The Abdomen Flashcards
Small intestine
Duodenum
Jejunum
Ileum
Large intestine
Cecum/ appendix
Ascending, transverse, descending colon
Sigmoid colon
Rectum/ anal
Peritoneum
- secretes serous peritoneal fluid
Parietal peritoneum – lines abdominal and pelvic cavities
Visceral peritoneum – covers organs
Peritoneal cavity
– closed in males, open in females via vagina.
– No organ in peritoneal cavity
Greater sac – extends from diaphragm into pelvis
Communicate via epiploic foramen
Lesser sac – smaller and lies behind the stomach.
Intraperitoneal organs (covered in visceral peritoneum)
Liver (except bare area posteriorly), spleen, first part of duodenum,
Stomach, jejunum ileum, spleen, transverse section of large intestine, sigmoid colon.
Retroperitoneal organs (partially covered in visceral peritoneum)
Pancreas (head and body), ascending and descending colons, kidneys, part of duodenum (part 2-4)
(NB. also cisterna chyli)
Part of the posterior surface of the liver ‘bare area of the liver’. Direct contact with the diaphragm.
Peritoneal ligaments
Two layered folds of peritoneum that connect solid viscera to the abdominal walls.
Peritoneal ligaments (4) for Liver (connected to diaphragm)
Falciform ligament; this separates and left and right lobes and attaches the liver to the anterior abdominal wall. Remnant of the foetal umbilical vein. Goes down as far umbilicus.
Coronary ligaments; attach inferior surface of diaphragm to the liver. There are a number of these.
Right and left triangular ligaments; where the anterior and posterior coronary ligaments meet.
Omenta
2-layered folds of visceral peritoneum that connects the stomach to another viscus. Omenta is the technical name for double layered visceral peritoneal membranes.
Greater omentum
Connects greater curvature of stomach to transverse colon
Lesser omentum
Suspends lesser curvature of stomach from the fissure of the ligamentum venosum and the porta hepatis on undersurface of liver.
Gastrosplenic omentum (ligament)
Connects greater curvature of the stomach to the spleen hilum
Mesenteries
2-layered folds of visceral peritoneum connecting parts of the intestines to the posterior abdominal wall
Functions of peritoneal ligaments, omenta, mesenteries
Permit blood, lymph vessels and nerves to reach the viscera
Liver function (4)
Production and secretion of bile
Metabolic activities related to fat, carbohydrate and protein metabolism.
Filtration of the blood; removal of bacteria
Synthesizes heparin – anti-coagulant
What type of gland is the pancreas?
exocrine (enzyme production for protein, fat, and carbohydrate metabolism). secretes enzymes into pancreatic duct. 90% of pancreas is exocrine.
endocrine (insulin, glucagon, and somatostatin production)
what does the bile duct and the main pancreatic duct open up into?
duodenum
name of duct that joins the bile duct from the liver
left and right hepatic duct
name of duct from gall bladder
cystic duct
what is the nerve supply to the pancreas?
vagal system (ANS)
blood supply for the pancreas
splenic artery and veins drain into the portal vein system
what is the name of the last part of the small intestine?
Ileum
where is the ileocecal valve?
between the ileum and the cecum (large intestine)
What are Peyer’s patches?
lymphoid tissue found in the lower ileum
What do Peyer’s patches do?
function is the immune surveillance of the intestinal lumen and to facilitate the generation of the immune response within the intestinal mucosa (many macrophages, B- lymphocytes and T-lymphocytes)
Kidneys - Intraperitoneal or Retroperitoneal organs?
retro-peritoneal organs
Anatomy of the kidneys
Renal cortex on the outside
Renal medulla with renal pyramids.
Renal pyramids end in renal papillae.
Where do the renal papillae drain?
into the major and minor calyces of the renal pelvis, then the ureter.
what are kidney stones made from?
calcium oxalate cristals or from crystallised uric acid
level of abdominal aorta, and level of bifurcation
T12, L5/S1 (common iliac arteries)
paired branches of abdominal aorta
suprarenal arteries
renal arteries
gonadal arteries
midline positioned single branches of abdominal aorta
Celiac trunk (first major branch of the abdominal aorta and supplies embryonic foregut),
superior mesenteric artery (embryonic midgut)
inferior mesenteric artery (embryonic hindgut)
What does the celiac trunk supply?
