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Anatomy 1 - MD > Week 4 - Abdomen > Flashcards

Week 4 - Abdomen Flashcards

1
Q

Which area of the body is the largest for malpractice?

A

the abdomen

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2
Q

Boundariers of the Abdomen

A

-superior: Diaphragm (seprates thoracic from abd cavity)
-inferior: Pelvis (continuous w/ pelvic cavity)
-posterior: veterbreal column + posterior/inferior ribs (lower part of thoracic cage)
-lateral: flank muscles
-anterior: abdominal muscles (rectus abdominus, external oblique, internal oblique, transversus abdominus + fasciae)

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3
Q

Peritoneal Space

A

organs covered by peritoneal (abdominal) lining

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4
Q

Retroperitoneal Space

A

organs posterior to the peritoneal lining
-most problematic for injuries (uncovered) + misdiagnosis
-major organ = kidneys (not well protected)

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5
Q

Pelvic Space

A

organs within the pelvis

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6
Q

Abdominal Wall is made of…

A

-skin
-superficial fasciae
-deep fascia
-extraperitional fascia
-parietal peritoneum

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7
Q

Abdominal Wall is lined with…

A

fascial envelope + parietal peritoneum

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8
Q

Rectus Abdominus

(origin, insertion, bloody supply, innervation)

Abd Wall Muscles

A

joins to 5th rib and sternum (above xiphoid)
-attached by 2 tendons
-origin: pubic symphysis + pubic crest
-insertion: xiphoid process of sternum + costal cartilage of 5, 6, 7th ribs
-bloody supply: inferior + superior epigastric
-innervation: thoracoabdominal nerves (anterior divisoons of 7th-11th lower intercostal nerves)

vertical midline of abdominal wall

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9
Q

External Oblique

(origin, insertion, action)

Abd Wall Muscles

A

-origin: external surfaces of ribs 5-12
-insertion: anterior iliac crest + fan shaped distribution to abdominal aponeurosis to Linea alba
-action: flexion of vertebral column (draws thorax down), rotates vertebral column, laterally flexes vertebral column

“hands in pocket” superior abd wall muscle

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10
Q

Internal Oblique

(origin, insertion)

Abd Wall Muscles

A

fibers perpendicular to external oblique
-origin: anterior iliac crest, lateral half of inguinal ligament, thoracocolumbar fascia
-insertion: costal cartilages of ribs 8-12, abdominal aponeurosis to Linea alba

intermediate abd wall muscle

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11
Q

Transversus Abdominus

(origin, insertion, trauma)

Abd Wall Muscles

A

deepest layer of abdominal muscle
-origins: costal cartilages/ribs 7-12, thoracolumbar fascia, front 2/3 of iliac crest (top border of pelvic bone), lateral 1/3 of inguinal ligament
-insertions: Linea alba, pubic symphysis, xiphoid process
-trauma: rigidity, fractured xiphoid/sternum, internal bleeding

sits below internal/external obliques + rectus abdominus

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12
Q

Origin

A

proximal attachment

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13
Q

Insertion

A

distal attachment

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14
Q

Thoracolumbar Fasciae

A

large diamond shaped sheet of connective tissue located at lower back

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15
Q

Inguinal Ligament

A

band of connective tissue extends diagnoally down from pelvis

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16
Q

Linea Alba

A

fibrous band of connective tissue runs down the front of abdominal wall

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17
Q

Pubic Symphysis

A

connective tissue joining R + L sides of lower pubic bone

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18
Q

Innervation of Transversus Abdominus

A

-lower 5 intercostal nerves: originate from T1-T11 nerves of spinal cord
-subcostal nerve: originate from T12 nerves of spinal cord
-Iliohypogastric nerve (lumbar plexus in lower back): originate from L1 of spinal cord
-Ilioinguinal nerve: lumbar plexus branch originating from L1 of spinal cord

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19
Q

Blood Supply of Skin Near the Midline:

A

-superior epigastric artery (branch of internal thoracic artery)
-inferior epigastric artery (branch of external iliac artery)

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20
Q

Blood Supply of Skin of the Flanks:

A

branches of intercostal, lumbar + deep circumflex arteries

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21
Q

Muscles of Lower Posterior Abdomen

(starting at 12th rib)

A

-quadratus lumborum
-psoas minor
-iliopsoas (psoas major + iliacus)
-tensor fasciae latae
-sartorius
-pectineus
-adductor longus
-gracilis
-adductor magnus
-quadriceps femoris (rectus femoris, vastus lateralis, vastus medialis)

