Anatomy M1 Test 2 Abdomen

Front 1

Abdominal Cavity

Back 1

-located between the thoracic diaphragm and the pelvic rim (linea terminalis)

-extends superiorly into the thoracic cage to about the 5th ICS in the supine position, consequently parts of the liver, stomach, and spleen are protected by the thoracic cage

Front 2

Contents of the Abdominal Cavity

Back 2

-peritoneal cavity
-GI organs: inferior portion of the esophagus, stomach, duodenum, intestines, appendix

-liver and billiary passages
-pancreas
-suprarenal (adrenal glands)
-kidneys and superior parts of the ureters

-lymphatic vessels, nerves, blood vessesls

Front 3

Linea Alba

Back 3

-median fibrous white line divides the abdomen into right and left sides

-indicated by a vertical groove from the xiphoid process to the pubis

Front 4

Linea Similunaris

Back 4

-curved line or groove (convex laterally)

-extends from the 9th costal cartilage to the pubis

-located 5-8 cm from the median plane

-represents the lateral border of the rectus abdominis muscle

Front 5

Subcostal plane

Back 5

-joins the inferior margins of the 10th costal cartilage passing through L2-L3

Front 6

Transtubercular Plane (TTP)

Back 6

-through the iliac tubercles

-usually passes through the body of L5

Front 7

Transpyloric Plane (TPP)

Back 7

-located midway b/w the jugular notch and the pubis

***usually midway b/w the xiphosternal joint and the umbilicus

-passes through the inferior border of L1

***Key plane: many abdominal viscera related to it

Front 8

Transumbilical plane (TUP)

Back 8

-through the umbilicus

-indicates the level of intervertebral disc b/w L3 - L4

***McBurney's Point, somewhere closer to ASIS

Front 9

Right Upper Quadrant

Back 9

Liver:right lobe
Gallbladder
Stomach: pylorus
Duodenum: parts 1-3
Pancreas: head
Right suprarenal gland
Right kidney
Right colic (hepatic) flexure
Ascending colon: superior part
Transverse colon: right half

Front 10

Left Upper quadrant

Back 10

Liver: left lobe
spleen
stomach
Jejunum and proximal ileum
Pancreas: body and tail
Left kidney
Left suprarenal gland
Left colic (splenic flexure
Transverse colon: left hall
Descending colon: superior part

Front 11

Right Lower quadrant

Back 11

Cecum
Verimiform appendix
Most of ileum
Right ovary
Right uterine tube
right ureter, abdominal part
Right spermatic cord: abdominal part
Uterus (if englarged)
Urinary bladder (if very full)

Front 12

Left lower quadrant

Back 12

Sigmoid colon
Descending colon: inferior part
Left ovary
Left uterine tube
Left ureter (abdominal part)
Left spermatic cord: abdominal part
Uterus (if enlarged)
Urinary bladder (if very full)

Front 13

Superficial fascia of the Anterior Abdominal Wall

Back 13

Fatty superficial layer, Camper's Fascia

Membranous Deep layer
Scarpa's fascia

Front 14

Deep fascia of the Anterior Abdominal Wall

Back 14

Thin strong layer over the superficial muscles

Front 15

Superficial (external) Inguinal Ring

Back 15

-just superior to the medial part of the inguinal ligament

-it is a triangular opening in the aponeurosis

-base located at and formed by the pubic crest, its apex is superolateral

-lateral crus inserts on the pubic tubercle

-medial crus inserts on the pubic symphysis

Front 16

Contents of Superficial Inguinal Ring

Back 16

-spermatic cord in the male
-round ligament in the female
-ilioinguinal nerve [L1] (frome lumbar plexus) transits through the ring to supply the skin over the superomedial aspect of the thigh

Front 17

External Oblique Muscle Aponeurosis

Back 17

-Inguinal ligament (Poupart's ligament)
-Lacunar ligament (Gubernat's ligament)
-Pectineal Ligament (Cooper's ligament)
-Superficial Inguinal ring
-External spermatic fascia

Front 18

Internal Oblique Muscle

Back 18

-Inserts on the linea alba and pubis via the conjoint tendon

-fibers run superoanteriorly and they become aponeurotic as they reach the median

Front 19

Internal oblique muscle aponeurosis

Back 19

-splits to form a sheath for the rectus abdominus muscle

-in male the spermatic cord passes through the internal oblique muscle fibers from which the cremasteric muscle is formed

-inguinal canal passes through it and is formed in part by the IOM

Front 20

Rectus Sheath

Back 20

-formed by the aponeurosis of the EOM, IOM, and transversus abdomininis as they insert into the linea alba

Front 21

Upper 2/3 of the Rectus Sheath between the costal margins and ASIS is formed by

Back 21

-EOM aponeurosis is anterior to the rectus abdominis

-IOM aponeurosis splits into two layers, with the anterior portion going ABOVE the rectus abdominis, and the posterior part going BELOW the rectus

-The transverse abdominis is posterior to the posterior part of the IOM aponeurosis

Front 22

Lower 1/3 of the rectus sheath between the ASIS and the pubic symphysis is formed by:

Back 22

-The aponeuroses of all three muscles form the anterior wall of the rectus sheath
-the FASCIA TRANSVERSALIS forms the posterior wall of the rectus

Front 23

Indirect Inguinal Hernias

Back 23

-protrusions that take an "indirect" approach through the abd wall

-leave the abd cavity LATERAl to the inferior epigastric vessels, traverse the deep inguinal ring, inguinal canal, and superficial inguinal ring

