Anatomy - Abdomen - Extra Anatomy Flashcards from Gray's Anatomy
1
Q
What does the costal margin separate?
A
The abdominal wall from the thoracic wall
2
Q
What separates the anterior abdominal wall from the thigh?
A
Inguinal ligament
3
Q
What separates the posterior abdominal wall from the gluteal region?
A
Iliac crest
4
Q
What abdominal viscera are protected by the thoracic cavity?
A
Those that project above the costal margin: 1. Stomach2. Liver3. Spleen4. Kidneys5. Abdominal esophagus
5
Q
How high can the diaphragm get during forceful expiration?
A
4th ICS
6
Q
Surface projection of deep inguinal ring?
A
Superior to inguinal ligament, midway between the ASIS and pubic symphysis
7
Q
Where can the pulse of the femoral artery be felt?
A
Inferior to inguinal ligament, midway between the ASIS and pubic symphysis
8
Q
Surface projection of superficial inguinal ring in men?
A
Follow the spermatic cord superiorly to the lower abdominal wall
9
Q
Surface projection of superficial inguinal ring in women?
A
The pubic tubercle can be palpated and the ring is superior and lateral to it
10
Q
What 6 things are visualized at the L1 transverse plane?
A
- The beginning and upper limit of the end of the duodenum2. The hila of the kidneys3. The neck of the pancreas 4. Celiac trunk originates at upper edge of L15. SMA originates at lower edge of L16. Left and right colic flexures are “close”
11
Q
What is the L1 transverse plane midway in between?
A
Between jugular notch and pubic symphysis
12
Q
Rib level of L1 transverse plane?
A
9th costal cartilage lower edge
13
Q
Surface projection of the spleen?
A
Superior edge of rib 9 to superior edge of rib 11and follows the contour of rib 10 and horizontally from midaxillary line to superior pole of left kidney
14
Q
2 groups of retroperitoneal lymph nodes clinically? Describe each.
A
- Pre-aortic lymph node group drains lymph from the embryological midline structures, such as the liver, bowel, and pancreas2. Para-aortic lymph node group, on either side of the aorta, drain lymph from bilateral structures, such as the kidneys and adrenal glands, and organs embryologically derived from the posterior abdominal wall, including the ovaries and the testes
15
Q
2 other names for para-aortic lymph nodes?
A
Lateral aortic or lumbar nodes
16
Q
Do the testes drain to the inguinal lymph nodes?
A
NOPE
17
Q
Procedure to access retroperitoneal lymph nodes, for example during surgical removal due to testicular cancer?
A
- Lateral paramedian incision in the midclavicular line2. 3 layers of the anterolateral abdominal wall (external oblique, internal oblique, and transversus abdominis) are opened and the transversalis fascia is divided3. Surgeon gently pushes the parietal peritoneum toward the midline, which moves the intraabdominal contents and allows a clear view of the retroperitoneal structures. 4. On the left, the para-aortic lymph node group is easily demonstrated, with a clear view of the abdominal aorta and kidney. On the right the IVC is demonstrated and has to be retracted to access the right para-aortic lymph node chain
18
Q
Does the peritoneal cavity need to be entered to remove retroperitoneal lymph nodes?
A
NOPE
19
Q
What would happen if one of the nerves to the muscles of the anterior abdominal wall was severed?
A
Atrophy of the muscle and asymmetrical proportions of the anterior abdominal wall
20
Q
What does the presence of a main and accessory pancreatic duct reflect?
A
The embryological origin of the pancreas from dorsal and ventral buds from the foregut
21
Q
What could cause pleural effusions to become ascites and vice versa?
A
Diaphragmatic hernias
22
Q
2 types of diaphragmatic hernias? Describe each.
A
- Morgani’s hernia: failed point of fusion between the xiphoid process and the costal margins on the right 2. Bochdalek’s hernia: failed point of fusion through an opening on the left when the pleuroperitoneal membrane fails to close the pericardioperitoneal canal
23
Q
What is a hiatus hernia? Consequence?
