Chapters 4 - Flashcards by W W

The ____ vertebra marks the inferior extent of the third part of the duodenum and the origin of the IMA

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Bellybutton dermatome

T10 (common site of referred pain)

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The abdominal wall consists of __ (#) tissue layers

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Superficial fascia of abdomen consists of what 2 layers?

Camper’s (outer) and Scarpa’s (inner, lacks fat)

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Scarpa’s fascia is continuous with ___?

Superficial perineal fascia (Colle’s fascia), superficial penile fascia, dartos fascia

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External oblique aponeurosis contributes to. . .

Inguinal ligament, rectus sheath, linea alba

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Internal oblique fibers run ____

Superiorly and medially (perpendicular to EO)

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Internal oblique is continuous with ___ m.

Cremaster

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Transversalis fascia gives rise to. . .

Internal spermatic fascia

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T/F: the peritoneal cavity is completely closed for all people

F - females have uterine tubes open

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Mesentery consists of ___ (#) layers of peritoneum

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During fetal life, the ___ mesentery supplies structures below the diaphragm

Dorsal

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During fetal life, the ____ mesentery supplies structures derived from foregut/spleen

Ventral

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The mesentery contains. . .

Nerves, lymphatic vessels, and blood vessels

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Parietal peritoneum forms ___ folds on the anterior abdominal wall, ___ of which contain remnants of fetal structures

5;3

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Median umbilical fold

Urachus (remnant of allantois)

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Medial umbilical folds (2x)

Medial umbilical ligaments (remnants of umbilical arteries)

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Lateral umbilical folds (2x)

Inferior epigastric blood vessels (supply abs)

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What innervates the skin, fascia, and muscles of the anterolateral abdominal wall?

Lower intercostals (T7-T11), subcostal (T12), and iliohypogastric/ilioinguinal nerves (L1)

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Rectus sheath is formed by the aponeuroses of. . .

Superior 3/4: internal oblique
Anterior: external oblique
Posterior: transversus abdominis

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The inferior epigastric arteries perforate the rectus abdominal muscles at the ___

Arcuate line

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The arcuate line is important because. . .

Below it, the rectus abdominis muscle rests directly on the transversalis fascia

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Posterior wall of the inguinal canal

Transversalis fascia (contains the deep inguinal ring)

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The inferior epigastric vessels are ___ to the deep inguinal ring

Medial

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Internal spermatic fascia is derived from. . .

Transversalis fascia

Anterior wall of inguinal canal

Aponeurosis of external oblique m. (contains superficial inguinal ring)

The inferior epigastric vessels are ___ to the superficial inguinal ring

Lateral

External spermatic fascia is derived from. . .

External oblique m.

Floor of inguinal canal

Inguinal ligament

Roof of inguinal canal

Transversus abdominis and internal oblique aponeuroses

Cremasteric fascia is derived from. . .

Fascia of internal oblique

Cremasteric reflex reflects status of. . .

L1 (ilioinguinal n. - sensory, genitofemoral n. - motor)

Testicular arises at level. . .

L2-L3 (from the aorta)

Ductus deferens artery arises from. . .

Internal iliac a.

Emission of sperm

T11-L1 (sm of ductus deferens)

Inguinal canal in females contains

Round ligament of uterus (gubernaculum)

Colicky pain comes from. . .

Contraction against an obstruction

Sharp, localized abdominal pain comes from. . .

Inflamed parietal peritoneum over affected structure

Splenic artery supplies. . . (4)

Spleen; neck/body/tail of pancreas; left side of greater curvature (L. gastroepiploic); fundus of stomach

Left gastric a. supplies. . . (2)

Lesser curvature of stomach, abdominal esophagus

Proper hepatic artery supplies. . . (3)

Lesser curvature (right gastric), liver, gallbladder (cystic artery)

Gastroduodenal artery supplies. . . (3)

Foregut duodenum, superior pancreas head (anterior/posterior superior pancreaticoduodenal arteries), greater curvature of stomach (r. gastroepiploic)

Foregut innervation

Sympathetics, greater splanchnic nerves (T7-9) - refer pain in epigastric/hypochondriac region ; parasymph from vagus and terminal ganglia

Hepatoduodenal ligament contains. . .

Hepatic portal vein, proper hepatic artery, and bile duct

Epiploic foramen

Communication to greater peritoneal cavity from omental bursa (lesser peritoneal cavity)

Omental bursa is ___ to stomach

Posterior

Borders of epiploic foramen

P: IVC, A: hepatoduodenal ligament, S: caudate lobe, I: duodenum

Surgical access to omental bursa (3 choices)

Lesser omentum, gastrocolic ligament, or gastrosplenic ligaments

Danger of operating in lesser omentum

R & L gastric arteries

Danger of operating in gastrocolic ligament

Middle colic artery

Danger of operating in gastrosplenic ligament

Short gastric a. and L gastroepipolic a.

