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Beth ANATOMY > Block 1 > Flashcards

Block 1 Flashcards

1
Q

what is the extent of the abdominal cavity?

A

Diaphragm to pelvic girdle

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2
Q

Abdominal surface anatomy can be divided into 4 quadrants, what are they?

A

RUQ LUQ RLQ LLQ

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3
Q

What organs sit in the RUQ of the abdomen?

A
  • colon (ascending, hepatic flexure),
  • duodenum (parts 1-3),
  • gall bladder,
  • biliary tree,
  • IVC,
  • pancreas (head + neck),
  • pylorus,
  • right kidney,
  • ureter
  • suprarenal gland
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4
Q

What organs sit in the LUQ of the abdomen?

A
  • colon (descending, splenic flexure),
  • duodenum (part 4),
  • left kidney,
  • ureter
  • suprarenal gland,
  • pancreas (body + tail),
  • spleen,
  • stomach,
  • jejunum + ileum
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5
Q

Which organs sit in the RLQ of the abdomen?

A
  • colon (caecum, appendix + ascending),
  • IVC,
  • right ductus deferens/ovary,
  • uterine tube,
  • ureter
  • ileum
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6
Q

Which organs sit in the LLQ of the abdomen?

A
  • colon (descending + sigmoid),
  • left ductus deferens/ovary,
  • uterine tube,
  • ureter,
  • jejunum,
  • ileum
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7
Q

Where is the transpyloric plane and how is it located?

A

L1

  • located halfway b/w suprasternal notch of manubrium + upper border of pubic symphysis. Passes through pylorus
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8
Q

Where is the subcostal plane and how is it located?

A

L3

sits under ribs

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9
Q

Where is the Supracristal plane and how is it located?

A

L4

top of iliac bone, useful landmark plane for lumbar puncture

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10
Q

Where is the transtubercular plane and how is it located?

A

L5

  • corresponds to a line uniting the two tubercles of the iliac crests
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11
Q

How many of each vertebrae are there?

A
  • 7 cervical vertebra
  • 12 thoracic vertebra
  • 5 lumbar vertebra
  • 5 sacral (fused) vertebra
  • 4 coccygeal (fused) vertebra
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12
Q

What is the point of using the regional abdomen model?

A
  • Regional models provide a standardised system for positioning/descriptions
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13
Q

What are the 9 regions of the regional abdominal model?

How are the regions divided?

A
  • Split into 9 regions by mid-clavicular lines, subcostal plane (L3) + transtubercular plane (L5)
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14
Q

What organs are located in the right hypochondrium?

A
  • Diaphragm
  • Costodiaphragmatic recesses
  • Liver
  • Hepatic flecture
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15
Q

What organs are located in the epigastric region?

A
  • Stomach
  • Liver
  • Gallbladder
  • Transverse colon
  • Lesser sac
  • Abdominal aorta
  • Duodenum
  • Pancreas
  • Kidneys
  • Suprarenal glands
  • Origin
  • Plexus of colonic trunk
  • Superior mesenteric artery
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16
Q

What organs are located in the left hypochondrium?

A
  • Diaphragm
  • Costodiaphragmatic recess
  • Stomach
  • Spleen
  • Pancreas tail
  • Splenic flecture
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17
Q

What organs are located in the right flank/lumbar?

A
  • Ascending colon
  • Small Intestine
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18
Q

What organs are located in the umbilical region?

A
  • Small intestine
  • Root of mesentry
  • Abdominal aorta
  • Inferior mesenteric artery origin and plexus
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19
Q

What organs are located in the left flank/lumbar region?

A
  • Descending colon
  • Small intestine
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20
Q

Which organs are located in the right iliac fossa?

A
  • Caecum
  • Appendix
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21
Q

What organs are located in the pubic region?

A
  • Small intestine
  • sigmoid colon
  • upper rectum
  • Ovary
  • Uterine tubes
  • common iliac arteries
  • (distended bladder)
  • (Enlarged uterus)
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22
Q

What organs are located in the left iliac fossa?

