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GI exam 1 > Organization of the abdomen > Flashcards

Organization of the abdomen Flashcards

1
Q

what vertebra level is the xiphoid process

A

TV10

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2
Q

what vertebra level is the umbiicus

A

LV3/LV4

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3
Q

what are some structures in the right upper quadrant

what part of the stomach, duodenum, pancreas, colon

A 
right liver lobe
gallbladder
stomach (pylorus) 
duodenum parts 1-3
pancreas--> head
right suprarenal gland
right kidney 
right colic (hepatic) flexure
superior part of the ascending colon 
right half of the transverse colon
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4
Q

what are some structures in the left upper quadrant ?

A 
left liver lobe
spleen
stomach
jejunum and proximal ileum
body and tail of pancreas
left kidney 
left suprarenal gland 
left hepatic flexure
transverse colon --> left half
superior part of the descending colon
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5
Q

what are some structures in the right lower quadrant

A 
cecum
appendix
most of ileum
inferior part of ascending colon 
right ovary 
right uterine tube 
right ureter (abdominal part) 
right spermatic cord (abdominal part) 
uterus (if enlarged) 
urinary bladder (if very full)
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6
Q

what are some structures in the left lower quadrant?

A 
sigmoid colon 
descending colon (inferior part) 
left ovary 
left uterine tube
left ureter (abdominal part) 
left spermatic cord (abdominal part) 
uterus (if enlarged)
urinary bladder (if very full)
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7
Q

what is method 1 for dividing the abdomen ?
how many regions ?
how many lines?
where do these lines intersect?

A

Four regions
one horizontal line and one vertical line intersecting at the umbilicus

4 regions:
right and left upper and lower quadrants

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8
Q

what is method 2 for dividing the abdomen ?
how many lines dividing into how many regions?

what are the regions named?

A

Two horizontal lines and Two midclavicular lines dividing the abdomen into 9 regions

Two horizontal lines:
Subcostal line - along lowest limit of costal margin LV3
Transtubercular line- through iliac crests at LV5

Regions:
Right and left hypochondriac 
right and left lateral regions
Right and left inguinal 
epigastric
umbilical 
pubic
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9
Q

what plane is at LV1

A

transpyloric plane

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10
Q

what level is the subcostal plane

A

LV3

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11
Q

transumbilical plane is what vertebral level

A

LV3/LV4

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12
Q

what plane is at the LV4

A

supracristal plane

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13
Q

what plane is at LV5

A

transtubercular plane

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14
Q

what plane is at SV1

A

interspinous plane

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15
Q

what are the 3 major osseous structures of the abdominal wall

A

lumbar vertebrae 1-5
ribs 7-12
pelvic girdle

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16
Q

what are the 2 layers of superficial fascia of the abdominal wall?

A

superficial fatty layer (Camper’s fascia)

deeper membranous layer (Scarpa’s fascia)

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17
Q

what is Scarpa’s fascia continuous with?

What does Scarpa’s fascia attach to?

A

continuous with Colle’s and Darto’s fascia of the perineum

attaches to the iliac crest, fascia lata below inguinal ligament, pubic tubercle

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18
Q

what is the fundiform ligament >

A

specialization of Scarpa’s fascia

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19
Q

what are the 3 layers of the deeper fascia of the abdominal wall

A

transversalis fascia –> lines all of abdominopelvic cavity, deep to muscle layer

subserous fascia–> loose, fatty CT between transversalis fascia and peritoneum

peritoneum–> serous membrane which lines the abdominopelvic cavity

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20
Q

origin of the external abdominal oblique

A

outer surfaces of ribs 5-12

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20
Q

what is contained in the lateral umbilical folds

A

inferior epigastric arteries

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20
Q

where is the supravesical fossa

what type of hernia occurs here

A
  1. Area between median and medial umbilical folds.

2. Supravesical hernias can occur here.

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20
Q

where is the medial inguinal fossa

what type of hernia occur here

A

area between medial and lateral folds

site of DIRECT inguinal hernias

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20
Q

where is the lateral inguinal fossa

what type of hernia’s occur here

A
  1. Area lateral to lateral umbilical fold

2. Site of INDIRECT inguinal hernias.

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20
Q

what two ligaments reinforce the groin and the area of weakness called the myopectineal orifice

A

inguinal ligament (strongest)

iliopubic tract (thickening of transversalis fascia)

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20
Q

insertion of external abdominal oblique

A

anterior iliac crest

via external abdominal oblique aponeurosis attaches to linea alba from xiphoid process to pubic symphysis

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20
Q

what is the action of the external abdominal oblique muscle?
one side acting alone?
innervation?

