module 2A Flashcards

1
Q

how many quadrants can the abdomen be divided into

A

4 but there are subdivisions of the 4

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2
Q

the surface of the anterior abdominal wall is subdivided into..

A

nine regions

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3
Q

what are the 9 regions

A
  1. epigastric region
  2. umbilical region
  3. hypogastric region
  4. left hypochondriac region
  5. left lumbar region
  6. left inguinal region
  7. right hypochondriac region
  8. right lumbar region
  9. right inguinal region
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4
Q

what is anterior abdominal wall protected by

A

soft tissue

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5
Q

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

A
  • skin
  • superficial fascia
  • investing fascia
  • external oblique
  • internal oblique
  • transversus abdominis
  • transversalis fascia
  • extraperitoneal fat
  • parietal peritoneum
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6
Q

where is the liposuction occur in the layers of the abdomen

A

superficial fascia

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7
Q

the rectus sheath

A

is a layer of fascia that envelops the rectus abdominis muscles

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8
Q

rectus abdominis Diastasis

A
  • condition where the rectus abdominis muscles become separated due to thinning and widening of the linea alba
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9
Q

what can RAD result from

A

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

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10
Q

how many arteries supply the anterior abdominal wall

A

2
- superior epigastric artery
- inferior epigastric artery

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11
Q

superior epigastric artery

A
  • is the terminal branch of the internal thoracic (mammary) artery
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12
Q

where does the superior epigastric artery enter

A

the rectus sheath posteriorly and anastomoses with the inferior epigastric artery

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13
Q

inferior epigastric artery

A

is a branch of the external iliac artery

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14
Q

rectus sheath hematoma

A
  • result of bleeding into the rectus sheath from damage to the superior and/or inferior epigastric arteries and/or their branches
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15
Q

how could rectus sheath hematoma result

A

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

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16
Q

what might be affected from a rectus sheath hematoma

A
  • anterior wall muscles, liver, intestines, stomach, pancreas, because of the pressure through the collection of blood superifically
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17
Q

what are the 2 groups responsible for lymph node draining

A
  • superficial lymphatic drainage
  • deep lymphatic drainage
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18
Q

superficial lymphatic drainage

A

drainage to the axillary nodes form above the umbilicus and to the superficial inguinal nodes below the umbilicus

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19
Q

deep lymphatic drainage

A

drainage to the external iliac, common iliac and lumbar nodes

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20
Q

what is the inguinal canal

A

clinically important passageway, which is approx 4-6cm in lenght, located in the lower anterior abdominal wall

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21
Q

location of inguinal canal

A

between the abdominal region and the pelvic region

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22
Q

inguinal rings what are they?

A

2 ends of the canal
- can be thought as the doorway for contents to enter and exit the inguinal canal

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23
Q

superficial inguinal ring + location

A

is an opening in the external oblique aponeurosis
- lies superior to the pubic tubercle

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24
Q

deep inguinal ring + location

A

invagination of the transversalis fascia
- lies superior to the midpoint of the inguinal ligament

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25
Q

contents of the inguinal canal: females main structure:

A

round ligament of the uterus

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26
Q

contents of the inguinal canal: males main structure:

A

spermatic cord

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27
Q

round ligament of the uterus

A

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

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28
Q

spermatic cord

A

a collection of vessels, nerves and ducts that run from the abdomen through the inguinal canal to the testes

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29
Q

contents of the inguinal canal regardless of gender

A
  • ilioinguinal nerve
  • exiting through the superficial inguinal ring
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30
Q

what does the ilioinguinal nerve supply for females

A

skin of the upper labia majora and mons pubis

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31
Q

what does the ilioinguinal nerve supply for males

A

the skin of the upper scrotum and root of the penis

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32
Q

what does the what does the ilioinguinal nerve supply for both genders

A

skin of the adjacent upper thigh

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33
Q

inguinal hernia

A

occur when contents of the abdominal cavity protrude into the inguinal canal

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34
Q

female inguinal hernia

A

where the round ligament of the uterus attaches to the tissue surrounding the pubic bone

