Anterolateral abdominal wall & Inginal region Flashcards

1
Q

What nerve innervates the cremaster muscle?

A

Gential branch of the genitofemoral nerve

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2
Q

Where does the cremasteric artery arise from?

A

Inferior epigastric artery

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3
Q

How does a direct inguinal hernia arise?

A
  • Weakness in the anterior abdominal wall in an inguinal triangle (thin inguinal falx or widened superior inguinal ring)
  • The intestines leave the abdominal cavity through the superficial inguinal ring
  • Lies outside of the spermatic cord
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4
Q

What layers of the abdominal wall contain/are involved in the direct inguinal hernia?

A

Happens at the Hessalback triangle

Contained by the Peritoneum and transversalis fascia

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5
Q

Boundaries of the Hessalbach triangle

A

Base: Inguinal ligament

Apex: Inferior epigastric vessels meets the rectus abdominus muscle

Medial: Rectus abdominus

Lateral: Inferior epigastric vessels

Floor: Conjoint tendon &Transversalis fascia

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6
Q

What nerve innervates the anterior scrotum?

A

Ilioinguinal nerve

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7
Q

What innervates the posterior scrotum?

A

Perineal branch of pudendal nerves

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8
Q

Why does indirect herniation occur?

A

The processes vaginalis persists after the sperm or ovaries descend the abdominal wall (through gubernaculum)

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9
Q

What happens in indirect herniation?

A

Loop of small intestine passes through the deep inguinal ring which has not closed in the processes vaginalis through the superficial into the scrotal sac

Neck of the hernia sac lies lateral to inferior epigastric vessels

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10
Q

What is the tunica vaginalis?

A

It is the remnant of the processes vaginalis that surrounds the testes forming serous membrane :

  • Parietal layer covers the inside of the internal spermatic fascia
  • Visceral layer covers the testes and epididymis.
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11
Q

What is the Arcuate line?

A

This is the point where the transversus abdmonius passes through the rectus abdominus muscles and forms three layers of muscle in the anterior part of the rectus abdominus leaving only the transversalis fascia.

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12
Q

What enters the arcuate line?

A

Inferior epigastric artery

Anastamoses at the umbilicus

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13
Q

Where does the neurovascular plane run?

A

Between the tranversus abdminus and internal oblique muscles

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14
Q

Musculophrenic artery

A

Branch of the internal thoracic artery

Supplies anterolateral surface of the diaphragm

Supplies anterior and posterior hypochondriac

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15
Q

Layers of the Anterolateral abdominal wall

A
  1. Skin
  2. Camper’s fatty fascia
  3. Scarpa’s fascia
  4. External Oblique
  5. Internal Oblique
  6. Transversus Abdmonious
  7. Transversalis fascia
  8. Extraperitoneal fasica
  9. Peritoneum (Parietal layer)
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16
Q

What are the two layers of the peritoneum?

A

Parietal peritoneum (Lines the abdominopelvic wall)

Visceral Peritoneum (Lines the organs)

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17
Q

Intraperitoneal organs?

A

They are completely covered by the visceral peritoneum

Liver, Stomach, small intestines, spleene

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18
Q

Extraperitoneal or Retroperitoneal organs?

A

These are partially surrounded by the visceral peritoneum

Kidneys & Adrenal gland

Descending and Ascending colon

Pancreas

Part of duodenum

Urinary bladder

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19
Q

Why is the duodenum a retroperitoneal organ?

A

During development the stomach turns 90 degrees around craniocaudal axis this turn bends the duodenum into a “C” shape.

It then moves to the right and adheres to the posterior wall

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20
Q

What contributes to the formation of lesser sac?

A

The rotation of the stomach and the fusion of the duodenum to the body wall contributes to lesser sac of the peritoneum

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21
Q

How is the greater omentum formed during development?

A

The stomach begins as a tube with two attachments to the abdominal body walls anteriorly and posteriorly.

As the stomach rotates it forms a lesser sac and a greater sac

The lesser sac attaches from the greater curvature of the stomach and will grow to give rise to the greater omentum

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22
Q

Where is the lesser omentum located?

A

It arises from the ventral mesentary located between the liver and stomach

23
Q

What is mesentary?

