Week 1- Introduction to the abdomen Flashcards

1
Q

Where does the abdominal cavity go to + from?

A

Abdominal cavity extends from the diaphragm to the pelvic girdle

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2
Q

What are the four quadrants?

A
  • RUQ
  • RLQ
  • LUQ
  • LLQ
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3
Q

What abdominal organs sit in the RUQ?

A
  • Colon (hepatic flexure, ascending)
  • Duodenum (parts 1-3)
  • Gallbladder
  • Liver
  • Biliary tree
  • IVC
  • Pancreas
  • Pylorus
  • Right Kidney
  • Right ureter
  • Right adrenal gland
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4
Q

What abdominal organs sit in the LUQ?

A
  • Colon (splenic flexure, descending)
  • Duodenum (4 part)
  • L Kidney
  • L ureter
  • L adrenal gland
  • Pancreas (body, tail)
  • Spleen
  • Stomach
  • Jujunum
  • Ileum
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5
Q

What abdominal organs sit in the RLQ?

A
  • Colon (caecum, appendix, ascending)
  • IVC
  • R ductus deferens
  • Ovary
  • R Uterine tubbe
  • R ureter
  • Ileum
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6
Q

What abdominal organs sit in the LLQ?

A
  • Colon (descending, sigmoid)
  • Left ductus deferens
  • Left ovary
  • Left uterine tube
  • Left ureter
  • Jejunum
  • Ileum
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7
Q

What are the abdominal planes?

A
  • Transpyloric (L1)
  • Subcostal (L3)
  • Supracristal (L4)
  • Transtubercular (L5)
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8
Q

What are the 9 regions?

Which planes divide these?

A
  • R + L Hypercondrium
  • R + L Flank/Lumbar
  • R + L Iliac Fossa
  • Epigastric
  • Umbilical
  • Pubic

Above Subcostal is hypercondrium

Below Transtubercular is iliac fossa

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9
Q

What organs are in each of the 9 regions?

A

R Hypercondrium:

  • Liver
  • Hepatic flexure of colon
  • Diaphragm
  • Costodiaphragmatic recess

L Hypercondrium:

  • Stomach
  • Spleen
  • Pancreatic tail
  • Splenic flexure of colon
  • Diaphragm
  • Costodiaphragmatic recess

Epigastric:

  • Liver
  • Stomach
  • Gallbladder
  • Transverse colon
  • Lesser sac
  • Abdominal aorta
  • Duodenum
  • Pancreas
  • Kidneys
  • Supradrenal glands
  • Origin + plexus of CT and SMA

Right F/L:

  • Ascending colon
  • Small intestine

Left F/L:

  • Descending colon
  • Small intestine

Umbilical:

  • Small intestine
  • Root of mesentery
  • Abdominal aorta
  • IMA + plexus

R IF:

  • Cecum
  • Appendix

L IF:

  • Sigmoid colon

Pubic:

  • Small intestine
  • Sigmoid colon
  • Upper rectum
  • Ovary
  • Uterine tube
  • Distended bladder
  • Enlarged uterus
  • Common iliac arteries
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10
Q

Where does foregut, midgut + hindgut pain usually refer to?

A

Foregut= Epigastric

Midgut= Umbilical

Hindgut= Pubic

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11
Q

What pain may refer to the R Hypercondrium?

A
  • Liver abcess
  • Hepatitis
  • Gall bladder
  • Biliary tree
  • Choleocystitis
  • Choleolithiasis
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12
Q

What pain may refer to the left hypercondrium?

A
  • Constipation
  • Splenic infarct
  • Abcess
  • Colitis
  • Diverticulitis
  • Pyelonephritis
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13
Q

What pain may refer to the Epigastrium?

A
  • Foregut pain
  • Aortic aneurysm
  • Pancreatitis
  • Ulcer
  • Gastritis
  • Reflux
  • MI
  • Pericarditis
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14
Q

What pain may refer to the Right Flank/Lumbar

A
  • Ascending colitis
  • Nephrolithiasis
  • Pyelonephritis
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15
Q

What pain may refer to the left flank lumbar?