The embryonic foregut structures;
Liver, stomach, abdominal oesophagus, spleen, parts of duodenum, pancreas head
What are the three major arteries coming off the celiac trunk?
splenic artery
left gastric artery
common hepatic artery
What does the superior mesenteric artery supply?
The embryonic midgut; lower part of duodenum, parts of pancreas (head), jejunum, caecum and appendix and parts of transverse colon
What does the inferior mesenteric artery supply?
Descending colon,
sigmoid colon and upper part of rectum
(= embryonic hindgut)
Three lateral visceral branches off the abdominal aorta
suprarenal artery
renal artery
testicular or ovarian artery
What does the abdominal aorta bifurcate into?
left and right common iliac arteries
Inferior vena cava - direct branches into top to bottom)
Hepatic veins suprarenal veins renal veins gonadal veins (right direct, left via renal vein) lumbar veins
what is the ligamentum venosum?
The fibrous remnant of the ductus venosus of the fetal circulation.
Attached to the left branch of the portal vein within the porta hepatis (gateway to the liver)
It is invested by the peritoneal folds of the lesser omentum within a fissure on the visceral/posterior surface of the liver between the caudate and main parts of the left lobe. Joins the stomach (lesser curvature)
What veins drain into the hepatic portal vein?
- Superior mesenteric vein
- Splenic vein
(inferior mesenteric vein drains into splenic vein)
What is the name of the vein(s) that leave the liver to drain into the vena cava?
left and right hepatic veins
what do hepatocytes convert glucose into?
glycogen
what are exocrine glands?
glands that secrete via a duct. eg. sweat glands, salivary glands, mammary glands
what are endocrine glands
glands that secrete directly into the blood, or surrounding tissues. eg. adrenal glands.
what does insulin do?
It stimulates adipose and muscle cells to take up glucose into their cells from the blood.
Abdominal regions
right hypochrondrium - epigastrium - left hypochondrium
right lumbar - umbilical region - left lumbar
right inguinal/ iliac region - hypogastric/ pubic - left inguinal/ iliac
anterior abdominal wall innervation
T7-T12 to all three anterior muscles,
L1 to oblique muscles.
Posterior abdominal wall innervation
Mostly branches of lumbar plexus, (L1-L4),
and subcostal nerve (Th12)
What does the lumbar plexus innervate? (L1-L4)
- posterior abdominal wall
- anterior medial thigh (motor and sensory)
femoral and obturator nerves are the most important. - There are several branches of L1 which supply the skin over the inguinal region, the scrotum and the labia majora
What ligaments make up the femoral ring?
inguinal ligament
lacunar ligament
pectineal ligament
What muscles originate at the inguinal ligament?
Internal oblique
transverse abdominis
Anterior Abdominal wall muscles (6)
- external oblique,
- internal oblique (with cremaster),
- transversus abdominis and
- rectus abdominis (and pyramidalis)
Posterior Abdominal wall muscles (4)
- psoas major (and minor),
- quadratus lumborum
- and iliacus
Where is the interior phrenic artery, and what does it supply?
Usually branches off the Celiac trunk, and supplies the diaphragm.
What does the left gastric artery branch into?
- the oesophageal branch that supplies the distal oesophagus, and the gastric branch that anastomoses with the right gastric artery. These flow along the lesser curvature of the stomach.
What do the small branches of the splenic artery supply?
They course down to supply the pancreas.
There is a large branch coming off the splenic artery - name and what does it supply?
Left gastroepiploic artery that supplies the greater curvature of the stomach. It anastomoses with the right gastroepiploic artery.
What is the epiploic foramen?
communication between the greater sac and the lesser sac
Which are the most important nerves from the lumbar plexus?
- femoral
- obturator nerve
what innervates the anterior medial thigh?
- nerves of the lumbar plexus
Several branches of L1 innervate skin area of which regions?
- inguinal
- scrotum
- labia majora
What branches off the LI nerve?
- going down the leg, the Genitofemoral nerve. This forks into femoral and genital branches.
