LECTURE 2- abdominal wall and peritoneum

Question 1

superior boundary of the abdomen

Answer 1

inferior thoracic apeture and diaphragm

Question 2

inferior boundary of the abdomen

Answer 2

iliac crest, inguinal ligament, pelvic inlet

Question 3

posterior boundary of the abdomen

Answer 3

lumbar vertebral column, psoas maj, quadratus lumborum

Question 4

lateral and anterior boundary of abdomen

Answer 4

abdominal wall muscles

Question 5

what are the 9 regions of the abdomen

Answer 5

down the middle: epigastric- umbilical- pubic

the sides: hypochondrium- flank- groin

Question 6

what are the layers of the abdominal wall from superficial to deep

Answer 6

skin- superficial fascia- ext oblique- int oblique- transversus abdominis- transversalis fascia- extraperitoneal fascia- parietal peritoneum

Question 7

fibre direction of rectus abdominis

Answer 7

longitudinal

Question 8

function of recuts abdominus

Answer 8

flex trunk

support/ compress abdominal wall

Question 9

innervation of rectus abdominus

Answer 9

anterior rami of thoracic spinal nerves

Question 10

external oblique aponeurosisi

Answer 10

from xyphoid process to pubic symphysis (lower border forms inguinal lig)

Question 11

external oblique action

Answer 11

flex trunk
bend trunk to same side
turn to opposite side

Question 12

innervation of external oblique

Answer 12

anterior rami of thoracic spinal nerves

Question 13

fibre direction of external oblique

Answer 13

infero medial (hands in pockets)

Question 14

internal oblique action

Answer 14

flex trunk

bend and turn to same saide

Question 15

internal oblique innervation

Answer 15

anterior rami of thoracic spinal nerves

and some L1

Question 16

internal oblique fibre direction

Answer 16

superomedial ( up to boobs)

Question 17

transversus abdominus action

Answer 17

supports abdominal wall

Question 18

transversus abdominus innervation

Answer 18

anterior rami of thoracic spinal nerves

some L1

Question 19

what divides the rectus sheath into 3/4 and 1/4

Answer 19

the arcuate line (which is halfway along the line from the umbilicus to the pubic bones)

Question 20

what happens in the upper 3/4 of the rectus sheath

Answer 20

all 3 abdominal wall muscles surround rectus abdominis
external oblique above
internal oblique splits
transversus abdominus below

Question 21

what happens below the arcuate line in the lower 1/4 of the rectus sheath

Answer 21

rectus sheath is in front of rectus abdominis only

behind is transversalis fascia and parietal peritoneum

Question 22

what is the arcuate line

Answer 22

halfway along the line from the umbilicus to the pubic bones

Question 23

what is the arterial supply of the rectus sheath

Answer 23

superior epigastric (from internal thoracic)
inferior epigastric (from external iliac)

both these arteries run underneath rectus abdominus (on top of transversalis fascia) and within the rectus sheath and ANASTAMOSE together

Question 24

what dermatomes supply the skin, muscle and parietal pertoneum of teh abdomen

Answer 24

t7-12 and L1

all of these nerves are anterior rami

Question 25

where do the anterior rami run in the neurovascular plane

Answer 25

run between transversus abdominis and internal oblique (analogous to the intercostal neurovascular plane) before piercing the muscular wall to reach the skin

Question 26

nerves that supply rectus sheath

Answer 26

lower 6 intercostal nerves t7-12 and L1 (iliohypogastric)

Question 27

between which 2 muscles do the nerves travel though

Answer 27

in between internal oblique and transversus abdominis

Question 28

what are the 2 pathways of venous tdrainiabe in the abdomen

Answer 28

axillary vein superiorly | femoral vein inferiorly

Question 29

what is the lymphatic drainage of the abdomen

Answer 29

superior abdomen- axillary nodes | inferior abdomen- groin and superior inguinal nodes

