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GI anatomy > Anterior Abdominal Wall And Peritoneal Cavity > Flashcards

Anterior Abdominal Wall And Peritoneal Cavity Flashcards

1
Q

What separated the abdomen and thorax

A

Diaphragm

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2
Q

What does the abdominal cavity contain

A

Gastrointestinal tract
Hepatobiliary system
Urinary system
Endocrine system
Spleen
Great vessels

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3
Q

What does the gastrointestinal tract contain

A

Stomach
Small and large intestine

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4
Q

What does the hepatobiliary system contain

A

Liver
Gallbladder

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5
Q

What does the urinary system contain

A

Kidney
ureters

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6
Q

What does the abdominal endocrine system contain

A

Pancreas
Adrenal glands

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7
Q

Great vessels of the abdomen

A

Abdominal aorta
Inferior vena cava

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8
Q

What are the abdominal walls composed of

A

Skin
Subcutaneous tissue
Muscles and their associated aponeuroses (flat tendons)

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9
Q

Aponeuroses

A

Flat tendons- anteriorly the muscles of the abdominal wall become apneurotic
Fibres of the 3 fuse together and in the midline they fuse with those on the opposite side forming a tough midline raphe (linea alba)
Also form the rectus sheath

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10
Q

How many lumbar vertebrae are there

A

5

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11
Q

Functions of the abdominal wall

A

Protect abdominal viscera
Increases intra-abdominal pressure eg for defecation and childbirth
Maintain posture and move the trunk

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12
Q

What is the internal aspect of the abdominal wall lined with

A

Parietal peritoneum - serous membrane

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13
Q

Key bony landmarks of abdominal cavity

A

• Xiphisternum
• Costal margin
• Iliac crests
• Anterior superior iliac spines (ASIS)
• Pubic tubercles
• Pubic symphysis (a fibrocartilaginous joint).

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14
Q

Four quadrants of the abdomen

A

Left and right upper and lower quadrants

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15
Q

Vertical line of abdomen

A

Runs down the midline through the lower sternum, umbilicus and Punic symphysis

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16
Q

Horizontal line of abdomen

A

Runs through umbilicus

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17
Q

4 imaginary lines that divide abdomen into 9 regions

A

Right and left mid clavicular lines
Subcostal line
Intertubercular line

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18
Q

Right and left midclavicular lines

A

Extend vertically from midclavicular point to mid-inguinal point (halfway between anterior superior iliac spine and pubic tubercle)

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19
Q

Subcostal line

A

Horizontal line drawn through the inferior-most parts of the right and left costal margins (10th costal cartilage)

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20
Q

Which costal cartilage does the Subcostal line run through

A

10th

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21
Q

Intertubercular line

A

Horizontal line through the tubercles of the right and left iliac crests and body of L5

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22
Q

Which lumbar vertebra does the intertubercular line run through

A

L5

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23
Q

9 regions of abdominal wall
(Starting at top going right to left)

A

Right hypochondrium
Epigastrium
Left hypochondrium

Right flank
Umbilical region
Left flank

Right iliac fossa
Suprapubic region
Left iliac fossa

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24
Q

Transpyloric plane position

A

Horizontal line that passes through tips of right and left 9th costal cartilages
Lies half away between superior border of manubrim and pubic symphysis

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25
Q

Transpyloric plane transects

A

Pylorus of stomach
Gallbladder
Pancreas
Hila of kidneys

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26
Q

Transumbilical plane

A

Position varies depending on amount of subcutaneous fat present
Lie approximately at level of L3

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27
Q

Intercristal plane

A

horizontal line drawn between the highest points of the right and left iliac crests.
It cannot be palpated from the anterior aspect of the abdominal wall
It is used to guide procedures on the back (e.g. lumbar puncture).

