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MRCS A > ANATOMY - Abdomen p1 > Flashcards

ANATOMY - Abdomen p1 Flashcards

1
Q

What is the peritoneal cavity?

A

The potential space between parietal and visceral peritoneum

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2
Q

what does the peritoneal cavity contain?

A

peritoneal fluid

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3
Q

3 constituents of peritoneal fluid

A

H2O
electrolytes
antibodies

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4
Q

what structure separates the 2 components of the greater sac?

A

transverse mesocolon aka mesentary of the transverse colon

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5
Q

what are the 2 main compartments of the greater sac?

A

supracolic compartment
infracolic compartment

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6
Q

where is the supracolic compartment of the greater sac?

A

above the transverse mesocolon

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7
Q

what viscera are contained in the supracolic compartment of the greater sac? (3)

A

spleen
liver
stomach

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8
Q

where is the infracolic compartment of the greater sac?

A

below the transverse mesocolon

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9
Q

what viscera are contained in the infracolic compartment of the greater sac? (3)

A

small intestine
ascending colon
descending colon

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10
Q

how is the infracolic compartment of the greater sac further divided?

A

into L + R infracolic spaces by mesentary of the small intestine

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11
Q

what structures connect the supra and infracolic compartments of the greater sac

A

paracolic gutters

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12
Q

where are paracolic gutters

A

lie between posterolateral abdominal wall + lateral aspect of the ascending/descending colon

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13
Q

where is the subphrenic recess

A

between the diaphragm and the liver

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14
Q

what separates the left and right subphrenic recesses?

A

falciform ligament

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15
Q

which is more common, a left or right subphrenic abscess? why?

A

Right
incr risk perf appendicitis or duodenal perf –> via R paracolic gutter

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16
Q

where is the lesser sac?

A

posterior to the stomach and lesser omentum

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17
Q

how is the lesser sac connected to the greater sac?

A

via opening in bursa = Epiploic foramen (of Winslow)

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18
Q

where is the epiploic foramen?

A

posterior to the free edge of the lesser omentum aka hepatoduodenal ligament

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19
Q

what is the name of the most distal portion of the peritoneal cavity in males?

A

retrovesical pouch
= double fold peritoneum between rectum and bladder

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20
Q

is the retrovesical pouch in males open or closed

A

closed

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21
Q

where is the Pouch of Douglas?

A

retrouterine pouch
double fold of peritoneum between the rectum and posterior wall of uterus

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22
Q

where is the vesicouterine pouch?

A

double fold perionteum
between anterior surface uterus and bladder

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23
Q

is the female pelvic peritoneum open or closed? why

A

open
uterine tubes open into peritoneal cavity

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24
Q

what is culdocentesis

A

extraction of fluid from the rectouterine pouch by inserting needle through posterior fornix vagina

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25
Q

use of culdocentesis

A

drainage pelvic abscess
extract peritoneal fluid

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26
Q

how does paracentesis work

A

needle at anterolateral abdominal wall, superior to bladder

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27
Q

care to avoid which artery in paracentesis?

A

inferior epigastric artery

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28
Q

how many lumbar vertebra

A

5

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29
Q

shape of lumbar VB

A

kidney shaped

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30
Q

are lumbar vertebra deeper anteriorly or posteriorly

A

anteriorly

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31
Q

shape of vertebral foramen lumbar spine

A

triangular

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32
Q

role of accessory process on lumbar spine vertebra

A

at base of each TP
site of mm attachment

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33
Q

role of mamillary process on lumbar spine vertebra

A

posterior surface of each superior articular process

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34
Q

which ligament is unique to the lumbar vertebra

A

iliolumbar ligaments (betw L5+S1) - strengthen lumbosacral joint

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35
Q

where does the iliolumbar ligament span between?

A

TP L5 –> ilia + pelvis

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36
Q

what are the 2 layers of superficial fascia below the umbilicus?

A

fatty superficial Campers
membranous deep Scarpas

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37
Q

what lies in between Campers and Scarpas fascia?

A

superficial aa vv nn

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38
Q

what are the 3 flat abdominal muscles?

