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Medicine year 1 semester 2 > Case 12- anatomy > Flashcards

Case 12- anatomy Flashcards

1
Q

Borders of the abdomen

A
  • Superior border- diaphragm, costal margin
  • Inferior border- Iliac crest, anterior superior iliac spine, inguinal ligament, pelvic crest, pelvic brim.
  • Central landmark- umbilicus (belly button). At the bottom of the midline you have the linea alba which is a tendon which connects the xiphoid process to the pubic symphis
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2
Q

4 quadrant model of the abdomen

A

Splits the abdomen into 4 zones. The vertical line is the midline, the horizontal line runs through the umbilicus (trans umbilicus plane). Based on anatomical and theoretical landmarks

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3
Q

Right upper quadrant of the abdomen

A

Right lobe of the liver, gallbladder, pylorus of the stomach, first 3 parts of the duodenum, head of the pancreas, right kidney and adrenal gland, distal ascending colon, hepatic flexure of colon, and right half of the transverse colon

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4
Q

Left upper quadrant of the abdomen

A

Left lobe of the liver, spleen, stomach, jejunum, proximal ileum, body and tail of the pancreas, left kidney and adrenal gland, left half of the transverse colon, splenic flexure of the colon, superior part of the descending colon.

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5
Q

Right lower quadrant of the abdomen

A

Majority of the ileum, caecum, vermiform appendix, proximal ascending colon, right ureter, part of the bladder, uterus, ovary and uterine tube (female) or ductus deferens (male).

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6
Q

Left lower quadrant of the abdomen

A

Distal descending colon, sigmoid colon, left ureter, part of the bladder, uterus, ovary and uterine tube (female) or ductus deferens (male).

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7
Q

9 region model of the abdomen

A

The two vertical lines are the mid-clavicular lines, the two horizontal lines are the sub-costal (through the 10th costal cartilage) and the trans-tubercular lines which is between the tubercles on the iliac crest.

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8
Q

Right Hypochondriac region

A

Liver, gallbladder, small intestine, ascending colon, transverse colon, right kidney.

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9
Q

Epigastric region

A

Oesophagus, stomach, liver, spleen, pancreas, small intestine, transverse colon, parts of the left and right kidney, adrenal glands and ureters

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10
Q

Left Hypochondriac region

A

Stomach, part of the left lobe of the liver, left kidney, spleen, tail of the pancreas, parts of the small intestine, transverse colon, descending colon.

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11
Q

Right lumbar region

A

Part of the liver, gallbladder, small intestine, ascending colon, right kidney

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12
Q

Umbilical region

A

Stomach, pancreas, small intestine, transverse colon, parts of the kidneys and ureters, cisterna chyli

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13
Q

Left lumbar region

A

Small intestine, part of the descending colon, part of the left kidney

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14
Q

Right Iliac region

A

Small intestine, appendix, caecum, ascending colon, right ovary and uterine tube (female), ductus deferens (male)

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15
Q

Hypogastric region

A

Small intestine, sigmoid colon, rectum, urinary bladder, right and left ureters, uterus (female), ovaries and uterine tubes (female), ductus deferens, seminal vesicle and prostate (male).

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16
Q

Left Iliac region

A

Small intestine, descending colon, sigmoid colon, left ovary and uterine tube (female), ductus deferens (male)

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17
Q

How many layers does the anterior abdominal wall have

A

9

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18
Q

Flat muscles in the anterior abdominal wall

A

There are three flat muscles whose fibres run in different directions for strength. The three flat muscles end in the aponeurosis which contains rectus abdominus muscles. It is supplied by the thoracoabdominal nerves and epigastric arteries.

1) External oblique muscle
2) Internal oblique muscle
3) Transversus abdominus muscle

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19
Q

Role of the anterior abdominal wall

A

The abdominal wall helps contain the abdominal organs, move the trunk, used in forced breathing and increase intra-abdominal pressure (excretion/birth).

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20
Q

Layers of the anterior abdominal wall

A

From superficial to deep
Skin–> Camper’s fascia (fat) –> Scarpa’s fascia (membrane)–> External oblique muscles –> Internal oblique muscles –> Transversus abdominus muscles –> Transversalis fascia –> Extraperitoneal fat –> Parietal peritoneal

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21
Q

External oblique muscle

A

Most superficial muscle. originates on the outer surface of the lower 8 ribs. It inserts on the iliac crest. Has an aponeurosis (tendon) which ends in the midline raphe (linea alba). The free edge forms the inguinal ligament.

