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Anatomy Exam 2 > Anatomy - General Abdomen > Flashcards

Anatomy - General Abdomen Flashcards

1
Q

What are the superior and inferior boundaries of the abdomen?

A

Superior: diaphragm
Inferior: pelvic region (continuous with pelvic cavity at the pelvic inlet)

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2
Q

What are the anterior and posterior boundaries of the abdomen?

A

Anterior: above = thoracic cage; below = abdominal muscles (rectus abdominus, external/internal obliques, transverse abdominis muscles, fascia)
Posterior: vertebral column and posterior/inferior ribs

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3
Q

What are the lateral boundaries of the abdomen?

A

Muscles of the flank

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4
Q

What are the 3 spaces of the abdominal cavity?

A

1) Peritoneal space/Peritoneum: abdominal lining
2) Retroperitoneal space: behind peritoneal space (kidneys)
3) Pelvic space: organs contained within pelvic area itself

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5
Q

Describe the anterior abdominal wall from most superficial to deep.

A 
Skin
Superficial fascia
Deep fascia
Extraperitoneal fascia
Parietal peritoneum
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6
Q

Where do the rectus abdominus muscles sit?

A

Vertical midline

-responsible for “six pack”

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7
Q

What are the 3 muscular layers of the abdominal wall that form a tube and give body continuity and shape?

A

1) External oblique (“hands in pocket”)
2) Internal obliques (“hands on tits”)
3) Transversus abdominus (wraps around)

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8
Q

What is ITB syndrome?

A

Inflammation of the IT band which causes pain on the lateral side of the hip

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9
Q

What are the muscles of the posterior abdominal wall?

A

Psoas major and minor

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10
Q

Where does the skin near the midline of the abdomen get its blood supply from?

A

Superior epigastric artery (branch of internal thoracic artery) and Inferior epigastric artery (branch of external iliac artery)

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11
Q

Where does the skin of the flanks get its blood supply from?

A

Branches from the intercostal, lumber and deep circumflex arteries

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12
Q

Where does abdominal venous blood go?

A

Network of veins that radiate from the umbilicus

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13
Q

Where does the abdominal venous blood drain above the umbilicus? Below the umbilicus?

A
  • Above into axillary vein through lateral thoracic vein

- Below into femoral vein through superficial epigastric and saphenous vein

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14
Q

What is the importance of the paraumbilical veins?

A

They form a portal system venous anastomosis (liver)

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15
Q

What is caput medusae?

A

When the portal veins are obstructed, the superficial veins around the umbilicus and paraumbilical veins become grossly distended

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16
Q

What is the cause of caput medusae?

A

Cirrhosis: liver doesn’t work and is clogged with fatty tissue -> venous system is compromised and venous blood pools and causes distention and blueish discoloration in superficial veins surrounding umbilicus
-seen in hepatitis, alcoholics, liver cancer, liver transplant

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17
Q

What conditions would cause caput medusea?

A

Portal obstruction, portal hypertension, fatty liver

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18
Q

What do the nerves of the anterior abdominal wall innervate?

A

The skin, muscles, parietal peritoneum

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19
Q

Where are the nerves of the anterior abdominal wall derived from?

A

Anterior rami of lower 6 thoracic and 1st lumbar nerves

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20
Q

What does inflammation of the parietal peritoneum (peritonitis) cause?

A

Pain in the overlying skin -> nerves activated -> increased muscle tone over that area -> muscle rigidity

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21
Q

What will you see with peritonitis?

A

Muscle rigidity where the peritoneum is being inflamed, generally caused by injury or illness of hollow organ (i.e. appendix)

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22
Q

Where does lymph drainage of the skin of the anterior abdominal wall above the umbilicus go? Below the umbilicus?

A
  • Upward to anterior axillary nodes (pectoral group of nodes)
  • Downward and laterally to superficial inguinal nodes
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23
Q

What could swelling in the groin be caused by?

A

Infection –> Lymph node blockage

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24
Q

What is the rectus sheath?

A

Long fibrous sheet that encloses the rectus abdominis

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25
Q

What nerves does the rectus sheath contain?

A

Anterior rami of lower 6 thoracic nerves

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26
Q

What forms the rectus sheath?

