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Block 1 > Introduction To The Abdomen > Flashcards

Introduction To The Abdomen Flashcards

1
Q

What are the borders of the abdominal cavity width ways?

A

Diaphragm

Pelvic girdle

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2
Q

What are the 4 quadrants of the abdominal cavity? How are they split?

A

RUQ, LUQ, RLQ + LLQ split using the umbilicus + midsternal planes

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3
Q

What is contained within the right upper quadrant (RUQ)?

A 
Ascending colon (hepatic flexure)
Duodenum (1-3)
Gall bladder
Biliary tree
IVC
Pancreas (head + neck) Pylorus
Right kidney
Ureter 
Suprarenal gland
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4
Q

What is contained within the left upper quadrant (LUQ)?

A 
Descending colon (splenic flexure) Duodenum (4)
Left kidney
Ureter
Suprarenal gland Pancreas (body + tail)
Spleen
Stomach
Jejunum
Ileum
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5
Q

What is contained with the right lower quadrant (RLQ)?

A 
Ascending colon
Caecum
Appendix
IVC
Right ductus deferens
Ovary
Uterine tube
Ureter
Ileum
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6
Q

What is contained within the left lower quadrant (LLQ)?

A 
Descending colon
Sigmoid
Left ductus deferens
Ovary
Uterine tube
Ureter
Jejunum
Ileum
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7
Q

What are the planes of the abdomen? What are their landmarks?

A

Transpyloric (L1)
Subcostal (L3)
Supracristal (L4)
Transtubercular (L5)

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8
Q

What are the 9 regions of the abdomen? How are they split?

A 
R + L hypochondrium
Epigastric
 R + L flank 
Umbilical
R + L iliac fossa
Pubic

Split down the MCLs, subcostal (L3) + transtubercular plane (L5)

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9
Q

What does the epigastric region of the stomach contain?

A 
Stomach
Liver
Gallbladder
Transverse colon
Lesser sac
Abdominal aorta
Duodenum
Pancreas
Kidneys 
Suprarenal glands
Origin/plexus of coeliac trunk + SMA
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10
Q

What can pain in the epigastric region indicate?

A 
Foregut pain
Aortic aneurysm
Pancreatitis
Ulcer
Gastritis
Reflux
MI
Pericarditis
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11
Q

What is contained within the umbilical region?

A

SI
Root of mesentery
Abdominal aorta
Origin/plexus of IMA

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12
Q

What can pain in the umbilical region indicate?

A

Midgut pain
Enteritis
Intestinal obstruction
Mesenteric occlusion

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13
Q

What is contained within the pubic region?

A 
SI
Sigmoid colon
Upper rectum
Ovary
Uterine tube
Distended bladder
Enlarged uterus
Common iliac arteries
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14
Q

What can pain in the pubic region indicate?

A 
Hindgut pain
Uterine pathology
Urinary tract infection/obstruction
Endometriosis
PID
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15
Q

What is contained within the right and left hypochrondrium?

A

Diaphragm
Costodiaphragmatic recesses

R: Liver, hepatic flexure of colon

L: stomach, spleen, pancreatic tail + splenic flexure of colon

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16
Q

What can pain in the right and left hypochondrium indicate?

A

R: Liver abscess, hepatitis, gallbladder/biliary tree problem, cholecystitis, cholelithiasis

L: constipation, splenic infarct, abscess, colitis, diverticulitis, pyelonephritis

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17
Q

What is contained within the right and left flank?

A

Ascending (R)
Descending (L)
SI

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18
Q

What can pain in the right and left flank indicate?

A

Ascending colitis (R)
Descending colitis (L)
Nephrolithiasis
Pyelonephritis

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19
Q

What is contained within the right and left iliac fossa?

A

R: caecum, appendix

L: sigmoid colon

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20
Q

What can pain in the right and left iliac fossa indicate?

A

R: appendicitis, gonadal pathology, gastroenteritis, inguinal hernia

L: diverticulitis, colitis, gonadal pathology, inguinal hernia, UC

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21
Q

What is a hernia?

A

Protrusion of tissue/organ through a retaining tissue either inside or outside the body

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22
Q

What may predispose someone to develop a hernia?

A 
Strain
Recent operation
Pregnancy
Stomach muscle weakness (e.g. failure of abdominal wall to close properly in womb as a congenital defect)
Advanced aging
Chronic coughing
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23
Q

What are the muscular layers of the abdominal wall (in order from most external to internal)?

A

Rectus abdominis
External oblique
Internal oblique
Transversus abdominis

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24
Q

What are the functions of the rectus abdominis?

A

Flex vertebral column outwards

Allows stomach to protrude upwards when lying down

(muscle fibres run vertically so move in this direction)

25
Q

What is the rectus sheath?

A

Fibrous sheath formed by the aponeuroses of flat abdominal wall muscles + the transversalis fascia that encloses the rectus abdominis muscle + epigastric vessels (inferior epigastric artery + vein)

26
Q

What happens to the rectus abdominis during pregnancy?

A

Stretches + moves away from midline (may predispose women to hernias around the umbilicus)

27
Q

What is the name of the midline fibrous aponeuroses?

A

Linea alba (runs from pubic bone up to sternum) that connects to all the abdominal muscular layers

28
Q

What is the inguinal ligament?

A

The free lower border of the external oblique passing from the ASIS to the pubic tubercle

29
Q

What direction to the muscle fibres go in the external oblique?

