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Anatomy Summer 2023 > Abdominal Wall > Flashcards

Abdominal Wall Flashcards

1
Q

Describe the two peritoneum

A

Peritoneum is a serous membrane that lines the abdominopelvic cavity and invests visceral organs

Visceral peritoneum: area of membrane that touches the visceral organs

Parietal peritoneum: area of membrane that lines the abdominal walls

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2
Q

What is the peritoneal cavity?

A

The space between the visceral and parietal membrane that contains only enough extracellular fluid to lubricate the membranes

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3
Q

What is present in the Right upper quadrant? (RUQ)

A

Liver: right lobe
gallbladder
stomach: pylorus
Duodenum: parts 1-3
Pancreas: Head
Right suprarenal gland
Right kidney
Right colic (hepatic) flexure
Ascending colon: superior part
Transverse colon: Right half

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4
Q

What is present in the Left Upper Quadrant? (LUQ)

A

Liver: left lobe
spleen
stomach
jejunum and proximal ileum
Pancreas: body and tail
left kidney
left suprarenal gland
left colic (splenic) flexure
Transverse colon: Left half
descending colon: superior part

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5
Q

What is present in the Right Lower Quadrant? (RLQ)

A

Cecum
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)
urinary bladder (if very full)

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6
Q

What is present in the Left Lower Quadrant? (LLQ)

A

sigmoid colon
descending colon: inferior part
left ovary
left uterine tube
left ureter: abdominal part
left spermatic cord: abdominal part
Uterus (if enlarged)
urinary bladder (if very full)

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7
Q

What special function does the Linea Alba serve?

A

Runs from xiphoid process to pubic symphysis

Allows small vessels and nerves to pass to the skin

Has umbilical ring where blood vessels used to run to the placenta

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8
Q

What special function does the Umbilicus serve/used to serve?

A

All layers at abdominal wall fuse at the umbilicus

Used to be the site of the umbilical cord for nutrients while in the womb

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9
Q

Where does the neurovascular plane live in the anterolateral abdominal wall?

A

Between the internal oblique and Transverse abdominis

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10
Q

What lives in the neurovascular plane in the anterolateral abdominal wall?

A

Nerves and blood vessels that supply the anterolateral wall of the abdominal cavity

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11
Q

Where do most of the nerves and blood vessels supplying the anterior part of the abdominal wall live?

A

They leave the neurovascular plane and lie in the subcutaneous tissue

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12
Q

How is the layout of the neurovascular plane in the anterolateral abdominal wall similar to that of the thoracic wall?

A

Layout is similar to how the intercostal spaces are in the thoracic cage

Nerves and blood vessels are present in intercostal spaces the same as the neurovascular plane

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13
Q

What other actions can the abdominal muscles do individually or combined?

A

Increase intra-abdominal pressure resulting in:
forced expiration
defecation
micturition (urination)
vomiting
child birth
heavy lifting

Trunk movements/pelvis tilting

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14
Q

What is the difference between a Dermatome and a peripheral nerve?

A

Dermatome: carried by a spinal nerve in a segmental distribution to supply an area of skin

Peripheral: fibers carried usually by a plexus and have specific names

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15
Q

What are the sensory nerves of the anterolateral abdominal wall?

A

Thoraco-abdominal nerves (T7-T11)
Subcostal nerve (T12)
L1 splits into two named nerves
- iliohypogastric
- ilio-Inguinal

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16
Q

Describe the Thoraco-abdominal nerves (T7-T11) and what they supply (dermatomes)

A

Continuation of intercostal nerves
Anterior/lateral cutaneous branches
- T9 above umbilicus
-T10 around umbilicus

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17
Q

What does the Subcostal nerve ( T12) supply?

A

supplies skin inferior to the umbilicus

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18
Q

Where does the iliohypogastric nerve supply?

A

supplies skin over iliac crest and hypogastric regions

Also the Internal oblique and Transverse abdominis

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19
Q

Where does the ilio-inguinal nerve supply?

A

supplies skin of inguinal region, external perineum, and adjacent thigh

Also the Internal oblique and Transverse abdominis

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20
Q

Pathway of a sensory nerve from the spinal cord to the skin

A

From ventral ramus -> neurovascular plane -> branch off to either lateral cutaneous branch or anterior cutaneous branch -> skin of those two regions

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21
Q

How is the arterial supply to the anterolateral abdominal wall similar to the nerve supply?

