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68 Cards in this Set
- Front
- Back
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Where do the following things pass through the diaphragm:
IVC esophagus and associated vagal trunks aorta |
central tendon
esophageal hiatus posterior to median arcuate ligament |
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What marks the true versus false pelvis?
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pectineal line and the iliopectineal line
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What are the two horizontal planes used to divide the abdomen?
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The subcostal plane is defined by the inferior most margins of the 10th costal cartilages. The intertubercular plane connects the left and right iliac crests at the iliac tubercle.
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Describe the superior, inferior, and posterior bony framework of the abdomen?
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The xiphoid process, costal margin, lateral end of the 11th rib, and the 12th rib form the framework for the superior part of the abdomen (logical enough, given that the diaphragm attaches to these points). The bodies and transverse processes of the five lumbar vertebrae, as well as their intervertebral discs, form a posterior framework for the abdomen. Finally, the superior part of the sacral alae and the "false" pelvis complete the bony framework.
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What are the layers of the abdomen (superficial to deep)?
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skin to camper's fascia to scarpa's fascia to external (abdominal) oblique, the internal (abdominal) oblique, and the transversus abdominis. Deep to these muscles is the transversalis fascia, then extraperitoneal fascia, and finally the (parietal) peritoneum.
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What other fascia is the fascia of the superficial abdominal fascia continuous with?
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fascia lata
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What is continuous so urine can travel through the abdomen?
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fascia
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What is the attachment, innervation of the external abdominal oblique muscles?
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5th-12th ribs, iliac crest, aponeurosis
7th-11th intercostal nn., subcostal |
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What is the attachment of the internal abdominal oblique muscles and transversus abdominis muscle?
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Thoracolumbar fascia, iliac crest, inguinal ligament, inferior border of the lower 3 or 4 ribs, aponeurosis
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Where do the ventral rami run?
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run between the transversus abdominis and the internal oblique
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What is the attachment of rectus abdominis?
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Xiphoid, RV-VII cartilages, pubic crest and tubercle
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What contributes to the rectus sheath at the following levels:
xiphoid umbilicus inferior to arcuate line |
external oblique only
anterior: external oblique aponeurosis and internal oblique aponeurosis posterior: The internal oblique aponeurosis and transversus abdominis aponeurosis Anterior: 3 muscular aponeurosis Posterior: TA fascia |
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Why doe sthe ilioinguinal nerve not have a lateral collateral branch if the iliohypogastric has one?
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The ilioinguinal nerve is the collateral branch of the L-1 ventral ramus, so it does not have a lateral cutaneous branch
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What connects the superficial epigastric vein and the lateral thoracic vein?
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The thoracoepigastric vein
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What are the folds formed from?
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) the inferior epigastric vessels are seen to throw the parietal peritoneum into a lateral umbilical fold. The (obliterated) ulbilical artery forms a medial umbilical fold, and the obliterated urachus forms a median umbilical ligament
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What forms the inguinal triangle?
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a triangle is formed by the lateral umbilical fold (epigastric vessels), the lateral border of the rectus abdominis, and the most inferior part of the inguinal ligament
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What makes up the inferior and superior lumbar triangle?
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medially by the latissimus dorsi muscle;[3] laterally by the external abdominal oblique muscle; and inferiorly by the iliac crest. The floor of the inferior lumbar triangle is the internal abdominal oblique muscle
quadratus lumborum muscle, laterally by the internal abdominal oblique muscle, and superiorly by the 12th rib. The floor of the superior lumbar triangle is the transversalis fascia and its roof is the external abdominal oblique muscle. |
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Where does the bowel herniate in the femoral hernia?
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femoral canal
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What do bowels go through in a direct hernia? Indirect hernia?
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). In a direct inguinal hernia the bowel will go through the inguinal triangle (medial to the inferior epigastric vessels) to reach the superficial inguinal ring.
indirect inguinal hernia enters the inguinal canal lateral to the inferior epigastric vessels (lateral umbilical fold). |
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What forms the conjoint tendon?
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Aponeuroses of the internal abdominal oblique and transversus abdominis
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: the _____________ is a fibro-muscular band that guides the testis into its corresponding part of the scrotum. The _________ is a projection that forms inferiorly from the peritoneal sac
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gubernaculum
processus vaginalis |
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What layers do the testes bring with them?
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slide TF = transversalis fascia, TA = transversus abdominis, IO = internal oblique, and EO = external oblique
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What muscle and aponeurosis does not contribute to spermatic fascia?
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transversus abdominis
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What patent structure leads to an indirect hernia?
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processus vaginalis
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What is a mesentery? What is a mesentery in the abdomen?
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Two intact, opposed serosal membranes that support an abdominal organ
In the abdomen, the mesenteries are parts of the (visceral) peritoneum, a closed serous membrane |
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What is primary and secondary retroperitoneal?
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Primarily Retroperitoneal:
Develop entirely “outside” (posterior to) the peritoneum Secondarily Retroperitoneal: Developed a mesentery, but lost it by fusing to the peritoneal sac |
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What 3 places can fluid accumulate in the body?
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paracolic gutters, hepatorenal pouch, rectovesical pouch
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Where is pancreatic referred pain?
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posterior below shoulder blades
anterior above umbilicus |
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What is a Whipple procedure?
