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SMP - GI > Lecture 3 - Anterior Abdominal Wall, Inguinal Region, and Peritoneum > Flashcards

Lecture 3 - Anterior Abdominal Wall, Inguinal Region, and Peritoneum Flashcards

1
Q

Definition of abdomen?

A

Region between diaphragm and pelvic inlet

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2
Q

2 walls of abdomen?

A

Anterior and posterior

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3
Q

What is the anterior wall of the abdomen made of? 3 types of components

A
  1. Skin
  2. Muscles
  3. Fascia
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4
Q

What is the pelvic brim?

A

The edge of the pelvic inlet

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5
Q

Is the area superior to the pelvic brim considered part of the abdomen? What is it called?

A

YES

Greater pelvis

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6
Q

Is the area inferior to the pelvic brim considered part of the abdomen? What is it called? 3 names

A

NOPE

Lesser pelvis = true pelvis = pelvic cavity

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7
Q

4 parts of adult pelvic bone?

A
  1. 2 coxal bones
  2. Sacrum
  3. Coccyx
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8
Q

What forms the pelvic inlet?

A
  1. Anteriorly: pubic symphysis
  2. Posteriorly: sacrum
  3. Laterally: pelvic rim
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9
Q

What is the iliac crest? 2 spines?

A

Superior margin of the pelvic bone, which terminates anteriorly as the anterior superior and inferior iliac spines

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10
Q

What attaches to the iliac crest?

A

Muscles and fascia of the:

  1. Abdomen
  2. Back
  3. Lower limbs
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11
Q

What is the pubic tubercle?

A

Rounded pubic crest on superior surface of the body of the pelvic bone

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12
Q

What is the pubic crest?

A

Area between the pubic tubercle and the pubic symphysis

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13
Q

What point of the pubic bone do clinicians palpate to do a lumbar puncture?

A

Iliac crest

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14
Q

What is the inguinal ligament?

A

Attaches to the anterior superior iliac spine and the pubic tubercle and is the lower upturned portion of the broad aponeurosis of the external oblique

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15
Q

What are aponeuroses?

A

Layers of flat broad tendons

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16
Q

What happens to the inguinal ligament as it articulates with the pubic tubercle?

A

It turns on itself and gives rise to 2 other ligaments:

  1. Lacunar ligament: medial triangular expansion
  2. Pectineal ligament: strong fibrous band that extends from the lacunar ligament along the pectineal line of the pubis
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17
Q

Other name for lacunar ligament?

A

Gimbernat’s ligament

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18
Q

Other name for pectineal ligament?

A

Cooper’s ligament

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19
Q

What is the pectineal line of the pubis?

A

Ridge on the superior ramus of the pubic bone that forms part of the pelvic brim

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20
Q

What are the 4 regions of the anterior abdominal wall in surface anatomy?

A

4 quadrants divided by the midsternal plane and the transumbilical plane (at L3/L4 level on a fit person)

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21
Q

Abdominal quadrants of the liver and gallbladder?

A

URQ and ULQ

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22
Q

Abdominal quadrant of the stomach and spleen?

A

ULQ

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23
Q

Abdominal quadrant of the small intestine?

A

LRQ and LLQ

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24
Q

Abdominal quadrant of the transverse colon?

A

URQ and ULQ

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25
Q

What are the 9 regions of the anterior abdominal wall in surface anatomy?

A

Regions separated by:

  • Midclavicular sagittal planes: 2 vertical lines from the right and left midclavicular points to the mid-point between the anterior superior iliac spines and the pubic tubercles
  • Subcostal transverse plane at L3: horizontal line inferior to the costal margin
  • Intertubercular transverse plane at L5: horizontal line at the transtubercle points of the iliac crests

to form:

  • Right an left hypochondrium
  • Epigastric region
  • Right and left flanks
  • Umbilical region
  • Right and left groins
  • Pubic region
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26
Q

Which of the 9 regions of the abdomen does pain from the foregut come from?

A

Epigastric region

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27
Q

Which of the 9 regions of the abdomen does pain from the midgut come from?

A

Umbilical region

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28
Q

Which of the 9 regions of the abdomen does pain from the hindgut come from?

A

Pubic region

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29
Q

Abdominal quadrant of the cecum and appendix?

A

RLQ

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30
Q

Abdominal quadrant of the end of the descending colon and sigmoid colon?

A

LLQ

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31
Q

What is McBurney’s point? Other name?

A

Surface projection of the BASE of the appendix, 1/3rd of the way up along a line from anterior superior iliac spine to the umbilicus

Other name = spinoumbilical point

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32
Q

How to palpate the inferior margin of the liver?

A

Ask patient to inhale deeply and palpate below the right 4th costal margin

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33
Q

What is the transpyloric plane (TPP)? What happens there?

