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OS 206: Abdomen and Pelvis > Anterior Abdominal Wall, Diaphragm, and Peritoneal Cavity > Flashcards

Anterior Abdominal Wall, Diaphragm, and Peritoneal Cavity Flashcards

1
Q

What is the abdomen?

A

Part of the trunk between thorax and pelvis that houses the digestive organs and part of the urogenital system

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2
Q

Functions of the anterior abdominal wall

A

1) Supports and protects viscera
2) Trunk movements (posture and rotation/flexion)
3) Ambulation
4) Increase of intra-abdominal pressure by muscle contraction
5) Disease diagnosis

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3
Q

Borders of the anterior abdominal wall

A

Superior: Costal margins (6th to 12th ribs) and xiphoid process
Inferior: ASIS, inguinal ligament, pubic crest, pubic symphisis
Lateral: Vertical plane thru ASIS

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4
Q

Vertebral level of the umbilicus

A

Between L3 and L4 / T10 dermatome

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5
Q

Fetal precursor of umbilicus

A

Site of fetal connection to the placenta (via umbilical vein and artery)

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6
Q

Composition of the linea alba

A

Union of aponeuroses of flat muscles on either side

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7
Q

T or F: Inferior to the umbilicus, the linea alba is not indicated by a groove

A

T

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8
Q

The linea semilunaris serves as a marker for what?

A

The lateral margin of the rectus abdominis

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9
Q

The transverse attachments between the anterior rectus sheath and rectus abdominis

A

Tendinous intersections

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10
Q

The inguinal groove extends from the ASIS to?

A

Pubic tubercle

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11
Q

T or F: The inguinal groove is composed of the folded lateral edge of external abdominal aponeurosis

A

F (It is composed of the folded inferior edge)

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12
Q

Two planes that divide the abdomen into 4 quadrants

A

Median plane and transumbilical plane

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13
Q

Imaginary vertical line following the linea alba from the xiphoid process to pubic symphysis

A

Median plane

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14
Q

Imaginary horizontal line at the level of the umbilicus

A

Transumbilical plane (L3 to L4)

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15
Q

Planes that divide the abdomen into 9 regions

A

Horizontal: Transpyloric and transtubercular planes
Vertical: Right and left midclavicular planes

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16
Q

Level of the transpyloric plane

A

L1 to L2

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17
Q

Aside from passing thru the pylorus, the transpyloric plane traverses what structure?

A

Hilum of the kidney

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18
Q

Level of the transtubercular plane

A

L5

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19
Q

The midclavicular planes pass from the midpoint of the clavicles to the midpoint of what structure?

A

Inguinal ligament

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20
Q

T or F: The subcostal plane (L3) passes thru the lower border of the 9th costal cartilage on each side

A

F (It passes thru the lower border of the 10th costal cartilage)

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21
Q

Three lateral regions of the abdomen (from top to bottom)

A

Right and left hypochondriac, right and left lumbar, right and left inguinal/iliac

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22
Q

Three median regions of the abdomen (from top to bottom)

A

Epigastric, umbilical, suprapubic/hypogastric

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23
Q

Contents of the right hypochondriac region

A

Liver, gallbladder, hepatic flexure of colon

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24
Q

Contents of the epigastric region

A

Liver, transverse colon, abdominal aorta and IVC

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25
Q

Contents of the left hypochondriac region

A

Stomach, spleen, splenic flexure of colon

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26
Q

Contents of the right lumbar region

A

Ascending colon, kidney, small intestine

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27
Q

Contents of the umbilical region

A

Duodenum, pancreas, small intestine, abdominal aorta and IVC, iliac vessels

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28
Q

Contents of the left lumbar region

A

Jejunum, pancreas, descending colon, kidney

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29
Q

Contents of the right inguinal region

A

Ileum, caecum, appendix

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30
Q

Contents of the suprapubic region

A

Small intestine, rectum, bladder, uterus/spermatic cords, iliac vessels

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31
Q

Contents of the left inguinal region

A

Sigmoid colon, small intestine

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32
Q

Visceral pain often refers to this region

A

Umbilical

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33
Q

Pain from heartburn and ulcers refer to this region

A

Epigastric

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34
Q

Gas pain may refer to this region

A

Left lumbar

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35
Q

Layers of the anterior abdominal wall from superficial to deep

A

Skin, superficial fascia, deep fascia, muscles, transversalis fascia, extraperitoneal/preperitoneal/peritoneal fat, parietal peritoneum

