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114 Cards in this Set
- Front
- Back
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Vertebral levels:
Transumbilical plane: Subcostal plane: Tanstubercular plane: |
umbilical: L3/L4
subcostal: L3 transtubercular: L5 |
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tendonous intersections of abs
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linea semilunaris on either side
linea alba in the middle tendonous intersecitions horizontally |
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vertebral levels:
xiphoid process illiac crest lowest level of costal margin (and which costal cartilage) |
xiphoid: T9
illiac crest (L4) lowest: 10th costal cartilage at L3 |
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where is the transpyloric line? what structures run thru it?
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L1 (9th costal cartilage)
stromach plyorus fundus of gallbladder duodenojejunal jn. neck of pancreas hilum of kidey |
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dartos and colle's facia
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dartos: campers fatty fascia in the scrotum
colle's: scarpa's membranous fascia in perineum |
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what are the three branches of the femoral artery that pierce the facia lata inferior to the inguinal ligament
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superfical circumflex illiac
superficial epigastric superficial external pedengdal |
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what happens to blood from the lateral cutaneous veins?
what is the significance of this special system |
drains into the THORACOEPIGASTIC VEIN which can drain to either the axillary vein or femoral vein
anastamoses provide back-up drainage |
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what is special about the paraumbilical vein?
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it drains deep to portal vein but if obstructed can drain to tributaries along anterior abdominal wall
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where are the following dermatomes?
T7 T10 L1: |
T7: xiphoid
T10: umbilicus L1: inguinal ligament/pubic symph |
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what are the three sets of deep lymphatics?
what line demarcates where superficial lymphatic drainage occurs? |
deep: parasternal (interal thoracic), lumbar (abdominal aorta), external illiac (external illiac artery)
superfical above umbilicus: anterior axillary supercial below ubilicus; superficial inguinal |
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what provides the innervation for the abdominal muscles?
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T7-T12 sometimes L1
EO, IO, TA: T7-L1 RA: T7-T12 Pyrimidalis: T12 |
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what is special about the lower insertion of the external oblique?
what about the internal oblique and TA? |
EO: makes inguinal ligament; floor of inguinal canal; superficial ring just lateral to pubic tubercle
IO and TA: conjoint tendon |
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anterior rectus sheath: what is split above arcuate line?
below arcuate line, what makes up posterior rectus sheath? |
IO
transversalis fascia |
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what important longitudinal vessels are found in the posterior rectus sheath?
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superior and inferior epigastric arteries
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what are the origin/insertion of inguinal ligament?
where is the lacunar ligament in relation to the femoral ring and supreficial inguinal ring? |
ASIS to pubercle
lacunar ligament (connects inguinal and pectinal ligament): medial border of femal ring, lateral to the superficial inguinal ring |
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what is special about the first lumbar nerve?
and the two branches, whats the difference? |
travels between IO and TA but doesn't enter rectus sheath
iliohypogastic: pierces both obliques to reach skin ABOVE SUPERFICIAL RING illioinguinal: pierces IO and runs NOT THOUGH INGUINAL CANAL; emerges at superfical ring |
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what makes up deep ring?
superfical ring? |
deep: evagination of transversalis fascia; superior to mid-point of inguinal ligatment; LATERAL TO INFERIOR EPIGASTRIC VESSELS
superfical: between lateral and medial crura of EO aponeurosis |
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what makes up the conjoint tendon? what is its purpose
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aponeurosis of IO and TA; insertes on pubic tubercle
strengthens posterior wall of medial half of inguinal canal |
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what are the walls of the inguinal canal?
(anterior, roof, posterior, floor) |
anterior: EO apoenurosis (lateral reinforcement: IO
roof: IO and TA Posterior: TF and (medial reinforcement: conjoint tendon) |
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what are the contents of the spermatic cord?
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vas deferens
testicular artery cremasteric artery pampiniform plexus lymph vessels sympathetic nerve fibers genital branch of genitofemoral nerve |
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when the spermatic cord starts, the structure(s) get covered by and pass through what layer?
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TRANSVERSALIS FASCIA
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what makes up the three layers of spermatic fascia?
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external: EO apo
cremasteric: IO (cremaster muscle ) and genital branch of genital femoral internal: transversalis fascia |
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If i was to stick a needle into a ball, describe in order what the layers of covering are until i reach the testis
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skin, dartos fascia, external spermatic fascia, cremaster fascia, internal spermatic fascai, parietal layer of tunica vaginalis, visceral layer of tunica vaginalis, tunica albiguinea
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where does the cremasteric artery come from?