A
  • Descending colitis
  • Nephroliothiasis
  • Pyelonephritis
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16
Q

What pain may refer to the umbilical region?

A
  • Midgut pain
  • Enteritis
  • Intestinal obstruction
  • Mesenteric occlusion
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17
Q

What pain may refer to the Right Iliac Fossa?

A
  • Appendicitis
  • Gonadal pathology
  • Gastroenteritis
  • Inguinal hernia
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18
Q

What pain may refer to the left iliac fossa?

A
  • Diverticulitis
  • Colitis
  • Gonadal pathology
  • Inguinal hernia
  • Ulcerative colitis
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19
Q

What pain may refer to the pubic region?

A
  • Hindgut pain
  • Uterine pathology
  • UTI/ UT obstruction
  • Endometriosis
  • Pelvic Inflammatory disease
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20
Q

Define Hernia

A

Protrusion of tissue / organ through a retaining tissue

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21
Q

What may predispose a person to hernia?

A
  • Surgery
  • Pregnancy
  • Congenital defects
  • Lifting
  • Obesity
  • Family history
  • Chronic coughing
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22
Q

How do you find the:

a) Transpyloric plane
b) Subcostal plance
c) Supracristal plane
d) Transtubercular?

A

a) Halfway between jugular notch + pubic symphsis. Passes through tips 9th CC
b) Immediately inferior to 10th CC. At lowest anterior point of costal margin
c) Highest point of Iliac crest
d) Tubrcles of iliac crest. (Palpable 5-7cm posterior to ASIS)

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23
Q

What features occurs at T8?

A

Xiphisternal plane + joint

T8 vertebral body

Central tendon of diaphragm

Diaphragmatic surface of heart

Superior hepatic border

24
Q

What features occur at the Transpyloric plane?