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36
Q

Two layers of the superficial fascia

A

Camper’s fascia (superficial fatty layer) and Scarpa’s fascia (deep membranous layer)

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37
Q

T or F: The anterior abdominal wall is made up of 4 paired muscles

A

T (3 flat/horizontal muscles: External oblique, internal oblique, transversus abdominis; 1 vertical muscle: rectus abdominis)

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38
Q

Origin, insertion, and action of the external oblique

A

O: External surfaces of 5th to 12th ribs
I: Xiphoid process, linea alba, anterior half of iliac crest, pubic crest, pubic tubercle
A: Rotates, flexes, and laterally bends the trunk; compresses abdominal contents

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39
Q

The inferior border of the external oblique aponeurosis forms what structures?

A

Inguinal ligament, reflex inguinal ligament, lacunar ligament

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40
Q

Abdominal ligament that crosses the midline to attach to the opposite side

A

Reflex inguinal ligament

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41
Q

Innervation of the external oblique

A

T6 to T12, subcostal nerve (T12)

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42
Q

T or F: The external oblique participates in the formation of the superficial inguinal ring

A

T

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43
Q

What structures exit the superficial inguinal ring in males and females respectively?

A

Spermatic cord and round ligament

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44
Q

Direction of fibers of the internal oblique

A

Superomedial but becomes inferomedial towards the inguinal ligament

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45
Q

Attachments of the internal oblique

A

Thoracolumbar fascia, iliac crest, inguinal ligament

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46
Q

The internal oblique contributes to what structure medially?

A

Rectus sheath and linea alba

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47
Q

The internal oblique contributes to what structure inferiorly?

A

Conjoint tendon (with transversus abdominis)

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48
Q

Conjoint tendon arches over what structure?

A

Spermatic cord

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49
Q

Innermost flat abdominal muscle

A

Transversus abdominis

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50
Q

Direction of fibers of transversus abdominis

A

Horizontal

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51
Q

T or F: The transversus abdominis contributes medially to the conjoint tendon and inferomedially to the rectus sheath

A

F (Transversus abdominis contributes medially to the rectus sheath and inferomedially to the conjoint tendon)

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52
Q

Innervation of the transversus abdominis

A

T6 to T12 ventral rami

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53
Q

Origin of the transversus abdominis

A

Posteriorly from the thoracolumbar fascia

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54
Q

T or F: Rotation of the trunk to the left involves the contraction of the ipsilateral obliques

A

F (It involves the contralateral obliques)

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55
Q

T or F: When extending the spine, the flat abdominal muscles contract passively

A

T (To provide resistance to prevent the spine from snapping)

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56
Q

Direction of fibers of the rectus abdominis

A

Vertical

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57
Q

Contributions of the rectus abdominis medially and laterally

A

Linea alba and linea semilunaris respectively

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58
Q

Posterior margin of the rectus abdominis

A

Ends posteriorly as the arcuate line (inferior margin or border of the posterior rectus sheath) midway between the umbilicus and pubic symphysis

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59
Q

Arteries contained by the rectus abdominis

A

Superior and inferior epigastric a.

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60
Q

Innervation of the rectus abdominis

A

T6 to T12 ventral rami

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61
Q

Action of the rectus abdominis

A

Main trunk flexor and passive resistance against spine extension

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62
Q

Origin and insertion of the pyramidalis

A

O: Pubic crest and pubic symphysis
I: Linea alba

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63
Q

T or F: The pyramidalis is absent in 20% of people

A

T

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64
Q

Strong but incomplete fibrous compartment of the rectus abdominis and pyramidalis

A

Rectus sheath

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65
Q

Borders of the rectus sheath

A

Superior: Xiphoid process and 5th to 7th costal cartilages
Inferior: Pubic symphysis and pubic crest
Medial: Linea alba
Lateral: Linea semilunaris

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66
Q

Contents of the rectus sheath

A

Superior and inferior epigastric a. and v., lymph vessels, distal portions of the thoracoabodminal nerves (T7-T12)