A
At the level of the esophageal hiatus, the diaphragm may be lax, allowing the fundus of the stomach to herniate into the posterior mediastinum => typically causes symptoms of acid reflux with ulceration
24
Q
What does the ventral embryonic pancreas form?
A
- Part of the head2. Uncinate process
25
What does the dorsal embryonic pancreas form?
1. Most of head2. Neck3. Body
26
What is polyhydramnios? What is it caused by?
Fetus not swallowing enough amniotic fluids because of annular pancreas around duodenum causing increase in overall volume of the amniotic sac
27
Does the hindgut include the anal canal?
Its upper part only
28
What parts of the GIT become secondarily retroperitoneal during development?
1. Ascending colon
29
Around what axis does volvulus of the small intestine occur?
SMA
30
What is included in the mesentery of the small intestine?
Arteries, veins, nerves, and lymphatics that supply the jejunum and ileum
31
Describe the lymph drainage of the GIT.
Pre-aortic lymph nodes at the origins of the three anterior branches of the abdominal aorta, which supply these structures: celiac, superior mesenteric, and inferior mesenteric groups of pre-aortic lymph nodes all draining superiorly to the cisterna chyli
32
Through what diaphragmatic opening do lymphatics travel?
Aortic hiatus
33
What parts of the abdomen do not drain into the thoracic duct? Where do they drain instead?
Upper abdominal wall to left and right subclavian trunks Left trunk to thoracic ductRight trunk to right lymphatic duct
34
What anterior thoracic wall muscle is at the same level as the transversus abdominis?
Innermost intercostals
35
What is a sign that visceral structures are in pain? Implication?
Guarding of the anterior abdominal wall = involuntary muscle spasms Palpation should we done with warm hands because cold hands can cause these reflexes as well
36
When cutting through muscle, it is best to do so in the direction of the muscle fibers. What is an exception to this?
Rectus abdominis because of the tendinous intersections
37
Effect of cutting nerves to a muscle?
Muscle paralysis
38
What are median incisions used for? Good and bad sides?
Exploratory proceduresGood: bloodlessBad: risk of necrosis
39
What are gridiron incisions used for? Other name? Describe it. What nerve do you need to be careful with?
= Muscle-splitting incisions Often used for appendectomy: external oblique aponeurosis is incised and retracted => aponeuroses + muscle of internal oblique and transversus are then incised along the course of the fibers and retractedIliohypogastric nerve needs to be preserved
40
Most common abdominal organ to rupture? Treatment?
SpleenSurgical removal to avoid death by blood loss
41
If a person is obese, and we want to describe the pain they are feeling by abdominal quadrant, how do we do this since they transumbilical plane will probably be lower than L3/L4?
Use the 9 regions not quadrants
42
What are paramedian incisions? Describe.
Sagittal plane incision through the anterior layer of the rectus sheath => then the muscle is retracted laterally => posterior rectus and peritoneum is then excised
43
What are tranverse incisions? Describe.
Incisions through the rectus abdominis BUT not at the tendinous intersections because that is where cutaneous nerves and epigastric vessels pierce through => incisions are then similar to a new intersection
44
What are transverse incisions not good for exploratory procedures?
Because superior/inferior extension is difficult
45
What are Pfannenstiel incisions? Other name? What 2 nerves need to be preserved?
Horizontal incisions with slight convexity used for genycological and obstetrical operations where rectus sheath and linea alba are transectedIliohypogastric and ilioinguinal nerves
46
What are subcostal incisions used for?
Access to gallbladder and biliary tract on right and spleen on left
47
Most common cause of peritonitis?
Infection
48
How many solid organs in the abdominal cavity? Are most retro or intraperitoneal?
9: liver, spleen, pancreas, kidneys, adrenals, and testesMost are retroperitoneal
49
What structure would a posterior gastric ulcer erode? Referred pain?
First it would leak into the lesser omentum and then it would erode the pancreas => referred pain to the back
50
Is the lesser sac a real space?
NOPE - potential
51
What structures would a duodenal peptic ulcer erode? Referred pain?
1. Gastroduodenal artery 2. Liver3. Gallbladder 4. Pancreas
52
Are peptic ulcers = gastric ulcers?
