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Bloc E - Digestion and metabolism > Anato > Flashcards

Anato Flashcards

1
Q

What are the 7 layers of the anterior abdominal wall?

A
  1. Skin
  2. Superficial fascia
  3. Fatty superficial layer (Camper’s fascia)
  4. Deep membranous layer (Scarpa’s fascia)
  5. Deep fascia
  6. Anterolateral wall muscles
  7. Transversalis fascia
  8. Extraperitoneal fatty tissue
  9. Peritoneum
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2
Q

External oblique muscle?

A

Fibbers orientation: Hands in pocket (sexternal)

Origin: Ribs 5-12

Insertion: Iliac crest, pubic crest, linea alba and xyphoid process –> forms inguinal ligament

Function: Anterior and lateral flexion of vertebral column

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3
Q

Internal oblique muscle?

A

Fibbers orientation: Hands on tits (seinterne)

Origin: Iliac crest and lateral part of inguinal ligaments

Insertion: Ribs 9-12 and linea alba

Function: Anterior and lateral flexion of vertebral column

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4
Q

Tranversus abdominis muscle?

A

Fibbers orientation: Horizontally

Origin: Iliac crest and lateral/upper part of inguinal ligament

Insertion: Linea alba and public crest

Function: Anterior and lateral flexion of vertebral columm

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5
Q

Rectus abdominis muscle?

A

Fibbers orientation: vertically

Origin: Pubic symphysis and crest

Insertion: Costal margin and xyphoid procress –> becomes pyramidalis muscle

Function: Anterior flexion of the vertebral column

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6
Q

What is the arcuate line?

A

Is the lower edge of posterior sheath of rectus abdominis. The transversalis fascia is directly posterior to rectus abdominis muscle below the arcute line while before the arcuate line, the rectus was between the anterior and posterior fascias of the internal oblique (IO).

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7
Q

Arterial supply of the anterior abdominal wall?

A
  • Superior epigastric a. –> from internal thoracic a.
  • Deep circumflex iliac a. –> from external iliac a.
  • Inferior epigastric a. –> from external iliac a.
  • Superficial epigastric a. –> from femoral a.
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8
Q

Venous drainage of the anterior abdominal wall?

A

Deep

  • Superior epigastric v. –> to internal thoracic v.
  • Deep circumflex iliac v. –> to external iliac v.
  • Superficial circumflex iliac v. –> to femoral v.
  • Inferior epigastric v. –> to external iliac v.

Superficial

  • Thoraco-epigastric v. –> to axillary v.
  • Superficial epigastric v. –> to femoral v.
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9
Q

Two important nerves of the pubic region?

A
  1. Iliohypogastric nerve: pierces the aponeurosis of the external abdominal oblique muscle 3-5 cm above the superficial inguinal ring
  2. Ilioinguinal nerve: emerges from the superficial inguinal ring and passes on the surface of the spermatic cord (or round ligament).
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10
Q

Layers of the inguinal canal?

A

From superficial to deep:

  1. Skin
  2. Dartos
  3. External spermadic fascia (from external oblique muscle)
  4. Cremaster muscle (from internal oblique muscle)
  5. Internal spermadic fascia (from traversalis fascia)
  6. Tunica vaginalis parietal
  7. Tunica vaginalis visceral
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11
Q

Ligaments of the inguinal canal?

A
  1. Cooper’s ligament: extension of the lacunar ligament that runs on the pectineal line of the pubic bone.
  2. Conjoint tendon: derived from fusion of the aponeuroses of the transversus abdominis and internal oblique muscles. On each side, it inserts into the pubic crest in continuity with the pectineal line. It forms the medial reinforcement to the posterior wall of the inguinal canal.
  3. Lacunar ligament: as the inguinal ligament reaches the pubic tubercle, it reflects backward and lateralward to attach to the pectineal line for about 1.25 cm. This posterior projection of the inguinal ligament is called the lacunar ligament.
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12
Q

What is the difference between a direct and indirect hernia?

A
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13
Q

Inguinal Triangle Hesselbach’s Triangle?

A
  • Medial border = Lateral margin of the rectus abdominis muscle/sheath
  • Superolateral border = Inferior epigastric vessels
  • Inferior border = Inguinal ligament (Poupart’s ligament)
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14
Q

Name those lines

A
  1. Midclavicular (or midinguinal) line
  2. Transpyloric plane
  3. Subcostal plane
  4. Transumbilical plane
  5. Intertubercular plane
  6. Interspinous plane
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15
Q

Name these

A
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16
Q

Name the content of the 4 quadrants

A

Right upper quadrant

Liver and Gallbladder

Left upper quadrant

Stomach and spleen

Right lower quadrant

Cecum, appendix, ascending colon & small bowel

Left lower quadrant

Descending and sigmoid colon & Small bowel

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17
Q

Name the 9 abnominal regions

A
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18
Q

Intraperitoneal Organs?

