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179 Cards in this Set
- Front
- Back
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Camper's Fascia
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Superficial fatty layer
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Scarpa's Fascia
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Deep superficial fatty layer
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Colle's fascia
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Scarpa's fascia that continues into perineum
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Break in urethra consequences
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Urine can pool deep to Scarpa's fascia
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Rectus sheath
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Aponeurosis of abdominal muscles on anterior side of body
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Linea semilunaris
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Tendinous line on the lateral side of rectus sheath
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Linea alba
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Tendinous line at the midline
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Abdominal muscle actions
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1. Support and compress viscera
2. Flex vertebral column with bilateral contraction 3. Lateral flexion of vertebral column with unilateral contraction 4. Rotation of trunk when internal abdominal oblique and contralateral external abdominal oblique contract simultaneously |
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Innervation of abdominal muscles
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Intercostal nerves T7-L1
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External abdominal oblique attachments
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Ribs 5-12 to Linea alba, pubic tubercle, anterior half of iliac crest
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Inguinal ligament
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Formed by external abdominal oblique aponeurosis; attached to the pectineal line of superior ramus of the pubis by the lacunar ligament
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Internal abdominal oblique attachments
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Thoracolumbar fascia to Inferior borders of ribs 10-12, linea alba, pectineal line via conjoint tendon
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Transversus abdominis attachments
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7th-12th costal cartilages, thoracolumbar fascia, iliac crest, lateral third of inguinal ligament to linea alba, pectineal line via conjoint tendon
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Fiber orientation for the 3 abdominal muscles
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External: Inferior and medial
Internal: Superior and medial; after ASIS it becomes inferior and medial Tranversus: Horizontal; after ASIS it becomes inferior and medial |
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Causes of abdominal enlargement
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Food, Flatus, Feces, Fat, Fluid, Fetus
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Rectus abdominis attachments
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Pubic symphysis and pubic crest to Xiphoid process and 5th-7th costal cartilages
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Innervation of rectus abdominis
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Thoracoabdominal segmental nerves
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Tendinous intersections
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Horizontal bands of fascia running through rectus abdominis
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Composition of Rectus sheath superior to ASIS
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Half and Half
Anterior is aponeuroses of external and half of internal; Posterior is aponeuroses of other half of internal and transverse |
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Composition of Rectus sheath inferior to ASIS
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All in
Anterior is aponeuroses of all 3 muscles; no posterior |
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Arcuate line
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Line of transition on posterior rectus sheath
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Transversalis fascia
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Internal layer of deep fascia; equivalent to endothoracic fascia
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Inguinal canal
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Passage through layers of abdominal wall allowing spermatic cord (male) or round ligament (female) to exit abdominal cavity
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Deep inguinal ring
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Internal entrance of inguinal canal in transversalis fascia
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Superficial inguinal ring
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Exit of inguinal canal in aponeurosis of external abdominal oblique
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Boundaries of Inguinal canal
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Anterior Wall: External abdominal oblique aponeurosis
Lateral and Medial borders: Lateral and medial crus Posterior Wall: Transversalis fascia and internal abdominal oblique Roof: arching fibers of internal abdominal oblique and transverses abdomens Floor: inguinal and lacunar ligaments |
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Inguinal triangle borders
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Laterally---inferior epigastric artery
Medially---lateral border of rectus abdomens Inferiorly---inguinal ligament |
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Clinical significance of inguinal triangle
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Localized area of weakness in abdominal wall = site for abdominal hernias (direct inguinal hernias)
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Deep Inguinal ring relationships
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Inferior epigastric artery (used to pass underneath arcuate ligament); ductus deferens (leaves); testicular artery (enters from psoas major); genital branch of genitofemoral nerve (enters to lie on spermatic cord)
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Where do testicles develop?
