Anatomy Flashcards
What are the contents of the inguinal ligament
round ligament ilioinguinal nerve genital branch of the genitofemoral nerve
What is the origin and insertion of the inguinal ligament
ASIS to pubic tubercle
Where is the anatomical landmark for the deep inguinal ring
halfway between ASIS and pubic tubercle
Where is the anatomical landmark for the superficial inguinal ring
superior to the pubic tubercle
What are the groin contents
lateral to medial Femoral.. Nerve Artery Vein Empty space Lymphatics
Greater omentum borders
greater curvature of the stomach transverse mesocolon - hepatic and splenic flexure
Where does the ilioinguinal nerve arise from?
L1
Where does the genitofemoral nerve arise from?
L1-2
Boundaries of the femoral triangle
Superior border – Formed by the inguinal ligament, a ligament that runs from the anterior superior iliac spine to the pubic tubercle. Lateral border – Formed by the medial border of the sartorius muscle. Medial border – Formed by the medial border of the adductor longus muscle. The rest of this muscle forms part of the floor of the triangle. It also has a floor and a roof: Anteriorly, the roof of the femoral triangle is formed by the fascia lata. Posteriorly, the base of the femoral triangle is formed by the pectineus, iliopsoas and adductor longus muscles.
Contents of the femoral triangle
Femoral sheath with: Femoral nerve Femoral artery Femoral vein - from which the great then Femoral canal Empty space Lymphatic nodes and vessels (Superficial inguinal LN)
Where does the femoral artery cross the inguinal ligament
The femoral artery crosses exactly midway between the pubic symphysis and anterior superior iliac spine (known as the mid-inguinal point).
What is a femoral hernia
In the case of femoral hernia, part of the bowel pushes into the femoral canal, underneath the inguinal ligament. This manifests clinically as a lump or bulge in the area of the femoral triangle. It usually requires surgical intervention to treat.
Where do you find the deep inguinal lymph nodes? Name of one?
under the inguinal ligament - the most superficial being Cloquet node
Branches of the abdominal aorta
the abdominal aorta has: 3 single anterior visceral branches (coeliac, superior mesenteric artery, inferior mesenteric artery) 3 paired lateral visceral branches (suprarenal, renal, gonadal) 5 paired lateral abdominal wall branches (inferior phrenic and four lumbar) 3 terminal branches (two common iliac arteries and the median sacral artery)
Where is the internal epigastric artery located?
The IEA can be 4 to 8 cm from midline regardless of body fat habitus or levels
Mnemonic for abdominal aorta
I - Inferior phrenic (parietal) Can - Coeliac Move - Middle suprarenal Somewhere - Superior mesenteric Really - Renal Lovely (and) - Lumbar x 4 pairs (parietal) Glorious - Gonadal In - Inferior mesenteric March - Median sacral (parietal) Terminal branches are the common iliacs
Path of the right renal artery
Runs behind the IVC
What is the median umbilical ligament
It is what the urachus becomes following birth. ligament from the apex of the bladder to the umbilicus
What is the medial umbilical ligament
Also called obliterated umbilical artery
Where is the arcuate line?
1/2 of the distance from the umbilicus to the pubic crest
What happens at the arcuate line?
It is the site of entry of the inferior epigastric artery in to the rectus sheath.
Also the site of weakness - spigelian hernia
What is the ileopubic tract
The ileopubic tract is a thickening of the transversalis fascia just behind the site of the inguinal ligament. it arches over the external iliac vessels. Important landmark in laparoscopic hernia repair.
Where would you find the deep inguinal ring?
The round ligament of the uterus enters the inguinal canal
When does the rectum become the anus
As it passes through the levator ani
Where do the cardinal ligaments originate and insert
From the cervix laterally to the pelvic side wall in the area of the obturator fascia.
What are the supporting structures of the bladder
Lateral ligament of the bladder - lateral bladder to the wall of the pelvic cavity. Contains neurovascular structures
Medial pubovesical liagment - from the neck of the bladder anteriorly to the arch of the pubis.
Median umbilical ligament - remnant of urachus. from top of bladder to the umbilicus
Medial umbilical liagment - obliterated umbilical artery. runs laterally along umbilical prevesical fascia
Umbilical prevesical fascia - from the MUL to the corresponding ligament on the other side.
Median sacral artery
Unpaired
Runs in the midline in the “presacral space” - between the presacral fascia and the rectal and rectosacral fascia
Also runs with a vein
Where does the external iliac artery run?
Arises from the Common iliac artery
Runs under the inguinal ligament and changes its name to the femoral artery here.