A

Transverse plane at vertebral level L1:

  1. Spinal cord ends
  2. Celiac trunk originates above at upper edge of L1
  3. Superior mesenteric artery originate below at lower edge of L1
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34
Q

What happens at the subcostal plane?

A

Inferior mesenteric artery originates

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35
Q

At what vertebral level to the renal arteries originate?

A

L2

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36
Q

What is the supracristal plane? What happens there?

A

Transverse plane at vertebral level L4 connecting superior edges of iliac crests => where the abdominal aorta bifurcates into the left and right common iliac arteries

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37
Q

What happens at the intertubercular plane?

A

Right and left common iliac veins join to form the IVC

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38
Q

5 skeletal landmarks to palpate the anterior abdominal wall?

A
  1. Xiphoid process
  2. Costal margin
  3. Iliac crests
  4. Anterior superior iliac spines
  5. Pubic symphysis
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39
Q

Other name for hypochondrium region?

A

Hypochondriac region

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40
Q

Other name for flank region?

A

Lumbar region

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41
Q

2 other names for groin region?

A

Inguinal region = iliac region

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42
Q

2 other names for pubic region?

A

Suprapubic region = hypogastric region

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43
Q

9 layers of the anterior abdominal wall? What 3 groups can we put them in?

A 
SUPERFICIAL:
1. Skin
2. Superficial fascia
3. Lateral group of muscles
MIDDLE: 
4. Anterior rectus sheath 
5. Rectus abdominis
6. Posterior rectus sheath
DEEP: 
7. Transversalis fascia
8. Extraperitoneal layer
9. Parietal peritoneum
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44
Q

Name of abdominal cavity proper?

A

Peritoneal cavity

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45
Q

Describe the 2 layers of superficial fascia of the anterior abdominal wall. Which one contains VAN?

A
  1. Camper’s fascia: outer layer composed primarily of fat where superficial branches of VANs reside (including anterior cutaneous nerves)
  2. Scarpa’s fascia: inner membranous layer
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46
Q

Which layer of superficial fascia of the abdominal wall can be variable in thickness?

A

BOTH:

  1. Camper’s is thin in athletic/emaciated people and thick in fat people
  2. Scarpa’s can be robust in individuals
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47
Q

What are Scarpa’s and Camper’s fascia continuous with inferiorly?

A
  1. Camper’s: superficial fascia of thigh and layer of perineal fascia
  2. Scarpa’s: fuses with fascia lata and Colle’s fascia = superficial perineal fascia

In men, both the superficial and deep fascia fuse to form the superficial fascia of penis + dartos fascia = layer of connective tissue found in the scrotum

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48
Q

To what does Scarpa’s fascia attach inferiorly? Purpose?

A

To the fascia lata of the thigh to prevent fluid located deep to it to enter the thigh, like extravesated urine or blood between it and the deep external oblique aponeurosis (e.g. caused by straddle injury)

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49
Q

Where does urine build up if the urethra ruptures in males?

A

Between Scarpa’s fascia and the muscles posterior to it, which can then leak into the scrotum causing the scrotum to swell

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50
Q

What is the scrotum?

A

Pouch of skin containing the testicles

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51
Q

Are the muscles of the abdomen covered by deep fascia?

A

NOPE

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52
Q

2 groups of muscles forming the anterior abdominal wall?

A
  1. Lateral group

2. Anterior group

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53
Q

3 muscles in the lateral group of the anterior abdominal wall? List from superficial to deep and indicate the arrangement of the muscle fibers.

A
  1. External oblique (same as external intercostals: from superior lateral to inferior medial obliquely)
  2. Internal oblique (divergent from posterior to anterior)
  3. Transversus abdominus (transverse orientation)
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54
Q

2 muscles in the anterior group of the anterior abdominal wall?

A

2 rectus abdominis

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55
Q

Actions of internal oblique muscles?

A
  1. Compress abdomen
  2. Flex trunk
  3. Bend trunk to same side, turning anterior part of abdomen to same side
  4. Active in forced expiration
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56
Q

Action of transversus obdominis?

A

Compress abdomen

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57
Q

Actions of rectus abdominis?

A
  1. Compress abdomen
  2. Flex vertebral column
  3. Tense abdominal wall
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58
Q

Innervation of external oblique?

A
  1. Intercostal nerves T7-T11

2. Subcostal nerve T12

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59
Q

Innervation of internal oblique?

A
  1. Intercostal nerves T7-T11
  2. Subcostal nerve T12
  3. Iliohypogastric and ilioinguinal nerves L1
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60
Q

Innervation of transversus abdominis?

A
  1. Intercostal nerves T7-T11
  2. Subcostal nerve T12
  3. Iliohypogastric and ilioinguinal nerves L1
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61
Q

Innervation of rectus abdominis?

