Anatomy Abdomen Book Flashcards
Spermatic cord contents
Arteries- cremastvtic, testicular, artery of ductus deferens
Veins- pampiniform
Nerves- genitofemoral (supplies cremastvtic muscle and symp/para for DD and arteries
Lymph
Ductus deferens
Layers of scrotum and there corresponding abdo origin
Tunica vaginalis- peritoneum
Internal spermatic fascia- trasversali fascia
Cremastatic fascia- Internal oblique
External fascia- external oblique
Borders of inguinal canal
Posterior- transversals fascia
Medially- conjoint ligament -IO+TA
Anteriorly- aponeurosis of external oblique - medially, internal oblique laterally
Laterally- internal oblique
Floor- inguinal ligament
Roof- TA, IO
Venous systems affected by liver cirrhosis
Rectal- inferior rectal and anal canal
Oesophageal - inferior
Caput medusa-from paraumbilical veins of hepatic portal to superior/inferior epigastric
Bare area of liver
Retroperitoneal
Artery commonly affected in bleeding duodenal ulcers
Gastroduodenal- if ulcer posterior
What is Pringles manoeuvre
Grasping free edges of lesser momentum
Control bleeding of liver laceration
Compressing hepatic artery, portal vein and cystic duct
Points at transpyloric plane
Inferior part of L1
Pylorus of stomach/first part of duodenum
Hila of kidneys
Duodenaljujenal junction
Neck of pancreas
9th CC
Fundus of gallbladder
Calots triangle borders
Superior- inferior border of the liver
Lateral inferior- cystic duct
Medial- Common hepatic duct
Cystic artery within
Which branch does cystic artery come from
Right hepatic
Blood supply of fundus of stomach
Short gastric arteries
From splenic
Location of stoma in Hartmanns
LLQ
What stomas are in RLQ
Ileostomy
Stoma in RUQ
Defunctioning transverse colostomy
What divides superficial and deep femoral branches
Lateral femoral circumflex artery
Sx of femoral nerve damage
Trouble standing and walking
Varicocele is ?
Due to compression or valvular disorder- pampiniform plexus
Billroth procedure
Removal of distal third of stomach and end to end anastomosis of stomach to duodenum
Used for malignancy
I- if distal third
II- if 2/3 and anastomosis to jejunum leaving blind end duodenal loop
Define AAA
> 3cm dilation or >50% than Normal
Gerotas fasciae
Covers perinephric fat of kidneys
Deficient inferiorly
Order of hilum of kidney
Ant->post
Renal vein, artery post sup, ureter
Ureter course
Retroperitoneal entire course
Descend on psoas major
Over genitofemoral nerve
Under gonadal vessel
Narrow at pelviureter junction
Run over external iliac artery/vein and under vas deferens
Points of narrowing of ureter
Uteropelvic junction
Crossing iliac vessels
Uterovesicle junciton
Borders of femoral triangle
Lateral- sartorius
Medial- adducts longus
Superior- inguinal ligament
Floor- illopsoas, pectinous, adductor longus
Roof- fascia lata
Mid inguinal vs midpoint of inguinal ligament
Mid inguinal- Pubic lymph and ASIS- femoral artery
Midpoint of IL- pubic tubercle and ASIS - deep inguinal ring
Femoral canal borders
Anterior- inguinal ligament
Posterior- pectineal ligament
Medial- lacunar
Lateral femoral vein
Function of femoral canal
Lymph drainage of lower limb
Room for vein to expand
Branches of renal, adrenal, gonadal and iliac arteries
Renal- L2
Adrenal- T12
Gonadal- L2
Illiac- L4
Jejenuc vs ileum
Jejenum- lies more at umbilicus
Redder
Valvulae conniventes
Fewer arcades
Longer vasa recta
Mesentary- lies superiorly and attached left to aorta
Villi- tall
Ileum
Suprapubic
Pinker
More arcades and shorter vasa recta
Peyers patches
Mesentary- inferior, attaches to right aorta
Villia- short
What is the median umbilical fold and lateral structures
Contains median umbilical ligament- remnants of urachus (previous connection of bladder and umbilicus)
Lateral- medial umbilical ligaments-remnants of umbilical artery
More lateral- lateral umbilical folds- inferiors epigastric vessels
Nerve found in inguinal canal but not spermatic cord
Ilioinguinal nerve
Anatomical relation of renal veins
Behind pancreases
Infront of renal arteries
Level renal vein joins IVC
L!
