Exam 2 Flashcards
L1 lumbar plexus nerves
iliohypogastric
ilioinguinal
2 major arteries that the internal thoracic artery gives rise to
superior epigastric artery
musculophrenic artery
external iliac artery gives rise to what 2 arteries
inferior epigastric artery
deep iliac circumflex artery
which artery is the dominant supply to the anterior wall
inferior epigastric artery
what are 3 branches of the inferior epigastric artery?
muscular artery
pubic artery
external spermatic/ cremasteric artery
the femoral artery gives rise to what 2 arteries?
superifical epigastric
superficial external pudendal
this vein is responsible for caput medusa in liver cirrhosis
paraumbilical veins
lymph drainage above the umbilicus
pectoral nodes
lymph drainage below the umbilicus
superficial inguinal nodes
intercostal muscle nerve innervation
T7-T11
subcostal muscle nerve intervation
T12
iliohypogastric and ilioinguinal nerve innervation
L1
this abd muscle is the straigt muscle of the abdomen and has tendonous intersections
rectus abdominis
this muscle of the abdomen forms lateral portion of inguinal canal and the cremasteric muscle
internal oblique
this action of this abdominal muscle is flexion of the vertebral column
external oblique
this abdominal muscle forms the inguinal ligament and superficial ring of the inguinal canal
external oblique
this abdominal muscle flexes and laterally bends the trunk, supports, and increases intra-abdominal pressure
transverse abdominis
this abdominal muscle forms the deep ring of the inguinal canal
transverse abdominis
name the layers of the rectus sheath from superficial to deep
external oblique
internal oblique
transversus
this is where the rectus sheath becomes anterior only
arcuate line
what are 4 different types of abd hernias?
umbilical
incisional
linea alba
linea semilunaris
this type of abdominal incision is along the linea alba and avoids arteries
midline
this type of abdominal incision is a horizontal cut and avoids nerve damage
transverse
this type of abdominal incision is 2.5 cm below costal margin to avoid the 7th thoracic nerve and is used for gallbladder and spleen procedures
subcostal
this type of abdominal incision splits muscle fibers and is used for appendectomies
muscle splitting
what are the 3 umbilical ligaments?
median umbilical
paired medial umbilical
paired lateral umbilical
if this umbilical ligament fails to close it may lead to urine leakage, it is also used for landmark for laparotomy
median umbilical ligament
these umbilical ligments are remnants of the umbilical arteries
paired medial umbilical ligaments
the action of this posterior abd muscle is extension and flexion of the vertebral column
quadratus lumborum
this posterior abd muscle flexes the vertebral column and the thigh
psoas
this is a fan shaped posterior abd muscle
iliacus
this is formed by 2 posterior abd muscles and is the major flexor of the thigh
iliopsoas
this is the most important nerve of the lumbar plexus
femoral nerve
this major nerve of the lumbar plexus innervates the anterior, lateral and medial leg
femoral nerve
2 major peripheral branches of lumbar plexus
L1- ilioinguinal and iliohypogastric
this is a double layer of peritoneum connecting viscera to abd wall
mesentery
this is a double layer of peritoneum attached to the stomach
omentum
this part of the peritoneum forms a ligament and connects viscera to abd wall
peritoneal ligament
this recess is posterior to the appendix
retrocecal
this recess is the lowest point in peritoneal cavity when supine and is the recess of the greater sac to the right of the epiloic foramen
Morrison’s pouch/ hepatorenal recess
these recesses are lateral to the ascending and descending colon
paracolic gutters
this recess is between the diaphragm and liver
subphrenic
*subphrenic abscess
peritonitis generates sticky fluid containing _______
fibrin
greater splanchnic nerve includes….
T5-T9
lesser splanchnic nerve includes…
T10 and T11
least splanchnic nerve includes…
T12
lumbar splanchnic nerve includes….
L1-L3
where does the greater splanchnic nerve synapse?
celiac ganglia
where does the lesser splanchnic nerve synapse?
superior mesenteric ganglia
where does the least splanchnic nerve synapse?
superior mesenteric ganglia
where does the lumbar splanchnic nerve synapse?
inferior mesenteric ganglia
PS innervation of the abdomen includes what 2 major nerves?
vagus
pelvic splanchnic nerve (S2-S4)
what 2 plexuses does the vagus nerve utilize to innervate the GI tract?
celiac plexus
superior mesenteric plexus
what plexus does the pelvic splanchnic nerve utilize to innervate the gut?
inferior mesenteric plexus
what 3 arteries does the celiac trunk give rise to?