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28
Q

McBurney’s point

A

Surface marking of the base of the appendix
Lies 2/3 of the way along a line drawn for the umbilicus to right anterior superior iliac spine

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29
Q

How many pairs of muscles comprise the anterolateral abdominal wall

A

4

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30
Q

4 pairs of muscles in anterolateral abdominal wall

A

External oblique
Internal oblique
Transversus abdominis
Rectus abdominis

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31
Q

Orientation of fibres in external oblique muscle

A

Diagonally - medially and inferiorly

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32
Q

Orientation of fibres in internal oblique muscles

A

Diagonally - medially and superiorly

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33
Q

Orientation of fibres in transversus abdominis muscles

A

Horizontally

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34
Q

Orientation of fibres in rectus abdominis muscles

A

Straight

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35
Q

Left and right rectus abdominis muscles

A

Lie either side of midline and either side of the linea alba
Attached to sternum and costal margin superior,y and pubis inferiorly

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36
Q

What is the rectus abdominis surrounded by

A

Aponeurotic rectus sheath

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37
Q

Order of sheets of muscle fibres in abdominal wall
Superficial to deep

A

External oblique
Internal oblique
Transversus abdominis

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38
Q

Role of 3 muscles in abdominal walls

A

When contract together increases intra-abdominal pressure

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39
Q

Role of oblique muscles when contract alone

A

Act as lateral flexors of the lumbar spine

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40
Q

What is rectus sheath composed of

A

aponeuroses of external oblique, internal oblique and Transversus abdominis

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41
Q

Linea alba

A

A tough midline raphe (seam) where all fibres of aponeuroses fuse

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42
Q

Composition of rectus abdominis muscle

A

Muscle segments interspersed with horizontal tendinous bands

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43
Q

Function of rectus abdominis

A

When the muscle segments hypertrophy with exercise, they bulge either side of the tendinous bands and can be seen on the anterior abdominal wall as bulges – the ‘six-pack’.
Rectus abdominis is a flexor of the lumbar spine.

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44
Q

What forms the anterior wall of the rectus sheath

A

EO aponeurosis and anterior layer of IO aponeurosis

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45
Q

What form the posterior wall of the rectus sheath

A

Posterior layer of the IO aponeurosis
Transversus abdominis aponeurosis

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46
Q

Transversalis fascia position

A

Lies deep to transversus abdominis
Lies superficial to parietal peritoneum

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47
Q

Inguinal ligament

A

most inferior part of the external oblique aponeurosis is attached to the anterior superior iliac spine laterally and the pubic tubercle medially, forming the inguinal ligament.

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48
Q

Which arteries supply the anterolateral abdominal wall

A

Musculophrenic artery
Superior epigastric artery
Inferior epigastric artery

All accompanied by deep veins

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49
Q

Musculophrenic artery

A

Branch of internal thoracic

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50
Q

Superior epigastric artery

A

Continuation of internal thoracic
Descends in rectus sheath

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51
Q

Inferior epigastric artery

A

Branch of external iliac artery
Ascends in the rectus sheath and anastomoses with the superior epigastric

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52
Q

When nerves innervate the anterolateral abdominal wall

A

Thoraco-abdominal nerves T7-T11
Subcostal nerve
Iliohypogastric and ilioinguinal nerves

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53
Q

Thoraco-abdominal nerves

A

T7-T11
Continuation of intercostal nerves
Somatic nerves contain sensory and motor fibres

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54
Q

Subcostal nerve

A

Originates from T12 spinal nerve
Runs along inferior border of 12th rib

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55
Q

Iliohypogastric and ilioinguinal nerves

A

Branches of L1 spinal nerve

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56
Q

Inguinal canal

A

Oblique passageway through the muscles of the anterior abdominal wall
Lies superior to the medial Healy of the Inguinal ligament
Passes through each layer of the abdominal wall as it r]travels medially and inferiorly

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57
Q

Length of Inguinal canal

A

5cm

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58
Q

What does the Inguinal canal extend from and to

A

Deep Inguinal ring laterally (an aperture in the transversalis fascia) to the superficial Inguinal ring medially (an aperture in the external oblique aponeurosis)

59
Q

Anterior border of the Inguinal canal

A

External oblique aponeurosis
Laterally only: internal oblique aponeurosis

60
Q

Posterior border of the Inguinal canal

A

Transversalis fascia
Medially only: medial fibres of the aponeuroses of the internal oblique and transversus abdominis

61
Q

Roof of the Inguinal canal

A

Transversalis fascia
Arching fibres if the internal oblique and transversus abdominis

62
Q

Floor of the Inguinal canal

A

Inguinal ligament (the lower border of the external oblique aponeurosis)

63
Q

Conjoint tendon

A

medial fibres of the aponeuroses of the internal oblique and transversus abdominis

64
Q

Abdominal wall hernias

A

A hernia is an abnormal protrusion of tissues or organs from one region into another through an opening or defect. Herniae of the anterior abdominal wall may occur if the muscles are weak or have been incised during surgery. A segment of the small intestine may protrude through a defect in the wall, forming a visible and palpable lump under the skin.

