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119 Cards in this Set

  • Front
  • Back

Median Umbilical Fold

Covers median umbilical ligament. Urinary Bladder to the Umbilicus

Medial Umbilical Fold

lateral to Median Umbilical ligament. Covers remnant of umbilical arteries

Lateral Umbilical Fold

covers Inferior epigastric vessels. Deep Inguinal Canal is lateral to it

Iliopubic Tract

Thickened Transversalis Fascia at inferior margin

Supravesical Fossae

Between Median and Medial Umbilical Folds. ***Site of Supravesical Hernia (direct)

Medial Inguinal Fossae

or Hasselbach Triangle. Between Medial and Lateral Umbilical folds. ** Site of indirect Inguinal Hernia

Lateral Inguinal Fossae

Lateral to lateral Umbilical fold. Deep inguinal ring is the most common site of INDIRECT inguinal hernia.

Arcuate Line

2/3 way up from the pubis to the umbilicus. Above, the muscular fascia splits anterior and posterior to the Rectus Abdominis. Below all layers go anterior

Inguinal Canal Borders

Ant: Aponeurosis of External Oblique


Post: Tranversalis Fascia - medially reinforced with CONJOINT LIG.


Floor: Laterally = Iliopubic Tract --> Infolded Inguinal Lig. --> Lacunar Ligament (Pectineal)


Roof:Tranversalis Fascia (lat) - centrally with CONJOINT LIG. and medial with Medial Crus.

Inguinal Lig

ASIS to the pubic tubercle. Thickened External Oblique Aponeurosis

Superficial Ring

Lower opening of the Inguinal Canal from by the medial and lateral crua (legs), intercrural fibres of the external aponeurosis

Lacunar Lig

Stems distally and medially to the femoral canal...continues as the Pectineal Lig.

Reflected Inguinal Ligament

After fibres of the external aponeurosis have curled under to make the inguinal ligament they will fan upwards and attach to the other external oblique aponeurosis

Embryology of Gonads

Descend into lowermost, anterior part of the anterior abdominal wall by week 7. For temperature control. Ovaries to Pelvic Cavity and Testes follow Gubernaculum Testis Cord.

Inguinal Canal Content

Ilioinuinal N. *only nerve not supplying testes


Round Lig of Uterus


Spermatic Cord :


-Ductus (Vas) Deferences) and Artery


-Testicular Artery


-Pampiniform Plexus (venous plexus of testes)


-Cremasteric Artery


-Autonomic N. Fibres (sympathetic and para)


Genital Br. of Genitofemoral

Layers of Spermatic Cord

External Spermatic Fascia --> Cremaster M --> Cremasteric Fascia-->Internal Spermatic Fascia --> Obliterated Processus Vaginalis

Layers of Scrotum and Testes

Skin > Dartos M. > Dartos Fascia > External Spermatic Fascia --> Cremaster M --> Cremasteric Fascia-->Internal Spermatic Fascia > Tunica Vaginalis

Thoracolumbar Fascia: Anterior

Anterior Surface of TVP > covers ant. QL > invests the Transverse Abdominis. Attaches to Iliac Crest, 12th Rib and makes the Lateral Arcuate Lig., in Diaphragm

Thoracolumbar Fascia: Middle Layer

Attaches to Tip of TVP > covers posterior of QL > invests the Internal Oblique

Thoracolumbar Fascia: Posterior Layer

From tips of the SP > covers erectors > invests the Lats

Transversalis Fascia

Recall (deep to the peritoneum and peritoneal fat). It will Change names as it travels backwards and covers various structures.


Transversalis Fascia > Renal Fascia > Psoas Fascia > then attached to Vert. Bodies and Pelvis Brim Line.