L gastric
splenic
common hepatic
* proper hepatic
* gastroduodenal- superior pancreaticoduodenal
* R gastric
branches of SMA
inferior pacreaticoduodenal
middle colic
R colic
iliocolic
branches of IMA
L colic
sigmoid branches
superior rectal artery
this is the junction between squamous epithelium and gastric columnar epithelium at the stomach
Z line
where is the MC site of gastric ulcers?
lesser curvature
if gastric ulcers are found here, they are considered cancerous until proven otherwise
greater curvature
rugae are almost absent along which stomach curvature
lesser
this is the 1st section of the small intestine
duodenum
this section of the small intestine has thick walls, more prominent plicae circulares and the mesentary has less fat, allowing branches of the emsenteric artery to be more clear
jejunum
this part of the small intestine has peyer’s patches and more arcades
ileum
these veins combine to form the portal vein
superior mesenteric
splenic (inferior mesenteric flows into splenic)
where is diverticulosis most of the time?
sigmoid colon
where is the appendix usually located?
retrocecal
what are 4 signs that can indicate appendicitis
- McBurney’s point
- Rovsing sign
- Psoaas sign
- Obturator sign
this branch of the SMA supplies the cecum and appendix
ileocolic artery
this artery connects the SMA (middle colic) and IMA (L colic)
marginal artery
what are the 4 lobes of the liver?
- L lobe
- R lobe
- caudate
- quadrate
liver HTN/ cirrhosis leads to ____________ anastomoses
portosystemic
what 3 types of varicies can liver HTN lead to?
- esophageal
- caput medusa (paraumbilical veins)
- hemorrhoids
gallbladder arterial supply
cystic artery
what do you have to cut for a cholecystectomy?
cystic duct
this duct comes from the liver
hepatic duct
this duct comes from the gallbaldder
cystic duct
this duct is formed by the cystic and hepatic ducts
common bile duct
where do bile ducts empty?
duodenum
pancreas arterial supply
splenic
superior and inferior pancreaticoduodenal
this part of the spleen produces lymphocytes
white pulp
this part of the spleen filters blood and contains phagocytes
red pulp
what 3 vaccines must be obtained after splenectomy
- h flu
- strep pneumoniae
- n meningitis
where do the lower 6 thoracic nerves lie
between internal oblique and transversalis muscle
what 3 muscles form the inguinal canal
- external oblique
- transversalis fascia
- internal oblique
what part(s) of the inguinal canal does the external oblique form?
- superficial inguinal ring
- inguinal ligament
- anterior wall
what part of the inguinal canal does the transversalis fascia form?
- deep ring
- posterior wall
what part of the inguinal canal does the internal oblique form?
roof
if an inguinal hernia passes through the ____ ring, it may travel to the scrotum or labia
superficial
this area contains the depression through which ________ inguinal hernias protude
Hasselbach triangle
direct hernias
what marks the borders of Hasselbach’s triangle?
rectus abdominis
inferior epigastric vessels
inguinal ligament
origin of indirect inguinal hernias
deep inguinal ring
lateral to inferior epigastric vessels
origin of direct inguinal hernias
posterior wall of inguinal canal
medial to inferior epigastric
list the cause, age, and location of indirect hernias
cause- congenital
age- children and young adults
location- unilateral, R side MC
list the cause, age and location of direct hernias
cause- acquired–> weak abd muscles (lifting)
age- older adults (men)
location- bilateral
this is an outpouching of peritoneum that occurs at the 12th week of fetal life
processus vaginalis
if this structure fails to obliterate at birth, congenital inguinal hernia is more likely
processus vaginalis
this is excessive fluid in the scrotum
hydrocele
what part of the testis produce sperm?
seminiferous tubules
the gubernaculum becomes what?
scrotal ligament
the distal part of the processus vaginalis becomes what?
tunica vaginalis
if a testis is undescended, does it produce sperm?
no
where is mature sperm stored?
epididymis
what part of the epididymis becomes continuous with the ductus deferns?
tail
in this reflex, you strok the internal medial thigh and the testicles retract
cremastic reflex
the cremastic reflex assumes what is intact?
genitofemoral nerve
what abdominal muscle forms the cremasteric muscle?
internal oblique
this scrotal muscle is smooth involuntary muscle that responds to temperature
dartos
this fasica of the testis is continuous with membranous layers of abd wall and is responsible for the scrotal septum
scarpa’s fascia
what are the major pelvic bones?
sacrum
coccyx
os coxae (hip bones)
this divides the true and the false pelvis
pelvic brim
what does the true pelvis contain?
bladder and reproductive organs
what is in the false pelvis
ileum and sigmoid colon
these pelvic ligaments divide the greater and lesser sciatic foramen
sacrospinous and sacrotuberous
what structures go through the greater sciatic foramen?