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inferior epigastric artery
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why do 90% of testicular varoceles occur on the left side?
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left testicular artery drains to left renal vein distal to SMA crossover
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genital femoral nerve (origin, branches, and purpose)
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L1, L2
anterior to psoas and divides just above inguianal ligament: genital branch: enters deep ring; motor to cremaster femoral branch: enters thigh posterior to inguinal ligament; sensory to the skin of antermedial thigh CREMASTER REFLEX |
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what are the borders of Hesselbach's triangle?
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medial: RA
inferior: inguinal ring lateral: inferior epigastric vessels |
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what guides the descent of the gonads?
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the GUBERNACULUM
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what is the relationship of vas deferens to pampiniform plexus?
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vas defernes is medial
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differentiate the following three hernias: indirect, direct, femoral
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indirect: passes through deep ring; crosses anterior to inguinal triangle, passes through superficial ring; enters scrotum; covered by all three coveringss of spermatic cord
direct: passes through inguinal triangle and passes thru supercial ring, DOENS'T REACH TESTIS, (no internal spermatic fascia covering), WIDDDEEEE NECK femoral: passes through femoral ring (lateral to puburcle and posterior to inguinal ligament) |
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what is the reflection of the two vaginalis layers between epididymis and testis called?
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sinus of the epididymis
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how does lymph drainage differ between scrotum and testis?
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scrotum: superfical inguinal===>deep inginal===>external illiac
testis: (follows blood supply to posterior ab wall)===>paraaortic nodes |
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what is the purpose of extraperitoneal CT? how is it distinguished?
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it has fat!!
separates TF from parietal peritoneum |
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Ligaments:
diaphagm to splenic flexture of colon: posterior wall to jejunum/illeum: posterior wall to sigmoid colon: pancrease to transverse colon: duodenum to right crus of diaphragm: |
diaphagm to splenic flexture of colon: phrenicocolic
posterior wall to jejunum/illeum: mesentary proper posterior wall to sigmoid colon: sigmoid mesocolon pancrease to transverse colon: trasnserve mesocolon duodenum to right crus of diaphragm: trietz |
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median, medial and lateral folds
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median umbilical ligament: remnant of fetal urachus
medial umbilical ligament: obliterated fetal artery lateral umbilical fold: contain inferior epigastric vessels |
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retroperitoneal organs
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SAD PUCKER
Suprearenal glands Aorta/IVC Duodenum (not 1st) Pancrease (not tail) Ureters Colon (A and D) Kidneys Rectum |
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what are the boundaries of the foramen of winslow?
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superior: cuadate lobe of liver
infer: 1st part of duodenum posterior: IVC anterior: hepatoduodenal ligament (portal vein posterior, bile duct of right, hepatic artery on left) |
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what are the boundaries of the lesser sac?
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posterior: pancreas, transverse mesocolon, diaphragm
anterior: lesser omentum and stomach right: epiploic foramen left: hilum of the spleen (lienorenal and lienogastric) |
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what are the two recesses of the liver? (whats in between)
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subphrenic and hepatorenal recess (pouch of morrison)
superior: subphrenic limited by coronary ligament inferior: hepatorenal recess limited by hepatorenal ligament |
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what structures are round to the left of the duodenal fossa?
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left colic artery and IMV
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what is special about the ligament of trietz?
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right crus to duodenjenjunal flexure
crosses aorta marks junction between retroperitonal duodenum and intraperitonal jejunum |
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the distal end of the appendix is often located....
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in the retrocecal fossa!
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what structure often passes through the sigmoid fossa?
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the left ureter
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what is the purpose of the paracolic gutters? where does fluid end up in each?
restriction of left lateral colic gutter: restriction of left medial colic gutter: restriction of right medial colic gutter: restriction of right later colic gutter: |
restriction of left lateral colic gutter: phrenicocolic ligament superiorly, pelvis inferiorly
restriction of left medial colic gutter: transverse colon superiorly restriction of right medial colic gutter: superiorlly at TC, inferiorly at J/I/mesentary proper restriction of right later colic gutter: |
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how is parietal pain conferred?
visceral? |
parietal: T7-T12
visceral: autonomic afferents (splanchnics) |
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describe the posterior border of the testis?
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posterior border is not covered with a serous membrane
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what marks the boundary (junction) between external iliac and femoral arteries?
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inguinal ligament
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the upper four muscular slips of origin of the external abdominal oblique interdigitate with...