What is the deep circumflex iliac artery
It is the first branch of the external iliac artery
Arises just before the EIA runs under the inguinal ligament
Courses laterally and curves posteriorly to supply the ilium and iliacus muscles in the iliac fossa
Paired with deep circumflex iliac vein
What is the second branch of the External iliac artery
Inferior epigastric artery
What is the route of the inferior epigastric artery?
Arises from the external iliac artery (2nd branch) at roughly the same place as the circumflex iliac artery
It goes superomedially, anterior to the transverse fascia up towards the rectus abdominis.
Supplies the rectus abdominis muscle.
Gives off a small branch - called pubic branch of IEA which anastamoses with the obturator artery to supply the medial compartment of the thigh.
What are the branches of the Internal iliac artery?
1st - umbilical artery
2nd - obturator artery
3rd - uterine artery
4th - Middle rectal artery
What does the umbilical artery do?
What does the obturator artery do?
supplies the medial compartment of the thigh
Passes though the obturator canal
(the pubic branch of the inferior epigastic artery can anastamose with it)
Where does the uterine artery travel?
Third branch of the Internal iliac artery
Runs in the cardinal ligament and divides to supply the upper reproductive tract.
Where does the middle rectal artery run?
4th branch of the IIA
Runs inferiorly to reach the middle third of the rectum and anastomoses with the superior and inferior rectal arteries.
Where does the ovarian artery originate and run?
Originates at the level of L2 from the aorta
Travels through the ovarian ligament or the infundibulopelvic ligament to the ovaries and tubes.
Crosses over the external iliac artery
Where is the deep dorsal vein of the clitoris?
Anterior to the bladder to drain the blood from the clitoris
Why is the inferior epigastic artery a defining landmark
It is the defining border before a direct and indirect inguinal hernia.
If hernia is lateral to the IEA - indirect hernia
If hernia is medial to the IEA - direct hernia
What triangle does a direct inguinal hernia travel through and what are its boundaries?
Hesselbach’s triangle
Lateral: Inferior epigastic artery
Medial: lateral border of abdominis rectus muscle
Inferior: inguinal ligament
Greater Omentum - functions
- Fat deposition
- Helps fight infections
- Helps limit spread of infections
What is the blood supply to the greater omentum?
Right and left gastroepiploic arteries
These anastamose with each other when the run along the greater curvature of the stomach
What is the venous drainage of the greater omentum?
Mimics the arterial supply
Drains in the gastroepiploic veins
What are the lobes of the liver?
Right lobe
Left lobe
Caudate lobe
Quadrate lobe
What are the ligaments associated with the liver?
Falciform ligament
Ligamentum teres (round ligament of the liver)
What does the falciform ligament do?
Separates the right and left lobe of the liver and connects the liver to the anterior abdominal wall
Where did ligamentum teres come from?
also known as the round ligament of the liver
remnant of the fetal left umbilical vein
What is the transition point from the ascending colon to the transverse colon called?
Right colic flexure
What is the blood supply to the transverse colon
Middle colic artery and vein
From the super mesenteric artery and vein
What is the name of where the transverse colon becomes the descending colon?
Splenic flexure or left colic flexure
What are the components of the large bowel?
caecum
ascending colon
transverse colon
descending colon
sigmoid colon
What are the components of the small bowel?
Duodenum
Jejunum
Ileum
What is the name of the portion of the bowel where the ileum meets the caecum
ileocaecal junction
Lesser Omentum - what are the boundaries
Lesser curvature of the stomach
to the liver
What has a mesentery?
Mesentary proper:
The jejunum and the ileum.
Arises where the duodenum meets the jejunum and terminates at the ileocaecal junction
Transverse mesocolon: for transverse colon
Sigmoid mesocolon: for sigmoid colon
Mesoappendix: mesentary for vermiform appendix
What is contained in the mesentery proper?
Blood vessels
Nerves
Lymphatics
(for the jejunum and the ileum)
Where do you find the apex of the sigmoid mesocolon?
Where the left common iliac artery branches in to the external/internal iliac
Where does the inferior epigastric vein come from and go to?
Arises from the superior epigastric vein and drains in to the external iliac vein
Where does the lymph from the jejunum and ileum drain?
In to the superior mesenteric nodes
What are the features of the large intestine?
Teniae coli - three thickened bands of longitudinal muscle
Haustra - sacculations of the colon
Omental appendages or epiploic appendages
What are the boundaries of the lesser sac
inferiorly: transverse mesocolon greater omentum.
superiorly: liver and diaphragm
anteriorly: lesser omentum
posteriorly: posterior abdominal wall and its organs
What is the most superior portion of the lesser sac called?
