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Anatomy > Anatomy of the Abdomen > Flashcards

Anatomy of the Abdomen Flashcards

1
Q

What is a hernia?

A

A condition in which part of whole of an organ or tissue abnormally protrude through the wall of the structure containing the organ or tissue.

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2
Q

What are the 2 horizontal planes separating the nine abdominal regions, and the horizontal plane separating the 4 quadrants?

A 
Subcostal plane (between lower edges of 10th CCs)
Intertubercular plane (L5)
Transumbilical plane.
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3
Q

Give the difference between a direct and indirect inguinal hernia.

A

Direct inguinal hernia goes through Hesselbach’s triangle, MEDIAL to inferior epigastric vessels. (tends to be acquired).
Indirect inguinal hernia goes through deep inguinal ring, LATERAL to inferior epigastric vessels. (tends to be congenital). MORE COMMON. (The inferior epigastric arteries are medial to the deep inguinal ring).

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4
Q

How can you quickly distinguish between a femoral and inguinal hernia on examination?

A

Femoral hernias are below and lateral to pubic tubercle.

Inguinal hernias are above and medial to pubic tubercle.

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5
Q

What is a mesentery?

A

A fold in the peritoneum which holds the GI tract in place. There is a ventral mesentery for proximal regions of the gut tube and a dorsal mesentery along the entire length of the system.

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6
Q

What are intraperitoneal structures?

A

Ones which are suspended from the abdominal wall by mesenteries.

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7
Q

What are retroperitoneal structures?

A

Ones which aren’t suspended by a mesentery and lie between the parietal peritoneum and abdominal wall. These include the kidneys and ureters.

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8
Q

What does the large intestine consist of?

A

The colon, caecum, appendix, rectum and anal canal.

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9
Q

Describe the perfusion of the colon.

A

Middle colic artery perfuses ascending and first 2/3 of transverse colon.
Inferior mesenteric artery perfuses distal 1/3 of transverse colon, descending and sigmoid colon and rectum.

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10
Q

What are the arcuate ligaments?

A

Median arcuate ligament: crosses the aorta and is continuous with the crus on either side.
Medial arcuate ligament crosses psoas major muscle and attaches the crura to the transverse process of L1.
Lateral arcuate ligament crosses the quadratus lumborum muscle and attaches the transverse process of L1 to rib 12.

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11
Q

Which bones form the pelvic inlet?

A

The sacrum posteriorly.
The pubic symphysis anteriorly.
Bony rim on pelvic bone laterally.

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12
Q

What is the lesser omentum?

A

A double-layer of peritoneum connecting the lesser curvature of the stomach and first part of the duodenum to the liver.

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13
Q

What is the omental foramen?

A

A small opening connecting the omental bursa (lesser sac) to the greater sac.

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14
Q

What is the transpyloric plane?

A

A horizontal plane which transects the body through the lower aspect of vertebra L1.
It is about midway between the jugular notch and the pubic symphysis.
It crosses the costal margin on each side at the 9th CC.

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15
Q

What anatomically significant things are at the level of the transpyloric plane?

A

The opening of the stomach into the duodenum (pyloric orifice), just to the right of L1.
Crosses through the neck of the pancreas.
Approximates the position of the hila of the kidneys; the inferior aspect of the left hilum and superior aspect of the right hilum (since left kidney sits slightly higher).
Origin of SMA.

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16
Q

What are the 3 major arteries which supply the GI tract?

A

Coeliac artery, branching from the AA at the upper border of L1 and supplies the foregut.
Superior mesenteric artery, from the lower border of L1 and supplies the midgut.
Inferior mesenteric artery, from LIII and supplying the hindgut.

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17
Q

Give the important venous shunts from left to right (since the IVC lies to the right of the vertebral column).

A

Left renal vein, draining the left kidney, left adrenal and left gonad.
Left common iliac, crosses at L5 to merge with right common iliac and form the IVC.
Left lumbar, draining the back and posterior abdominal wall on the left side.

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18
Q

What is significant about portal hypertension?

