Exam IV Abdomen Flashcards
What are the layers of the anterolateral wall, from superficial to deep, underneath the skin?
1) Camper fascia (superficial fatty layer)
2) Scarpa fascia (epimysium)
3) external oblique m.
4) internal oblique m.
5) transversus abdominus m.
6) transversalis fascia
7 extraperitoneal fat
7) parietal peritoneum
*investing fascia (superficial, intermediate. and deep) overlie each muscle layer
The semilunar line is where?
at the respective lateral aspects of the aponeuroses of the internal and external obliques
What is the lower boundary of posterior rectus sheath?
arcuate line
What makes up the anterior layer of the rectus sheath, ABOVE the arcuate line?
- part of internal oblique m. aponeurosis
- aponeurosis of external oblique m.
What makes up the posterior layer of the rectus sheath, ABOVE the arcuate line?
- part of the internal oblique m. aponeurosis
- aponeurosis of transverse abdominal m.
The inferior epigastric artery originates from ____ ___ artery to anastomose with superior epigastric artery and ___ ____ artery.
external iliac; internal thoracic
From what nerve do the iliohypogastric and iliolingual nerves arise?
anterior ramus of spinal nerve L1
From where does the superior epigastric artery orginate?
internal thoracic artery
What arteries originate from the femoral artery?
- superficial circumflex iliac
- superficial epigastric
From where does the deep circumflex artery arise?
external iliac artery
What makes up the anterior layer of the rectus sheath, BELOW the arcuate line?
- part of internal oblique m. aponeurosis
- external oblique m. aponeurosis
- transverse abdominal m. aponeurosis
What makes up the posterior layer of the rectus sheath, BELOW the arcuate line?
transversalis fascia only
What is the incision for gallbladder removal called?
subcostal
What incision is made for hysterectromy?
Pfanenstiel (suprapubic)
What incisions are for appendectomy?
- Gridiron
- transverse
What incisions are made for exploratory operations?
- median/midline
- left paramedian incision
What is the tradeoff with making an incision to the linea alba, and what explains this tradeoff?
- lesser perfusion to this region
- will be less bleeding but takes longer to heal
The internal spermatic fascia in the spermatic cord is a continuation of what layer or the anterolateral abdominal wall?
transversalis fascia
The INTERNAL oblique muscle becomes what in the spermatic cord?
cremaster muscle
The external spermatic fascia is a continuation of what layer of the anterolateral abdominal wall?
external oblique muscle aponeurosis
What does the inguinal canal encapsulate in males? Females?
spermatic cord; round ligament of the uterus
The internal (deep) inguinal ring is an invagination of what structure?
transversalis fascia
The internal (superficial) inguinal ring is a narrow opening made from what structure?
aponeurosis of external oblique m.
Where and how do direct hernias occur?
- In Hesselbach’s triangle, which is just medial to deep inguinal ring
- internal organs protrude through deep inguinal ring
What structures in the abdominal cavity are retroperitoneal?
- kidneys
- pancreas
- vertebrae
- aorta
- IVC
Epigastric pain is usually referred from where?
visceral peritoneum of foregut structures
Pubic pain is usually referred from where?
visceral peritoneum of hindgut strucures
Compare the nerve supply and sensation of the parietal peritoneum to the visceral peritoneum.
- parietal has somatic nerve supply and is sensitive to pressure, pain, and temperature. sensation is well localized
- visceral peritoneum has autonomic fibers, no tactile or thermal receptors, and pain is referred
What is another name for the LESSER omentum?
hepatogastric ligament
What is another name for the GREATER omentum?
gastrocolic ligament
What is an adhesionotomy?
separation of peritoneal membranes
What can cause peritonitis?
infiltration of bacteria caused by
- tissue necrosis
- trauma
- ulceration
- external sources, internal gas, fecal matter
Peritonitis can lead to what 2 things?
- adhesions (parietal and visceral membranes converge)
- ascites
What artery supplies the foregut?
celiac trunk
What artery supplies the midgut?
superior mesenteric artery
What artery supplied the hindgut?
inferior mesenteric artery
What structures are categorized as MIDGUT?
- stomach
- pancreas
- liver
- proximal duodenum
What structures are categorized as HINDGUT?
- left transverse colon
- descending colon
- sigmoid colon
- most of rectum
What part of the esophagus is protective against reflux?
lower esophageal sphincter (LES)
What and where is the z line?
- transition of epithelia from stratified squamous to columnar
- at esophagogastric junction
What are the 3 muscle layers of the stomach?
- radial
- longitudinal
- transverse (oblique)
How does the jejunum compare to the ileum?
- shorter and thicker
- blood vessels are thicker, mesentery tends to be redder
- more packed with adipose tissue and greater abundance of gut-associated lymphatic tissue (GALT)
- less extensive arterial arcades
What artery supplies the cecum? What does it branch into?
ileocolic artery; appendicular artery
What artery supplies the transverse colon?
middle colic artery
What arteries supplies the descending colon?
- proximally: superior mesenteric vein
- distally: inferior mesenteric vein
What are the functions of the spleen?
- red pulp recycles RBCs, bilirubin, iron
- white pulp plays a role in adaptive and innate immune systems
- serves as reservoir for blood
What is the largest branch of the celiac trunk?
splenic artery
What part of the pancreas is adjacent to the hilum of the spleen? What part is adjacent to duodenum?
tail; head
What artery provides blood supply to greater curvature of stomach?
pancreticoduodenal artery
What part of the peritoneum envelops the liver?
coronary ligament
What separates the ANATOMICAL lobes of the liver?
- falciform ligament
- left sagittal fissure
What part of the liver contains the caudate and quadrate lobe?
left FUNCTIONAL liver
What is the difference between the hepatic vein and the portal vein?
- hepatic vein is draining blood from liver segments to the IVC
- portal vein is draining blood from the GI tract to the liver
What separates the FUNCTIONAL lobes of the liver?
portal triad
What segments constitute the left functional liver?
1-4
What is the trajectory of blood through the liver lobules from the hepatic artery and portal vein?
sinusoid>central vein>hepatic vein>IVC
The ampulla of Vater is formed by the merging of which 2 ducts?
bile and pancreatic ducts
What drains bile into the duodenum?
Ampulla of Vater, via the major duodenal papilla
What type of pain does biliary colic produce?
epigastric
Where is gallbladder pain referred to?
regions of abdomen, thorax, and shoulder
What causes cholecystitis?
blockage of bile cystic duct
What kind of epithelium is found in the bladder?
transitional
Where does ureteric colic cause pain?
- lumbar region
- inguinal region
- proximal thigh
- external genitalia
