Workbook 1 Flashcards
Where is the abdomen?
Between the thorax and the pelvis
What is the name of the ligament that acts as an inferior border for surface marking of abdomen?
Inguinal ligament
What are the 4 quadrants of the abdomen?
Right upper
Left upper
Right lower
Left lower
What are the 2 planes which make up the 4 quadrants of the abdomen?
Transverse umbilical line
Midsagittal line
What are the 9 regions of the abdomen?
Right and Left hypochondriac
Epigastric
Right and Left lumbar
Umbilical
Right and Left iliac
Hypogastric/ pubic
What are the planes which make up the 9 regions?
Midclavicular lines
Transpyloric and intertubercular planes
What structures are in the right hypochondriac region?
Liver, gall bladder and right kidney
What structures lie in the epigastric region?
Stomach, liver, pancreas and kidneys
What structures lie in the left hypochondriac region?
Stomach, liver tip, left kidney and spleen
What structures lie in the right lumbar?
Tip of liver, small intestine, ascending colon and right kidney
What structures lie in the umbilical region?
Stomach, pancreas, small intestine and transverse colon
What structures lie in the left lumbar region?
Descending colon, left kidney and small intestine
What structures lie in the right inguinal region?
Caecum, appendix, ascending colon and small intestine
What structures lie in the pubic region?
Small intestine, sigmoid colon and bladder
What structures lie in the left inguinal?
Small intestine, descending colon, and sigmoid colon
What is the dermatome level of the umbilicus?
T10
What is the vertebrae level of the umbilicus?
L3 and L4
Explain herpes zoster infection
Shingles
All dermatomes can be affected
Presents with painful vesicles at exact location of dermatome
What are the 4 muscles of the anterior abdominal wall?
External oblique
Internal oblique
Transversus abdominis
Rectus abdominis
What is the linea alba?
Band of connetcive tissue down middle of rectus sheath
What is the large connective tissue which covers the anterior abdominal wall?
Rectus sheath
What 3 muscle aponeuroses form the rectus sheath?
Internal oblique
External oblique
Transversus abdominis
What 2 muscles lie within the rectus sheath?
Rectus abdominis
Pyramidalis muscles
What is the function of the pyramidalis?
Tense the linea alba
What is the name of where the posterior layer of the rectus sheath ends?
Arcuate line
Describe the superficial vasculature of the anterior abdominal wall
Superior epigastric artery and vein
Inferior epigastric artery and vein
Where do the superior epigastric arteries arise from?
Distal aspect of the internal thoracic arteries
Where do the superior epigastric veins drain to?
Internal thoracic vein
Where do the inferior epigastric arteries arise from?
External iliac arteries
Where do the inferior epigastric veins drain to?
External iliac veins
Describe caput medusa
Formation of dilated abdominal wall veins which extend from umbilicus
Secondary to portal hypertension
Which lymphatic nodes does lymphatic drainage go to above the umbilicus?
Axillary
Which lymphatic nodes does the lymphatic drainage go to below the umbilicus?
Superficial inguinal
What are the muscles of the posterior abdominal wall?
Psoas major
Iliacus
Quadratus lumborum
What are the 3 opening of the diaphragm?
Aortic, Oesophageal and vena caval openings
At what levels are there openings in the diaphragm?
T8
T10
T12
What does the foregut run from and to?
Oesophagus to the duodenum
Where does the midgut run from and to?
Opening to bile duct in duodenum to the proximal 2/3rds of transverse colon
Where does hindgut run from and to?
Distal 1/3rd of transverse colon to the rectum
What arteries supply the foregut, midgut and hindgut?
Foregut - coeliac trunk
Midgut - inferior mesenteric artery
Hindgut - superior mesenteric artery
What are the 3 branches of the coeliac trunk?
Left gastric artery
Common hepatic artery
Splenic artery
Where does the superior mesenteric artery leave the abdominal aorta?
L1
At what vertebral level does the abdominal aorta divide into 2 common iliac arteries?
L4
Describe the level of main arteries leaving the abdominal aorta
Coeliac trunk - T12
SMA - L1
Renal artery - L1-2
IMA - L3
Common iliac arteries - L4
Where are the 4 sites if portal-systemic anastomoses?
Oesophageal
Rectal
Para and peri-umbilical
Colic veins with retroperitoneal veins
Describe the abdominal venous drainage
Splenic vein
Inferior mesenteric vein
Superior mesenteric vein
All drain to portal vein which goes into liver
What are the relevance of the anastomoses?