A

Double layers membrane through which nerves and vessels pass between the body wall and viscera (organs)

24
Q

Name the 6 mesentaries

A
  • Small intestine mesentary
  • Transverse mesocolon
  • Sigmoid mesocolon
  • Mesoesophagus
  • Mesogastrium
  • Mesoappendix
25
Why is the transverse mesocolon significant?
It divides the abdominal cavity into supracolic (stomach, liver, and spleen) and infracolic compartments (small intestine and ascending and descending colon)
26
What divides the infracolic compartment?
The infracolic compartment is under the greater omentum and is divided into the left and right infracolic spaces by the mesentery of the small intestine
27
What are peritoneal ligaments?
Parietal and visceral layers of peritoneum that connect organs to the abdominal wall or other organs
28
What is the falciform ligament?
Connects the liver to the anterior body wall and divides into left and right lobes
29
What is the hepatogastric ligament?
This ligament or mesentery connects the liver to the stomach (portion of lesser omentum)
30
What is the hepatoduodenal ligament?
Connects the liver to the duodenum (portion of lesser omentum)
31
What is the gastrosplenic ligament?
Connects the spleen to the stomach
32
What is the gastrophrenic ligament?
This connects the stomach to the diaphragm
33
What is the gastrocolic ligament?
It connects the greater curvature of the stomach to the transverse colon
34
What is the phrenicocolic ligament?
It connects the transverse colon to the diaphragm
35
What are paracolic gutters?
These are grooves between the lateral aspect of the ascending/descending colon and the abdominal wall
36
What are the branches of the celiac trunk?
Common hepatic artery Left gastric artery Splenic artery
37
What are the branches of the Common hepatic artery?
Proper hepatic artery Gastroduodenal artery (Right gastric, Right gastromental, pancreaticoduodenal artery)
38
What is the nerve supply for the esophagus?
Parasympathetic : Esophageal plexus (Vagus nerve) Sympathetic: greater Splanchic nerve, periarterial plexuses
39
What is the blood supply for the esophagus?
Left gastric artery and vein Inferior phrenic artery (superior to celiac trunk) esophageal veins → azygos vein → systemic
40
What are the three constrictions of the esophagus?
Cervical (C5-C6, cricopharyngeus muscle) Thoracic (Aortic arch and trachea) Diaphragmatic (esophageal hiatus and phrenicoesophageal ligament)
41
What enters the caval opening of the diaphragm?
Inferior vena cava Right phrenic nerve branches some T8 level
42
What enters the esophageal hiatus of the diaphragm?
Esophagus Vagus nerve plexus Some small esophageal arteries T10 level
43
What enters the aortic hiatus?
Descending aorta Azygos vein thoracic duct T12
44
What are the regions of the stomach?
Cardia (Part connecting with esophagus with cardia orifice) Fundus dilated superior part related to the left dome of diaphragm) Cardiac notch (between the cardiac orifice and the fundus) Body(between the fundus and pyloric antrum funnel shaped) Pyloric part (pyloric antrum is funnel shaped leads to the pyloric canal to the pylorus sphincter muscles
45
What is the veins going from the stomach?
Prepyloric → Right gastric Short gastric vein → splenic vein Right gastro-omental vein → SMV Left gastro-omental vein → splenic vein → SMV Right/left gastric vein → portal vein
46
Innervations of the stomach
Parasympathetic : left vagus nerve → anterior vagal trunk (lesser curvature and anterior of stomach) Right vagus nerve → posterior vagal trunk (lesser curvature, posterior and anterior surface of stomach) Sympathetic: greater splanchnic and celiac plexus (T6-9)
47
What are the 4 parts of the duodenum?
Superior (L1, ascends from pylorus and has an ampulla, hepatoduodenal ligament) Descending (L2-3, Major ampulla receives hepatopancreatic ampulla) Horizontal (L3, behind superior mesentary vessels) Ascending (left of L3)
48
What is the blood supply of the duodenum?
Proximal (until ampulla of Vater): gastroduodenal artery→ superior pancreaticoduodenal artery Distal (part 4→ ampulla of Vater): SMA → inferior pancreaticoduodenal artery
49
In what quadrant does most of the jejunum lie?
Left upper quadrant
50
Most of the ileum lies where?
In thr RLQ and some in the LLQ
51
How much of the small intestine is jejunum and how much is ileum?
Jejunum : 2/5 Ileum: 3/5
52
What is the arterial supply for the jejunum and ileum?
**_Superior Mesentaric artery_** The arteries unite to form arches called arcades and give rise to vasa recta
53
What is Teniae coli?
3 distinct longitudinal thickened bands of smooth muscle mesocolic tenia (transverse & sigmoid mesocolon attach) Omental tenia (omental appendices attach) Free tenia (nothing is attached)