A

IO
EO
Transversalis Abdominis

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39
Q

when do the flat muscles become aponeurosis>?

A

at the anteromedial aspect

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40
Q

what happens to the flat mm aponeurosis at the midline of the abdomen?

A

becomes linea alba

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41
Q

where does the linea alba expand between?

A

xiphoid process to the pubic symphysis

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42
Q

in which direction do the external oblique muscle fibres run

A

inferomedially

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43
Q

origin/insertion external oblique

A

5-12th rib –> iliac crest + PT

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44
Q

action external oblique

A

contralateral rotation torso

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45
Q

innervation external oblique muscle

A

thoracoabdominal T7-11
subcostal nn T12

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46
Q

in what direction do the internal oblique muscle fibres run?

A

superomedially

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47
Q

origin/insertion internal oblique muscle

A

inguinal ligament, iliac crest lumbodorsal fascia –> ribs 10-12

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48
Q

action internal oblique muscle

A

bilateral - compression of abdomen
unilateral - ipsilateral rotation torso

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49
Q

innervation internal oblique muscle

A

thoracoabdominal nerve T7-11
subcostal nn T12
Lumbar plexus

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50
Q

which is the deepest flat muscle of the abdomen?

A

transversus abdominis

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51
Q

in what direction do the transversus abdominis muscle fibres run in

A

transversely

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52
Q

what structures is deep to the transversus abdominis muscle

A

transversalis fascia

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53
Q

origin/insertion transversus abdominis

A

inguinal ligament, CC 7-12, IC+ thoracocolumbar fascia

–>
conjoint tendon, xiphoid process, linea alba + pubic crest

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54
Q

action transversus abdominis

A

compression abdominal contents

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55
Q

innervation transversus abdominis

A

thoracoabdominal nn T7-11
subcostal nn T12
lumbar plexus

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56
Q

what are the 2 vertical muscles

A

rectus abdominis
pyramidalis

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57
Q

what structure splits the rectus abdominis into 2?

A

linea alba

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58
Q

what is the name of the markings made by the lateral borders of the rectus abdominis?

A

linea semilunaris

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59
Q

what is the name of the fibrous strips which intersect the rectus abdominis?

A

tendinous intersection

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60
Q

origin/insertion rectus abdominis

A

crest of the pubic bone –> xiphoid process + CC 5-7

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61
Q

action rectus abdominis

A

assists flat muscles in compression
stabilises pelvis during walking
depresses ribs

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62
Q

innervation rectus abdominis

A

thoracoabdominal nn T7-11

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63
Q

is pyramidalis superficial or deep to rectus abdominis?

A

superficial

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64
Q

origin/insertion pyramidalis

A

pubic crest + pubic symphysis –> linea alba

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65
Q

action pyramidalis

A

tenses linea alba

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66
Q

innervation pyramidalis

A

subcostal nn T12

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67
Q

what is the rectus sheath comprised of?

A

the aponeurosis of the 3 flat mm

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68
Q

which muscles do the rectus sheath enclose?

A

rectus abdominis
pyramidalis

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69
Q

which mm aponeurosis comprise the anterior wall of the rectus sheath

A

EO
1/2 IO

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70
Q

which mm aponeurosis comprise the posterior wall of the rectus sheath?

A

1/2 IO
TA

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71
Q

at what point do all of the rectus sheath aponeurosis move to the anterior wall?

A

at arcuate line
1/2 way between umbilicus and PS

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72
Q

where is the midclavicular line?

A

middle of clavicle to mid inguinal point

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73
Q

where is the umbilicus

A

midway between xiphoid process + PS

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74
Q

where is the linea semilunaris

A

between the 9th rib to PT

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75
Q

where is the transpyloric line

A

1/2 way between jugular notch + PS
L1

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76
Q

where is the intertubecular line

A

between the superior aspects of the R and L iliac crest

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77
Q

midline surgical incision

A

through linea alba

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78
Q

use of midline surgical incision

A

accessing abdominal cavity

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79
Q

paramedian incision

A

lateral to linea alba

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80
Q

use of paramedian surgical incision

A

good access to more lateral structures e.g. kidney, spleen, adrenals

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81
Q

issue with paramedian incision

A

ligates blood vessels and nerves to muscles medial to incision –> atrophy

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82
Q

kocher incision

A

inferior to xiphoid process –> inferolaterally in parallel to R costal margin

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83
Q

use of kocher incision

A

gaining access to GB

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84
Q

Chevron/rooftop incision

A

Kocher
+ extend incision to other side of abdomen

85
Q

use Chevron incision

A

adrenalectomy (b/l)
oesophagectomy
gastrectomy
hepatic resection
liver transplant