A
  • Liver
  • Stomach (ST)
  • Spleen
  • Duodenum (1st and 4th parts)
  • Small intestines (SI)
  • Cecum
  • Appendix
  • Transverse colon (TC)
  • Sigmoid colon
  • Rectum (upper 1/3)
  • Fallopian tubes/ovaries
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19
Q

Retroperitoneal Organs?

A

Primarily retroperitoneal:

  • Adrenal glands, kidneys, ureter, bladder
  • Aorta, inferior vena cava

Secondarily retroperitoneal organs:

  • Head and neck of the pancreas (but not the tail)
  • Second and third portions of the duodenum (but not the first or fourth)
  • Ascending and descending portions of the colon (but not the transverse or sigmoid)
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20
Q

Name the different Mesentaries and Omenta

A
  • Lesser omentum - stabilizes the position of the stomach and provides an access route for blood vessels and other structures entering or leaving the liver.
  • Greater omentum - hangs like an apron from the lateral and inferior borders of the stomach.
  • Mesentery proper - a thick mesenterial sheet that provides stability to the small intestine, but permits some independent movement.
  • Transverse mesocolon - supports the transverse colon, extending from pancreas on the posterior wall to the transverse colon.
  • Sigmoid mesocolon - supports the sigmoid colon.
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21
Q

What are the lesser sac ligaments?

A

Gastrocolic ligament (GC) - a portion of the greater omentum (GO) that stretches from the greater curvature of the stomach to the transverse colon. It forms part of the anterior wall of the lesser sac.

Lesser omentum (LO) (two parts):

1) Hepatogastric ligament (HG) - connects the liver to the lesser curvature of the stomach.
2) Hepatoduodenal ligament (HD) - connects the liver (porta hepatis) to the duodenum. It contains the proper hepatic artery, hepatic portal vein, common bile duct (portal triad).

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22
Q

Ligaments of the liver?

A
  • The falciform ligament (falciform in Latin = “sickle-shaped”) is a ligament that attaches the liver to the anterior body wall. It is a broad and thin antero-posterior peritoneal fold.
  • The ligamentum teres is a remnant of the umbilical vein of the fetus.
  • Triangular ligament
23
Q

Identify these structures

A
24
Q

The external sphincter of the stomach comes from where?

A

The right crus of the diaphragm. Function: sphincter that prevents stomach contents from refluxing up the esophagus when intra-abdominal pressure rises during inspiration

25
Q

4 parts of the duodenum?

A

C shape tube with 4 parts:

  1. First part: ½ is intraperitoneal, connected to liver via the hepatoduodenal ligament (5 cm)
  2. Second part: begins at the superior duodenal flexure and ends at the inferior duodenal flexure (7-10 cm)
  3. Third part: begins at the inferior duodenal flexure (5-7.5 cm)
  4. Fourth part: intraperitonealcurves anteriorly and terminates at the duodenojejunal flexure (5 cm) –> site of ligament of Treitz from right crus of diaphragm
26
Q

What is the ligament of Treitz?

A

The suspensory muscle of duodenum that connects the duodenum (4th part) to the diaphragm, comes from the RIGHT CRUZ OF DIAPHRAGM.

27
Q

Jejunum vs Ileum?

A

Jejunum

  • Fewer arterial arcades and longer straight arteries (vasa racta)
  • Plicae circulares

Ileum

  • Peyer’s patches (aggregations of lymphoid tissue)
  • More fat
  • Site of Meckel’s diverticulum
28
Q

What is a Intussusception?

A

An intussusception is a medical condition in which a part of the intestine has invaginated into another section of intestine, similar to the way in which the parts of a collapsible telescope slide into one another.

29
Q

Parts of the colon?

A
  • Cecum: Small to Large Intestine Transition
  • Appendix: Located 1/3 of the distance from the ASIS to the navel, watch out for situs invertus*
  • Taenia coli: 3 separate longitudinal ribbons of smooth muscle on the outside of the ascending, transverse, descending and sigmoid colons ®contract lengthwise to produce the haustra
  • Epiploic appendices: small pouches of the peritoneum filled with fat and situated along the colon and upper part of the rectum.
  • Haustra: small pouches caused by sacculation, which give the colon its segmented appearance.. Haustral contractions are slow segmenting movements that occur every 25 minutes.
  • Sigmoid colon: last part after descending colon
  • Site of diverticulosis: outpocketings of the colonic mucosa and submucosa through weaknesses of muscle layers in the colon wall
30
Q

What is Diverticulosis?

A

Outpocketings of the colonic mucosa and submucosa through weaknesses of muscle layers in the colon wall. These are more common in the sigmoid colon, which is a common place for increased pressure.

31
Q

3 branches of celiac trunk?

A
  1. Common hepatic
  2. Left gatric
  3. Esophageal branches
32
Q

Common hepatic divides in ?

A
  1. Propper hepatic
  2. Gastroduodenal
33
Q

Branches of propper hepatic?

A
  1. Right gastric
  2. Left hepatic
  3. Right hepatic
  4. Cystic
34
Q

Gastroduodenal becomes?

A

Superior pancreaticoduodenal

35
Q

Branches of superior mesentric?