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22
Q

Abdominal Venous Drainage

A

collected into a network of veins that radiate from the umbilicus

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23
Q

Drained above via axillary vein via…

Venous Drainage

A

lateral thoracic vein

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24
Q

Drained below via femoral vein via…

Venous Drainage

A

superficial epigastric + great sapphenous vein

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25
Q

Paraumbilicus Veins

Venous Drainage

A

form clincially important portal system venous anastomosis

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26
Q

Caput Medusae

A

superficial veins aorund umbilicus + paraumbilical veins connecting them to portal vein become distended
-portal vein obstruction
-distended veins radiate out from umbilicus
-occurs with: any blockage, liver problems, alcoholism, difficulty defecating, cancer
-leads to backup -> compression -> distension (could be a tumor)

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27
Q

Abdominal Nerves

A

supply skin, muscles + parietal peritoneum
-derived from: anterior rami of lower 6 thoracic nerves + L1 nerves

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28
Q

Inflammation of Parietal Peritoneum

A

causes pain in overlying skin + increase reflex in tone of abdominal musculature of the same area

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29
Q

Lymphatic drainage of skin above the umbilicus:

A

drains upwards to anterior axillary nodes (pectoral group of nodes)

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30
Q

Lymphatic drainage of skin below the umbilicus:

A

drains downward/laterally to superficial inguinal nodes

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31
Q

Swelling of groin possibly due to:

A

enlarged superificial inguinal node

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32
Q

Rectus Sheath

A

formed by aponeurosis of 3 lateral abdominal muslces (internal oblique, external oblique, transverse abdominus)
-long fibrous sheath enclosing the rectus abdominus + pyramidalis
-contains anterior rami of lower 6 thoracic nerves
-contains superior/inferior epigastric + lymphatic vessels

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33
Q

Anterior Wall of Rectus Sheath

Rectus Sheath

A

formed by aponeurosis of external oblique (in front of the muscle)
-firmly attached to rectus abdominus by tendinous intersections

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34
Q

Posterior Wall of Rectus Sheath

Rectus Sheath

A

formed by thoracic wall of 5th, 6th, 7th costal cartilages + intercostal spaces
-is NOT attached to rectus abdominus

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35
Q

Transversus Abdominus Aponeurosis

Rectus Sheath

A

behind the muscle

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36
Q

Esophagus

A

carries food + liquid to the stomach

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37
Q

Small Intestine

A

duodenum, jejunum, ileum

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38
Q

Large Intestine

A

cecum, ascending colon, transverse colon, descending colon sigmoid colon

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39
Q

Abdominal Cavity

A

separated form the throax by the diaphragm
-lined with peritoneum

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40
Q

Pelvic Cavity

A

lower portional of abdominal cavity
-“pelvic region”
-pelvis, vertebrae, sacrum

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41
Q

Cholecystitis

A

inflammation of gallbladder
-common in young women especially after pregnancy

42
Q

Pelvic Inflammation

A

diffused tenderness
-may be ectopic pregnancy or ovarian cyst

43
Q

Referred Pain: RUQ Organs

A

-liver: cholecystitis or liver lac
-kidney
-gallbladder: pain w/o trauma = gallbladder disease
-pancreas
-lung

44
Q

Referred Pain: LUQ Organs

A

-heart
-lung
-spleen: rigidity under lower ribs
-kidney
-stomach

45
Q

Referred Pain: RLQ Organs

A

-appendix: rebound tenderness = appendicitis
-ureter
-bladder
-colon: colitis or diverticulitis
-gonads

46
Q

Referred Pain: LLQ Organs

A

-ureter
-bladder
-colon: colitis or diverticulitis
-gonads

47
Q

RUQ Pain + Associated Conditions

A

-acute cholcystitis
-acute hepatitis
-hepatic abscess
-hepatomegaly
-perforated duodenal ulcer
-acute pancreatitis
-retrocecal appendicitis
-herpes zoster
-myocardial ischemia
-RLL pneumonia

48
Q

RLQ Pain + Associated Conditions

A

-appendicitis
-regional enteritis
-diverticulitis
-leaking aneurysm
-abd. wall hematoma
-ruptured ectopic pregnancy
-ovarian cyst
-PID
-endometriosis
-kidney stones
-groin hernia

49
Q

LUQ Pain + Associated Conditions

A

-gastritis
-acute pancreatitis
-splenic enlargement, rupture, aneurysm
-myocardial ischemia
-LLL pneumonia

50
Q

LLQ Pain + Associated Conditions

A

-sigmoid diverticulitis
-leaking aneurysm
-ruptured ectopic pregnancy
-PID
-endometriosis
-seminal vesiculitis
-enteritis