65
Q

Laparotomy

A

This term describes the surgical opening of the anterior abdominal wall, undertaken for major operations where good access to the abdomen is needed. A midline sagittal incision of the linea alba involves minimal risk to nerves and muscles. Ideally, muscles are split, rather than cut. Where possible, keyhole surgery (laparoscopy) is performed, as it is associated with less post-operative pain, faster wound healing and a smaller risk of wound infection and post-operative hernia.

66
Q

Abdominal aortic aneurysm (AAA)

A

This is an abnormal swelling of the wall of the aorta. The affected portion of the wall becomes distended, but it is weak and prone to rupture. An aneurysm may be detected on abdominal examination, felt as a pulsatile mass in the midline of the abdomen. Examination of the abdomen must always include palpitation of the aorta, as detection can be lifesaving. Sudden rupture of an AAA carries an extremely high mortality rate.

67
Q

Inguinal hernia

A

An inguinal hernia is a protrusion of abdominal contents (normally part of the greater omentum or loops of small intestine) through the anterior abdominal wall into the inguinal canal. Inguinal hernias are indirect or direct.

68
Q

Indirect Inguinal hernia

A

In an indirect inguinal hernia, intra-abdominal contents are forced through the deep inguinal ring and into the canal. The abdominal contents may even be forced along the canal and through the superficial ring. From here, the hernia may extend into the scrotum in males or into the labia majora in females. Indirect hernias are more common than direct hernias. They are more likely to get stuck in the canal and become ‘irreducible’. Potentially, herniated tissue can ‘strangulate’ and become ischaemic. This is a surgical emergency.

69
Q

Direct Inguinal hernia

A

In a direct inguinal hernia, intra-abdominal contents are forced through the posterior wall of the inguinal canal (i.e. the relatively weak transversalis fascia) and directly through the superficial ring. The herniated abdominal contents do not pass through the deep inguinal ring in direct inguinal hernias. Although they are less common than indirect hernias, direct inguinal hernias are often easier to reduce.

70
Q

Which is more common an indirect or direct Inguinal hernia

A

Indirect

71
Q

Peritoneum

A

A serous membrane that lines the abdominal wall and covers the viscera within it
Parietal and visceral peritoneum continuous with each other

72
Q

Parietal peritoneum

A

Lines abdominal wall
Can be seen with the naked eye

73
Q

Innervation of parietal peritoneum

A

Somatic nerves that supply the overlying muscles and skin

74
Q

Pain from the parietal peritoneum

A

Usually sharp, severe and well localised to the abdominal wall

75
Q

Visceral peritoneum

A

Covers abdominal viscera

76
Q

Innervation of visceral peritoneum

A

Visceral sensory nerves

77
Q

Pain from the visceral peritoneum

A

Can be severe
Usually dull and diffuse
May be perceived as nausea or distension

78
Q

Peritoneal cavity

A

A thin film of peritoneal fluid lies in it- allows viscera to slide freely alongside each other

79
Q

Intraperitoneal viscera

A

almost completely covered by peritoneum e.g. the stomach

80
Q

Retroperitoneal viscera

A

posterior to the peritoneum, hence only covered by peritoneum on their anterior surface e.g. the pancreas and abdominal aorta.

81
Q

Secondarily retroperitoneal viscera

A

These organs were intraperitoneal in early development but came to be ‘stuck down’ onto the posterior abdominal wall.

