Exam 1 Flashcards
What are the four important dermatomes?
C4 - Shoulders
T4 - Nipple line
T10 - Umbilicus
L1 - Groin
What are the layers of the abdominal wall?
Superficial fascia (camper’s & scarpa)
Muscles
Rectus sheath
Transversalis fascia
What forms the rectus sheath above the arcuate line?
External and half of internal anterior
Transversus and half of internal go posterior
How do nerves run to the abdominal muscles?
Nerves run between the transversus and the internal oblique
Innervated by nerves T7 to L1
How is blood supplied to the abdominal muscles?
Through the superior epigastric artery
What is the function of the abdominal muscles?
Flexion and create pressure for a variety of actions
What is the lympathic drainage pattern of the superficial abdomen wall?
Above the umbilicus goes to axillary
Below the umbilicus goes to the superficial inguinal
What is the lymphatic drainage pattern of the deep abdominal wall?
Follows deep arteries to parasternal, lumbar and external iliac nodes
What is the function of the gubernaculum?
Drags the gonads down and through the abdominal wall
What does the inguinal canal contain?
Spermatic cord (males)
Round ligament (females)
Genital branch of the genitalfemoral nerve
Part of ilio-inguinal nerve
Where do the ilio-inguinal and iliohypogastric nerves originate from?
L1
What is the difference between preperitoneal and retroperitoneal?
Preperitoneal describes the extraperitoneal fascia anterior to the peritoneum
Retroperitoneal refers to the estraperitoneal fascia posterior to the peritoneum
What vascular structure is the marker for if a hernia is indirect or direct?
Inferior epigastric artery
Indirect is lateral
Direct is medial
What forms the deep ring for the inguinal canal?
Transversalis fascia
What forms the superficial ring for the inguinal canal?
Aponeurosis of the external oblique
What is the most likely place for a hernia to occur?
Hessel-vox triangle
What are intraperitoneal structures?
Organ is surrounded by the peritoneum
Stomach, small intestine, liver, transverse and sigmoid colon
What is a femoral hernia?
Passes through the femoral canal and into the thigh
More common in women
What are the retroperitoneal structures?
Organ is not fully surrounded by the peritoneum
Kidneys, pancreas, rectum, ascending and descending colon
What is the greater omentum?
Covering of the abdominal organs
Can move to help fight infection/inflammation
What forms the anterior wall of the inguinal canal?
Aponeurosis of the internal oblique
What forms the roof of the inguinal canal?
Internal oblique
What forms the posterior wall of the inguinal canal?
Transversalis fascia
What forms the floor of the inguinal canal?
Inguinal ligament
What three structures come off the celiac trunk?
Splenic
Left gastric
Common hepatic
Where does the esophagus pass through the diaphragm and what passes with it?
Pass through diaphragm at T10 and the vagal trunk pass with it.
Posterior vagal trunk comes from the left vagus nerve
Anterior vagal trunk comes from the right vagus nerve
What supplies blood to the heart?
Lesser curvature - left gastric artery (hepatic artery proper)
Greater curvature - right gasto-omental artery (gastroduodenal artery)
What are the branches of the superior mesenteric artery?
Posterior inferior pancreaticoduodenal artery (duodenum) Jejunal (jujenum) Anterior and posterior cecal arteries (cecum) Ileocolic artery (appendix) Right colic (ascending colon) Middle colic (transverse colon)
What is McBurney’s point?
Location most often associated with appendicitis
What runs down the middle of the liver?
Falciform ligament
What does the porta hepatis contain?
Bile duct
Portal vein
Hepatic artery proper
What are the different lobes of the liver?
Left
Right
Caudate (superior)
Quadrate
Where is pain from the foregut referred to?
Back of the shoulder and below the armpit
What structure is most likely to be compressed by a growing tumor in the pancreas?
Either celiac trunk or the superior mesenteric artery
What supplies blood to the foregut?
Celiac trunk from T12
Contains stomach, liver, pancreas, gallbladder, and duodenum
What supplies blood to the midgut?
Superior mesenteric artery from L1
Includes duodenum, jejunum, ileum, cecum, appendix, ascending and two thirds of transverse colon
What supplies blood to the hindgut?
Inferior mesenteric artery from L3
Includes one third of transverse colon, descending colon, sigmoidal colon, rectum and upper part of anal canal
Where does the spleen lie?
Area of rib 9 to 10
What are the branches of the inferior mesenteric artery?
