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GI > Abdominal Organization : Part I > Flashcards

Abdominal Organization : Part I Flashcards

1
Q

umbilicus level

A

LV3/Lv4

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2
Q

xiphoid process

A

TV10

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3
Q

What are the 9 quadrants? what lines divide them?

A

subcostal plane: LV3

Transtubercal plane LV5

MCL’s

R/Lt hypochondrium, epigastric

R/L flank/lateral region, umbilical

R/L inguial/groin, pubic

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4
Q

how do you divide the quadrants?

A

midsagittal plane

transumbilical plane (LV3/4)

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5
Q

organs located in RUQ

A

right love of liver

gallbladder

pylorus of stomach

duodenuma: parts 1-3

head of pancreas

rt. kidney

superior portion of ascending colon

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6
Q

organs locate din LUQ

A

left lobe of liver

spleen

stomach

jejunum and proximal ileum

body and tail of pancreasleft kidney

left half of transverse colon

descending colon superior portion

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7
Q

RLQ

A
  • cecum
  • appendix
  • most of ileum
  • ascending colon: inferior part
  • right ovary
  • right uterine tube
  • right ureter
  • right spermatic cord
  • uterus
  • urinary bladder if very full
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8
Q

LLQ

A
  • sigmoid colon
  • descending colon: inferior part
  • left ovary
  • left uterine tube
  • left ureter: abdominal part
  • lefts spermatic cord
  • uterus if enlarged
  • urinary bladder if very full
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9
Q

transpyloric plane

A

LV1

through stomach

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10
Q

subcoastal plane

A

under ribs

LV3

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11
Q

transumbilical plane

A

LV3/4

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12
Q

supracristal

A

LV4

highest point of illiac crest: stay below for lumbar punctures

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13
Q

transtubercular plane

A

LV5

through tubercles of iliac crest

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14
Q

interspinous plane

A

SV1

through ASIS

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15
Q
A
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16
Q

layers of anterolateral abominal wall

A
  1. skin
  2. superficial fatty fascia layer (camper’s fascia)
  3. deep memmbranous fascial layer (Scarpa’s fascia)
  4. external oblique
  5. internal oblique
  6. transverse abdominus muscle
  7. transversalis fascia
  8. extraperitoneal fat (subserous fascia)
  9. parietal peritoneum
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17
Q

superficial fascia of abdominal wall

A
  1. Campers fascia
  2. Scarpa’s fascia
  • continous with Colle’s and Dartos fascia of perineum
  • attaches to iliac crest, fascia lata below inguinal ligmaent and pubic tubercle
  • the fundiform ligament is a specialization of Scarpa’s Fascia (a sling for the penis, from the pubic bone)
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18
Q

Deeper fascias of abdominal wall

A
  1. Transversalis fascia: lines all of abdominoplevic cavity; deep to muscle layer
  2. subserous fascia: loose, fatty CT between transversalis fascia and peritoneum
  3. parietal peritoneum: serous membrane which lines the abdonimopelvic cavity
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19
Q

external abdominal oblique muscle

A

Origin: Outer surfaces of ribs 5-12

I: anterior iliac crest; via external abdominal oblique aponeurosis attaches to linea alba from xiphoid process to pubic symphysis

A: flexion of vertebral column and pelvis; compression and support of abdominal viscera; one side acting alone causes lateral flexion of trunk, and rotation to opposite side (torsional mvmt of trunk)

N: intercostal, subcostal, iliohypogastric nn.

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20
Q

internal abdominal oblique. what do inferior fibers compose?

A

O: thoracolumbar fascia; anterior iliac crest; lateral inguinal ligament

I: inferior borders of ribs 9-12; via internal abdonominal oblique aponeurosis to linea alba from xiphoid process to pubic symphysis

A: flexion of vertebral column and pelvis; compression and support of abdominal viscera; one side acting alone causes lateral flexion and rotation of same side (torsional movment of trunk)

N: intercostal, subcostal, iliohypogastric, ilioinguinal nn.

