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Anatomy I > Week 6 Content > Flashcards

Week 6 Content Flashcards

1
Q

Identify and describe the boundaries of the abdominal wall.

A

Superior - right and left costal margins, xiphisternal joint

Inferior - a line on either side connecting the ASIS to the pubic symphysis

Lateral - vertical lines ascending from the ASIS on each side

Posterior - lumbar paravertebral musculature

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2
Q

Identify and describe the 4 planes of the abdomen.

A

Subcostal plane - line through the most inferior parts of the costal cartilage (10th rib), also passing through the body of L3

Transtubercular plane - line passes through the iliac tuberosities at the L5 level

Sagittal plane (2) - mid-clavicular lines, extends inferior from the mid-clavicle to the mid-inguinal point

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3
Q

Describe the transpyloric plane.

A

AKA Addison’s plane, a transverse plane that is slightly above the subcostal plane, through the body of L1

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4
Q

Describe the interspinous plane.

A

A transverse plane that is slightly below the transtubercular plane.

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5
Q

Name the 9 quadrants of the abdomen.

A

Upper region from R to L: R hypochondraic, epigastric, L hypochondraic

Middle region from R to L: R lumbar, umbilical, L lumbar

Lower region from R to L: R inguinal, hypogastric, L inguinal

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6
Q

Describe the contents of the RUQ.

A 
Liver
Gallbladder
Right suuprarenal gland
Right kidney
Ascending colon (superior part)
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7
Q

Describe the contents of the LUQ.

A 
Spleen
Stomach
Pancreas - body and tail
Left kidney
Transverse colon (left half)
Descending colon (superior part)
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8
Q

Describe the contents of the RLQ.

A 
Cecum
Veriform appendix
Right ovary
Right ureter
Most of ileum
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9
Q

Describe the contents of the LLQ.

A 
Sigmoid colon
Descending colon (inferior part)
Left ovary
Left ureter
Left spermatic cord
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10
Q

Describe the layers of the abdominal fascia.

A

Just deep to skin is the superficial fascia’s fatty layer (Camper’s fascia) and then deep to that is the superficial fascia’s membranous layer (Scarpa’s fascia). Together the Camper’s fascia and Scarpa’s fascia make up the subcutaneous tissue.

Next deep structures are investing (deep) fascia covering the abdominal muscles: the external oblique, internal oblique, and transverse abdominis

Deep to the abs are transversalis fascia, then extraperitoneal fascia, and finally the parietal perironeum.

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11
Q

Which fascial layer continues as the fascia lata of the thigh?

A

Scarpa’s fascia, the superficial fascia’s membranous layer

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12
Q

Describe OINA for external oblique.

A

O: external surface of ribs 5-12

I: linea alba, pubic crest, iliac crest, pubic symphysis

N: inferior 5 thoracic nerves, subcostal nerve (T12), and iliohypogastric nerve (L1)

A: trunk flexion, rotation, lateral rotation; compress abdominal contents

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13
Q

Describe OINA for internal oblique.

A

O: thoracolumbar fascia, anterior iliac crest, lateral half of inguinal ligament

I: linea alba, pubic crest, inferior surface of ribs 11-12

N: lower 5 thoracic nerves, subcostal (T12) and iliohypogastric (L1) nerves

A: trunk flexion, rotation, lateral rotation; compress abdominal contents

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14
Q

Describe OINA for transversus abdominis.

A

O: TLF via lateral raphe, iliac crest, lateral 1/3 of inguinal ligament, internal surface of costal cartilages 7-12

I: linea alba, pubic crest, pubic synphysis

N: lower 5 thoracic nerves, subcostal (T12) and iliohypogastric (L1) nerves

A: compress and support abdominal viscera, tightens TLF

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15
Q

Describe OINA for rectus abdominis.

A

O: pubic symphysis, pubic crest

I: xiphoid process, costal cartilages 5 and 7

N: lower 5 thoracic nerves, subcostal (T12) and iliohypogastric (L1) nerves

A: trunk flexion; tenses anterior abdominal wall

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16
Q

Briefly describe the rectus sheath.

A

A dense fibrous sheath enclosing the rectus abdominis muscle, formed by the fusion of aponeuroses of the abdominal muscles

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17
Q

Where is the arcuate line?

