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1 GI and liver > anatomy of the abdominal wall and peritoneum > Flashcards

anatomy of the abdominal wall and peritoneum Flashcards

1
Q

what are the borders of the abdominal wall?

A

superior - the xiphoid process of the sternum & coastal cartilages

inferior - iliac crest & public bones of the pelvis

anterior - the abdominal muscles

posterior - the spine

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2
Q

what are the lines dividing the abdominal area?

A

midclavicular x2
transpyloric plane
inter-tubercular plane

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3
Q

what are the 9 abdominal regions?

A

TOP 1/3
right hypochondriac, epigastric, left hypochondriac

MID 1/3
right lumbar/flank, umbilical, left lumbar/flank

BOTTOM 1/3
right iliac, hypogastric/suprapubic, left iliac

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4
Q

where is the transpyloric plane (of Addison)

A
  • Midway between the pubic synthesis and the jugular notch
  • Runs from the tip of the 9th costal cartilage
  • at approximately the level of L1 vertebral body
  • it is the point where the midclavicular line crosses the costal margin?
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5
Q

where is McBurney’s point?

A
  • between the umbilicus and the anterior superior iliac spine (ASIS) on right side
  • it lies 2 thirds of the way along this line, over the iliac fossa.
  • It is where the base of the appendix usually lies (tender in acute appendicitis)
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6
Q

what are the 4 layers of the abdominal wall?

A
  • Skin
  • Superficial fascia: Fatty connective tissue
  • Muscles and associated fascia
  • Parietal peritoneum
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7
Q

how many Anterior abdominal wall muscles are there?

A
  • 3 Pairs of flat muscles

- 2 pairs of vertical muscles

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8
Q

name the 3 flat muscles of the anterior abdominal wall?

A
  • external oblique
  • internal oblique
  • transversus abdominis
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9
Q

where does the external oblique originate and insert?

A

originates from lower ribs (5-12)

insertions

  • iliac crest
  • pubic bone (crest, symphysis, tubercle)
  • becomes aponeruiosis ( xiphoid process and the linea alba)
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10
Q

what are the functions of the external and internal obliques?

A
  1. Contralateral rotation of the torso.
  2. flexion of the trunk
  • Bilateral contraction of EO, rectus abdominis and IO - this flexes the trunk by drawing the pubis towards the xiphoid (like in crunches or sit-ups)
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11
Q

where does the internal oblique originate and insert?

A

ORIGINS:

  • the inguinal ligament,
  • iliac crest
  • the lumbodorsal fascia

INSERTIONS:

  • ribs 10-12,
  • costal cartilages,
  • becomes Aponeurosis: Xiphoid process, pubic tubercle, linea alba, pubic synthesis
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12
Q

which of the flat muscles is deepest? which is largest?

A

EO - largest
IO - deep to EO, smaller and thinner
transversus abdominis - deepest

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13
Q

what direction to each of the flat muscles fibres run?

A

EO - ‘hands in pockets’ inferomedially
IO - superomedially, perpendicular to EO
transversus abdominis - horizontally

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14
Q

what is the innervation of the flat muscles?

A
  • Thoracoabdominal nerves (T7-T11)
  • subcostal nerve (T12).

IO and transversus abdominis:
- additionally innervated by branches of the lumbar plexus.

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15
Q

what is the function of the transversus abdominis?

A

Compression of abdominal contents.

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16
Q

what are the origins and insertions of the transversus abdominis?

A

origins - the inguinal ligament, costal cartilages 7-12, the iliac crest and thoracolumbar fascia.

insertions - the conjoint tendon. Aponeurosis: Xiphoid process, pubic tubercle, linea alba, pubic synthesis

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17
Q

what is the aponeurosis in the anterior abdominal wall?

A
  • each flat muscle forms an aponeurosis (broad flat tendon tissue that anchors muscles) near to midclavicular line
  • aponeurosis of each flat muscles connects with its pair on other side of midline
  • the aponeurosis covers the vertical rectus abdominis muscle
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18
Q

what is the white central line extending from the xiphoid process of the sternum to the pubic symphysis called? what is it made of?

A
  • the linea alba
  • a fibrous structure
  • formed from the aponeuroses of all the flat muscles where they meet in the midline
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19
Q

name the 2 vertical muscles

A
  1. rectus abdominis

2. pyramidalis

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20
Q

what are the origins and insertions of the rectus abdominis?

A

origins - pubic crest

insertions - xiphoid process, costal cartilage of ribs 5-7

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21
Q

what are the origins and insertions of the pyramidalis?

A

origins - pubic crest and pubic symphysis

insertions - the linea alba

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22
Q

what is the function of the rectus abdominis?

A
  • compressing the abdominal viscera,
  • stabilises the pelvis during walking,
  • depresses the ribs
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23
Q

what is the function of the pyramidalis?

A

to tense the linea alba.

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24
Q

what is the innervation for the vertical muscles?

A

rectus abdominis - Thoracoabdominal nerves (T7-T11).

pyramidalis - Subcostal nerve (T12).

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25
Q

which is the bigger of the vertical muscles? describe their shapes?

A

rectus abdominis - long, paired muscle, found either side of the midline in the abdominal wall

pyramidalis- small triangular muscle, found superficially to the rectus abdominis.

26
Q

what is thelinea semilunaris?

A

surface marking created by the lateral borders of the rectus abdominis muscles

27
Q

what is the blood supply to the vertical muscles?

A

Inferior epigastric arteries (+ superior for pyramidalis)

28
Q

what makes up the ‘6 pack’?

A

The rectus abdominis muscle, the tendinous intersections of this muscle, and the linea alba

29
Q

what muscles is the rectus sheath formed from?

