Anatomy Abdomen Flashcards
1
Q
Calot’s triangle borders
A
superior: inferior border of liver
medial: common hepatic duct
lateral: cystic duct
located at the porta hepatis of liver
2
Q
Calot’s triangle contents
A
cystic artery, right hepatic artery, Lund’s lymph node
3
Q
inguinal (Hesselbach) triangle borders
A
inferior: inguinal ligament
medial: lateral border of rectus abdominis muscle
lateral: inferior epigastric vessels
4
Q
inguinal Hesselbach triangle relevance
A
no structures within it
demarcates area of weakness through which direct hernia occurs and enters inguinal canal
5
Q
difference between direct and indirect inguinal hernias
A
DIRECT: protrudes through inguinal triangle, can exit through superficial inguinal ring, origin medial to inferior epigastric vessels
INDIRECT: protrudes through deep inguinal ring and exits through superficial ring, origin lateral to inferior epigastric vessels
both can reach scrotum
6
Q
inferior epigastric vessels origin
A
external iliac artery and vein
7
Q
subdivisions of peritoneal cavity and what divides them
A
lesser sac (omental bursa): posterior to stomach and lesser omentum --> connected to greater sac via epiploic foramen of Winslow greater sac: divided into supracolic and infracolic compartments by transverse mesocolon (mesentery of transverse colon) infracolic : divided into right and left infracolic spaces by mesentery of small intestine supracolic and infracolic compartments are connected by right and left paracolic gutters (between posterolateral abdominal wall and lateral aspect of ascending or descending colon)
8
Q
location of epiploic foramen
A
posterior to hepatoduodenal ligament (free edge of lesser omentum)
9
Q
supracolic compartment contents
A
stomach, liver, spleen
10
Q
infracolic compartment contents
A
small intestine, ascending and descending colon
11
Q
subphrenic recesses
A
potential spaces in supracolic compartment, between diaphragm and liver
right and left spaces separated by falciform ligament of liver
12
Q
subphrenic abscesses
A
accumulation of pus in right or left subphrenic spaces, more common on right due to high frequency of appendicitis or ruptured duodenal ulcers
(pus reaches up to right subphrenic space through right paracolic gutter)
13
Q
differences between peritoneal cavity in pelvis of males vs females
A
males: rectovesical pouch
females: rectouterine pouch (Douglas) + vesicouterine pouch
14
Q
characteristic of lumbar vertbebrae
A
triangular vertebral foramen
largest in size to support weight
15
Q
length of esophagus
A
25 cm
16
Q
esophagus origin and end levels
A
cricoid cartilage inferior border C6 - cardiac orifice of stomach T11
17
Q
esophageal hiatus level
A
T10
18
Q
type of epithelium of esophageal muscosa
A
stratified squamous
19
Q
upper esophageal sphincter made of
A
cricopharyngeus muscle, constricts to prevent air into esophagus
20
Q
lower esophageal sphincter made of
A
no muscles, at gastro-esophageal junction to the left of T11, “physiological” sphincter (made of acute angle and compression of walls due to high intra abdominal pressure)
21
Q
4 physiological constrictions of esophagus
A
ABCD Aortic arch Bronchus (left) Cricoid cartilage Diaphragmatic hiatus
22
Q
esophagus blood supply
A
thoracic: thoracic aorta + inferior thyroid artery
abdominal: left gastric artery + left inferior phrenic arterty
23
Q
barret’s esophagus
A
long-standing GERD causes metaplasia of lower epithelium - squamous to columnar (like stomach)
24
Q
esophageal cancer types
A
squamous cell carcinoma, most common
adenocarcinoma, from Barret’s esophagus, only in inferior third of esophagus
present with dysphagia and weight loss
25
transpyloric plane level
L1, demarcated by pyloric sphincter
26
greater curvature of stomach start to end
starts at cardiac notch to reach pyloric antrum - lateral border of stomach
27
lesser curvature of stomach start to end
