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RC Test 3 > Anatomy > Flashcards

Anatomy Flashcards

1
Q

trans umbilical plane

A

passes through umbilicus at intervertebral disk between L3 and L4

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2
Q

RUQ contents

A 
right lobe of liver
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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3
Q

LUQ contents

A 
left lobe of liver
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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4
Q

RLQ content

A 
cecum
vermiform appendix
most of ileum
ascending colon: inferior part
right ovary
right uterine tube
right ureter: abdominal part
right spermatic cord: ab part
uterus
urinary bladder if full
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5
Q

LLQ content

A 
sigmoid colon
descending colon: inferior part
left ovary
left uterine tube
left ureter: ab part
left spermatic cord: ab part
uterus
urinary bladder if full
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6
Q

RUQ abdominal pain ddx

A 
dissecting aneurysm
gallbladder disease
hepatitis
hepatomegaly
pancreatitis
peptic ulcer disease
pyelonephritis
kidney stones
renal infarct
appendicitis
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7
Q

LUQ abdominal pain ddx

A 
dissecting aneurysm
esophagitis
hiatal hernia
esophageal rupture
gastritis
pancreatitis
peptic ulcer disease
pyelonephritis
kidney stones
renal infarct
splenic abscess
splenic rupture
splenic infarction
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8
Q

RLQ pain ddx

A

appendicitis
cholecystitis
crohns
kidney stones

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9
Q

LLQ pain ddx

A 
diverticulitis
IBS
lactose intolerance
celiac
kidney stones
constipation
crohns
ulcerative colitis
intestinal obstruction
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10
Q

lower abdomen pain ddx

A 
aortic aneurysm
colitis including IBS
diverticulitis
intestinal obstruction
perforated viscus
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11
Q

epigastric region

A

foregut organs

above L1

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12
Q

paraumbilical region

A

midgut organs

L1-umbilicus

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13
Q

suprapubic region

A

hindgut organs

below umbilicus

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14
Q

how many layers are in the anterior abdominal wall

A

7-9 layers

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15
Q

list layers of anterior abdominal wall from outside to inside

A 
skin
superficial fascia (Campers in superior region, Campers and Scarpa in inferior)
deep fascia (epimysium)
muscle (0,1, or 3)
transversalis fascia
extraperitoneal fat
parietal peritoneum
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16
Q

where is scarpas fascia located

A

only below umbilicus
superiorly attaches to rectus / external oblique epimysium
may retain fluid underneath due to straddle injury

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17
Q

what is diastasis recti

A

abdominal separation

gap of roughly 2.7 cm or greater between the sides of the rectus abdominus muscle

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18
Q

who gets diastasis recti

A

newborns and pregnant women

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19
Q

4 variations of diastasis recti

A

open (split vertically)
open below navel
open above navel
completely open (split vertically and horizontally)

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20
Q

how many layers are in the wall of the linea alba

A 
6
skin
superficial (Camper) fascia
linea alba
transversalis fascia
extraperitoneal fat
parietal peritoneum
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21
Q

how many layers are in the wall of the rectus abdominis above the umbilicus

A 
8
skin
superficial (Camper) fascia
anterior rectus sheath
rectus abdominis muscle
posterior rectus sheath
transversalis fascia
extraperitoneal fat
parietal peritoneum
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22
Q

how many layers are in the wall of the rectus abdominis below the umbilicus

A 
7
skin
superficial fascia (Camper and Scarpa)
anterior rectus sheath
rectus abdominis muscle
transversalis fascia
extraperitoneal fat
parietal peritoneum
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23
Q

how many layers are in the wall lateral to the rectus abdominis

A 
8
skin
superficial (Camper) fascia
external oblique muscle
internal oblique muscle
transversus abdominis muscle
transversalis fascia
extraperitoneal fat
parietal paeritoneum
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24
Q

where is the inguinal canal

A

above inguinal ligament

formed by descending of testis or round ligament of uterus

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25
Q

describe the movement of the testis

A

was located inside abdominal cavity between parietal peritoneum and transversalis fascia
retroperitoneal
transversed obliquely during embryogenesis through the layers of anterolateral abdominal wall just above inguinal ligament