Superior rectal
Left colic
Sigmoidal
Where are the kidneys located in relation to the ribs?
TXII to LIII
How does the lymphatic system of the abdomen work?
Follows three main arteries, the superior and inferior mesenteric and the celiac
What nerves supply the kidneys, foregut, midgut and hindgut?
Foregut - Greater splanchnic nerve T5 - T9
Midgut - Lesser splanchnic nerve T9 - T10
Hindgut - Lumbar splanchnic L1 - L2
Kidneys - Least splanchnic nerve T12
What forms the portal vein?
Splenic vein and superior mesenteric vein
Where are portosystemic anastomoses most likely to occur?
Umbilicus
Anus
Gastroesophageal junction
Where do parasympathetic stimulation come from?
Either the vagal nerve or after two thirds of the transverse colon it comes from S2-S4
Where are the motor sensory fibers in the spinal cord?
Ventral side
Where does sensory information return to the spinal cord?
Dorsal side
Where does the greater splanchnic nerve go to?
Celiac ganglion
Where does the lesser splanchnic nerve go to?
Aorticorenal ganglion
Where does the least splanchnic nerve go to?
Renal plexus
What supplies blood to the suprarenal glands?
Superior suprarenal arteries from the inferior phrenic artery
What are the branches of the lumbar plexus?
Iliohypogastric (L1) Ilio-inguinal (L1) Genitofemoral (L1 & L2) Lateral cutaneous nerve of thigh (L2 & L3) Obtrurator (L2 - L4) Femoral (L2 - L4)
Where does referred pain from the heart go?
Upper thorax and medial arm
Where does referred pain from the midgut go?
Umbilical region
Where does referred pain from the kidneys go?
Flanks and pubic region
Where does referred pain from the hindgut go?
Left and right flanks and groins
Lateral and anterior thighs
What are the two most common types of diaphragmatic hernias?
Morgagni’s - xiphoid process and costal margins
Bochdalek’s - pericardioperitoneal canal is failed to close by the pleuro-peritoneal membrane
What is the thoracic wall made of?
Ribs and sternum
How does lymphatic drainage occur in the breast?
75% goes to the axillary
What does the sagittal plane divide into?
Left and right
What are the classifications of the ribs?
True ribs 1-7
False ribs 8-12
Floating ribs 11 & 12
What structures form the sternal angle?
Meeting of the body and manubrium of sternum
What are the intercostal muscles? Where do the intercostal veins and arteries run?
Innermost
Internal
External
Run in between the internal and innermost muscles
Where is a chest tube inserted?
Between the miaxillary and anterior axillary line around the fourth or fifth rib
What is the lymphatic drainage of the thoracic wal?
Intercostal nodes in back
Parasternal nodes in front
Where do the aorta, esophagous and inferior vena cava pass through the diaphragm?
Inferior vena cava - T8
Esophagous - T10
Aorta - T12
What does the root of the lung contain?
Bronchus
Pulmonary artery and vein
What are the two important veins for the posterior thoracic wall?
Azygos - right side
Hemizygous - left side
Which nerve runs behind the lung and which nerve runs in front of it?
Phrenic is anterior
Vagus is posterior
What nerve innervates the diaphragm?
Right phrenic nerve
What is a bronchopulmonary segment?
An area of the lung that can be safely removed without affecting the other areas of the lung
In which lung does the bronchi and arteris split before entering?
The right lung
What is on the anterior surface of the heart?
Right ventricle
What is on the base of the heart?
Left atrium
What is on the left pulmonary surface of the heart?
Left ventricle
What is on the right pulmonary surface of the heart?
Right atrium
What is on the diaphragmatic surface of the heart?
Left ventricle
How is left vs right sided heart determined?
Which ever side gives off the posterior interventricular branch
What are the papillary muscles?
Where valves attach to the wall of the heart
What cusps does the pulmonary valve have?
Right
Left
Anterior semilunar
What does the transverse pericardial sinus allow you to place your fingers behind?
The great arteries
What cusps does the aortic valve have?
Left
Right
Posterior
What cusps does the tricuspid valve have?
Anterior
Posterior
Septal
Which nerve stimulates the vocal cords?
Left recurrent laryngeal
How is the pelvis divided into the false and true pelvis?
By the pelvic inlet
Superior is false pelvis
Inferior is true pelvis
What is the function of the sacrotuberous and sacrospinous ligaments?
Prevent upward tilting of sacrum