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35
Q

male inguinal hernia

A

where the spermatic cord enters the scrotum

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36
Q

symptoms of inguinal hernias

A

generalized pain in the anterior abdominal wall
- bruising, budling, pain when bending over, lifting objects, coughing, weakness in abdominal wall

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37
Q

what is the posterior abdominal wall

A
  • musculoskeletal wall with numerous blood vessels and nerves supply it
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38
Q

posterior abdominal wall: superior muscles

A

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

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39
Q

posterior abdominal wall : inferior muscles

A
  • psoas major, iliacus, quadratus lumborum
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40
Q

psoas major oringinates

A

on the lumber vertebrae and together with the iliacus merges to form iliopsoas

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41
Q

what forms the iliopsoasa

A

psoas major and iliacus

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42
Q

where does the psoas major attach

A

lesser trochanter of the femur

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43
Q

where does the quadratus lumborum oringate

A

on the iliac crest (of innominate bone) and lumbar vertrae

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44
Q

where does quadratus lumborum inserts

A

on rib 12

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45
Q

tight quadratus lumborum

A

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

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46
Q

what is the lumbar plexus

A

network of nerve fibers responsible for supplying innervation to the skin and musculature of the lower limb

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47
Q

where is the lumbar plexus formed

A

in the psoas major muscle from the ventral (anterior) rami of lumbar spinal nerves 1-4

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48
Q

where do the branches of the lumbar plexus emerge

A

from the psoas major and further divide into serval cords

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49
Q

what are the nerves of the lumbar plexus

A
  • iliohypogastric nerve
  • ilioinguinal nerve
  • genitofemoral nerve
  • lateral femoral cutaneous nerve
  • femoral nerve
  • obturator nerve
  • lumbosacral trunk
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50
Q

iliohypogastric nerve

A

(spinal nerve L1) supplies the skin and muscles of the lower anterior abdominal wall

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51
Q

ilioinguinal nerve

A

(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

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52
Q

genitofermoral nerve

A

(spinal nerves L1 and 2)
- divides into 2 branches

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53
Q

what does the genitofemoral branch into?

A

genital branch
femoral branch

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54
Q

genital branch

A

enters the inguinal canal

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55
Q

femoral branch + genital branch supply?

A

supplies a small aera of skin on the upper anterior thigh

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56
Q

lateral femoral cutaneous nerve

A

of the thigh (spinal nerves L2 and 3) supplies the skin of the anterolateral thigh

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57
Q

femoral nerve

A

(spinal nerves L2-L4)
- supplies the muscles of the anterior compartment of the thigh, hip, and knee joints and skin of the anterior thigh

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58
Q

obturator nerve

A

(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

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59
Q

lumbosacral trunk

A

is formed by L4 that joins with L5
- joins S1-4 ventral rami to form the sacral plexus

60
Q

what does the lumbosacral truck join

61
Q

femoral nerve entrapment

A
  • pinching of the femoral nerve at some point along its course
62
Q

symptoms of femoral nerve entrapment

A
  • pain
    numbness or weakness along the front of the tight
63
Q

cause of femoral nerve entrapment

A

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

64
Q

neuropathy

A

referring to the damage or dysfunction of nerves

65
Q

etiological

A

causing or contributing to the development of a disease or condition

66
Q

sympathic innervation: autonomic nerves

A

the lumbar sympathetic trunk runs down the posterior abdominal wall lateral to the vertebral column

67
Q

parasympathetic : autonomic nerves what supplies it?