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Abdomen
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Layers of Spermatic cord
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External spermatic fascia
Cremaster muscle Internal spermatic fascia |
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Contents of Spermatic cord
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Ductus deferens, testicular artery, pampiniform plexus of veins, genital branch of genitofemoral nerve, lymph vessels
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External spermatic fascia
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Continuous with external abdominal oblique
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Internal spermatic fascia
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Continuous with transversus abdominis
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Cremaster muscle
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Strands of internal oblique pulled down into spermatic cord; innervated by genitofemoral nerve
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Tunica vaginalis
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Peritoneal extension covering testes on anterior and lateral sides
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Gubernaculum testis
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Guides descent of testes in scrotum
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Process vaginalis
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Pulls portion of peritoneum into scrotum during descent of testes (becomes tunica vaginalis)
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Hydrocele
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Fluid build up in scrotum; common in newborns
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Indirect inguinal hernia
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Herniation of abdominal contents through deep inguinal ring, inguinal canal, and superficial inguinal ring; finds cracks and worms through (no busting through); emerges lateral to inferior epigastric artery
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Direct inguinal Hernia
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Herniation through local weakness in abdominal wall in region of inguinal triangle; emerges medial to inferior epigastric artery
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Inguinal vs Femoral hernia
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Inguinal = above and medial to pubic tubercle
Femoral = below and lateral to pubic tubercle |
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Peritoneum Description and Location
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Continuous serous membrane lining abdominal wall and organs; deep to transversalis fascia; Parietal and Visceral layers; mesenteries
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Mesenteries
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Peritoneum that carries arteries, nerves, veins, and lymphatics between abdominal organs and body wall
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Peritoneum functions
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Reduces friction to facilitate free movement; resists infection by exuding fluid and cells; stores fat
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Structures associated with peritoneum
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Ligaments; folds; recess
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Peritoneal problems
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Peritonitis; Ascites; Adhesions
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Mesenteries that connect stomach, small intestine, and large intestine to posterior body wall
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Mesogastrium, transverse mesocolon, mesentery proper, sigmoid mesocolon
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Greater omentum
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Peritoneal fold that hangs from greater curvature of stomach down in front of transverse colon where it attaches
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Lesser omentum
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Connects lesser curvature and first part of duodenum to liver
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Hepatoduodenal ligament carries?
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Major vessels and ducts to/from liver
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Peritoneal cavity subdivisions
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1. Lesser sac (omental bursa): remnant of right half of coelomic cavity
2. Greater sac: communicates with lesser sac by epiploic foramen |
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Greater omentum ligaments
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Gastrocolic
Gastrosplenic Gastrophrenic |
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Lesser omentum ligaments
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Hepatogastric
Hepatoduodenal |
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Location of epiploic foramen?
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Posterior to hepatoduodenal ligament
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Peritoneal folds
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Falciform ligament (superior to umbilicus)
Median, medial (2), and lateral (2) umbilical folds (inferior to umbilicus) |
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Retroperitoneal structures
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Organs posterior to parietal peritoneum along dorsal body wall that are relatively fixed: 2nd and 3rd part of duodenum, ascending colon, descending colon, pancreas, kidney, major blood vessels
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Anatomical lobes of liver
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Right lobe (right of falciform ligament)
Left lobe (left of falciform ligament) Quadrate lobe Caudate lobe |
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Functional lobes of liver
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Right: right anatomical
Left: left anatomical, quadrate, caudate |
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Quadrate and Caudate lobes of liver location
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On right anatomical side of liver; quadrate is beside gallbladder; caudate is beside IVC
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Liver covered by visceral peritoneum except?
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Bare area and where gallbladder lies
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What connects liver to anterior abdominal wall?
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Falciform ligament
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What connects liver to stomach?
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Lesser omentum
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Glissons capsule
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Collagenous capsule that covers the external surface of liver; exposed only in bare area
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Triangular ligament
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Right and left coronary ligaments
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Porta hepatis
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Entrance/exit on inferior side of liver for hepatic portal vein, proper hepatic artery and hepatic duct
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Falciform ligament
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Midline fusion of left and right coronary ligaments; derived from ventral mesentery of embryo
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Ligamentum tere hepatis
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Represents obliterated umbilical vein of embryo
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Potential spaces adjacent to liver
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Subphrenic recess, Hepatorenal recess, Subhepatic recess
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Recess that fluids will drain to around liver when supine?
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Hepatorenal recess
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Digestive tract
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Esophagus, Stomach, Duodenum, Jejunum, Ileum, Ascending colon, Transverse colon, Descending colon, Sigmoid colon, Rectum,
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Esophagus enters stomach at?
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Gastroesophageal junction
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Hiatal hernia
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Movement of cardiac portion of stomach up into thorax
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Sphincters of stomach
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Lower esophageal and pyloric sphincters
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Fundus of stomach
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Everything above the lower esophageal sphincter
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Rugae
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Longitudinal folds on inner surface of stomach
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Anterior/Superior relationships to stomach
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Anterior abdominal wall, Left costal margin, Diaphragm
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Posterior relationships to stomach
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Diaphragm, Left suprarenal gland, Upper pole of left kidney, Pancreas, Left colic flexure (splenic flexure)
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Left relationships to stomach
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Spleen
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Right relationships to stomach
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Quadrate and left lobes of liver
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Organs that are secondarily retroperitoneal
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Pancreas, 2nd and 3rd parts of duodenum
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Main pancreatic duct
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Conducts pancreatic digestive enzymes into GI tract at duodenal papilla
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Accessory pancreatic duct
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Empties into duodenum proximal to main pancreatic duct
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Right and left hepatic ducts
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Moves bile formed in liver out
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Gall bladder function
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Stores and concentrates bile
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Cystic duct
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Duct from gall bladder
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Common bile duct
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Cystic and common hepatic duct join to form; empties into duodenum
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Sphincter of Oddi
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At end of common bile duct; if closed, bile goes back up to the gall bladder
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Duodenum divisions
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Rostral horizontal, Descending, Caudal horizontal, Ascending
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Ampulla of Vater
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Joining of main pancreatic duct with common bile duct
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Gallstones most common in?