A
  1. Intercostal nerves T7-T11

2. Subcostal nerve T12

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62
Q

External oblique:

  1. Origins?
  2. Insertions?
A
  1. Muscular slips from outer surfaces of lower 8 ribs (5 to 12)
  2. Lateral lip of iliac crest (including the anterior superior iliac spine) with aponeurosis ending in linea alba
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63
Q

Internal oblique:

  1. Origins?
  2. Insertions?
A
  1. Thoracolumbar fascia, iliac crest between between origins of external and transversus, lateral 2/3rds of inguinal ligament (including the anterior superior iliac spine)
  2. Inferior border of lower 3-4 ribs with aponeurosis ending in linea alba, conjoint tendon, plus public crest and pectineal line
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64
Q

Transversus abdominis:

  1. Origins?
  2. Insertions?
A
  1. Thoracolumbar fascia, medial lip of iliac crest, lateral 1/3rd of inguinal ligament, costal cartilages of ribs 7 to 12
  2. Aponeurosis ending in linea alba, conjoint tendon, plus public crest and pectineal line
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65
Q

Rectus abdominis:

  1. Origins?
  2. Insertions?
A
  1. Pubic crest, pubic tubercle, and pubic symphysis

2. Costal cartilages of ribs 5 to 7, and xiphoid process

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66
Q

How do the lateral group muscles attach to the corresponding muscle on the other side?

A

Via a broad aponeurosis that encases the 2 rectus abdominis in a rectus sheath

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67
Q

2 parts of rectus sheath? What is each made of? Symmetrical?

A

ABOVE ARCUATE LINE

  1. Anterior rectus sheath: comprised of aponeurosis of the external oblique and half aponeurosis of internal oblique
  2. Posterior rectus sheath: comprised of half the aponeurosis of the internal oblique and aponeurosis of transverse abdominis

BELOW ARCUATE LINE

  1. Anterior rectus sheath: comprised of aponeuroses of the external and internal obliques and transverse abdominis
  2. NO posterior rectus sheath

Asymmetrical because the posterior one ends at the arcuate line

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68
Q

Where does the posterior rectus sheath end? What happens at this area?

A

At the arcuate line, midway between the umbilicus and pubic crest => where the inferior epigastric artery and vein enter the posterior rectus sheath and travel superiorly posterior to the rectus abdominis

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69
Q

What is the linea alba?

A

Where the aponeuroses interlace in the midline

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70
Q

Position of rectus abdominis in relation to linea alba?

A

On either side

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71
Q

Superior and inferior borders of linea alba?

A
  1. Superior: xiphoid process

2. Inferior: pubic symphysis

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72
Q

Sensory innervation of umbilicus region?

A

Intercostal nerve T10

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73
Q

Sensory innervation of two upper quadrants of abdominal wall?

A

Intercostal nerves T7 to T9

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74
Q

Sensory innervation of two lower quadrants of abdominal wall?

A

Anterior rami of T11 to L1

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75
Q

Blood supply of superior abdominal wall?

A
  1. Superficially: musculophrenic artery (terminal branch of the internal thoracic artery)
  2. Deep: superior epigastric artery (terminal branch of the internal thoracic artery)
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76
Q

Blood supply of deep lateral abdominal wall?

A
  1. Intercostal arteries 10 and 11

2. Subcostal artery

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77
Q

Blood supply of inferior abdominal wall?

A
  1. Superficially: superficial epigastric artery medially and superficial circumflex iliac artery laterally (both from femoral artery)
  2. Deep: inferior epigastric artery medially and deep circumflex iliac artery laterally (both from external iliac artery)
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78
Q

Why is the inferior epigastric artery an important landmark?

A

It helps to define inguinal hernias

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79
Q

Lymph drainage of superficial abdominal wall above the umbilicus?

A

Axillary lymph nodes (anterior or posterior)

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80
Q

Lymph drainage of superficial abdominal wall below the umbilicus?

A

Superficial inguinal lymph nodes

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81
Q

7 body parts draining to the superficial inguinal lymph nodes?

A
  1. Lower abdominal wall
  2. Buttocks
  3. Penis
  4. Scrotum
  5. Labium majorus
  6. Lower parts of vagina
  7. Anal canal
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82
Q

Lymph pathway from superficial inguinal lymph nodes?

A

=> external iliac lymph nodes => lumbar lymph nodes

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83
Q

Other name for lumbar lymph nodes?

A

PARA-aortic lymph nodes

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84
Q

Location of neurovascular bundle of anterior abdominal wall?

A

Between internal oblique and tranversus abdominis muscles

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85
Q

Muscle located superiorly to external oblique?

A

Pectoralis major

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86
Q

Muscle located laterally to external oblique?

A

Latissumus dorsi

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87
Q

List the aponeuroses of the 3 lateral group muscles of the anterior abdominal wall from closest to the midline to furthest.

A
  1. External oblique
  2. Internal oblique
  3. Transversus abdominus
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88
Q

What is special about the rectus abdominis muscles?