*Makes Medial Arcuate Lig. of Diaphragm

Psoas Major

TVPs, lat Vert. Bodies and IVDs > Lesser Trochanter


Innervation: APR L1, L2, L3


Action: Flexes Thigh, Trunk, lateral flexes vertebrae, balance

Psoas Minor

Lateral T12 and L1 Vert. Bodies and IVD > Pectineal Line of Pubis and Iliopectinal Arch (helps make the Lacuna Lig.)


Innervation: APR L1


Action: Flexes Vertebrae

Iliacus

Sup 2/3 of Iliac fossa, ala of sacrum and ant. SI ligament > tendon of Psoas Mj to Lesser Trochanter of the Femur


Innervation: Femoral N. (L2-L4)


Action: With Psoas Mj. Flexes Thigh, Trunk, Stabilizes Hip, weak external rotator of hip

Quadratus Lumborum

Medial 12th Rib and TVPs of Lumbar (L1-L4) > Iliolumbar Lig and internal lip of Posterior iliac crest


Innervation: Anterior branches of T12-L4 nerves


Action: Extends and Lat. Flex of Vertebrae, fixes 12th rib during inspiration (opposite to diaphragm pull)

Diaphragm

Innervation: Phrenic Nerve (C3-C5). (Motor and Sensory) , Intercostal N.(peripheral sensation)


Blood: Pericardiophrenic A. (internal Thoracic)


Musculophrenic A. (anteriorly)


Superior Phrenic A.


Inferior Phrenic A.

Subcostal Nerve

APR of T12...not in Lumbar plexus, below 12th rib... Runs like an intercostal nerve of the 12th rib. Passes through TA of the abdominal wall to run between it and IO


Supplies: ant. lat ab wall and skin


descends over iliac crest and hip

Lumbar Nerve Plexus

Sympathetic Innervation


- iliohypogastric, ilioinguinal


-genitofemoral


-lateral femoral cutaneous


- femoral (to psoas and iliacus)


- obturator (and accessory obturator)


- Lumbosacral Trunk

Iliohypogastric N. (T12, L1)

Pierces TA and innervates it and the IO


Supplies: skin over the iliac crest and superior lateral buttocks (cluneal N do the rest), skin over inguinal lig. and pubic region

ilioinguinal N. (T12, L1)

Runs parallel to the iliac crest


Pierces TA at about ASIS, drops into the inguinal canal (doesn't enter via deep inguinal ring).Divides into Femoral and Scrotal/Labial divisions


Supplies the lower TA and IO, ant scrotum/labia and anterior-medial thigh.



Genitofemoral N. (L1, L2)

Pierces the Psoas Mj. but remains below the psoas fascia. Femoral Br. passes under the inguinal lig to supply the femoral Triangle


Genital br. travels through inguinal canal to the Cremaster M and the skin of Scrotum/Labia

Lateral Femoral Cutaneous N (L2, L3)

Travels inferior and lateral across the iliac crest. Passing under the Inguinal Lig. 2-3cm medial to the ASIS. Supplies the Anterior and Lateral Skin of the thigh


Has Post and Ant Br.

Femoral N. (L2, L3, L4)

Emerges lateral to the Psoas and travels down its lateral border. Anterior to Iliacus then passes under the inguinal ligament


Supplies: Hip Flexors and knee Extensors (anterior thigh muscles) and the Skin over the Anterior and Medial thigh with anterior cutaneous branches.

Obturator N (L2, L3, L4)

Emerges on the medial border of the psoas and travels under it. Drops into the lesser pelvis and travels over the pelvis brim to the Obturator Foramen where it exits through the Obturator groove into the medial thigh


Supplies: Adductor muscles and the skin of the medial thigh


*10% have an accessory

Lumbosacral Trunk (L4, L5)

Roots unite near the pelvis brim. Lumbar Components travel inferiorly over the saral ala to meet the sacral plexus ***Why we might get Sciatica from L4/L5 disruptions.

Abdominal Cavity Borders

Superior: Diaphragm, Inferior Thoracic Aper.


