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182 Cards in this Set
- Front
- Back
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Name two layers of superficial fascia
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Campers and Scarpas
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Linea alba
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Line between two rectus abdominis muscles
Extends from xiphoid process to pubic symphysis Formed by fusion of aponeuroses of external oblique, internal oblique and transverse muscles of abdomen |
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Rectus Sheath
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Formed by fusion of aponeuroses of external oblique, internal oblique and transverse muscles
Encloses rectus abdominis and sometimes pyramidalis -also contains superior and inferior epigastric vessels and ventral rami T7-T12 |
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Anterior layer of rectus sheath
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Above arcuate line - aponeuroses of external and internal oblique
Below arcuate line- aponeuroses of external, internal and transverse muscles |
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Posterior layer of rectus sheath
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Above arcuate line - aponeuroses of internal oblique and transverse
Below arcuate line - rectus abdominis in contact with transversalis fascia |
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Boundaries of Hesselbachs triangle
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Rectus abdominis
Inguinal ligament Inferior epigastric |
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Hesselbachs triangle is site for
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Direct inguinal hernia
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Superficial ring
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Triangular opening in aponeurosis of external oblique that lies just lateral to pubic tubercle
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Deep inguinal ring
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Lies in transversalis fascia, lateral to inferior epigastric vessels
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Inguinal canal runs from..
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Deep to superficial inguinal rings
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Inguinal canal transmits
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-Spermatic cord or round ligament of uterus
-genital branch of genitofemoral nerve Also run through deep inguinal ring |
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Indirect inguinal hernia passes through
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Inguinal canal
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Does ilioinguinal nerve passe through inguinal canal
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Yes, passes through the inguinal canal and superficial inguinal ring but does not pass through deep inguinal ring
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Anterior wall of inguinal canal
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Aponeuroses of external and internal oblique
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Posterior wall of inguinal canal
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aponeurosis of transverse abdominal and transversalis fscia
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Superior wall (roof) of inguinal canal
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Arching fibers of internal oblique and transverse muscles
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Floor of inguinal canal
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Lacunar and inguinal ligaments
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Where does inguinal hernia occur
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Superior to inguinal ligament
Medial to pubic tubercle |
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Pathway of indirect inguinal hernia
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Through the deep inguinal ring, inguinal canal, superficial inguinal ring, descends in scrotum
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Indirect inguinal hernia in relation to inferior epigastric vessels is..
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Lateral
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Which side is indirect inguinal hernia usually on
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Right
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Which hernia is more common
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Indirect
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If indirect hernia is congenital, what caused it
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Persistent processus vaginalis
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Pathway of direct inguinal hernia
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Goes directly through posterior wall of inguinal canal in triangle of Hasselbach but DOES NOT go to scrotum
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Direct inguinal hernia in relation to inferior epigastric vessel
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Medial
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Spermatic cord is composed of
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Ductus deferens
Testicular and cremastic arteries Pampiniform plexus of testicular veins Genital branch of genitofemoral and cremasteric nerves and testicular sympathetic plexus Lymph vessels |
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External spermatic fascia is derived from
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External oblique
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Cremasteric fascia originates in
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Internal oblique muscle
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Internal spermatic fascia derived from
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Transversalis fascia
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Supravesical fossa
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Depression on anterior abdominal wall between median and medial umbilical folds
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Medial inguinal fossa
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Depression on anterior abdominal wall between medial and lateral umbilical folds of peritoneum
-Lateral to supravesical fossa -Site for direct inguinal hernias |
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Lateral inguinal fossa
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Depression on anterior abd wall, lateral to lateral umbilical fold
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Which umbilical fossas is site for direct inguinal hernia
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Medial inguinal fosssa
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Median umbilical ligament is a remnant of
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urachus
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Median umbilical ligament lies
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Between transversalis fascia and peritoneum and extends from apex of bladder to umbilicus
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Medial umbilical ligament is a remnant of
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Umbilical artery
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Medial umbilical ligament is located
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Between transversalis fascia and peritoneum and extends from side of bladder to umbilicus
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Lateral umbilical fold
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Covers inferior epigastric vessels and extends from medial side of deep inguinal ring to arcuate line
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Transversalis fscia
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Lining fascia of entire abdomenopelvic cavity between parietal peritoneum and inner surface of abdominal muscles
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What fascia forms deep inguinal ring
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Transversalis
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Nerves of anterior abdominal wall
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Subcostal
Iliohypogastric Ilioinguinal |
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Subcostal nerve is a ventral ramus of
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12th thoracic nerve
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Subcostal nerve innervates
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Muscles of anterior abdominal wall
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Subcostal nerve has a branch. It is..