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removal of the distal segment (antrum) of the stomach; the first and second portions of the duodenum; the head of the pancreas; the common bile duct; and the gallbladder.
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How do parasympathetics and sympathetics travel in the foregut?
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Vagus follows the gut (and to a lesser extent, the arteries), sympathetics follow the arteries (which also follow the gut)
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How do nerves reach the stomach? What is the basis for referred visceral pain?
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Preganglionic sympathetics reach the stomach via the (thoracic) greater splanchnic nerves (specifically, T-6 to T-9 lateral horns in this Netter Plate). Preganglionic parsympathetics reach the stomach by the anterior and posterior vagal trunks. Note that both pathways include sensory (afferent) fibers. Those running with the sympathetics provide the basis for referred (visceral) pain.
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Where is referred pain for the liver?
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shoulder
Right T7-T10 |
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What does midgut and hindgut innervation follow? what provides parasympathetic innervation to the hindgut?
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Superior mesenteric artery
Inferior mesenteric artery S-2 to S-4 lateral horns and travelled on pelvic splanchnic nerves. |
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How can infections spread among the fascia layers? How can urine travel?
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Infections can spread from the perineal region (where Colles' fascia is located) to the scrotum via the dartos fascia or to the lower abdomen via Scarpa's fascia. Extravasted urine can also travel into the lower abdominal region deep to the superficial fascia.
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What are the layers of the jejunum?
What extra layer does the stomach have? What layer does the thoracic duodenum lack? |
serosa (visceral peritoneum)
longitudinal muscle layer circular muscle layer is deeper submucosa mucosa oblique muscle layer serosa layer |
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What are the boundaries of the midgut?
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half the descending duodenum to distal third of transverse colon
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How do you distinguish the foregut, midgut, and hindgut?
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The celiac trunk is the artery supplying the foregut, the superior mesenteric artery supplies the midgut, and the inferior mesenteric artery supplies the hindgut
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When the stomach first rotate 90 degrees around superior mesenteric?
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when midgut herniates into umbilical cord
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What does the ventral mesogastrium become?
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falciform ligament and lesser omentum
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What is the falciform ligament a remnant of?
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left umbilical vein
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What froms the lateral umbilical fold, the medial umbilical fold and the median umbilical ligament?
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the inferior epigastric vessels are seen to throw the parietal peritoneum into a lateral umbilical fold. The (obliterated) ulbilical artery forms a medial umbilical fold, and the obliterated urachus forms a median umbilical ligament
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Where is the rectovesical pouch, vesicouterine, rectouterine pouch?
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The rectovesical pouch is between the bladder and rectum in males. In females, because the uterus is between the bladder and the rectum there is a vesicouterine pouch between the bladder and the uterus and a rectouterine pouch between the uterus and the rectum.
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What is the other name of the Pouch of Douglass?
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rectouterine pouch
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What is the line of Toldt? How is it clinically important?
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line on the lateral aspects of the ascending and descending colons where the visceral peritoneum meets the parietal. For transperitoneal nephrectomies (i.e., removal of a kidney through the peritoneum) this line must be dissected to gain access to the kidney.
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Where are tranplanted kidneys placed?
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Instead, transplanted kidneys are placed by the external iliac vessels so that the ilium can support and protect the kidney. The donor kidney's renal vessels are attached to the recipient's external iliac vessels. In the case shown here, the recipient received a left kidney from his brother, which was placed in the right inguinal region.
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Arteries to the kidneys do not _______? Renal arteries have what branches?
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anastamose
anterior branch and a posterior branch |
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What is the ureteropelvic junction ?
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where renal pelvis becomes ureter
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What makes us cisterna chyli?
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intestinal
l r lumbar |
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nodes?
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superficial and deep inguinal nodes
external iliac nodes |
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kidneys lymph drainage
inferior mesenteric nodes lead to |
lumbar trunk
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superior mesenteric and celiac trunk lumph drainage leads to?
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intestinal trunk
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What makes up internal spermatic fascia?
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Transverus fascia
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What hernia goes from deep inguinal ring to superficial ring?
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indirect
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What is the great omentum?
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dorsal mesogastrium
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What makes up cremaster fasica
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EAO
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What makes up external spermatic fascia?
internal spermatic fascia? |
IAO
transversus fascia |
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What is the processus vaginalis made of?
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parietal peritoneum
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Which hernia skips the deep inguinal ring?
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direct
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What layer is not included in spermatic cord?
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transversus abdominis aponeurosis
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What makes up conjoint tendon?
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IAO and transversus fascia
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What kind of muscle is longitudinal?
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somatomotor
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What structure is posterior to the free margin of the hepatoduodenal ligament?
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epiploic foramen
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What 3 structures are in the hepatoduodenal ligament?
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Hepatic Triad:
Common bile duct Proper Hepatic Artery Hepatic Portal Vein |
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What does the right gastric artery come off of?
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common hepatic
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What arteries are in the lesser curvature?
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L R gastrics
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If you were to release an internal hernia in the paraduodenal recess, what vessels are you in danger of hitting?
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left colic artery and inferior mesenteric vein
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Does the cecum have a mesentery?
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No
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How do you get hemorrhoids?
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high portal blood pressure. Back up of Superior blood vein flow to middle and inferior rectal vein
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