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81 Cards in this Set
- Front
- Back
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Quadrants of the abdomen: overview
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9 regions, divided by 5 planes
Planes: Transpyloric, Subcostal, Intertubercular Lines: Midclavicular |
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Quadrants of the Abdomen:
regions |
Upper (left to right): Left Hypochondratic, Epigastric, Right Hypochondratic
Middle: Left Lumbar, Umbilical, Right Lumbar Lower: Left Inguinal, Hypogastric, Right Inguinal |
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Quadrants of the abdomen:
Transpyloric plane |
halfway b/t jugular notch and upper pubic symphosis
-crosses the tip of the 9th costal cartilage and L1 vert -over pylorus, neck of pancreas, superior right kidney, hila left kidney, duodenojejunal junction |
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Quadrants of the abdomen:
Subcostal plane |
connects lowest point of the two costal margins
lies across upper L3 vert |
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Quadrants of the abdomen:
Transpyloric plane |
connects tubercles of right and left iliac crests
passes through L5 vert |
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Quadrants of the abdomen:
Midclavicular Line (Semilunar Lines) |
passes through mid-point b/t ASIS and pubic symphosis
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Scarpa's Fascia
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under fatty layer of fascia (campars)
holds sutures well potential space b/t Scarpa's and deep fascia rupture of urethra will allow urine to leak into perineal pouch, leading to scrotum and penis keeps blood from pooling above Transubilical Line |
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Rupture of Urethra
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urine passes into superficial perineal pouch
urine can travel into the scrotum, penis, and to the CT of the lower anterolateral abdominal wall CANT pass into thighs b/c superficial perineal fascia blends w/ deep fascia lata of thigh |
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Cremaster Reflex
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Innervated by Ilioinguinal N
stroking the inside of the thigh stimulates the cremaster muscle if a Cryptic Testi is present in young male, can be done to try and encourage the dropping of the testicle |
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Hesselbach's Area
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area of the anterolateral abdominal wall that isnt covered by the transverse abdominal muscle
weak area, plays a minor role in the repair of inguinal hernia |
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Arcuate Line
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lies halfway b/t umbilical and pubic bone
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Abdominal Surgical Incisions:
Decisions on where to place |
adequate exposure then cosmetic affect
location depends on location of organ, bony boundaries, avoiding neurovascular bundles muscles are Split b/t their fibers, not Transected |
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Abdominal Surgical Incisions:
Median |
avoids muscles, major vessels and nerves
involves the Linea Alba |
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Abdominal Surgical Incisions:
Paramedian |
Made in the Sagittal plane and involves rectus sheath
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Abdominal Surgical Incisions:
Oblique McBurney |
used in Appendectomies
parallels external oblique, close to the right ASIS goes through external oblique, internal oblique, and transversalis |
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Abdominal Surgical Incisions:
Transverse Lanz |
in right iliac fossa
diff from McBurney in that it is more transverse -extends more medially towards Rectus Abdominus -lies nearer to ASIS more likely to separate Iliohypogastric and Ilioinguinal N |
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Abdominal Surgical Incisions:
Pfannestiel |
used for Caesarian Section or Urinary Bladder Surgery
transverse incision through recti muscles, just above pubes |
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Fossa of the Anterolateral Abdominal Wall
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Medial lie posterior to Hesselbach's area, potential site for direct Hernai
Lateral fossae is where indirect Inguinal Hernai may occur |
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Inguinal Hernia
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protrusion of Parietal Peritoneum and viscera through opening in cavity
Indirect: occur lateral to inferior epigastric, enters deep inguinal ring -can enter scrotum in males Direct: medial to inferior epigastric, goes through superficial inguinal ring |
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Lumbar Trigone (Petit's Triangle)
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b/t anterolateral border of Latissiumus Dorsi and Posterior EO
Abdominal wall consists of only CT b/t skin and IO can be site of protrusion of a lumbar abscess or lumbar hernia |
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Surgical Incisions in the Posterior Abdominal Wall
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approach to some organs
made through lumbar triangle to avoid major muscle tissue and nerves/vessels |
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Posterior Abdominal Pain
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Iliopsoas clinically important to kindeys, ureters, cecum, appendix, pancreas, nerves
suspected inflammation is tested using Psoas Test, a positive test results in pain |
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Psoas Test
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patient lies on unaffected side
extends thigh of affected side against resistance |
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Abdominal Aortic Aneurysm
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possible erosion of lumbar vert. due to expanding aneurysm
Tumors in the Pancreas and Stomach can transmit pulsations into the Aorta that could present as an aneurysm Pulsations of an aneurysm can be detected left of the mid-line Ultrasonography can be used to detect, prosthetic graft can be used to fix |
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Collateral Routes of the Abdominal Veins when IVC is Obstructed
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Inf. Epigastric to Sup. Epigastric to IT to SVC
Superficial Epigastric/Superficial Circumflex Iliac-->Great Saphenous-->Lateral Thoracic-->Axillary-->SVC Epidural Venus Plexus-->Lumbar Veins-->Azygous System |
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Umbrella Filter in Venus System
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used to block Venous Emboli (clot) from lower extremities from getting to the heart
must be placed Inferior to the entrance of the Renal Veins Ligation or Plication (reducing size of IVC) can also be used |
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Lymphatic Drainage of the Testis
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nodes at the junction of the renal vein and IVC receive drainage from all of the lower half of the body
