Week 3 Flashcards
List abdominal wall layer
Symptoms of appendicitis
Periumbilical or epigastric pain that migrates to the right lower quadrant of the abdomen
External Oblique Action
Compress, flex, rotate
External Oblique Innervation
Lower 6 thoracic nerves
How do external oblique muscle fibers run?
Lateral to medial (Superior to inferior)
Internal oblique action and innervation
compress, flex, rotate
lower 6 thoracic nerves and L1
Transversus abdominus action and innervation
compress and support
lower 6 thoracic nerves and L1
How do transversus abdominus muscle fibers run?
horizontal
Rectus abdominus action and innervation
flex
T7-T11
How do rectus abdominus muscle fibers run?
vertical
What does the rectus sheath do?
covers rectus abdominus
allows attachment of oblique muscles
What is the arcuate line?
Demarcation of where the fibers of the posterior rectus sheath stops
Can be a weak spot in abdominal wall where hernias can form
where you can find Inferior epigastric artery and vein without destroying fascia
What 2 arteries are the main arteries of the abdominal wall and anastamose at the umbilicus?
superior epigastric artery
inferior epigastric artery
Superior epigastric artery comes from what artery?
Internal thoracic artery
Inferior epigastric artery comes from what artery?
Iliac artery
What does the lateral umbilical fold contain?
inferior epigastric vessels
What did the medial umbilical fold used to be?
umbilical artery
What did the median umbilical fold used to be?
urachus
Inguinal ligament is formed by ?
external abdominal oblique aponeurosis
Where is the inguinal canal found and what runs through it?
Just above the medial half of the inguinal ligament
Allows passage of spermatic cord in men
Allows passage of round ligament of uterus in women
what is Deep ring of inguinal canal?
opening in the transversalis fascia that serves as the opening to the inguinal canal
What is the superficial ring of the inguinal canal?
defect in the aponeurosis of external oblique
serves as exit to the inguinal canal
What are boundaries of inguinal canal?
Which ring of inguinal canal can be accessed to look for hernias?
Superficial ring
What muscle covers the spermatic cord?
Cremaster muscle
What is course of spermatic cord?
runs through the inguinal canal and exits the superficial ring
Cremaster muscle innervation
genital branch of the genitofemoral nerve
What is cremaster reflex?
When inner thigh is stroked, sensory fibers of the femoral branch of the genitofemoral nerve and the ileoinguinal nerve are stimulated.
These synapse in the spinal cord and activate the motor fibers of the genital branch of the genitofemoral nerve which cause the cremaster muscle to contract and elevate testis
What does scrotum contain?
Testes
epididymis
lower part of spermatic cord (vas deferens and blood vessels)
What is raphe?
line dividing scrotum into two compartments
runs along under side of penis and continues along midline of perineum and anus
What supplies blood to scrotum?
posterior scrotal arteries
What are the layers of fascia around testes?
Tunica vaginalis (parietal and visceral)
Tunic albugenia
What is the ligament that occurs between the tunica vaginalis and the tunic albugenia?
gubernaculum
What role does the gubernaculum play?
pulls the testes down from abdominal cavity into scrotum during development
where does lymph from testes drain to?
Lumbar (lateral aortic) nodes
What are the main abdominal incisions?
what is targeted during liposuction?
Camper’s fascia
what is rectus diastasis?
a conditionin which the area along linea alba widens and the right and left rectus abdominus separate
what is umbilical hernia
condition in which the intestines protrude through the abdominal muscles at the belly button
What is Caput Medusae?
appearance of distended and engorged superficial epigastric veins which are seen radiating from the umbilicus across the abdomen
Caused from LIVER dz (anything that causes liver fibrosis)
any vessels draining into the portal vein cant empty easily
If a patient with liver cirrhois needs paracentesis because they have abdominal ascites, what veins do you need to be careful not to cut?
superficial epigastric veins
What nerves allow the cremaster muscle to move the scrotum up and down?
genitofemoral
ileoinguinal
pudendal
posterior femoral cutaneous
What is a testicular variocele?
when veins in the scrotum (pampiniform plexus) become abnormally enlarged because the valves in the veins aren’t working properly
What is nutcracker syndrome?
compression of the left renal vein between the aorta and the superior mesenteric artery which results in elevated left renal vein pressure and possible collateral vein development
What are symptoms of nutcracker syndrome?
Intermittent hematuria with or without left flank pain or abdominal pain or varicocele
where does blood from the pampiniform plexus drain into?
left renal vein
What is testicular hydrocoele?
fluid in scrotum
What is cut in vasectomy?
vas deferens
What happens in patent proccessus vaginalis?
tunica vaginalis of scrotum has a defect which allows the intestines to enter into scrotum
What artery is medial to the deep ring of the inguinal canal?
inferior epigastric artery
What is inguinal hernia?
portion of small intestine enters inguinal canal
what part of the surface anatomy of the inguinal area should be examined when investigating for hernia?
Inguinal (hesellbach’s) triangle
will bulge in certain types of hernias
what age group are indirect inguinal hernias found in?
any age but more common in young
what age group are direct inguinal hernias found in?
elderly
Indirect inguinal hernia via ?
deep inguinal ring and along inguinal canal
direct inguinal hernia via?
via transversalis fascia (hesselbachs triangle)
What type of hernia enters the scrotum
indirect inguinal hernia (complete)
What type of hernia does not enter the scrotum?
direct inguinal hernia (incomplete)
What causes indirect inguinal hernia?
patent or reopened proccessus vaginalis
What causes direct inguinal hernia?
weakened abdominal wall
How does a direct inguinal hernia run in relation to the inferior epigastric artery?
direct hernia passes medially to the inferior epigastric artery and enters somewhere along the defect in the wall of the inguinal canal and comes through the superficial ring of inguinal canal
how does a indirect inguinal hernia run in relation to the inferior epigastric artery?
indirect inguinal hernia runs laterally to the inferior epigastric artery and enters the deep ring of inguinal canal
Where do you see a direct inguinal hernia?