A

The arteries follow the same path as the nerves in the neurovascular plane and distribution follows the muscles

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22
Q

How are the vessels different when it comes to the anterolateral vessels compared to the anterior vessels?

A

Anterolateral vessels seem to flow more in a circumferential pattern (wrap around)

Anterior vessels seem to flow more in a vertical patter in rectus sheath

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23
Q

Describe the pathway of an Inguinal Hernia

A

Pass through the inguinal canal into the scrotum in males and the labia majus in females

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24
Q

What is the most common inguinal hernia?

A

indirect inguinal hernias

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25
Q

List the contents of the spermatic cord

A

Ductus Deferens (Vas Deferens)
Arteries
venous plexus
lymphatic vessels
sympathetic nerves to arteries and ductus deferens
genital branch of genitofemoral nerve

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26
Q

Clinical significance of the internal oblique and transverse abdominis muscles attaching to the throacolumbar fascia

A

Lumbar stabilization
when contracted, they pull bilaterally on the transverse processes which help to lift and stabilize the lumbar vertebrae

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27
Q

Describe the difference between the two layers of peritoneum

A

Parietal peritoneum - lines internal wall
sensitive to pressure, pain, heat, cold, and laceration
well localized pain

Visceral peritoneum - lines organs
insensitive to pain BUT sensitve to stretching and chemical irritation
Pain referred to dermatomes (spinal ganglia)

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28
Q

Intraperitoneal

A

completely covered with visceral peritoneum
similar to how lungs are

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29
Q

Extraperitoneal

A

completely outside peritoneum

30
Q

Retroperitoneal

A

partially covered/outside
EX: kidneys

31
Q

Subperitoneal

A

under peritoneum
urinary bladder only touches parietal peritoneum superiorly

32
Q

What is a hernia?

A

Bulging of tissue through an abnormal hole or opening
usually occurs through fossae

33
Q

Mesentary

A

-double layer of peritoneum
-surrounds organs and connects to the body wall
-usually named for organs they surround
-provides a pathway for neurovascular structures to communicate between organ and body wall

34
Q

Omentum

A

-double layer of peritoneum
-from stomach and duodenum to organs

35
Q

What are the two parts of the omentum?

A

Greater omentum - 4 layers and hangs like an apron from stomach and duodenum

Lesser omentum - 2 layers that connect stomach and duodenum to the liver

36
Q

Peritoneal ligament

A

-double layer of peritoneum
-attaches an organ to the abdominal wall OR an organ to another organ

37
Q

What passes through the Caval opening?

A

Inferior vena cava
Right phrenic nerve
Lymphatic vessels going to the liver

38
Q

What happens to the Caval opening when the diaphragm contracts?

A

This widens the opening, dilating the IVC for greater blood flow to the heart

39
Q

What passes through the Esophageal Hiatus?

A

Esophagus
Vagal trunk
Gastric vessels
Lymphatic vessels

40
Q

What does the right crus do when crossing the Esophageal Hiatus?

A

This forms a sphincter around the esophagus when the diaphragm contracts constricting the Hiatus

41
Q

What passes through the Aortic Hiatus?

A

Descending aorta
Thoracic duct
Azygos & Hemi-azygos veins

42
Q

What passes through the Medial Arcuate Ligament?

A

Psoas major

43
Q

What passes through the Lateral Arcuate Ligament?

A

Quadratus Lumborum (QL)

44
Q

What arteries are unpaired Visceral branches from the abdominal aorta?

A

Celiac artery
superior and inferior mesentaric arteries

45
Q

What arteries are paired visceral branches of the abdominal aorta?

A

Suprarenal arteries
Renal arteries
Gonadal arteries

46
Q

What arteries are paired parietal branches of the abdominal aorta?

A

Phrenic arteries
subcostal arteries
lumbar arteries

47
Q

What artery is unpaired parietal branch of the abdominal aorta?

A

Median sacral artery

48
Q

What veins drain into the IVC from the abdominopelvic region?