Lymphangitis: inflammation of lymphatic vessels Lymphadenitis: inflammation of lymphatic nodes Lymphatic system is involved in the spread (metastasis) of cancer cells |
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Lymphedema
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accumulation of interstitial fluid, occurring when the lymph doesn't drain from a certain area of the body
can occur when lymph nodes are removed or when they become cancerous and lose function |
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Peritonitis
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inflammation of the peritoneal membrane, interfering with the normal fxn of the organ
peritoneum is well innervated, resulting in more pain from large incisions than small ones puncture wound or infection from appendix can cause peritoneum inflammation |
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Ascites
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irritation of the peritoneum leading to the serous membrane producing an abnormal amount of fluid
can present w/ sloshing sound while walking or a protruding stomach |
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Paracolic Gutters
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provide pathways for the flow or entrapment of intraperitoneal materal (fluid, tumor cells)
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Collateral Routes for Obstructed Blood Flow to Liver
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possible because Portal Vein has no valves, so blood can flow backwards
portal-systemic anastomoses are communications b/t portal venous system and systemic venous system (IVC or SVC) |
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Prehepatic Distention
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Caput Medusa
severe portal obstruction where paraumbilical veins become varicose and look like small snakes radiating under skin around umbilicus |
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Portal Hypertension
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scarring and fibrosis from cirrhosis obstructs portal vein, increasing pressure and causing portal hypertension
large varicose veins result at the anastomoses b/t portal and systemic veins can result in rupture of veins and hemorrhage |
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Celiac Nodes
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found near the celiac trunk, can be very hard to resect for Gastric Cancer
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Viscerosomatic Pain:
Stomach |
Nerve Supply: Ant., Post. Vagal Trunk, Celiac Ganglia
Spinal Cord: T5-T10 Referred Site: Epigastric and Hypochondriac regions (gastric peptic ulcer) |
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Viscerosomatic Pain:
Duodenum |
Nerve Supply: Post. Vagal trunk, Celiac and Sup. Mesenteric Ganglia
Spinal Cord: T5-T10 Referred Site: Epigastric region, Right Shoulder (perforated ulcer) |
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Viscerosomatic Pain:
Small Intestine |
Nerve Supply: Post. Vagal Trunk, Celiac Ganglia
Spinal Cord: T5-T10 Referred Site: Periumbilical Region (acute intestinal obstruction) |
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Viscerosomatic Pain:
Colon |
Nerve Supply: Post. Vagal Trunk, Celiac, Sup., Inf. Mesenteric Trunk
Spinal Cord: T1-T12, L1-L3 (distal) Referred Site: Hypogastric region (ulcerative colitis), left lower quadrant (sigmoiditis) |
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Pancreatic Surgery
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Pancreatic disease frequently spreads to Omental Bursa and Retroperitoneal Tissue due to close proximity
Omental Bursa can be entered by: incising lesser omentum incising gastrocolic ligament incising transverse mesocolon |
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Spleen damage due to rib fracture
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close proximity to ribs 9-11 makes it vulnerable to rib fractures
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Splenectomy
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care must be taken not to hit the tail of the pancreas, found in the hilum of the spleen
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Liver Palpation
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difficult to palpate, possible along anterosuperior surface
Glisson's capsule around liver can cause right upper quadrant pain w/ swelling of the liver, guarding, and rebound tenderness |
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Porta Hepatis
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structures inside might be injured during cholecystectomy
Portal Vein, Hepatic A, and Hepatic Ducts |
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Pathological Material in Recesses
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can be transported from one recess to another, especially on right side (due to gallbladder)
Subphrenic recess is a common site for abscess formation |
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Liver Lacerations
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superficial may be sutured, but severe injury usually requires removal of a lobe
"Lobectomy" |
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Blood Supply of the Liver
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Hepatic Arteries 30%
Portal Vein 70% common variants include left hepatic from left gastric and right hepatic from Sup. Mesenteric Artery |
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Hartmann's Pouch
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bulging of inferior surface of Gallbladder Infundibulum
used by surgeon to apply traction towards fundus to better visualize neck and cystic duct |
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Gallbladder Removal
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Care must be taken to not leave a long stump of the cystic duct
can lead to inflammation, a future source of stones |
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Hepatoduodenal Ligament
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palpation and occlusion of includes the common hepatic artery
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Nephroptosis (dropped Kidney)
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ureter is normal length
Ectopic Kidney: ureter is shortened |
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Renal Cysts
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product of polycystic kidney disease, important feature of renal failure
causes enlargement of kidney |
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Renal Hypertension
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Stenosis of renal artery reduced blood flow, stimulating secretion of Rennin
Rennin yields Angiotensin 2, inducing vasoconstriction, increasing blood pressure this must be excluded when diagnosing high blood pressure |
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Ureter Surgery
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Extraperitoneal Approach used for surgery
Lumbar Sympathetic, Cecum, Ascending Colon, and Ureter susceptible to injury pain secondary to ureter disease is referred to the ipsilateral testicle |
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Ureteric Calculi