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26
Q

contents of male inguinal canal

A

spermatic cord- ductus deferens, testicular artery and vein

go into scrotum

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27
Q

contents of female inguinal canal

A

round ligament of uterus

attaches to subcutaneous tissue of labium majus

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28
Q

what is an abdominal hernia

A

protrusion of parietal peritoneum and/or abdominal viscera (small intestine) through a normal or abnormal opening from the cavity

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29
Q

what % of abdominal hernias are inguinal

A

80-90%

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30
Q

what determines if emergency treatment is required for a hernia

A

if it is strangulated

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31
Q

direct (acquired) inguinal hernia

A

herniating bowel passes medial to inferior epigastric vessels
pushes through peritoneum and transversalis fascia in inguinal triangle
enters inguinal canal

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32
Q

indirect inguinal hernia

A

herniating bowel passes lateral to inferior epigastric vessels to enter deep inguinal ring

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33
Q

predisposing factor for direct inguinal hernia

A

weakness of anterior abdominal wall in inguinal triangle

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34
Q

frequency of direct inguinal hernia

A

less common
1/3 to 1/4
older men

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35
Q

layers that exit from abdominal cavity in direct inguinal hernia

A

peritoneum plus transversalis fascia

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36
Q

course of direct inguinal hernia

A

through or around inguinal canal, usually transversing only medial third of canal, external and parallel to vestige of processus vaginalis

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37
Q

direct inguinal hernia exit from anterior abdominal wall

A

via superficial ring
lateral to cord
rarely enters scrotum

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38
Q

predisposing factor for indirect inguinal hernia

A

patency of processus vaginalis in younger persons

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39
Q

frequency of indirect inguinal hernia

A

2/3 to 3/4

common in newborns

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40
Q

layers that exit from abdominal cavity in indirect inguinal hernia

A

peritoneum of persistent processus vaginalis plus all 3 fascial coverings of cord/round ligament

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41
Q

course of indirect inguinal hernia

A

transverses inguinal canal (entire canal if sufficient in size) within processus vaginalis

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42
Q

indirect inguinal hernia exit from anterior abdominal wall

A

via superficial ring inside cord

commonly passes into scrotum/labium majus

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43
Q

umbilical abdominal hernia

A

around umbilicus

common in newborns

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44
Q

epigastric abdominal hernia

A

midline along linea alba above umbilicus

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45
Q

semilunar abdominal hernia

A

along semilunar line

where external transverse connect to rectus abdominis

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46
Q

diaphragmatic abdominal hernia

A

typically posterior and left sided

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47
Q

sex differences in groin hernias

A

men 8x more likely to get one and 20x more likely to need a repair
lifetime risk is 25% in men and 5% in women
women median age 60-79
men median age 50-69

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48
Q

what is the etiology of caput medusa

A

superficial veins anastomose with deep veins

when deep veins are blocked superficial veins are enlarged

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49
Q

when do you see caput medusa

A

hepatic portal vein hypertension or obstruction
causes embryonic umbilical vein to reopen and carry blood away from the liver onto the anterior abdominal wall veins (superior and inferior epigastric veins)

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50
Q

why do you get hypothesia instead of anesthesia when a dermatome isn’t working

A

segments overlap with one another

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51
Q

xiphoid process dermatome

A

T7

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52
Q

umbilicus dermatome

A

T10

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53
Q

inguinal ligament dermatome

A

L1

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54
Q

common abdominal surgical incisions

A 
anterior subcostal
upper midline laparotomy (stomach, pancreas)
periumbilical midline laparotomy
pararectal incision (sigmoid colon)
lower midline laparotomy
mcburnery (appendix)
inguinal incision (inguinal canal)
pfannenstiel incision (pelvic organs)
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55
Q

what is the peritoneum

A

transparent serous membrane that lines the abdominopelvic cavity and wraps around the organs

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56
Q

2 peritoneum layers

A

parietal- lines internal surface of the walls of the cavity

visceral- wraps around organs

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57
Q

parietal peritoneum pain sensation

A

served by same blood and lymphatic vessels and nerves in the region that it is adjacent to
sensitive to all general somatic sensations
pain well localized

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58
Q

visceral peritoneum pain sensation

A

served by the same blood and lymphatic vessels and nerves as the organ it covers
not sensitive to general sensations
sensitive to stretch and chemical irritation
pain poorly localized, may be referred to surface

