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222 Cards in this Set
- Front
- Back
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Pelvic inlet
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Separation between abdominal organs and pelvis
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What is the shape of the diaphram?
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Shape of diaphram changes continusously w/breathing
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What causes flattening of diaphram?
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COPD or rupture by trauma can flatten diaphram
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What happens when u relax the abdominal wall?
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Contracts diaphram = inspiration
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What happens when u contract abdominal wall?
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Relaxes diaphram = expiration aka sucking in your gut
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What is the valsalva maneuver?
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↑ intraabdominal pressure = closed glottis + sphincter tone is maintained
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Where is the transumbilical plane?
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L3-L4 disc
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What are the dividing lines in the 9 region orginizational pattern?
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4 lines of reference = 1. midclavicular lines, 2. subcostal plane, 3. transtubercular plane
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What is the line called at the lateral part of the rectus abdominus?
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Linea semilunaris
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What is the mid line in the abdomen called?
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Linea alba
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What is the vertebral level of umbilicus?
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L3-L4
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What level is the transpyloric plane?
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L1 = end of the stomach
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What level is the bifucation of the abdominal aorta?
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L4-L5 (near the umbilicus)
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What strctures do the transpyloric plane cut through?
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1. Fundus of gall bladder, 2. neck of pancrease, 3. SMA, 4. Portal vein, 5. transverse mesocolon, 6. duodenaljejunal junction, 7. hila of the kidney
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What are the layers of the abdominal wall?
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1. Parietal peritoneum, 2.
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When u sew the abdominal wall
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Scarpas fascia - pass thru the fat + pass thru the other fat
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What is the covering on the intestines?
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Parietal peritoneum
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What muscle becomes the inguinal ligament?
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External abdominal oblique - direction = hands in pockets, Ligamentous attachments = ASIS -> pubic tubercle
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What muscle atatches to the aponeurosis of the external abdominal oblique?
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Pectoralis
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What is the direction of the interanl abdominal oblique muscle?
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Hands on chest
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Which direction does the transcersusu abdominus muscle go?
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Horizontal
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Aponeurosus
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Like a tendon except thinner
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What is sewn back together after a midline incesion?
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Linea alba - the membrane between the rectus abdominus muscles- umbilicus is relatively in the same spot
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What is the muscle that is present in 20% of people and triangle shaped near the pubic symphesis?
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Pyramidalis muscle
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Which direction is the intramuscular exchange of fibers?
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90 ° to each other
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What is the fascial layer above the arcuate line?
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Rectus abdominus sheath
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What is covering the muscle below the arcuate line?
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Muscle covered by PERITONEUM below the arcuate line
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How many round ligaments in females?
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3
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What continues below the dome of the diaphram?
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Lungs extend well below the top of the abdomen on both sides - thus if someone is shot in the chest wall near the diaphram u have to consider the lungs too
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What are the layers of the abdomen above the arcuate line?
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What are the layer of the abodomen below the arcuate line?
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What are the muscles of the abdominal wall?
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1. Quadratus lumborum, 2. iliacus, 3. psoas major
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What is the floor of the inguinal canal?
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Inguinal ligament
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What is seen exiting the inguinal canal?
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Spermatic cord
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What layer of the abdomen forms the superficial/ external inguinal ring?
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External abdominal oblique -> inguinal ligament -> superficial/external inguinal ring
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What layer of the abdomen forms the deep inguinal ring?
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Transversalis fascia
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What arteries are in anastomosis in the abdome?
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Epigasstric arteries
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Where does the ilioinguinal nerve cutaneous innv?
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Goes to groin and thigh - ilioinguinal (L1)
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Where does the iliohypogastric nerve emerge in the abdomen?
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Iliohypogastric (L1)emerges through the aponeurosis of the EXTERNAL ABDOMINAL OBLIQUE
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Where does the ilioinguinal emerge in the abdomen?
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Ilioinguinal (L1) is shown emergin through external ring w/spermatic cord
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Mcburneys point
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Where we do incision for the appendectomy
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Pfannensteil
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Bikini cut - in OB-GYN
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What vein is used in an IVC occlusion?