A

Roughly at the level of the umbilicus, the point of transition where all 3 abdominal aponeuroses pass anteriorly.

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18
Q

Describe the rectus sheath above the level of the umbilicus, anteriorly and posteriorly.

A

Anteriorly: aponeuroses of external oblique and 1/2 of internal abdominal oblique

Posteriorly: aponeuroses of 1/2 of other internal oblique and TA

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19
Q

What is the linea alba?

A

Where the anterior and posterior walls of the rectus sheath meet and fuse in the anterior median line.

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20
Q

Describe the rectus sheath below the level of the umbilicus, anteriorly and posteriorly.

A

Anteriorly: aponeuroses of all 3 muscles now pass anteriorly over the rectus abdominis with no fascia from the muscles passing posteriorly

Posteriorly: a thin fascial film (transversalis fascia) remains posteriorly that protects the rectus abdominis from rubbing against the abdominal contents

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21
Q

Describe the innervation of the anterior abdominal wall.

A

Supplied by:

  • ventral primary rami of thoracic spinal nerves T6-T11
  • ventral primary rami of T12 (subcostal n.)
  • ventral primary rami of L1 (iliohypogastric and ilioinguinal nerves)
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22
Q

Describe the cutaneous landmarks for innervation of the anterior abdominal wall.

A

T10 - umbilical area
T7 - xiphoid area
L1 - pubic area

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23
Q

Describe the arterial supply to the anterior abdominal wall.

A

Superior epigastric (branch of the internal thoracic artery) and Inferior epigastric (branch of the superficial epigastric artery off of the external iliac) enter the rectus sheath posterior to the rectus abdominis and anastomose with the rectus muscle

Posterior intercostal arteries that accompany intercostal nerves also supply anterior abdominal wall

Additional supply comes from the direct branches of the abdominal aorta and lumbar arteries

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24
Q

Describe caput medusae.

A

AKA medusa’s head

Distended superficial epigastric veins

Common in portal HTN, can be caused by liver failure

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25
Q

Describe the inguinal canal.

A

A passage from the abdominal cavity through the anterior abdominal wall that lies right above the inguinal ligament, formed by folds of the external oblique aponeurosis

Openings are called superficial and deep inguinal rings

Contents: inguinal nerve, blood and lymphatic vessels, spermatic cord in males, round ligament of the uterus in females

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26
Q

Where does the inguinal ligament insert?

A

ASIS to pubic tubercle

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27
Q

Describe the borders of Hesselbach’s triangle.

A

Medial border - rectus sheath

Lateral border - inferior epigastric artery

Inferior border - Poupart’s ligament (inguinal lig)

RIP

Triangle carries the inguinal canal and the external (superficial) inguinal ring

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28
Q

Compare and contrast acquired and congenital inguinal hernias.

A

Acquired (direct) hernias are caused by the wear and tear of living, such as childbirth, weight gain, and other muscle strain.

Congenital (indirect) hernias are present from birth and happen at points of weakness in the abdominal wall. Children’s hernias are almost always congenital. In men, the hernia will be within the spermatic cord.

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29
Q

Describe the peritoneum, including its layers and function.

A

A thin, transparent serous membrane that consists of 2 layers:

  • Parietal peritoneum - lines abdominal wall
  • Visceral peritoneum - lines the visceral organs

Space between is lined with serous fluid to allow frictionless movement between the wall and the organs and between organs

Not all organs are covered by the peritoneum

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30
Q

What is peritoneal effusion?

A

AKA Ascites, defined as >25 mL of fluid buildup in the peritoneal cavity

Can be caused by liver cirrhosis, HF, HTN, hepatic vein blockage

Sx: increased SOB

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31
Q

Describe the mesentery.

A

A double layer of peritoneum that encloses the abdominal organs

Provides a means of neurovascular communication and organ attachment to posterior abdominal wall

Contained with the fibrous tissue of the mesentery are blood and lymph vessels, nerves, lymph nodes, and adipose tissue

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32
Q

Describe the omentum.

