module 2A Flashcards
how many quadrants can the abdomen be divided into
4 but there are subdivisions of the 4
the surface of the anterior abdominal wall is subdivided into..
nine regions
what are the 9 regions
- epigastric region
- umbilical region
- hypogastric region
- left hypochondriac region
- left lumbar region
- left inguinal region
- right hypochondriac region
- right lumbar region
- right inguinal region
what is anterior abdominal wall protected by
soft tissue
what are the layers of the anterior abdominal wall from superficial to deep
- skin
- superficial fascia
- investing fascia
- external oblique
- internal oblique
- transversus abdominis
- transversalis fascia
- extraperitoneal fat
- parietal peritoneum
where is the liposuction occur in the layers of the abdomen
superficial fascia
the rectus sheath
is a layer of fascia that envelops the rectus abdominis muscles
rectus abdominis Diastasis
- condition where the rectus abdominis muscles become separated due to thinning and widening of the linea alba
what can RAD result from
any number of conditions that weaken the linea alba, resulting in protrusion of abdominal contents
- this conditions is characterized by a protruding midline and can also cause lower back pain
how many arteries supply the anterior abdominal wall
2
- superior epigastric artery
- inferior epigastric artery
superior epigastric artery
- is the terminal branch of the internal thoracic (mammary) artery
where does the superior epigastric artery enter
the rectus sheath posteriorly and anastomoses with the inferior epigastric artery
inferior epigastric artery
is a branch of the external iliac artery
rectus sheath hematoma
- result of bleeding into the rectus sheath from damage to the superior and/or inferior epigastric arteries and/or their branches
how could rectus sheath hematoma result
from a direct tear of the rectus sheath or of the abdominal muscles
- blood collects in the anterior abdominal wall causing bruising, tenderness, pain, and bulding of the abdomen
what might be affected from a rectus sheath hematoma
- anterior wall muscles, liver, intestines, stomach, pancreas, because of the pressure through the collection of blood superifically
what are the 2 groups responsible for lymph node draining
- superficial lymphatic drainage
- deep lymphatic drainage
superficial lymphatic drainage
drainage to the axillary nodes form above the umbilicus and to the superficial inguinal nodes below the umbilicus
deep lymphatic drainage
drainage to the external iliac, common iliac and lumbar nodes
what is the inguinal canal
clinically important passageway, which is approx 4-6cm in lenght, located in the lower anterior abdominal wall
location of inguinal canal
between the abdominal region and the pelvic region
inguinal rings what are they?
2 ends of the canal
- can be thought as the doorway for contents to enter and exit the inguinal canal
superficial inguinal ring + location
is an opening in the external oblique aponeurosis
- lies superior to the pubic tubercle
deep inguinal ring + location
invagination of the transversalis fascia
- lies superior to the midpoint of the inguinal ligament
contents of the inguinal canal: females main structure:
round ligament of the uterus
contents of the inguinal canal: males main structure:
spermatic cord
round ligament of the uterus
a fibromuscular band attached to the uterus on either side in front of and below the opening of the fallopian tube and passing through the inguinal canal to the labia majora
spermatic cord
a collection of vessels, nerves and ducts that run from the abdomen through the inguinal canal to the testes
contents of the inguinal canal regardless of gender
- ilioinguinal nerve
- exiting through the superficial inguinal ring
what does the ilioinguinal nerve supply for females
skin of the upper labia majora and mons pubis
what does the ilioinguinal nerve supply for males
the skin of the upper scrotum and root of the penis
what does the what does the ilioinguinal nerve supply for both genders
skin of the adjacent upper thigh
inguinal hernia