A
  1. Juejuneal artery
  2. Vasaracta
  3. Inferior pancreatic
  4. Middle colic
  5. Right colic
  6. Iliocolis –> posterior and anterior cecal
36
Q

Branches of inferior mesentric ?

A
  1. Sigmoid –> superior rectal
  2. Left colic
37
Q

Spleen’s position?

A

1×3×5×7×9×11 rule:

Size = 1” by 3” by 5” (1 inch = 2.54 cm)

Weight = approximately 7 oz (1 oz = 28.3 grams)

Position = lies between the 9th and 11th ribs

Gastric, renal and colic impressions

38
Q

Spleen’s functions?

A
  1. Storage of RBCs
  2. Destruction of worn-out RBCs
  3. Removal of foreign material from the blood
  4. Production of mononuclear leukocytes

While the spleen performs a number of important functions, it is not essential to life. Other organs such as the liver and bone marrow are able to take over many of its jobs.

39
Q

Spleen’s vascularization

A
  • Splenic artery: from the celiac trunk
  • Splenic vein: travels on the posterior surface of the pancreas, below the artery, joins with the superior mesenteric vein to form the portal vein
40
Q

Splenomegaly ?

A

Enlargement of the spleen

Usually associated with increased workload (such as in hemolytic anemias), which suggests that it is a response to hyperfunction. It is therefore not surprising that splenomegaly is associated with any disease process that involves abnormal red blood cells being destroyed in the spleen. Other common causes include congestion due to portal hypertension and infiltration by leukemias and lymphomas (Often an indication of liver disease).

41
Q

Parts of the pancreas?

A
  1. Head
  2. Neck
  3. Body
  4. Tail: extends to the hilum of the spleen in the lienorenal ligament
  5. Ulcinate process
42
Q

Ducts of the pancreas?

A
  • Common bile duct: common hepatic & cystic duct
  • Sphincter of Oddi: muscular valve that controls the flow of digestive juices (bile and pancreatic juice) through the ampulla of Vater into the second part of the duodenum (D2)
  • Duct of Santorini: additional accessory pancreatic duct which connects straight to the duodenum at the minor duodenal papilla
43
Q

Pancreas’ blood suplpy

A
  • Gastroduodenal artery from celiac trunk
  • Anterior and posterior inferior pancreaticoduodenal arteriole from gastroduodenal artery
  • Splenic artery
  • Dorsal pancreatic from dorsal pancreatic from spenic artery
44
Q

Liver’s ligaments?

A

Ductus venosus shunts a portion of the left umbilical vein blood flow directly to the inferior vena cava. Thus, it allows oxygenated blood from the placenta to bypass the liver.

45
Q

Liver’s lobes?

A

4 anatomical lobes

  1. Left lobe
  2. Right lobe
  3. Quadrate lobe
  4. Caudate lobe

8 functional segments

46
Q

Gallbladder

A

Function

Storage of the bile created by the liver

47
Q

Hepatoduodenal ligament contains?

A
  1. Portal vein
  2. Bile duct
  3. Proper hepatic artery
48
Q

Autonomic innvervation of abdomen?

A

Parasympathetic (synapses on the wall of organs)

  1. VAGUS NERVE – esophagus to end of the proximal 2/3 of the transverse colon
  2. PELVIC SPLANCHNIC NERVES – distal 1/3 of the transverse colon to the rectum

Sympathetic (Synapse in the aortic, superior mesenteric or inferior mesenteric plexuses)

  1. THORACIC SPLANCHNIC NERVES
  • Greater splanchnic nerve (T5-9)
  • Lesser splanchnic nerve (T10-11)
  • Lowest (least) splanchnic nerve (T12)
  1. Lumbar splanchnic nerves (L1-2)
49
Q

Identify

A
50
Q

Identify

A
51
Q

What are the arpertures of the diaphragm?

A

Apertures

  1. Caval foramen: right phrenic and lymphatics
  2. Esphageal hiatus: vagus nerve, esophageal vessels and lymphatics
  3. Aortic huatus: thoracic duct and azygos vein

These nerves do not pass through the apertures:

  1. Left phrenic: pierces the diaphragm
  2. Sympathetic trunks: posterior to the medial arcuate ligament
  3. Subcostal: posterior to the lateral arcuate ligament
52
Q

Lumbar plexus?

A

Lumbar plexus: ventral rami L1 to L4

  1. Subcostal n. (T12)
  2. Iliohypogastric n. (L1)
  3. Ilioinguinal n. (L1)
  4. Genitofemoral n. (L1, L2) *pierces psoas muscle
  5. Lateral cutaneous nerve of the thigh (L2, L3)
  6. Femoral n. (L2, L3, L4)
  7. Obturator n. (L2, L3, L4)
53
Q

The general visceral sensory AFFERENT fibers are part of the sympathetic ou parasympathetic system?

A

Unlike the efferent fibers of the autonomic nervous system, the afferent fibers are not classified as either sympathetic or parasympathetic.

54
Q

The vagus nerve supplies motor parasympathetic fibers to all the organs except which one?

A

Addrenal gland

Bloc E - Digestion and metabolism (6 decks)

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