guessed high yield book abdomen Flashcards
what does the scarpa fascia continue as inferiorly
as the superficial perineal fascia (collets fascia)
how is the parietal peritoneum separated from the transversals fascia
variable amount of extraperitoneal fat
what are the 3 flat muscles of the abdomen
external oblique, internal oblique, transversus abdominus
what muscles contribute to the aponeuroses of the rectus sheath
external oblique, internal oblique, transversus abdominus
what are the 2 vertical muscles of the anterolateral abdominal wall
rectus abdominis and pyramidalis
which flat muscle does NOT originate posteriorly from the thoracolumbar fascia
external oblique
which abdominal muscle gives rise to the inguinal ligament
external oblique
what does the inguinal ligament span from
ASIS and the pubic tubercle
what percentage of people have the pyramidalis muscle
80%
what do surgeons use the attachment of the pyramidalis muscle to the linea alba for
as a landmark for median abdominal incision
what are found within the rectus sheath (besides the muscles that make it up)
superior and inferior epigastric arteries and veins, lymphatic vessels, distal portions of the thoraco-abdominal nerves
what demarcates the transition between the aponeurotic posterior wall of the sheath covering the superior 3/4 of the rectus and the transversals fascia covering the inferior quarter
arcuate line
what is the dermatome to the umbilicus
T10
what is the dermatome to the inguinal fold
L1
what cutaneous branches supply to the skin superior to the umbilicus
T7-T9
what cutaneous branches supply to the skin around the umbilicus
T10
what does the superficial epigastric vein arise from
femoral vein
what does the lateral thoracic vein arise from
axillary vein
what do the superior epigastric vessels and the muscophrenic vessels arise from
internal thoracic
what do the inferior epigastric and the deep circumflex iliac vessels arise from
external iliac vessels
what does the superficial circumflex iliac arise from
femoral artery
what does the superficial epigastric vessels arise from
great saphenous vein
what is the superior epigastric artery a direct continuation of
internal thoracic artery
where does the inferior epigastric arise from the external iliac artery
just superior to the inguinal ligament
where does lymph superior to the transumbilical plane drain mainly to
axillary lymph nodes
where do superficial lymphatic vessels inferior to the transumbilical plane drain to
superficial inguinal lymph nodes
what space is located between the transversals fascia and the parietal peritoneum
space of Bogros
where does an epigastric hernia occur
through the linea alba in the midline between the xiphoid process and the umbilicus
what plane are paramedic incisions made in
sagittal plane
what type of incisions are typically used for appendectomy
Gridiron (muscle-splitting) incisions
where is McBurneys point
approximately 2.5 cm superomedial to the ASIS on the spina-umbilical line
what do subcostal incisions provide access to
gallbladder and biliary ducts on right side and spleen on left side
what do the lateral umbilical folds cover
the inferior epigastric vessels
what is the supravesical fossa between
median and medial umbilical folds
what is the medial inguinal fossa between
the medial and lateral umbilical folds (also known as hesselbach triangles)
what is the site of indirect inguinal hernias
hesselbachs triangle
what is the site for the indirect inguinal hernia
deep inguinal rings which are located in the lateral inguinal fossa
what forms the medial boundary of the subinguinal space
lacunar ligament
what is the main occupant of the inguinal canal in males and females
spermatic cord in males and round ligament of uterus in females
what does the lateral crus attach to
pubic tubercle
what does the medial crus attach to
pubic crest
what is the internal spermatic fascia derived from
transversalis fascia
what is the cremasteric fascia derived from
investing fascia
what does the cremaster muscle do
reflexively draw the testis superiorly in the scrotum, particularly in response to cold
what is the smooth muscle of the fat-free subcutaneous tissue of the scrotum
dartos muscle
what is the cremaster muscle innervated by
genital branch of genitofemoral nerve
what does the testicular artery arise from
aorta
what does the artery of the ductus deferent arise from
inferior vesical artery
what does the cremasteric artery arise from
inferior epigastric artery
what do the lymphatic vessels of the scrotum drain into
superficial inguinal lymph nodes
what does the right testicular vein enter into
IVC
what does the left testicular vein enter into
left renal vein
what is the condition called when there are undescended testes
cryptorchidism
what nerve is at risk of damage when there is repair due to direct inguinal hernia
iliohypogastric nerve
what finding suggests an indirect inguinal hernia
detection of an impulse at the superficial ring and a mass at the site of the deep ring
what is indicative of a direct inguinal hernia
a sudden impulse is felt medial to the finger when the person coughs or bears down
what is the anterolateral surface of the scrotum nerve supply to the
lumbar plexus
what is the nerve supply to the postern-inferior aspect of the scrotum
sacral plexus
what side do varicoceles typically occur
left side
where does metastasis originally occur with cancer of testes
retroperitoneal lumbar lymph nodes
where does metastasis first occur with cancer of the scrotum