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22
Q

Internal oblique

A

Deep to the external oblique. Originates from the thoracolumbar fascia posteriorly. As well as the iliac crest and the inguinal ligament. It inserts on the lower three or four ribs. Forms an aponeurosis which ends in the linea alba. Attaches to the pubal crest and pectineal line.

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23
Q

Transversus abdominus

A

Originating from the thoracolumbar fascia posteriorly, the iliac crest, the inguinal ligament and the costal cartilages of the lower 6 ribs. It inserts in the pubic crest and pectineal line and forms and Aponeurosis ending in the linea alba. Final layer

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24
Q

Rectus abdominus

A

Not part of the layers of the abdominal wall as its only in the central region. Originates in the pubic crest, pubic tubercle and pubic symphysis. It inserts in the costal cartilages of ribs 5 to 6 and the xiphoid process. Forms the 6 pack

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25
Q

Pyramdalis muscle

A

A small triangular muscle that is found superficial but inferior to the rectus abdominus muscle. It attaches to the pubis bone and the linea alba. Function is to tense the linea alba, is not present in everyone.

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26
Q

Rectus sheath

A

A covering which encloses the rectus abdominus muscle and the pyramidalis muscle.

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27
Q

Aponeurosis

A

A sheet of fibrous tissue which has a wide area of attachment, often appears white

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28
Q

Linea alba

A

Midline where rectus sheath fuses, fusion of posterior and anterior wall of the rectus sheath.

29
Q

Linea semilunaris

A

The lateral edge of the rectus sheath on each side

30
Q

Arcuate line

A

5 to 6cm below the umbilicus level, where the posterior wall of the rectus sheath finishes

31
Q

What forms the rectus sheath above the arcuate line

A

Superior 75% of the rectus sheath
• The anterior wall is formed from the aponeuroses of the external oblique and half of the internal oblique.
• The posterior wall is formed by the aponeuroses of half the internal oblique and the transversus abdominus.

32
Q

What forms the rectus sheath below the arcuate line

A

The inferior 25% of the rectus sheath
• The anterior wall is formed by the aponeuroses of the external oblique, the internal oblique and the transversus abdominis.
• There is no posterior wall -the rectus abdominis is in direct contact with the transversalis fascia

33
Q

Innervation of the thoracoabdominal wall

A

The thoracoabdominal nerves which originate from the spinal nerves

34
Q

The neurovascular plane

A

Between the internal oblique and the transversus abdominus. It contains the vessels and nerves which supply the skin and muscles of the anterolateral abdominal wall. The nerves and vessels are transversely orientated and segmental

35
Q

Blood supply to the abdominal wall

A

The epigastric arteries. The superior and inferior epigastric artery anastomose, providing collateral circulation between the subclavian and external iliac arteries

36
Q

Superior epigastric artery

A

Arises from the internal thoracic artery. It enters the rectus sheath and descends on the posterior surface the rectus abdominis. Anastomoses with the inferior epigastric artery.

37
Q

Inferior epigastric artery

A

Arises from the external iliac artery above the inguinal ligament. It enters the rectus sheath and ascends between the rectus abdominis and the posterior layer of the rectus sheath.

38
Q

Superficial epigastric arteries

A

Arises from the femoral artery and runs superiorly toward the umbilicus over the inguinal ligament.

39
Q

Venous drainage of the abdominal wall

A

Through the epigastric veins which follow the arteries. The paraumbilical vein from the portal system anastomoses with the epigastric veins from the caval system. Portal hypertension can cause varices in this area which creates caput medusae.

40
Q

Characteristics of the Jejenum

A 
Wall- thick
Diameter- larger
Vasa recta- long
Arcades- few
Fat in mesentery- less
Circular folds (plicae circulares)- numerous, prominent
Peyer's patches- no (few)
41
Q

Characteristics of the Ileum

A 
Wall- thin
Diameter- smaller
Vasa recta- short
Arcades- many
Fat in mesentery- more
Circular folds (plicae circulares)- fewer, less prominent
Peyer's patches- yes (many)
42
Q

The small intestine

A

Assists in absorbing and digesting food, is 6 to 7m long. The jejunum makes up 2/5 of the small intestine while the ileum makes up 3/5. The duodenum is the first part of the small intestine.

43
Q

Attachments of the small intestine

A

The small intestine is attached to the posterior abdominal wall by folds of peritoneum (the mesentery). Vessels pass between the two layers of mesentery to the small intestine.