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Thoracoepigastric vein is enlarged - blood being drained around the IVC obstruction
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What artery is used in a cardiac by pass?
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Left internal thoracic artery -> causes more blood to come up from the inferior epigastric artery in the abdomen
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In what fold does the inferior epigastric vessels run?
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Lateral umbilical fold
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Where does the gonadal tissue start?
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Near the kidneys -> descends thru the abdominal wall -> creates scrotum -> brings all its blood supply and nervous attachments with it
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Gubernaculum
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Acts as a guide and anchor but does not pull testicle
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What 2 things does the external abdominal oblique form?
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1. External ring, 2. inguinal ligament
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What type of angle does the spermatic cord travel?
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Spermatic cord travels obliquely thru the abdominal wall
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NAVEL from lateral to medial
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Nerve, artery, vein, empty space, lacunar ligament
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Stand on the right side - Left hand on artery and vein is medial to it
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Lacunar ligament
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Tissue that is between the bone and inguinal ligmanet near the pubic tubercle
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Pectineal ligament
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Crura of the external rign
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Lateral + medial crura (1/2 each of the circle of tissue)
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What does the internal oblique muscle become?
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Layer goes with the spermatic cord -> becomes the cremasteric fascia/muscle
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Cremater reflex
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Run hand up leg and then testicles rise up
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What forms the roof of the inguinal canal?
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Transversus absominis
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What forms the internal/deep inguinal ring?
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Transversalis fascia
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Iliopubic tract
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?
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What does scarpas fascia become in the scrotum?
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Dartos fascia = scarpas fascia in the scrotum + attaches to inguinal ligament + fascia lata of the thigh
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Pectineal ligament
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Thickened periosteum
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Which direction does the ductus deferens turn to go to the prostate?
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Inferiorly
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Female equivilent of ductus deferens
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Female round ligament
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Lymphatics of testicle
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Lymphatics of scrotum
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Testicular artery
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Indirect hernia
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Indirect follow indirect course through the canal - starts
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Direct hernia
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Goes directly thru the abdominal wall -> into the scrotum
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Inguinal triangle
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1. Rectus muscle, 2. inferior epigastric arteyr, 3. inguinal ligament. Location of the internal and external rigng- if its lateral to epigastric vessels = indirect hernia, if hernia in hasselbach triangle = direct hernia
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Tap at the end of finger vs side of finger
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Hernia bulging towards you
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What type of hernia does a baby have?
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Indirect hernia - follows the patent tunica vaginalis
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Working doesn’t cause the hernia
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Straining does (caughing, sneezing, deficating); problems = recurrent respiratory infections + constipation
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Incarcerated indirect hernia
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Incarcerated = stuck -> strangulated -> necrotic -> surgical emergency
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What is the disease of undescended testis?
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Cryptochidism - if testicle is not in the scrotum by 1 yo it is in the INGUINAL CANAL -> ↑ risk on the contralateral side of a tumor
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Patent processus vaginalis causes what problems?
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Indirect hernia
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Hydrocele in scrotum
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Diagnsed by trans-illumination with light source + could have indirect hernia b/c of patent tunica vaginalis; treat hernia -> hydrocele can go away
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Excessive development of pampiniform plexus
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Air conditioning system of testicles -> VARICOCELE = "Bag of wrom"
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Testicular torsion
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Surgical emergency -> diagnosis with ultrasound to check blood supply to testicle ->
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Femoral hernia
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In the thigh/leg and goes thru the empty space in NAVEL
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Lateral border of rectus muscle where it meets arcuate line below belly button. Small weak spot -> lump
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Spigelian hernia - lump on the abdominal wall
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What is peritoneum?
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Stuff that holds the guts together + is everywhere
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What sticks to inflammation an stops the spread of it?
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Greater omentum
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What structure is used in dialysis?
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Peritoneal dialysis uses the greater surface area to remove waste products from blood by diffusion
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What ligament is formed fro peritoneum as is the round ligament?
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Falciform ligament
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Lesser omentum (aka hepatogastric ligament)
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Connects liver to stomach
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Edge of lesser omentum
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Hepatoduadenal ligmaent
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What goes thru the hepatoduadenal ligament?