A

Hepatic portal vein
Right suprarenal vein
Right/left renal vein
Right gonadal vein
Right/left common iliac vein
Right/left inferior phrenic vein

49
Q

What is special about the left renal vein?

A

Multiple veins branch off of it including:
-left suprarenal vein
-left gonadal vein

50
Q

Flow of lymph from the abdominopelvic region to the venous system

A

Internal/External iliac lymph nodes -> Common iliac nodes -> pre-aortic lymph nodes -> intestinal lymphatic trunks -> intestinal lymphatic trunks + lumbar lymphatic trunks + thoracic lymphatic trunks -> cisterna chyli -> Thoracic duct -> left subclavian + internal jugular -> left venous angle

51
Q

What is a Hiatal Hernia?

A

This protrudes into the thorax through the esophageal Hiatus

52
Q

Types of Hiatal Hernias?

A

Para-esophageal

Sliding

53
Q

What is a para-esophageal hernia?

A

-less common
-through the fundus and pouch of peritoneum
-usually no regurgitation because cardia of stomach stays in place

54
Q

What is a sliding hernia?

A

-more common
-abdominal esophagus, cardia, and fundus slide superiorly through hiatus when lying down/bending over
-Regurgitation is possible due to right crus being weak

55
Q

What are abdominal Hernias?

A

structure pierces through abdominal wall tissue

56
Q

What is an Epigastric Hernia?

A

-protrudes through linea alba
-usually fat lobules in hernia
-painful if nerve is compressed

57
Q

What is an Umbilical Hernia?

A

-weakness from incomplete closure of umbilical ring
-common in neonates
-mostly common in women and obese

58
Q

What is an Inguinal Hernia?

A

A hernia that passes through/around the inguinal canal

59
Q

What gender usually has more inguinal hernias?

A

Males

60
Q

What is a Direct Inguinal Hernia?

A

-passes through or around inguinal canal
-medial portion of inguinal canal
-lateral to spermatic cord
-RARELY enter the scrotum
-palpable at the superficial inguinal ring

61
Q

What is an Indirect Inguinal Hernia?

A

-more common
-Transverses entire inguinal canal
-inside the spermatic cord
-enter the scrotum (or labia majus)
-palpable at superficial & deep inguinal rings

62
Q

What are the two Gridiron incisions?

A

McBurney

Suprapubic

63
Q

What is a McBurney incision?

A

-muscle splitting
-usually for appendix surgery
-2.5cm superomedial to ASIS
-spares muscles of the anterolateral abdominal wall

64
Q

What is a Suprapubic incision?

A

-“bikini” incision
-C-Sections
-Horizontal incision
-spares the Rectus abdominis muscle

65
Q

What is Peritonitis?

A

-inflammation of peritoneum
-usually from bacterial contamination from surgery or a traumatic penetration or rupture

-symptoms: pain in overlying skin, increased muscle tone, and tenderness, fever, and constipation

66
Q

What is General Peritonitis?

A

-widespread peritonitis in the peritoneal cavity
-dangerous and lethal because peritoneal surfaces absorb material RAPIDLY

67
Q

What is Ascites?

A

-excess fluid in peritoneal cavity
-distended abdomen
-usually from mechanical damage (internal bleeding) or portal hypertension, starvation, or metastasis of cancer cells

68
Q

What are Peritoneal Adhesions?

A

-scar tissue
-becomes sticky from fibrin (usually associated with damage to peritoneum)
-limits visceral movement
-forms between visceral peritoneum and organs AND between visceral and parietal peritoneum

69
Q

What are hiccups?

A

-involuntary spasms of diaphragm
-sudden inhalation
-sound is from the epiglottis closing
-usually from indigestion, diaphragm irritation, alcoholism

70
Q

Where is diaphragmatic pain referred to?

A

-Phrenic nerve (C3-C5) is usually to the shoulder region

-Inferior intercostal nerves is usually referred to the costal margins

71
Q

What is an abdominal aortic aneurysm (AAA)?

A

-abnormal and excessive dilation or ballooning of abdominal aorta
-usually congenital or weakness in aortic wall causes this
-90% fatal if ruptured
-will be severe back or abdominal pain

Anatomy Summer 2023 (8 decks)

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