Exam 3 Abdomen, Pelvis Flashcards
Interspinous plane
goes through ASIS
promontory of sacrum
Transpyloric plane
L1,2 disc
boundaries of abdominal region
superior: diaphragm
ant & lat: abdominal muscles
post: lumbar verteb, quadratus muscle
inf: iliac crests, sup iliac spine, inguinal lig, pubic tubercle, pubic crest, pubic symphysis
6 planes that pass through abdomen
- Transpyloric: disc L1,2
- pylorus of stomach - subcostal: disc L2,3
- lowest level of costal cartilage - Transumbilical: disc L3,4
- umbilicus - supracrestal: body of L4
- highest border of iliac crest - Transtubercular: body of L5
- iliac tubercles - interspinous: sacral promontory
- ASIS
epigastric region
- between midclavicular lines
- superior to subcostal plane (disc L2,3)
- liver, stomach, gallbladder, transverse colon, pancreas
L Hypochondriac region
*upper row, left column
inferior border: subcostal plane (disc L2,3)
medial border: L midclavicular line
organs: stomach, spleen, pancreas, splenic flexure of large intestine (sharp bend between transverse/descending colon)
relation of spleen to midaxillary line
majority of spleen is posterior to midaxillary line (ribs 8-11)
9 abdominal regions
Upper row: (superior to subcostal plane L2,3)
1.R Hypochondriac (right of R midclavicular line)
2.Epigastric (between midclavicular lines)
3.L Hypochondiac (left of L midclavicular line)
Middle Row: between subcostal (L2,3) & transtubercular (L5)
4.R lumbar
5.Umbilical
6.L lumbar
Lower Row: inferior to Transtubercular plane (L5)
7.R iliac
8.Hypogastric
9.L iliac
4 areas of abdominal region
- Ant, Lat abdominal walls (abdominal mms)
- inguinal (inguinal lig, canal)
- Post abdominal wall (lumbar spine, plexus)
- abdominal cavity (organs, vessels)
boundaries of anterior abdominal wall
anterior: rectus abdominis
lateral: ext/int obliques, transverse abdom
rectus sheath
*part of ant abdominal wall
epigastric region: ext obliques split–>A/P sheath
umbilical region: *int oblique splits into A/P
-ant: aponeurosis of ext,int obliques
-post:aponeurosis of int oblique, transverse abdom
hypogastric region:
- ant:aponeuroses from ext & int obliques, transverse abdom
- meet ventrally, form sleeve around each rectus muscle
- post: fascia transversalis–thin layer of CT
Linea Alba
- found in anterior abdominal wall
- abdominal fibers pass from superficial–>deep (& vice versa)
- interwinding of L/R rectus sheath in midline
- xiphoid process to pubic symphysis
external abdominal oblique
N:
- intercostal N T6-T11
- subcostal N
- iliohypogastric N
Internal Obliques & Transverse Abdominis
N:
- intercostal N T6-T11
- subcostal N
- iliohypogastric N
- ilioinguinal N
blood vessels to abdominal wall
- superior epigastric A (from internal thoracic A)
- to region above umbilicus - inferior epigastric & deep circumflex iliac A (from external iliac A)
- to region below umbilicus
IN ADDITION:
Posterior intercostal A from T10,11, Subcostal A & Lumbar A (from aorta)
-travel central and anastomose with sup/inf epigastric A
pathway of blood vessels to abdominal wall
Aorta->subclavian A->internal thoracic A->super epigastric A –>above umbilicus
Aorta->common iliac A->external iliac A->inferior epigastric A & deep circumflex iliac A–>below umbilicus
Aorta->posterior intercostal A, subcostal A, lumbar A–>umbilicus
veins to abdominal wall
*accompany each of the arteries
superior epigastric V->internal thoracic V->brachiocephalic V–> superior vena cava
inferior epigastric & deep circumflex iliac V ->external iliac V -> common iliac V–>inf vena cava
lumbar V –>inf vena cava
post intercostal & subcostal V –>azygos V & hemiazygos V–> superior vena cava
inguinal canal
Males:
- ilioinguinal N
- spermatic cord
- vas deferens, testicular A, pampiniform venous plexus of testicular V, genital branch of genitofemoral N
Females
- Round L of uterus
- ilioinguinal N
- genital branch of genitofemoral N
inguinal region: hernias
Indirect inguinal hernia: (most common)
-herniation of small intestine into DEEP inguinal ring through inguinal canal, out the SUPERFICIAL inguinal ring
Direct inguinal hernia:
-herniation of small intestine through conjoint tendon (int oblique & transverse abdom) and directly out superficial inguinal ring
aponeurosis of external obliques
becomes inguinal ligament
what structure in females does round ligament of uterus go through?