A

Sigmoid colon

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23
Q

Which organs/pathology can refer pain to the Right hypochondrium?

A
  • Liver abscess
  • Hepatitis
  • Gallbladder/Biliary tree
  • Cholecystitis
  • Cholelithiasis
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24
Q

Which organs/pathology can refer pain to the Epigastric region?

A
  • Foregut pain
  • Aortic aneurysm
  • Pancreatitis
  • Ulcer
  • Gastritis
  • Reflux
  • Myocardial Infarction
  • Pericarditis
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25
Q

Which organs/pathology can refer pain to the Left hypochondrium?

A
  • Constipation
  • Splenic infarct
  • Diverticulitis
  • Pyelonephritis
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26
Q

Which organs/pathology can refer pain to the Right flank/Lumbar?

A
  • Ascending colitis
  • Nephrolithiasis
  • Pyelonephritis
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27
Q

Which organs/pathology can refer pain to the Umbilical region?

A
  • Midgut pain
  • Enteritis
  • Intestinal Obstruction
  • Mesenteric occlusion
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28
Q

Which organs/pathology can refer pain to the Left Flank/Lumbar region?

A
  • Descending colitis
  • Nephrolithiasis
  • Pyelonephritis
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29
Q

Which organs/pathology can refer pain to the Right iliac fossa?

A
  • Appendicitis
  • Gonadal pathology
  • Inguinal hernia
30
Q

Which organs/pathology can refer pain to the pubic region?

A
  • HIndgut pain
  • Uterine pathology
  • UTI/Urinary tract obstruction
  • Endometriosis
  • Pelvic inflammatory disease
31
Q

Which organs/pathology can refer pain to the left iliac fossa?

A
  • Diverticulitis
  • Gonadal pathology
  • Inguinal hernia
  • Ulcerative colitis
32
Q

Define hernia?

A

protrusion of tissue/organ through a retaining tissue

33
Q

Name some predisposing factors to abdominal wall hernias?

A
  • FHx
  • loss of tissue strength + elasticity (direct inguinal hernia)
  • residual embryological channels (congenital hernia)
  • increased intra-abdominal pressure e.g. obesity, chronic constipation, chronic cough, smoking (causing chronic cough)
  • previous surgery
34
Q

From superficial to deep name the layers of the abdomen

A
  1. Skin
  2. Fatty subcutaneous tissue CAMPERS FASCIA
  3. Deep membraneous subcutaneous tissue SCARPA FASCIA
  4. EXTERNAL OBLIQUES
  5. INTERNAL OBLIQUES/RECTUS ABDOMINIS
  6. TRANSVERSUS ABDOMINIS
  7. TRANSVERSALIS FASCIA
  8. Extraperitoneal fat
  9. PARIETAL PERITONEUM
35
Q

What are the muscles of the abdomen? What direction are the muscle fibres?

A
  • External Oblique
  • Internal Oblique
  • Rectus Abdominis
  • Transversus Abdominis
36
Q

What are the functions of rectus abdominis?

What happens to rectus abdominis during pregnancy?

A
  1. Flexing the torso + vertebral column in the abdominal region
  2. Compression of the abdomen
  3. Stabilisation of the torso

Divarication of rectus abdominis muscles (DRAM)/diastasis recti –> right + left sides of the rectus abdominis spread apart at the stomach midline (linea alba) –> can lead to hernia formation around the umbilicus

37
Q

What is the linea alba?