A

flexion of the vertebral column and pelvis

compression and support of abdominal viscera

one side acting alone causes lateral flexion of trunk and rotation to OPPOSITE side (torsional movement of trunk)

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20
Q

what is the origin of the internal abdominal oblique muscle

A

thoracolumbar fascia
anterior iliac crest
lateral inguinal ligament

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20
Q

what is the insertion of the internal abdominal oblique muscle

A

inferior borders of ribs 9-12

via internal abdominal oblique aponeurosis to linea alba from xiphoid process to pubic symphysis

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20
Q

what is the action of the internal abdominal oblique muscle

A

flexion of the vertebral column and pelvis

compression and support of abdominal viscera

one side acting alone causes lateral flexion of trunk and rotation to the same side

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20
Q

what is the innervation of the internal abdominal oblique

A

intercostals
subcostal
iliohypogastric
ilioinguinal

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20
Q

what do the inferior fibers of the IAO muscle give rise to?

what is the function of this structure

A

cremaster muscle

plays an important role in temperature regulation of the testes

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20
Q

what is the arcuate line

A

line that demarcates the lower limit of the posterior layer of the rectus sheath.

It is also where the inferior epigastric vessels perforate the rectus abdominis.

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20
Q

what are the origin and insertion of the transversus abdominis

A

origin- inner surface of ribs 7-12
thoracolumbar fascia
anterior iliac crest
lateral inguinal ligament

insertion:
via aponeurosis to linea alba

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20
Q

what is the action of the transversus abdominis

A

compression and support of abdominal viscera

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20
Q

what is the innervation of the transversus abdominis

A

intercosta
subcostal
iliohypogatric
ilioinguinal

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20
Q

what is the origin of the rectus abdominis

A

pubic symphysis and pubic crest

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20
Q

insertion of the rectus abdominis

A

costal cartilages of 5-7

xiphoid process

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20
Q

what is the action of the rectus abdominis

A

flexion of the vertebral column and pelvis

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20
Q

what is the innervation of the rectus abdominis

A

ventral rami T6-T12 (intercostal, subcostal)

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20
Q

what are the tendinous intersection of the rectus abdominis

A

3-4 attachments of the rectus abdominis to the rectus sheath

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20
Q

what is the origin and insertion of the pyramidalis

A

origin:
pubic bone
anterior to rectus abdominis

insertion:
linea alba

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20
Q

what is the action of the pyramidalis

A

tenses linea alba

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20
Q

what is the innervation of the pyramidalis

A

subcostal n

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20
Q

what is the clnical signficance of anterolateral musculature fiber direction ?

A

important in surgery
Muscle fibers should be split parallel to their fiber direction. Thus, each layer will require to be split in a different direction.

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20
Q

what are the layers of the anterolateral abdominal wall starting from most exterior

A 
skin
superficial (Camper's) fascia (fatty layer) 
superficial fascia (membranous) Scarpa's 
external abdominal oblique muscle 
internal oblique 
transversus abdominis 
transversalis fascia 
extraperitoneal fascia 
parietal peritoneum
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20
Q

what does the rectus sheath surround and what is it formed from

A

rectus abdominis and pyramidalis

formed from decussation of external and internal abdominal oblique and transversus abdominis aponeurosis

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20
Q

what is the composition/organization of the rectus sheath above the arcuate line

A

the internal abdominal oblique aponeurosis splits into anterior and posterior laminae.
Thus, here the anterior layer of the rectus sheath is composed of external and internal abdominal oblique aponeuroses.

The posterior layer of the rectus sheath is composed of internal abdominal oblique and transversus abdominis aponeuroses.

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20
Q

what is the composition/organization of the rectus sheath below the arcuate line

A

All 3 muscle aponeuroses pass anterior to rectus abdominis.
Here the anterior layer is composed of external and internal abdominal oblique and transversus abdominis aponeuroses.

The posterior layer is composed of only transversalis fascia.

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20
Q

what attaches to the linea alba

where does it extend from

A

midline site of attachment of external, internal and transversus aponeuroses

extends/runs from xiphoid process to pubic symphysis

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20
Q

what is the linea semilunaris

A

lateral, fused border of rectus sheath

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20
Q

where does the median umbilical fold run

A

runs from the apex of the bladder to the umbilicus

the median umbilical ligament (urachus) is found within this fold

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20
Q

where does the medial umbilical ligament run

A

runs towards umbilicus

the medial umbilical ligaments (occluded portion of umbilical aa) are found within the folds

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20
Q

what are the dermatomes of the abdomen?

