Pelvis, Abdomen Flashcards
What makes up the posterior wall of the inguinal canal?
Transversalis fascia
What makes up the anterior wall of the inguinal canal?
EOM aponeurosis
What makes up the anterior wall of the inguinal canal?
EOM aponeurosis
What fascia covers a direct hernia
External spermatic fascia
What fascia covers an indirect hernia?
Peritoneum and layers of spermatic cord
What hernia enters the deep inguinal ring
Indirect hernia
Main vessels and nerves in the abdominal wall are deep to what muscle layer?
Internal oblique muscle
Origin of the superior epigastric artery
Internal thoracic artery
Peritoneum initially irritated in acute appendicitis
Visceral peritoneum
Location of the appendix from the ileocecal valve
1 inch below ileocecal valve
Origin of iliohypogastric nerve
L1
What nerve may be injured in appendectomy leading to weakening of the anterior abdominal wall
Iliohypogastric nerve
Vertebral level - start of abdominal aorta?
T12
Vertebral level - end of abdominal aorta?
L4
It bifurcates to the right and left common iliacs
Anterior unpaired branches of the abdominal aorta
Celiac trunk
SMA
IMA
Lateral paired visceral branches of the abdominal aorta
Suprarenal
Renal
Gonadal
Unpaired branches of the abdominal aorta
Celiac
SMA
IMA
Median sacral
Terminal branches of the abdominal aorta
Median sacral (unpaired) Common iliac (paired)
Vertebral level - celiac artery
T12
Branches of the celiac trunk
Left gastric
Splenic
Common Hepatic
Beaches of the splenic artery
Short gastric
Left gastroepiploic
Branches of the common hepatic artery
Right gastric
Proper hepatic
Gastroduodenal
Branches of the gastroduodenal artery
Right gastroepiploic
Superior pancreaticoduodenal artery
Branches of the SMA
Inferior pancreaticoduodenal artery Middle colic Right colic Ileocolic Jejunal and ileal branches
Origin of the appendicular artery
Ileocecal artery - SMA
Vertebral level - SMA
L1
Midgut
D2 to 2/3 of transverse colon
Branches of IMA
Left colic
Sigmoid
Superior rectal
Vertebral level - IMA
L3
Anterior to the SMA
NECK of the pancreas
Posterior to SMA
D3 (horizontal part)
Foregut
Parynx, esophagus, stomach, proximal 1/2 of duodenum
Origin of foregut, midgut and hindi it
Endodermal lining of the yolk sac
Upper border of the anal canal
Dentate line/ Pectinate line
Innervation of ascending colon
CN X
Innervation of sigmoid colon
Pelvic sphlancnic nerves (from S2-S4)
Where does pain radiate - foregut derivatives ?
Epigastric
Where does pain radiate - hindgut derivatives ?
Hypogastric
Where does pain radiate - midgut derivatives?
Periumbilical area
Lymph nodes that receive lymph from stomach?
Celiac nodes
Left gastric vein - what does it drain? Where does it drain?
Drains left portion of lesser curvature of stomach and distal esophagus
Opens directly into the portal vein
Portal tributaries involved in porto-systemic shunting
Left gastric v
Paraumbilical v
Superior rectal v
Blood supply of the liver
70% portal vein
30% hepatic artery
Fatty tags
Appendices epoploicae
Permanent folds in the mucous membrane of SI
Plicae circulares - absent in colon
Where is villi present? SI or Colon?
SI
No villi in the colon
Where are Peyer’s patches found?
SI - most in ileum
Caudate and quadrate lobes - functional part of what part?
Left
What keeps the liver in position in the abdominal cavity?
Attachment of the hepatic veins to the IVC (Snell)
The peritoneal ligaments and abdominal muscle tone play a minor role
Liver biopsy?
Full expiration
8th or 9th ICS MAL
(Snell)
Why is pain in acute chole referred to the shoulder?
