GB 22. Surface Anatomy of the Abdomen

Question 1

What are the names of the planes that allow the abdomen to be split into 4 quadrants?

Answer 1

[1] Transumbilical Plane
- goes through L3 and L4

[2] Midline Plane
- from the xiphoid process to the pubic symphysis

Question 2

What are the names of the planes that allow the abdomen to be split up into 9 quadrants?

Answer 2

[1] Mid-Clavicular Planes (2 of them)

[2] Transpyloric Plane
- the TIP of the 9th costal cartilage

[3] Transtubercular Plane (L4/L5)

Question 3

What are some of the important structures associated with the Transpyloric Plane? (L1?)

Answer 3

[1] Tip of 9th Costal Cartilage
[2] Fundus of Gall Bladder
[3] Pylorus of the Stomach
[4] Neck of Pancreas
[5] Formation of Portal Vein
[6] Origin of the Superior Mesenteric Artery
[7] Hila of the Kidneys
[8] End of Spinal Cord
[9] Spleen (?)

Question 4

If you have pain in your right hypochondrium area, what pain/illness may that be associated with?

Answer 4

• liver

- infected gall bladder (+ murphy’s sign)

Question 5

If you have pain in your right iliac fossa area, what pain/illness may that be associated with?

Answer 5

• appendicitis
• meckel’s diverticulum (late stages)
• testicular/ovarian pain

Question 6

If you have pain in your left iliac fossa area, what pain/illness may that be associated with?

Answer 6

• infected sigmoid colon
• diverticular disease
• testicular/ovarian pain

Question 7

What is anatomical variance and why may it arise?

Answer 7

everybody’s bodies are different!

- the stomach in one person may be smaller while in another it is larger!

Question 8

In general, what does the sympathetic nervous system do to influence gastrointestinal secretion, motor activity and sphincters + blood vessels??

Answer 8

• it causes the inhibition of gastrointestinal secretion and motor activity
• it causes the contraction of gastrointestinal sphincters and blood vessels
• (contraction of muscles)

Question 9

In general, what does the parasympathetic nervous system do to influence the gastrointestinal tract and its activities?

Answer 9

• it stimulates gastrointestinal secretion and motor activity
• it relaxes the gastrointestinal sphincters and blood vessels

Question 10

Which parts of the spinal cord are sympathetic?

Answer 10

thoracolumbar

Question 11

Which parts of the spinal cord are parasympathetic?

Answer 11

craniosacral

Question 12

Does the sympathetic nervous system extend beyond the thoracolumbar area?

Answer 12

Yes - there are sympathetic trunks (chains) that allow the sympathetic system to have a wider effect

Question 13

What are the lengths of the pre-synaptic and post-synaptic axons in the sympathetic nervous system?

Answer 13

• short pre-synaptic neuron

- long post-synaptic neuron

Question 14

What are the lengths of the pre-synaptic and post-synaptic axons in the parasympathetic nervous system?

Answer 14

• long pre-synaptic neuron

- short post-synaptic neuron

Question 15

What are the dermatomes of the anterior abdominal wall?

Answer 15

T7 to L1

Question 16

Visceral afferents/pain usually travel with what type of nervous system fibres?

Answer 16

• usually travel with sympathetic fibres

Question 17

What nerve is associated with the kidney?

Answer 17

T12

Question 18

How does the brain interpret visceral pain?

Answer 18

the brain interprets visceral pain from associated dermatome

e.g. appendicitis pain is felt peri-umbilically first

Question 19

What are the 5 spots where the appendix may be in?

Answer 19

[1] Preileal
[2] Postileal
[3] Pelvic
[4] Subcecal
[5] Retrocecal

Question 20

What is the importance of McBurney’s Point? What part of the appendix is present there?

Answer 20

• the base of the appendix is always at McBurney’s Point even though there are 5 different locations

Question 21

What are the horizontal lines present in the rectus abdominis muscle?

Answer 21

tendinous intersections

Question 22

What is the inguinal ligament made up of (what is the covering of it)?

Answer 22

It is formed from the aponeurosis of the external oblique muscle

Question 23

What are some common surgical incisions/scars?