44
Q

Jejenum location

A

The jejenum begins at the Duodenojejunal junction, it is mostly found in the LUQ.

45
Q

Ileum location

A

The Ileum ends at the Ileocecal junction and is mostly found in the RUQ

46
Q

Arterial arcades

A

Where the arteries unite to form loops. The arterial arcades then give rise to the straight vasa recta. The arterial arcades provide back up vessels if the blood supply is occluded, reducing the risk of ischaemia.

47
Q

Circular folds

A

Found in the inner mucosal lining of the small intestine surrounding the lumen. They increase the surface area of the small intestine for absorption

48
Q

Palpating during a rectal exam- anal canal

A

Pectinate line, ischioanal fossae, bony structures (coccyx and sacrum), walls of the rectum, anal sphincter muscles and other related structures.

49
Q

Palpating during a rectal exam- males

A

Prostate gland, rectovesical pouch, base of bladder (in some cases), seminal vesicles if enlarged, bulb of the penis

50
Q

Palpating during a rectal exam- females

A

Retrouterine pouch (pouch of Douglas), cervix in some cases, retroverted uterus

51
Q

Hernia

A

A hernia is a protrusion of an organ or tissue through its covering into an abdominal position outside its normal compartment. This usually occurs through a weak area of muscle or the surrounding tissue or due to increased intra-abdominal pressure.

52
Q

Hernia risk factors

A

Age, obesity, previous surgery, ascites, pregnancy, heavy lifting, constipation and chronic cough.

53
Q

Hernia classification

A
  • Location-anatomical position
  • Development-congenital vs acquired
  • Potential for complications-reducible vs irreducible
54
Q

Reducible hernia

A

Can be pushed back into its original position

55
Q

Incarcerated (irreducible) hernia

A

Unable to push back into its original position

56
Q

Obstructed hernia

A

The hernia contents are compacted causing bowel obstruction as the bowel lumen is not patent

57
Q

Strangulation hernia

A

Squeezing of the hernia causes ischaemia due to lack of blood supply to the tissue

58
Q

Indirect hernia

A

More common than direct hernias. The peritoneal sac (and potentially bowel) enters the inguinal canal via the deep inguinal ring. The degree to which the sac herniates depends on the amount of processus vaginalis still present. Large herniations are possible-reaches the scrotum.

59
Q

Direct hernia

A

Direct inguinal hernias are acquired (usually in adulthood) due to weakened abdominal muscles. The peritoneal sac bulges into the inguinal canal via the posterior wall and can enter the superficial inguinal ring. The sac is not surrounded by the coverings of the contents of the canal.

60
Q

Difference between direct and indirect hernias

A

Direct hernias are medial to the inferior epigastric vessels. Indirect hernias are lateral to the inferior epigastric vessels and enter the inguinal canal through the superficial inguinal ring.

61
Q

Femoral hernias

A

Uncommon, 3:1 women to men ratio. Femoral hernias occur when the abdominal viscera or omentum passes through the femoral ring and into the femoral canal. Early repair is required. High rate of strangulation.

62
Q

Different types of umbilical hernia

A
  • Omphalocele-congenital
  • Infantile- associated with prematurity
  • Adult- associated with pregnancy, obesity and ascites
63
Q

Paraumbilical hernia

A

Central swelling usually above or below the umbilicus. May become very large. More common in adults (especially women). May be associated with obesity and weak abdominal muscles. The sac may contain both the bowel and the omentum.

64
Q

Incisional hernias

A

Occurs as a result of abdominal surgery incision, very common. Can reoccur after repair

65
Q

Risk factors for incisional hernia

A
  • Pre-op -elderly, obesity, diabetes, steroid use
  • Intra-op- open surgery, sutures, technique
  • Post-op-wound infection, chronic cough, abdominal distension
66
Q

Epigastric hernias

A

Occurs through a defect in the linea alba. This is an area of relative weakness. Commonly in men aged 20-50. Sometimes there are multiple herniations. Differential diagnosis is diastasis recti (widening of linea alba but no defect). Need surgical repair due to risk of complications.

67
Q

Obturator hernias

A

Elderly women, or patients with chronically raised intra-abdominal pressure. Protrudes from the pelvic cavity through the obturator foramen. Can cause bowel obstruction. Difficult to diagnose-palpable on rectal/pelvic examination only.

68
Q

Spigelian hernia

A

High risk of strangulation. Small tender mass at the lower lateral edge of the rectus abdominus. Occurs at the semilunar line around the level of the arcuate line

Medicine year 1 semester 2 (61 decks)

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