Intro to the abdomen

Question 1

Which organs sit in the Right Hypochondrium region?

Answer 1

Liver

Hepatic flexure of colon

Question 2

Which organs sit in the Epigastric region?

Answer 2

Stomach
Liver 
Gallbladder
Transverse colon 
Abdominal aorta/ SMA/ Coeliac Trunk 
Duodenum 
Pancreas 
Kidneys 
Adrenal glands

Question 3

Which organs sit in the Left Hypochndrium region?

Answer 3

Stomach
Spleen
Pancreatic tail
Splenic flexure of colon

Question 4

Which organs sit in the Umbilical region?

Answer 4

Small intestine
Abdominal Aorta
Root of mesentery
IMA

Question 5

What is the surface anatomy for the Transpyloric Plane?

Answer 5

L1

Midway between suprasternal notch and upper body of pubic symphysis.

Question 6

What is the surface anatomy for the Subcostal Plane?

Answer 6

L3

Lowest anterior point of the costal margin

Question 7

What is the surface anatomy for the Supracristal Plane?

Answer 7

L4

Highest point of the iliac crests (posteriorly)

Question 8

What is the surface anatomy for the Transtubercular Plane?

Answer 8

L5

Tubercles of the iliac crests

Question 9

Which organs sit in the Right Flank region?

Answer 9

Ascending colon

Small intestine

Question 10

Which organs sit in the Left Flank region?

Answer 10

Descending colon

Small intestine

Question 11

Which organs sit in the Right Iliac Fossa region?

Answer 11

Caecum

Appendix

Question 12

Which organs sit in the Pubic region?

Answer 12

Small intestine 
Sigmoid colon 
Upper rectum 
Ovary
Uterine tube 
Distended bladder
Enlarged uterus 
Common iliac arteries

Question 13

Which organs sit in the Left Iliac Fossa region?

Answer 13

Sigmoid colon

Question 14

What are the functions of the Rectus Abdominus?

Answer 14

Compress abdominal contents
Flex vertebral column (e.g. to lift legs)
Tense abdominal wall

Question 15

What is the Rectus Sheath?

Answer 15

Fibrous sheath formed by the aponeuroses of the flat abdominal wall muscles and the transversalis fascia.
Encloses vertical muscles and epigastric vessels.

Question 16

What happens to the position of the Rectus Abdominus during pregnancy?

Answer 16

Moves laterally - away from midline

Question 17

What is the Linea Alba?

Answer 17

Palpable midline running from Xiphoid Process to the Pubic Tubercle formed by the joining of aponeuroses of flat abdominal muscles.

Question 18

What are the layers of the abdominal wall above the arcuate line?

Answer 18

Skin 
Subcutaneous fat 
Superficial fascia
External obliques 
Internal obliques
Transversus Abdominus 
Transversalis fascia 
Extraperitoneal fascia
Parietal peritoneum

Question 19

How is the Linea Alba relevant for surgery?

Answer 19

No blood supply so suitable for surgical access however lack of blood supply can hinder recovery after surgery and increases risk of herniation

Question 20

What are the attachments of the External Obliques?

Answer 20

Origin = Outer surface of ribs 5-12 
Insertion = Iliac crest, linea alba

Question 21

What is the nerve innervation to the External Obliques?

Answer 21

Anterior rami of lower 6 thoracic spinal nerves (T7-12)

Question 22

What are the attachments of the Internal Obliques?

Answer 22

Origin = thoracolumbar fascia, iliac crest, lateral inguinal ligament 
Insertion = ribs 10-12, linea alba, pubic crest, conjoint tendon (forms inguinal canal)

Question 23

What is the nerve innervation to the Internal Obliques?

Answer 23

Anterior rami of lower 6 thoracic spinal nerves (T7-12) and L1

Question 24

What are the attachments of the Transversus Abdominus?

Answer 24

Origin = thoracolumbar fascia, iliac crest, lateral 1/3 of inguinal ligament, costal cartilages of ribs 7-12 
Insertion = Aponeurosis ending in linea alba, upper pubis, conjoint tendon

Question 25

What is the nerve innervation to the Transversus Abdominus?