A

They have tendinous intersections

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89
Q

What is located posterior to the rectus abdominis inferior to the arcuate line?

A

Transversalis fascia covering the transversus abdominis muscles posteriorly to separate it from parietal peritoneum

90
Q

What is the pyramidalis muscle? Function? Innervation?

A

Vertical muscle inferior/anterior to rectus abdominis that is triangular and may be absent with origin on pubis and insertion into linea alba

Function: tenses the linea alba

Innervation: subcostal nerve T12

91
Q

Location of transversus abdominis muscle aponeurosis with regards to the rectus abdominis?

A
  • Superior to arcuate line: posterior

- Inferior to arcuate line: anterior

92
Q

What is a rectus hematoma?

A

Inferior epigastric artery and/or vein bleed into the rectus sheath

93
Q

Do the superior and inferior epigastric arteries anastamose with each other? Purpose?

A

YES, which provides alternate pathways for blood

94
Q

What do the inferior epigastric arteries arise from?

A

External iliac arteries

95
Q

Lymph drainage of deep abdominal wall?

A
  1. Parasternal lymph nodes
  2. Lumbar lymph nodes
  3. External iliac nodes
96
Q

Sensory innervation of xiphoid process?

A

T7

97
Q

Is the motor/sensory innervation of the anterior abdominal wall also sensory to the parietal peritoneum?

A

YUP

98
Q

Sensory innervation of pubic symphysis?

A

L1

99
Q

What are the 2 methods of surgical repair following a radical masectomy? Explain each. Which works best?

A
  1. Transverse rectus abdominus myocutaneous (TRAM) flap surgery***: contra OR ipsilateral rectus adbominus muscle is used to replace the mass lost and retains its superior blood supply because it had both a superior (superior epigastric) and an inferior one (inferior epigastric, which is cut and ligated)
  2. Latissimum dorsi flap
100
Q

Treatment for extravasation of fluid between Scarpa’s fascia and external oblique aponeurosis?

A

Bore needle above pubic symphysis to drain the fluid

101
Q

Purpose of scrotum?

A

To allow the testes to be in an environment of 35 degrees Celcius (instead of 37) so that immature germ cells can develop into sperm

102
Q

How long does testicular descent take?

A

6 months

103
Q

Through what space does testicular descent occur? Describe it.

A

Through the inguinal canal = short space that traverses the aponeurotic areas of the 3 lateral muscles of the anterior abdominal wall made by the tubular evagination of transversalis fascia

104
Q

What is a hernia?

A

Any tissue that inappropriately protrudes from its normal location to an aberrant location

105
Q

What is the inguinal canal at risk for? Why?

A

Hernias because it represents a weakness in the anterior abdominal wall

106
Q

Where is the inguinal canal located?

A

Superior to the medial portion of the inguinal ligament

107
Q

2 openings of inguinal canal? What is each made of? Position of each?

A
  1. Superficial ring (medial: superior to pubic tubercle): external oblique aponeurosis
  2. Deep ring (lateral: midway between ASIS and pubic symphysis): transversalis fascia
108
Q

What runs through the inguinal canal in adult males?

A
  1. Spermatic cord

2. Ilio-inguinal nerve L1

109
Q

What runs through the inguinal canal in adult females?

A
  1. Round ligament of the uterus
  2. Genital branch of genitofemoral nerve
  3. Ilio-inguinal nerve L1
  4. Some lymphatics from the uterus
110
Q

Boundaries of the inguinal canal?

A

MALT: roof => anterior wall => floor => posterior wall

  1. Roof: MUSCLE: arching fibers of the transversus abdominis and internal oblique
  2. Anterior wall: APONEUROSES: formed by the external oblique aponeurosis and reinforced laterally by aponeurosis of internal oblique muscle
  3. Floor: LIGAMENTS: medial one-half of the inguinal ligament and small portion of lacunar ligament
  4. Posterior wall: TRANSVERSALIS/TENDON: formed by the transversalis fascia laterally and reinforced along its medial 1/3 by the conjoint tendon
111
Q

What is the conjoint tendon?

A

Tendinous insertions of medial most portions of the aponeuroses of the internal oblique and transversus abdominis

112
Q

What reinforces the medial part of the floor of the conjoint tendon?

A

Lacunar ligament

113
Q

What reinforces the weak portions of the deep ring of the inguinal canal?

A

Strong superficial wall

114
Q

What reinforces the weak portions of the superficial ring of the inguinal canal?

A

Strong deep wall

115
Q

9 contents of spermatic cord?

A
  1. Genital branch of genitofemoral nerve
  2. Deferential artery
  3. Ductus deferens
  4. Pampiniform plexus of testicular veins
  5. Testicular artery from abdominal aorta
  6. Cremasteric artery and vein
  7. Sympathetic efferents and visceral afferents (later ones carrying pain)
  8. Lymphatics
  9. Remnants of the processus vaginalis
116
Q

Describe the process of gonad descent.