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serratus anterior and latissmus dorsi
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second part of the duodenum: intra or retroperitoneal
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secondarily retro peritoneal
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Pain from a subphrenic abscess that irritates the central portion of the parietal peritoneum lining the diaphragm is usually referred to the
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shoulder
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The right boundary of the upper recess of the lesser sac (omental bursa) is the
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IVC
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where do the two crura attach medially?
what is the inferior attachment of the diaphragm? what are the 3 ligaments |
RIght crura: L1, L2, L3
Left crura: L1, L2 median arcuate: aortic arch medial: psoas muscle lateral: quadratus lumborum muscle |
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what is the origin of the three adrenal arteries?
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superior: inferior phrenic
middle: aorta inferor: renal artery |
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vertebral levels:
aortic hiatus: bifurcation: celiac trunk: SMA: IMA: |
aortic hiatus: T12
bifurcation: T4 celiac trunk: T12 SMA: T12/L1 IMA: L3 |
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vertebral levels:
IVC central tendon exit: bifurcation: |
IVC exit T8
bifurcation L5 |
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where do the 5 lumbar segmental veins drain?
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1/2: azygos (right), hemiazygous (left)
3/4: IVC 5: inferor to iliolumbar vein |
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contribution of the lumbar plexus nerves?
which is lateral to psoas? pierces psaos? medial to psoas) |
subcostal: T12
Illiohypogastric/ilioinguinal: L1 Genitotemoral: L1/L2 (pierces posas) Lateral femoral cutaneous: L2-L3 Femoral: L2/L3/L4 (lateral to psoas) obturator L2, L3, L4 (medial to psoas) lumbosacral trunk (L4, L5) |
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at what vertebral level do white communicates stop?
vertebral level and where do greater splanchnic nerves synapse? lesser least? lumbar? |
greater (T5-9): celiac ganglion
lesser (T10-T11), least (T12), lumbar (L1-L2): superior mesenteric, aorticorenal, inferior mesenteric |
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describe parasympathetic innvervation of the GI tract:
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CNX: GI tract to hindgut
S2-S4: hindgut and kidney |
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vertebral level of kindeys:
outer covering of kidney? space containing the renal pelvis, fat within this space? |
T12-L3
out covering = capsule renal sinus, pernephric fat |
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from renal artery, take me to a glomerulus
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renal artery, segmental artery (X5), lobar, interlobar, arcuate, interlobular, afferent arterole
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where are the 3 constrictions of the ureter?
describe the blood supply? |
3 constrictions: renal pelvis joins ureter, ureter crosses pelvic brim, ureter pierces ab wall
supply: upper 1/3: renal artery middle 1/3: testicular/ovarian arteries lower 1/3: common/internal arteries lots of anastamoses |
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kidneys:
sympathetic nerve origin: preganglionic fiber synapse: postganglionic fiber path: parasympathetic origination: visceral afferents: |
sympathetic nerve origin: least and lumber splanchnics (T12-L2
preganglionic fiber synapse: aortico-renal ganglion postganglionic fiber path: follow arteries parasympathetic origination: S2-S4 visceral afferents: T11-L2 (same as symp) |
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what passes between the right crus and the abdominal aorta?
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thoracic duct
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which kidney is lower?
which is french? which nerves run posterior to the kidney/ |
right lower (adrenal behind IVC)
left is french illiofemoral and illiohypogastric |
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through what layers must you cut through to surgically approach the kidney (skin to capsule)?
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thoracocolumbar fascia, lats, Eo, Io, Ta, lateral QL, pararenal fat, renal fascia, perirenal fat, capsule
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para vs. peri renal fat? what separates them
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para: connected to posterior kidney, continuous with extraperitoneal fat
renal fascia separates peri: surrounds kidney and enters pelivic sinus; surrounds adrenals and separates it from the kidney |
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anterior relationships of kindeys (R and L)
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right kidney: adrenal, 2nd part of duodenum
left kindey: adrenal, stomach, pancreas, jejunum right adrenal: IVC reft adrenal: pancreas, lesser sac, stomach |
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what are the periotneal coverings of the right and left kideys?