A

L1 Vertebral body

Pylorus

Duodenum part 1

Attachement of transverse mesocolon

SMA

Fundus gallbladder

Portal vein formation

Pancreatic neck

Kidney hila

Renal arteries + veins

25
What features occur at the subcostal plane?
L3 vertebral body Duodenum 3rd part IMA
26
What features occur at the supracristal plane?
L4 vertebral body Aortic birfurcation Landmarking L4 spinous process for LP
27
What features occur at the transtubercular plane?
L5 vertebral body IVC formation close to midline
28
What are the layers from skin to parietal peritoneun?
* Skin * Superficial fascia (Campers/ Scarpers below umbilicus) * Rectus Abdominus (if in centre) * External obliques * Internal obliques * Transversus abdominus * Transversalis fascia * Parietal peritoneum
29
What are the layers of the abdominal wall muscles?
Superifical --\> Deep * Rectus Abdominus (depending on where you are) * External obliques * Internal obliques * Transversus abdominus
30
What is superficial fasica? What are the types + demarcation point?
a) Connective tissue b) *Above umbilicus*: Single layer, continous with superficial fascia in other body regions * Below umbilicus:* **Campers:** Fatty superifical layer **Scarpers:** Membranous deep layer
31
What is the collective function of the anterolateral abdominal muscles? What might be the consequence of a weakness of part of the abdominal wall musculature?
* Keep abdominal viscera in abdominal cavity * Protect viscera from injury * Maintain position of viscera in erect postion from gravity Contraction aids: * *Quiet/forced expiration* (by pushing viscera upwards which pushing relaxed diaphragm into thoracic cavity) * *Coughing/ Vomiting* Also: * Increases intrabdominal pressure: childbirth, micturition, defecation b) Hernination
32
Name the flat abdominal muscles?
* External obliques * Internal obliques * Tranversus abdominus
33
What is the a) loaction + muscle fibre direction b) function c) innervation External obliques?
a) Immediately deep to superficial fascia Laterally placed muscle Fibres inferomedial direction * Origin:* Outter surfaces ribs 5-12 * Insertion:* Lateral lip iliac crest Large aponeurotic compnent covers anterior abdo wall as aproaches midline formes linea alba b) Compress abdominal contents Flex trunk Each muscle bend trunk to same side turning anterior part of abdomen to opposite side c) Anterior rami T7-T12
34
What are the attachments of the lineaalba? Does the linea alba have a good blood supply? Why is this useful to know for surgery?
1) Rectus Abdominus External obliques Internal obliques Transversus abdominus 2) Poor blood supply therefore may not heal well
35
What is the a) loaction + muscle fibre direction b) function c) innervation * INTERNAL OBLIQUES?*
a) Deep to internal obliques Superomedial direction * Origin*: Thoracolumbar fascia, iliac creset between origins of external + transversus. Lateral 2/3 inguinal ligament * Insertion:* Boarder lower 3/4 ribs (ribs 8-9) Aponeurosis ending in linea alba anteriorly Pubic crest + pectineal line b) Compress abdo contents Flex trunk Each muscle bends trunk + turns anterior part of abdomen to same side c) Anterior rami of T7-L1
36
What is the a) loaction + muscle fibre direction b) function c) innervation Transversus abdominus?
a) Deep to internal obliques Transverse running fibres *Origin:* Thorocolumbar fascia Medial lip iliac crest Lateral 1/3 inguinal ligament CC ribs 8-12 *Insertion:* Aponeurosis ending in linea alba Pubic crest + Pectineal line b) Compress abdominal contents c) Anterior rami T7-L1
37
What is the a) loaction + muscle fibre direction b) function c) innervation Rectus Abdominus?
a) *Origin =* Pubic: crest, tubercle + symphesis * Insertion:* CC ribs 5-7 Xiphoid process Extends length anterior abdo wall separated by linea alba @ midline Intersected by *tendinous intersection* b) Compress abdominal contents Flex vertebral column Tense abdominal wall c) Anterior rami T7-T12
38
What is the rectus sheath? What happens to the position of rectus abdominis during pregnancy? What else does it contain?
a) Encloses rectus abdominus Formed by aponeuroses of flat abdo wall muscles *Above arcuate line* (midway between umbilicus + pubis symphysis): sheath completely encloses RA Anteriorly--\> EO apn + 1/2 IO apn Posteriorly --\> 1/2 IOapn + TA apn *Below arcuate line:* All aponeuroses move to anterior wall rectus sheath RA in contact with transversalis fascia posterially b) Stretches + moves apart from linea alba c) Inferior epigastric artery + vein
39
What is the layer underneath the traversalis fascia? What is its innervation + therefore sensitive to?
**Parietal Peritoneum** Somatic sensroy therefore localised pain Sensitive to: pain, pressure, laceration, temperature
40
How does the anterior abdominal wall get is NV supply? What are the dermatomal regions? Name the 2 important arteries, where they meet + their role