A

T7-L1

20
Q

what are the cord levels of the thoracoabdominal and subcostal nerves

A

T7-T12

20
Q

where do nerves of the abdomen course? between what layers…

A

course between the transversus abdominis and internal oblique

20
Q

what branches do the thoracoabdominal and subcostal nerves provide?

A

lateral cutaneous branches and anterior cutaneous branches

20
Q

where do the iliohypogastric and ilioinguinal nn pierce through and through what muscle as they course anteriorly?

A

pierce the internal oblique near the ASIS

run between the internal and external oblique, then terminate as anterior cutaneous branches to the suprapubic region (iliohypogastric) or anterior scrotal/labial branches to the perineal region (ilioinguinal).

20
Q

what are two arteries that are superficial and branches off the femoral artery?

A
  1. Superficial epigastric a.

2. Superficial circumflex iliac a.

20
Q

what are the 7 deep arteries of the abdomen

A 
musculophrenic 
superior epigastric 
inferior epigastric 
posterior intercostal 
subcostal 
lumbar 
deep circumflex iliac
20
Q

what are the two arteries of the abdomen that are branches off the internal thoracic artery

A

musculophrenic

superior epigastric

20
Q

where does the superior epigastric artery run?

with what artery does it anastomose ?

A
  1. runs between rectus abdominis and posterior layer of rectus sheath.
  2. Anastomoses with inferior epigastric a. in region of umbilicus.
20
Q

where does the inferior epigastric artery give off from the external iliac a.

where does it ascend in the body wall ?

what does it pierce and anastomose with?

A

given off medial to the deep inguinal ring

  1. Ascends along anterior body wall, covered with peritoneum to form the lateral umbilical fold.
  2. Pierces posterior layer of rectus sheath to anastomose with superior epigastric a.
20
Q

through what muscle layers do the posterior intercostal and subcostal aa’s course? as well as the lumbar artery

A

between internal abdominal and transversus abdominus muscles

20
Q

what deep artery branches from the external iliac artery

A

deep circumflex iliac a.

20
Q

what are the three major veins that the abdomen drains into ?

A

a. axillary vein via lateral thoracic vein.
b. internal thoracic vein via musculophrenic and superior epigastric vv.
c. femoral vein via superficial epigastric and superficial circumflex iliac vv.

20
Q

what are the major veins that deep veins drain into?

A

a. internal thoracic vein via musculophrenic and superior epigastric vv.
b. external iliac vein via inferior epigastric and deep circumflex iliac vv.
c. IVC via lumbar vv.
d. azygos vein via posterior intercostal and subcostal vv.

20
Q

what anastomosis is around the umbilicus

A

a portal-caval anastomosis

20
Q

what is the thoracoepigastric vein a venous anastomosis between?

A

b/w lateral thoracic vein and superficial epigastric

20
Q

superior to the transumbilical plane where does superficial lymph drain?

A

axillary and parasternal lymph nodes

20
Q

inferior to the transumbilical plane where does the superficial lymph drain

A

superficial inguinal lymph nodes

20
Q

what are three locations that deep lymphatic material drain ?

A

a. To external iliac nodes via channels which parallel inferior epigastric and deep circumflex iliac vessels.
b. To lumbar lymph nodes via channels which parallel lumbar vessels.
c. To parasternal nodes via channels which parallel superior epigastric vessels.

20
Q

where is the inguinal region

A

between the ASIS and pubic tubercle

GROIN

20
Q

where is the location of the L1 dermatome

A

iliac crest
ASIS
Inguinal region
anterior scrotum or labia majora

20
Q

what are the dermatomes of the abdomen?

A

T7-L1

20
Q

what is the dermatome of T10

A

umbilicus

20
Q

what cord levels are the iliohypogastric and ilioinguinal nn

A

L1

iliohypogastric - superior

ilioinguinal - inferior

20
Q

what is the major superficial artery supply of the abdomen

A

a. Mostly perforating branches of deeper arteries (see below).

b. Also directly from branches of femoral artery
1. Superficial epigastric a.
2. Superficial circumflex iliac a.

20
Q

what is the dermatome of T10

A

umbilicus

20
Q

where is the location of the L1 dermatome

A

iliac crest
ASIS
Inguinal region
anterior scrotum or labia majora

20
Q

what are the cord levels of the thoracoabdominal and subcostal nerves

A

T7-T12

20
Q

what cord levels are the iliohypogastric and ilioinguinal nn

A

L1

iliohypogastric - superior

ilioinguinal - inferior

20
Q

where do nerves of the abdomen course? between what layers…

A

course between the transversus abdominis and internal oblique

20
Q

what branches do the thoracoabdominal and subcostal nerves provide?