Answer 23

[1] Midline
[2] Paramedian
[3] Flank
[4] Kocher
[5] Gridiron
[6] Pfannenstiel

Question 24

When is the Kocher incision normally used?

Answer 24

usually to get to the gall bladder

Question 25

What is the Gridiron incision normally used?

Answer 25

usually for the appendix (appendectomy)

Question 26

When is the Pfannenstiel incision normally used?

Answer 26

Caesarian or C-section

Question 27

Why might the Paramedian incision be bad?

Answer 27

- incision lateral to rectus abdominis | - can get necrosis of the rectus abdominis muscle

Question 28

What happens in a Midline incision?

Answer 28

- moves around the umbilicus | - there is no damage to muscles as it is running down through the linea alba

Question 29

What is the location of the liver (e.g. what costal cartilage is it located close to)?

Answer 29

- in right upper quadrant | - it is from the right 5th costal cartilage

Question 30

Where is the spleen located? (be specific)

Answer 30

- behind ribs 9 to 11 on the left side | - behind the mid-axillary line

Question 31

When the spleen is enlarged/inflamed where does it go?

Answer 31

- it can increase 3x in size | - it moves towards the right iliac fossa

Question 32

What vertebral level does the Coeliac Trunk exit the abdominal aorta?

Answer 32

T12

Question 33

What vertebral level does the Superior Mesenteric Artery exit the abdominal aorta?

Answer 33

L1

Question 34

What vertebral level does the Renal Artery exit the abdominal aorta?

Answer 34

L1

Question 35

Which arteries come off of the abdominal aorta at L1?

Answer 35

[1] Superior Mesenteric Artery | [2] Renal Artery

Question 36

What artery comes off of the abdominal aorta at L2?

Answer 36

Gonadals

Question 37

What artery comes off of the abdominal aorta at L3?

Answer 37

Inferior Mesenteric Artery

Question 38

What are the 2 main areas that lymph gets drained to? How is the lymph drainage defined?

Answer 38

Abdomen is split into superior and inferior through the Transumbilical Plane [1] Above Transumbilical Plane - drains to axillary nodes [2] Below Transumbilical Plane - drains to superficial inguinal nodes

Question 39

In the condition of Caput Medusae, what does it mean if blood is flowing away from the umbilicus?

Answer 39

that there is portal hypertension (that may have arised from liver damage)

Question 40

In the condition of Caput Medusae, what does it mean if blood is flowing towards the umbilicus?

Answer 40

if the blood is flowing towards the umbilicus, the IVC may be damaged or blocked - this needs immediate treatment!

Question 41

Where does the spinal cord end in adults?

Answer 41

L1/L2

Question 42

Where does the spinal cord end in children?

Answer 42

L3/L4

Question 43

When is a lumbar puncture done?

Answer 43

it is usually to gain a specimen of the cerebral spinal fluid (CSF)

Question 44

What are the layers from the skin all the way in to the CSF?

Answer 44

``` [1] skin/subcutaneous fat [2] superficial/deep fascia [3] supraspinous/intraspinous ligaments (if central or lateral) [4] ligamentum flavum [5] dura [6] arachnoid layers [7] CSF! ```

Question 45

What are the layers from the skin all the way in to the CSF? - LOOK THIS OVER

Answer 45

``` [1] skin/subcutaneous fat [2] superficial/deep fascia [3] supraspinous ligament [4] interspinous ligament [5] ligamentum flavum [6] dura [7] arachnoid layers [8] subarachnoid space CSF! ```

Question 46

Where is a lumbar puncture normally done?

Answer 46

L3/L4

Question 47

What are the layers from the skin all the way in to the CSF?

Answer 47

``` [1] skin [2] subcutaneous fat [3] superficial fascia [4] deep fascia [5] supraspinous ligament [6] interspinous ligament [7] ligamentum flavum [8] dura [9] arachnoid layers CSF! ```

Question 48

Describe the position of a direct hernia in relation to the inferior epigastric vessels.

Answer 48

neck of the hernia is MEDIAL to the inferior epigastric vessels