LOs abdomen Flashcards
boundaries of abdomen
anterior: abdominal wall
posterior: vertebral column
superior: diaphragm
inferior: pelvic inlet (pubic tubercle to lumbar spine)
functions of anterior abdominal wall
- support trunk
- support abdominal viscera
- manage intra-abdominal pressure during respiration
- move trunk and maintain posture
greater versus lesser sac
greater sac: main abdominal space
lesser sac: omental bursa, posterior to stomach, diverticulum (extension) of greater sac
mesentery
what vessels do these mesenteries cover?
1. mesentery proper
2. sigmoid mesocolon
3. transverse mesocolon
double layer of peritoneum, conduit of neurovascular supply between organ and body wall
- superior mesenteric vessels – since mesentery proper is connected to small intestine (midgut)
- inferior mesenteric vessels – since sigmoid mesocolon is connected to sigmoid (hindgut)
- middle colic vessels – since transverse colon is innervated by middle colic of SMA
ligaments of greater omentum
gastrosplenic
gastrocolic
gastrophrenic
ligaments of lesser omentum
which one contains the portal triad?
hepatoduodenal – contains portal triad
hepatogastric
intraperitoneal
organs fully enclosed by visceral peritoneum and suspended by mesenteries; organ developed within peritoneal cavity
retroperitoneal
organs enclosed only by parietal peritoneum; organ developed posterior to peritoneal cavity
primarily retroperitoneal
developed posterior to peritoneal cavity, never had mesentery
intraperitoneal organs
superior/1st segment of duodenum
jejunal, ileum
transverse colon
liver
gallbladder
retroperitoneal organs: primary
primary:
1. kidney
2. suprarenal glands
retroperitoneal organs: primary and secondary
primary:
1. kidney
2. suprarenal glands
secondary
1. duodenum (2nd/desc, 3rd/horz, 4th/ascend)
2. colon (asc, desc)
3. rectum (upper 2/3)
4.
retroperitoneal: secondarily
- descending (2nd seg) duodenum
- horizontal (3rd seg) duodenum
- ascend (4th seg) duodenum
- ascend colon
- descend colon
rectum (upper 2/3) - pancreas
secondarily retropertioneal
previously intraperitoneal but moved posteriorly to peritoneal cavity during development
inguinal canal content female
round ligament of uterus (homolog to ductus deferens)
ilioinguinal nerve
components of rectus sheath above vs. below arcuate line
above arcuate line
1. anterior rectus sheath: EAO, IAO
2. posterior rectus sheath: IAO, TA
below arcuate line
1. anterior rectus sheath: EAO, IAO, TA
2. posterior to RA: transversalis fascia
significance of arcuate line
provides passageway for INFERIOR EPIGASTRIC VESSELS to innervate RA
arcuate line
demarcates transition between posterior rectus sheath and transversalis fascia
inguinal canal boundaries
floor: inguinal ligament
posterior: transversalis fascia
anterior: EAO aponeurosis
inguinal canal content male
spermatic cord
1. ductus deferens
2. ductus deferens a. and v.
3. testicular a. and v. (pampinform plexus)
4. ilioinguinal nerve
5. genital branch of genitofemoral n.
covered by: cremaster muscle, its fascia, and vessels
superficial fascia: camper vs. scarpa
camper = more superficial, fatty layer right under skin
scarpa = deep to camper, membranous layer directly superficial to EAO. where sutures happen
innervation of anterior abdominal mm
RA: T6-T12
EAO: T7-T12
IAO and TA: T6-L1
T6-T11 = thoracoabdominal nerve
T12 = subcostal nerve
landmarks for abdominal skin
T4 = xiphoid process
T5/6 = nipple
T10 = umbilicus
indirect inguinal hernia
- more common 66%
- congenital
- protrusion is LATERAL to inferior epigastric vessels
- protrusion passes through deep and superficial inguinal ring
direct inguinal hernia
- less common
- acquired
- protrusion is MEDIAL to inf epigastric vessels
- passes only through superficial inguinal ring
stomach quadrant and functions
LUQ, RUQ
1. store food
2. HCl disinfects food and denatures protein
4. activates protease pepsin
3. produces chyme
esophagus functions
- transports food from mouth to stomach
- warms or cools food
- muscles enable peristalsis of foods – transitions from skeletal to smooth muscle (voluntary –> involuntary)
small intestine quadrant and function
LUQ, RUQ
1. enzymatic digestion of food
2. absorption of nutrients
liver quadrant and function
RUQ
1. produces bile and plasma proteins
2. detoxifies
3. stores glycogen
gallbladder quadrant and function
RUQ
1. stores and releases bile – bile emulsifies fats and enhances digestion/absorption
2. consists of bilirubin, cholesterol, water, ions
major duodenal papilla: location and function
on superior duodenum; all bile comes through this from gallbladder via common bile duct
portal triad