A
  • 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
68
Q

how many autonomic plexuses are in our bodies

69
Q

aortic (prevertebral plexus)

A
  • associated with aortic plexus are prevertebral ganglia
70
Q

prevertebral ganglia

A
  • celiac
  • superiormesenteric
  • inferior mesenteric
  • aorticorenal ganglia
71
Q

what does the aortic (prevertebral plexus) innervate

A
  • stomach
  • small + large intestine
  • kidneys
72
Q

superior hypogastric plexus

A

the aortic plexus continues inferiorly until it reachs the bifurcation of the descending aorta (forming this plexus)

73
Q

superior hypogastric plexus what does it innervate

A
  • uterus
  • prostate
  • bladder
  • rectum
  • perineum
74
Q

diabetic gastroparesis

A

impaired innervation to the abdominal viscera, dysmotility can result
- no structural abnormalities within the gut
- no inflammation

75
Q

symptoms of diabetic gastroparesis

A
  • bloating
  • abdominal pain
  • nausea
  • vomiting
76
Q

what is the aortic plexus formed by

A

anterior and posterior vagal truncks of vagus nerve

77
Q

dysmotility

A

a condition when peristalsis becomes disordered

78
Q

the abdominal aorta where does it descend into

A

the abdomen through the aortic hiatus of the diaphragm at T12

79
Q

where does the abdominal aorta bifurcates

A

at L4/L5 vertebral level into left and right common iliac arteries which then bifurcates into external iliac arteries and internal iliac arteries

80
Q

what would prolonged hypertension result in?

A

weakened abdominal aorta

81
Q

what is the largest and thickest blood vessel in the body

A

abdominal aorta

82
Q

what are the 3 important unpaired arteries that supply the gastrointestinal tract

A
  • celiac artery
  • superior mesenteric artery
  • inferior mesenteric artery
83
Q

where does the celiac artery form

A

at the level of T12

84
Q

how many branches does the celiac artery have? + what are they

A
    • left gastric
    • common hepatic
    • splenic arteries
85
Q

what does the celiac artery + branches supply

86
Q

foregut

A
  • refers to the division of the gastrointestinal tract from the distal esophagus to the proximal duodenums
  • includes pancreas, liver, gallbladder
87
Q

superior mesenteric artery (SMA) forms?

A

at the level L1

88
Q

branches of the superior mesenteric artery

A
  • inferior pancreaticoduodenal artery
  • jejunal artery
  • ileal artery
  • middle and right colic arteries
89
Q

what does the SMA supply?

90
Q

midgut

A

the division of the gastrointestinal tract spanning from the distal duodenum to the proximal half of the transverse colon

91
Q

where does the inferior mesenteric artery form

A

vertebral level L3

92
Q

how many branches + what are they off the IMA

A
  • left colic artery
  • sigmoidal arteries
  • superior rectal (hemorrhoidal) artery
93
Q

what does the IMA supply

94
Q

hindgut

A

division of the gastrointestinal tract spanning from the distal third of the transverse colon to the rectum

95
Q

what arises from the lateral sides of the aorta

A

three paired viscerla branches

96
Q

what are the 3 paired visceral branches

A
  • suprarenal arteries
  • renal arteries
  • gonadal arteries
97
Q

location of suprarenal artey

98
Q

where are right and left suprarenal arteries formed

99
Q

where does renal artery form

100
Q

where are the left and right renal arteries formed

A

between the level L1 and L2

101
Q

where does the gonadal artery form

102
Q

where does the right and left gonadal (testicular or ovarian) arteries form

103
Q

what do the posterior parietal branches supply

A

musculoskeletal structures of the posterior abdominal wall

104
Q

what are the posterior parietal branches

A
  • right and left inferior phrenic arteries
  • lumbar arteries
105
Q

right and left inferior phrenic arteries

A

arise just below the aortic hiatus

106
Q

what do the right and left inferior phrenic arteries supply

A

inferior surface of the diaphragm

107
Q

lumbar arteries

A

run in series with the intercostal arteries and supply the posterior abdominal wall

108
Q

splenic artery infarction

A

the artery is obstructed
- severse pain in upper left quadrant
- slow to develop (pain)

109
Q

how is the inferior vena cava formed ?