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right: liver, small intestine (right colic flexure)
left: stomach, spleen, jejunum (descending colon) |
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ureter relationships:
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anteriorly crossed by gonadal vessels
left ureter: later to IMV both: cross bifurcation of common illiac |
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describe the lymph drainage of GI:
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pre-aortic (celiac, SM, IM): drain from GI tract by whatever feeds into those arteries (connected by intestinal trunk)
para aortic (lumbar) X2 , drain kidneys, adrenals, gonads, common iliac and deep wall Cistrna chyli: receives lymph from all three and transmits to thoracic duct |
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he sympathetic supply to the adrenal glands has preganglionic nerve cell bodies in
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T5-T8
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esophageal hiatus is surrounded by... @ which vertebral level
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right crus muscle fibers at T10
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lining of espophagus and stomach changes from ___ to ____ at what point.
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smooth squamous to columnar epithelal at z-line
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3 layers of smooth muscle in the stomach.
innervation? |
outer longitudinal concentrated along curvatures
middle circular: bond and pylorus. concentrated at pylorus to make sphincter innnermost oblique: loops over fundus (parallel to lesser curvature) parasymp: inhibit contraction (chyme go) symp: constrict (chyme stop!) |
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what are the relationships to the stomach (anterior and posterior)?
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anterior: abs, left costal margin, diaphragm, left lung, left lobe of liber
posterior: left adrenal gland, upper left kidney, spleen, pancreas, splenic artery, transverse mesocolon and colon |
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where is the most likely site to have a duodenal ulcer?
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1st part
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where does the superior pancreaticoduodenal veins drain?
inferior? |
superior: portal vein
inferior: SMV |
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spleen is cound over which ribs
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9/10/11
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viceral referred pain is which vertebral ganglia
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T5-T9
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An perforating ulcer through the posterior wall of the pylorus of the stomach can result in massive hemorrhage into the omental bursa most likely due to damage to which artery?
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gastroduodenal
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describe the initial path of the SMA
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posterior to neck of pancreas
anterior to 3rd part of duodenum |
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what is meckel's diverticulum?
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remnatnt of vitelline duct (proximal yolk stalk)
2 feet from iliocecal jn, 2 inches long found on anti-mesenteric surface of ileum |
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what are the "plicae circularis" of the colon?
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semilunar folds
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where is mcburney's point?
describe pain as appendicitis progresses? |
mcburney's point: (where base of vemiform appendix is located) 1/3 distance from ASIS to umbilicus
initial pain: refferred pain @T10 sharp/localized somatic at mcburneys if bad |
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what is the phrenicocolic ligament, what is its purpose?
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tethers splenic flexure of colon to diaphragm, gives support to the spleen
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name three portal caval anastamoses:
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esophagus: left gastrics (portal) and azygos (caval)
anus: superior rectal vein (portal) and middle/inferior rectal(caval) anterior abdominal wall around umbilicus: para-umbilical veins (portal) and anterior abdominal veins (caval) |
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Venous drainage of the large intestines is carried by various tributaries of the portal venous system. The inferior mesenteric vein usually passes to the portal system on which side of the duodenal/illeal jn?
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left side
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what is the largest bland in the body?
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the liver
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where is the fundus of the gallbladder?
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in the angle btw rectus abdominus and right costal margin near midclavicular line
9th costal cartilage |
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what are the relationships to the gallbladder?
what about the hepatic flexure of the colon? |
anterior: visceral liver
funus: anterior ab wall posterior: 1st and 2nd duodenm hepatic flexure: posterior/inferior to body |
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what are the borders of the triangle of calot? why important?
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superior: liver
right: : cystic duct right: common hepatic duct in 75% of people: cystic artery funs thru 24%: anterior to common hepatic duct |
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How does the right hepatic artery enter the liver relative to the hepatic duct
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a. passes posterior, rather than anterior, to the common hepatic duct.
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what is the structure that lies to the right of the porta hepatis
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IVC
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what is the kocher surgical maneuver?
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visualize common bile duct (expose posterior duodenum and pancreas)
cut peritoneum, reflect duodenum and pancreas to the left |
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what are the two intraperitoneal attachments of the spleen? what else is contianed?
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splenorenal (w/ tail of pancreas) and gastrosplenic (w/ short gastric arteries.
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liver: divide the physiological segments into blood supply segments
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II and III: lateral
IV: medial VIII/V: anterior VI/VII: posterior left supplies lateral and medial middle supplies: medial and anterior right supplies: anterior and posterior |
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tumor in which part of the pancreas can produce obstructive jaundice by compressing the common bile duct?
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head
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anterior and posterior relationships of the the pancreas?