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Lateral cutaneous branch - innervates skin of the side of the hip
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Iliohypogastric nerve arises from
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L1
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Iliohypogastric nerve innervates
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internal oblique and transverse abdominal muscles
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Iliohypogastric nerve has two branches. Name them, what do they supply
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Lateral cutaneous branch supplies skin of lateral side of buttocks
Anterior cutaneous branch - supplies skin above pubis |
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Ilioinguinal nerve arises from
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L1, pierces internal oblique near deep inguinal ring and accompanies spermatic cord through inguinal canal and then goes through superficial ring
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Ilioinguinal nerve innervates
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Internal oblique + transverse
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Ilioinguinal nerve has two branches. Name them, what supply?
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Femoral branch - innervates upper and medial thigh
Anterior scrotal - skin of root of penis and anterior scrotum |
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Cremasteric reflex
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Drawing up of testis by contraction of cremaster muscle when skin on upper medial thigh is stroked
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Lymphatics above umbilicus drain into
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axillary lymph nodes
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Lymphatics below umbilicus drain into
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Superficial inguinal nodes
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Superior epigastric artery arises from
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Internal thoracic artery, enters rectus sheath and descends on posterior rectus abdominis
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Superior epigastric artery anastomoses with
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inferior epigastric within rectus abdominis
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Inferior epigastric artery arises from
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External iliac above inguinal ligament, enters rectus sheath and ascends between rectus abdominis and posterior layer of rectus sheath
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Inferior epigastric anastomoses with
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superior epigastric, providing collateral circulation between subclavian and external iliac
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Inferior epigastric artery gives rise to..
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Cremasteric artery which accompanies spermatic cord
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Deep circumflex iliac artery arises from
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External iliac and runs laterally along inguinal ligament and iliac crest between internal oblique and transverse muscles
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Superficial epigastric artery arises from
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Femoral and runs superiorly toward umbilicus over inguinal ligament
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Superficial epigastric artery anastomoses with
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branches of inferior epigastric
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Superficial circumflex iliac artery arises from
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Femoral artery
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Peritoneum definition
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Serous membrane lined by mesothelial cells
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Peritoneum has 2 layers - name them
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Visceral and parietal
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Parietal peritoenum lines
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Abdominal and pelvic walls and inferior surface of diaphragm
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Parietal peritoneum is innervated by
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Phrenic
Lower intercostal Subcostal Iliohypogastric Ilioinguinal |
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Visceral peritoneum is innervated by
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Visceral nerves that travel together with autonomic nerves
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Lesser omentum
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Double layer of peritoneum extending from porta hepatis of liver to lesser curvature of stomach and beginning of duodenum
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Lesser omentum consists of
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Hepatogastric and hepatoduodenal ligaments
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Which vessels go in lesser omentum
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Right and left gastric vessels
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Lesser omentum has right free margin that contains
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Proper hepatic artery
bile duct portal vein |
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Greater omentum is derived from
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dorsal mesentery
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Greater omentum is located
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hangs down like apron from greater curvature of stomach covering transverse colon and other abdominal viscera
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Which vessels does greater omentum transmit
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right and left gastroepiploic vessels
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Why is greater omentum called "abdominal policeman"
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Because it plugs the neck of hernial sac preventing entranc of small intestine
Adheres to areas of inflammation preventing peritonits |
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Which ligaments constitute greater omentum
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Gastrosplenic
Splenorenal Gastrophrenic ligament Gastrocollic ligament |
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Mesentery proper
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Fan shaped double fold of peritoneum that suspends jejunum and ileum from posterior abdominal wall and transmits nerves and blood vessels to and from small intestine
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Falciform ligament
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Sickle shaped peritoneal fold connecting liver to diaphragm and anterior abdominal wall
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Falciform ligament contains
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Ligamentum teres hepatis and paraumbilical vein
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Round ligament of liver
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lies in falciform ligament
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Round ligament is a remnant of
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Left umbilical vein
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Coronary ligament
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connection with bare area of the liver
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Ligamentum venosum is remnant of
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Ductus venosus
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Peritoneal cavity
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Potential space between parietal and visceral peritoneum
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Is peritoneal cavity a completely closed sac
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In males its completely closed, in females its open through uterine tubes, uterus and vagina
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Peritoneal cavity has two parts- what are they
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Greater and lesser sac
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Lesser sac
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Irregular space that lies behind liver, lesser omentum, stomach and upper anterior part of greater omentum
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Name of communication between greater and lesser sacs
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Epiploic foramen