A

There are anastomoses between portal and systemic venous drainage, concentrated around the inferior end of the oesophagus, inferior part of the rectum and the umbilicus.
Portal hypertension causes these veins to enlarge and blood to skip the liver and enter the caval system.
Leads to oesophageal and rectal varices and caput medusae (umbilical veins enlarged and visible).

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19
Q

What is the origin, insertion and function of the pyramidalis muscle?

A

Origin: pubic symphysis
Insertion: linea alba
Function: tenses linea alba

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20
Q

What is the origin, insertion and function of the rectus abdominis muscle?

A

Origin: pubic crest, pubic tubercle and pubic symphysis.
Insertion: costal cartilages of ribs 5-7; xiphoid process
Function: compresses abdomen; flex vertebral column

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21
Q

What separates the transversalis fascia from the parietal peritoneum?

A

Extraperitoneal fascia.

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22
Q

What is the superficial fascia split into?

A

A fatty layer (Camper’s), and a membranous layer deep to this (Scarpa’s).

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23
Q

What is the greater omentum?

A

An apron-like peritoneal fold which attaches to the greater curvature of the stomach and the first part of the duodenum.

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24
Q

What is the lesser omentum divided into?

A

A medial hepatogastric ligament, which passes between the stomach and liver.
A lateral hepatoduodenal ligament, which passes between the duodenum and liver.
The hepatoduodenal ligament ends laterally as a free margin and serves as the anterior border of the omental foramen.

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25
Q

Which parts of the colon are intraperitoneal and which parts are retroperitoneal?

A

Intraperitoneal: transverse and sigmoid colon.

(Secondarily) retroperitoneal: ascending and descending.

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26
Q

What are the main branches of the superior mesenteric artery?

A

Middle colic, right colic, ileocolic, ileal and jejunal arteries.

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27
Q

Where do the midgut and hindgut begin?

A

Foregut extends from distal 3rd of oesophagus to 2nd part of duodenum at entrance of bile duct.
Midgut: 2nd part of duodenum to 2/3 along transverse colon.
Hindgut: distal 1/3 of transverse colon to rectum.

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28
Q

What attaches the liver to the anterior abdominal wall and to the stomach?

A

Attached to anterior abdominal wall by falciform ligament.

Attached to stomach by the hepatogastric ligament of the lesser omentum.

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29
Q

Give the divisions of the thoracic splanchnic nerves.

A

Greater splanchnic nerves arise from T5-T9
Lesser splanchnic nerves arise from T10, T11
Least splanchnic nerves arise from T12.

30
Q

Describe the location and lengths of the different sections of duodenum.

A

1st part: 5cm long (first 2cm is intraperitoneal (has a mesentery)). L1.
2nd part: 7-10cm. Right of L1-L3 (descending).
3rd part: 6-8m. Crosses L3
4th part: 5cm. To L2 (ascending).

31
Q

Describe the location of the pancreas.

A

Head, neck and uncinate process lie in “G” of duodenum, anterior to IVC.
Body extends to left across the aorta to left kidney.
Tail extends from kidney to spleen and is intraperitoneal (in a dorsal foregut mesentery).

32
Q

What is the part of the greater omentum between the greater curve of the stomach and front of the transverse colon called?

A

Gastrocolic ligament.

33
Q

Give the basic anatomical position of the spleen.

A

Posterior on the left side, under ribs 9 - 11.

34
Q

Define dermatome.

A

Area of skin supplied by a single spinal nerve.

35
Q

Pain from which viscera is referred to the epigastric region and why?

A

Pain from foregut structures (as far as duodenal papilla, stomach, pancreas, liver, gall bladder).
Since epigastric region supplied by T7/8

36
Q

Pain from which organs is referred to the umbilical region?

A

Midgut structures, from duodenal papilla to hepatic flexure, including appendix.

37
Q

Why might pain from appendicitis move from its referred region (umbilical) to right inguinal region?

A

When the inflammation spreads to the surrounding peritoneum, the pain becomes localised and constant.