NOTE: inferior fibers of IAO give rise to the cremaster muscle which plays an important role in temperature regulation of testes

21
Q

Transversus abdominus muscle

A

O: inner surface of ribs 7-12; thoracolumbar fascia; anterior iliac crest; lateral inguinal ligament

I: via aponeurosis to linea alba

A: compression and support of abdominal viscera

N: intercostal, subcostal, iliohypogastric, ilioinguinal nn

22
Q

Rectus abdominus muscle

A

O: pubic symphysis and pubic crest

I: costal cartilages 5-7, xiphoid process

A: flexion of vertebral column and pelvis

N: ventral rami T6-12 (intercostal, subcostal nn)

NOTE: tendinous intersections: 3-4: attachments of rectus abdominis to rectus sheath

23
Q

Pyrimidalis:

A

O: pubic bone, anterior to rectus abdominis

I: linea alba

A: tenses linea alba

N: subcostal n.

24
Q

Rectus Sheath: arcuate line, linea alba, linea semilunaris

A
  • fascia surrounding rectus abdominis and pyramidalis; formed from decussation of external/internal abdominal oblique and transversus abdominis aponeurosis
  • composition changes midway between umbilicus and pubic symphysis at the arcuate line
  • above arcuate line: anterior layer: is external/internal abdominial oblique aponeuroses, posterior layer is transversus abdominus aponeurosis
  • below arcuate line: all 3 layers pass anterior to rectus abdominis
  • linea alba: midline site of attachment of aponeuroses: runs from xiphoid process to pubic symphisis
  • linea semilunaris: lateral, fused border of rectus sheath
25
Q

5 folds/ligaments?

A
  1. Median umbilical fold: runs from apex of bladder to umbilicus (median umbilical ligament/urachus found here)

2/3. Medial umbilical folds: run towards umbilicus: medial umbilical ligaments (occluded portion of umbilical aa. found within the folds)

4/5. lateral umbilical folds: contain the inferior epigastric aa.

26
Q

anterolateral abdomina wall hernias

A

“ventral hernias” due to weakness in rectus sheath

  • umbilical hernia
  • linea alba hernia
  • linea semilunaris hernia
  • incisional hernia
27
Q

dermatomes

A

(T7-11) = abdomen

T6: xiphoid process

T10: umbilicus

L1: inguinal region; anterior scrotum, labia (iliac crest, ASIS, inguinal region)

  • iliohypogastric n, ilioninguinal n.
28
Q

Fossae of abdominal wall

A
  1. supravesical fossa: betwen median and medial umbilical folds
    * site of supravesical hernias
  2. medial inguinal fossa: between medial and lateral folds
    * direct inguinal hernias
  3. lateral inguinal fossa: area lateral to lateral umbilical fold
    * indirect inguinal hernia
29
Q

superficial abdominal wall innervation?

A

intercostal nn. (anterior and lateral branches) T7-11

subcostal n. T12

iliohypogastric n L1

ilioinguinal n L1

30
Q

where are nerves located?

A
  • nerves course between transversus abdominis and internal oblique
  • thoracoabdominal and subcostal nn provide lateral cutaneous branches and terminate anteriorly as cutaneous branches

iliohypogastric and ilioinguinal nn pierce internal oblique near the ASIS, run between the internal and external oblique, then terminate as anterior branches

31
Q

superficial aa. of abdominal wall

A
  • mostly perforating branches of deeper arteries
  • superficial epigastric a, and superficial circumflex iliac a. (branches from femoral a.)
32
Q

deep arteries

A
  1. musculophrenic a. (terminal branch of internal thoracic a.)
  2. superior epigastric a. (terminal branche of internal thoracic a.)
  • runs between rectus abdominis and posterior layer of rectus sheath
  • anastomoses with inferior epigastric a. in region of umbilicus
  1. inferior epigastric a. (branch of external iliac a. given off medial to deep inguinal ring)
  • ascneds along anterior body wall, inside lateral umbilical fold
  • pierces posterior layer of rectus sheath to anastamose with superior epigastric a.

4/5: posterior intercostal and subcostal aa. (b/w internal abdominal and transversus abdominus muscles)

  1. lumbar a.
  2. deep circumflex iliac. a.
33
Q

Where do superficial veins drain?