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Portal triad -> digestive tract; thru the epiploid foramen (hepatoduadenal ligament + liver)
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What is the fluid that comes off a severe liver disease?
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Ascitic fluid = severe liver disease that the liver loses fluid
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What is the space below the colon?
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Infracolic
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What is the space above the colon?
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Supracolic
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What is the pringles maneuver?
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Index finger thru epipolic foramen around the portal triad. Compresses the hepatic artery and the portal vein to stop bleeding from the liver. Bile duct is present but not important to hemostasis
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What lvl does the abdomen end?
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Bottom of L4
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What lvl does the pelvis begin?
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Top of L5
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In what space is the ureters, great vessels, and muscles of the posterior abdominal wall?
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retroperitoneal
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In which direction is the appendix?
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Posterior position
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What organ is the gallbaldder resting on?
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Liver
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What is behind the stomach?
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Pancreas
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Where does the liver and pancreas provide digestive juices?
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Delivers to 2nd portion of the duodenum
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Where is bile stored?
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Gall bladder
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What are the 3 main branches off the abdominal aorta?
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1. Celiac, 2. superior mesenteric, 3. inferior mesenteric
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Where is venous drainage of the GI routed to?
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Routed to the liver
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What two veins join to become the portal vein?
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Splenic vein + SMV = portal vein
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Is venous blood devoid of O2?
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No its just lower in O2 content. Rich in nutrients
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Z line?
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where the esophagus becomes stomach lining = root of esophagus -> stomach= esophagogastric junction
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Where is the omenta attached?
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Its attached to the stomach + colon (gatrocolic ligament)
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What is the area called if u cut the stomach out of where its sitting?
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Stomach bed - contatins the omental bursa + splenic artery + tail of pancreas
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What are the 3 things that are in contact with the stomach?
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1. Spleen, 2. kidney, 3. colon
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What is the primary organ making up the stomach bed?
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Pancreas
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What is holding the transverse colon to the abdominal wall?
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Mesocolon
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What is the disease called if the stomach is pulled into to the thorax? problems
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Hiatal hernia -> reflux -> sx -> pull stomach down -> sew the diaphram closed
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What happens when there is a paraesophageal hernia?
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The z-line is fine but the stomach fundus goes into the abdomen -> stragulation -> stopped food -> bacteria -> pressure -> serous symptoms -> cut off blood supply -> necrosis -> operation is needed quickly
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Barium study
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Done under floroscopy - activly drinking contrast -> radiologist is taking the picutres on and off
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What part of the stomach goes up into the thorax in the paraesophageal hernia?
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Fundus
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What is the folds in the stomach called?
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Rugae
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What disease Flattens out the rugae in the stomach?
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Lynitus plastica (stomach cancer)
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Circular folds
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Jejunum
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What is the muscle that closes off the stomach?
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Pylorus
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What provides parasympathetic innv to the stomach, liver, pyloris?
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Anterior + posterior vagus
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Where does the sympathetic nerve fibers arise in the abdomen?
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In the celiac plexus
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Where does the lymp from the stomach and abdominal esophagus drain to?
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Celiac plexus (lymph)
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If there is a lymphadenopathy in the liver and stomach. What location is the lymph nodes?
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Celiac region
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Where does the inferior meseneteric vein dump into?
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Dumps into the splenic vein
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What is the sympathetic innv of the stomach and small intestine?
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Sympathetics from the greater splanchnic, celiac plexus, and periarterial plexuses
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Which portions of the duodenum are mobile?
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First portion and the 4th part of the duodenum are mobile
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Which parts of the duodenum are fixed?
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Second and third part of the duodenum are fixed in location
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What is the vertebral level of the first part of the duodenum?
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L1
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What is the vertebral level of the third part of the duodenum?
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L3
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What vessels run over the their part of the duodenum?
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Superior mesenteric vessels run over the third portion of the duodenum
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If the vomit is green?
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The food is after the 2nd part of the duodenum
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What is the problem in SM A syndrome?