A

Happens in both sexes!

  1. Gonads are between the parietal peritoneum and the transversalis fascia in the abdomen and attached to the external oblique aponeurosis by connective tissue called the gubernaculum
  2. Medial to the gubernaculum, the peritoneal cavity sends a processus vaginalis downwards towards the scrotum or labia majora
  3. The processus vaginalis grows and the gonads are able to slide down behind it (in females this is inside the pelvic cavity without passing through the anterior abdominal wall)
  4. As the testes and their accompanying vessels, ducts, and nerves, pass through the inguinal canal, they carry with them the same layers of the anterior abdominal wall, which form the spermatic cord
  5. Once the testes reach the scrotum, the process then pinches off from the peritoneal cavity
  6. The testes remain in a cavity called the cavity of tunica vaginalis, which is an extension of the developing peritoneal cavity that becomes separated off during development
117
Q

What does the layer of the internal oblique muscle of the scrotum become after testicular descent?

A

It gives rise to the cremasteric muscle and fascia

118
Q

What is the cremasteric reflex? What to note?

A

Stimulation of the inner thigh (sensory fibers in ilioinguinal nerve) results in elevation of the corresponding testis into the inguinal canal that is brought about by contraction of the cremasteric muscle (stimulation of the genital branch of the genitofemoral nerve)

The cremasteric reflex is more active in children, tending to diminish with age

119
Q

What does cryptorchidism refer to? Treatment?

A

Undescended testis

Surgical descent of the cryptorchid testis as soon as possible for newborn or else the testis will be infertile and will likely become cancerous later in life

120
Q

What is a hydrocele? Complication?

A

Presence of fluid in processus vaginalis from peritoneal fluid indicating that the processus vaginalis remains patent
This causes further groin weakness and higher risk of inguinal hernias

121
Q

What is a hematocele?

A

Presence of blood in tunica vaginalis

122
Q

What is a varicocele?

A

Enlargement of testicular veins

123
Q

5 layers around testes and what they correspond to in the anterior abdominal wall?

A

SUPERFICIAL:

  1. Skin
  2. Dartos fascia => BOTH Scarpa’s and Camper’s fascia
  3. Lateral group of muscles:
    - External spermatic fascia => external oblique aponeurosis
    - Cremasteric fascia and muscle => internal oblique muscle

MIDDLE: NONE

DEEP:

  1. Internal spermatic fascia => transversalis fascia
  2. Obliterated processus vaginalis = visceral and parietal tunica vaginalis => parietal peritoneum
124
Q

Which layers of the anterior abdominal wall ate NOT represented around the testes? Explain each.

A
  1. Transversus abdominis muscle: because the processus vaginalis passes under the muscle fibers
  2. Middle portion of anterior abdominal wall (because descends lateral to this)
  3. Extraperitoneal layer (obliterated with processus vaginalis)
125
Q

Attachements of round ligament of the uterus?

A

Uterus and connective tissue of labia majora

126
Q

Lymphatic drainage of uterus?

A
  1. Internal iliac lymph nodes

2. Superficial inguinal lymph nodes (through inguinal canal)

127
Q

Lymphatic drainage of external genital tumors?

A
  1. Superficial inguinal lymph nodes

2. Internal iliac lymph nodes (through inguinal canal)

128
Q

2 types of hernias relating to the inguinal canal?

A
  1. Inguinal hernias

2. Femoral hernias

129
Q

2 types of inguinal hernias? Describe each. Where and why do these happen?

A
  1. Direct: the neck lies medial to the inferior epigastric vessels and the head of the hernia moves into the Hesselbach’s triangle
  2. Indirect: the neck of the hernia lies lateral to the inferior epigastric vessels, and passes trough the deep inguinal ring and the head of the hernia is often found in the scrotum in males or the labia majora in females

Happen because in both men and women the groin is a weak area in the abdominal wall due to the descent of the gonads

130
Q

Are inguinal hernias more likely to occur in men or women? Why?

A

Occur 30 times more often in males than in females because the spermatic cord weakens this area in males

131
Q

Which hernia type is common in older men?

A

Direct inguinal hernias

132
Q

Which hernia type is common in infants and tend to be congenital?

A

Indirect inguinal hernias

133
Q

What is the femoral ring?

A

Weak area in the lower anterior abdominal wall below the inguinal ligament and medial to the external iliac vessels

134
Q

What is a femoral hernia? What happens with time?

A

Loop of small intestine protrudes through the femoral ring into the femoral canal

Starts as a small protrusion but enlarges with time by passing through an opening in the subcutaneous tissue into the thigh which can cause interference with the blood supply to viscera making this a medical emergency as necrosis will occur

135
Q

Are femoral hernias more common in men or women?