A

lateral cutaneous branches and anterior cutaneous branches

20
Q

where do the iliohypogastric and ilioinguinal nn pierce through and through what muscle as they course anteriorly?

A

pierce the internal oblique near the ASIS

run between the internal and external oblique, then terminate as anterior cutaneous branches to the suprapubic region (iliohypogastric) or anterior scrotal/labial branches to the perineal region (ilioinguinal).

20
Q

what is the major superficial artery supply of the abdomen

A

a. Mostly perforating branches of deeper arteries (see below).

b. Also directly from branches of femoral artery
1. Superficial epigastric a.
2. Superficial circumflex iliac a.

20
Q

what are two arteries that are superficial and branches off the femoral artery?

A
  1. Superficial epigastric a.

2. Superficial circumflex iliac a.

20
Q

what are the 7 deep arteries of the abdomen

A 
musculophrenic 
superior epigastric 
inferior epigastric 
posterior intercostal 
subcostal 
lumbar 
deep circumflex iliac
20
Q

what are the two arteries of the abdomen that are branches off the internal thoracic artery

A

musculophrenic

superior epigastric

20
Q

where does the superior epigastric artery run?

with what artery does it anastomose ?

A
  1. runs between rectus abdominis and posterior layer of rectus sheath.
  2. Anastomoses with inferior epigastric a. in region of umbilicus.
20
Q

where does the inferior epigastric artery give off from the external iliac a.

where does it ascend in the body wall ?

what does it pierce and anastomose with?

A

given off medial to the deep inguinal ring

  1. Ascends along anterior body wall, covered with peritoneum to form the lateral umbilical fold.
  2. Pierces posterior layer of rectus sheath to anastomose with superior epigastric a.
20
Q

through what muscle layers do the posterior intercostal and subcostal aa’s course? as well as the lumbar artery

A

between internal abdominal and transversus abdominus muscles

20
Q

what deep artery branches from the external iliac artery

A

deep circumflex iliac a.

20
Q

what are the three major veins that the abdomen drains into ?

A

a. axillary vein via lateral thoracic vein.
b. internal thoracic vein via musculophrenic and superior epigastric vv.
c. femoral vein via superficial epigastric and superficial circumflex iliac vv.

20
Q

what are the major veins that deep veins drain into?

A

a. internal thoracic vein via musculophrenic and superior epigastric vv.
b. external iliac vein via inferior epigastric and deep circumflex iliac vv.
c. IVC via lumbar vv.
d. azygos vein via posterior intercostal and subcostal vv.

20
Q

what anastomosis is around the umbilicus

A

a portal-caval anastomosis

20
Q

what is the thoracoepigastric vein a venous anastomosis between?

A

b/w lateral thoracic vein and superficial epigastric

20
Q

superior to the transumbilical plane where does superficial lymph drain?

A

axillary and parasternal lymph nodes

20
Q

inferior to the transumbilical plane where does the superficial lymph drain

A

superficial inguinal lymph nodes

20
Q

what are three locations that deep lymphatic material drain ?

A

a. To external iliac nodes via channels which parallel inferior epigastric and deep circumflex iliac vessels.
b. To lumbar lymph nodes via channels which parallel lumbar vessels.
c. To parasternal nodes via channels which parallel superior epigastric vessels.

20
Q

where is the inguinal region

A

between the ASIS and pubic tubercle

GROIN

20
Q

what muscle aponeurosis forms the inguinal ligament and where does the inguinal ligament extend from?

where in relation to the inguinal ligament do muscles and neurovascular bundles pass?

A
  1. Inferior, “rolled-under” portion of external oblique aponeurosis extending from ASIS to pubic tubercle.
  2. Marks transition from abdomen to thigh.
  3. Muscles, neurovascular bundle of lower limb passes INFERIOR to inguinal ligament.
20
Q

what are three ligaments off the inguinal ligament

A

lacunar ligament
pectineal ligament
reflected ligament

20
Q

what is the lacunar ligament and where does it attach

A

medial fibers of inguinal ligament which attach lateral to pubic tubercle; crescent-shaped ligament which forms medial border of femoral canal.

20
Q

what is the pectineal ligament and where does it attach

A

lateral continuation of lacunar ligament fibers attaching to the pectineal line of the superior pubic ramus.

20
Q

what is the reflected ligament and where does it attach

A

continuation of superomedial fibers of inguinal ligament which attach to the linea alba.