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Men; over 40; Native Americans; Diabetes people
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Mesenteric windows
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Jejunum exhibits this, where fat is kept away from intestinal wall
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Taeniae coli
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Longitudinal bands of smooth muscle on external colon
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Haustra
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A bundle of large intestine formed by taeniae coli
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Haustra function
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Resorption of water from feces
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Appendages epiploicae
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Tags of fat attached to taeniae coli
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Demarkation of midgut and hindgut
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Splenic flexure of colon
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Point where parasympathetic innervation changes from vagus nerve to sacral nerves
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Splenic flexure of colon
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Division between foregut and midgut
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Site where biliary tree enters in 2nd part of duodenum
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Unpaired branches off of abdominal aorta
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Celiac artery
Superior mesenteric artery Inferior mesenteric artery |
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Celiac artery
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Supplies foregut structures (liver, stomach, pancreas, duodenum, spleen); surrounded by celiac plexus
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Superior mesenteric artery
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Supplies midgut regions (duodenum, jéjunum, ileum, colon); surround by superior mesenteric plexus
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Inferior mesenteric artery
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Supplies hindgut structures (descending colon, sigmoid colon, and superior part of rectum)
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Paired branches off of abdominal aorta
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Inferior phrenic artery
Renal artery Lumbar arteries Testicular/ovarian arteries Common iliac artery |
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Inferior phrenic artery supplies?
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Diaphragm
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Renal artery
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Supplies kidneys; usually has suprarenal branch to supply suprarenal (adrenal) gland
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Lumbar arteries
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5 segmental arteries supplying posterior body wall
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Common iliac artery
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Terminal branches of abdominal aorta; branches into external and internal iliac arteries
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What organ has poor collateral circulation?
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Kidney
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Celiac trunk divisions
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Left gastric artery
Splenic artery Common hepatic artery |
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Left gastric artery
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On lesser curvature of stomach; anastomoses with right gastric artery
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Splenic artery branches
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Has two branches: Pancreatic artery and left gastroepiploic artery (runs along greater curvature of stomach)
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Common hepatic artery branches
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Right gastric artery
Gastroduodenal artery Proper hepatic artery |
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Branches of gastroduodenal artery
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Right gastroepiploic artery
Superior pancreaticoduodenal artery |
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Branches of Proper Hepatic artery
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Right hepatic artery
Cystic artery Left hepatic artery |
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Branches of Superior Mesenteric artery
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Inferior pancreaticoduodenal artery
Iliocolic artery Right colic artery Middle colic artery Intestinal arteries (8-12) Marginal artery |
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Iliocolic artery supplies?
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Ileum, cecum, appendix, ascending colon
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Right colic artery supplies?
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Ascending colon and transverse colon
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Middle colic artery supplies?
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Transverse colon
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Intestinal arteries supply?
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Jejunum and ileum; form arcades, which divide into straight vasa recti
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Marginal artery
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Anastomoses along border of large intestine with branches of ileocolic, middle colic, right colic, and inferior mesenteric arteries
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Inferior Mesenteric artery branches
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Left colic artery
Sigmoid artery Superior rectal artery Marginal artery |
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Left colic artery supplies
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Descending colon
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Inferior Vena Cava drains?
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Lower limbs, trunk, kidneys, and gonads
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Inferior Vena Cava tributaries?
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Common iliac veins, renal veins, lumbar veins, and right gonadal vein
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Left gonadal vein
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Drains into left renal vein
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Tributaries of hepatic portal vein
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Superior mesenteric vein and Splenic vein (inferior mesenteric usually drains into splenic before)
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Hepatic portal system function
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To divert blood from gastrointestinal system, pancreas, and spleen for enzymatic processing by liver
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Hepatic veins
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Filtered blood from liver goes to IVC
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Portocaval anastomoses
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1. Superior rectal vein with inferior rectal line
2. Branches of colic veins with the renal veins 3. Remnant of left umbilical vein with paraumbilical and superior/inferior epigastric veins 4. Esophageal veins (gastric) with esophageal veins (azygos) |
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Increase in hydrostatic pressure in venous portal system?
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Obstructions in return of blood through liver; alternate pathways are found at sites where venous drainage is shared by both hepatic portal and systemic venous system
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Causes of blockage of venous drainage?