A

White line –> midline fibrous aponeurosis

Attachments of linea alba:

  • xiphoid process
  • pubic symphysis
  • aponeuroses of abdominal muscles

Linea alba is relatively avascular + aneural therefore it is a good access point for abdominal surgery –> blood loss is minimal + major nerves are avoided

Can insert needle/cannula safely through linea alba

38
Q

Describe the location of the external and internal oblique muscles

A
  • External oblique –> superficial to internal oblique, passes inferomedially from T5-12 to linea alba, iliac crest, anterior superior iliac spine (ASIS), pubic tubercle
  • Internal oblique –> deep to external oblique, lower fibres pass medially + upper fibres pass superomedially from the throracolumbar fascia, iliac crest + lateral inguinal ligament to the linea alba, lower ribs, upper pubis + conjoint tendon
39
Q

Where is the Inguinal ligament?

A
  • the free lower border of external oblique passing from anterior superior iliac spine (ASIS) to pubic tubercle
40
Q

What lies between transversus abdominis and internal oblique muscles?

A

A neurovascular plane

41
Q

What is the rectus sheath formed of? what does it enclose?

What is the significance of the arcuate line?

A
  • The rectus abdominis muscle is contained within a fibrous sheath formed by the aponeurosis of transversus abdominis, external oblique + internal oblique muscles + transversalis fascia

Rectus sheath encloses rectus abdominis + epigastric vessels –> inferior epigastric artery + inferior epigastric vein (blunt-force trauma can cause bleed + increase intra-abdominal pressure resulting in pain –> rectus sheath haematoma

42
Q

Name the collective functions of the muscles of the abdominal wall

A
  • Support
  • Protection
  • Posture maintenance
  • Intra-abdominal pressure to support defecation, micturition + parturition (also vomiting + coughing)
  • (Weakness of part of the abdominal wall musculature can result in hernia)
43
Q
A
44
Q

What are the Attachements, Innervation and Function of the Internal Obliques

A

Attachments: Originates from ribs 5-12, and inserts into the iliac crest and pubic tubercle.

Functions: Contralateral rotation of the torso.

Innervation: Thoracoabdominal nerves (T7-T11) and subcostal nerve (T12).

45
Q

What are the attachments, function and innervation of the Internal Obliques?

A

Attachments: Originates from the inguinal ligament, iliac crest and lumbodorsal fascia, and inserts into ribs 10-12.

Functions: Bilateral contraction compresses the abdomen, while unilateral contraction ipsilaterally rotates the torso.

Innervation: Thoracoabdominal nerves (T7-T11), subcostal nerve (T12) and branches of the lumbar plexus.

46
Q

Describe the course of the superior and inferior epigastric arteries

A
  • Superior + inferior epigastric arteries travel + meet in the rectus sheath –> unite the subclavian artery with the external iliac artery –> forms an arterial shunt if the aorta is narrowed
47
Q

Explain the motor nerve supply of the abdominal muscles and how would a patient present with damage?

A
  • carries nerve impulse from CNS which trigger muscles to contract
  • damage could cause weakness, twitching + paralysis of abdominal muscles in this region (could result in hernia)
48
Q

Explain the sensory nerve supply of the abdominal muscles and how would a patient present with damage?

A
  • carries sensory information towards the CNS
  • damage could cause pain, numbness, tingling, increased sensitivity, burning + problems
49
Q

Why are certain surgical incisions used?

A
  • Surgical incisions/endoscopy ports take into account the position + course of arteries + nerves in order to minimise iatrogenic damage
  • Incisions are based upon the organ/region to be accessed + route of minimal damage
  • Increasing use of endoscopic access has led to these approaches being used less frequently
50
Q

What are the names of these surgical incisions?

What is the relevance of them?

A

MEDIAN/MIDLINE: linea alba incised. Tissue is relatively avascular - slow healing

PARAMEDIAN: Recust sheath incised, rectus muscle displaced laterally to avoid nerve damage

GRIDIRION (muscle splitting) at MCBURNEY’S POINT: What nerve is at risk? potential consequence

PFANNENSTIAL (SUPRAPUBIC): what nerves are at risk?

SUBCOSTAL (KOCHER): Inferior to costal (thoracic) margin - what are at high risk of damage?