--75% of inguinal hernias

Front 24

Direct Inguinal Hernias

Back 24

-protrude ANTERIORLY through the post wall of the inguinal canal and leave the abd cavity MEDIAL to the inferior epigastric vessels

-pass through the inguinal triangle (Hesselbachs triangle)

Front 25

Hesselbachs's Triangle

Back 25

-located posteriorly to the superficial inguinal ring and is bounded by

1. Inguinal lig (inferior)
2. Inferior Epigastric vessels (lateral)
3. Rect Abdominis (medial)

Front 26

The ilioinguinal nerve is a content of the:

Inguinal Canal or Spermatic Cord

Back 26

***Inguinal Canal

-passess through the inguinal canal, exits through the superficial inguinal ring to supply the skin of the penis, groin, and anterior part of the scrotum or labia majora, and the root of the clitoris

Front 27

Layers of the scrotum and Testes

Back 27

From Outside --> In
Scrotum
External spermatic fascia
Internal spermatic fascia
Tunica vaginalis (peritoneum)
Tunica Albuginea and Epididymus
Seminiferous Tubules

Front 28

Nerve supply of the Cremaster Muscle

Back 28

The genital branch of the genitofemoral nerve (L1 - L2)

-efferent arm of the cremasteric or abdominal reflex is the genital branch of the genitofemoral nerve (L1 - L2) through the superficial inguinal ring

Front 29

Peritoneum

Back 29

-two layers
1. Parietal peritoneum --> lines the abdominal wall
2. Visceral peritoneum--> covers the abdominal viscera and forms the serosa of the organs

-separated from each other by a small amount of capillary fluid by the mesothelial cells
-function of the fluid is to lubricate the peritoneal surfaces (no friction)

these layers form the peritoneal cavity which is a potential space

Front 30

Peritoneal cavity

Back 30

-closed in males
-in females there is communication with the exterior through the uterine tubes, uterus and vagina

-Divided into two peritoneal sacs
1. Greater-->extending from the diaphragm to the pelvic floor
2. Lesser--> Omental bursa = lies posterior to the stomach and liver

Front 31

Lesser Omentum

Back 31

-double layered sheets of peritoneum that connects the lesser curvature of the stomach and proximal part of the duodenum to the liver

-individually hepatogastric and hepatoduodenal ligaments

Front 32

Greater Omentum

Back 32

fat-laden fold of the peritoneum that hangs down from the greater curvature of the stomach like an apron and connects the stomach with the diaphragm, spleen, and trans colon

Front 33

Peritoneal Recesses

Back 33

-peritoneal folds that form blind pouches or tubular cavities that are closed on one end and open into the abdominal cavity

ex. retrocecal recess
uterovescical
retrouterine
uterorectal (pouch of Douglas)

Front 34

Retrocecal Recess

Back 34

-at the iliocecal junction, posterior to the cecum

***appendix usually lies in it

Front 35

Paracolic gutters

Back 35

-medial and lateral longitudinal channels that are related to the ascending and desc. colon

-these gutters slope superiorly to posteriorly, so when fluid accumulates in the peritoneal cavity, it will follow these gutters to the superior part of the abdomen when the patient is supine

Front 36

Boundaries of the Epiploic Foramen

Back 36

-this is what allows the omental bursa to communicate with the main peritoneal cavity

-Anteriorly = the portal hepaticus (portal triad)
-Posteriorly = IVC and the right crus of the diaphragm
-Superiorly = the caudate lobe of the liver
-Inferiorly = the superior part of the duodenum

Front 37

Nerve supply of the stomach

Back 37

-parasympathetic supply is provided by the vagus nerve and its anterior (left vagus) and posterior (right vagus) branches

-sympathetic supply is through the celiac plexus and T6-T9 (efferent greater splanchnic (t5-T9)

Front 38

Ascending or 4th part of the Duodenum

Back 38

-Suspensory ligament of Treitz
(musculus suspensorius duodemi)

-this ligament of Treiz is a musculofibrous band that enters from the upper aspect of the Ascending part of the duodenum to the right crus of the diaphragm and tissue around the celiac trunk

Front 39

Nerve supply of the duodenum

Back 39

-vagus and sympathetic nerves Lesser splanchnic (T10-T11)

Front 40

Portal Vein

Back 40

It is where the SMV joins with the splenic vein at the posterior aspect of the neck of the pancreas

-behind the head of the pancreas

Front 41

Relationships of the Pancreas

Back 41

-Behind the stomach and anterior to:

IVC
Aorta
Left Crus of the diaphragm
Left Kidney

Front 42

Nerve Supply of the Pancreas

Back 42

-vagus

-Greater splanchnic nerve

-Celiac and superior mesenteric plexuses

Front 43

Splenorenal ligament

Back 43

contains splenic vessesls and tail of the pancreas

Front 44

Gastrosplenic ligament

Back 44

Short gastric vessels
-left gastro-omental vessels

Front 45

Location of the Gallbladder

Back 45

-located in and between the right costal margin and the right linea semilunaris at the transpyloric plane L1

Front 46

Sphincter of Oddi

Back 46

The ampullary portion of the bile duct is guarded this

Front 47

Posterior relationships for both kidneys

Back 47

-diaphragm
-psoas major muscle
-quadratus lumborum
-12th rib
-lateral edge of the erector spinae muscles

Front 48

Anterior relationships for the right kidney

Back 48

-liver
-2nd part of duodenum
-ascending colon
-SI

Front 49

Anterior relationships for the left kidney

Back 49

stomach
-spleen
-pancreas
-left colic flexure
-small intestine