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59
Q

cell type in the peritoneum

A

simple squamous epithelial cells

mesothelium

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60
Q

intraperitoneal organs

A

completely covered by peritoneum and has a mesentary

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61
Q

retroperitoneal organs

A

partially covered by peritoneum

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62
Q

mesentary

A

2 layers of peritoneum adhere together connecting intraperitoneal organs to abdominal wall

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63
Q

why is the female peritoneum not closed

A

opens through uterine tubes, uterus, and vagina

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64
Q

greater omentum

A

starts from greater curvature of the stomach and proximal duodenum
drapes down like an apron and folds back upwards to attach to transverse colon

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65
Q

lesser omentum

A

connects lesser curvature of stomach and duodenum to liver

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66
Q

function of greater omentum

A

prevents visceral peritoneum adherence to parietal peritoneum
stores excess calories
cushions abdominal organs
insulates against heat loss
adheres to inflamed organs to localize infection
can herniate

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67
Q

what are peritoneal ligaments

A

double layer peritoneum that connects ne organ with another organ or to the peritoneal wall

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68
Q

peritoneal folds

A

reflection of peritoneum raised from the internal abdominal wall by underlying structures (usually blood vessels and ducts)

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69
Q

peritoneal lesser sac

A

space posterior to lesser omentum and stomach

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70
Q

peritoneal greater sac

A

main and larger part of peritoneal cavity

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71
Q

2 compartments of greater sac

A

supracolic

infracolic

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72
Q

supracolic compartment of greater sac

A

above transverse colon, including stomach, liver and spleen

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73
Q

infracolic compartment of greater sac

A

below transverse colon, including small intestine, ascending and descending colon

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74
Q

typical peritoneal fluid volume

A

20 ml

increases to 50 ml during ovulation

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75
Q

typical peritoneal fluid color

A

clear and/or slightly yellowish

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76
Q

cloudy, turbid peritoneal fluid

A

infection

77
Q

milky peritoneal fluid

A

inflammatory condition

peritonitis, pancreatitis, appendicitis

78
Q

red peritoneal fluid

A

traumatic tap or malignancy

79
Q

green peritoneal fluid

A

ruptured gall bladder, pancreatitis, or intestinal perf

80
Q

what is peritonitis

A

infection and inflammation of peritoneum

81
Q

etiology of peritonitis

A

traumatic penetration or rupture of abdominopelvic organs
gas, fecal matter, bacteria enters peritoneal cavity
exudation of serum, fibrin, cells, pus into cavity

82
Q

symptoms of peritonitis

A

pain, fever, gas under diaphragm when standing, paralyzed bowel movement, ab wall guarding

83
Q

what is ascites

A

excess fluid accumulation in peritoneal cavity
several liters of fluid
resp and bowel movements can be affected

84
Q

etiology of ascites

A

internal bleeding, portal hypertension, cancer metastasis, starvation

85
Q

starvation ascites in children

A

Kwashiorkor
severe malnutrition caused by deficiency in dietary protein
lack of protein causes osmotic imbalance in GI and causes swelling of the gut

86
Q

abdominal paracentesis

A

surgical puncture of the peritoneal cavity for the aspiration and drainage of fluid
typically for diagnostics
therapeutic to reduce intra-abdominal pressure

87
Q

intraperitoneal injection

A

peritoneum is semipermeable and lies over blood vessels and lymphatic ducts
fluid injected into peritoneal cavity is absorbed rapidly
some ovarian cancer treatments involve this type of admin

88
Q

peritoneal dialysis

A

helps renal failure patients

89
Q

what are peritoneal adhesions

A

healing from infection, inflamm, or surgery causes fibrous tissue to form between visceral peritoneum or between visceral and parietal peritoneum

90
Q

result of peritoneal adhesions

A

limit normal movement of viscera causing ab pain, gut twisting, or volvulus

91
Q

treatment for severe peritoneal adhesions

A

surgical separation of adhesions

92
Q

overview of GI tract

A

mouth > pharynx > esophagus > stomach > small intestine (duodenum, jejunum, ileum) > large intestine (cecum, ascending, transverse, descending, sigmoid, rectum) > anal canal

