Anatomy Flashcards
What causes pain in the thoracoabdominal nerves (T7-T11)? Where can the pain be referred to?
Pain from lower thoracic wall (due to pleurisy of costal pleura), may be referred to abdomen (T10 innervates umbilicus level)
What pain goes trhough subcostal nerve (T12)?
Pain from upper GI appendages (peptic ulcer), may refer to back
What pain is involved in iliohypogastric and ilioinguinal nerves (L1)?
Pain from ureters may refer to groin and scrotum
What does the superficial circumflex iliac artery anastomose with? (3)
Deep circumflex iliac artery, superior gluteal, and lateral femoral circumflex artery
What are the superficial vascular supplies of the anterolateral abdominal wall?
Superficial epigastric and superficial circumflex iliac arteries from the femoral artery
Where do lymphatics drain if they are above the umbilicus? Below?
Above – axillary
Below – superficial inguinal
What embryonic structure are abdominal muscles derived from?
Hypomere
What makes up the conjoint tendon (falx inguinalis)? Where are they attached?
The fusion of the lowermost fibers of internal oblique with the deeper fibers of transversus abdominis muscle arching over spermatic cord (or round ligament of the uterus) to attach to pubic crest and pecten pubis
What happens in the case of a weak conjoint tendon?
What about in the patent remnant of processus vaginalis?
What about one that pierces through the deep inguinal ring
Direct inguinal hernias
Indirect hernia
Indirect
What is Valsa’s maneuver?
Guarding is abdominal contraction due to palpation with cold hands (involuntary) or for protection (voluntary)
Rigidity is involuntary muscle spasms due to inflammatory irritation of abdominal muscle’s nerve supply (i.e., acute appendicitis)
What is in the inguinal canal? What is the difference between males and females?
Transmits thick spermatic cord in males and thin round ligament of the uterus in females
What are the boundaries of the inguinal canal?
Anterior wall — formed mainly by external oblique aponeurosis reinforced laterally by the internal oblique aponeurosis
Posterior wall — formed mainly by transversalis fascia reinforced medially by conjoint tendon
Roof — formed by arching fibers of internal oblique and transversus abdominis muscles
Floor — formed mainly by the inguinal ligament gutter
What are the two types of inguinal hernias? What are the differences? Which one is the most common?
Indirect – leaves abdominal cavity lateral to inferior epigastric artery. Commonly exits superficial inguinal ring to descend into scrotum or labium majus. It may be palpated at the superficial inguinal ring when asking patient to strain (with coughing)
Direct — leaves abdominal cavity medial to inferior epigastric artery. It pushes directly into the inguinal canal through or around a weak conjoint tendon, usually against inguinal (Hesselbach’s) triangle
Indirect is more common
What are the boundaries of the inguinal (Hesselbach’s) triangle?
Bound by inferior epigastric artery laterally, rectus abdominis medially, and inguinal ligament inferiorly
What is incisional hernia?
Protrusions of omentum or organs through the sites of surgical incisions, this may result from improper healing of abdominal wall following surgery or from weakness of the abdominal wall muscles following the cutting of their motor innervation
What are intraperitoneal organs?
Intraperitoneal — abdominal organs invaginate peritoneal sac from behind and suspends from the body wall by a double layer of peritoneum (mesentery)
What are retroperitoneal organs?
Retroperitoneal — abdominal organs are located posterior to peritoneum so that they only have anterior and lateral coverings
Which peritoneal ligament is a part of an momentum and which one is connected only to its adjacent organs?
Gastrosplenic ligament – connected to omentum
Splenorenal ligament – only connected to adjacent organs
Lowest part of pelvic cavity in standing position where abdominal fluids or blood from male/female genital organs (e.g., uterine tube) may accumulate
Rectovesical pouch — males
Rectouterine (Douglas) pouch — females
What causes peritonitis? How can it become life-threatening?
Peritoneal inflammation due to chemical irritation or bacterial, or fungal infections
Life-threatening condition — due to the large surface area of peritoneum and rapid absorption of bacterial toxins
Lowest part of abdominal peritoneal cavity in supine position between right lobe of the left and right kidney; infected fluid can freely enter this space from omental bursa or subphrenic recess (between liver and diaphragm)
Hepatorenal recess — Morison’s pouch/recess
How is bacterial peritonitis treated?
In bacterial peritonitis, patient is propped in a seated position (>45°) in order to force infected fluid to flow downward into pelvic cavity where absorption is slower and to reduce spreading of infection to pleura through diaphragm from subphrenic space
What are Peritoneal adhesions?
Tough fibrous tissue bridges, which may complicate peritonitis of any reason and can be the source of chronic abdominal pain and/or bowel or uterine tube obstruction and infertility
What is GERD? What can it lead to?
Incompetent gastroesophageal junction may cause gastric acids to regurgitate to lower esophagus. It can lead to Barret’s esophagus where esophageal epithelium undergoes metaplastic change (stratified squamous epithelium is reversible replaced by columnar), prone to ulceration and stricture, causing dysphagia — may progress to esophageal cancer