within lesser omentum (primarily hepatoduodenal ligament); all are anterior to omental foramen
consists of:
1. hepatic artery proper
2. hepatic portal vein
3. common bile duct
pancreas quadrant and function
RUQ, LUQ
1. makes enzymes
2. makes bicarbonate to neutralize chyme
an endocrine gland
large intestine function
NO digestion
1. absorbs water and minerals
2. has lots of bacteria
3. incomplete longitudinal layer
foregut arterial main supply and content
arterial: celiac trunk
contents (6):
1. stomach
2. pancreas
3. duodenum
4. spleen
5. gallbladder
6. liver
midgut arterial main supply and content
arterial: SMA
contents (5):
1. cecum
2. appendix
3. ascending colon
4. transverse colon
5. small intestine
hindgut arterial main supply and content
arterial: IMA
contents (4)
1. transverse colon
2. descending colon
3. sigmoid
4. rectum
retroperitoneal: secondarily
- descending (2nd seg) duodenum
- horizontal (3rd seg) duodenum
- ascend (4th seg) duodenum
- ascend colon
- descend colon
rectum (upper 2/3) - pancreas
caput medusae
HPV –> paraumbilical –> superficial and inferior epigastric vv –> IVC
EPIGASTRIC
esophageal varicies
HPV –> L gastric –> esophageal –> azygos –> SVC
rectal varicies
IMV –> superior rectal –> middle and inferior rectal –> internal iliac –> IVC
retroperitoneal dilated veins
IMV –> L colic –> lumbars –> IVC
lymph nodes in abdomen
preaortic (anterior of abdomen) –> cisterna chyli
retroaortic (posterior) –> cisterna chyli
lateral aortic (within AA) – drains into lumbar trunk –> cisterna chyli
lymph nodes in pelvis
external iliac
internal iliac
common iliac
what LE lymph node drains into external iliac?
deep inguinal
psoas major attachments
origin: T12-L5 transverse processes
insertion: lesser trochanter of femur
QL attachments
origin: 12th rib, L1-L4
insertion: iliac crest
iliacus attachments
origin: iliac fossa, iliac crest, sacroiliac lig
insertion: lesser trochanter femur
what passes through median arcuate ligament?
aortic hiatus
aortic hiatus
T12
contents:
1. descending aorta
2. thoracic duct
aortic hiatus marks transition of thoracic aorta into abdominal aorta
what passes through medial arcuate ligament?
psoas
what passes through lateral arcuate ligament?
QL
caval opening
T8
contents: IVC
esophageal hiatus
T10
contents:
1. parasymp vagal trunk
2. esophagus
pelvic inlet boundaries
sacral promontory
arcuate line of ilium
pectineal line of ischium
pubic symphysis
function: divides pelvis into lesser and greater
pelvic outlet boundaries
coccyx
sacrotuberous and sacrospinous ligament
ischial tuberosity
pubic arch (inf pubic ramus –> pubic symphysis)
lesser (true) pelvis
bounded superiorly by pelvic inlet, inferiorly by pelvic outlet
greater (false) pelvis
above pelvic inlet
SI joint stabilizers (3)
- sacrospinous: sacrum –> ischial spine
- sacrotuberous: sacrum –> ischial tuberosity
- anterior sacroiliac: sacrum –> ilium
male vs. female pelvis
male:
1. subpubic angle 70 deg
2. heart shaped inlet (due to greater prominence of sacral promontory)
3. narrower outlet and cavity
5. narrower sacrum and more convex
female:
1. subpubic angle 90-100 deg
2. oval shaped inlet
3. wider outlet and cavity
4. wider sacrum (ala) and more flat
ischioanal fossa boundaries
ceiling: levator ani
lateral wall: obturator internus
medial-inferior: rectum
ischioanal fossa contents
- fat pads
- connective tissue
- pudendal canal:
-pudendal nerve
-internal pudendal a/v
outside of canal, these become inferior rectal a,v,n
features of scrotum (deep –> superficial)
testis visceral
testis parietal
internal spermatic fascia
cremasteric muscle
external spermatic fascia
tunica dartos (deep layer)
superficial fascia
skin
functions of pudendal nerve and branches
- defecation
- urination/micturition
- parturition (childbirth)
- erection
- ejaculation
erection innervation
parasympathetic S2-S4
pelvic splanchnic nn. –> prostatic plexus –> cavernous nerves –> corpus cavernosum relax and enlarge
ejaculation innervation
sympathetic L1-L2
lumbar splanchnic –> superior and inferior hypogastric plexus –> muscles contract
most commonly injured artery due to pelvic fracture?
internal/external iliac artery
obturator artery
pelvic viscera sympathetic innervation
- sympathetic trunk
> gray rami: postganglionic nerves that synapsed within trunk
> sacral splanchnic: preganglionic nerves that synpases outside of trunk
> ganglion impar: end of sacral sympathetic trunks that unite at coccyx tip - periarterial plexus – vasoconstricts arteries starting at internal iliac
- hypogastric plexus: superior and inferior (inf is mixed)
inferior hypogastric plexus
mixed innervation!
parasympathetic: pregang pelvic splanchnic
sympathetic: pregang sacral splanchnic