A

A double layer of peritoneum that attaches the stomach to the body wall or to other abdominal organs

Greater omentum - fat-laden fold of peritoneum that connects stomach with transverse colon

Lesser omentum - connects the lesser curvature of the stomach and duodenum to the liver

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33
Q

Describe the location and contents of the abdominal cavity.

A

Located superior to the pelvic inlet and limited superiorly by the thoracic diaphragm

Contains the peritoneum and abdominal viscera

34
Q

Describe the esophagus.

A

Muscular tube extending from the pharynx to the stomach (25 cm long)

Function - transportation of food from oral cavity to stomach

Passes through esophageal hiatus of the diaphragm to enter into the abdominal cavity

Peristaltic action creates rapid food movement from the oral cavity to the stomach

Called the thoracic esophagus superiorly and abdominal esophagus inferiorly

35
Q

Describe the location and function of the stomach.

A

Expandable part of the digestive tract that lies between the esophagus and the small intestine

Function - provide enzymatic digestion of food, converting solid food to a liquid mixture called chyme

Capable of holding 2-3 L of food

36
Q

Describe the 4 parts of the stomach.

A

Cardia - part surrounding the cardial orifice (the connection
between the stomach and the esophagus)

Fundus - dilated superior aspect of the stomach that is related to the left dome
of the diaphragm

Body - center, lying between the fundus and the pyloric antrum

Pyloric - funnel-shaped region of the stomach at the bottom. The distal aspect
is characterized by the pyloric sphincter which controls discharge of the
stomach contents into the duodenum

37
Q

Describe the small intestine’s function and name its parts in order.

A

Function - continue food digestion

3 parts:

  • Duodenum
  • Jejunum
  • Ileum
38
Q

Describe the duodenum.

A

First and shortest part of the small intestine; C-shaped

Bile and pancreatic ducts enter into the duodenum for digestive purposes

4 parts: superior, descending, horizontal, ascending

39
Q

Describe the jejunum and ileum.

A

Together they are 6-7 meters long

No clear demarcation between jejunum and ileum but surgeons are able to distinguish based on:
- Jejunum is often redder, thicker, and has a greater vascularity than the ileum

40
Q

Describe the spleen.

A

Largest lymphatic organ, located in the LUQ, next to the pancreas

Primary function: eliminate old and damaged cells from the circulation, filter antigens, and contribute to the immune response

Its removal does not seriously impair the immune response

41
Q

Describe the pancreas.

A

Organ lies posterior to the stomach, points towards the spleen

Functions:
- secreting gastric juices for the small intestine that enters the duodenum via the pancreatic ducts
- endocrine gland supplying the body with insulin and glucagons from the
Islets of Langerhans

For descriptive purposes, it is divided into four parts
- Head, neck, body and tail

42
Q

Describe the liver.

A

Largest Gland in the body and is found in the RUQ; has 2 lobes (L and R) separated by falciform ligament

Function: metabolic activities, secretion of bile, and storage of glycogen

It also is responsible for processing the products of digestion as well as
endogenous and exogenous substances like drugs and toxins that enter the
circulation

43
Q

Describe the portal triad.

A

Bile duct - formed by the common hepatic duct and the cystic duct (gall bladder)

Hepatic artery - arises from the aorta and delivers well-oxygenated blood to the liver

Portal vein - arises from the mesenteric and splenic veins and empties into the liver, carries nutrient-rich blood

44
Q

Describe the large intestine.

A

Cecum - first part of the large intestine, blind intestinal pouch; connected to ileum via the ileocecal valve; attached to vermiform appendix

Colon - described in 4 parts (ascending, transverse, descending, sigmoid); functions to remove fluid from fecal matter

Rectum and anal canal - continuation of the colon, sphincters for control of defacation

45
Q

Describe the vermiform appendix.

A

Attached to the cecum of the large intestine

Blind divertculum

Function not well understood

46
Q

Describe the kidneys.

A

Lie on the posterior abdominal wall

Function: remove excess water, salts, and wastes of protein metabolism from the blood while returning nutrients and chemicals back to the blood

Superior aspect of kidney contains the suprarenal glands or adrenal glands, which function to produce hormone and steroids for body

47
Q

Describe the ureters.