occur when contents of the abdominal cavity protrude into the inguinal canal
female inguinal hernia
where the round ligament of the uterus attaches to the tissue surrounding the pubic bone
male inguinal hernia
where the spermatic cord enters the scrotum
symptoms of inguinal hernias
generalized pain in the anterior abdominal wall
- bruising, budling, pain when bending over, lifting objects, coughing, weakness in abdominal wall
what is the posterior abdominal wall
- musculoskeletal wall with numerous blood vessels and nerves supply it
posterior abdominal wall: superior muscles
made up by diaphragm
- muscular extensions of the diaphragm, right and left crus insert onto the lumbar vertebrae
- larger right cura oringates from the bodies of lumbar vertebra 1-3 and the smaller left cura originates from the bodies of lumbar 1-2
posterior abdominal wall : inferior muscles
- psoas major, iliacus, quadratus lumborum
psoas major oringinates
on the lumber vertebrae and together with the iliacus merges to form iliopsoas
what forms the iliopsoasa
psoas major and iliacus
where does the psoas major attach
lesser trochanter of the femur
where does the quadratus lumborum oringate
on the iliac crest (of innominate bone) and lumbar vertrae
where does quadratus lumborum inserts
on rib 12
tight quadratus lumborum
increase the load on a few anatomical structures
- muscle on one side of the posterior wall becomes tight it may life the corresponding site of ones pelvis causing misalignment
- might pull at ribs limiting reaching and breathing
- if both of them are tight cause compression on the spine resulting in back pain
what is the lumbar plexus
network of nerve fibers responsible for supplying innervation to the skin and musculature of the lower limb
where is the lumbar plexus formed
in the psoas major muscle from the ventral (anterior) rami of lumbar spinal nerves 1-4
where do the branches of the lumbar plexus emerge
from the psoas major and further divide into serval cords
what are the nerves of the lumbar plexus
- iliohypogastric nerve
- ilioinguinal nerve
- genitofemoral nerve
- lateral femoral cutaneous nerve
- femoral nerve
- obturator nerve
- lumbosacral trunk
iliohypogastric nerve
(spinal nerve L1) supplies the skin and muscles of the lower anterior abdominal wall
ilioinguinal nerve
(spinal nerve L1)
- runs through the inguinal canal, emerging from the superfiical inguinal ring supplying skin of the upper medial thigh, root of penis, and anterior scrotum, or skin of the mon pubis and labium majus
genitofermoral nerve
(spinal nerves L1 and 2)
- divides into 2 branches
what does the genitofemoral branch into?
genital branch
femoral branch
genital branch
enters the inguinal canal
femoral branch + genital branch supply?
supplies a small aera of skin on the upper anterior thigh
lateral femoral cutaneous nerve
of the thigh (spinal nerves L2 and 3) supplies the skin of the anterolateral thigh
femoral nerve
(spinal nerves L2-L4)
- supplies the muscles of the anterior compartment of the thigh, hip, and knee joints and skin of the anterior thigh
obturator nerve
(spinal nerves L2-L4)
- supplies the muscles of the medial compartment of the thigh, hip, and knee joints and the skin of the medial thigh
lumbosacral trunk
is formed by L4 that joins with L5
- joins S1-4 ventral rami to form the sacral plexus
what does the lumbosacral truck join
S1-4
femoral nerve entrapment
- pinching of the femoral nerve at some point along its course
symptoms of femoral nerve entrapment
- pain
numbness or weakness along the front of the tight
cause of femoral nerve entrapment
is a disc herniation at vertebral level L2/3 or L3/4 as the disc bulges it impinges the femoral nerve
- lifting heavy things or obesity can cause herniated disc
neuropathy
referring to the damage or dysfunction of nerves
etiological
causing or contributing to the development of a disease or condition
sympathic innervation: autonomic nerves
the lumbar sympathetic trunk runs down the posterior abdominal wall lateral to the vertebral column
parasympathetic : autonomic nerves what supplies it?