A

the aponeuroses of the 3 flat muscles (EO,IO,transversus abdominis)

30
Q

what muscles does the rectus sheath enclose?

A

the 2 vertical muscles ( rectus abdominis, pyramidalis)

31
Q

describe the rectus sheath layers in the upper 2/3 of the abdomen?

A

The anterior wall - is formed by the aponeuroses of the external oblique, and of half of the internal oblique. (1.5 layers)

The posterior wall- is formed by the aponeuroses of half the internal oblique and of the transversus abdominis.
(1.5 layers)

anterior/posterior to rectus abdominis muscle (enclosed)

32
Q

describe the rectus sheath layers in the lower 1/3 of the abdomen?

A

anterior wall - formed by all the aponeuroses (EO,IO,transversus abdominis)

posterior wall - none (in direct contact with the transversalis fascia)

33
Q

what line divides the upper 2/3 from the lower 1/3 of the abdomen?

A

the arcuate line

  • Approximately midway between the umbilicus and the pubic symphysis
34
Q

what arteries supply the abdominal wall?

A
  • epigastric (sup + inf)
  • segmental lumbar arteries
  • Intercostal arteries
35
Q

what veins drain the abdominal wall?

A
  • Intercostal veins drain into the azygos system
  • Lumbar veins drain to the veins of the posterior abdominal wall and the azygos system
  • Superior and inferior epigastric veins drain to subclavian and femoral veins respectively
36
Q

what is the peritoneum?

A

a continuous membrane which lines the abdominal cavity and covers the abdominal organs

37
Q

what is the role of the peritoneum?

A
  • support the viscera/organs

- providespathways for blood vessels and lymph to travel to and from the viscera.

38
Q

what are the 2 layers to the peritoneum?

A
  • visceral (lines the organs)

- parietal (lines the wall)

39
Q

what epithelium lines the peritoneum?

A
  • simple squamous epithelial cells
  • called mesothelium
  • same for both layers
40
Q

what derived the 2 layers of the peritoneum in the embryo?

A

pariteal - somatic mesoderm

visceral - splanchnic mesoderm

41
Q

what is the nerve supply of the parietal peritoneum? how does this affect pain sensation?

A
  • same somatic nerve supply as the region of the abdominal wall is lines
  • so well localised pain
42
Q

what is the nerve supply of the visceral peritoneum? how does this affect pain sensation?

A

has the sameautonomicnerve supply as the viscera it covers

  • pain is poorly localised
  • pain is referred to dermatomes
43
Q

what are the 2 functions of the peritoneal cavity (potential space)?

A
  • the peritoneal fluid acts as a lubricant to enable free movement of abdominal viscera/organs ]
  • contains antibodies to fight infection
44
Q

what are intraperitoneal organs?

give examples

A
  • if they are enveloped by visceral peritoneum anteriorly and posteriorly
    eg. stomach,spleen,liver
45
Q

what are retroperitoneal organs?

A
  • when organs are not covered in visceral peritoneum

- only parietal peritoneum on their anterior surface

46
Q

what is the difference between primary and secondary retroperitoneal organs?

A

primary - developed as retroperitoneal (oesophagus, rectum and kidneys)

secondary - initially intraperitoneal (ascending and descending colon)

47
Q

what abdominal organs are retroperitoneal ?

A

SAD PUCKER

Suprarenal glans (adrenal)
Aorta & IVC 
Duodenum 
Pancreas 
Ureters 
Colon (asc,desc) 
Kidneys 
Eosophagus 
Rectum
48
Q

what is a mesentery?

A

= double layer of visceral peritoneum

49
Q

what are the roles of the mesenteries?

A

connects intraperitoneal organs to posterior abdominal wall

carries blood vessels, nerves, lymphatics

absorbs nutrients

50
Q

what organ is the main mesentery connected to?

A
  • the small intestine
51
Q

what is an omentum?

A

omenta =

  • sheets of visceral peritoneum
  • that extend from thestomach and proximal part of the duodenum to other abdominal organs.
52
Q

what is the role of the GREATER omentum?

how many layers is it?

A

= 4 visceral peritoneum layers

  • attaches to GREATER curvature of stomach + proximal duodenum + transverse colon
  • migrates to infected viscera
  • contains lots of lymph’s and vessels
53
Q

what is the role of the LESSER omentum?

what are its attachments?

A

= a double layer of visceral peritoneum (smaller then great)

  • attaches from thelesser curvatureof the stomach and the proximal part of the duodenum to the liver.
54
Q

what 2 ligaments does the lesser omentum contain?

A
  1. the hepatogastric ligament
    (flat broad sheet)
  2. the hepatoduodenal ligament
    (free edge)
55
Q

what important vessels does the lesser omentum contain?

what organ do they supply?

A

the portal triad

  • hepatic artery
  • portal vein
  • bile dict

within the hepatoduodenal ligament (the free edge)

provides blood suppply to liver

56
Q

what is a peritoneal ligament?

A
  • the double fold of peritoneum that connects the viscera to another viscera or the abdominal wall
57
Q

what is the falciform ligament?

A
  • sickle shaped
  • attaches anterior surface of liver to anterior abdominal wall
  • its free edge contains the ligamentum teres
58
Q

what is the ligamentum teres ?

A

a remanent of the umbilical vein (oxygenated blood from placenta to fetus)

on the free edge of the falciform ligament

59
Q

what is the urachus?

A
  • fibrous cord

- remnant of a channel between the bladder and the umbilicus

60
Q

what is a dermatome?

A
  • area of skin
  • which is supplied by the same sensory ganglia and spinal cord segments as the nerve fibres innervating the viscera

eg. Irritation of thediaphragm(e.g. as a result of inflammation of the liver, gallbladder or duodenum) may result inshoulder tip pain.

1 GI and liver (6 decks)

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