82
Q

Mesenteries

A

Folds of peritoneum that contain fat and suspend the small intestine and parts of the large intestine from the posterior abdominal wall

83
Q

What are embedded in the mesenteries

A

Arteries that supply the intestine (from the abdominal aorta) and veins that drain the gut (tributaries of the portal venous system)

84
Q

Greater and lesser omenta

A

Folds of peritoneum that are usually fatty and connect the stomach to other organs

85
Q

Greater omentum

A

hangs from the greater curvature of the stomach and lies superficial to the small intestine

86
Q

Lesser omentum

A

connects the stomach and duodenum (the first part of the small intestine) to the liver. The hepatic artery, the hepatic portal vein, and the bile duct (the ‘portal triad’) are embedded within its free edge.

87
Q

Portal triad

A

Hepatic artery
Hepatic portal vein
Bile duct

88
Q

Ligaments

A

Folds of peritoneum that connect organs to each other or to the abdominal wall

89
Q

Falciform ligament

A

connects the anterior surface of the liver to the anterior abdominal wall

90
Q

Coronary and triangular ligaments

A

connect the superior surface of the liver to the diaphragm.

91
Q

Peritoneal folds

A

raised from the internal aspect of the lower abdominal wall and are created by the structures they overlie, like carpet running over a cable. Sometimes they are difficult to see.

92
Q

Median umbilical fold

A

lies in the midline and represents the remnant of the urachus, an embryological structure that connects the bladder to the umbilicus.

93
Q

Medial umbilical folds

A

• Lateral to the median umbilical fold lie the medial umbilical folds. These represent the remnants of the paired umbilical arteries, which returned venous blood to the placenta in foetal life.

94
Q

Lateral umbilical folds

A

Lateral to the medial umbilical folds are the lateral umbilical folds. The inferior epigastric arteries lie deep to these peritoneal folds. They supply the anterior abdominal wall.

95
Q

Order of peritoneal folds

A

Median —> medial —> lateral

96
Q

2 regions of peritoneal cavity

A

Greater and lesser sac

97
Q

Lesser sac/ omental bursa

A

Smaller
Space that lies posterior to the stomach and anterior to the pancreas

98
Q

Greater sac

A

Larger
Remaining part of peritoneal cavity

99
Q

Epiploic Foramen

A

greater and lesser sacs communicate with each other via a passageway that lies posterior to the free edge of the lesser omentum

100
Q

What does the GI system develop from

A

Embryonic gut tube

which lies in the midline of the abdominal cavity, suspended from the posterior abdominal wall by the dorsal mesentery. Major branches of the abdominal aorta that supply the developing gut tube travel through the dorsal mesentery.

ventral mesentery connects the stomach to the anterior abdominal wall. As the liver grows within it, the anterior part of the ventral mesentery becomes the falciform ligament and the posterior part becomes the lesser omentum.

101
Q

Dorsal mesentery

A

Major branches of the abdominal aorta that supply the developing gut tube travel through

102
Q

Ventral mesentery

A

connects the stomach to the anterior abdominal wall. As the liver grows within it, the anterior part of the ventral mesentery becomes the falciform ligament and the posterior part becomes the lesser omentum.

103
Q

Peritonitis

A

Peritonitis describes infection and inflammation of the peritoneum. It may be localised (i.e. to the region of peritoneum adjacent to an inflamed / infected organ) or generalised (affecting the whole peritoneum). Peritonitis may be caused by inflammation of an organ (e.g. the pancreas) or rupture of a hollow viscus (e.g. the stomach or bowel). Rupture of the intestine allows faecal matter and bacteria to contaminate the peritoneum. Because the peritoneum has a large surface area and is semi-permeable, peritonitis can lead to sepsis and is hence a life-threatening condition. Peritonitis is extremely painful.

104
Q

Peritoneal adhesions

A

In a healthy abdomen, a thin layer of peritoneal fluid allows the abdominal viscera to slide freely alongside each other. Adhesions are pathological fibrous connections between the parietal and visceral peritoneum. When the peritoneum is irritated (e.g. by infection) it produces fibrin which causes the parietal and visceral peritoneum to adhere to each other. These connections may become fibrous. They can cause chronic abdominal pain and they increase the risk of volvulus (twisting) of the intestine, because it can no longer move freely.