medial surface, starts at cardia to reach angular notch (junction between body and pylorus)
attached to hepatogastric ligament
28
Lesser omentum attachments
from stomach and duodenum to liver
29
Greater omentum attachments
from stomach to transverse colon
30
Stomach blood supply
anastomoses of right and left gastric arteries along lesser curvature
Anastomoses of right and left gastro omental arteries along greater curvature
31
sliding vs rolling hiatal hernia
sliding: lower esophageal sphincter slides up superiorly with part of cardia
rolling: sphincter stays in place while part of cardia slides up next to it
32
epiploic foramen contents
hepatoduodenal and hepatogastric ligaments
33
parts of duodenum
D1 superior: hepatoduodenal ligament - common for duodenal ulcers
D2 descending: curves around pancreatic head - posterior to transverse colon - major duodenal papilla (opening of ampulla of Vater)
D3 inferior: crosses over aorta and ICV but posterior to SMA and vein - inferior to pancreas
D4 ascending: duodejejunal flexure - at junction, suspensory muscle of duodenum (ligament of Treitz)
34
duodenal ulcer causes and complications
H. pylori, chronic NSAID
| perforation can cause peritonitis or erosion of gastroduodenal artery --> hypovolemic shock
35
differences between jejunum and ileum
jejunum has longer vasa recta and less arcades (arterial loops) - red color
ileum - pink color, short vasa recta, more arcades
36
duodenum blood supply
proximal to duodenal papilla D2: gastroduodenal artery
distal to D2: inferior pancreaticoduodenal artery
transition marks change from foregut to midgut
37
jejunoileum blood supply
SMA
38
ileocecal valve importance in large bowel obstruction
```
if competent (no backflow into ileum): closed loop obstruction (2 points obstructed) - emergency, perforation
if incompetent (backflow allowed): less emergent, decompresses the cecum
```
39
cecum blood supply
ileocolic artery (from SMA)
40
most common position of appendix
retrocecal
41
cecum and appendix embryologic origin
midgut
42
appendix blood supply
appendicular artery (from ileocolic or right colic artery)
43
right colic flexure at which organ
liver
44
left colic flexure at which organ
spleen
45
colon length
150 cm
46
large intestine features to distinguish it from small intestine
- omental appendices (small pouches of peritoneum filled with fat on surface)
- teniae coli (3 longitudinal strips of muscle)
- haustra
- wider diameter
- -> these features end at rectosigmoid junction
47
embryological origin of colon
midgut: ascending + 2/3 transverse
hindgut: 1/3 transverse + descending + sigmoid
48
colon blood supply
right colic - ascending
middle colic - transverse
left colic - descending
sigmoid arteries - sigmoid (from left colic)
49
which part of rectum relaxes to accumulate and store feces
ampulla - continuous with anal canal
50
rectum blood supply
superior rectal artery - terminal continuation of IMA
middle rectal artery - internal iliac artery
inferior rectal artery - internal pudendal artery
51
what is palpated with DRE
anterior wall of rectum is in direct contact with prostate and seminal vesicles / cervix
52
anal canal sphincters
internal: surrounds upper 2/3, involuntary smooth muscle
external: surrounds lower 2/3, voluntary muscle, continuous with puborectalis muscle
53
what is anorectal ring
fusion of internal and external anal sphincters and puborectalis muscle, at junction of rectum and anal canal
54
what is pectinate line
"dentate line"
| divides upper part of anal canal made of columnar epithelium from lower part made of stratified squamous epithelium
55
anal canal blood supply
above pectinate line: superior rectal artery
below pectinate line: inferior rectal artery
--> anastomosing branches from middle rectal artery supply both
56
location of liver
right hypochondrium
57
where is the bare area of the liver
posterior aspect of diaphragmatic surface, direct contact with diaphragm