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67
Q

Composition of the rectus sheath

A

Decussation and interweaving of the aponeuroses of the 3 flat muscles

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68
Q

Composition of the anterior rectus sheath

A

Aponeurosis of the external oblique and anterior lamina of superior 2/3 of internal oblique aponeurosis

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69
Q

Composition of the posterior rectus sheath

A

Aponeurosis of the transversus abdominis and posterior lamina of the superior 2/3 of the internal oblique

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70
Q

Inferior end of the posterior rectus sheath

A

Arcuate line or linea semicircularis

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71
Q

Clinical importance of the arcuate line

A

The arcuate line delineates the transversalis fasica below it, not an ideal place for stitches

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72
Q

Nerve supply of the anterior abdominal wall

A

T5 to T11 (including lateral cutaneous branches of T7-T9/T10), subcostal nerve (T12), 2 terminal branches of L1 (iliohypogastric and ilioinguinal)

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73
Q

Distal, abdominal parts of the ventral rami of the inferior 6 thoracic spinal nerves (T7 to T11)

A

Thoracoabdominal nerves

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74
Q

Distribution of the thoracoabdominal nerves

A

T7 to T9: superior to umbilicus
T10: level of umbilicus
T11 with subcostal (T12) and iliohypogastric and ilioinguinal nerves (L1): inferior to umbilicus

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75
Q

Innervates the suprapubic region

A

Iliohypogastric

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76
Q

Nerves that travel anteroinferiorly between the internal oblique and transversus abdominis

A

Thoracoabdominal, subcostal, iliohypogastric nerves

77
Q

T or F: Iliohypogastric and ilioinguinal nerves pierce the internal oblique at the ASIS to travel superficial to it and deep to the external oblique

A

T

78
Q

Primary blood vessels of the anterior abdominal wall

A

Internal thoracic, external iliac, femoral a., greater saphenous v.

79
Q

Branches of the internal thoracic

A

Superior epigastric, musculophrenic

80
Q

Branches of the external iliac

A

Inferior epigastric, deep circumflex iliac

81
Q

Branch of the femoral a.

A

Superficial circumflex iliac

82
Q

Branch of the greater saphenous v.

A

Superficial epigastric

83
Q

T or F: The superior and inferior epigastric a. anastomose in the epigastric region

A

F (They anastomose in the umbilical region)

84
Q

T or F: Venous drainage is via accompanying veins paired with their respective arteries

A

T

85
Q

T or F: Blood drains towards the umbilicus

A

F (Blood drains away from the umbilicus)

86
Q

Superficial epigastric v. (femoral v. tributary) and lateral thoracic v. (axillary v. tributary) anastomose thru what vein, uniting the veins of the superior and inferior halves of the body

A

Thoraco-epigastric v.

87
Q

3 superficial inguinal v. end in what vein?

A

Greater saphenous v.

88
Q

Importance of superficial and deep anastomoses of veins

A

Collateral circulation when either vena cava is occluded

89
Q

Superficial lymphatic drainage of the abdomen

A

Superior to the umbilicus: To axillary or cervical nodes

Inferior to the umbilicus: To superficial inguinal nodes

90
Q

Deep lymphatic drainage of the abdomen

A

Accompanying deep veins -> External iliac / common iliac / lumbar nodes -> cisterna chyli and thoracic duct

91
Q

Inferior portion of the anterior abdominal wall, also known as the groin

A

Inguinal region

92
Q

The inguinal region extends between what two structures?

A

ASIS and pubic tubercle

93
Q

Anatomical significance of the inguinal region

A

Region where structures enter and exit the abdominal cavity

94
Q

Clinical significance of the inguinal region

A

Entry/exit pathways serve as potential sites of herniation

95
Q

Boundaries of Hesselbach’s Trigone / Inguinal Triangle

A

Medial: Lateral border of rectus abdominis
Lateral: Inferior epigastric vessels
Inferior: Inguinal ligament

96
Q

Structural weakness of the inguinal triangle

A

Only peritoneum, endoabdominal fascia, and transversalis fascia form the wall (devoid of muscle insertion); deep inguinal ring lies internal to it while the superficial inguinal ring lies external to it

97
Q

T or F: Direct inguinal hernias in the inguinal triangle are more common in females

