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Anatomy II - Post-Midterm > Abdominal Wall - Herniae - Peritoneum - Pain Transmission > Flashcards

Abdominal Wall - Herniae - Peritoneum - Pain Transmission Flashcards

1
Q

Q. What are the muscles of the abdominal wall? Origins, Insertions, Innervation, Actions.

A

A. The muscles of the abdominal wall are External Oblique, Internal Oblique, Transversus Abdominus, Rectus Abdominus.

External Oblique
N = Inferior 6 thoracic nerves
A = Bilateral: flexes trunk; compresses the abdominal cavity. Unilateral: contralateral rotation of the trunk
Internal Oblique
N = Inferior 6 thoracic nerves and first lumbar nerve (iliohypo and ilioinguinal nerves)
A = Unilateral contraction: ipsilateral rotation. Bilateral contraction: trunk flexion; compresses abdominal cavity to increase intraabdominal pressure
Transversus
N =
A = Compresses abdomen and supports abdominal viscera
Rectus
O/I = Proximal attachment is xiphoid process and cartilage of ribs 5, 6, 7. Distal attachment is pubic sympysis and pubic crest.
A = Flexion of trunk and compression of abdomen
N = Lower 6 thoracic spinal nerves

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2
Q 
What types of pain are felt in the:
Parietal Peritoneum?
Visceral Peritoneum?
Parietal Pleura?
Visceral Pleura?
A

You had to know which feels like sharp, cutting, knife life burning.
Parietal Peritoneum – pain not referred; local @ site of pathology
Visceral Peritoneum – gripping, squeezing, twisting, churning – pain is referred; area of skin supplied by same spinal segment as affected organ.
Parietal Pleura – gripping, squeezing, aching, etc (same as visceral peritoneum);
- upper costal pleura –> intercostal nerves 1-6 refer pain to upper thoracic wall
- lower costal pleura/outer rim of diaphragmatic pleura –> intercostal nerves 7-12 refer pain to lower thoracic wall & ant ab wall
- central diaphragmatic pleura/mediastinal pleura –> phrenic nerve (C3-5) refers to shoulder and base of neck
Visceral Pleura = NO PAIN

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3
Q

Q. What muscles flex the trunk?

A

A. External oblique (bilateral contraction), Internal oblique (bilateral contraction), Rectus abdominus

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4
Q

Q. What muscles compress the abdomen?

A

A. All of the abdominal muscles do. External oblique (bilateral contraction), Internal oblique (bilateral contraction), Transversus abdominus, Rectus abdominus

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5
Q

Q. What muscle contralaterally and ipsilaterally rotate trunk?

A

A. External oblique (unilateral contraction) contratlaterally rotates trunk. Internal oblique (unilateral contraction) ipsilaterally rotates trunk.

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6
Q

Q. What muscles make up the posterior abdominal wall?

A

Iliacus, psoas major (Iliopsoas) and Quadratus Lumborum.

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7
Q

What is the innervation of Iliopsoas?

A

Femoral Nerve from L2, L3

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8
Q

What are the attachments of Quadratus Lumborum? What is its action relative to spine?

A

Quadratus lumborum
O = Iliac crest
I = 12th rib (inferior surface)
A = Lateral flexion of spine, fixation of rib 12 during forced inspiration

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9
Q

Q. Where does the superior epigastric artery arise from?

A

A. The superior epigastric artery is a direct continuation of the Internal Thoracic Artery

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10
Q

Q. With what artery does the superior epigastric anastomose?

A

A. The superior epigastric artery anastomoses with the Inferior Epigastric Artery

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11
Q

Q. Where does the inferior epigastric artery come from?

A

A. The inferior epigastric artery is a branch of the external iliac artery.

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12
Q

Q. Superficial cicumflex iliac and superficial epigastric arteries branch from where?

A

A. The superficial circumfex iliac and superficial epigastric branch from the femoral artery.

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13
Q

Q. What does the deep circumflex artery supply?

A

A. The deep circumflex artery supplies the anterior abdominal wall.

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14
Q

Q. Where do the lymph nodes / vessels drain?

A

A. The superficial lymph vessels superior to the umbilicus drain mostly into ipsilateral axillary nodes and some into parasternal nodes. The superficial lymph vessels below the umbilicus drain into ipsilateral inguinal nodes.