93
Q

organs associated with GI tract

A

liver, gallbladder, pancreas, spleen, kidneys, adrenals

94
Q

what is the significance of the primitive GI tract separations

A

each region gives rise to organs that share the same primary blood supple, nerve innervation, and lymphatic drainage route

95
Q

foregut organs

A 
mouth
pharynx
esophagus
stomach
superior half of duodenum
96
Q

midgut organs

A 
inferior half of duodenum
jejunum
ileum
cecum
appendix
ascending colon
right 2/3 of transverse colon
97
Q

hindgut organs

A

left 1/3 of transverse colon
descending colon
sigmoid colon
rectum

98
Q

3 constrictions of esophagus

A

cervical- junction w pharynx
thoracic- crossing w aortic arch/ L main bronchus
diaphragmatic- junction with stomach

99
Q

muscle makeup of esophagus

A

internal circular and external longitudinal muscles
superior 1/3 = voluntary striated
mid 1/3 = mix of smooth and striated
inferior 1/3 = all smooth muscle

100
Q

another name for pyrosis

A

heartburn

101
Q

etiology of pyrosis

A

regurgitation of small amounts of food or gastric fluid into lower esophagus

102
Q

common perception of pyrosis

A

chest pain

103
Q

describe the venous drainage of the lower esophagus

A

dual venous drainages- to systemic veins via azygous vein system and to the liver via portal vein

104
Q

etiology of esophageal varices

A

during portal hypertension, most venous blood flows through lower esophageal region toward azygous veins causing varices

105
Q

outcome of esophageal varices

A

can be ruptured by food resulting in extensive internal bleeding into stomach
may vomit fresh blood (not exposed to stomach acid)

106
Q

what is Zenker diverticulum

A

a posterior evagination off the upper portion of the esophagus just below the lower pharynx

107
Q

symptoms of zenker diverticulum

A 
often asymptomatic
found in older adults
dysphasia/ lump in throat
food trapped in outpouching, leading to:
-regurgitation
-cough
-halitosis
-infection
108
Q

stomach cardia

A

part surrounding the cardial orifice (connection w esophagus)

109
Q

fundus of stomach

A

dilated superior part, reaches left 5th intercostal

110
Q

body of stomach

A

major part between fundus and pyloric antrum

111
Q

pyloric part of stomach

A

pyloric antrum
pyloric canal
pylorus (sphincter)
pyloric orifice

112
Q

gastric rugae

A

gastric folds

longitudinal ridges of gastric mucosa on the interior of the stomach

113
Q

3 nonpaired arteries to the abdomen

A
  1. celiac trunk/axis
  2. superior mesenteric artery (SMA)
  3. inferior mesenteric artery (IMA)
114
Q

what arteries come off the celiac trunk to the stomach?

A 
celiac trunk at T12
-left gastric (left lesser curvature)
splenic artery:
-left gastro-omental (left greater curvature)
-short gastric (fundus)
common hepatic artery:
-right gastric (right lesser curvature)
-right gastro-omental (right greater curvature)
115
Q

where do veins of stomach drain to

A

hepatic portal vein

116
Q

where do lymph nodes of stomach drain to

A

celiac lymph nodes

117
Q

what is a hiatal hernia

A

protrusion of part of the stomach into the mediastinum through esophageal hiatus

118
Q

two types of hiatal hernia

A

sliding (95%)

paraesophageal (5%)

119
Q

sliding hiatal hernia

A

abdominal portion of esophagus + cardia + part of fundus all herniated
regurg possible

120
Q

paraesophageal hiatal hernia

A

cardia remains in normal position
part of fundus herniated
usually no regurg

121
Q

congenital diaphragmatic hernia

A

1/2200 newborns
poor development of diaphragm
may have pulmonary hypoplasia
high mortality

122
Q

incidence of hiatal hernias

A

increases w age
60% of people aged 50 or older
9% are symptomatic

123
Q

symptoms of hiatal hernia

A

heartburn
difficulty swallowing
nausea, vomiting
usually worse after meals or when laying flat