- branches of the left and right vagus nerves “vagal trunks” carry parasympathetic fibers to the aortic plexus
- spinal nerves from S2-4 called “pelvic splanchnic nerves” carry parasympathic fibers to the superior hypogastric plexus
how many autonomic plexuses are in our bodies
5
aortic (prevertebral plexus)
- associated with aortic plexus are prevertebral ganglia
prevertebral ganglia
- celiac
- superiormesenteric
- inferior mesenteric
- aorticorenal ganglia
what does the aortic (prevertebral plexus) innervate
- stomach
- small + large intestine
- kidneys
superior hypogastric plexus
the aortic plexus continues inferiorly until it reachs the bifurcation of the descending aorta (forming this plexus)
superior hypogastric plexus what does it innervate
- uterus
- prostate
- bladder
- rectum
- perineum
diabetic gastroparesis
impaired innervation to the abdominal viscera, dysmotility can result
- no structural abnormalities within the gut
- no inflammation
symptoms of diabetic gastroparesis
- bloating
- abdominal pain
- nausea
- vomiting
what is the aortic plexus formed by
anterior and posterior vagal truncks of vagus nerve
dysmotility
a condition when peristalsis becomes disordered
what are gonads a component of
the endocrine and reproductive system
gonads produce what
gametes but also produce reproductive hormones that regulate gametogenesis
during childhood and gonads
- only produce small quantities of these reproductive hormones
- the production of sex hormones increase once the gonads receive a “start signal at puberty”
where does the signal come from at puberty
the brain specifically from the hypothalamus and pituitary glands
what is considered the regulatory center for the endocrine system
hypothalamus and pituitary gland
- synthesis and release of hormones that control important organ systems in the body
what is the hypothalamic-pituitary-gonadal axis (HPG axis)
the hormonal pathway regulating the maturation and function of the reproductive system
about the HPG axis
major signaling pathway between the hypothalamus, pituitary gland, gonads which regulates the productive of specific hormones that direct the function of the reproductive system
hormones in the HPG axis
- gonadotropin releasing hormone
- Luteinzing hormone
- follile-stimulating hormone
what does the hypothalamus release?
gonadotropin releasing hormone
gonadotropin releasing hormone
at around age 10-12 GnRH neurons receive signals to start producing GnRH
what does GnRH induce?
the release of gonadotropins
gonadotropins
hormones that regulate sexual development and reproductive function
what does the anterior pituitary release
luteinizing hormone and follicle-stimulating hormone
anterior pituitary : GSP axis
- once GnRH is released, travels towards the anterior pituitary and binds secretory cells (gonadotrophs), causing them to produce gonadotrophins (LH and FSH)
examples of 2 gonadotrophins
luteinizing hormone
follicle-stimulating hormone
gonads: GSP axis
- ## LH and FSh released by pitutiary gland into the bloodstream (to produce different effecting in each sex)
function of HPG axis in males
- regulation of testosterones production
- spermatogenesis
function of HPG axis females
- regulation of menstrucal cycle
steps of the HPG axis
- hypothalamus ->GmRH
- anterior pitutiary-> LH + FSH
- Gonads
what modulate GnRH and gonadotropin release
feedback circuit in the HPG axis
males and females GnRH releasing
from the hypothalamus in a pulsatile manner
- frequency and size of the GnRH pulses determine the synthesis and secretion of gonadotropins (which determines the synthesis of sex hormones in the gonads)
secretion of GnRH in males
- GnHR pulses have a relatively constant frequency throughout the day
secretion of GnRH in females
the frequency pulses varies depending on the stage of the menstrual cycle
frequency and amplitude of GnRH pulses
critical for normal gonadotropin release
- to avoid the down regulation of the GnRH receptor in the pituitary, maintaining the heightened sensitivity of the receptor
GnRH self regulation
via a negative feedback signal from the gonads
inhibin
- protein secreted by granulosa (female) and sertoli (male) cells in response to FSH acculation
- major function is the negative feedback control of pituitary FSH secreation
what does GnRH down regulate
FSH synthesis and FSH secretion
how many cycles does the ovarian cycle consist of
2
- follicular phase
- luteal phase
which are separated by ovulation
hormones in the follicular phase
FSH
LH
estrogen
follicular phase: FSH