Inferior: Superior Pelvic Aperature (Pelvic Cavity * not true border)


Ant: Costal Margins, Xiphoid , Abdominal Wall, ASIS, inguinal lig., pubic tubercles, superior pubic crests and pubic symphysis


Post: Post Ab. wall, lumbar vertebrae, Psoas, QL

Parietal Peritoneum

Covers the walls of the Abdominal Cavity. We can have folds in the Peritoneum (median, medial and lateral umbilical). Pernitoneal Fossa can be formed between folds or organs covered.


Diaphragmatic or Abdominal or Pelvic

Visceral Peritoneum

Covers the organs. Only autonomic innervation

SupraColic Compartment

A greater peritoneal sac containing liver, gall bladder and cystic duct, stomach, spleen 1st part of duodenum. Inferior border is the Transverse Mesocolon Mesentary

InfraColic Compartment

A greater peritoneal sac containing the jejenum, ileum, caecum, appendix and the ascending and descending colon. The superior border is the Transverse Mesocolon Mesentary

Omental Bursa

The lesser peritoneal sac (caused by the 90 deg. right turn made by the stomach during development). Posterior to the Stomach and Lesser Omentum and Superior to the Transverse Mescolon Mesentary.

Omental Foramen

Free edge of the Lesser Omentum forms the anterior border (also called the Heptaduodenal Lig.). The Liver is above, the 1st part of duodenum is below and the IVC and right crus of diaphragm is behind. How the greater and lesser peritoneal sacs communicate

Diaphragmatic Peritoneum

Refers to the Shoulder, clavicle

Abdominal Peritoneum

Innervated by Intercostal and Subcostal N, Ilioinguinal and iliohypogastric N


Causes sharp localized pain.

Pelvic Peritoneum

Innervated by the obturator nerve


Refers to the low back and inner thigh

Intraperitoneal Organs

Completely covered with visceral peritoneum.


Esophagus, Stomach, 1st part of duodenum, liver, spleen, jejunum, ileum, caecum, transverse colon, sigmoid colon

Retroperitoneal Organs

Between the posterior abdominal wall and the parietal peritoneum which covers there anterior surface.


Kidneys, ascending and descending colon, duodenum parts 2-4, ab. aorta, IVC

Subperitoneal Organs

Between the inferior pelvic wall and covered superiorly with parietal peritoneum

Omentum

Double layer that extends away from the stomach and first part of duodenum

Greater Omentum

From Greater curvature of the stomach to the Omental Tenia of the anterior transverse colon

Lesser Omentum

connects the lesser curvature of the stomach to the the liver (inferior)

Mesentery

double layer of peritoneum as a result of the invagination of a developing organ that contains a NeuroVascular bundle. Connects set organ to the posterior abdominal or pelvic wall

Transverse Mesocolon Mesentery

Attaches the Transverse Colon (from posterior Tenia Mesocolica) to the posterior abdominal wall just inferior to the pancreas

Mesentery Proper

Attaches the jejunum and the ileum and their loops to the posterior wall. Along with their vessels ( the superior mesenteric artery)

Mesosigma Mesentery

Holds the sigmoid colon to the right iliac fossa (posterior pelvic wall) with its vessels branching from the inferior mesenteric artery

Peritoneal Ligament

Double layer of peritoneum that connects one organ with another or the abdominal wall. Often lacks a neuromuscular bundle

Falciform Ligament

Reflected diaphragmatic peritoneum that has been used to form visceral peritoneum of the liver. Keeps liver attached to diaphragm

Hepatoduodenal Ligament

Thickened edge of Lesser Omentum attaching the Liver to the Duodenum.


Contains portal Triad (portal vein, hepatic artery, and bile duct)

Gastrosplenic Ligament

Reflection of Stomach's visceral peritoneum onto the hilum of the spleen

Gastrocolic Ligament

Fixed part of the superior Greater Omentum that results in the attachment of the greater Curvature of the Stomach to the Transverse Colon

Splenorenal Ligament

Reflection of parietal peritoneum onto the hilum of the spleen.