20
Q

what is the inguinal canal

A
  1. Oblique passage through anterolateral body wall allowing for passage of the spermatic cord (round ligament of uterus) into scrotum (labia majora).

forms during gonadal descent from abdomen to scrotum (or labia)

20
Q

what is the gubernaculum

A

thick ligament attaching testes to anterior body wall at future site of deep inguinal ring.

20
Q

what is the deep inguinal ring?
what does it form from ?
where is it located in relation to the epigastric arteries?
what abnormality can occur here?

A

a. Entrance to inguinal canal from abdominal cavity.
b. Formed as an evagination in transversalis fascia.
c. Located lateral to inferior epigastric arteries
d. Site of indirect inguinal hernias

20
Q

what is the superficial inguinal ring?

what is it formed from?

A

a. Exit from inguinal canal into scrotum or labia majora.

b. Formed from split in fibers of the external abdominal oblique aponeurosis.

20
Q

where does the lateral crus attach

A

pubic tubercle

20
Q

where does the medial crus attach

A

pubic crest

20
Q

where do the intercrural fibers of the superficial inguinal ring arch b/w?

A

fibers which arch between medial and lateral crus

20
Q

what are the boundaries of the inguinal canal (anterior, floor, roof, posterior)

A

a. Anterior – external oblique aponeurosis
b. Floor – inguinal ligament
c. Roof – internal oblique and transversus abdominis
d. Posterior – transversalis fascia laterally; reinforced medially by conjoint tendon.

20
Q

what can occur in the inguinal triangle

A

direct inguinal hernia

20
Q

what is the conjoint tendon composed of?

where does it attach?

A
  1. The conjoint tendon (falx inguinalis) is composed of the inferior-most fibers of the internal and transversus abdominis muscles.
  2. Attaches to the pubic bone posterior to the superficial inguinal opening.
20
Q

what are the general contents of the spermatic cord?

A 
ductus deferens
testicular artery
artery of ductus deferens 
pampiniform plexus of veins 
autonomic and lymphatics of testes
20
Q

what is the ductus deferens

A

muscular tube which transports sperm from epididymis.

20
Q

what is the testicular artery a branch of

A

abdominal aorta

20
Q

what is the artery of the ductus deferens a branch of

A

superior vesicle artery

20
Q

what do the pampiniform plexus of veins merge to form

A

testicular vein

20
Q

what are the coverings of the spermatic cord staring most exterior

A 
skin 
dartos fascia and muscle
external muscle and fascia
cremaster muscle and fascia
internal spermatic fascia
tunica vaginalis
20
Q

what is dartos fascia

A

superficial fascia of abdominal wall

20
Q

what is external spermatic fascia origin

A

external abdominal oblique aponeurosis

20
Q

what is cremaster muscle and fascia origins

A

internal abdominal oblique muscle

20
Q

what is the internal spermatic fascia origin

A

transversalis fascia

20
Q

what is the tunica vaginalis origin

A

evagination of peritoneum which forms the serous cavity around testes

20
Q

what is the canal of nuck caused by

A

in females if the processus vaginalis fails to close

20
Q 
what are indirect inguinal hernia's.
congenital or acquired?
what is the cause 
occur in what fossa?
how far do herniated materials extend and into what
A

a. Represent 2/3 of all inguinal hernias.
b. More common in males; and more common on right side.
c. Congenital; caused by a failure of proximal processus vaginalis to close.
d. Occur in lateral inguinal fossa; lateral to inferior epigastric vessels.
e. Herniated material passes through deep inguinal ring and into inguinal canal.
f. May extend all the way to scrotum (or labia majora). pass through superficial ring

20
Q

what are direct inguinal hernia’s
congenital or acquired? what is the cause
what tendon provides protection against this type of hernia
how far does this type of hernia extend

A

a. Represent 1/3 of all inguinal hernias.
b. More common in males.
c. Acquired; caused by a weakness in anterior body wall posterior to superficial inguinal ring.
d. The conjoint tendon provides a natural protection against direct hernias.
e. Occur in medial inguinal fossa (Hesselbach’s triangle); medial to inferior epigastric vessels.
f. Do not extend into scrotum or labia majora. but may pass through superficial inguinal ring

20
Q

which type of hernia is usually unilateral and right

A

indirect

132
Q

which type of hernia is more common in elderly

A

direct

133
Q

between what layers of the abdominal wall is prostheses for repairing inguinal hernias placed

A

between transversalis fascia and the parietal peritoneum

GI exam 1 (11 decks)

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