A

Women

136
Q

What are ventral hernias? What can these be explained by?

A

Anterior abdominal wall hernias that are neither inguinal nor femoral and are less common

Can be explained in terms of weaknesses in the anterior wall muscles and/or aponeurosis

137
Q

Most common 4 types of ventral hernias? Describe each.

A
  1. Umbilical: up to 3 yo and after 40 yo
  2. Linea alba: occurs in epigastric region, is more common in men and rarely contains viscus
  3. Linea semilunaris: occurs in midlife and develops slowly at the lateral edge of the rectus sheath
  4. Incisional: occurs at site of previous laparotomy scar
138
Q

What is a viscus?

A

An internal organ of the body

139
Q

Other name for linea semilunaris hernia?

A

Spigelian hernia

140
Q

What is a laparotomy?

A

Surgical incision into the abdominal cavity

141
Q

Borders of Hesselbach’s triangle where direct inguinal hernias occur? Other name?

A
  1. Lateral border: inferior epigastric artery
  2. Medial border: lateral edge of rectus abdominis
  3. Inferior border: inguinal ligament

Other name = inguinal triangle

142
Q

Other name for linea alba hernia?

A

Epigastric hernia

143
Q

What could increase interabdominal pressure and cause a hernia at a weakened portion of the anterior abdominal wall?

A
  1. COPD causing frequent coughing
  2. Allergies causing frequent sneazing
  3. Lifting weights
  4. Pregancy
144
Q

What is a gravid uterus?

A

Pregnant uterus

145
Q

What is the peritoneum?

A

Serous connective tissue epithelial membrane lining the viscera

146
Q

2 parts of peritoneum? Describe each.

A
  1. Visceral peritoneum = the part of the peritoneum that lines the organs of the GIT
  2. Parietal peritoneum = the part that lines the body wall
147
Q

2 abdominal organ possible positions relative to peritoneum?

A
  1. Retroperitoneal

2. Intraperitoneal

148
Q

Describe the development of retroperitoneal viscera.

A

During development, the GIT develops as a tube attached via a dorsal and ventral mesentery within a tube => tube will undergo various twists and turns => some of the ventral mesentery resorbed into the posterior wall => some of the organs will become fixed to the posterior abdominal wall and are only partially covered by visceral peritoneum and are more immobile

149
Q

Describe intraperitoneal organs.

A

Completely covered by visceral peritoneum and mobile with a mesentery attaching them to the posterior wall

150
Q

List the 11 retroperitoneal structures.

A
  1. Kidneys + ureters
  2. IVC
  3. Abdominal aorta
  4. Most of the duodenum (except for the superior and end of the ascending parts)
  5. Ascending colon
  6. Descending colon
  7. Most of pancreas (not the tail)
  8. Rectum
  9. Adrenal glands
  10. Lymphatic channels
  11. Nerves
151
Q

Is the peritoneal cavity a true space?

A

NOPE, potential with only a few ccs of fluid

152
Q

What are ascites?

A

Fluid filled peritoneal cavity

153
Q

2 spaces of the peritoneal cavity? Describe each. Are they continuous?

A
  1. Greater sac = space from diaphragm to pelvic cavity and entered immediately when cutting through parietal peritoneum
  2. Omental bursa = posterior to stomach and liver

YUP, continuous at the epiploic foramen

154
Q

Describe the omental bursa during development.

A

It also extends into the greater omentum, but this space disappears over time

155
Q

List the 12 intraperitoneal structures.

A
  1. Stomach
  2. Abdominal esophagus
  3. Jejunum
  4. Ileum
  5. Liver
  6. Spleen
  7. Gallbladder
  8. Transverse colon
  9. Sigmoid colon
  10. Cecum and appendix
  11. Superior and end of ascending parts of duodenum
  12. Tail of pancreas
156
Q

What is responsible for the abdominal organs being retro or intraperitoneal?

A

Gut rotation during development, as well as partial disappearance of the dorsal and/or ventral mesenteries

157
Q

Other name for omental bursa?

A

Lesser sac

158
Q

What structure separates the abdomen into a greater and lesser sac?

A

The lesser omentum forming the anterior wall of the lesser sac

159
Q

What is the lesser omentum?

A

Double layer of peritoneum extending from lesser curvature of stomach/beginning of duodenum to porta hepatis of liver on inferior/visceral surface and consisting of hepatogastric and hepatoduodenal ligaments

160
Q

What 5 structures do folds of peritoneum form in the abdominopelvic cavity?

A
  1. Greater omentum
  2. Lesser omentum
  3. Peritoneal ligaments
  4. Mesentery
  5. Covering over pelvic organs
161
Q

What does the lesser omentum contain?

A

Right and left gastric vessels + portal triad

162
Q

What does the free margin of the lesser omentum contain? What is this called?