105
Q

Ascites

A

Ascites is an increased volume of peritoneal fluid. It occurs secondary to other pathology, such heart failure, liver failure or intra-abdominal malignancy. The abdomen may become very distended, and it is very uncomfortable. An ascitic drain can be used to remove the fluid and relieve symptoms, but fluid will usually reaccumulate.

106
Q

Growth, migration, and rotation of organs during development

A

responsible for the formation of the lesser sac and results in some organs being ‘pushed’ onto the posterior abdominal wall and becoming retroperitoneal.

107
Q

Inguinal canal contents

A

Different between males and females

108
Q

3 parts of the developing gut tube

A

Foregut
Midgut
Hindgut

109
Q

Boundaries of foregut

A

Oesophagus—> Ends halfway along duodenum

110
Q

Boundaries of midgut

A

Halfway along duodenum —> 2/3 of the way along the transverse colon

111
Q

Boundaries of hindgut

A

2/3 of the way along the transverse colon —> ends at upper anal canal

112
Q

Peritonitis

A

Inflammation/ infection of the peritoneum

113
Q

Adhesions

A

Fibrous connections between the parietal and visceral peritoneum
Tethers organs to each other or to the abdominal wall

114
Q

Ascites

A

Increased volume of peritoneal fluid

115
Q

Visceral pain from foregut

A

Epigastrium

116
Q

Visceral pain from midgut

A

Umbilicus

117
Q

Visceral pain from hindgut

A

Suprapubic region

118
Q

Structures in left upper quadrant

A

Spleen
Stomach

119
Q

Structures in right upper quadrant

A

Liver

120
Q

Which abdominal visceral are protected by the ribs

A

Spleen
Liver

121
Q

Which quadrant contains the appendix

A

Right lower quadrant

122
Q

Which artery supplies the foregut structures

A

Celiac trunk

123
Q

Which artery supplies the midgut structures

A

Superior mesenteric artery

124
Q

Which artery supplies the hindgut structures

A

Inferior mesenteric artery

125
Q

Anterior superior iliac spines (ASIS)

A

Most anterior point of pelvis

126
Q

Which side of the vertebral column is the descending aorta

A

Patient’s left

127
Q

Which side of the vertebral column is the inferior vena cava

A

Patient’s right

128
Q

Tubercles of iliac crests

A

Widest part of pelvis

129
Q

How to identify McBurney’s point

A

2/3 of the way along a line drawn from the umbilicus to the right ASIS

130
Q

What layer lies between the parietal peritoneum and transversus abdominis

A

Transversalis fascia

131
Q

What parts of the large intestine are intraperitoneal

A

Transverse colon

132
Q

What parts of the large intestine are retroperitoneal

A

Ascending and descending colon

133
Q

What connects the small intestine and colon to the POSTERIOR abdominal wall

A

Mesenteries

134
Q

What hangs over the anterior surface of the abdominal viscera

A

Omenta

135
Q

What is the inferior border of the abdominal cavity

A

Inguinal ligaments / pubic tubercles and pubic symphysis

136
Q

What layer of tissue lies directly below the skin in the midline

A

Camper’s fascia- fatty layer of superficial fascia

137
Q

Camper’s fascia

A

Fatty layer of superficial fascia directly below the skin

138
Q

Scarpa’s fascia

A

Membranous layer to superficial fascia
Lies deep to Camper’s fascia

139
Q

What lies deep to camper’s fascia

A

Scarpa’s fascia

140
Q

Which nerves supply sensation to the anterior abdominal wall

A

Thoraco-abdominal nerves (T7-T11)
Iliohypogastric nerve (L1)
Ilioinguinal nerve (L1)
Subcostal nerve (T12)

141
Q

Position of IVC and abdominal aorta in abdomen

A

IVC = right
Aorta = left

142
Q

Which nerves supply the parietal peritoneum

A

Thoracoabdominal and subcostal nerves

143
Q

What lies between the transversalis abdominus and parietal peritoneum

A

Transversalis fascia

144
Q

What goes through the diaphragm at T12

A

T12
aorta perforates the diaphragm
thoracic duct perforates the diaphragm
azygous vein perforates the diaphragm
coeliac trunk leaves the aorta

GI anatomy (5 decks)

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