Ligaments of the Liver

Falciform, R/L Coronary and R/L Triangular (all anchor to diaphragm)


Round Ligament.


Between Coronary Ligaments is the Bare area of the liver.

Suprahepatic Recesses

Or Infradiaphragmatic. Space between the top of the liver and the diaphragm. Air from stomach or intestines can accumulate here (gastric perforations)

Falciform Ligament

Divides the liver into the right and left lobes

Hilum of the Liver

Contains the portal triad: Hepatic Artery, Portal Vein, Hepatic Duct

Hepatic Artery

Delivers oxygenated blood to the liver

Portal Vein

Brings newly absorbed nutrients from the GI tract to the liver

Hepatic Duct

Eliminates secretory product - BILE from the liver to the gall bladder

Diaphragmatic Surface of the Liver

Superior/Posterior/Lateral -Contains the Falciform Lig., right and left lobes, the rib impressions (laterally) and the bare area (posteriorly).

Visceral Surface of the Liver

Inferior Surface - Contains 4 Lobes: Left, Right, Caudate (posteriorly) and Quadrate (anteriorly)


Right Lobe of the Liver

to the right of the Groove for the Gall Bladder (ant) and the IVC (post). Has Impressions from the right Kidney (renal), the Colon, and the duodenum.

Left Lobe of the Liver

Left of the the Ligament Teres (or the Round Ligament) *remnant of the Umbilicus and the Ligament Venousum. Has Esophageal and Gastric impressions

Caudate Lobe of Liver

Posterior Between the IVC and the and the Ligament Venosum

Quadrate Lobe of the Liver

Anterior to the hilum of the liver between the gall bladder and the round ligament *remember that the round ligament also has peritoneum within it.

Venous Drainage of the Liver

3 Hepatic Veins - Right, Middle and Left that all come from within the liver to open into the IVC

Common Hepatic Duct

the union of the Right and Left Hepatic Ducts - Secrete Bile from the Liver

Cystic Duct

Option 1 for the passage of Bile from the Liver. Transports bile to be stored in the Gallbladder. Is continuous with the Neck of the Gallbladder

Common Bile Duct

Option 2 for passage of Bile from the Liver. Can receive Bile from either the Liver via the Common Hepatic Duct or From the Gallbladder via the Cystic Duct.


Path - Behind Duodenum part 1> through head of Pancreas > Hepatopancreatic Ampulla which is the opening (enlargement) into the small intestine. There is a Sphincter at the opening called Oddi's sphincter.

Gall Bladder

Stores bile. Has a fundus, body and neck.

Anatomical Structures of the Stomach

External


lesser curvature, greater curvature, cardia (with cardia sphincter, cardiac notch, fundus, body , pylorus (antrum =wider, canal = narrows) with pyloric sphincter.


Internal


Rugae = thick mucosa with longitudinal folds

Abdominal Esophagus

1 inch in length enters the cardia of the sphincter

Cardia Sphincter

Functional Sphincter that has a ring of smooth muscle

Plyoric Sphincter

Anatomical Sphincter that is structurally formed to act as a sphincter... its doesn't squeeze (no muscle contraction)

Arteries of the Lesser Curvature of the Stomach

Left and Right Gastric Arteries

Arteries of the Greater Curvature of the Stomach

Right and Left Gastro-Omental Arteries

Pelvic Cavity Borders

Superior = abdominal cavity


Anterior = pubic bones and pubic symphysis


Posterior = sacrum and coccyx


Inferior = pelvic diaphragm ( levator ani

Pelvic Intra-peritoneal Organs

Superior 1/3 of Rectum, Uterus, Uterine Tubes and Ovaries(not covered by peritoneum)

Pelvic Retroperitoneal Organs

middle 1/3 of the rectum, upper part of the pelvic ureter (lumbar part)

Pelvic Subperitoneal Organs

Lower pelvic ureter, urinary bladder, prostate, pelvic part of Vas deferens, seminal vesicles, pelvic part of vagina

Peritoneal Pouches of the Pelvis

Recto-vesical (males only), Recto Uterine (female), Vesico-uterine (female)

Broad Ligament of the Uterus

Double layer of peritoneum that results from the invagination of the Uterine Tubes entering the the uterus...