51
Q

Diffused Mid-Abdominal Pain + Associated Conditions

A

-peritonitis
-acute pancreatitis
-early appendicitis
-gastroenteritis
-dissecting/rupturing aneurysm
-intestinal obstruction
-diabetes mellitus

52
Q

Visceral Pain

A

stretching of hollow organs or capsule of solid viscus, leading to poorly localized/characterized pain
-dull, cramping, aching
-can be localized to sensory cortex to an approximate spinal cord level (determined by embryologic origin of organ involved)

lining of the organ; deep pain

53
Q

Foregut Organs

Visceral Pain

A

produce pain in epigastric region
-stomach, duodenum, biliary tract

54
Q

Midgut organs

Visceral Pain

A

produce periumbilical pain
-small bowel, appendix, cecum

55
Q

Hindgut Organs

Visceral Pain

A

produce suprapubic or hypogastric pain
-colon (including sigmoid), intraperitoneal portions of genitourinary tract

56
Q

Parietal Pain

A

caused by irritation of fibers that innervate the parietal peritoneum
-can be localized to dermatome superficial to site of painful stimulus

57
Q

With any disease progression, viseceral pain will lead to

A

parietal pain, causing tenderness

58
Q

Localized peritonitis leads to:

A

rigidity and rebound tenderness

59
Q

Referred Pain

A

pain or discomfort perceived at a site distant from affected organ because of overlapping transmission pathways

60
Q

Rebound Tenderness

A

press slowly + let go quickly; produces pain once pressure is removed

61
Q

Sub-diaphragmatic Irritation

Referred Pain

A

ipsilateral supraclavicular or shoulder pain

62
Q

Gynecologic pathology

Referred Pain

A

back or lower extremity pain

63
Q

Biliary Tract Disease

Referred Pain

A

R infrascapular pain

64
Q

Myocardia Ischemia

Referred Pain

A

mid-epigastric, neck, jaw or L extremity pain

65
Q

Ureteral Obstruction

Referred Pain

A

ipsilateral testicular pain

66
Q

Hollow Organs

A

allow materials to pass through; act as “holding tanks”
-decreased risk of injury when organ is empty
-air is present (soft, resonant sound - same sound as solid organ when it’s full ex. fluid in abdomen or pneumonia)
-full = increased pressure = increased chance of rupture

stomach, large intestine, small intestine pancreas

67
Q

Solid Organs

A

significant blood supply; no air present + hard/echo sound
-increased risk of injury (bruising, tearing - hematuria)

liver, spleen, pancreas, kidney, ovaries, testes

68
Q

Spleen

Palpation

A

palpate for enlarged spleen under L ribcage
-have pt raise arms above head

69
Q

Liver

Palpation

A

press firmly below costal margin
-ask pt to take a deep breath
-may feel liver slide against your hand
-normal liver is not tender

70
Q

Kidneys

Palpation

A

under posterolateral portion of ribcage
-R kidney rests more inferior than L
-bruising, pooling of blood, swelling

71
Q

Abdominal Rigidity

Palpation

A

occurs secondary to muscle guarding or blood accumulation (indication of internal injury)
-check for rebound tenderness
-normal percussion findings: solid organs have dull thump resonant sound
-positive/abnormal finding: hard, solid echo over area that should sound shallow

72
Q

Hernia

A

protrusion of organ through defect in the wall of the cavity

73
Q

Classifications of Hernias

A

-reducible: easily manipulated back in place
-irreducible/incarcerated: cannot be reduced due to adhesions in hernia sac
-strangulated: herniated intestine becomes twisted or edematous

74
Q

Inguinal Hernia

A

pressure in the abdominal wall finds a weak spot, intestine passes through
-bilateral in 20% of cases
-R side more frequent than L side

75
Q

Direct Hernia

Inguinal Hernia

A

herniation through muscle weakness in inguinal canal
-acquired
-25% common
-increased abdominal pressure weakens fascia
-can be caused by constipation, coughing, straining, heavy lifting, prostate enlargement

76
Q

Indirect Hernia

Inguinal Hernia

A

herniation through inguinal ring
-congenital
-75% common, 3x more likely in males
-can develop at any age but prevalent in infants less than 1 y/old

77
Q

Femoral Hernia

A

through femoral canal
-4% incidence
-common in elderly women
-female prediposition (3:1)
-increased abd pressure
-hernia sac bulges into femoral canal (medial to femoral vein)

78
Q

Bilateral Hernia

A

R + L inguinal hernia (simultaneous)
-L hernia present = 25% risk of occult R inguinal hernia
-common in children + elderly men
-L hernia present -> check for R side