Which one of these structures most likely lies posterior to the head of the pancreas? |
anterior: omental bursa, stomach, 1st duodenum, left lobe of liver
posterior: ab aorta, left kidney, lower half of left adrenal IVC!! |
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You were asked to assist in a surgical operation on a young patient to treat an ulcer in the first part of the duodenum. You would expect that the surgeon will approach the ulcer by doing an anterior abdominal wall incision in the following region:
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epigastric
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Following an emergency appendectomy your patient complained of having paresthesia (numbness) of the skin at the pubic region. The most likely nerve that has been injured during the operation is:
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illiohypogastric
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During a laparoscopic examination of the deep surface of the lower anterior abdominal wall (using a lighted scope on a thin tube inserted through the wall), the attending physician noted something of interest and asked the young resident to look at the medial inguinal fossa. To do so, the young doctor would have to look at the area between the:
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medial umbilical ligament and inferior epigastric artery
this is the place in the abdominal wall where there is an area of weak fascia called the inguinal triangle--direct inguinal hernias can break through this space. |
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If one were to make an incision parallel to and 2 inches above the inguinal ligament, one would find the inferior epigastric vessels between which layers of the abdominal wall?
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The correct answer is: transversus abdominis and peritoneum
The inferior epigastric vessels lay on the inner surface of the transversus abdominis and are covered by parietal peritoneum. Remember, the peritoneum lies over the inferior epigastric vessels to make the lateral umbilical fold. |
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which structures are secondarily retroperitoneal?
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Fusion fascia forms when an organ becomes secondarily retroperitoneal. Secondarily retroperitoneal organs started out in a mesentery, but then got pushed against the posterior body wall during development. So, the peritoneal covering on the face of these organs which was pushed against the posterior body wall became fusion fascia--a relatively avascular plane of fascia that holds these organs to the posterior body wall. The ascending colon, descending colon, duodenum, and pancreas are all secondarily retroperitoneal organs which are attached by fusion fascia.
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In order to approach the area posterior to the stomach, a surgeon decided to go through the lesser omentum. Before incising the mesentery she was careful to find and preserve a nerve lying in the upper portion of the hepatogastric ligament, i.e., the
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hepatic branch to the anterior vagal trunk
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During an emergency splenectomy, the surgeon accidentally tore the gastrosplenic ligament and its contents. The artery (ies) likely to be damaged in this event is (are) the:
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short gastrics
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The division between the true right and left lobes (internal lobes) of the liver may be visualized on the outside of the liver as a plane passing through the:
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gallbladder fossa and IVC
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what do the left and right hepatic arteries supply?
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The left and right hepatic arteries help support the parenchyma and stroma of the liver. The left hepatic artery supplies the left & quadrate lobes of liver, and part of the caudate lobe. The right hepatic artery supplies the right lobe and part of the caudate lobe. So, the left hepatic artery must be clamped to perform surgery on the quadrate lobe.
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A patient was diagnosed with pancreatitis due to a reflux of bile into the pancreatic duct caused by a gallstone. The stone is likely to be lodged at the:
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hepatopancreatic ampulla
he hepatopancreatic ampulla is the very short segment of duct which represents the joining of the common bile duct and the main pancreatic duct. Once these two ducts form the hepatopancreatic ampulla in the wall of the duodenum, the bile and pancreatic enzymes are emptied into the second portion of the duodenum, through the major duodenal papilla. If a gallstone was stuck in the hepatopancreatic ampulla, bile could back up and flow backwards into the main pancreatic duct |
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the blockage of a main bile duct in the quadrate lobe will likely cause reduced flow of bile secretion in the:
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Like the left hepatic vein, the left hepatic duct drains bile from the left lobe, quadrate lobe, and part of the caudate lobe of the liver. So, an obstruction in the quadrate lobe would reduce bile secretion in the left hepatic duct. The right hepatic duct and hepatic vein drain the right lobe and part of the caudate lobe.
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what veins drain into the left renal vein?
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The left inferior phrenic vein, left suprarenal vein, and left ovarian/testicular vein all drain into the left renal vein (although their analogs on the right side drain directly into the IVC).
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Where do cells that secrete epinephrine and norepinephrine receive their innervation?
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Cells that secrete epinephrine and norepinephrine are innervated by preganglionic fibers from the greater thoracic splanchnic nerve.
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The vagus nerve passes into the abdomen by passing through the
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esophageal hiatus
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With one exception, preganglionic sympathetic axons synapse upon postganglionic sympathetic dendrites or cell bodies. The exception to this general rule occurs within the:
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The suprarenal medulla is directly innervated by preganglionic sympathetic fibers from the greater thoracic splanchnic nerve.
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