- FSH levels continue to rise from the last few days of the previous cycle and peak during the first weak of the follicular phase
what does the rise in FSH do : follicular phase
- stimulates 5-7 primary oocytes to begin their maturation
what does FSH induce: follicular phase
- the proliferation of granulosa cells in the follicles, the production of inhibin, and the expression of LH receptors on theca cells
LH: follicular phase
- before LH levels increase, one or 2 of the developing follicles emerge as dominant
- LH binds to the LH receptors on theca cells to induce the production of estrogen precursors, which diffuse into the neighboring granulosa cells
- LSH binds granulosa cells to produce estrogen from these precursors
estrogen follicular phase
- secretion of the dominant follicle leads to a slight decrease in the levels of LH and FSH, causing the atresia of the other recruited follicles
- thus only one of the follicles will prevail and reach maturity, containing a mature oocyte
hormones in the ovulatory phase
- LH
- estrogen
estrogen: ovulatory phase
- continues to rise as the follicle matures
- estrogen exerts a positive feedback action on the anterior pituitary to cause a surge in LH secretion
LH: ovulatory phase
- increase in LH (surge) mature fallicle ruptures, releasing the oocyte into the oviduct, also causes the reinitiation of meiosis in the oocyte, leading to formation and release of secondary oocytes
- reasons for rupture: proteolytic enzyme activity , ovarian smooth muscle contractions to increase intrafollicular pressure, vascular alterations of perifollicular vessels
hormones of the luteal phase
- FSH
- LH
- progesterone
- estrogen
what do FSH and LH cause in luteal phase
- the empty follucle to transform into the corpus luteum
- ## corpus luteum then releases progesterone (more) and some estrogen
what does the release of progesterone and estrogen do to LH and FSH
inhibits the production of them
what does progesterone affect in luteal phase
uterine lining, so it is receptive to implanatation
if ferilization occur : luteal phase
implantation occurs, the corupus luteum will continue to produce progesterone in response to hormonal signals from the implanting embryo
what does the corpus luteum produce
hormones that inhibit the secretion of FSH and LH
what happens if no fertilization : luteal phase
- inhibition of FSH and LH production will cause the corpus luteum to atrophy and become the corpus albicans
- decreasing progesterone and estrogen increasing FSH and recruitment of follicles for the next cycle
what are the 3 phases of the uterine cycle
- menses
- proliferative
- secretory
menses phase : uterine cycle
- where the cycle restarts
- implanatation does not occur
- decrease in estrogen and progesterone at end of luteal phase causes endometrial growth to cease
- lining that was prepared for implanation shed due to release of local prostaglandins that constrict blood supply and result in tissue death
what does prostaglandins cause
- shedding (blood supply contrition)
- rhythmic contractions of the myometrium (dislodge the uterine lining)
proliferative phase : uterine cycle
- start of this phase endometrium consists of only a few layers of cells and is less than 1mm thick
- estrogen secreation increases due to newly developing follicle, causing repair and growth of the endometrium 3-5mm in thickness
- coincides with the latter part of the ovarian follicular phase
secretory phase: uterine cycle
- uterine endometrium is receptive to implantation
- coincides with the luteal phase of the ovaries when the oocyte has been released and the corpus luteum is producing progesterone
- progesterone increases the blood supply to the uterine lining and reduce the contractility of smooth muscle in the uterus
- no implantation: uterine lining is shed and cycle restarts
hormones in the male cycle
LH and FSH which affect the function of the testes
luteinizing hormone
LH enters the testes and stimulates interstitial Leydig cells to make and release testoerone into the testes and blood
follicle stimulating hormone
FSH enters the testes and stimulates sertoli cells to produce androgen-binding protein (ABP) and inhibin
ABP
is a protein that specifically binds testosterone to help concentrate it in the luminal fluid of the seminferous tubules
inhibin males
will go to pituitary gland and downregulate FSH production
male cycle regulation
- continuous
- regulated by a negative feedback system
- rising levels of testosterone and inhibin act on hypothalamus and pituitary inhibiting the release of GnRH, FSH and LH
- once testerone and inhibin levels decrease again the cycle restarts