Difference in drainage of renal veins
Left 3x as long- crosses aorta
Left- recieves left suprarenal and gonadal
Right and above go direct to IVC
What is Meckel diverticulum ?
How common, size?
Where is it found?
Blood supply
Remnant of Vitello-intestinal duct (connects yolk sac and intestine in fetus)
Found in 2%, 2in long
Found on antimesenteric border of ileum
Ileal branch of SMA
Borders of epiploic foramen
Superior- caudate process of liver
Inferior- first part of duodenum
Anterior- Free edge of lesser omentum containing bile duct, hepatic artery, portal vein
Posteriorly- IVC
Difference between cell lining, arterial supply, venous drainage, nerve supply, lymphatic drainage above and below dentate line
Above
Columnar
Arterial- superior rectal (IMA)
Venous- IMV
Nerve- autonomic - symp pelvic plexus, para- pelvic splanchnic
Lymph- inferior mesenteric lymph node
Below
Squamous
Arterial-middle (internal iliac) and inferior rectal arteries (internal pudendal)
Venous- internal pudendal
Somatic- inferior rectal branch of pudendal
Lymph- superficial inguinal
Where is the portal vein formed and what from
Transpyloric plane behind neck of pancreas
SMV and splenic (IMC drains into splenic)
What structures are lateral to the bladder
Levator ani
Obturator internus
Origin of 2 heads of rectus abdominis
Medial - pubic symphysis
Lateral upper boarder of pubic crest- larger
Where does the rectus abdo insert
Insert into 5-7th CC and xiphi
Blood supply of rectus abdo
Sup and inf epigastric
Embryo origins of urethra and bladder
Proximal urethra and bladder- mesopnephric ducts
Distal- urogenital sinus
Where is urethra narrowest and widest
Narrowest- membranous, external meatus, bladder neck and entrance to navicular fossa ( near end of urethra)
Widest- prostatic, bulb and navilcular fossa
Cell lining of urethra
Transitional - rest
Stratified squamous - spongy
Origin of inferior epigastric
External iliac
Anastomoses with superifical epigastric which comes from femoral below ignuinal
And superior epigastric which origiantes from internal thoracic
Layers of rectus sheath at different points
Above costal margin- just consists of external oblique ap anteriorly -no others
Above arcuate line- ext and half of int anterior
TA- post
Below- all anterior
Spigelian hernia location, tx and complications
Between RA medially and semilunar line laterally (formed by EA, IA,TA) usually below arcuate line
Open or lapro
Small and high risk of strangulation
Most common visceral artery aneurysm
Splenic
Artery supply of adrenals
Sup- inferior phrenic
Mid- aorta
Inf- renal
Tributes for portal vein
IMV drains into splenic
Splenic and SMV form Portal
Short gastric, left gastroepiloic drain into splenic
Right gastroepiploic- SMC
Cystic and left and right gastric straight into portal
IVC relation to portal and number of valves
IVC posterior
0
What ligament contain that portal triad
Hepatoduodenal ligament
Relation of hepatoduodenal ligament to epiploic foramen
HP lig is anterior
Borders of epiploic foramen
Ant- triad
Post- IVC, right crus of diaphragm
Sup- caudate lobe
Inf- first part of duo
Uterine artery relation to ureter
Anterior and superior
Nerve supply of ureter
Has internal pacemaker for peristalsis
Symp- thoracolumbar pre ganglionic- aorticorenal and inf/sup hypogastric
Para- S2-4
Cutaneous pain- referred to T11-L2
Ureter relation to internal iliac and testicular artery
Anterior to internal iliac
Post to test
Venous drainage of ureter and muscle
Inf end of ureter covered in venous plexus- drain via renal and gonadal vein
Has 2 layers of spiral muscle
Where does testicular development begin
At mesodermal ridge
Prostate gland location, number of lobes and the female equivalent
Between bladder and urogenital ridge
5
Skene gland
Layers of teste capsule
Tunica vasculosa- innermost vascular
Tunica albuginea- tough fibrous
Tunica vaginalis- closed peritoneal sac
Visceral- close to testes
Parietal- adherent to internal spermatic cord and separated to visceral by fluid
Layers closest to skin of scrotum
Dartos fascia and muscle
Nerve innervating cremastvtic reflex
Genital branch of gentiofemoral
Permanent folds of GI tract
Plicae circularis
Spiral valve of Heister- cystic valve
Villae
Trasverse rectal
Lymph node drainage pathway of colon
Epicolic- serial wall
Paracolic- medial side of ascending/descending or mesenteric border of transverse
Intermediate- named branches of colonic vessels
Pre aortic (IM, SM)
What can be incised to give greater mobility of 12th rib
Costovertebral ligament
Attach between 12th rib and 1+2nd transverse processes of lumbar
Posterior gastric ulcer bleed affects which artery?