A

The aponeurosis of 3 lateral muscles:

1) External oblique
2) Internal oblique
3) Transverse abdominus

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27
Q

What vasculature does the rectus sheath contain?

A

The superior and inferior epigastric vessels and lymphatic vessels

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28
Q

What is the most anterior part of the rectus sheath? The most posterior part?

A

Anterior - aponeurosis of the external oblique muscle

Posterior - the thoracic wall (5th, 6th and 7th costal cartilages)

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29
Q

What can cause hernias in the rectus sheath?

A

Surgeries in the midline

Pregnancies

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30
Q

How is the rectus muscle enclosed within the rectus sheath?

A

The aponeurosis of the internal oblique splits to enclose the rectus muscle

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31
Q

At what level does the aponeurosis of the internal oblique split to enclose the rectus muscle?

A

Between the costal margin (between the ribs) at the level of the antero-superior iliac spine (at level of iliac crests)
-at this level the aponeurosis of the external oblique is directed in front of the rectus abdominus and the transversus is directed behind it

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32
Q

How is the rectus sheath attached to the rectus muscle?

A

Only anteriorly, by the muscles tendinous intersections

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33
Q

At rectus sheath between level of anterior superior iliac spine and pubis where are the 3 aponeurosis directed?

A

All 3 are directed in front

34
Q

What does the esophagus do?

A

Carry food and liquid into the stomach

35
Q

What are the three parts of the small intestine?

A

1) Duodenum
2) Jejunum
3) ilium

36
Q

What are the parts of the large intestine?

A

Cecum (including appendix), ascending colon, transverse colon, descending colon, sigmoid colon

37
Q

What separates the abdominal cavity from the thoracic cavity?

A

Diaphragm

38
Q

What lines the abdominal cavity?

A

Peritoneum

39
Q

What is a hiatal hernia?

A

Defect in abdominal cavity -> Intestines enter thoracic cavity through a hole in the diaphragm - patients present with chest pain that is alleviated by sitting up

40
Q

What is the largest concern with trauma and LUQ pain?

A

Splenic injury

-Mono causes spleen enlargement -> NO contact sports x 3 months to avoid trauma and ruptured spleen

41
Q

What is rebound tenderness?

A

Pain felt upon removal of pressure from the abdomen, indication of parietal pain

42
Q

What is diverticulitis?

A

Inflammation in the out pockets of the colon, generally when stool gets stuck in them (the individual out pockets are called diverticulosis)

43
Q

What would RUQ pain indicate?

A
  • Liver: liver lac (traumatic)

- Gall bladder: cholecystitis (atraumatic)

44
Q

What would RLQ pain indicate?

A
  • Appendix: rebound tenderness
  • Colon: colitis, diverticulitis
  • Pelvic inflammation: diffuse tenderness
  • Problem with ureter/bladder/gonads
45
Q

What would LUQ pain indicate?

A
  • Spleen: rigidity under ribs (traumatic)

- Stomach

46
Q

What would LLQ pain indicate?

A
  • Colon: colitis, diverticulitis

- Pelvic inflammation: diffuse tenderness

47
Q

What is a possible risk of repeated STD infection?

A

PID, which causes diffuse pelvic pain

48
Q

What is visceral pain caused by?

A

Stretching of a hollow organ or capsule of a hollow organ

-dull and starts first

49
Q

Where is visceral pain of the foregut organs felt?

A

Stomach, duodenum, biliary tract -> felt in EPIGASTRIC region

50
Q

Where is visceral pain of the midgut organs felt?

A

Most small bowel, appendix, cecum -> felt in PERIUMBILICAL area

51
Q

Where is visceral pain of the hindgut organs felt?

A

Most of colon, including sigmoid and intraperitoneal portion of GU tract -> felt in SUPRAPUBIC or HYPOGASTRIC area

52
Q

What is parietal pain?

A

Caused by irritation of fibers that innervate the parietal peritoneum

  • comes after visceral pain
  • can be localized where inflammation is
  • rebound pain
53
Q

What is referred pain?

A

Pain or discomfort perceived at a site distant from the affected organ because of overlapping transmission pathways
-visceral pain

54
Q

What are classical examples of referred pain?