deep inguinal ring
posterior abdominal wall boundaries
posterior boundaries:
- lumbar vert
- QL
- psoas major
lumbar plexus
*post abdominal wall
- ventral rami of L1-5 spinal nerves
- L2-4 divide as they pass through psoas
- ant division: obturator N, part of genitofemoral N, part of lumbosacral trunk
- post division: lat femoral cutaneous N, femoral N, (accessry obturator N)
- iliohypogastric N: L1
- ilioinguinal N: L1
- genitofemoral N: L1, ant div L2
- lateral femoral cutan N: post div L2,3
- femoral N: post div L2,3,4
- obturator N: ant div L2,3,4
- lumbosacral trunk: ant div L4,5
iliohypogastric N
L1
sensory to skin: lateral glutes, hypogastric region
motor: ext/int obliques, transverse abdom
ilioinguinal n
L1
sensory: skin pubic symphysis, inguinal region, anterior scrotum, labia majora
motor: internal oblique, transverse abdom
genitofemoral N
L1,L2
sensory: femoral branch, genital branch
dermatomes in the thigh
lateral femoral cutaneous N (L2,3): lateral thigh
ant femoral cutaneous N (L2,3): ant/medial thigh
posterior femoral cutaneous N (S1,2,3): posterior thigh
posterior division of L1,2,3: mid gluteal region
posterior division of S1,2,3: medial gluteal region
lumboinguinal L1,2: near femoral triangle
ilioinguinal L1: proximal medial thigh (crotch area–>medial to femoral triangle)
organs in upper half of abdominal cavity
- liver
- gallbladder
- stomach
- spleen
- pancreas
- kidneys
organs in lower half of abdominal cavity
large, small intestines
blood supply to abdominal organs
- Arteries off abdominal aorta to organs
- venous system (2 routes) to inferior vena cava
- venous hepatic portal system
- stomach, pancreas, spleen, SI, LI –>liver (processing) –> inferior vena cava - venous systemic system
- liver, kidneys, suprarenal glands, testes, ovaries, lumbar vertebrae, muscles of abdomen return DIRECTLY to inferior vena cava
- venous hepatic portal system
Liver
- heaviest organ
- 4 lobes: R,L, caudate, quadrate
- metabolic function:
- glucose conversion, storage, release
- amino acid conversion to glucose
- bile salt formation
- storage of minerals, iron
- excretory organ
inferior surface of liver
- gallbladder, IVC, hepatic triad, quadrate, caudate
- hepatic A, hepatic portal V enter near superior end of gallbladder
- common hepatic duct joints w/ cystic duct to form common bile duct
- hepatic triad:
- hepatic A, portal V, bile duct
blood supply of the liver
2 sources:
1. hepatic A: delivers oxygenated blood from general circulation 2. hepatic portal V: delivers deoxygenated blood from small intestine containing nutrients
*blood drains out of the liver via hepatic V
blood flow from abdominal aorta to gallbladder
abdominal aorta–>celiac trunk–>common hepatic A–>proper hepatic A–>R,L hepatic A–>cystic A–>gallbladder
hepatic portal vein
formed by union of:
- splenic V (spleen, stomach, pancreas)
- superior mesenteric V (stomach, SI, ascending colon, R half transverse colon)
- inf mesenteric V drains into splenic V –>portal V
- drains L half of transverse colon, descending colon, sigmoid colon, rectum
function of gallbladder
stores bile
which plane does pancreas sit?