A
  1. Proper hepatic artery
  2. Bile duct
  3. Portal vein

= hepatic triad

163
Q

What is the greater omentum? What does it particularly adhere to? Function?

A

Layer of peritoneum in the abdominopelvic cavity that forms skirt-like structures from the greater curvature of the stomach to the transverse colon by folding inwardly

Adheres to areas of imflammation

Protects the abdominal cavity

164
Q

What is the greater omentum referred to as?

A

Abdominal policeman

165
Q

What does the greater omentum contain?

A

Right and left gastroepiploic vessels

166
Q

Other name for right and left gastroepiploic vessels?

A

Right and left omental vessels

167
Q

What are abdominal mesenteries? Functions?

A

Double layer of peritoneum in the abdominal cavity

Functions:

  1. Give intraperitoneal organs mobility by attaching them to the posterior abdominal wall
  2. Provide a conduit for vessels, nerves, and lymphatics
168
Q

4 abdominal mesenteries? Describe each. How many layers do they all have?

A

ALL TWO LAYERS:

  1. Mesentery of small intestine: fan-shaped that suspends the jejunum and ileum from the posterior abdominal walls with the root of the mesentery extending from duodenojejunal junction (ligament of Treitz) to right iliac fossa and connects to ileocecal junction
  2. Transverse mesocolon: connects transverse colon to posterior abdominal wall by passing across anterior surface of pancreas
  3. Sigmoid mesocolon: V-shaped peritoneal fold connecting sigmoid colon to pelvic and abdominal walls (apex of V near left common iliac artery branching point; left limb along medial border of psoas major; right limb descends into pelvis and ends at S3)
  4. Mesoappendix: connects appendix to mesentery of ileum
169
Q

What does the mesentery of the small intestine contain? How long is it?

A

Contains superior mesenteric and jejunal and ileal vessels, nerves, lymphatics

6’’ long

170
Q

What does the transverse mesocolon fuse with? What does this form?

A

Fuses anteriorly with posterior layer of greater omentum to form gastrocolic ligament

171
Q

What does the transverse mesocolon contain?

A

Contains middle colic vessels, nerves, and lymphatics

172
Q

What does the sigmoid mesocolon contain?

A

Contain sigmoid and superior rectal vessels + IMVs + nerves and lymphatics of the sigmoid colon

173
Q

List and describe the 9 types of peritoneal ligaments.

A
  1. Lienogastric ligament: from greater curvature of stomach to hilus of spleen
  2. Lienorenal ligament: from hilus of spleen to left kidney AND diaphragm
  3. Gastrophrenic ligament: from greater curvature of stomach to diaphragm
  4. Gastrocolic ligament: from greater curvature of stomach to transverse colon
  5. Phrenicolic ligament: from left colic flexure to diaphragm
  6. Falciform ligament: connects liver to anterior abdominal wall
  7. Ligamentum teres hepatic: remnant of the left umbilical vein at inferior/free end of falciform ligament and left border of quadrate lobe
  8. Coronary ligament: peritoneal reflection from diaphragmatic area of liver to the diaphragm
  9. Ligamentum venosum: remnant of ductus venosus lying in fissure of liver forming left boundary of caudate lobe of liver
174
Q

Other name for lienogastric ligaments?

A

Gastrosplenic ligaments

175
Q

What does the lienogastric ligament contain?

A

Contains short gastric vessels + gastro-omental vessels

176
Q

Which peritoneal ligament helps support the spleen?

A

Phrenicolic ligament

177
Q

What does the falciform ligament contain?

A

Its free lower border contains the ligamentum teres hepatic

178
Q

Other name for ligamentum teres hepatic?

A

Round ligament of liver

179
Q

Which peritoneal ligament encloses bare area of liver?

A

The coronary ligament

180
Q

Is the surface area of the peritoneum greater than that of the skin?

A

YUP

181
Q

What is peritoneal dialysis?

A

If there is a problem with the kidneys, fluid can be infused into the peritoneal cavity, where it will be quickly absorbed into the blood stream. The newly absorbed fluid will dilute the toxic material in the blood, and be secreted back into the peritoneal cavity, where it can be drained via a procedure called paracentesis (surgical puncture of the peritoneal cavity to remove fluid)

182
Q

Can blood transfusions in infants be performed through their peritoneal cavity? Why/why not?

A

Yes, because they are capable of absorbing whole RBCs through their peritoneum

183
Q

What area of the peritoneum has the greatest absorptive power? Clinical significance?

A

Area under diaphragm

Clinical significance:

  1. Often anesthetic is injected into the peritoneal cavity b/c it is absorbed very quickly
  2. Patients with peritonitis should be in Fowler’s position (sitting up) so the fluid is not absorbed under the diaphragm, settles lower down in the peritoneal cavity and can be drained
184
Q

Can infections spread from peritoneal cavity to pleural cavity?