superficial inguinal lymph nodes
where is pain from the inferior surface of the central part of the diaphragm typically referred
to the C3-C5 dermatomes over the shoulder
what is visceral peritoneum primarily stimulated by
stretching and chemical irritation
where is pain from foregut derivatives typically experienced
epigastric region
what mesentery is commonly known as “the mesentery”
small intestine mesentery
describe the greater omentum
4-layered peritoneal fold that hands down like an apron from the greater curvature of the stomach and the proximal part of the duodenum (then after descending, folds back and attaches to the anterior surface of the transverse colon and its mesentery
describe the lesser omentum
2-layered peritoneal fold that connects the lesser curvature of the stomach and the proximal part of the duodenum to the liver
how is the liver connective to the anterior abdominal wall
falciform ligament
what does the portal triad consist of
portal vein, hepatic artery and bile duct
where does the mental bursa (lesser sac) lie
posterior to the stomach and lesser omentum
how do the lesser and greater sac communicate
epiploic foramen/ OOMENTAL foramen
what does the hepatoduodenal ligament contain
hepatic portal vein, hepatic artery, bile duct
what is the anterior border of the epiploic foramen
hepatoduodenal ligament
what effectively blocks the external os (opening) of the uterus to most pathogens but not sperm
mucous plug
what occurs when an ulcer perforates the wall of the stomach or duodenum, spilling acid content into the peritoneal cavity
general peritonitis
where is the needle inserted for paracentesis
superior to the empty urinary bladder (in order to avoid the inferior epigastric artery)
what is the medical term for removal of the gall bladder
cholecystectomy
where does digestion mostly occur
stomach and duodenum
where does absorption of chemical compounds occur primarily
small intestine
where does most reabsorption of water occur
ascending colon
what is the hepatic portal vein formed by the union of
superior mesenteric and splenic veins
what fascia is the phrenic-esophageal ligament an extension of
inferior diaphragmatic fascia
what is the right border of the abdominal esophagus continuous with
lesser curvature of the stomach
what is the jagged lien where the mucosa abruptly changes from esophageal to gastric mucosa
Z line
what vertebral level is the cardia of the stomach typically at
T11
what is the stomach anteriorly related to
diaphragm, left lobe of liver, and anterior abdominal wall
what is the stomach posteriorly related to
OOmental bursa and pancreas
what is the arterial supply to the lesser curvature
right and left gastric arteries
what is the arterial supply along the greater curvature of the stomach
right and left gastro-OOmental (gastro-epiploic)
what do the funds and upper body of the stomach receive blood from
short and posterior gastric arteries
what do the right and left gastric veins drain into
hepatic portal vein
what do the short gastric and left gastro-mental veins drain into
splenic veins
what is the anterior vagal trunk mainly derived from
left vagus nerve
what is the posterior vagal trunk mainly derived from
right vagus nerve
what is the primary site for absorption of nutrients from ingested materials
small intestine
what is the superior part of the duodenum overlapped by
liver and gallbladder
what 2 ducts come together to form the hepatopancreatic ampulla
bile and main pancreatic ducts
what vertebral level is the superior part of the duodenum at
anterolateral to L1 vertebra
what vertebral level is the descending part of the duodenum at
right of L2-L3 vertebrae
what vertebral level is the inferior duodenum at
anterior to L3 vertebrae
what vertebral level is the ascending part of the duodenum at
Left of L3
what is the terminal branch of the SMA
ileocolic artery
where is the right colic flexure located
deep to the 9th and 10th ribs
what is the main arterial supply to the transverse colon
middle colic artery
what people are highly prone to esophageal varices
people with alcoholic cirrhosis
what is another name for heartburn
pyrosis
where do all gastric nodes eventually drain
celiac lymph nodes
where does pain from the posterior gastric ulcer tend to refer to
the back
where is visceral referred pain from a gastric ulcer felt
in the epigastric region because the stomach is supplied by pain afferents that reach T7 and T8 spinal sensory ganglia and spinal cord segments through the greater splanchnic nerve
what is the spleen associated with posteriorly
left 9th-11th ribs
what is the largest branch of the celiac trunk
splenic artery
what does the splenic vein unite with in order to form the hepatic portal vein
SMV (posterior to the neck of the pancreas)
what 2 things join to form the hepatopancreatic ampulla
the main pancreatic duct and the bile duct
what 2 ducts unite to form the common bile duct
common hepatic duct and the cystic duct
what ribs does the liver normally lie deep to
ribs 7-11 on right side
what part of the liver lies in direct contact with the diaphragm
bare area of the liver
what encloses the portal triad
lesser omentum
which lobe of the liver is larger
right
what is the largest derivative of the celiac plexus
hepatic plexus
where do efferent lymphatic vessels from the bile duct pass to
celiac lymph nodes
what duct connects the neck of the gall bladder to the common hepatic duct
cystic duct
where does blood from the SMV mostly go