38
Q

Give the arterial supply of the rectum.

A

Superior rectal artery from IMA.
Middle rectal artery from the internal iliac artery.
Inferior rectal artery from the internal pudendal artery (from the internal iliac artery).

39
Q

What do the anterior and posterior coronary ligaments of the liver demarcate?

A

The position of the bare area of the liver: these ligaments are reflections of visceral peritoneum. They come together laterally to form the left and right triangular ligaments.

40
Q

Describe the quadrate lobe.

A

Visible on anterior part of visceral part of liver and is bounded on the left by the fissure for the ligamentum teres and on the right by the fossa for the gallbladder. Functionally related to left lobe of the liver.

41
Q

Describe the caudate lobe.

A

Visible on the posterior part of the visceral surface of the liver. Bounded on the left by the fissure for the ligamentum venosum and on the right by the groove for the IVC. Functionally, separate from right and left lobes of the liver.

42
Q

What is the minor duodenal papilla?

A

Where the accessory pancreatic duct enters the duodenum, found just above the major pancreatic duct.

43
Q

What are the branches of the gastroduodenal artery?

A

Posterior superior pancreaticoduodenal artery.

Then bifurcates into right gastroepiploic artery and anterior superior pancreaticoduodenal artery.

44
Q

How does the splenic artery reach the spleen and how do the short gastric arteries reach the stomach?

A

The splenic artery passes through the splenorenal ligament.

The short gastric arteries pass through the gastro-splenic ligament to supply the fundus of the stomach.

45
Q

What is the first branch of the SMA?

A

Inferior pancreaticoduodenal artery, splits into anterior inferior pancreaticoduodenal and posterior inferior pancreaticoduodenal arteries which anastomose with their superior counter-parts to supply the head and uncinate process of the pancreas and the duodenum.

46
Q

The merger of which two veins forms the hepatic portal vein?

A

Superior mesenteric and splenic veins.

47
Q

Give 3 important sites of porto-systemic anastomoses.

A

The gastro-oesophageal junction around the cardia of the stomach (tributaries with azygos system).
The anus - superior rectal vein with the inferior and middle rectal veins.
The anterior abdominal wall around the umbilicus. The para-umbilical veins anastomose with veins of the anterior abdominal wall.

48
Q

Describe lymph drainage in the abdomen.

A

End as coeliac, superior mesenteric and inferior mesenteric groups of pre-aortic lymph nodes. All drain into superior groups: coeliac nodes drain into cisterna chyli.

49
Q

How many paravertebral ganglia are usually present in each section of the sympathetic trunks?

A 
Three in cervical region.
Eleven or twelve in thoracic region.
Four in lumbar region.
Four or five in sacral region.
Ganglion impar anterior to the coccyx.
50
Q

What is unique about the pelvic splanchnic nerves?

A

They are the only splanchnic nerves to carry parasympathetic fibres: they don’t originate from the sympathetic trunk but originate directly from the anterior rami of S2 - S4.
Preganglionic parasympathetic fibres pass to the inferior hypogastric plexus.

51
Q

What are the 3 major divisions of the abdominal prevertebral plexus?

A

Coeliac plexus - from median arcuate ligament to the origin of the SMA.
Aortic plexus - just below origin of SMA to bifurcation into the two common iliac arteries.
Superior hypogastric plexus - final part before the prevertebral plexus continues into pelvic cavity (to become inferior hypogastric plexus).

52
Q

What supplies the parasympathetic innervation to hindgut, foregut and midgut?

A

Foregut and midgut supplies by Vagus nerve.

Hindgut supplied by the pelvic splanchnic nerves.

53
Q

How can you distinguish a lumbar vertebra?

A

The vertebral bodies are larger than the vertebrae in any other region and increase in size from L1 to L5.
The pedicles are short and stocky.
The transverse processes are long and slender.

54
Q

What anchors the diaphragm to the lumbar vertebrae?

A

The crura.
The right crus is the longest and broadest and is attached to the bodies of L2 and L3 and the intervertebral disc.
The left crus is attached to the bodies of L1 and L2 and the associated intervertebral disc.