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15
Q

Q. Where do SVC and IVC collect blood from?

A

A. The SVC collects venous blood above the diaphragm. The IVC collects venous blood below the diaphragm.

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16
Q

Q. Which veins are involved in the deep anastomosis?

A

A. The deep anastomosis is between the superior epigastric and infereior epigastric vein.

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17
Q

Q. Where does the deep anastomosis drain?

A

A. The dep anastomosis drains as follows:
Superior epigastric vein → Internal thoracic vein → subclavian vein → brachiocephalic vein → SVC.
Inferior epigastric vein → External iliac vein → Common iliac vein → IVC

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18
Q

Q. Describe superficial anastomosis?

A

A. The superficial epigastric vein arises from the paraumbilical vein. The superficial anastomosis drains into the the superficial epigastric → thoracoepigastric vein → Lateral thoracic vein (CHECK)

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19
Q

Q. What happens if the IVC or SVC are obstructed?

A

A. If the IVC or the SVC are obstructed, the deep anastomes and superficial anastomoses will dilate to increase blood flow.

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20
Q

Q. What is caput medusae?

A

A. Caput medusae is a pathology of the liver. Reduced blood flow to the liver can result in enlarged anastomoses that become visible.

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21
Q

Q. Where do paraumbilical veins drain into? What do they anastomose with?

A

A. The paraumbilical veins drain into the Portal Vein. The parumbilical veins anastomose with the thoracoepigastric vein and superficial epigastric vein.

22
Q

Q. What is the superficial inguinal ring made of?

A

A. The superficial inguinal ring is made of the external oblique muscle.

23
Q

Q. What is the deep inguinal ring made of?

A

A. The deep inguinal ring is made of the fascia of tranversalis muscle.

24
Q

Q. What is located in the inguinal ring in females?

A

Round ligament.

25
Q

Q. Where does the round ligament attach?

A

A. The round ligament attaches to the labia majora.

26
Q

Q. What makes the dartos muscle and what is its action?

A

Fibers from the external oblique muscle. Dartos muscle contraction causes wrinkling when cold.

27
Q

Q. What makes the cremaster muscle and what is its action?

A

Fibers from the internal oblique muscle. Cremaster muscle draws the testes into the scrotum when cold.

28
Q

Q. What is cryptochordism? What are side effects of cryptochordism?

A

Undescended testes. Side effects are sterility and testicular cancer.

29
Q

Q. What is testicular hydrocele?

A

Filling of the scrotum with fluid (CHECK). If the processus vaginalis does not obliterate and remains open, fluid can accummulate. Test with light.

30
Q

Q. Where does the left testicular vein drain?

A

Into the left renal vein.

31
Q

Q. Where does the right testicular vein drain?

A

Into the IVC.

32
Q

Q. What is femoral hernia?

A

Facts of the femoral hernia. FEMORAL = FATAL
–protrusion through femoral canal; lymphatic vessels and nodes–sup. to it is femoral ring (femoral sheath–transversus and iliopsoas outpouch)
lateral——(artery){vein}(empty compartment)—–medial; intestine can enter

33
Q

Q. Where would Small Intestine enter into femoral ring?

Q. Where would femoral arery, veins, nerves enter into femoral ring?

A

@@@@@@@@

34
Q

Q. What do these terms mean for a hernia prognosis?

  • Reducible
  • Irreducible
  • Obstructed
  • Strangulated
A

Reducible - smaller, content can pushed back to where it belongs
Irreducible - a. incarcerated : lumen of SI sac open & adhesions develop between lumen & sac; can be left as is.
b. obstructed : lumen closed in hernial content–accumulates chyme–digestion compromised
c. strangulated ; neck of herniae is squeezed–tissue death, gangrene