Answer 25

Anterior rami of lower 6 thoracic spinal nerves (T7-12) and L1

Question 26

What are the functions of the abdominal muscles?

Answer 26

1. Movement 2. Support of vertebral column 3. Defecation / urination 4. Holding organs in place

Question 27

What is the arcuate line?

Answer 27

Lower limit of posterior layer of Rectus Sheath

Question 28

What are the vertical muscles of the abdominal wall?

Answer 28

Rectus Abdominus | Pyramidalis muscles

Question 29

What are the attachments of the Pyramidalis muscles?

Answer 29

``` Origin = Pubis, Pubic symphysis Insertion = Linea Alba ```

Question 30

What is the nerve innervation of the Pyramidalis muscles?

Answer 30

Anterior ramus of T12

Question 31

What is the function of the Pyramidalis muscles?

Answer 31

Tenses linea alba

Question 32

What are the functions of the external obliques?

Answer 32

Compress abdominal contents | Contralateral rotation of torso

Question 33

What are the functions of the internal obliques?

Answer 33

Compress abdominal wall | Ipsilateral rotation of torso

Question 34

Where does lymphatic fluid in the abdomen drain to?

Answer 34

``` Axillary nodes (armpits) Inguinal nodes (groin) ```

Question 35

Define intra-peritoneal

Answer 35

Structures covered in peritoneum

Question 36

Define retroperitoneal

Answer 36

Structures outside (behind) of the peritoneum

Question 37

Define mesentery

Answer 37

Fold of peritoneum suspending an organ from the abdominal wall

Question 38

Define secondary retroperitoneal

Answer 38

Intraperitoneal structures that later become retroperitoneal during development

Question 39

What stimuli are viscera sensitive (and not sensitive) to?

Answer 39

Sensitive to stretch, hypoxia, chemicals, environmental changes Not sensitive to cutting or thermal stimuli

Question 40

What is a dermatome?

Answer 40

Area of skin innervated by a single spinal nerve

Question 41

How does pain referral work?

Answer 41

Sensory nerves from organs share pathways/ routes of travel with other sensory nerves. Brain confuses the location /origin of signal and assumes pain is of dermatomal (skin) origin

Question 42

At what vertebral level does the Coeliac Trunk originate?

Answer 42

T12

Question 43

At what vertebral level does the Superior Mesenteric Artery originate?

Answer 43

L1 (Transpyloric)

Question 44

At what vertebral level does the Inferior Mesenteric Artery originate?

Answer 44

L3 (Subcostal)

Question 45

What are the 4 tissue layers of the GI tract?

Answer 45

From lumen outwards: Mucosa Submucosa Muscularis Serosa

Question 46

What does the mucosa layer of the GI Tract consist of?

Answer 46

1. Layer of epithelial cells 2. Lamina Propria (connective tissue + blood vessels) 3. Muscularis Mucosae (layer of smooth muscle - contractions create folds to increase surface area)

Question 47

What does the submucosa layer of the GI tract consist of?

Answer 47

1. Connective tissue 2. Blood vessels 3. Lymphatics 4. Submucosal (Meissner's) Plexus

Question 48

What does the muscularis layer of the GI Tract consist of?

Answer 48

2 smooth muscle layers (inner circular and outer longitudinal) - with Myenteric (Auerbach's) Plexus sandwiched in between the two muscle layers

Question 49

What does the Serosa layer of the GI Tract consist of?

Answer 49

Connective tissue covered with simple squamous epithelium

Question 50

What is the blood supply to the abdominal wall?

Answer 50

Superior and inferior epigastric arteries Inferior arises from the external iliac artery and the superior arises from the internal thoracic artery

Question 51

At what vertebral level is the aortic hiatus?

Answer 51

T12

Question 52

In which direction would you displace the Rectus Abdominus muscle when doing a paramedian incision for surgical access, any why?

Answer 52

Laterally - to avoid stretching nerves (which travel from lateral to midline where they pierce the RA and its sheath)