A

Diagonally downwards towards the midline where it connects to the rectus sheath

30
Q

What is the linea alba made up of?

A

Anterior part of intermediate fascia + all the superficial fascia until the arcuate line where the rest of the rectus abdominis goes behind the deep fascia

31
Q

What direction does the internal oblique muscle fibres go in?

A

Diagonally upwards towards the midline

32
Q

What is attached to the internal oblique muscle?

A

Linea alba
Some of the lower ribs
Rectus sheath

33
Q

What direction does the transversus abdominis muscle fibres run in?

A

Horizontally

34
Q

Where is the neurovascular plane?

A

Between the transversus abdominis + the internal oblique

35
Q

What are the functions of the abdominal wall muscles collectively?

A 
Movement
Support
Pressure for defecation/urination
Giving birth
Vomiting
Cough
Holding everything in
36
Q

In order from superficial to deep, what are the layers of the abdominal wall?

A 
Skin
Superficial fascia
Muscle + aponeuroses
Tranversalis (deep) fascia
Parietal peritoneum
37
Q

Why is it useful to know the structure of the linea alba during surgery?

A

It does not contain any vessels so will not heal well however, you can safely stick a needle or cannula into it

38
Q

How does the upper 3/4 of the rectus sheath differ from the lower 1/4?

A

Above arcuate line (~umbilicus) there is aponeurotic fibrous tissue all around the rectus abdominis

Below the arcuate line, this fibrous tissue is only present anteriorly, posteriorly it is formed by the transversalis fascia

39
Q

Where do the superior and inferior epigastric arteries travel? Why is this useful to know?

A

Travel + meet in rectus sheath

This unites the subclavian artery with the external iliac artery forming an arterial shunt if the aorta is narrowed

40
Q

What are the surgical incisions that can be made in the abdomen to gain access?

A

Median/midline (linea alba incised)

Paramedian (rectus sheath incised)

Gridiron (muscle splitting) at McBurney’s point

Pfannenstiel (suprapubic)

Subcostal (Kocher) (inferior to costal thoracic margin)

41
Q

What is at high risk of damage if making a subcostal (Kocher) incision?

A

T9 nerve
Superior epigastric artery
Thoracoabdominal nerves

42
Q

In a paramedian incision, why is the rectus muscle displaced laterally?

A

To move the muscle fibres in a direction that will not damage all the nerves attached to it

43
Q

Where does abdominal wall lymphatic fluid drainage pass to?

A

Axillary lymph nodes (RUQ + LUQ)

Inguinal lymph nodes (RLQ + LLQ)

44
Q

Where is the gut tube located? What is it surrounded by?

A

Located within peritoneal cavity + surrounded by a layer of tissue called peritoneum

45
Q

What is the difference between retro-peritoneal and secondary retro-peritoneal?

A

Retro-peritoneal: structure behind (outside) peritoneum

2ndary: intra-peritoneal structure that later becomes retroperitoneal

46
Q

What is mesentery?

A

Double-layered fold of peritoneum suspending an organ from the abdominal wall
- supplies GI tract with blood supply + lymph drainage

47
Q

What do we start off as in development?

A

A multi layered flat sheet of cells surrounded by fluid-filled bags

48
Q

What needs to happen to the flat disc of cells during embryo development to form the gut tube?

A

Lateral folding so that a prawn-shaped tube is formed -> puts skin on outside (ectoderm) + gut tube lining on inside (endoderm)

1 layer -> 2 layers (bilaminar embryonic disc) -> 3 layers (trilaminar embryonic disc)

49
Q

What is the difference between visceral and parietal peritoneum?

A

Visceral: covers organs + insensitive to burning/cutting so visceral pain is vague, diffuse + poorly defined/located

Parietal: covers inside of body wall + has somatic innervation so highly sensitive to many stimuli

50
Q

What are the 3 main arteries that branch from the abdominal aorta and supply the gut tube? What vertebral level to they originate from?

A
  1. Coeliac trunk (T12)
  2. SMA (L1)
  3. IMA (L3)
51
Q

What are the 3 different regions of the gut tube? What are the boundary points between them?

A 
Lower oesophagus
FOREGUT
1.5th of duodenum
MIDGUT
Proximal 2/3 of transverse colon
HINDGUT
Upper anal canal
52
Q

What type of sensory stimuli is the viscera sensitive to?

A

Stretch
Hypoxia
Chemicals
Environmental changes

BUT NOT cutting or thermal stimuli

53
Q

What is a dermatome?

A

An area of skin innervated by a single spinal nerve

54
Q

Why does visceral pain get referred?

A

Visceral (organ) + somatic sensory (afferent) nerves enter the spinal cord together + travel in the same spinal tracts

The brain confuses the location + origin of signal as it assumes the pain is of dermatomal (skin) origin

55
Q

What are somatic nerves?

A

Sensory nerves innervating the skin

56
Q

What are afferent and efferent nerves?

A

Afferents: away from the organ/gland to the brain

Efferent: from the brain to the organ/gland

57
Q

Where does sympathetic and visceral sensory nerves of the gut tube travel?

A

Alongside the blood supply

58
Q

What nerves innervate the different regions of the gut tube?

A

Foregut: T5-9
Midgut: T10-11
Hindgut: T12-L1

Block 1 (54 decks)

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