86
Q

Mercedes Benz incision

A

Chevron + vertical incision + breaking xiphisternum

87
Q

use Mercedes Benz incision

A

adrenalectomy (b/l)
oesophagectomy
gastrectomy
hepatic resection
liver transplant ***

88
Q

Mcburney incision

A

2 perependicular lines
splits fibres of mm without cutting hence better healing
1/3 way between ASIS + umbilicus

89
Q

use Mcburney incision

A

open appendicectomy

90
Q

what are the 5 posterior abdominal wall muscles?

A

iliacus
psoas major
psoas minor
quadratus lumborum
diaphragm

91
Q

what does psoas sign indicate

A

irritation to iliopsoas group mm

92
Q

how is psoas sign ilicited

A

flex hip –> lower abdo pain

93
Q

origin/insertion quadratus lumborum

A

iliac crest + iliolumbar ligament –> superomedially –> TP L1-4 + inferior border 12th rib

94
Q

action quadratus lumborum

A

extends + lateral flexes vertebral column
flexes 12th rib during inspiration

95
Q

innervation quadratus lumborum

A

anterior rami L1-4

96
Q

origin/insertion psoas minor

A

VB T12 + L1 –> superior rami pubis aka pectineal line

97
Q

action psoas minor

98
Q

innervation psoas minor

A

anterior rami L1

99
Q

what % of population have psoas minor

100
Q

origin/insertion iliacus

A

surface iliac fossa + ASIS –> lesser trochanter femur

101
Q

action iliacus

A

flexes thigh
laterally rotates thigh

102
Q

innervation iliacus

A

femoral nn L2-4

103
Q

origin/insertion psoas major

A

TP + VB T12-L5 –> lesser trochanter femur

104
Q

action psoas major

A

flexes thigh at hip
lateral flexion vert column

105
Q

innervation psoas major

A

anterior rami l1-3

106
Q

how is the fascia of the posterior abdominal wall named

A

in relation to muscle it overlies

107
Q

what is the psoas fascia attached to medially

A

lumbar vertebraw

108
Q

what is the psoas fascia continuous with laterally

A

thoracocolumnar fascia

109
Q

how many layers to thoracocolumnar fascia (+names)

A

3
anterior
medial
posterior

110
Q

what muscle is between anterior and medial thoracocolumnar fascia layers

A

quadratus lumborum

111
Q

what muscles are between medial and posterior thoracocolumnar fascia layers

A

deep back muscles

112
Q

superiorly, what structure does the thoracocolumnar fascia thicken to become?

A

lateral arcuate ligament

113
Q

laterally, what does the posterior layer of the thoracocolumnar fascia cover?

A

latissimus dorsi

114
Q

what cell types are the parietal and pleural peritoneum made of?

A

simple squamous ep cells aka mesothelium

115
Q

embyrological origin - parietal peritoneum

A

somatic mesoderm

116
Q

nn supply parietal peritoneum

A

somatic nn

117
Q

is parietal peritoneal pain well localiesd

118
Q

what sensations is the parietal peritoneum sensitive to

A

pressure
pain
laceration
temperature

119
Q

embryological origin visceral peritoneum

A

splanchnic mesoderm

120
Q

nn supply visceral peritoneum

A

same autonomic nn as viscera it covers

121
Q

is pain well localised on the visceral peritoneum?