Question 30

do the superficial lymphatics and deepy lymphatics follow the arteries or veins

Answer 30

superficial lymphatic= arteries | deep lymphatics= veins

Question 31

what does the visceral peritoneum cover

Answer 31

abdominal organs

Question 32

what does the parietal peritoneum cover

Answer 32

lines the body wall

Question 33

what supplies the parietal peritoneum

Answer 33

- somatic nerves to the body wall (thoracic and lumbar nerves) - phrenic nerves- up by diaphragm - obturator nerve- down in pelvis SOP

Question 34

what is the parietal peritoneum sensitive to

Answer 34

touch, pain, temperature, pressure

Question 35

what type of pain is felt in the parietal peritoneum

Answer 35

localised pain

Question 36

what is the nervous supply of the visceral peritoneum and the mesenteries

Answer 36

afferent fibres of the autonomic nervous system

Question 37

what is the visceral peritoneum and the mesenteries sensitive to

Answer 37

stretch eg when you eat too much

Question 38

what kind of pain is felt in the visceral peritoneum and the mesenteries

Answer 38

de-localised pain

Question 39

what is mesentery

Answer 39

when visceral perotneum comes back around on itself | anchors viscera to the body wall

Question 40

what mesentery(s) suspends the midgut and hindgut

Answer 40

only one mesentery- the DORSAL

Question 41

what mesentery(s) susupends the foregut

Answer 41

by both DORSAL and VENTRAL mesenteries

Question 42

which organs in the abdomen are retroperitoneal

Answer 42

SAD PUCKER S(adrenal gland) aorta/ ivc duodenum (distal 2/3) ``` Pancreas (except tail Ureters Colon (ascending and descending) Kidneys Esophagus Rectum ```

Question 43

acronym for retroperitoneal organs

Answer 43

SAD PUCKER

Question 44

where is the lesser sac located

Answer 44

behind the lesser omentum, liver and the stomach

Question 45

how was the lesser sac created

Answer 45

created due to rotation of the foregut strucutres (drags lesser omentum round to create a pocket)

Question 46

where is the greater omentum derived from

Answer 46

the dorsal mesentery | big dick

Question 47

where is the lesser omentum derived from

Answer 47

ventral mesentery | v=L

Question 48

what is the opening to the lesser sac called

Answer 48

the omental foramen foramen of winslow epiploic foramen

Question 49

what is in the free edge of the lesser omentum

Answer 49

the portal triad

Question 50

what is the hepatoduodenal ligament

Answer 50

part of the lesser omentum extending between the porta hepatis of the liver --> superior part of the duodenum.

Question 51

what is the hepatogastric ligament

Answer 51

connects the liver --> lesser curvature of the stomach. It contains the right and the left gastric arteries. In the abdominal cavity it separates the greater and lesser sacs on the right.

Question 52

which 2 ligaments make up the lesser omentm

Answer 52

hepatogastric (medial) and hepatoduodenal (lateral) ligaments

Question 53

what does the greater omentum attach to

Answer 53

the greater curvature of the stomach

Question 54

what suspends the jejenum to the terminal ileum

Answer 54

mesentery

Question 55

what suspends the transverse colon

Answer 55

transverse mesocolon

Question 56

what suspends the sigmoid colon

Answer 56

sigmoid mesocolon

Question 57

what are paracolic gutters

Answer 57

peritoneal sulci to the lateral and ascending colons

Question 58

what is the function of the paracolic gutters

Answer 58

create a pathway for peritoneal fluid, pus, bile, blood etc to migrate around the abdomen

Question 59

why is the right paracolic gutter more clinicallly significant than the left

Answer 59

the right side is a bit larger (the left is limited by the phrenico-colic ligament) the right side of the peritoneum = continusous with the peritoneum of the hepatic recess and lesser sac

Question 60

what is the clinical significance of the paracolic gutter

Answer 60

migration of fluids can cause pain to present in sites that are distant from the site of the affected organ eg if sitting fluid migrates downwards and presents as acute appendicitis but if standing it migrates into the lesser sac and collects there