35
Q

Q. Why is femoral hernia so dangerous?

A

MOST DANGEROUS ; typically irreducible–>strangulated (ischemia, gangrene)

36
Q

Q. What is Direct Inguinal Hernia?

A

DIRECT – older men with weak abdominals – hernia passes directly through abdominal wall. Region called inguinal triangle (Hasselbachs triangle) – inf. @ inguinal lig, medial @ rectus ab, lateral@ inf. epigastric artery and vein.

37
Q

Q. What is Indirect Inguinal Hernia?

A

INDIRECT – most common form hernia–>deep inguinal ring –> (lat. to epigastric artery and vein) inguinal canal – might extend into scrotum by following pretraced pathway of vaginal process.
Less chance of developing if physically fit.

38
Q

Q. What is congenita diaphragmatic hernia?

A
  • large posterolateral defect in diaphragm–content of abdomen shifted into thoracic cavity because opening for digestive tract is too wide – sliding hernia later in life
  • severe underdeveloped lungs (1 or both) = lethal (pulmonary hypoplasia)
39
Q

Q. What is congenital umbilical hernia?

A

@@@@

40
Q

Q. What are the boundaries of Hasselbach’s Triangle?

A

A. Inferior boundary – Inguinal ligament; Medial boundary – rectus abdominus; Lateral boundary – inferior epigastric artery and vein.

41
Q

Q. Is the transverse colon intraperitoneal or extraperitoneal?

A

A. The transverse colin is intraperitoneal.

42
Q

Q. What organs are intraperitoneal?

A

Organs almost completely covered by visceral peritoneum. Jejenum, Ileum, Stomach, Transverse Cikin,

43
Q

Q. What organs are extraperitoneal / retroperitoneal?

A 
Organs between abdominopelvic (posterior) and parietal peritoneum. 
SAD PUCKER 
S uprarenal
A orta
D uodenum
P ancreas
U reter
C olon (ascending/descending)
K idney
E sophagus
R ectum
44
Q

If an abdominal infection has spread retroperitoneally, which of the following structures is most likely affected?

A

1) Stomach
2) Transverse colon
3) Jejunum
4) Descending Colon <– ANSWER
5 ) Spleen.

45
Q

Q. What is the difference in peritoneal space in males and females?

A

A. In males, the peritoneal space is completely sealed. In females, there is access through the oviducts.

46
Q

Q. Where is the lesser omentum spread?

A

A. The lesser omentum is between the lesser curvature of the stomach and the first part of duodenum and liver.

47
Q

Q. What does the greater omentum attach to?

A

A. Greater omentum attaches to the anterior wall of the transverse colon.

48
Q

Q. Where is the lesser sac located?

A

A. The lesser sac is located behind the stomach between 2 layers of greater omentum. The superior recess of the lesser sac is between the diaphragm and liver (coronary ligament) and the inferior recess is between layers of the greater omentum.

49
Q

Q. What is the omental foramen?

A

A. The omental foramen allows for communication between the omental bursa (the lesser sac) and the greater sac.
Greater Sac: divided by transverse colon; supracolic – stomach, liver, spleen; & infracolic – SI, Asc and Desc Colon —->both of them freely communicate through paracolic gutters (lateral to ascending and descending colon)
Infracolic divided into L&R infracolic spaces (rectouterine pouch – where blood and other body fluid can accumulate due to injury

50
Q

Q. What is the muscularis layer?

A

A. In the muscularis layer, the skeletal muscles are gradually replaced with smooth muscle. There are two layers. The inner layer is circular. The outer layer is longitudinal. The stomach has a third obliquely running muscle. CHECK

Anatomy II - Post-Midterm (2 decks)

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