NOPE, gastric ulcers are a type of peptic ulcers
53
Most common site for duodenal ulcers? How is this imaged? What do we call this?
Superior duodenum: in images performed after barium swallows, it is visible as a triangular shadow known as the duodenal cap
54
What structure can be damaged by a hemocolectomy or nephrectomy?
Descending duodenum
55
Consequence of necrosis of a part of ileum?
Paralytic ileus and accumulation of chyme proximal to necrosis site
56
How can trauma to the abdomen affect the SI?
Often damaged bytrauma = can be crushed against the anterior margin of S1, which can lead to leakage of intestinal contents into the peritoneal cavity, resulting in peritonitis
57
Can colon cancer lead to obstruction?
Uncommon because of large lumen
58
What are diverticula? Where do they usually happen?
Very small pockets of the colonic wall (like miniature hernias) - common in the sigmoid colon
59
What is a colostomy? What parts of the colon are usually used?
Surgical operation in which a piece of the colon is diverted to an artificial opening in the abdominal wall so as to bypass a damaged part of the colonUse sigmoid, transverse, and cecum as they are intraperitoneal
60
Common volvulus site in colon?
Sigmoid colon
61
What is colitis? What can it lead to?
Chronic inflammation of the colon, which can lead to loss of bowel control
62
Where are the anastomoses of the marginal artery weak?
Splenic flexure and recto-sigmoid junction
63
What is a positive psoas sign? When is a positive one seen?
Extending thigh at the hip joint causes pain and flexion ameliorates painAppendicitis
64
Can acute appendicitis lead to thrombosis of the appendicular artery?
YUP
65
Earliest sign of pancreatitis?
Enlarged tail with fat and cysts
66
What can tumors in the body and neck of the pancreas cause?
Obstruction of portal vein or IVC
67
Common damage to the pancreas during car accidents? What does this cause?
It can be crushed against the anvil-like vertebral column, often due to compression by a seatbelt or steering wheel during a car accident => rupture of the pancreas often tears its ducts, which allows pancreatic juice to enter the parenchyma of the gland and neighboring tissues => pancreatic juice digests these tissues, which is quite painful
68
5 very common sites of metastases from pancreatic cancer?
1. Regional nodes: celiac and SMA2. Liver3. Lung/pleura4. Intestine5. Peritoneum
69
Can obstruction to normal flow of urine anyway along the pathway cause serious uropathies?
YUP
70
Which is least complicated: liver or kidney transplant? Why?
Kidney is not as complicated as the liver. This is because surgeons only have to deal with a small number of blood vessels and that the entire kidney is transplanted and not only a part of it.
71
What is hypermobility of the kidney?
The kidney can move up or down in its fascial compartment
72
Incision placement for laparoscopic kidney surgery?
ASIS
73
Where are aneurysms found most commonly?
Large arteries, like the abdominal aorta (below the renal arteries) or the iliac arteries
74
4 parts of duodenum? Describe each along with their vertebral level. Which one is the longest?
1. The superior part (L1): extends from the pyloric orifice of the stomach to the neck of the gallbladder, is just to the right of the body of vertebra L1, mostly horizontal2. The descending part (L2/L3): curves around head of pancreas, just to the right of midline and extends from the neck of the gallbladder to the lower border of vertebra L33. The inferior part (L3)=horizontal part: longest section, crossing the IVC, the aorta, and the vertebral column 4. The ascending part (L2/L3): upward on, or to the left of, the aorta to approximately the upper border of vertebra L2 and terminates at the duodenojejunal flexure
75
Quadrant of pylorus?
URQ
76
What parts of the duodenum are in the URQ?
First 3 parts
77
Quadrant of head of the pancreas?
URQ
78
Are both superficial fascia layers found in the upper abdominal wall?
NOPE - only Camper's
79
What are the 3 muscles of the anterior abdominal wall separated by?
FAT
80
Possible answer for why the posterior rectus sheath ends at the arcuate line?