79
Q

Incisional Hernia

A

type of ventral hernia; develops in scar of prior laparotomy or drain site
-risks include:
1. vertical scar
2. wound infection (wound opens up)
3. wound dehiscence (getting surgical site wet)
4. malnutrition
5. obesity
6. tobacco use (decreased vascularization)

bacteria degrades sutures -> infection

80
Q

Complications of Hernia

A

-bowel incarceration: trapping abdominal contents within hernia
-strangulation: pressure compromises blood supply (decreased venous pressure), ischemia, necrosis (gangrene)
-small bowel obstruction

81
Q

HIDA Scan

A

hepatobiliary iminodiacetic acid scan of liver function

82
Q

Cholecystitis

(Manifestation)

A

stone in cystic duct -> bile still produced -> flow is blocked -> inflamed gallbladder (cholecystitis)

83
Q

Pancreatic Cancer

(Manifestation)

A

tumor compresses CHD -> backup of bile + buildup of bilirubin -> jaundice + pain from swelling

(painless jaundice)

84
Q

R Hepatic Artery

A

branches off to cystic artery, supplies gallbladder

85
Q

Gallbladder

A

responsible for concentrating + storing bile
-sits under the liver in RUQ
-hollow organ of smooth muscle (does not relax or empty well)
-lies in shallow depression on interiro ruface of the liver
-capacity = 30-50 mL of bile
-connected to CHD by cystic duct
-blood supply = cystic artery (originating from RHA)

86
Q

Bile

A

responsible for helping the body to digest fats
-golden color
-1/4 -1 1/4 L bile produced daily

87
Q

Bile Composition

A

-water
-electrolytes (Na+, K+, Ca2+, Cl-, HCO3)
-fatty acids
-cholesterol
-bilirubin
-bile salts

88
Q

Increased production of bile leads to…

A

production of gallstones when gallbladder is non-functional

89
Q

Factors associated w/ increased risk of gallstone development

A

-obesity (increased abd pressure)
-pregnancy (very common, increased pressure)
-Crohn’s Disease
-terminal ileal resection
-gastric surgery
-Sickle Cell Disease

90
Q

Murphy’s Sign

A

RUQ pain upon palpation causes cessation of breathing
-indicates cholecystitis

91
Q

Gallstone Disease

A

revealed by ultrasound
-3 stages:
1. cholesterol supersaturation in bile
2. crystal nucleation
3. stone growth

92
Q

Symptomatic Cholelithiasis

A

pain occurs due to stone obstructing cystic duct
-increased wall tension
-pain resolves when stone passes
-pain 1-5 hours (rarely >24 hours)
-can cause acute/chronic cholecystitis
-epigastric/RUQ pain, no fever/WBC

93
Q

Acute Cholecystitis

A

acute GB inflammation due to cystic duct obstruction
-persistent RUQ pain
-incr. WBC
- + Murphy’s sign

94
Q

Chronic Cholecystitis

A

recurrent bouts of cholecystitis leading to chronic GB wall inflammation/fibrosis
-no fever/WBC

95
Q

Chronic Calculous Cholecystitis

Symptomatic Cholelithiasis

A

recurrent inflammatory process due to recurrent cystic duct obstruction
-90% lead to gallstones
-leads to scarring/wall thickening
-scar tissue does not function well
-treatment: laparotic cholecystectomy

96
Q

Acute Calculous Cholecystitis

Symptomatic Cholelithiasis

A

persistent cystuc duct obstruction
-GB distension, edema
-pain persists >24 hours
-palpable tender RUQ mass
-sonography for inital imaging

97
Q

Acute Acalculous Cholecystitis

A

caused by GB / biliary stasis from lack of enteral stimulation by cholecystokinin
-5-10% of acute cholecystitis cases
-seen in critically ill pts or prolonged TPN
-likely to progress to gangrene

98
Q

Cholangitis

A

infection of bile ducts due to CBD obstruction secondary to stones/strictures
-Charcot’s triad + Raynaud’s Pentad
-may lead to life threatening sepsis

99
Q

Charcot’s Triad

Cholangitis

A

jaundice, fever + RUQ pain
-70% of pts

100
Q

Raynaud’s Pentad

Cholangitis

A

collection of signs + symptoms suggesting obstructive ascending cholangitis
-combination of Charcot’s Traid w/ shock + AMS

101
Q

Complications of Acute Cholecystitis

A

-empyema of GB: pus filled GB due to bacterial proliferation in obstructed GB (high fever)
-emphysematous cholecystitis: severe RUQ pain + sepsis (common in men + diabetics, air in GB wall)
-perforated GB: contained abscess in RUQ occuring in 10% of pts

Anatomy 1 - MD (6 decks)

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