b) **Travels around the abdominal wall from the vertebral column toward the anterior midline** * T7- L1 spinal nerves:* supply skin, muscle + parietal peritoneum of anterior abdo wall Anterior rami pass around body posterior to anterior in an inferomedial direction. Give off **lateral cutaneous branches + end as anterior cutaneous branches**- which pass through rectus abdominus muscle + anterior wall of rectus sheath to supply the skin * Intercostal nerves T7-T11:* leave intercostal spaces continue onto anterolateral abdominal wall **between internal obliques + transversus abdominus muscle.** Enter rectus sheath + pass posterior to lateral aspect of RA muscle c) **T7-T9: Xiphoid process --\> just above umbilicus** **T10: Umbilicus** **T11-L1: Below umbilicus including pubic region** d) **Superior + inferior epigastric arteries anastmoses in rectus sheath** Unite subclavian + external iliac artery providing arterial shunt if aorta narrowed
41
How does knowing where the NV supply to abdomen guide surgical placement of incisions?
Surgical incisions/endoscopy ports take into account the position and course of arteries and nerves in order **to minimise iatrogenic damage**
42
Name + draw location of the 5 incisions.
1) **Median/ Midline** 2) **Paramedian** 3) **Gridiron (muscle splitting) @ McBurney Point** 4) **Pfannenstiel (suprapubic)** 5) **Subcostal (Kocher)**
43
With a midline incision: What is incised + is it a problem What does it allow entry into?
a) Linea alba Relatively avascular therefore long healing time Also aneural b) Peritoneum
44
With a Paramedian incision: What is incised? What muscle is diplaced + why?
a) Rectus sheath b) Rectus abdominus divided/displaced laterally towards its nerve supply so not to damage the nerves
45
Gridiron incision @ McBurney's point: Where McBurney's point? What does it allow access to? Which nerve is at risk + what are the consequences?
a) 1/3 way from ASIS to umbilicus b) Ceacum + Appendix c) Ilioinguinal + Iliohypogastric nerve (Branch L1): at risk of hernia formation
46
What is a Pfannestiel cut used for? What nerves are at risk?
a) Cesarean + Pelvic organ access b) Ilioinguinal nerve
47
What is at risk with a Subcostal (Kocher) incision?
T9 nerve Superior epigastric artery Thoracoabdominal nerves (7th-11th intercostal nerve. They run between the layers of abdominal muscles to innervate the muscles of the anterolateral abdominal wall. Anterior and lateral and cutaneous branches provide nerve supply to the skin.)
48
Where does lymphatic drainage of the abdominal wall go to? b) What is it relavent to?
**Above umbilicus: Axillary nodes** **Below umbilicus: Superficial inguinal nodes** The lymphatic drainage of more superficial tissues and the skin is regional b) **To spread of infection/cancers**
49
What is lymphatic fluid? What are lymph nodes?
a) Tissue fluid not returned at the venous end of capillary which contains: plasma proteins, lymphocytes +/- cell bacteria/ debris. It is transported along lymph vessels + returned to the bloodstream near the heart b) Small swelllings in the lymphatic system where lymph is filtered + lymphocytes formed
50
The gut tube is located within the _____ \_\_\_\_\_ and is surrounded by a layer of tissue called \_\_\_\_\_
The gut tube is located within the peritoneal cavity, and is surrounded by a layer of tissue called peritoneum
51
# Define: a) Intra peritoneal b) Retro-peritoneal c) Mesentery d) Secondary retropetitoneal
a) Structure covered in peritoneum b) Structure behind the peritoneum c) Fold of peritoneum suspending an organ from the abdo wall d) Intraperitoneal structure that leter becomes retroperitoneal
52
Embryology: From the trilaminar disc what layer once folded forms the gut tube? What way does the tub fold to form the gut tube?
Endoderm b) Laterally (side-side)
53
What is the role of the parietal + visceral peritoneum? Label the diagram
**Line future abdominal wall and surround and support the organs**
54
The gut tube blood supply arises from 3 main arteries which branch off abdominal aorta. ## Footnote *Name these arteries, the vertebral level of artery origin, the region it suppies, the boundaries, the visceral/sympathetic nerves that travel alongside the blood supply*
_Coelia Trunk:_ * T12 * Foregut * Lower oesophagus --\> Major duodenal papilla (proximal 1/2 2nd part duodenum) * T5-T9 _Superior Mesenteric Artery:_ * L1 * Midgut * Major duodenal papilla --\> Proximal 2/3 Transverse Colon * T10-T11 _Inferior Mesenteric Artery:_ * L3 * Hindgut * Distal 2/3 Transverse Colon --\> Upper anal canal * T12-L1
55
What is visceral peritoneum sensitive + insensitive to? Describe visceral pain
Sensitive: *Stretch, hypoxia, chemical + environmental changes* Insensitivie: *Cutting/ burning/ thermal stimuli* **Visceral (organ) pain is a vague, diffuse, and poorly defined/located sensation**
56
What is a dermatone?
An area of skin innervated by a single spinal nerve
57
Visceral Pain: Referral Describe what happens
Visceral (organ) & somatic sensory (afferent) nerves enter the spinal cord together and travel in the same spinal tracts Brain confuses origin of signal + assumes pain is of dermatomal origin