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Angle of the SMA becomes too sharp the patient has vomit of food + digestive juices (green bile)
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How do u fix SMA syndrome?
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Do a GI bypass. Cut the jejunum -> connect it back to the stomach
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What is the ligament that divides the duodenum and jejunum?
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Suspensory ligament of treitz - divides the upper GI bleed vs the lower GI bleed
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What color is a upper GI bleed?
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Red
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What color is a lower GI bleed?
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Black sticky and tarry
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What are the branches off the superior pancreaticoduodenal artery?
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Anterior and posterior pancreaticoduedenal arteries
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What are the 3 branches off the celiac trunk?
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1. Splenic, 2. left gastric, 3. common hepatic
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What are the branches off the common hepatic?
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1. Gastroduodenal artery, 2. proper hepatic
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What are the branches of the gastroduodenal artery?
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1. Right gastro-omental, 2. superior pancreaticoduodenal artery
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What are the branches of the superior pancreaticoduodenal artery?
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1. Anterior pancreaticoduodenal, 2. posterior pancreaticoduodenal artery
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What does the pancrease wrap around?
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The portal vein, IVC, abdominal aorta
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Where are the arterial arcades more prominent in?
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Ileum
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Where are the vasa recta longer?
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Jejunum
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Where are the walls of the small intestine thicker?
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Jejunum
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Where is the cancer in the left half of the colon?
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Inferior mesenteric nodes
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Wehre is the cancer in the small intestine?
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SMA nodes
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What is providing parasympathetic innv of the small intestine?
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Vagus
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What are providing ysmpathetic innv of the small intestine?
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Sympathetic trunks in the abdomen
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What is sitting deep to the transverse colon?
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Jejunum
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How can u tell the differeence between jejunum vs the ileum on barium?
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the jejunum has more rough parts + ileum is more smooth
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What part of the small intestine empties into the colon?
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Ileum -> cecum -> colon
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What part of the large intestine is mobile?
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Cecum
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What part of the large intestine is fixed?
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Ascending colon = fixed in location
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What is the rule of 2s for meckles diverticulum?
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2% of population, 2 feet from the ileocecal valve, 2% of trouble. Causes right sided diverticulitis
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If cancer in lower rectum and anus
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Permanent ostomy
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What is the stripe in the middle of the colon?
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Taeniae coli
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What parts of the large intestine are held down?
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Ascending + descending colon are retroperitoneal + held down by the peritoneum
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What is it called when the cecum and sigmoid colon are twisted?
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Volvulus
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What are the folds on the large intestine called?
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Haustra
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What do u inject into the rectum?
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Double contrast barium enema
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What are out pouchings in the colon called?
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Diverticuli - left side of colon
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-ostomy
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Opening to skin
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Ileostomy?
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Ilium to skin - Entiere colon dosent need to work -> heal if inflamed or iriritated
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Colostomy?
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Uses the colon but avoids the sigmoid and rectum -> allows healing
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A diverting colostomy with a closed rectal pouch for ruptured diverticulitis. What is the procedure called?
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Hartmann's procedure - allows healing + can be reversed later
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Where does the ureter go relative to the large vessels that go into the leg?
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Ureter = superficial to the leg vessels
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Which direction does the SMA face?
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To the right
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Which direction does the IMA face?
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To the left
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What is the last branch off the IMA?
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Superior rectal artery
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Where does the middle and inferior rectal artery come from?
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From the internal iliac artery
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What artery causes anastomosis in the large intestine?
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Marginal artery
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Where is the superior ganglionic plexus located?
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SMA
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Where is the inferior ganglionic plexus located?
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IMA
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Where is the hypogastric plexus located?
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On the sacrum
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When dose the parasympathetic innv switch to S2, 3, 4?
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At the 1/3 descending transverse colon
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Where is the appendiceal opening located?
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Located next to the ileal orifice
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What type if imaging is used to diagnose a ruptured appendix?
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Ultrasound
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What is another name of the right colic flexture?
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Hepatic flexture
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What is another name for the left colic flexture?
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Splenic flexture
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What are the symptoms of malrotation of the stomach?