not covered in any visceral peritoneum
58
at which level does the aorta bifurcate and into what
L4
| right and left common iliac arteries
59
level of aortic hiatus in diaphragm
T12
60
normal aorta diameter
less than 3 cm
61
branches of abdominal aorta
- inferior phrenic arteries
- celiac trunk at T12
- SMA at L1
- middle suprarenal arteries at L1 (adrenals)
- renal arteries between L1 and L2
- gonadal arteries at L2
- IMA at L3
- lumbar arteries from L1 to L4
- median sacral artery at L4 (coccyx, sacrum, lumbar vertebrae)
62
branches of celiac trunk
- left gastric
- splenic
- common hepatic
63
left gastric artery branches
esophageal branches
| continues to supply lesser curvature and anastomose with right gastric artery
64
splenic artery pathway + branches
posterior to stomach, along superior margin of pancreas, through splenorenal ligament
branches:
- left gastroepiploic (greater curvature, anastomoses with right)
- short gastrics (5-7 small branches supply fundus)
- pancreatic branches (body and tail of pancreas)
terminates into 5 branches that supply spleen
has tortuous appearance
65
common hepatic artery branches
* sole arterial supply of liver*
- proper hepatic
- gastroduodenal
proper hepatic:
- right gastric
- right and left hepatic (right hepatic give cystic)
gastroduodenal:
- right gastroepiploic
- superior pancreaticoduodenal (inferior from SMA)
66
which organ receives blood from the 3 branches of the celiac trunk
stomach
67
celiac trunk compression syndrome
median arcuate ligament (fibrous anchor of diaphragm that forms aortic hiatus) lies anterior to celiac trunk instead of superior --> compressing it
68
position of SMA related to pancreas
neck of pancreas is anterior to it
| uncinate process is posterior to it along with inferior duodenum
69
SMA branches
- inferior pancreaticoduodenal (pancreatic head, uncinate process, duodenum)
- jejunal and ileal
- right colic
- middle colic
- ileocolic (gives appendicular)
70
SMA and IMA supply structures of which embryonic origin
SMA: midgut
IMA: hindgut (distal 1/3 transverse till rectum)
71
IMA level and location
L3
| inferior border of duodenum, 3-4 cm above bifurcation into common iliacs
72
IMA branches
- left colic (distal 1/3 of transverse, descending colon)
- sigmoid arteries
- superior rectal
they cross OVER left ureter
73
watershed areas
splenic flexure, rectoigmoid junction
| --> blood supply from 2 large arteries - more sensitive to systemic hypoperfusion
74
falciform ligament
attaches anterior surface of liver to anterior abdominal wall
contains ligamentum teres (remnant of umbilical vein)
75
coronary ligament
attaches superior surface of liver to diaphragm
has anterior and posterior folds which unite at each side to make right and left triangular ligaments
demarcates the bare area of liver
76
right and left triangular ligaments
made from union of anterior and posterior coronary ligaments at apex of liver, attach it to diaphragm
77
lesser omentum attachment to liver
attaches liver to lesser curvature of stomach and D1
| consists of hepatoduodenal ligament and hepatogastric ligament
78
what surrounds the portal triad
hepatoduodenal ligament
79
what are the hepatic recesses
- subphrenic space: between diaphragm and liver, divided into right and left by falciform ligament
- subhepatic: between liver and transverse mesocolon
- morison's pouch: between liver and right kidney, deepest part of peritoneal cavity when supine (for bedridden patients)
80
anatomical structure of liver
left lobe, right (larger) lobe
| 2 accessory lobes arise from right lobe - on visceral surface: caudate and quadrate
81
where is caudate lobe
upper part of visceral surface
| between IVC and fossa made by ligamentum venosum (remnant of fetal ductus venosus)
82
where is quadrate lobe
lower part of visceral surface
| between gallbladder and fossa made by ligamentum teres
83
what is the liver covered with