- superior and inferior gluteal nerves and arteries
- piriformis muscle
- sciatic nerve
what structures go through the lesser sciatic foramen?
- internal pudendal artery and vein
- obturator tendon
- nerve to obturator
what nerve leaves the pelvis via the greater sciatic foramen, then re-enters via the lesser sciatic foramen?
pudendal nerve
what levels is the sacral nerve plexus?
L4-S3
what 2 major nerves make up the sacral plexus and what levels are they?
sciatic- L4-S3
pudendal- S2-S4
lumbosacral plexus includes what spinal nerves?
L4-S4
what 3 structures form the pelvic floor?
levator ani
small coccygeus muscles
covering fascia
what are the 3 parts of the levator ani muscle?
puborectalis
pubococcygeus
iliococcygeus
this pelvic muscle supports and flexes the coccyx
coccygeus
what 2 things can lead to levator ani/ pelvic floor dysfunction
pudendal nerve
lumbosacral plexus
this pelvic muscle rotates the thigh laterally, is innervated by the internal pudendal and gluteal arteries, and the fibers pass through the lesser sciatic foramen
obturator internus
this pelvic muscle passes through the sciatic foramen and is a lateral rotator when the hip is extended and an abductor when hip is flexed
piriformis
anterior pelvic ligaments
puboprostatic
pubovesicle
this ligament of the pelvis can be found posteriorly and connects the sacrum around one side of the rectum to the prostate or vagina
sacrogenital ligament
this subperitoneal ligament is passive support of the uterus
cardinal ligament
this subparitoneal ligament is for stability of the uterus and cervix
retrouterine
this subperitoneal fascia is for the passage of nerves and vessels
hypogastric sheath
this is located between the anal canal and the perineal membrane
perineal body
this is where ureteric orifices are in the bladder
trigone
this is the muscle that tightens with bladder contraction
detrusor
what are the 4 parts of the male urethra?
intramural/ preprostatic
prostatic
intermediate/ membranous
spongy
this structure carries sperm from the testis to ejaculatory duct
ductus deferens
this is the junction of the vas deferns and the duct of the seminal vesical
ejaculatory duct
this is attached to the bladder and does not store sperm
seminal vesical
this gland produces mucus like secretions that enter the urethra during sexual arousal to protect the sperm from acidic urine
bulbo-urethral gland
this ligament attaches the uterus to the side walls of the pelvis
broad ligament
this ligament attaches the ovary to the uterus just below the point where uterine tube enters the uterus
ovarian ligament
this ligament holds the uterus forward
round ligament
this ligament covers neurovascular supply of the uterus
suspensory ligaments
this ligament connects the isthmus of the uterus to the sacrum
uterosacral ligament
this is the open end of the fallopian tube that surrounds portion of ovary
ostium
what are the parts of the fallopian tube?
infundibulum
ampulla
isthmus
this part of the anus/ rectum can be a site for infection that spreads quickly
ischio-anal fossae
this is a horizontal passageway through the obturator fascia from the lesser sciatic notch to the posterior edge of the perineal membrane that contains the pudendal nerve, artery, and vein
Alcock’s canal
what spinal nerve controls the external anal sphnicter?
S4
this is where the anal cell type changes and squamous metaplasia are found
pectinate line/ anal transformation zone (ATZ)
what are the 2 major portions of the penile body?
corpora cavernosa
corpus spongiosum
what 2 major nerves are responsible for erection?
pudendal nerve S2-S4
pelvic splanchnic nerve S2,3,4
* S2, 3, 4 keeps the penis off the floor
dextrocardia
pleural effusion
Blunting of costophrenic angle, common in pleural effusion
pneumomediastinum
*less demarcated than pneumopericardium
*doesn’t extend as far as pneumopericardium
pneumothorax
-may see airway deviation
-lack of lung markings
- deep sulcus sign when pt lying on back
pneumopericardium
- more demarcated and extends farther than pneumomediastinum
elevated hemidiaphragm
batwing (CHF)
kerley B lines
miliar TB
cavitating lung mass
silhouette sign
pneumonia
lung nodule (<3 cm)
lung mass (>3 cm)
where is proper central line/ PICC line placement?
junction of SVC and RA
where should ET tubes be placed?
5 cm above carina
list heart valves as they appear in cxr (top to bottom)
pulmonary
aortic- in profile
mitral- en face
tricuspid