Perhaps this weakness in the posterior sheath below the arcuate line allows for easier expansion of the lower abdominal wall during pregnancy than if the formation of the rectus sheath didn't change
81
Purpose of the inguinal canal's oblique orientation?
Allows it to be longer than if it was straight, and we want it to be longer because the increased length permits a greater amount of abdominal musculature to surround it and thus reduce the likelihood of inguinal hernias
82
Can a direct inguinal hernia pass into the inguinal canal?
YES
83
What happens if the testis looses its attachment to the gubernaculum? What is this called?
The testis is free to rotate around its testicular vessels and such rotation can strangulate the blood supply to the testis and cause the sperm producing cells to die = testicular torsion
84
Which is thicker: tunica albuginea or tunica vaginalis?
Tunica albuginea
85
What is the dominant tubular structure in the spermatic cord?
Vas deferens
86
Is the vas deferens muscular?
YUP
87
Where are the umbilical ligaments located?
Deep surface of the abdominal wall but superficial to the peritoneum:1. Median umbilical ligament is a fibrous cord that passes between the bladder and the umbilicus and is the remnant of the embryological urachus2. Medial umbilical ligaments are the fibrous cords that are the remnants of the two umbilical arteries3. Lateral umbilical ligament is simply a term applied to the inferior epigastric vessels
88
What is SMA syndrome?
Compression of the duodenum
89
Location of splenic artery compared to splenic vein?
Superior
90
Where do the splenic and SMV meet to form the splenic vein?
Posterior to neck of pancreas
91
Does the IMV contribute to the formation of the portal vein?
NOPE
92
Describe the paraumbilical vein anastomosis according to Suarez.
Between some portal system veins that accompany the round ligament of the liver to the anterior abdominal wall and some systemic veins that are located in the fascia of the anterior abdominal wall
93
What are the 2 types of hiatal hernias? Which is more common? Which is more serious?
1. ***Sliding hiatal hernias: the stomach and the section of the esophagus that joins the stomach herniate into the chest through the hiatus2. Paraesophageal hiatal hernias (more SERIOUS): some of the stomach squeezes through the hiatus and becomes positioned adjacent to the esophagus. The seriousness of this type of hernia results because the stomach can become ischemic due to its blood supply being strangulated
94
What is pyloric stenosis?
Hypertrophy of the pylorus in babies causing weight loss and vomiting
95
What is the hepatobiliary triangle? Other names?
= triangle of Calot = cystohepatic triangle = space bordered by:1. Cystic duct inferiorly2. Common hepatic duct medially3. Visceral surface of the liver superiorly
96
Location of portal triad in the hepatoduodenal ligament?
1. Hepatic artery proper: LEFT2. Common bile duct: RIGHT3. Portal vein: POSTERIOR
97
When is omental caking?
Spread of cancer to greater omentum causes a radiologic sign named that way
98
Are the viscera sensitive to temperature or cutting?
NOPE (only ischemia and stretch)
99
What vessel halts the ascent of a horseshoe kidney?
IMA
100
4 gutters of peritoneal cavity? Which 3 drain to rectouterine/rectovesical pouch?
1. Right lateral - lateral to the ascending colon and cecum2. *Left lateral - lateral to the descending and sigmoid colon3. *Right medial - between the root of mesentery and the ascending colon4. *Left medial - between root of mesentery and descending colon
101
Where does the right lateral gutter drain? Why is this important?
It is open superiorly as well as well as inferiorly. This gutter is of particular surgical importance because of the slow percolation of infected fluids from such relatively common sites of infection as appendix, gall bladder, right kidney, lesser curvature of stomach and first and second parts of the duodenum. When a patient is supine, it allow infected fluid to enter the hepatorenal pouch or the subphrenic recess with potentially grave consequences because of this region’s inaccessibility and close relations to the pleural and pericardial cavities. Conversely, if the patient is maintained in a semi-sitting position, fluids descend to the relatively accessible rectovesical or rectovesical pouch, that can be drained with a syringe from the rectum or vagina
102
Through which diaphragm opening to the sympa trunks pass?
Medial arcuate ligament
103
Does the ilioinguinal nerve pass the entire inguinal canal?
NOPE