124
Q

pylorospasm

A

spasmodic contraction of pylorus

food stays in stomach, resulting in overfilling and vomiting

125
Q

congenital hypertrophic pyloric stenosis

A

1/150 males

1/750 femals

126
Q

carcinoma of stomach

A

most common in body or pyloric part of stomach

associated with feeling full and vomiting

127
Q

gastric ulcer

A

an open lesion of stomach mucosa, associated with infections of H.pylori
ulcer erodes arteries, causes bleeding and can cause wall perforation

128
Q

referred pain from stomach

A

epigastric region pain
afferent fibers from stomach and 1st part of duodenum, via splanchnic nerve, go to T7-T8 level
dermatome sensation from T7, T8

129
Q

4 parts of duodenum

A

superior- L1
descending - L2
horizontal- L3
ascending- L3-L2

130
Q

overview of duodenum

A

25 cm
retroperitoneal
C-shaped around head of pancreas

131
Q

what is inside the lumen of the duodenum

A

plicae circularies
major duodenal papilla
minor duodenal papilla

132
Q

what significant structure enters the posteromedial wall of the duodenum

A 
hepatopancreatic ampulla (common bile duct + pancreatic duct coming together)
ampulla surrounded by the hepatopancreatic sphincter (smooth muscle)
133
Q

what arteries supply the duodenum from the celiac trunk?

A

common hepatic > gastroduodenal, which branches into:

  • supraduodental artery
  • posterior superior pancreaticoduodenal
  • anterior superior pancreaticoduodenal
134
Q

what arteries supply the duodenum from the superior mesenteric artery?

A
  • posterior inferior pancreaticoduodenal

- anterior inferior pancreaticoduodenal

135
Q

where do duodenal veins drain?

A

hepatic portal vein

136
Q

what is a duodenal/peptic ulcer?

A

inflammatory erosion of duodenal mucosa
can cause inflammatory adhesion to surrounding organs
perforations cause peritonitis

137
Q

where do peptic ulcers occur?

A

65% occur on the posterior wall of the 1st part within 3 cm of the pylorus

138
Q

what is a significant symptom of peptic ulcers?

A

erosion to gastroduodenal artery causes severe bleeding into duodenum, retroperitoneum, or lesser sac of peritoneal cavity

139
Q

referred pain of duodenum

A

lower epigastric region and occasionally umbilical

if irritates the diaphragm, upper right shoulder

140
Q

jejunum

A

2/5 small intestine

mostly in LUQ or around umbilicus

141
Q

ileum

A

3/5 small intestine

mostly in RLG or inguinal region

142
Q

what is the mesentery

A

fan shaped peritoneal fold that attaches jejunum and ileum to the posterior abdominal wall

143
Q

what are 3 differentiating factors between jejunum and ileum

A

wall thickness
vascular supply pattern
plicae circulares

144
Q

jejunum wall

A

thick and heavy

145
Q

ileum wall

A

thin and light

146
Q

jejunum vascular supply

A

long vasa recta with a few large loops

147
Q

ileum vascular supply

A

short vasa recta with many short loops

148
Q

jejunum circular folds (plicae circulares)

A

large, tall, closely packed

149
Q

ileum circular folds (plicae circulares)

A

low and sparse, absent in distal parts

150
Q

peyers patches in jejunum vs ileum

A

few in jejunum

many in ileum

151
Q

bloody supply to jejunum and ileum

A

superior mesenteric artery gives of to the left 15-18 branches of mesenteric arteries to both jejunum and ileum
SMV collects blood to hepatic portal vein

152
Q

ileal (meckels) diverticulum

A

most common congenital anomaly of the gut due to a remnant vitelline duct
contains 2 ectopic tissues- stomach mucosa and pancreatic
on opposite side of the mesentery

153
Q

ileal (meckels) diverticulum rule of 2s

A

2% of the population
2” long
2 ft from ileocecal junction

154
Q

symptoms of ileal (meckels) diverticulum

A

bleeding (consider for lower GI bleeding in children < 2)
GI track obstruction
when inflamed, pain mimics appendicitis

155
Q

ileus

A

small bowel motility disorders that mimic obstruction (no mechanical obstruction)

156
Q

paralytic ileus

A

paralysis of small bowel movement mostly due to surgery
stagnations = no peristalsis
ab distention, nausea, malaise
can be from unknown causes such as systemic illnesses