Glisson's capsule (fibrous layer)
| distension of capsule causes sharp pain
84
where is the porta hepatis
| contents
visceral surface, between caudate and quadrate - it runs in the hepatoduodenal ligament
all vessels, nerves (vagus), ducts except hepatic veins
mainly: hepatic artery, portal vein, common hepatic duct
85
liver blood supply
dual supply:
hepatic artery proper 25% - non-parenchymal part
hepatic portal vein 75% - parenchyma, partially deoxygenated blood with nutrients from small intestine, for detoxification
venous drainage through many small hepatic veins which drain into IVC
86
gallbladder storage capacity
30-50 mL
87
what is Hartmann's pouch
mucosal fold in neck of gallbladder, most common location for gallstone impaction, causing cholestasis
88
biliary tree pathway
bile made in liver, travels through right and left hepatic ducts which combine to make common hepatic duct
CHD joins cystic duct to form common bile duct which travels posterior to D1 and pancreatic head to reach pancreatic duct and form ampulla of Vater (hepatopancreatic ampulla) which opens in D2 via major duodenal papilla and is regulated by sphincter of Oddi
89
what stimulates contraction of gallbladder
parasympathetic stimulation causes contraction of GB and relaxation of sphincter of Oddi
+ cholecystokinin (gustatory response)
90
charcot's triad
for cholangitis
| fever, jaundice, RUQ pain
91
pancreas level and position in peritoneal cavity
transpyloric plane L1
| retroperitoneal EXCEPT its tail
92
pancreas and vessels relationship
- aorta and IVC pass posterior to head
- SMA passes behind neck but anterior to uncinate
- splenic and superior mesenteric vein unite behind neck of pancreas to form portal vein
- splenic artery traverses superior border of pancreas
93
pancreatic tail attached to spleen by what
splenorenal ligament with the splenic vessels
94
pancreas blood supply
pancreatic branches from splenic artery
| pancreatic head also from superior and inferior pancreaticoduodenal arteries (from gastroduodenal -celiac- and SMA)
95
pancreatitis causes
```
GET SMASHED
Gall stones
Ethanol
Trauma
Steroids
Mumps
Autoimmune
Scorpion sting
HyperCa, hypertriglycerides, hyperparathyroidism
ERCP
Drugs (sodium valproate, azathioprine and sulphonamides)
```
96
relevance of vascular segments of spleen
arterial branches from splenic artery do not anastomose with each other, enabling subtotal splenectomy without affecting other segments
97
splenectomy vaccine
Pneumococcal, meningococcal, and Haemophilus influenzae (Hib)
2 weeks before or after surgery
98
shape of adrenal glands
right: pyramidal
left: semi lunar
99
adrenal gland layers
outer capsule, cortex, medulla
100
adrenal gland cortex function
from mesoderm
zona glomerulosa - aldosterone (mineralocorticosteroids)
zona fasciculata - cortisol (corticosteroids)
zona reticularis - DHES (androgens)
101
adrenal gland medulla function
from ectodermal neural crest cells
| contains chromaffin cells, secrete adrenaline (catecholamines)
102
pheochromocytoma
tumor in adrenal medulla
secretes adrenaline and noradrenaline
phenoxybenzamine - adrenaline antagonist
103
what encloses the kidneys and adrenal glands
renal fascia "Gerota's fascia"
104
avascular plane of kidney
line of Brodel
along lateral slightly posterior border of kidney, important access for open and endoscopic surgeries, minimizes risk of damage to major arteries
105
lymphatic drainage of kidneys
para-aortic nodes
106
segmental vascular supply of kidneys relevance
like spleen, branches do not anastomose
can perform partial nephrectomies
NB: if one branch is obstructed, its part of kidney will die because no other supply
107
pelvic kidney location
kidney that failed to ascend
| level of common iliac artery
108
root of mesentery function and pathway
mesentery: anchors small and large intestine to posterior abdominal wall, provides conduit for vessels