A

lateral thoracic vein –> axillary vein

musculophrenic/superior epigastric vv. –> internal thoracic v.

superficial epigastric and superficial circumflex iliac v –> femoral v.

34
Q

where do deep veins drain?

A

musculophrenic/superior epigastric v –> internal thoracic v.

inferior epigastric/deep circumflex iliac vv –> external iliac v.

lumbar vv –> IVC

posterior intercostal/subcostal vv. –> azygos vein

35
Q

Where do superficial lymphatics drain?

A

superior to transumbilical plane –> axillary nodes

inferior to transumbilical plane –> superfiical inguinal lymph nodes

36
Q

What are ligaments of inguinal region? what do they reinforce?

A
  • inguinal ligament, iliopubic tract
  • these ligaments reinforce the myopectineal orifice: an area of weakness, where three most common hernias occur
37
Q

inguinal ligament? three specializations?

A

inferior, “rolled under” portion of external oblique aponeurosis

Specializations:

  • lacunar ligament: medial fibers of inguinal ligament which attach lateral to pubic tubercle; crescent-shaped ligament which forms medial border of femoral canal
  • pectineal ligament: lateral continuation of lacunar ligament attaching to pectineal line of superior pubic ramus
  • reflected ligament: continuation of superiomedial fibers of inguinal ligament which atach to linea alba
38
Q

how does inguinal canal form?

A
  • during gonadal descent from abdomen to scrotum (or labia)
  • gubernaculum = thick ligament attaching testes to anterior body wall at furutre site of deep inguinal ring
39
Q

deep inguinal ring

A
  • site of indirect hernias
  • entrance to inguinal canal from abdominal cavity
  • formed as an evagination of transversalis fascia
  • located lateral to inferior epigastric aa.
40
Q

superficial inguinal ring

A
  • site of direct inguinal hernias
  • exit from inguinal canal into scrotum or labia majora
  • formed from split in fibers of the external abdominal oblique aponeurosis
  • lateral crus: attaches to pubic tubercle
  • medial crus: attaches to pubic crest
  • intercrural fibers: artch between medial/lateral crus
41
Q

boundaries of inguinal canal/

A

anterior: external oblique aponeurosis
floor: inguinal ligament
roof: internal oblique and transversus abdominus muscles
posterior: transversalis fascia laterally; reinforced medially by conjoint tendone

42
Q

Conjoint tendon

A
  • medial reinforcement of posterior part of inguinal canal- composed of the inferior-most fibers of the internal and transversus abdominis muscles
  • attaches to the pubic bone posterior to the superficial inguinal opening
  • aka “inguinal falx” tendon
43
Q

what does external abdominal oblique aponeurosis go to form?

A

external spermatic fascia

44
Q

what does internal abdominal oblique go to form?

A

cremaster muscle

45
Q

contents of inguinal canal?

A

Male: spermatic cord, ilioinguinal n, genital branch of genitofemoral n.

  • contains: ductus deferens, testicular a, artery of ductus deferens, pampiniform plexus of veins, autonomic and lymphatics of testes
    female:
  • round ligament of utuerus, ilioinguinal n. genital branch of genitofemoral n.
46
Q

what covers the testes/spermatic cord?

A

skin

dartos fascia: superficial fascia of abdominal wall

external spermatic fascia = external oblique aponeurosis

cremaster muscle/fascia = internal abdominal oblique muscle

internal spermatic fascia = transversalis fascia

tunica vaginalis = evagination of peritoneum (processus vaginalis) - forms around serous cavity of testes

47
Q

indirect hernia

A

*** through superficial ring****

2/3 of all inguinal hernias: more common in males on rt. side

  • congenital, caused by failure of proximal processus vaginalis to close
  • occur in lateral inguinal fossa; lateral to inferior epigastric vessels
48
Q

Direct Hernia

A

*** superficial inguinal ring***

  • more common in males: 1/3 of cases

aquired; caused by a weakness in atnerior body wal posterior to superficial inguinal ring

  • conjoint tendon provides a natural protection against direct hernias

occurs in medial inguinal fossa (Hesselbach’s triangle); medial to inferior epigastric vessles

GI (12 decks)

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