A

YUP, serious ones and patient could die of pneumonia

185
Q

Is the peritoneal cavity closed or open? Clinical significance?

A

Closed in males and open in females because the tip of the fallopian tube opens directly into the peritoneal cavity = recto-uterine pouch

Clinical significance: sexually transmitted infections (like gonorrhea) can progress through the female reproductive tract and eventually cause peritonitis

186
Q

2 recesses of the peritoneum? Location?

A
  1. Subphrenic recess
  2. Hepatorenal recess

Around the liver

187
Q

Other name for hepatorenal recess?

A

Morrison’s pouch

188
Q

3 serous sacs of body?

A
  1. Pleural cavity
  2. Pericardial cavity
  3. Peritoneal cavity
189
Q

Other names for epiploic foramen?

A

Omental foramen = foramen of winslow

190
Q

What can get stuck in lesser sac?

A

Viscera = hernias

191
Q

What is anterior to lesser sac?

A

Stomach

192
Q

What is posterior to lesser sac?

A

Pancreas

193
Q

Other name for recto-uterine pouch?

A

Douglas pouch

194
Q

What is the rectovesical pouch?

A

Pocket between the rectum and the urinary bladder in males lined by peritoneum

195
Q

How to confirm diagnosis of ectopic pregnancy?

A

Aspirate fluid from Douglas pouch: blood will indicate ectopic pregnancy

196
Q

How to confirm diagnosis of pelvic inflammatory disease?

A

Aspirate fluid from Douglas pouch: pus will indicate pelvic inflammatory disease

197
Q

What is a pneumoperitoneum? How to diagnose?

A

Air in peritoneal cavity

Diagnosis requires CXR

198
Q

Potential causes of pneumoperitoneum?

A
  1. Peptic ulcer
  2. Burst appendix
  3. Penetrating injury
199
Q

How to see a pneumoperitoneum in CXR?

A

Air pocket below right diaphragmatic border between it and the liver

200
Q

Complication of barium contrast to image the GIT?

A

Barium in airways

201
Q

Where would pain be felt if there was a hernia in the omental foramen?

A

LUQ

202
Q

List all of the transverse planes of the anterior abdominal wall and their vertebral level.

A
  1. Transpyloric plane: L1
  2. Subcostal plane: L3
  3. Transumbilical plane: between L3 and L4
  4. Supracristal plane: L4
  5. Intertubercular plane: L5
203
Q

Does Camper’s fascia continue in the thigh?

A

YUP

204
Q

Actions of external oblique muscles?

A
  1. Compress abdomen
  2. Flex trunk
  3. Bend trunk to same side, turning anterior part of abdomen to opposite side
  4. Active in forced expiration
205
Q

Direction of inguinal canal? Length?

A

Extends downward, medially, and anteriorly => 4 cm

206
Q

What layer of the anterior abdominal wall helps to form the fundiform ligament of the penis?

A

Scarpa’s fascia

207
Q

Position of deep inguinal ring in relation to the inguinal ligament?

A

Superior

208
Q

Position of deep inguinal ring in relation to the inferior epigastric vessels?

A

Lateral

209
Q

Shape of superficial inguinal ring?

A

Triangular

210
Q

Size of round ligaments in females?

A

Depends on hormones, so atrophied in post-menopausal women

211
Q

Does the visceral and parietal tunica vaginalis cover the whole testis?

A

Only part of it

212
Q

Can you see all of the layers surrounding the testes in a cadaver?

A

NOPE, they’re all stuck together so can only see skin, external spermatic fascia surrounding the spermatic cord and tunica vaginalis surrounding the testes

213
Q

Other name for deferential artery in the spermatic cord? Where does it branch from?

A

Ductus deferens artery from the inferior vesical artery from the internal iliac artery

214
Q

Innervation of parietal peritoneum? What kind of pain is it sensitive to?

A

Somatic afferents from associated spinal nerves

Sensitive to well-localized pain

215
Q

Innervation of visceral peritoneum? What kind of pain is it sensitive to?

A

Autonomic afferents back to CNS

Poorly localized referred discomfort

216
Q

Other name for ligamentum teres?

A

Round ligament of the liver

217
Q

When are ascites detectable?

A

When 500 mL accumulates

218
Q

Borders of omental foramen?

A
  1. Anterior: hepatoduodenal ligament containing portal triad
  2. Superior: caudate lobe of the liver
  3. Posterior: IVC
  4. Inferior: superior part of duodenum
219
Q

Where is paracentesis performed? How?

A

LLQ or linea alba

Using the Z-tract technique to minimize fluid leakage after performing a paracentesis: the skin is slowly pulled down while the needle is advanced in 5 mm increments, aspirating as you go

220
Q

What does the mesoappendix contain?

A

Appendicular vessels + nerves + lymphatics

SMP - GI (21 decks)

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