122
Q

how does visceral peritoneum pain present

A

referred to dermatomes

123
Q

what are intraperitoneal organs

A

organs covered by visceral peritoneum anteriorly and posteriorly

124
Q

e.g.s of intraperitoneal organs

A

stomach
liver
spleen
jejunum/ileum
transverse + sigmoid colon

125
Q

what are retroperitoneal organs

A

not associated with visceral peritoneum
only covered by parietal peritoneum anteriorly

126
Q

what are the 2 types of retroperitoneal organs

A

primarily retroperitoneal organs
secondarily retroperitoneal organs

127
Q

what is a primarily retroperitoneal organ?

A

organ develops and remains outside parietal peritoneum

128
Q

examples of primarily retroperitoneal organs (3)

A

oesophagus
rectum
kidneys

129
Q

what is a secondarily retroperitoneal organ?

A

organ is initially intraperitoneal, surrounded by mesentary
throughout development, becomes retro as mesentary is fused with posterior abdominal wall

130
Q

e.g.s of secondarily retroperitoneal organs (2)

A

ascending colon
descending colon

131
Q

Mnemonic for retroperitoneal organs

A

SAD PUCKER
Suprarenal/adrenal glands
Aorta + IVC
Duodenum except prox 2cm + cap
Pancreas except tail
Ureters
Colon - ascending/descending
Kidneys
Eosophagus
Rectum

132
Q

what is a mesentary

A

double layer of visceral peritoneum which connects intraperitoneal organs to the posterior abdominal wall
it provides a pathway for aa/vv/nn/LN to reach viscera from the body wall

133
Q

what is a peritoneal ligament

A

double fold of peritoneum which connects viscera together
or viscera to the abdominal wall

134
Q

what is pain referred in relation to?

A

embryological origin of the organ

135
Q

organs originating from foregut (6)

A

oesophagus
stomach
pancreas
liver
gall bladder
duodenum

136
Q

organs originating from midgut

A

duodenum distal to entrance of CBD/major papilla to junction of proximal 2/3 of transverse mesocolon

137
Q

organs originating from the hindgut

A

distal 1/3 of the transverse colon –> anal canal

138
Q

where does pain refer from retroperitoneal organs

139
Q

where does irritation of the diaphragm refer pain to

A

shoulder tip

140
Q

what are the 4 parts of the stomach?

A

cardia
fundus
body
pylorus

141
Q

level of cardia of stomach

142
Q

What are the 3 sections of the pylorus

A

antrum
canal
sphincter

143
Q

level of transpyloric plane

144
Q

where does the greater curvature of the stomach extend between?

A

cardiac notch –> pyloric antrum

145
Q

arterial supply greater curvature stomach

A

branches short gastric aa
+ R+L gastro-omental aa

146
Q

which ligament attaches to the lesser curvature of the stomach?

A

hepato gastric ligament

147
Q

arterial supply lesser curvature of stomach

A

L gastric aa
R gastric branch of hepatic aa

148
Q

what structures are superior to the stomach?

A

oesophagus + L dome of diaphragm

149
Q

what structures are anterior to the stomach?

A

diaphragm
greater omentum
anterior abdominal wall
L lobe of liver
gall bladder

150
Q

what structures are posterior to the stomach

A

lesser sac
pancreas
L kidney
L adrenal spleen
Spleen
splenic aa
T mesocolon

151
Q

level of inferior oesophageal sphincter

152
Q

is the inferior oesophageal sphincter under voluntary or involuntary control

A

involuntary

153
Q

role of pyloric sphincter

A

controls exit of chyme from the stomach

154
Q

what does the pyloric sphincter contain?

A

smooth muscle

155
Q

when does the stomach empty into the duodenum?

A

when intragastric pressure is greater than the resistance of the pylorus

156
Q

relation of greater omentum to stomach

A

hangs down over greater curvature
then folds back on itself and attaches to transverse mesocolon

157
Q

relation of lesser omentum to stomach

A

continuous with peritoneal layer of stomach
arises from the lesser curvature, ascending to attach to the liver

158
Q

which sac does the stomach lie anteriorly to?