157
Q

intussesception

A

part of intestine has invaginated into another section
happens in kids under 5
result in obstruction
diagnose w ultrasound (bulls eye)
can cut off blood supply and cause tissue of wall to die

158
Q

symptoms of intussesception

A 
sudden pain that comes and goes every 20 min
vomiting
stool w blood and mucus
nausea
cramping pain
159
Q

treatment of intussesception

A

barium or air enema
laparotomy
surgery

160
Q

small intesting referred pain

A

T10 periumbilical

161
Q

unique anatomical characteristics of large intestine (OETHS)

A

omental (epiploic) appendices - small fatty omentum like projections
taenia coli- 3 longitudinal muscle bands, not present in the appendix and rectum
haustra- saccular protrustion between transverse folds
semilunar folds- separate haustra on interior

162
Q

cecum

A

blind pouch
RLQ
intraperitoneal, no mesentery
orifice for appendix

163
Q

vermiform appendix

A

blind intestinal diverticulum off of cecum
6-10 cm long, contains lymphoid tissue
has its own mesentery

164
Q

epidemiology of appendicitis

A

common in young people
300,000 cases/year
most common cause of acute ab pain requiring surgery

165
Q

pain associated with appendicitis

A

vague pain around umbilicus (T10)
may transfer to RLQ with time to “mcburneys point” due to direct inflammation of parietal wall of the anterior wall peritoneum

166
Q

rupture of appendix

A

peritonitis
ab rigidity
nausea
vomiting

167
Q

mcburneys point

A

right side of abdomen

1/3 distance from anterior superior ileac spine to umbilicus

168
Q

appendix function

A

trap for heavy particles that are ingested

169
Q

peritoneal status of colon sections

A 
cecum- intra
ascending- retro
transverse- inta
descending- retro
sigmoid- intra
rectum/anal canal- retro
ALTERNATE
transverse and sigmoid have their own mesenteries
170
Q

volvulus

A

a loop of bowel and mesentery abnormally twisted on itself

cause obstruction and vascular ischemia

171
Q

volvulus epidemiology

A

occurs most frequently in middle aged and elderly men

2-3/100,000 people per year

172
Q

most common volvulus

A

sigmoid volvulus most common (8% of all intestinal obstructions)
cecum second

173
Q

treatment for sigmoid volvulus

A

sigmoidoscopy

barium enema

174
Q

perianal abscess

A

pus accumulation in the ischioanal fossa

175
Q

cryptitis

A

inflammation of anal sinuses

176
Q

anal fissure

A

slit like lesion
12 o clock below anal valves
once one develops, internal anal sphincter goes into spasm, causing further separation of the tear constricting blood flow in the area, impairing healing, and causing pain

177
Q

anal fistula

A

channel connects anal canal and perianal abscess

178
Q

hemorrhoids

A

4-5% of the population with peal incidence from 45-65 yo
internal - above pectinate line (painless)
external - below pectinate line (painful)

179
Q

diverticulosis

A 
external evagination (out pocketing) of colon mucosa
mostly in middle aged or elderly
age dependent prevalence
85% in sigmoid colon
infection and rupture can happen
180
Q

colectomy

A

removal of ileum, colon, rectum, and anal canal

181
Q

ileostomy

A

establish an opening between the ileum and the skin

182
Q

colostomy

A

establish an opening between the colon and the skin

183
Q

sigmoidostomy

A

establish an opening from the sigmoid to the skin

184
Q

colonoscopy

A

endoscopic exam of large bowel and distal part of small intestine with a CCD camera
visual diagnosis of ulceration and polyps
biopsy/removal of suspected colorectal cancer lesions

185
Q

colonoscopy complications

A

1/200 have a serious complication
1/2000 perforations
2.6/1000 bleeding
3/100000 death

186
Q

causes of upper GI bleeding

A

esophageal varices

gastric or duodenal ulcer

187
Q

causes of lower GI bleeding

A 
meckels diverticulum
crohns
colonic diverticulum
colorectal cancer
hemorrhoid
anal fissure
arteriovenous malformation
188
Q

stats of lower GI bleeding causes

A

40% diverticuli
21% IBS
10-15% cancer, coagulopathy, anal disease
2% arteriovenous malformation

RC Test 3 (22 decks)

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