The superior recess of the omental bursa
Where does the lesser omentum arise and attach
Inferior border of the liver and lesser curvature of the stomach
Where does the lesser and greater sac communicate?
Through the omental foramen - a small opening posterior to the hepatic portal vein, the hepatic arteries and the cystic duct.
How many parts of the duodenum are there and what are they called?
- Superior
- Descending
- Horizontal
- Ascending
Is the duodenum intra- or retro- peritoneal?
First portion (superior) is intraperitoneal and the other three are retroperitoneal
Middle colic artery - arises from? located?
Arises from the superior mesenteric artery
located in the transverse mesocolon in the mid-saggital plane
Is the pancreas intra- or retro- peritoneal?
The pancreas is retroperitoneal except for its tail which is intraperitoneal
What does the coeliac trunk branch in to?
three branches:
- Left gastric artery (stomach)
- Common hepatic artery (liver)
- Splenic artery (spleen)
What does the splenic artery supply blood to?
Spleen and pancreas
What does the common hepatic artery supply blood to?
liver
pylorus of the stomach
duodenum
pancreas
gallbladder.
Is the IVC RP or IP
retroperitoneal
Are the ureters and
adrenals
intraperitoneal or retroperitoneal?
retroperitoneal
What is different about where the gonadal vessels run?
The left gonadal vein drains into the left renal vein. the right gonadal vein drains directly into the inferior vena cava.
What is the space between the diaphragm and the liver called?
Subphrenic recess
What is the opening between the greater and lesser sac called?
Omental foramen
Foramen of winslow
Epiploic foramen
What is the join between the stomach and the greater omentum called?
Gastrocolic ligament
What does the gastrosplenic ligament connect and contain?
Stomach and spleen (left border of the omentum).
Contains short gastric
vessels and the left gastroepiploic vessels.
What is the Hepatoduodenal ligament
a portion of the lesser omentum that folds around the portal triad and connects the liver to the duodenum
What is the portal triad
Proper hepatic artery
the portal vein
the common bile duct
What is directly under the hepatoduodenal ligament?
The omental foramen
What level does does the aorta bifurcate?
At L4/L5, the aorta will split into the common iliac artery.
Branches of the internal iliac artery (with memory aid!)
I love going places in my very own underwear!
Posterior:
I: iliolumbar artery
L: lateral sacral artery
G: gluteal (superior and inferior) arteries
Anterior:
P: (internal) pudendal artery
I: inferior vesical (vaginal in females) artery, and superior vesical artery
M: middle rectal artery
V: vaginal artery
O: obturator artery
U: umbilical artery and uterine artery
Branches of the posterior internal iliac artery and what they do, where they go
- Iliolumbar A: wraps back up off the posterior division, to bring blood supply to the iliacus, psoas, quadrates lumbormum muscles.
- Lateral Sacral :descends down the lateral side of the sacrum into sacral foramina
- Superior Gluteal Artery: blood supply to the gluteal muscles (gluteus medium and minimum). Exits the pelvis via the greater sciatic foramen, ABOVE the piriformis
Branches of the anterior internal artery and what they do, where they go
- The Umbilical artery: was attached to the umbilicus.. in the adult the artery becomes obliterated so that there is no longer blood coming to the artery. HOWEVER, there are arteries that branch off of the umbilical artery in the portion where it is not obliterated:
- Superior vesicle arteries: come to the superior portion of the bladder - Obturator Artery: comes out of the pelvis through the obturator foramen to give blood supply to the medial thigh.
- Middle Rectal Artery: going towards the rectum (nothing else is going towards the rectum from the anterior division)
- Inferior Gluteal A: exits the greater sciatic foramen BELOW the piriformis to bring blood supply to the gluteus maximus
- Internal Pudendal Artery: exits the greater sciatic foramen BELOW the piriformis. To differentiate this from the inferior gluteal, you know that the pudendal artery will exit closer to the later side of the pelvis because it needs to wrap around the spinous process and com back through the lesser sciatic foramina to go to the external genitalia.
Where does the ovarian artery originate?
Origin. The ovarian artery arises anterolaterally from the aorta just inferior to the renal arteries and superior to the inferior mesenteric artery (between L2 and L3).
At what level does the do the common iliacs bifurcate?
Sacral promontory
What does the ureter do at the level of the bifurcation of the common iliac arteries?
crosses it, from lateral to medial.