55
Q

What are the ascending lumbar veins?

A

Long, anastomosing venous channels which connect the common iliac, iliolumbar and lumbar veins with the azygos and hemi-azygos veins of the thorax.

56
Q

Describe the location of the cisterna chyli.

A

Posterior to the right side of the abdominal aorta, anterior to the bodies of vertebrae L1 and L2.

57
Q

Which trunks form the cisterna chyli?

A 
Intestinal trunk (formed by pre-aortic nodes).
Right and left lumbar trunks (formed by lateral aortic/ lumbar nodes).
58
Q

Where do major abdominal blood vessels arise?

A

The coeliac trunk originates from the aorta at the upper border of the L1 vertebra.
The SMA originates at lower border of L1 vertebra (transpyloric plane).
The renal arteries originate at approx. L2 vertebra.
The IMA originates at L3.
The aorta bifurcates at L4.
The left and right common iliac veins join to form IVC at L5.

59
Q

What is McBurney’s point?

A

1/3 of the way up along a line from the right ASIS to the umbilicus. Used to surface mark the position of the appendix.

60
Q

How does the rectus abdominis muscle assist with respiration?

A

It depresses the rib cage on expiration.

61
Q

Describe the layers of fascia covering the spermatic cord.

A 
External spermatic fascia, derived from external oblique aponeurosis.
Middle spermatic (cremasteric) fascia, derived from internal oblique muscle.
Internal spermatic fascia from the transversalis fascia.
62
Q

What are the linea semilunaris?

A

Tendinous intersections found at the lateral border of the rectus abdominis muscle, extending from the 9th costal cartilage to the pubic tubercle, formed by the aponeurosis of the internal oblique to enclose the rectus.

63
Q

What is the deep inguinal ring?

A

A gap in the transversalis fascia found 1cm above inguinal ligament.

64
Q

Give the layers of the abdominal wall from superficial to deep.

A

Skin
Superficial fascia (Camper’s - fatty layer; Scarpa’s - membranous layer)
Muscles
Transversalis fascia
Extraperitoneal fascia
Peritoneum
The muscles has deep fascia on their anterior and posterior surfaces but these are unremarkable, except the more developed transversalis fascia.

65
Q

What forms the inguinal ligament?

A

Lower border of external oblique aponeurosis.

66
Q

How can the contraction of abdominal wall muscles increase intraabdominal pressure to help with defecation, voiding the bladder and childbirth (as opposed to breathing)?

A

Closing the epiglottis in the larynx to prevent air from escaping the lungs.

67
Q

What does the transverse mesocolon divide the greater sac into?

A

A supracolic and an infracolic compartment.

68
Q

How does the dorsal mesentery of the small intestine further divide the infracolic compartment of the greater sac?

A

Divides it into left and right infracolic compartments.

69
Q

What connects the supracolic and infracolic compartments, and in which direction does peritoneal fluid usually flow?

A

The left and right paracolic gutters.

Fluid usually flows upwards towards the diaphragm.

70
Q

Describe the passage of preganglionic sympathetic fibres destined for abdominopelvic organs.

A

Pass through paravertebral ganglia without synapsing. Pass via the splanchnic nerves to prevertebral ganglia and associated plexuses where they all synapse except fibres destined for adrenals. They then run with the arteries to the effector organs.

71
Q

Where would you mark the surface position of the gall bladder?

A

Where the transpyloric plane meets the right MCL (the tip of the right 9th CC/ where the lateral border of the rectus abdominus muscle crosses the costal margin).

72
Q

Describe how you would surface mark the kidneys.

A

Draw the transpyloric plane on the posterior abdominal wall.
Medial border (hilum) marked 4-5cm from posterior median line.
Kidney likely to be 5-7cm broad and 9-12cm long.
Superior poles covered posteriorly by 12th ribs.
Inferior poles are 3-4cm above iliac crests.
Ureters descend almost vertically from the hila into the iliac fossae.

Anatomy (8 decks)

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