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pebbles in the calices, ureters, or urinary bladder, and may cause ureteric colic pain
referred pain may range depending on size of stone can be removed using nephroscope, or using Lithotripsy to break stones |
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Peptic Ulceration of Proximal Duodenum
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Posterior Perforation more common in ulceration
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Gallbladder Inflammation
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may cause adhesion, and allow stones to pass from cystic duct, common bile duct to proximal duodenum
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Posterior Perforation of Distal Duodenum
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may allow fluid to enter lesser sac, pancreas, or retroperitoneal tissue
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Anterior Perforation of Proximal Duodenum
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releases liquid/air into the supramesocolic compartment
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Renal Vein Compression
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can occur as the result of a clamp-like action b/t SMA and Aorta
can also include the 3rd portion of duodenum |
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Mobile Small Intestine
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small intestine is very mobile, can be found anywhere in abdominal cavity
can be involved in femoral, inguinal, umbilical, obturator, and diaphragmatic hernias |
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Vitelline Duct Persistance:
Ileal Diverticulum |
found as a diverticulum in terminal 2 feet of ileum
always found on antimesenteric border (opposite mesenteric) can become inflamed and produce pain mimicking that of appendicitis |
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Teniae Coli
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hold sutures well, and assist anastomoses of resected segments
converge to mark base of appendix |
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Appendix Location
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dependent upon length of appendix and final position of cecum
lies deep to a point 1/3 way along oblique line, which joins right ASIS and Umbilical |
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Appendicitis
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inflamed appendix
if resting on psoas major, Forced Extension of right thigh at hip cause pain in right lower quadrant if resting on obturator internus, Flexion and Lateral Rotation of right thigh will cause lower abdominal pain |
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Occlusion of SMA
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may result in total or segmental infarction of Midgut
may be nourished by IMA by marginal artery, causing doubling in size and becoming tortuous |
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Tumors of the Sigmoid Colon
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can be palpated through Iliacus Muscle
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Pelvic Ligaments during Pregnancy
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hormone Relaxin increases flexibility of pelvic ligaments
results in increase in diameter of pelvic outlet during childbirth also causes swayback and waddle in pregnant women, also knee instability |
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Pelvic Inlet Measurements:
True Diameter |
true diameter of pelvis is b/t Posterior Superior Pubic Symphysis to Sacral Promontory
-narrowest inflexible dimension a baby's head must fit |
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Pelvic Inlet Measurements:
Transverse Diameter |
90 degrees to true, from arcuate line on one side to other
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Pelvic Inlet Measurements:
Oblique Diameter |
measured from Iliopubic Eminence of one side to Sacroiliac Articulation of other side
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Differences in Pelvis b/t Sexes
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female wider than male
Ischial Tuberosities point outward in female Greater Sciatic Notch of Pelvic Inlet is rounded in Females, elongated in Males |
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Wider Female Pelvis and Locomotion
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Femur rests on Tibia at a greater angle, making running more inefficient
more knee injuries result |
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Pelvic Muscles during Childbirth
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Muscles of the Pelvic Diaphragm can be torn during child birth
damage to muscles or nerves can result in Urinary Incontinence, Fecal Incontinence, or Fecal Retention |
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Perforation of Penile Urethra
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urine can enter the Perineal Space
most vulnerable area of the urethra is just below perineal membrane if Deep (Bucks) Fascia of penis isn't perforated, urine will be contained -if it is, it will fill the Superficial Perineal Space |
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Male Circumcision
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surgical removal of prepuce of penis
can be performed on adults for medical reasons if Prepuce becomes tight and cant be pulled back |
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Female Circumcision
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Cultural
can be removal of Clitoral Prepuce, Prepuce and Glans Total removal of Clitoris and Labia Or sewing shut of vagina |
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Pudendal Nerve Block
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relieves pain during childbirth
Injection occurs where pudendal nerve crosses the Sacrospinous Ligament The nerve is palpated through the wall of the vagina Perineal nerve only innervates Post. 2/3, so a block of the Ilioinguinal must be performed for the Ant. 1/3 Doesnt always work because innervation from the Posterior Cutaneous branch of Perineal may overlap and not be anesthetized |
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Spinal Block during Child Birth
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injection into subarachnoid space b/t L3-4
blocks all motor and sensory innervation to legs, Perineum, Pelvic Diaphragm, Birth Canal Spinal Headache is common complication |
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Caudal Epidural during Child Birth
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given via catheterization to sacral canal roots of S2-4
doesn't block sensory to legs or upper reproductive mother can feel contractions but feels no discomfort from birth canal Upper innervated by T11-12, middle and lower by S2-4 |
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Innervation of Ejaculation
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Sympathetic- internal urethral sphincter closed
Parasympathetic- urethral muscle contracts Somatic N. System through Pudendal contracts Bulbospongiosus Sympathetic stimuli to smooth muscle denies remission |