Splenic
Male vs female pelvis
Female is wider, shallower
Ischial tuberosities are further apart in females
Obturator foramina- oval in females, round in males
Pelvic cavity is deeper in males
Inlet round in females and heart in males
Pubic arch wider in females - 80-90 vs 60-70
Sites of portosystemic anastomosis
Collaterals between portal and systemic
Gastrooesophageal - around cardia - left gastric vein anastomose with azygous
Anus- superior rectal vein of portal with middle and inferior of systemic
Anterior abdo wall around umbilicus- para umbilical anastomose with veins
Location of deep inguinal ring
Midpoint of inguinal ligament
1.5cm above
Which hernia is more likely to extend into scrotum
Indirect
Potential patent processus vaginalis
Level of pancreatic body
L1/2
Anatomy of uncinate process of pancreas
Extends medially from left of pancreatic head
Posterior to SMA
Blood supply of pancreas
From branches of splenic artery for body and tail
Head- gasproduodenal and SMA
Where ducts of pancreas drain
Main- from tail and body- joins bile duct in duodenum
5% separate
Accessory- drains uncinate and inferior head opening into duodenum at minor duodenal papilla
What is pancreas formed from and what is found behind it
Foregut
Portal vein formation behind neck
Which parts of pancreas and duodenum are intraperitoneal
Pancreas- tail
Duodenum- 1st part
Hilum of kidney relative to duodenum
Posterior
Anatomical positions relative to third part of duodenum
Ant- SMA and vein
Post- psoas, ICV, aorta and right ureter
Big of treitz hold DJ flexure at 3/4th part of duodenum
Which artery supplies distal third of oesophagus
Left gastric
Why are intraoperative cholangiograms used
After dissected calots triangle
Small incision in cystic duct- dye inserted
Useful to identify bile leak, distal occlusions and correct identification of cystic duct
What does the artery of Drummond supply
Is the anastomosis of left and middle colic artery
Most common positioning of appendix
Retrocaecal then pelvic
RF of transverse incision for appendectomy
Damage to iliohypogastric nerve
Could cause direct inguinal hernia due to weakness in muscles
Peritoneal covering of rectum
Upper - anterior and lateral
Middle - anterior
Lower- none
Where does rectum start relative to sacrum
S3
Number of transverse folds in rectum
3
Called Houston’s valves
Arterial supply of rectum
Superior rectal- from IMA
Middle rectal from internal iliac
Inferior rectal from internal pudendal
What does obturator interns pass through
Lesser sciatic foramen
Muscles attaching to perineal body
Bulbospongiosum
Levator Ani
External anal sphincter
Testicular anastomoses with ?
Artery of vas
Hence why testicles do not atrophy if testicular artery is cut
Composition of anal sphincter
Internal- circular muscle
External- surrounds and more distally - 3 parts, deep, superficial and subcutaneous
Deep blends with puborectalis
Borders of quadrate and caudate lobes
Quadrate- right gallbladder, left round ligament (prev umbilical vein), post hepata portis
Caudare- ant hepata portis, right IVC, left ductus venosum shunt to IVC
Quadratus lumborum attachment, innervation and action
Origin: Medial aspect of iliac crest and iliolumbar ligament
Insertion: 12th rib
Action: Pulls the rib cage inferiorly. Lateral flexion.
Nerve supply: Anterior primary rami of T12 and L1-3