A

lesser sac

159
Q

aa anastomoses along lesser curvature stomach

A

R + L gastric aa

160
Q

aa anastomoses along greater curvature stomach

A

R + L gastro-omental aa

161
Q

L + R gastric veins drain into

A

hepatic portal vein

162
Q

short gastric veins and + L + R gastro omental veins drain into –>

163
Q

L gastric aa is a branch of

A

coeliac trunk

164
Q

R gastric aa is a branch of

A

proper hepatic aa

165
Q

L gastro-omental aa is a branch of

A

splenic aa

166
Q

R gastro-omental aa is a branch of

A

gastro-duodenal aa

167
Q

parasymp inn stomach

A

anterior and posterior vagal trunks from vagus nn

168
Q

symp inn stomach

A

T6-9 –> coeliac plexus via greater splanchnic nn

169
Q

LN drainage stomach

A

gastric + gastro-omental LN

170
Q

where do the gastric + gastro-omental LN drain into

A

coeliac LN on the posterior abdominal wall

171
Q

how long is the small intestine

172
Q

what are the 3 parts of the small intestine

A

duodenum
jejunum
ileum

173
Q

what are the 4 parts of the duodenum

A

superior D1
descending D2
inferior D3
ascending D4

174
Q

spinal level D1 duodenum

175
Q

what connects D1 to the liver

A

hepatoduodenal ligament

176
Q

which part of the duodenum is the common site of ulceration

177
Q

route of D1 duodenum

A

ascends up from pylorus of stomach

178
Q

route of D2 duodenum

A

curves inferiorly around head of pancreas
posterior to transverse colon, anterior to right kidney

179
Q

what is the major feature of D2 duodenum

A

major duodenal papilla aka Ampulla of Vater opening

180
Q

aa supply duodenum up to the Ampulla of Vater

A

gastroduodenal aa

181
Q

what is the gastroduodenal aa a branch of

A

hepatic aa

182
Q

D3 duodenum route

A

travels to the left, crossing IVC and aorta
inferior to pancreas and posterior to SMA/V

183
Q

D4 duodenum route

A

after crossing aorta, ascends and curves anterior to join jejunum at duodenaljejunal flexure

184
Q

what special feature does D4 of the duodenum have

A

suspensory ligament

185
Q

role of suspensory ligament of the duodenum

A

contraction widens angle of duodenaljejunal flexure

186
Q

aa supply to duodenum distal to ampulla of Vater

A

inferior pancreatico-duodenal aa

187
Q

vv drainage duodenum

A

vv follow aa
ultimately drain into hepatic portal vv

188
Q

LN duodenum

A

pancreatoduodenal + Sup mesenteric LN

189
Q

2 most common causes duodenal ulcer

A

h pylori
chronic NSAID use

190
Q

which aa can be eroded in a duodenal ulcer

A

gastroduodenal aa

191
Q

are the jejunum and ileum intra or retroperitoneal

A

intraperitoneal

192
Q

role of ileocecal valve

A

prevents reflux of colon contents into SI

193
Q

jejunum vs ileum - location

A

jejunum - LUQ
ileum - RLQ

194
Q

jejunum vs ileum - wall thickness

A

jejunum - thick
ileum - thin

195
Q

jejunum vs ileum - vasarecta

A

jejunum - longer
ileum - shorter

196
Q

jejunum vs ileum - arcades/aa loops

A

jejunum - less
ileum - more

197
Q

jejunum vs ileum - colour

A

jejunum - red
ileum - pink

198
Q

aa supply jejunum and ileum

199
Q

how does SMA supply the jejunum and ileum

A

SMA moves in between layers of the mesentary branching into around 20 branches
branches anastomose to form arcades/loops
from the arcades - long, straight aa arise = vasa recta

200
Q

vv supply jejunum and ileum

201
Q

LN jejunum and ileum

A

Sup mesenteric LN

202
Q

what does the mesoappendix do

A

suspends appendix from the terminal ileum

203
Q

what is the most common position of the appendix

A

retro-cecal

204
Q

aa supply appendix

A

appendicular aa

205
Q

what is the appendicular aa a branch of

A

ileocecal aa

206
Q

what is the ileocecal aa a branch of

207
Q

venous supply appendix

A

appendicular vv

208
Q

inn appendix

A

ANS - symp (T10) and parasym
via ileocolic branch of SM plexus

209
Q

LN appendix

A

within mesoappendix + ileocolic LN

MRCS A (36 decks)

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