A

union of the right and left common iliac veins at L5

110
Q

how does the inferior vena cava ascends

A

through the caval opening of the diaphragm to return blood to the heart

111
Q

what are the tributaries of the inferior vena cava

A
  • right and left renal veins
  • hepatic veins
  • inferior phrenic
  • lumbar veins
  • left suprarenal
  • right gonadal veins
112
Q

what is inferior vena cava syndrome

A

results from obstruction of the inferior vena cava due to compression and/or infarction of its major tributaries

113
Q

if there was inferior vena cava compression where would there be swelling?

A

below the diaphragn, specifically lower limbs

114
Q

what could an obstruction be from

A

blood clot or tumor

115
Q

what are the 2 layers of the peritoneum

A

parietal and visceral

116
Q

parietal peritoneum

A

lines the inferior surface of the diaphragm, the abdominal and pelvic walls, and forms a roof over the pelvic viscera

117
Q

visceral peritoneum

A

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

118
Q

peritonitis

A

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

119
Q

symptoms of peritonitis

A

abdominal pain, weight loss, and tenderness of the abdomen

120
Q

what is the peritoneum

A

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

121
Q

what does the peritoneum form

A

peritoneal cavity

122
Q

peritoneum cavity

A

a potential space containing a small amount of serous fluid
- is the space between the parietal and viseral layers of the peritoneum

123
Q

which sex has incomplete closure of the peritoneal cavity

A
  • females
  • have communication with the exterior by the opening of the fallopian tubes
124
Q

what are the 2 structures formed by the tissues of the peritoneum

A

double folds
- omenta
- mesenteries

125
Q

what is the omenta

A
  • large double fold of peritoneum
  • consisting of the greater (hanging below the stomach) and the lesser (between the stomach and liver) portions
126
Q

what does the omenta help do

A

cushion the intestines and act as a protective barrier for infection and trauma of the underlying abdominal organs

127
Q

what is mesenteries

A

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

128
Q

what are organs considered in the cavity

A

intraperitoneal or retroperitoneal

129
Q

what are intraperitoneal organs

A

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)

130
Q

what are retroperitoneal organs

A

found behind the peritoneum and are only covered anteriorly
example kidney

131
Q

what are the 2 parts to the peritoneal cavity with the abdomen

A

greater sac
lesser sac

132
Q

lesser sac

A

(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

133
Q

how does the lesser sac communicate with the greater sac

A

through the epiploic (omental) foramen (of winslow)

134
Q

the greater sac

A

extends from the diaphragm to the pelvis

135
Q

nerve supply: partietal peritoneum

A
  • phrenic nerves
  • lower intercoastal nerves
  • and more
136
Q

nerve supply visceral peritoneum

A
  • visceral sensory nerves that accompany autonomic nerve
137
Q

pain: parietal peritoneum

A

well localized sensitivity to pain

138
Q

pain: visceral peritoneum

A

pain is poor localized

139
Q

why is parietal peritoneum more sensitive to localized pain?

A
  • 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
140
Q

reactive lymphadenopathy

A

occurs when lymph nodes become swollen due to an immune response from lymphocytes

141
Q

symptoms of reactive lymphadenopathy

A

tenderness, pain, and warmth upon touch in the region of the affected lymph nodes

142
Q

pre-aortic lymph nodes: location

A

anterior surface of the aorta in close proximity to the major unpaired branches of the aorta

143
Q

where/what do the pre-aortic lymph drain

A

from the foregut, midgut, and hindgut structures

144
Q

para-aortic lymph nodes (lumbar lymph nodes) location

A

along the length of the aorta, on the right and left

145
Q

what/where do the para-aortic lymph nodes drain

A

from the posterior abdominal wall, kidneys, suprarenal glands, ureters, gonads (ovaries and testes), uterus, and uterine tubes

146
Q

retroperitoneal organs

A

Suprarenal (adrenal) glands,
Aorta/Inferior Vena Cava,
Duodenum (second and third segments),
Pancreas,
Ureters,
Colon (ascending and descending only),
Kidneys,
Esophagus, and
Rectum.