transpyloric plane: disc L1,2
pancreas arterial blood supply
- pancreatic A: off splenic A
- superior pancreaticoduodenal A: off gastroduodenal A (off common hepatic A)
- inferior pancreaticoduodenal A: off superior mesenteric A (off abdominal aorta)
*venous blood enters hepatic portal vein–>liver
spleen
- largest lymphoid organ
- located behind stomach at L posterior abdominal wall
- laterally @ ribs 9-11
blood supply:
- abdominal aorta–>celiac A–>splenic A
- splenic vein joins w/ superior mesenteric V–>hepatic portal V
esophagus
- oral cavity through esophageal hiatus-T10
- ends @ cardiac portion of stomach
- Receives blood from:
- thoracic aorta
- L gastric A (off celiac trunk)
- L inferior phrenic A (off abdominal aorta)
- venous blood–>L gastric V–>portal system
stomach
- cardiac region: esophagus to stomach
- fundus: superior dome
- pylorus: tubular inferior end to duodenum
- lesser curvature: short sup-medial
- greater curvature: long inferior-lateral
stomach arterial blood supply
- L gastric A (from celiac trunk–>L part of lesser curvature)
- R gastric A (from Common or Proper Hepatic A –> R part of lesser curvature)
- L gastroepiploic A (from splenic A–>L part of greater curvature)
- R gastroepiploic A (from gastroduodenal A–>R part of greater curvature)
- Short gastric A (from splenic A –>fundus of stomach)
stomach venous supply
*venous blood–>hepatic portal system
- R, L gastric V–>portal V
- short gastric V, L gastroepiploic V–>splenic V
- R gastroepiploic V–>superior mesenteric V
Small Intestines: duodenum blood supply
- Duodenum (from pylorus–>jejunum)
* Arterial blood (5 arteries)- supraduodenal (off gastroduodenal A)
- superior pancreaticoduodenal (off gastroduodenal A)
- inferior pancreaticoduodenal (off sup mesenteric A)
- branches from R gastroepiploic (off gastroduodenal A)
- branches from R gastric (off common/proper hepatic A)
small intestines: jejunum & ileum blood supply
jejunum: ~2.5 meters (mainly in umbilical region)
ileum: ~3.5 m (to cecum of ascending colon–mainly in hypogastric & R iliac regions)
- superior mesenteric A –>jejunal, ileal A
- veins–>superior mesenteric V–>portal system
Intestines: quadrants
RUQ: ascending colon, duodenum, jejunum, transverse colon
LUQ: jejunum, transverse colon, descending colon
LLQ: descending colon, a little jejunum, ileum, sigmoid
RLQ: cecum, ascending colon, ileocecal junction, appendix, ileum, a little jejunum
Large intestines
- begins @ R iliac region: cecum, appendix post
- ascending colon: hepatic (R colic) flexure @ liver
- transverse colon: splenic (L colic) flexure @ spleen
- descending colon:
- sigmoid colon (in pelvis)
- rectum in midsagittal plane
- anal canal
transverse mesocolon
mesentery that suspends the transverse colon from the posterior abdominal wall
Large intestines blood supply
- superior mesenteric A: MIDGUT
* iliocolic A: ileocecal jcn, cecum, appendix, inf ascending colon
* R colic A: ascending colon
* middle colic A: to hepatic fixture, R half transverse colon - inferior mesenteric A: to remaining parts (HINDGUT)
* Lt colic A- L sup colic: L half of transverse colon
- L inf colic: descending colon
* sigmoid A
* superior rectal A
3.superior/inferior mesenteric V–>portal V
Pelvic Arteries
- External Iliac (off abdominal aorta)
- internal iliac A
- posterior div
- iliolumbar A
- superior gluteal A
- lateral sacral A
- anterior division (differ by gender)
- common:
- umbilical A
- obturator A
- middle rectal A
- internal pudendal A
- inferior gluteal A
- median sacral A
- vaginal A (female) = inferior vesical A (male)
- uterine A (female)
- common:
- posterior div
Kidneys: boundaries
Ant:
-L: spleen, stomach, pancreas, L colic (splenic) flexure, jejunum
-R: liver, R colic (hepatic) flexure, duodenum
Post:QL, diaphragm (common site of referred pain)
Lateral: transverse abdominis (common site of referred pain)
medial: psoas major (common site of referred pain)
superior: suprarenal gland
L kidney: T11-L2
R kidney: T12-L3
renal cortex
glomerulus, bowman’s capsule, prox/distal convoluted tubule
Renal pyramids (medulla)
papillary duct (collecting tubule), loop of henle (between prox & dist convoluted tubules)
suprarenal glands
-medial superior pole of kidney
-cortex
*cortisol, aldosterone, corticosterone, estrogen, progesterone
-medulla
*epinephrine, norepinephrine
Blood supply:
-superior suprarenal A (off inferior phrenic A)
-middle suprarenal A (off abdominal aorta)
-inferior suprarenal A (off renal A)
-suprarenal V
referred pain site for kidney/ureter
inguinal region, ant thigh
referred pain site for gallballder, liver
R shoulder, scapula area
pancreas referred pain site
L shoulder, midback
stomach/duodenum
R shoulder, upper trap, lower thoracic
abdominal arteries (9)
- inferior phrenic A: level of aortic hiatus (T12)
- celiac trunk A: T12
- superior mesenteric A: L1
- middle suprarenal A: L1
- renal A: L2
- testciular/ovarian A: below renal
- inferior mesenteric A: L3
- lumbar A: side of aorta @ L1-4 level
- common iliac A: disc L4,5
celiac trunk
- common hepatic A:
* R gastric A
* proper hepatic–>L hepatic A
* proper hepatic–>R hepatic A–>cystic A
* gastroduodenal A- supraduodenal
- superior pancreaticoduodenal
- R gastroepiploic
- L gastric A
- esophageal A - splenic A
- pancreatic A
- short gastric A
- L gastroepiploic A
common iliac A
- internal iliac A
- pelvic organs, muscles, perineum - external iliac A (becomes femoral A when it passes deep to inguinal Lig)
- deep circumflex A
- inferior epigastric A: abdominal wall
