds are indirect hernias.

107
Q

What is the inguinal region? (2)

A
  • AKA groin
  • Extends between anterior superior iliac spine and pubic tubercle
108
Q

Inguinal Region-
* Bilaminar flexor retinaculum of the hip joint: (3)

A

o Formed by inguinal ligament and iliopubic tract
o Extends from anterior superior iliac spine to pubic tubercle
o Spans the Subinguinal space (lacunar ligament forms medial boundary)

109
Q

Inguinal Region-
Inguinal ligament:

A

o Dense band constituting inferior most part of the external oblique aponeurosis

110
Q

Inguinal ligament

Insertion:
Fibres:

A

Pubic tubercle

Most fibres

111
Q

Lacunar ligament

Insertion:
Fibres:

A

Superior pubic ramus

Deeper fibres passing posteriorly

111
Q

Lacunar ligament

Insertion:
Fibres:

A

Superior pubic ramus

Deeper fibres passing posteriorly

112
Q

Pectineal ligament

Insertion:
Fibres:

A

Pecten pubis
Lateral deeper fibres

113
Q

Reflected inguinal ligament

Insertion:
Fibres:

A

Contralateral external oblique aponeurosis

Superior fibres fanning upward

114
Q

What is the iliopubic tract? (3)

A
115
Q

What is the iliopubic tract? (3)

A
116
Q

Where is the inguinal canal located? (2)

A
  • Oblique passage 4cm long directed inferomedially
  • Lies parallel and superior to the medial half of the inguinal ligament
117
Q

What are the openings of the inguinal canal? (2)

A
  • Deep (internal) inguinal ring
  • Superficial (external) inguinal ring
118
Q

What are the features of the * Deep (internal) inguinal ring? (4)

A
119
Q

What are the features of the superficial (external) inguinal ring? (3)

A
120
Q

Lateral crus attaches to…
Medial crus attaches to…

A

§ Lateral crus- attaches to the pubic tubercle
§ Medial crus- attaches to the pubic crest

121
Q

Inguinal canal boundaries

Posterior wall

Lateral third/deep ring:
Middle third:
Medial third/superficial ring:

A

Transversalis fascia

Transversalis fascia

Conjoint tendon and reflected inguinal ligament

122
Q

Inguinal canal boundaries

Anterior wall

Lateral third/deep ring:
Middle third:
Medial third/superficial ring:

A

Internal oblique & lateral crus

Lateral crus and intercrural fibres

Intercrural fibres and external spermatic fascia

123
Q

Inguinal canal boundaries

Roof

Lateral third/deep ring:
Middle third:
Medial third/superficial ring:

A

Transversalis fascia

Musculo-aponeurotic arches of internal oblique and transversus abdominis

Medial crus

124
Q

Inguinal canal boundaries

Floor

Lateral third/deep ring:
Middle third:
Medial third/superficial ring:

A

Iliopubic tract

Inguinal ligament

Lacunar ligament

125
Q

Inguinal canal boundaries

Floor

Lateral third/deep ring:
Middle third:
Medial third/superficial ring:

A

Iliopubic tract

Inguinal ligament

Lacunar ligament

126
Q

Inguinal canal contents

Male AND female (3)

A

In both male and female
* Ilioinguinal n.
* Sympathetic nn.
* Lymphatics

127
Q

Inguinal canal contents

Female

A
  • Round ligament of
    uterus
128
Q

Inguinal canal contents

Male (4)

A
128
Q

Inguinal canal contents

Male (4)

A
129
Q

What is a hernia?

A

Infolding of small/large intestine; forms pouch of peritoneum that pushes through ant. abdomen wall.

130
Q

Direct vs indirect inguinal hernia:

A

A direct inguinal hernia shows a bulge from the posterior wall of the inguinal canal, whereas an indirect inguinal hernia passes through the inguinal canal or the groin. In the indirect inguinal canal, it is difficult to feel the defect as it occurs behind the external oblique muscle fibres.

131
Q

What are the features of an indirect inguinal hernia? (3)

A
132
Q

What are the features of a direct inguinal hernia? (2)

A
133
Q

What are the features of a femoral hernia? (2)

A
134
Q

What are abnormal hernias? (2)

A
  • Abnormal protrusion of a structure through tissues which normally contain it
  • Most commonly in the inguinal, femoral, umbilical and epigastric regions.
135
Q

Indirect vs Direct inguinal hernias: (6)

A
136
Q

What is a femoral hernia? (5)

A
137
Q

Anatomical features of inguinal canal that minimize herniation: (5)

A
138
Q

Anatomical features of inguinal canal that minimize herniation: (5)

A

MBBCh 2- ANAT2020A (60 decks)

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