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Pregnancy, cirrhosis of liver
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Enlargement of rectal vessels
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Hemorrhoids
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Enlargement of esophageal veins
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Esophaeal varices
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Enlargement of paraumbilical/epigastric veins
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Caput medusa
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Renal sinus
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Site where vessels and ureter enter and leave kidney
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Renal cortex
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Outer portion of kidney; glomeruli for blood filtration; renal columns
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Renal medulla
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Inner portion; composed of renal pyramids that contain tubules ducts for water resorption
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Renal papillae
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Apex of renal pyramids; extend into minor calyx
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Minor calyx
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Receives fluid single renal papilla; several minor calyces form a major calyx
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Major calyx
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Join to form single renal pelvis
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Renal pelvis
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Receives drainage of major calyces; continues as ureter
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Which kidney is higher?
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Left
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Renal arteries carry how much cardiac output?
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About 20%
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Restriction points of ureter
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1. Narrowing of pelvis to ureter proper
2. Ureter crosses common iliac artery bifurcation before bending down into pelvis 3. Penetration of bladder wall |
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Symptoms of kidney stones
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Flank, lower abdomen, and groin pain; blood in the urine
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Adrenal glands
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Superior to kidneys; secretes steriod hormones (outer cortex) and catecholamines (inner medulla)
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Posterior abdominal wall muscles
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Quadratus lumborum
Psoas major Iliacus |
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Quadratus lumborum attachments
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Rib 12 and tips of lumbar TP to iliolumbar ligament
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Quadratus lumborum innervation
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Ventral primary rami of T12, L1, L2, L3
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Psoas major attachments
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Lumbar TP to common tendinous attachment on lesser trochanter of femur
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Quadratus lumborum functions
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Stablizes T12 in inspiration; Laterally flexes trunk
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Psoas major functions and innervation
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Flexor of thigh; Ventral primary rami of L1-L3
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Iliacus function and innervation
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Flexor of thigh; Femoral nerve
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Lumbar plexus nerves
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Iliohyposgastric nerve
Ilioinguinal nerve Lateral femoral cutaneous nerve Genitofemoral nerve Femoral nerve Obturator nerve Lumbosacral trunk |
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Lumbar plexus location
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Formed by ventral primary rami of L1-L4 and contribution of T12
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Iliohypogastric nerve innervation
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Cutaneous of posteriolateral gluteal region and suprapubic area
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Ilioinguinal nerve innervation
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Cutaneous of proximal medial thigh and scrotum/mons pubis
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Lateral femoral cutaneous nerve innervation
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Cutaneous of lateral side of thigh
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Genitofemoral nerve
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Cutaneous of genitalia and thigh; genital branch joins spermatic cord to innervate cremaster muscle
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Femoral nerve innervation and origin
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Anterior region of thigh; L2-4
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Obturator nerve innervation and origin
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Medial side of thigh; L2-L4
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Lumbosacral trunk
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Contributes lumbar fibers to sacral plexus; L4-5
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Greater splanchnic nerve
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Preganglionic sympathetic fibers that innervate celiac ganglion
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Lesser splanchnic nerve
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Preganglionic sympathetic fibers that innervate aorticorenal ganglion
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Least splanchnic nerve
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Preganglionic sympathetic fibers that innervate renal ganglion
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Lumbar splanchnic nerves
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L1-3 enter into inferior mesenteric plexus and contribute fibers to superior hypogastric plexus
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Postganglionic sympathetic cell bodies located?
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In collateral ganglia around major vessels in abdomen
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Preganglionic parasympathetic cell bodies located?
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Dorsal motor nucleus of vagal nucleus
S2-S4 of spinal cord |
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Postganglionic parasympathetic cell bodies located?
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In walls of organs they innervate
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Postganglionic fibers innervate?
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Smooth muscle of GI tract
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Superficial lymphatic drainage of abdomen
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Superior to umbilicus: Ultimately to axillary nodes
Inferior to umbilicus: Superficial inguinal nodes |
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Visceral nodes of abdomen
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Celiac, superior mesenteric, inferior mesenteric nodes
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Celiac node group
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Left gastric, right gastric, hepatic, pyloric, pancreatico-splenic
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Superior mesenteric node group
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Mesenteric, Ileocolic, right colic, middle colic
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Inferior mesenteric node group
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Left colic, Sigmoid, Superior rectal
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Parietal nodes of abdomen
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Follows major vessels; each has groups of 2-8 nodes named from associated vessel
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Lumbar nodes
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Receive drainage from lymphatics associated with abdominal organs
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Intestinal trunks
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Receive drainage of lumbar nodes; drain into cisterna chyli
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