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1. Stomach extends lower into abdomen, 2. jejunum is bunched in RUQ, 3. colon is not in its usual place
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What organs are located in the transpyloric plane?
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L1 - pancraese, kidneys, portal vein, SMA,
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What is the largest solid gland in the body?
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Liver
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What covers the liver on its posterior side?
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Coronary ligament + R + L tringular
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Why is there a bare area on the liver?
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Because part of the liver is touching the diphram
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if u poured water in the Pelvis where does it accumulate?
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Rectovesical pouch
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If u poured water above the xyphoid process. Where does it accumulate?
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Hepatorenal recess
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If u poured water above the transverse
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Infracolic recess
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What vessel dives into the liver?
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Portal vein
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How many hepatic segments are in the liver? What are its contents of each segment?
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8 hepatic segments + each has 1 vein out + 1 artery into + branch of portal vein + branch of biliary system coming out.
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What type of imaging if u c white bone?
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CT
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What two things make up the bile duct?
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Common hepatic duct + cystic duct
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Percutaneous transhepati cholangiogram?
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Needle through skin -> into bile duct -> inject contrast
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Endoscopic retrograde cholangio pancreatography (ERCP)
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Endoscope -> mouth -> stomach -> 2nd portion of duodenum -> catherter in main papilla -> contrast in main papilla - > find gall stones
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What carries the pain signals back to the brain in the liver/biliary system, pancreas, heart?
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Phrenic nerve -> referred pain
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What type of imaging is used to find gall stone?
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Ultrasound
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What types of problems if there are gall stones (cholelithiasis) in the bile duct?
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1. Biliary stasis, 2. pancreatitis (gall stone blocks the pancreas -> proteases back up -> digest ur own body)
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What is the lymphatic drainage of the liver?
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Celiac plexus
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Gall bladder cancer -> liver -> fatal
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Drains to hepatic nodes + ciliac nodes
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What does the pancreas make?
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Digestive juices + insulin
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What are the 4 parts of the pancreas?
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1. Head, 2. neck, 3. body, 4. tail
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What wraps around the head of the pancreas?
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duodenum
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Where is the kidney located? Intraperitoneal or retroperitoneal
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Kidney - intraperitoneal
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What artery supplies the gall bladder?
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Cystic artery
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What happens if u block the gall bladder and then have bacteria
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Infection
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Problem in heart attack is lack of O2 in cardiam myosites
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What is it called when there is a back log of venous blood shown on the belly button?
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Caput medusa
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What veins take over for the portal vein if the protal vein is blocked off in the liver?
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Left gastric v -> esophageal vericosies
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Upper GI bleed if it goes thru the body mouth? Rectum?
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Mouth = maroon, rectum = black
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Lower GI bleed if ig goes through body?
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Rectum = maroon
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What are the 4 places for portal hypertension?
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1. esophageal vericoscies
2. hemorrhoids 3. caput medusa 4. swollen connectsion between systemic and portal systems of bare area of liver 5. swollen connections between veins asscciated with retroperitoneal parts o fthe gastro-intestinal tract and teh body wall |
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If a patient is unable to get a replacement liver what do they do?
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They bypass the liver -> allows the pressure in the portal vein to be releived. Prevents bleeding to death
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What are the muscles of the posterior abdominal wall?
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1. Psoas major, 2. iliacus
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What nerve passes thru the diaphram with the IVC?
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Right phrenic nerve
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What nerve passes thru the diaphram with the esophagus?
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Anterior and posterior vagal trunks
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What happens if the thoracic duct is damaged?
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Chyle leaks -> fat comes out of the intestine -> thoracic duct -> pleural cavity leak
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What connects the crura?
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Median arcuate ligament = connects the crura
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Contraction of the diaphram move it which direction?
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Down
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What is the blood supply to the diaphram?
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1. Superior phrenic a, 2. inferior phrenic a
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What is the irritation if the phernic nerve?
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Hiccups
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Right kidney is lower b/c?
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Of the liver
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Which muscle protects most of the kidney?
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Quadratus lumborum muscle
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What test do u use to check for infected kidneys?
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Lloyd's punch - thumping the patients kidney
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