Irritation of the subdiaphragmatic parietal peritoneum (supplied by phrenic nerve C3-5)
The skin in the shoulder is supplied by supraclavicular nerves (C3,C4)
Uncinate process of the pancreas
Within the head
Blood supply of pancreas
Splenic a
Superior and inferior pancreaticoduodenal a
The long axis of the spleen lies where?
Along the shaft of the 10th rib
Pancreatic islet cells start secreting insulin and glucagon starting ?
5th month
Largest branch of celiac artery
Splenic artery
Retro peritoneal space
12th thoracic vertebra to sacrum and iliac crests
Renal hilum structures - from anterior to posterior
Renal vein
Renal artery
Pelvis
VAP!
Muscles that form posterior wall of retro peritoneum
Psoas
Quadratus lumborum
Origin of transverse abdominis
What structures hold the kidneys in position
Perirenal fat, renal fascia, pararenal fat
What part of the duodenum is anterior to the right kidney?
D2
Kidneys - blood supply?
Aorta - renal arteries - segmental - lobar - interlobar - arcuate - interlobular - afferent
MC location of gastric ulcer
Lesser curvature at or near incisura
Posterior stomach perforation - where will contents accumulate?
Omental bursa
Fundus of stomach supplied by?
Short gastric arteries
Blood supply to lesser curvature
Right and left gastric
Blood supply to greater curvature of stomach
Right and left gastroepiploic
Blood supple to gastric fundus
Short gastric
Where do the right and left gastric v drain?
Portal cein
Where do the L gastroepiploic v drain?
Splenic –> portal v
Where does the right gastroepiploic v drain?
SMV –> portal vein
Most common site of gastric carcinoma
Pylorus
Distance from nostril to 1st esophageal constriction
7.2 inches
18 cm
Distance from nostril to 2nd esophageal constriction
11.2 in
28 cm
Distance from nostril to 3rd esophageal constriction
17.2 in
44 cm
Most anterior structure within the renal hilum
Vein
VAP - vein, artery, pelvis
Kidney fascia
Gerota’s fascia
Adrenal fascia
Gerota’s fascia
Along with kidney
Fat within renal fascia
Perirenal fat
Outside - pararenal fat
Renal transplantation anastomoses
Renal artery anastomosed to internal iliac artery
Renal vein to external iliac vein
Injury of left testicle –> swelling and tenderness - thrombosis of which vein?
Left renal vein - drains to IVC
MC site of varicocele
Left
Posterior to right adrenal
Diaphragm
Posterior to left adrenal
Diaphragm
Embryonic derivative of adrenal medulla
Neural crest – ectoderm
Embryonic derivative of adrenal cortex
Mesoderm
Inferior supra renal artery is from?
Renal artery
Right supra renal artery drains into?
IVC
Blood supply of adrenals
Superior - from inf phrenic a
Middle - from abdominal aorta
Inferior - from renal a
Weight of adrenal gland
4g
Weight of thyroid gland
20g
Renal pain - what spinal cord level?
T12
Site for kidney transplantation
Iliac fossa on posterior abdominal wall
3 constrictions of the ureter
UPJ
As it crosses the pelvic brim
Where it pierces the bladder wall
MCC of Cushing’s syndrome
Supra renal cortical hyperplasia
IVC - on right or left of aorta?
IVC ascends on the right side of the aorta
Three lateral visceral tributaries of the IVC
Right adrenal
Right testicular or ovarian
R and L renal
Beginning of the thoracic duct in the abdomen
Cisterna chylii
Nerve supply to the skin of lower abdominal wall
Iliohypogastric
Nerve that passes through inguinal canal to supply the skin to the groin, scrotum, labia majora
Ilioinguinal nerve
Femoral nerve roots
L2, L3, L4
Largest branch of lumbar plexus
Femoral nerve
Nerve roots of obturator nerve
L2,3,4
Nerve roots of genitofemoral nerve
L1,2
Nerve supply to cremaster muscle
Genital branch of genitofemoral nerve
Enters the spermatic cord
Nerve that enters the spermatic cord
Genitofemoral nerve - genital branch