A
  • Sub-diaphragmatic irritation
  • Gynecologic pathway
  • Biliary tract disease
  • MI
  • Uretral obstruction
  • Aortic aneurysm (referred pain straight to the back)
55
Q

What is the role of hollow organs?

A

Allow materials to pass through (stomach, large intestine, small intestine) or act as holding tanks (gall bladder, urinary bladder)

56
Q

When are hollow organs at less risk for injury?

A

When they are empty

57
Q

What classifies solid organs?

A

Significant blood supply - liver, spleen, kidney, pancreas, ovaries and testes

58
Q

What is the risk of injury to solid organs?

A

High risk of injury - bruising and tearing

59
Q

How do you palpate the liver?

A

Place fingers below RT-costal margin and press firmly

-checking for rigidity, masses, tenderness, size (enlargement present in hepatic disease)

60
Q

How do you palpate the spleen?

A

Check for enlargement under LT-rib cage

-be careful when suspicious of pt having Mono because spleen may be enlarged

61
Q

What is the main cause of trauma to kidneys?

A

Mountain biking –> shock of riding bike itself

62
Q

What does it mean to percuss for tissue density?

A

Lightly place one hand over abdomen (palm down) and index/middle fingers of opposite hand tap DIP joints

  • normal: solid organs -> dull thump/resonant sound; hollow organs -> hard echo/sound hollow
  • positive: hard, sound echoing over areas that should sound hollow
63
Q

Which kidney is more inferior?

A

Right kidney (because of liver)

64
Q

What is rigidity?

A

Muscle guarding that occurs secondary to blood accumulation

-parietal pain

65
Q

What is a hernia?

A

Protrusion of an organ or part of an organ through a defect in the wall of the cavity normally containing it

66
Q

What is an indirect inguinal hernia?

A

A hernia that passes through the path of the inguinal canal; pass through both deep and superficial inguinal rings and into the scrotum

  • Congenital
  • Mass is lateral to inferior epigastric artery
67
Q

What is a direct inguinal hernia?

A

A hernia that bulges through a weakness in the abdominal wall

  • Acquired
  • Mass is medial to inferior epigastric artery
  • Less common; associated with heavy lifting, straining due to constipation, coughing or prostatic enlargement
68
Q

Which type of inguinal hernia is more common?

A

Indirect - 75% inguinal hernias and 3x more in males

69
Q

What is a reducible hernia?

A

A hernia that can be pressed back into place (reduced) manually

70
Q

What is an incarcerated/irreducible hernia?

A

A hernia that cannot be manually reduced - as the intestine constantly slides up and down, adhesions form and the hernia can’t go back into place because scar tissue limits the movement of the hernia

71
Q

What is a strangulated hernia?

A

When the adhesions get very bad, the intestine twists and the hernia becomes strangulated
-Causes: ischemia, inflammation, obstruction and necrosis

72
Q

Groin hernias are found in what percent of the population?

A

5% of the MALE population

73
Q

Groin hernias are what percent of all hernia cases?

A

86%

74
Q

Are groin hernias more prevalent in males or females?

A

5x more often in males than females

75
Q

What percentage of groin hernias are inguinal and femoral?

A 
Inguinal = 96%
Femoral = 4%
76
Q

If a left inguinal hernia is present, what is the probability that there is an occult right inguinal hernia?

A

25%

  • occult = there but asymptomatic
  • common in children and elderly men
77
Q

What is a femoral hernia?

A

Intestinal herniation through the femoral canal

  • Gender predisposition: female by 3:1 ratio
  • Associated with increased intraabdominal pressure, common in elderly women
78
Q

Where does the femoral canal lie?

A

Immediately medial to the femoral vein

79
Q

What is an incisional hernia?

A

A hernia that develops in the scar of a prior laparotomy or drain site

80
Q

What are 3 risks for postoperative hernia development?

A

1) Wound dehiscence (when contents under the sutures protrude; let it heal by 3rd intention- from the inside out)
2) Malnutrition
3) Obesity

81
Q

What are potential complications of an incisional hernia?

A

Bowel incarceration, strangulation, small bowel obstruction

82
Q

What should you clean an open wound with?

A

Normal saline

-NOT hydrogen peroxide (which would cause the wound to swell and heal poorly)

Anatomy Exam 2 (5 decks)

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