A

Convey the waste products absorbed by the kidneys to the bladder in the pelvis

Run inferiorly from the kidney, over the common iliac arteries to the bladder

48
Q

Is blood drainage from the left gonads more or less effective than from the right gonads? Why or why not?

A

Drainage from left gonads is less effective because blood supply to the right gonads come straight off of the abdominal aorta, whereas the left side has a less direct route

49
Q

Describe the 3 constriction points of the renal system.

A

1st constriction - ureteropelvic junction, right after kidney

2nd constriction - pelvic inlet, between common iliac artery branches of internal and external iliac arteries

3rd constriction - entrance to bladder

50
Q

Name the contents of the pelvic cavity.

A

Bladder
Urethra
Reproductive organs (ovaries, fallopian tubes, uterus, cervix, vagina in women; testis, seminal vesicle, vas deferens, ejaculatory duct, and prostate in men)

51
Q

Describe the bladder.

A

Hollow pouch with strong muscular walls with characteristic of distensibility

Functions - temporary reservoir for urine

Urethra - muscular tube that conveys urine from the bladder

52
Q

Describe the female reproductive organs.

A

Ovaries - female reproductive glands, produces ova (oocytes) and estrogen

Fallopian tubes or uterine tubes - extend laterally from the uterus and open
near the ovaries. Functions to convey the ovum from the ovary to the uterus.

Uterus - thick walled, pair shaped, hollow muscular organ. Provides
environment for embryo and fetus development

Cervix - neck region of the uterus.

Vagina - musculomembraneous tube extending from the cervix to the
vestibule of the vagina. Functions as a passageway

53
Q

Describe the male reproductive organs.

A

Testis - male gonad, one of two reproductive glands found in the scrotum. Functions to produce spermatozoa and testosterone.

Seminal Vesicle -lies between the bladder and the rectum. Function to secrete a
thick alkaline fluid that mixes with the sperm as they pass into the ejaculatory duct.

Ductus Deferens or Vas Deferens - continuation of the duct of the epididymus. It
begins in the epididymis and eventually joins with the duct of the seminal vesicle to form the ejaculatory duct.

Ejaculatory Duct - slender tube that arises by the union of the duct of a seminal
vesicle with the ductus deferens and connects into the urethra

Prostate - accessory gland, secretes fluid that helps to form part of the seminal fluid

54
Q

What makes up the posterior abdominal wall?

A

Bones - lumbar vertebrae, sacrum, wings of ilium, ribs 11-12

Muscles - diaphragm, iliacus, psoas major, quadratus lumborum

55
Q

Describe OINA for psoas major.

A

O: transverse processes, bodies, and IVDs of T12-L5

I: lesser trochanter with iliacus as iliopsoas tendon

N: ventral primary rami of L2-4

A: hip flexion; trunk flexion and lateral flexion

56
Q

Describe OINA for psoas minor.

A

O: bodies of vertebrae T12 and L1 and the IVD in between

I: pubic bone

N: ventral primary ramus of L1

A: pelvis flexion, vertebral column flexion

57
Q

Describe OINA for iliacus.

A

O: iliac fossa

I: lesser trochanter with psoas major as iliopsoas tendon

N: femoral n. via nerve to iliacus

A: hip flexion

58
Q

Describe OINA for quadratus lumborum.

A

O: iliac crest, iliolumbar ligament, and transverse processes of lower lumbar vertebrae

I: rib 12, transverse process of upper lumbar vertebrae

N: subcostal n. and upper lumbar ventral primary rami

A: trunk lateral flexion; extends vertebral column; elevates hip; stabilizes rib 12 against inhalation

thin, strap-like muscle

59
Q

Describe the nerves of the lumbosacral plexus.

A

Lumbar plexus is derived from L2-L4

  • Iliohypogastric - L1
  • Ilioinguinal - L1
  • Genitofemoral - L1-2
  • Lateral femoral cutaneous - L2-3
  • Femoral - L2-4
  • Obturator - L2-4
  • part of L4 forms lumbosacral trunk

Sacral plexus is derived from L4-S4

  • Superior gluteal - L4-S1
  • Inferior gluteal - L5-S2
  • Sciatic - L4-S3
  • Pudendal - S2-S4
  • twigs to piriformis - S1-4
  • nerve to obturator internus - L5-S2
  • nerve to quadratus femoris - L4-S1
60
Q

Describe the arterial supply to the posterior abdominal wall.