when does the males cycle repeat
between 4 and 8 times every 24hours
steroidogenesis pathway
vitial biological pathway by which steroid hormones are synthesized in the body
- thus reproductive hormones also play vital regulatory roles in other body systems
why do males and females produce different amount of sex hormones
- biological synthetic pathway is the same
- sex hormones are steroid hormones
- steroids have wide range of function in the body
- large hormone pathway
- which hormone is produced depends on the organ producing it
- all these hormones have extra effect in the body such as metabolism
what else to hormones help with
inducing development of secondary sexual characteristics after onset of puberty
HPG axis disorders
- disruptions in normal sex hormones production and metabolism can result in a variety of disorders depending on the timing of the disruption (fetal or adult) and the type of disruption (which hormone, how much, which part of the pathway)
hypogonadism : males
- decreased production of gonadal hormones leads to below-normal function of the gonads and retardation of sexual growth and development in children
- males the body does not produce enough testerone , which play keys role in masculine growth and puberty
gynecomastia
excessive development of male breasts that can be caused by a variety of endocrine disorders
hyperandrogenism female
excessive secretion of androgens by the adrenal cortex, ovaries, testes
- males kinda of unsure so typically used in female
polycystic ovarian syndrome
- hormonal condition
- results in infrequent or prolonged menstrual periods and the development of small collection of fluid (follicles) in the ovaries which leads to the failure of regular egg release
the abdominal aorta where does it descend into
the abdomen through the aortic hiatus of the diaphragm at T12
where does the abdominal aorta bifurcates
at L4/L5 vertebral level into left and right common iliac arteries which then bifurcates into external iliac arteries and internal iliac arteries
what would prolonged hypertension result in?
weakened abdominal aorta
what is the largest and thickest blood vessel in the body
abdominal aorta
what are the 3 important unpaired arteries that supply the gastrointestinal tract
- celiac artery
- superior mesenteric artery
- inferior mesenteric artery
where does the celiac artery form
at the level of T12
how many branches does the celiac artery have? + what are they
- left gastric
- common hepatic
- splenic arteries
what does the celiac artery + branches supply
foregut
foregut
- refers to the division of the gastrointestinal tract from the distal esophagus to the proximal duodenums
- includes pancreas, liver, gallbladder
superior mesenteric artery (SMA) forms?
at the level L1
branches of the superior mesenteric artery
- inferior pancreaticoduodenal artery
- jejunal artery
- ileal artery
- middle and right colic arteries
what does the SMA supply?
midgut
midgut
the division of the gastrointestinal tract spanning from the distal duodenum to the proximal half of the transverse colon
where does the inferior mesenteric artery form
vertebral level L3
how many branches + what are they off the IMA
- left colic artery
- sigmoidal arteries
- superior rectal (hemorrhoidal) artery
what does the IMA supply
hindgut
hindgut
division of the gastrointestinal tract spanning from the distal third of the transverse colon to the rectum
what arises from the lateral sides of the aorta
three paired viscerla branches
what are the 3 paired visceral branches
- suprarenal arteries
- renal arteries
- gonadal arteries
location of suprarenal artey
L1
where are right and left suprarenal arteries formed
level L1
where does renal artery form
L1/L2
where are the left and right renal arteries formed
between the level L1 and L2
where does the gonadal artery form
at L2
where does the right and left gonadal (testicular or ovarian) arteries form
at L2
what do the posterior parietal branches supply
musculoskeletal structures of the posterior abdominal wall
what are the posterior parietal branches
- right and left inferior phrenic arteries
- lumbar arteries
right and left inferior phrenic arteries
arise just below the aortic hiatus
what do the right and left inferior phrenic arteries supply
inferior surface of the diaphragm
lumbar arteries
run in series with the intercostal arteries and supply the posterior abdominal wall
splenic artery infarction
the artery is obstructed
- severse pain in upper left quadrant
- slow to develop (pain)
how is the inferior vena cava formed ?