51
Q

Outine the lymphatic drainage of the abdominal wall

A

Abdominal wall lymphatic drainage passes to axillary and inguinal nodes.

Lymph drainage follows quadrants:

  • upper quadrants drain to axillary nodes
  • lower quadrants drain to superficial inguinal nodes

The lymphatic drainage of more superficial tissues + skin is regional

52
Q

What are lymph nodes?

A

Lymph nodes : small swellings of lymphoid tissue in the lymphatic system where lymph is filtered + lymphocytes are formed. Part of the immune system

53
Q

What is lymphatic fluid?

A

Lymphatic fluid: clear/white fluid that is collected, filtered + transported by the lymphatic systems from around the tissues to the blood circulatory system. Contains lymphocytes

54
Q

Where is the gut tube located during development?

A
  • The gut tube is located within the peritoneal cavity + is surrounded by a layer of tissue called peritoneum (serous membrane)
55
Q

Explain what is meant by :

intraperitoneal

Retro-peritoneal

Secondary retro-peritoneal

Mesentry

A

Intra-peritoneal –> structure covered in peritoneum

Retro-peritoneal –> structure behind (outside) of the peritoneum

Mesentery –> double-layered fold of peritoneum suspending an organ from the abdominal wall

Secondary retro-peritoneal –> intra-peritoneal structure that later becomes retroperitoneal

56
Q

The gut tube blood supply arises from 3 main arteries which branch from the abdominal aorta, what are ther?

A

Coeliac trunk (T12) supplies foregut

Superior mesenteric artery (L1) supplies midgut

Inferior mesenteric artery (L3) supplies hindgut

57
Q

What does the foregut consist of?

A

(lower oesophagus –> major duodenal papilla)

lower oesophagus, stomach, spleen, liver, gall bladder, pancreas, 1st + 2nd part of duodenum

58
Q

What does the midgut consist of?

A

major duodenal papilla –> last third of transverse colon

3rd + 4th part of the duodenum, jejunum, ileum, caecum, ascending colon, transverse colon (2/3)

59
Q

What does the hindgut consist of?

A

last third of transverse colon –> upper anal canal

transverse colon (1/3), descending colon, sigmoid colon, rectum, upper anal canal

60
Q

How is visceral pain felt?

A

vague, diffuse + poorly defined/located sensation

61
Q

What are viscera sensitive to?

What are viscera not sensitive to?

A

Sensitive to stretch, hypoxia, chemicals & environmental changes

Not sensitive to cutting or thermal stimuli

62
Q

What is a dermatome?

A

an area of skin innervated by a single spinal nerve (this is the evidence-based dermatome to which we standardise

63
Q

Describe why visceral pain is vague and poorly defined

A

Visceral (organ) + somatic sensory (afferent) nerves enter the spinal cord together + travel in the same spinal tracts

  1. Brain confuses location/origin of signal
  2. Perceives that pain is of dermatomal (skin) origin
  3. Sensory nerves from organs share pathways/routs of travel with other sensory nerves
64
Q

Outline regions of referred paim

A
65
Q

What are visceral nerves?

A
  • autonomic division of NS, conduct impulses to + from internal organs, glands + blood vessels
66
Q

What are somatic nerves?

A

part of peripheral NS associated with the voluntary control of body movements via skeletal muscles

67
Q

What are sympathetic nerves?

A

part of autonomic NS that prepares the body to react to stresses such as threat or injury (e.g. fight or flight). Short neurones, quick response

68
Q

What are parasympathetic nerves?

A

part of autonomic NS that controls functions of the body at rest + helps maintain homeostasis in the body

69
Q

What are afferent nerves?

A
  • nerve that carries sensory nerve impulses from the periphery towards the CNS
70
Q

What are efferent nerves?

A
  • nerve that carries impulses from the CNS toward the periphery e.g. motor nerve
71
Q
A

Beth ANATOMY (1 decks)

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