A

F (More common in males)

98
Q

Location of the inguinal canal

A

Parallel and superior to the medial half of the inguinal ligament

99
Q

Borders of the inguinal canal

A

Roof: Internal oblique and transversus abdominis
Floor: Inguinal ligament
Anterior wall: External oblique
Posterior wall: Transversalis fascia

100
Q

External exit of the inguinal canal thru the external oblique aponeurosis

A

Superficial inguinal ring

101
Q

Location of the superficial inguinal ring

A

Superolateral to the pubic tubercle

102
Q

Borders of the superficial inguinal ring

A

Roof: Arching fibers of the internal oblique and transversus abdominis
Floor: Inguinal ligament reinforced medially by lacunar ligament
Anterior wall: External oblique aponeuorsis
Posterior wall: Laterally - transversalis fascia, medially - internal oblique and conjoint tendon

103
Q

Contents of superficial inguinal ring

A

Spermatic cord and round uterine ligament (males and females respectively), ilioinguinal nerve (L1, sensory to genital region, superior to spermatic cord), blood and lymphatic vessels, patent sac for scrotum (in babies)

104
Q

Internal entrance to the inguinal canal thru the transversalis fascia

A

Deep inguinal ring

105
Q

Location of the deep inguinal ring

A

1.25 cm superior to the midinguinal ligament, lateral to the epigastric vessels, medial to origin of transversus abdominis

106
Q

T or F: The testes migrates thru the processus vaginalis

A

T

107
Q

Patent processus vaginalis

A

May cause congenital herniation

108
Q

Origin of the internal spermatic fascia

A

Transversalis fascia

109
Q

Origin of the cremaster muscle

A

Internal oblique

110
Q

Origin of the external spermatic fascia

A

External oblique

111
Q

Contents of the spermatic cord

A

Pampiniform plexus, ductus deferens, cremasteric artery, testicular artery, artery of the ductus deferens, genital branch of the genito-femoral nerve, sympathetic nerve fibers, lymph vessels

112
Q

T or F: While females do not have a spermatic cord, they have a cremaster muscle

A

F (Females also do not have a cremaster muscle)

113
Q

5 peritoneal folds/ligaments of the posterior surface of the anterior abdominal wall

A

Median umbilical fold (1), medial umbilical folds (2), lateral umbilical folds (2)

114
Q

Extent of the median umbilical fold

A

Midline from apex of bladder to umbilicus

115
Q

The median umbilical ligament, contained in the median umbilical fold, covers the remnant of what embryonic structure which connects the fetal urinary bladder with the amniotic sac?

A

Urachus (Non-closure leads to chronic renal problems with urine coming out of the umbilicus)

116
Q

Medial umbilical folds are remnants of what embryonic structure?

A

Umbilical arteries

117
Q

Lateral umbilical folds go over which structures?

A

Inferior epigastric vessels

118
Q

Fossae between median and medial folds

A

Supravesical fossae

119
Q

Fossae between medial and lateral folds

A

Medial inguinal fossae

120
Q

Fossae lateral to lateral folds

A

Lateral inguinal fossae

121
Q

Fossa that is the site of the deep inguinal ring (under the peritoneum)

A

Lateral inguinal fossa

122
Q

Extends between the liver and abdominal wall peritoneum above the umbilicus

A

Falciform ligament

123
Q

The round ligament of the liver, also known as the ligamentum teres hepatis, is the remnant of what structure?

A

Umbilical vein

124
Q

Clinical significance of round ligament

A

Blood may be cannulated here prior to the closure of the umbilical vein for babies in need of cannulation

125
Q

Musculoaponeurotic partition forming the roof of the abdomen and floor of the thorax

A

Diaphragm

126
Q

Functions of the diaphragm

A

1) Respiration
2) Assists in raising intra-abdominal pressure
3) Facilitates blood circulation (thru IVC)

127
Q

Innervations of the diaphragm

A

1) Phrenic nerve (C3 to C5) - sensory and motor
2) Intercostal nerves (T5 to T11) - sensory of peripheral portion
3) Subcostal nerve (T12) - sensory of peripheral portion

128
Q

Apertures on diaphragm surface

A

IVC (T8), esophageal hiatus (T10), aortic hiatus (T12 inferior border)