union of the right and left common iliac veins at L5
how does the inferior vena cava ascends
through the caval opening of the diaphragm to return blood to the heart
what are the tributaries of the inferior vena cava
- right and left renal veins
- hepatic veins
- inferior phrenic
- lumbar veins
- left suprarenal
- right gonadal veins
what is inferior vena cava syndrome
results from obstruction of the inferior vena cava due to compression and/or infarction of its major tributaries
if there was inferior vena cava compression where would there be swelling?
below the diaphragn, specifically lower limbs
what could an obstruction be from
blood clot or tumor
what are the 2 layers of the peritoneum
parietal and visceral
parietal peritoneum
lines the inferior surface of the diaphragm, the abdominal and pelvic walls, and forms a roof over the pelvic viscera
visceral peritoneum
covers organs so when their visceral surfaces are in contact with each other or with the parietal peritoneum the serous fluid between the peritoneal surfaces allows for free movement
peritonitis
inflammation of the peritoneum that is usually caused by a bacterial infection
- rapid progressive disease of the abdominal cavity which can be fatal if left untreated
symptoms of peritonitis
abdominal pain, weight loss, and tenderness of the abdomen
what is the peritoneum
serous membrane that help support the organs in the abdominal cavity and also allows nerves, blood vessels, and lymph vessels to pass through to the organs
what does the peritoneum form
peritoneal cavity
peritoneum cavity
a potential space containing a small amount of serous fluid
- is the space between the parietal and viseral layers of the peritoneum
which sex has incomplete closure of the peritoneal cavity
- females
- have communication with the exterior by the opening of the fallopian tubes
what are the 2 structures formed by the tissues of the peritoneum
double folds
- omenta
- mesenteries
what is the omenta
- large double fold of peritoneum
- consisting of the greater (hanging below the stomach) and the lesser (between the stomach and liver) portions
what does the omenta help do
cushion the intestines and act as a protective barrier for infection and trauma of the underlying abdominal organs
what is mesenteries
double folds of peritoneum anchor the abdominal organs to the posterior abdominal wall, helping keep those organs in place while still allowing for some mobility
what are organs considered in the cavity
intraperitoneal or retroperitoneal
what are intraperitoneal organs
almost completely covered by the peritoneum
- parts of the gut which require mobility
- anchored to the posterior abdominal wall by a double-fold of peritoneum (the mesentery)
what are retroperitoneal organs
found behind the peritoneum and are only covered anteriorly
example kidney
what are the 2 parts to the peritoneal cavity with the abdomen
greater sac
lesser sac
lesser sac
(omental bursa)
- lies behind the stomach, extending upward to the diaphragm (superior recess), downward between the layers of greater momentum (inferior recesses), left as the spleen and right where it communicates with the greater sac
how does the lesser sac communicate with the greater sac
through the epiploic (omental) foramen (of winslow)
the greater sac
extends from the diaphragm to the pelvis
nerve supply: partietal peritoneum
- phrenic nerves
- lower intercoastal nerves
- and more
nerve supply visceral peritoneum
- visceral sensory nerves that accompany autonomic nerve
pain: parietal peritoneum
well localized sensitivity to pain
pain: visceral peritoneum
pain is poor localized
why is parietal peritoneum more sensitive to localized pain?
- because it receives the same somatic nerve supply as the region of the abdominal wall that it lines: therefore, pain from the parietal peritoneum is well localized
reactive lymphadenopathy
occurs when lymph nodes become swollen due to an immune response from lymphocytes
symptoms of reactive lymphadenopathy
tenderness, pain, and warmth upon touch in the region of the affected lymph nodes
pre-aortic lymph nodes: location
anterior surface of the aorta in close proximity to the major unpaired branches of the aorta
where/what do the pre-aortic lymph drain
from the foregut, midgut, and hindgut structures
para-aortic lymph nodes (lumbar lymph nodes) location
along the length of the aorta, on the right and left
what/where do the para-aortic lymph nodes drain
from the posterior abdominal wall, kidneys, suprarenal glands, ureters, gonads (ovaries and testes), uterus, and uterine tubes