A

Descending thoracic aorta enters the abdominal cavity through the diaphragm and
becomes the abdominal aorta

The abdominal aorta divides at the level of L4 vertebra into right and left common iliac arteries

The common iliac arteries divide into internal and external iliac arteries
- Internal iliac supplies the viscera of the pelvic cavity
- External iliac passes under the inguinal ligament and enters the anterior
compartment of the thigh. It changes names to the femoral artery when crossing under the inguinal ligament.

The inferior epigastric artery arises from the external iliac artery before it enters the
anterior thigh compartment. It supplies the inferior aspect of the anterior abdominal wall

61
Q

Describe the inferior vena cava.

A

The largest vein in the body

It returns blood from both lower extremities, anterior abdominal wall and abdominal pelvic viscera

It arises about the L5 vertebra from a union of the common iliac veins

It ascends through vena cava foramen in the diaphragm and continues to the heart

62
Q

Describe the diaphragm generally.

A

A musculotendinous partition separating the thoracic and abdominal cavities

Major muscle of inspiration

Composed of a central tendon in the shape of a boomerang into which the peripheral muscle portion inserts

63
Q

Describe the peripheral muscle portion of the diaphragm.

A

Sternal portion: fibers arising from the xiphoid and inserting into central tendon

Costal portion: arises from internal surface of lower 6 ribs and costal cartilage and lateral and medial arcuate ligaments, inserts into central tendon

Lumbar portion: arises from lumbar vertebrae in the form of a right crus (L1-3 and their discs) and left crus (L1-2 and their discs)

64
Q

Describe the openings of the diaphragm.

A

Sternocostal hiatus - passage of the superior epigastric vessels and some lymphatics

Foramen for the inferior vena cava - AKA caval opening; passage for IVC and right phrenic nerve

Esophageal hiatus - passage for esophagus and vagal trunks

Aortic hiatus - passage for aorta and thoracic ducts

Sympathetic trunk passes posterior to the medial arcuate ligament

65
Q

T/F: Camper’s fascia is a fatty layer that is filled with smaller vessels.

A

True

66
Q

T/F: Scarpa’s fascia is a membranous layer that marks the entry into the abdominal cavity.

A

True

67
Q

What is the thoracic level of the caval opening, and what structures pass through it?

A

T8

IVC, right phrenic nerve

68
Q

What is the thoracic level of the esophageal hiatus, and what structures pass through it?

A

T10

Esophagus, anterior and posterior vagal trunks, esophageal branches of left gastric artery and vein

69
Q

What thoracic level is the aortic hiatus, and what structures pass through it?

A

T12

Aorta, thoracic duct, azygos vein

70
Q

What is the function of the parietal peritoneum?

A

It covers the retroperitoneal organs

71
Q

What are the major organs of the retroperitoneum?

A

Kidneys
Pancreas
Duodenum

72
Q

Why are organs termed retroperitoneal?

A

They have peritoneum on their anterior side only

They are not suspended by mesentery in the abdominal cavity and lie between the parietal peritoneum and posterior abdominal wall

73
Q

Why does the lesser omental sac exist?

A

It forms as part of the rotation of the foregut

74
Q

What is the arterial supply for the spleen, stomach, and liver?

A

the Celiac trunk

75
Q

What is the significance of the duodenal-jejunal flexure?

A

This is where the small bowel transitions from retroperitoneal to intraperitoneal

76
Q

What is the significance of the terminal ileum?

A

It marks the transition from the small to large bowel.

77
Q

Where is the appendix located?

A

It is attached to the cecum

78
Q

Which artery supplies most of the ascending and transverse colon?

A

The superior mesenteric artery

79
Q

Where is the transition zone of the organs supplied by the superior and inferior mesenteric arteries?

A

The mid transverse colon, but there’s no exact area where the transition occurs

80
Q

Which artery supplies the descending and sigmoid colon?

A

The inferior mesenteric artery

81
Q

Which artery(s) supply the rectum and distal parts of the sigmoid colon?

A

Partially supplied by inferior mesenteric artery and branches of the iliac arteries

Anatomy I (14 decks)

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