129
Q

Components of the aponeurotic central part of the diaphragm

A

Clover-shaped leaves and central tendon

130
Q

Size and location of clover-shaped leaves

A

Right lateral leaf - Largest; curves posteriorly
Anterior/middle leaf - Intermediate size; inferior to the heart
Left lateral leaf - Smallest

131
Q

Characteristics of the central tendon of the diaphragm

A

Trifoliate aponeurotic portion whose superior aspect fuses with the inferior surface of the fibrous pericardium; Perforated by the caval/IVC foramen

132
Q

Components of the muscular peripheral part of the diaphragm

A

Sternal portion, costal portion, lumbar portion

133
Q

Attachment of the sternal portion of the diaphragm

A

Posterior part of xiphoid process

134
Q

Characteristics of the costal portion of the diaphragm

A

Arise from the internal part of the ribs interdigitating with transversus abdominis; Forms right and left hemidiaphragms

135
Q

Origin of the lumbar portion of the diaphragm

A

Upper lumbar vertebra

136
Q

Ligaments of the lumbar portion of the diaphragm

A

Median arcuate ligament, medial arcuate ligaments, lateral arcuate ligaments

137
Q

The median arcuate ligament, arching over the anterior aspect of the aorta and uniting the right and left crura of the diaphragm, forms what structure?

A

Aortic hiatus

138
Q

Composition of medial arcuate ligaments

A

Condensation of psoas muscle fascia

139
Q

Musculotendinous bands that arise from the anterior surfaces of L1 to L3 vertebra, ALL, and intervertebral discs

A

Crura of the diaphragm

140
Q

Characteristics of the right crura of the diaphragm

A

Larger and longer than the left crus, arises from L1 to L3/L4, forms the esophageal hiatus

141
Q

Characteristics of the left crura of the diaphragm

A

Arises from L1 to L2/L3

142
Q

Arteries supplying the superior diaphragmatic surface

A

Superior phrenic a. (from thoracic aorta), musculophrenic a. and pericardiophrenic a. (from internal thoracic a.)

143
Q

Arteries supplying the inferior diaphragmatic surface

A

Inferior phrenic a. (from abdominal aorta)

144
Q

Veins draining the superior diaphragmatic surface

A

Superior phrenic v. (into IVC), musculophrenic v. and pericardiophrenic v. (into internal thoracic v.)

145
Q

Veins draining the inferior diaphragmatic surface

A

Inferior phrenic v. (right into IVC, left anteriorly into IVC and posteriorly into left renal v.)

146
Q

Lymphatic drainage of superior diaphragmatic surface

A

Diaphragmatic nodes -> phrenic nodes -> parasternal and posterior mediastinal nodes

147
Q

Lymphatic drainage of inferior diaphragmatic surface

A

Superior lumbar lymph nodes

148
Q

Characteristics of indirect hernia

A

Appears lateral to inferior epigastric vessels; usually congenital when the processus vaginalis fials to resorb upon birth

149
Q

Characteristics of direct hernia

A

Appears medial to inferor epigastric vessels; commonly occurs among the elderly due to chronic cough and prostatic problems that increase intra-abdominal pressure

150
Q

Thin potential space within the abdominal cavity that continues to the pelvic cavity

A

Peritoneal cavity

151
Q

Lining of the peritoneal cavity

A

Continuous layer of simple squamous epithelium (mesothelium) that forms the parietal and visceral peritoneum

152
Q

Contents of the peritoneal cavity

A

No organs, only a thin film of peritoneal fluid (composed of water, electrolytes, and other substances)

153
Q

Function of peritoneal fluid

A

Lubricates peritoneal surfaces allowing smooth mobility of visceral organs

154
Q

Two types of peritoneum

A

Parietal and visceral peritoneum

155
Q

More external walls of the peritoneal cavity that lines the internal surface of the abdominopelvic wall

A

Parietal peritoneum

156
Q

Characteristics of parietal peritoneum

A

Sensitive to pressure, pain, heat and cold, and laceration with well-localized pain; supplied by same blood and lymphatic vasculature and nerves as wall region it lines