Gastric carcinoma begins in the ____ and metastasizes to the _____

Pyloric part; cisterna chyli (produces L supraclavicular node of Virchow)

____ artery is subject to erosion by penetrating ulcer of posterior wall of stomach

Splenic

___ artery is subject to erosion by ulcer in lesser curvature

L. gastric

___ artery is subject to erosion by ulcer in posterior wall of duodenum

Gastroduodenal

Penetrating ulcer pain may refer to ___

Shoulder

Spleen is protected posterolaterally by ribs ____ (#)

9-12

The head/neck/body of the pancreas are located _____ while the tail is ____ and located in the splenorenal ligament

Secondarily retroperitoneal; peritoneal

Pancreatic adenocarcinoma develops commonly in the ___ and causes pain in ___

Head; epigastric region radiating to back

Obstructed bile duct causes ___

Obstructive jaundice

Jejeunum has ___ arcades and ___ vasa rectra

Short; long

Ileum has ___ arcades and ___ vasa rectra

Long; short

Ileocolic a. supplies. . .

Distal part of ileum, appendix, cecum, proximal part of ascending colon

R. colic artery supplies

Ascending colon

Middle colic artery supplies. . .

Proximal 2/3 of transverse colon

Pain from small intestine referred to. . .

T5-T10 (epigastric, umbilical)

Pain from cecum/appendix/early colon referred to. . .

T10-T12 (umblical, hypogastric, lumbar)

Midgut part of duodenum is ___ (location)

Secondarily retroperitoneal (~L3)

SMA syndrome

Horizontal duodenum is compressed by SMA/aorta

Ligament of Treitz

Suspends duodenojejunal junction; marker for hematemesis v. hematochezia

2s of Meckel's diverticulum

2 ft from ileocecal junction, 2% of population, 2in long, 2 tissues (gastric or pancreatic)

Retroperitoneal organs

SAD PUCKER - Suprarenal glands, aorta/IVC, duodenum (2nd/3rd), pancreas (except tail), ureters, colon (ascending/descending), kidneys, esophagus, rectum

Psoas sign

Right thigh extended at hip against resistance

Obturator sign

Right thigh flexed and internally rotated

Complication of appy

Iliohypogastric n. lesion - weakening of anterior abdominal wall, direct inguinal hernia

Sigmoid volvulus

Sigmoid colon twisted; left-sided colicky pain, abdominal distension, hematochezia

LLQ pain (MCC)

Diverticulitis

Common sites for bowel infarction

Splenic flexure and rectum

Hepatic portal vein is located ___ to the pancreas neck

Posterior (unites with SMV, splenic vein)

Portal HTN effects

(1) Esophageal varices (from L gastric vein-->eso plexus), (2) internal hemorrhoids (superior rectal v-->middle/inferior rectal vein), (3) caput medusa (paraumbilical veins --> superior epigastric veins), (4) splenomegaly

L kidney is ___ compared to R kidney

Superior, anterior to 11/12 ribs

R renal artery passes ____ to IVC

Posterior

L renal vein passes ____ to abdominal aorta

Compression of L renal vein by SMA aneurysm may cause. . .

Varicocele

Arteries supplying the ureters

Renal a. (upper), common iliac (middle), superior vesical a. (lower)

Renal colic may radiate to. . .

T11-L2 dermatomes (back above iliac crest, inguinal region, and scrotum/labia majora)

MCC site for abdominal aortic aneurysm

L4 (just above bifurcation)

Aorta branch points in abdomen (5)

T12 - celiac, L1 - SMA, L2 - renal, L2-L3 - gonadal, L3 - IMA

IVC formed at level. . .

L5 by union of common iliac veins, ascends right of midline

Hiatuses of diaphragm (3)

Caval (T8, IVC/R phrenic), esophageal (T10, esophagus + vagal trunks), aortic (T12, aorta/azygos/thoracic duct)

T/F: Caput medusae develop in patients with pancreatic carcinoma

Appy pain is carried by. . .

Lower thoracic splanchnic nerves

Ileum v. jejenum

Ileum: more fat in mesentery, thinner, less vascular

Division of urogenital and anal triangles

Ischial tuberosities (imaginary line)

Pelvic diaphragm attaches. . .

Base: bony/fascial walls of lesser pelvis just below pelvic brim; apex - anal triangle

Levator ani is located in. . .

Anterior 2/3 of pelvic diaphragm

Components of levator ani (3)

Pubococcygeus muscle, puborectalis, iliococcygeus

Muscle encircling the vagina, prostate, and anorectal junction attaching to perineal body

Pubococcygeus

Muscle bounding urogenital hiatus and forming part of external anal sphincter

Puborectalis

Muscle derived from tendinous arch attaching to anococcygeal raphe between anal canal/coccyx

Iliococcygeus (S4/S5)

Ischiococcygeus m. is located. . .

Posterior 1/3 of pelvic diaphragm

Innervation of pelvic diaphragm

Ventral rami of S2/S3 and branches of pudendal n.