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Lesser sac has three recesses - what are they
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Superior - behind stomach, lesser omentum, and left lobe of liver
Inferior - behind stomach extending to greater omentum Splenic |
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Paracolic gutters
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Lie lateral to ascending colon (right) and lateral to descending colon (left)
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Epiploic foramen
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Natural opening between lesser and greater sacs
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Borders of epiploic foramen
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Superior - caudate lobe of liver
Inferior - 1st part of duodenum Anterior - free edge of lesser omentum Posterior - IVC |
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What forms stomach bed
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Pancreas
Spleen Left kidney Left suprarenal gland Transverse colon+ mesocolon Diaphragm |
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Is stomach covered by peritoneum
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Yes
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4 regions of stomach
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Cardia
Fundus Body Pylorus |
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Fundus lies where
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Inferior to apex of heart, level of 5th rib
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Blood supply of stomach
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Right and left gastric arteries
Right and left gastroepiploic arteries Short gastric arteries |
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Name of longitudinal folds of mucous membrane of stomach
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Rugae
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Small intestine extends from
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pyloric opening to iliocecal junction
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Duodenum is
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C shaped tube , shortest of small intestine
Surrounds head of pancreas |
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Is duodenum retroperitoneal or peritoneal
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Retroperitoneal, except for the beginning of the first part of duodenum
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First part of duodenum is connected to liver by
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Hepatoduodenal ligament
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Blood supply of duodenum
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Celiac + SMA
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First part of duodenum is
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Duodenal cap, into which pylorus invaginates
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Second part of duodenum is
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Descending, junction of foregut and midgut
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Main pancreatic and common bile duct open into
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descending (2nd) part of duodenum
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Third part of duodenum is
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Transverse
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Transverse part of duodenum crosses
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IVC, aorta, vertebral column
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Fourth part of duodenum is
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Ascending
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What fixes in position duodenojejunal junction
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Suspensory ligament of Treitz
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Circular folds of jejunum
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Plicae circularis
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Which part of small intestine contains Peyers patches
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Ileum
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Compared to ileum, arterial arcades of jejunum
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Are less prominent
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Is vasa recta longer in jejunum or ileum
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Jejunum
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Meckels diverticulum is located
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2 feet proximal to ileocecal junction
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Which percent of population has Meckel diverticulum
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2%
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Meckels diverticulum is a remnant of
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Yolk sac
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Large intestine consists of
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Cecum
Appendix Rectum Anal canal Colon |
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FUnction of large intestine
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Convert liquid contents to semisolid feces by absorbing water, salts and electrolytes
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Is colon retroperitoneal
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Ascending and descending parts are retroperitoneal
Sigmoid and transverse have peritoneum covering called mesocolon |
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Innervation and blood supply of ascending and transverse colons
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SMA + vagus nerve
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Innervation and blood supply of descending and sigmoid colon
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IMA + pelvic splanchnic nerves
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3 distinctive features of colon
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Teniae coli - narrow bands of outer muscular coat
Haustra -sacculations Epiploic appendages - peritoenum covered sacs of fat |
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Cecum definition
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Blind pouch of large intestine
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Cecum lies in
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right iliac fossa
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Is cecum surrounded by peritonum
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Yes
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McBurneys point is located
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at junction of lateral 1/3 of line between right anterior superior iliac spine and umbilicus
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Mcburneys point is clinically significant because
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its the point of max tenderness during appendicitis
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Which organ is the largest organ and the body and largest gland
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Liver
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Is liver surrounded by peritoneum
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Yes, except bare area
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Liver is attached to diaphragm by ligaments - name them
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Coronary and falciform
Left and right triangular |
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Blood supply of liver
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Oxygenated blood from hepatic artery
Deoxygenated blood from portal vein |
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Venous blood of liver is drained by
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Hepatic veins into IVC
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Portal triad consists of
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Portal vein
Hepatic artery Bile duct |
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Right lobe of liver has two segments - name them
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Anterior and posterior
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Left lobe has two segments - name them
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Medial and lateral
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Superior medial part of left lobe is called
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Caudate lobe
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Inferior medial part of left lobe of liver is called
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Quadrate lobe
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Quadrate lobe of liver receives blood from?