root: bare area, attaches mesentery to posterior abdominal wall
oblique orientation: left side of L2 till right sacroiliac junction
109
which part of mesentery is most mobile
transverse mesocolon
110
most common area of volvulus
sigmoid
111
retroperitoneal organs
```
SAD PUCKER
Suprarenal glands
Aorta + IVC
Duodenum (except 2cm of D1 "cap")
Pancreas (except tail)
Ureters
Colon (ascending + descending)
Kidneys
Esophagus
Rectum
```
112
mesentery vs omentum
both are double layers of visceral peritoneum
omentum comes from stomach mainly and proximal part of duodenum
mesentery for rest of organs (named according to organ its covering, "the mesentery" for small intestine)
113
lesser omentum consists of
hepatogastric ligament and hepatoduodenal ligament
114
embryological origin of organs and referred pain
foregut referred to epigastric region:
esophagus, stomach, pancreas, liver, gallbladder, duodenum (proximal to entrance of CBD)
midgut referred to umbilical region:
duodenum to proximal 2/3 of transverse colon
hindgut referred to pubic region:
distal 1/3 of transverse to upper part of anal canal
115
abdominal muscles
3 flat: external oblique, internal oblique, transversus abdominis
2 vertical: rectus abdominis, pyramidalis
116
linea alba
aponeuroses of all 3 flat muscles join in midline of abdomen
| from xiphoid to pubic symphysis
117
rectus abdominis structure
split in half by linea alba
lateral borders create linea semilunaris
tendinous intersections are fibrous strips that intersect the muscle horizontally --> intersections + linea alba: 6 pack
118
pyramidalis location
anterior to rectus abdominis
| triangle shape, base at pubis bone, apex at linea alba
119
rectus sheath
aponeuroses of 3 flat muscles covering rectus abdominis
anterior wall: external oblique + 1/2 internal oblique
posterior wall: 1/2 internal oblique + transversus abdominis
120
arcuate line
midway between umbilicus and pubic symphysis
below arcuate, rectus sheath has only anterior wall with the 3 aponeuroses of the 3 muscles
no more posterior wall, rectus abdominis in direct contact with transversalis fascia
121
superficial fascia composition based on location
above umbilicus: single sheet
| below umbilicus: Camper's fascia and Scarpa's fascia - superficial vessels and nerves run between them
122
inguinal canal function
allows structures to pass from abdominal cavity to external genitalia
123
indirect hernia cause
failure of processus vaginalis to regress
| sac herniates in canal based on amount of processus vaginalis still present
124
what is gubernaculum
fibrous cord which attaches to gonads, guides them in their descent, then attaches them to future scrotum or labia
125
what does gubernaculum become
males: scrotal ligament
females: ovarian ligament + round ligament of uterus
126
mid-inguinal point vs midpoint of inguinal ligament
mid inguinal: between ASIS and pubic symphysis - femoral pulse
midpoint of inguinal ligament: between ASIS and pubic tubercle - above this point is the opening of inguinal canal
127
inguinal canal walls
anterior: external oblique aponeurosis
posterior: transversalis fascia
roof: internal oblique, transversus abdominis, transversalis fascia
floor: inguinal ligament, lacunar ligament
128
inguinal ligament made of
external oblique aponeurosis
129
deep/internal inguinal ring made of
transversalis fascia
| above midpoint of ligament
130
superficial/external inguinal ring made of
external oblique aponeurosis
131
inguinal canal contents
spermatic cord (male), round ligament (female), ilioinguinal nerve, genital branch of genitofemoral nerve
132
ilioinguinal nerve function
sensory innervation of genitalia
133
genital branch of genitofemoral nerve function
supplies cremaster muscle + anterior scrotal skin
| OR skin of mons pubis + labia majora
134
direct hernia cause
weakness in abdominal muscles
135
What ligament attaches to lesser curvature of stomach
hepatogastric ligament