to the right liver
true or false: the hepatic portal vein and its tributaries have no valves
true
what is the most frequently injured organ in the abdomen
spleen
what are most exocrine pancreatic problems secondary to
biliary problems
what side of the body are subphrenic abscesses more common
right because of the frequency of ruptured appendices and perforated duodenal ulcers
where is a subphrenic abscess often drained
by an incision inferior to, or through, the bed of the 12th rib
what is the most common source of an aberrant right hepatic artery
SMA
what is the most common source of an aberrant left hepatic artery
left gastric artery
what is the primary site for detoxification of substances absorbed by the GI tract
liver
what is the most common cause of portal hypertension
alcoholic cirrhosis
where is the needle commonly direct for a liver biopsy
through the right 10th intercostal space in the midaxillary line
what is the common site for impaction of gallstones
hepatopancreatic ampulla
where does pain from impaction of a gallbladder develop and then shift to
develops in the epigastric region and shifts to the right hypochondriac region at the junction of the 9th costal cartilage and the lateral border of the rectus sheath
what is the renal fascia continuous with superiorly
fascia on the inferior surface of the diaphragm
posteriorly, what does the superior parts of the kidneys lie deep to
11th and 12th ribs
is the renal vein anterior or posterior to the renal artery in the hilum
anterior
what is the apex of the renal pelvis continuous with
ureter
where do the ureters normally demonstrate relative constrictions
junction of the ureters and the renal pelves, where the ureters cross the brim of the pelvic inlet, and during their passage through the wall of the urinary bladder
what is the major attachment of the suprarenal glands
diaphragmatic crura
where do the renal arteries arise
at the level of the IV disc between L1 and L2
which renal artery is longer and describe its relationship to the IVC
right renal artery passes posterior to the IVC
what does the left renal vein receive from
left suprarenal vein, left gonadal vein and a communication with the ascending lumbar win
where does each renal vein drain into
IVC
where do superior suprarenal arteries arise from
inferior phrenic arteries
where do middle suprarenal arteries arise from
abdominal aorta near the level of origin of the SMA
where do the inferior suprarenal arteries arise from
renal arteries
which suprarenal vein drains directly into the IVC
right
what does the left suprarenal vein often have to join with before emptying into the left renal vein
inferior phrenic vein
where do lymphatic vessels from the middle part of the ureter usually drain
common iliac lymph nodes
where do lymphatic vessels from the inferior part of the ureters typically drain
common, external or internal iliac lymph nodes
where does pain from the ureters typically refer to
ipsilateral lower quadrants of the anterior abdominal wall and especially to the groin
what is the medical term to describe dropped kidney
Nephroptosis
what is the site for transplanting a kidney
in the iliac fossa of the greater pelvis
what is the medical term for a kidney stone
renal calculus
where is pain due to a kidney stone referred
to the cutaneous areas innervated by the spinal cord segments and sensory ganglia, which also receive visceral afferents from the ureter, mainly T11-L2
what is the main source of presynaptic sympathetic fibers serving abdominal viscera
lower thoracic splanchnic nerves
what does the stomach (foregut) receive innervation from
T6-T9 levels
what does the small intestine through the transverse colon (midgut) receive innervation from
T8-T12levels
what does the descending colon (handgun) receive innervation from
T12-L2 levels
what are pelvic splanchnic nerves derived directly from
anterior rami of spinal nerves S2-S4
what plexuses does the inter mesenteric plexus give rise to
renal, testicular/ovarian and ureteric plexuses
what does the right crus of the diaphragm arise from
the first 3-4 lumbar vertebrae
what does the left crus of the diaphragm arise from
first 2-3 lumbar vertebrae
where do the superior phrenic veins drain into
IVC
what is the chief flexor of the thigh
iliopsoas
what nerve roots does the genitofemoral nerve arise from
L1-L2
what spinal nerve roots does the lateral cutaneous nerve of the thigh arise from
L2,L3
at what vertebral level does the aorta bifurcate
L4
what artery gives rise to the deep circumflex iliac and inferior epigastric arteries
external iliac artery
what level does the IVC begin and due to the union of what
anterior to L5 vertebrae by the union of the common iliac veins
where does lymph from the common iliac drain to
right and left lumbar lymph nodes
where does the inferior end of the thoracic duct lie
anterior to the L1 and L2 vertebral bodies between the right crus of the diaphragm and the aorta
where does the thoracic ultimately end
by entering the venous system at the junction of the left subclavian and internal jugular veins (left venous angle)
where is pain resulting from irritation of the diaphragmatic pleura or the diaphragmatic peritoneum referred to
shoulder region (area of skin supplied by the C3-C5 segments of spinal cord)
where does irritations of peripheral regions of the diaphragm, innervated by inferior intercostal nerves, referred
it is more localized at the skin over the costal margins of the anterolateral abdominal wall