- Iliaohypogastric nerve
- Ilioinguinal nerve
Blood Supply to the Abdominal Wall - arteries (3)
Superior epigastric artery
- a branch of the internal thoracic artery, which comes off the subclavian artery: it anastomoses with the inferior epigastric artery
Inferior epigastric artery
- a branch of the external iliac artery (which is an extension of the common iliac artery)
Deep circumflex iliac artery
- another branch off the external iliac artery (runs along the iliac crest)
Blood Supply to the Abdominal Wall - Veins (3)
• Deep veins: superior epigastric, inferior epigastric and deep circumflex iliac veins; they run parallel to the arteries of the same name and drain into the internal thoracic and external iliac veins
- also superficial veins
where do the superficial veins run?
Superficial veins: form a network radiating out from the navel and then drain into the axillary veins via the lateral thoracic veins and into the femoral arteries via superficial gastric and great saphenous veins
transversus abdominis
deepest of the 3 abdominal muscles. horizontal fibres. Attaches to lower six ribs, abdominal aponeurosis, iliac crest, inguinal ligament thoracolumbar fascia
Linea Alba is the central, line, what is the name of the other?
Linea semilunaris
where is the deep inguinal ring?
classically described as immediately above the midpoint of the inguinal ligament (midway between the anterior superior iliac spine and the pubic tubercle
what is the cremaster muscle?
formed from the internal oblique muscle
the cremaster muscle is a thin layer of skeletal muscle found in the inguinal canal and scrotum, surrounding the testis and spermatic cord. The cremaster muscle is a paired structure.
which nerves innervate the Internal oblique (and cremaster)
Thoracic nerves (T6-T12 and L1)
what is the rectus sheath?
It is an aponeurosis of the three muscles (transverses abdominis, internal oblique, external oblique) that encloses the rectus abdominis muscle.
what muscle forms the inguinal ligament?
the external oblique muscles… it is the inferior border of the aponeurosis.
Posterior Abdominal Wall Muscles (3)
Psoas major
Iliacus
Quadratus lumborum
Psoas major
transverse processes, bodies and intervertebral discs of T12 to L4 (L5) > lesser trochanter of the femur. Inn.: lumbar plexus (L1-L4)
Iliacus
Iliac fossa > lesser trochanter of the femur. Inn.: Femoral nerve
Quadratus lumborum
iliolumbar ligament, , iliac crest, tips transverse processes L1-L3 > Rib XII. Inn.: Lumbar plexus (L1-L4)
what passes through the inguinal canal?
males - spermatic cord, cremaster muscle, ilioinguinal nerve
females -round ligament of the uterus, ilioinguinal nerve
what is the gubernaculum?
As the scrotum and labia majora form in males and females, respectively, the gubernaculum aids in the descent of the gonads (both testes and ovaries)
what is the tunica vaginalis?
Part of the lining of the abdominal cavity travels with the testes – processus vaginalis
The processus vaginalis covers the testis as the tunica vaginalis
deep inguinal ring
point at which the testis pushes through the transversalis fascia
superficial inguinal ring
point at which the testis pushes out through the external oblique aponeurosis
The layers of the abdomen
skin Camper's fascia Scarpa fascia external obliques internal obliques transversus abdominis trasversalis fascia (level of deep inguinal ring) extra peritoneal fascia (loose connective tissue) parietal peritoneum visceral peritoneum
what is the spermatic cord?
‘lifeline’ for the testes (its blood supply, lymph drainage, vas deferens, nerves)
What is a hernia?
A protrusion of part of the abdominal contents beyond the normal confines of the abdominal wall - most common are inguinal hernias
what lies above the inguinal ligament, and what lies below the inguinal ligament?
above - inguinal canal
below - femoral canal
what does the femoral canal contain?
lymph vessels and nodes and runs besides the femoral artery and vein
Contents of femoral triangle (NAVY)
laterally to medially Nerve Artery Vein y-fronts
Where does the foregut run from?
the abdominal oesophagus to the major duodenal papilla (where the bile duct empties into the descending part of duodenum)
includes the pancreas (lying behind the stomach), liver, spleen and gall bladder.
what is the name of the vein that all the abdominal organs drain into?
Hepatic portal vein
what is the name of the vein/s from the liver to the inferior vena cava?
hepatic veins
the superior mesenteric vein and the ……… meet to form the hepatic portal vein
splenic vein (runs behind the pancreas)
what is the big vein that drains into the splenic vein?
inferior mesenteric vein
An organ is classed as intraperitoneal if…..
it is covered with visceral peritoneum and attached by mesenteries
(more mobile)
An organ is classed as retroperitoneal if…
it is not completely wrapped in visceral peritoneum
more fixed location