Oesophageal varices
Haemorrhoids
Caput medusa
Explain lymph nodes around the aorta
If vessel comes out aorta anteriorly the drainage will be pre-aortic and if vessel protrudes out side of aorta then there is para-aortic nodes
Describe the sympathetic innervation of the abdominal wall
Abdominopelvic splanchnic nerves
Prevertebral sympathetic ganglia
Abdominal aortic plexuses
Describe the parasympathetic innervation of the abdominal wall
Anterior and posterior abdominal trunks - 10th cranial nerve
Pelvic splanchnic nerves - S2,3,4
What is the parasympathetic effect on the GI tract?
GI secretion increased
Peristalsis or motility increased
Blood vessels vasodilation
What is the sympathetic effect on the GI tract?
GI secretion decreased
Peristalsis or motility decreased
Blood vessels vasoconstriction
What is a vagotomy?
Cutting of the vagal nerve
Reduces gastric acid secretion
Where does pain in the foregut, midgut and hindgut refer to?
Foregut - epigastric region
Midgut - umbilical region
Hindgut- suprapubic region
What ventral rami does the lumbar plexus come from?
L1-L4
Where is the lumbar plexus?
Within major psoas muscle and branches emerge lateral to, on surface of or medial to psoas major muscle
What is the root of the iliohypogastric nerve?
L1
What is the root of the ilioinguinal nerve?
L1
What is the root of the lateral cutaneous nerve?
L2
What is the root of the gentiofemoral nerve?
L1 and L2
What is the root of the obturator nerve?
L2,3 and 4
What is the root of the femoral nerve?
L2-4
Where is the the kidneys level on vertebrae?
T12-L3
Right kidney slightly lower than left due to liver
What are the 3 main structures entering or leaving the hilum of the kidneys?
Renal artery
Renal vein
Ureter
How are the kidneys peritonised?
Retroperitoneal
Describe the Ureters
Are muscular ducts that carry urine from kidneys to urinary bladder
How is the ureters peritonised?
Retroperitoneal
What is the term to describe the expanded upper part of the ureter?
Renal pelvis
Where are the 3 constrictions of the ureter on route to urinary bladder?
Pelviureter junction
Ureter crosses the brim of pelvic inlet
During their passage through the wall of urinary bladder
Where is the anatomical location of the adrenal gland?
Between supra-medial aspect of the kidneys and the diaphragmatic crura
What type of gland is the adrenal gland?
Endocrine
What is the peritoneum coverings of wall and viscera?
Wall - Parietal peritoneum
Viscera - Visceral peritoneum
What peritoneal layer is more sensitive to pressure, pain, heat and cold?
Parietal peritoneum
What is present within the peritoneal cavity?
Peritoneal fluid
What is the difference between intra and retro peritoneal?
Intra - completely surrounded by visceral peritoneum
Retro - only covered on anterior surface and therefor firmly attached to posterior wall
Name the retroperitoneal organs
SAD PUCKER
Suprarenal gland
Aorta/IVC
Duodenum -2 and 3rd part
Pancreas - except tail
Ureters
Colon - ascending and descending
Kidneys
Oesophagus
Rectum
Name the intraperitoneal organs
Stomach
Spleen
Liver
Ileum and jejunum
Transverse and sigmoid colon
Bulb and first part of duodenum
What is the space behind the stomach called?
The lesser sac and remainder of cavity is the greater sac
What is the opening between the lesser and greater sac?
Epiploic foramen
What is another name for the lesser sac?
Omental bursa
Describe the boundaries of the epiploic foramen
Situated posterior to free edge of lesser omentum to the hepatoduodenal ligament
What is an omentum?
Double layer extension of the peritoneum - there is the lesser and greater omentum
What are the attachments of the greater and lesser omentum?
Greater - greater curvature of stomach
Lesser - lesser curvature of the stomach
What is the ligament called which is part of the lesser omentum?
Gastro-hepatic ligament
What is the ligament called which is part of the greater omentum?
Gastro-colic ligament
What is the difference between omentum and mesentery?
Omentum extends from stomach
Mesentery is the peritoneal extension from posterior abdominal wall
Describe the innervation of the parietal peritoneum
Lower 6 thoracic nerves and L1
Pain is somatic and precisely loacalised
Describe the innervation of the visceral peritoneum
Autonomic nerves
Pain is referred, dull and poorly localised
Referred to midline
What is the falciform ligament and what structures lie within its free border?
Connects anterior part of liver to ventral wall of abdomen
Contains the umbilical vein
Where do you locate the transpyloric plane?
Halfway between the suprasternal notch and upper border of pubic symphysis
What are the costal cartilage markings of the gall bladder?
9th right
Does the liver move with inspiration?
Yes as intraperitoneal so its mobile
Explain Murphy’s Sign
Elicited in patients with acute cholecystitis
Pain on inspiration
If inflamed when examined then positive
Where does the spleen site in relation to ribs?
Left 9 to 11 ribs