Drains to? |
Left hepatic artery and drains into left hepatic duct
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Caudate lobe of liver receives blood from
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Right and left hepatic arteries
Drains into right and left hepatic ducts |
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Liver cirrhosis causes
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Portal hypertension
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Portal hypertension results in
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Esophageal varices (dilated veins in lower esophagus)
Hemoroids (dilated veins around anal canal) Caput medusa (dilated veins around umbilicus) Ascites Jaundice |
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Gallbladder is located
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Junction of right ninth costal cartilage and lateral border of rectus abdominis
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Gallbladder is in contact with
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Dudodenum and transverse colon
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Where is gallbladder located in respect to liver
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Between right and quadrate lobes
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Pancreas is located
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FLoor of lesser sac
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Is pancreas retroperitoneal
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Yes, except for small portion of tail
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If tumors are present in head of pancreas, what will clinical presentation be
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Jaundice
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Blood supply of pancreas
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Branches of splenic artery
Superior and inferior pancreaticoduodenal arteries |
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What kind of gland in pancrease
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Both endocrine and exocrine
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Name two ducts of pancreas
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Main and accesoory
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What drains bile from liver
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Right and left hepatic ducts
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Righ and left hepatic ducts form
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Common hepatic duct
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What accompanies common hepatic duct
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Proper hepatic artery+ portal vein
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What is common site of impaction of gallstones
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Cystic duct
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Common bile duct is
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Common hepatic + cystic ducts
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Ampulla of Vater is
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Common bile duct + main pancreatic duct opens into 2nd part of duodenum through papillae
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Sphincter of Oddi
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sphincter of ampulla of VAter
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Is spleen a digestive organ
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No, lymphatic organ
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Location of spleen
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Ribs 9-11
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Ventral mesentery forms
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Lesser omentum
Falciform, coronary and triangular ligaments of liver |
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Dorsal mesentery forms
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Greater omentum, mesentery of small intestine, mesoappendix, transverse and sigmoid mesocolons
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Celiac trunk arises from
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Front of abdominal aorta immediately below aortic hiatus of diaphragm, between right and left crura
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Celiac artery divides into
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Left gastric, splenic and common hepatic arteries
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Left gastric artery is
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Smallest artery of celiac trunk
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Left gastric artery has two branches - name them
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Esophageal and hepatic
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Left gastric artery runs within
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lesser curvature of stomach
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Largest branch of celiac trunk
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SPlenic artery
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Common hepatic artery gives rise to
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Proper hepatic artery
Right gastric artery Gastroduodenal artery |
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Proper hepatic artery gives rise to
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right and left hepatic arteries
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SMA arises from
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Aorta behind neck of pancreas
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Portal system
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System of vessels in which blood collected from intestinal capillaries passes through portal vein and then through liver capillary sinusoids before reaching to IVC
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Portal vein drains
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abdominal part of gut
spleen pancreas gallbladder |
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Portal vein is formed by
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SMV + splenic vein
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What kind of blood does portal vein carry
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Deoxygenated contains nutrients
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SMV accompanies
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SMA
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Aorta passes through aortic hiatus of diaphragm at level of
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T12
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Where does aorta bifurcates in right and left common iliac arteries
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L4
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IVC is formed
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on right side of L5 by union of two common iliac veins
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where does IVS pass through diaphragm
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T8
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Subcostal nerve level
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T12
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Subcostal nerve innervates
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external + internal oblique
transverse rectus abdominis pyramidalis |