Hesselbachs triangle
Where do you see an indirect inguinal hernia?
scrotum
how do you find hernia on PE
put finger in superficial inguinal ring and have patient cough
If you feel hernia at fingertip on PE, what type hernia?
indirect inguinal hernia
If you feel hernia along side of finger on PE, what type hernia?
direct inguinal hernia
What is a femoral hernia?
abdominal tissue herniates through femoral canal
more common women
General disposition of the abdominal visceral
What is the greater sac in the peritoneal cavity?
all the space that is between the parietal and visceral layers of peritoneum and is filled with peritoneal fluid
What is the peritoneal cavity?
a potential space that is between the parietal and visceral peritoneum
What is the lesser sac in the peritoneal cavity?
a contained area between the pancreas, the liver, posterior wall of stomach, and between the layers of omentum
also filled with peritoneal fluid
How do the greater and lesser sac communicate with each other?
epiploic foramen of Winslow
What innervates parietal peritoneum?
Somatic nerves
What innervates visceral peritoneum?
Visceral afferents
What is mesentery?
double layer of visceral peritoneum that extends from the posterior abdominal wall
Parietal vs visceral pain
Parietal pain can be located (point to one area)
Visceral pain is more dull and generalized
Retroperitoneal vs Intraperitoneal
Retroperitoneal refers to structures located posterior to peritoneum
Kidneys, aorta, etc
Intraperitoneal refers to structures suspended from abdominal wall by mesentery
intestine, stomach, liver
What does secondary retroperitoneal mean?
intraperitoneal structures whose mesentery fuses with to posterior abdominal wall
ascending/descending colon, pancreas, duodenum
What is function of mesentery?
support viscera
store fat
serve as route for vessels, nerves, and lymphatics to travel to and from the gut
What is omentum?
mesentary that is attached mostly to stomach
What does the hepatoduodenal ligament contain?
hepatic artery proper, common bile duct, and portal vein
(portal triad)
What is the hepatoduodenal ligament made of?
lesser omentum
What is hepatogastric ligament ?
lesser omentum connects the liver to the lesser curvature of the stomach. It contains the right and the left gastric arteries. In the abdominal cavity, it separates the greater and lesser sacs on the right.
Greater omentum comes off of where?
The greater curvature of stomach to transverse colon
What is function of the greater omentum?
It adheres to inflammed or injured peritoneal lined structures and creates adhesions which separate the injured structures from access to the periotoneal cavity so less chance of spread of infection
Surgeons also use the greater omentum to wrap around injured structues
What is the clinical importance of the right lateral pericolic gutter?
important for reabsorption of peritoneal fluids
If you are laying down, where will peritoneal fluid accumulate?
Hepatorenal recess (aka right posterior subphrenic space) and pelvic cavity
Another name for the pharynx
throat
what separates pharynx from esophagus
upper esophageal sphincter
What is function of stomach?
receive bolus
produce and release chyme into duodenum
secrete HCL (parietal cells)
secrete pepsinogen (chief cells)
digestion of protein begins
very limited absorption
function of pylorus
allow food from the stomach into the duodenum
Function of rugal folds in stomach
direct liquid quickly towards pyloric region of stomach
Rugal folds are formed from ?
oblique muscle layer of stomach
does duodenum have mesentery
no
what type of structure is duodenum
secondary retroperitoneal
function of duodenum?
neutralizes chyme
bicarbonate from pancreas and Brunners glands
secretes mucus
continues digestion
bile from gallbladder and pancreatic enzymes
lipase, protease, nuclease, amylase
limited absporption (absorbs iron)
why are ulcers most common in the first part of duodenum?
lack of Brunners glands
describe the interior of the duodenum
bulb (first part of the duodenum) is smooth
rest of duodenum has plica circulara
there is also major and minor papillae (drainage ducts from bile ducts and pancreas)
What sits in the c shape of the duodenum?
head of pancreas
What holds up the duodenal-jejunal junction
suspensory ligament of Treitz
What makes up the small intestine?
duodenum
jejunum
ileum
after digestion and absorption is completed in the small intestine, watery nutrient poor material is passed to?
through the ileocecal valve to the cecum
what parts of the small intestine have mesentery
jejunum and ileum
What is Meckel’s diverticulum?
remnant of yolk sac present in 2% of population
What is function of large intestine
absorb water (2L/day)
absorb salt
secrete mucus
produce stool
store stool
where is appendix found
coming off cecum
what are teniae coli
Parts of large intestine
function of rectum
store feces
what structures support the weight of feces in the rectum?
rectal folds of Houston
what muscles allow pooping to occur
levator ani muscles
Where will patient with appendicitis complain of pain
pain in lower right abdomen at McBurney’s point
Radiological findings in a patient with appendicitis
air in bowel
fluid around appendix
thick appendix
What is a possible complication of appendicitits?
peritonitis
What is peritonitis?
inflammation of peritoneum which occurs when it comes in to contact with irritating substances
Difference between gastric and duodenal peptic ulcer disease
what is volvulus?
rotation of gut on its mesentery