157
Q

More internal walls of the peritoneal cavity that invests visceral organs

A

Visceral peritoneum

158
Q

Characteristics of visceral peritoneum

A

Insensitive to pressure, pain, heat and cold, and laceration with poorly localized pain; supplied by same blood and lymphatic vasculature and nerves as the organ it covers

159
Q

Organs almost completely covered by visceral peritoneum

A

Intraperitoneal organs

160
Q

Examples of intraperitoneal organs

A

Stomach, superior part of the duodenum, jejunum and ileum, transverse and sigmoid colon, superior rectum, liver and gallbladder, spleen

161
Q

Organs exterior to the peritoneal cavity and posterior to the peritoneum

A

Retroperitoneal organs

162
Q

Examples of retroperitoneal organs

A

Kidneys and ureters, abdominal aorta and IVC, part of the duodenum, part of the pancreas

163
Q

Double layer of peritoneum derived from invaginations of peritoneum by an organ

A

Mesentery

164
Q

Functions of the mesentery

A

Connects visceral organ to body wall constituting a continuity of parietal and visceral peritoneum; movement of organs; neurovascular communication

165
Q

Double layer extension or peritoneal fold that passes from the stomach and proximal part of the duodenum to adjacent organs

A

Omentum

166
Q

Large peritoneal fold that hangs from greater curvature of stomach and proximal part of duodenum, attaching to the transverse colon and its mesentery

A

Greater omentum

167
Q

Parts of the greater omentum

A

1) Gastrophrenic lig.
2) Gastrosplenic lig.
3) Gastrocolic lig.

168
Q

Smaller layer that connects lesser curvature of stomach and proximal part of duodenum to liver; more primitive ventral mesentery

A

Lesser omentum

169
Q

Parts of the lesser omentum

A

1) Hepatogastric lig.

2) Hepatoduodenal lig. (contains liver portal triad)

170
Q

Two main divisions of the peritoneal cavity

A

Greater sac and lesser sac

171
Q

Divisions of the greater sac delineated by the transverse mesocolon

A

Supracolic and infracolic compartments

172
Q

Organ contents of supracolic compartment

A

Stomach, duodenum, pancreas, liver, and spleen

173
Q

Spaces of the supracolic compartment

A

Subphrenic recess, subhepatic recess, hepatorenal recess/Morrison’s pouch

174
Q

Location and boundaries of hepatorenal recess/Morrison’s pouch

A

Located at right subhepatic space bounded by the right lobe of liver, right kidney, and duodenum

175
Q

Most dependent portion of abdominal cavity when in supine position

A

Hepatorenal recess/Morrison’s pouch

176
Q

Organ contents of the infracolic compartment

A

Jejunum and ileum, large intestine, sigmoid colon and rectum

177
Q

What structure further divides the infracolic compartment into right and left infracolic spaces?

A

Mesentery of the small intestine

178
Q

Spaces of the infracolic compartment

A

Rectovesical pouch, rectouterine pouch/pouch of Douglas

179
Q

Characteristics of rectovesical pouch

A

Located between bladder and rectum, dependent portion in males

180
Q

Characteristics of rectouterine pouch/pouch of Douglas

A

Between rectum and uterus, dependent portion in females

181
Q

Clinical significance of rectouterine pouch/pouch of Douglas

A

Site where fluid accumaltes when there are ruptured cysts in the ovaries, uterus, or appendix

182
Q

Divisions of the lesser sac/omental bursa

A

Superior recess and inferior recess

183
Q

Location of the lesser sac

A

Posterior to the stomach and lesser omentum

184
Q

Function of the lesser sac

A

Permits free movement of the stomach on structures posterior and inferior to it

185
Q

Limits of the superior recess

A

Posteriorly by the diaphragm and posterior layers of the coronary ligament

186
Q

Location of the inferior recess

A

Between superior parts of the greater omentum

187
Q

Communication between greater and lesser sacs

A

Foramen of Winslow

188
Q

Boundaries of the foramen of Winslow

A

Superior: Caudate lobe of liver
Inferior: Superior part of duodenum
Anterior: Portal triad
Posterior: IVC and crus of diaphragm

189
Q

Clamping of the hepatoduodenal ligament to interrupt blood flow and prevent excessive bleeding

A

Pringle’s manuever

OS 206: Abdomen and Pelvis (5 decks)

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