Round Ligament of the Uterus

Anterior to the broad ligament. Attaches uterus to the lateral pelvic walls

Rectum

Recto-sigmoid junction is at the level of S2-3. Formed from the continuation of the Tenia Coli of the Sigmoid Colon


Ampulla Rectalis and the Anal Canal

Rectal Shape

S shape...with 3 lateral flexures


1) superior convex to the right because of superior internal, transverse rectal fold on the left


2) intermediate convex to the left because of the intermediate internal, transverse rectal fold on the right


3) Inferior ...same as the superior but due to inferior transverse fold

Puborectalis

Subcomponent of the Levator ani (inferior diaphragm of the pelvis) Separate the Ampulla and the Canal. Pulling it forward (attached on the superior pubic rami next to the symphysis)

Blood Supply of the Rectum

Superior Rectal ( from inferior mesenteric) - Ampulla


Middle Rectal ( ant. branch of the internal iliac) - Ampulla


Inferior Rectal (br. of the internal pudendal that branches from the internal iliac)

Above Pectineal Line

arteries - inferior mesenteric


veins - drains to portal vein


lymph - internal iliac lymph nodes


nerves - Visceral (sym, para) to the inferior mesenteric ganglion

Below the Pectineal Line

arteries - internal iliac (middle directly and inferior indirectly)


veins - to the IVC


lymph - to the superficial inguinal lymph nodes


nerves - somatic (motor and sensory) pudendal nerve

Suppositories

Drugs delivered through the anus will reach the rectal ampulla and be absorbed through the portal vein into the liver (metabolism)

Pelvic Ureter

Retroperitoneal -passes into the pelvis anterior to the bifurcation of the common iliac artery


- passes obliquely, inferior, medially through the wall of the bladder


- is first covered by a bridge (either uterine artery in females of the Vas Deferens in Males)

Bladder

Distensible musculo-membranous organ


Reservoir for urine


Mucosa with many folds except in the Vesicular Trigone

Empty vs Full Bladder

Empty - in lesser pelvis, posterior to the pelvic bones


Full - can reach up to the UMBILICUS and creates a supravesiclar recess between bladder and the ant. abdominal wall



Vesicle Trigone

Smooth mucosa at the base of the badder (over the prostate)


Posterior tips of triangle border by the Uretic Orifices


Anterior tip is internal Urethra Orifice

Interuretic Fold

Between left and right uretic orifices. Can become overgrown with enlarged prostate, resulting in a secondary cavity that holds urine in...preventing the complete draining of the bladder

Bladder Apex

anteriorly, attached to the umbilicus by median umbilical ligament

Body of Bladder

superiorly covered with peritoneum


Held by the obterator internus, levator ani tendinous arch and levator ani

Base of the Bladder

receives the ureters at the postero-lateral angles

Neck of the Bladder

Lies on the prostate, fundus and the inferior lateral portions meet

Male Urethra

20 cm


Pelvic Part - Intramural (INTERNAL URETHRA SPHINCTER) and Prostatic


Membranous part - EXTERNAL SPHINCTER


Spongy Urethra or Perineal

Female Urethra

4 cm


Pelvic Part - INTERNAL URETHRA SPHINCTER


Perineal Part - EXTERNAL SPHINCTER

Pudendal Nerve

S2, 3, 4- keeps the pee off the floor (same with poop)...Innervation of the urethra and bladder


Onuf's nucleus is the origin, will have trouble if artery of Adamkiewicz is malfunctioning

Prostatic Urethra

Urethral crest > Seminal Colliculus (with prostatic Utricle (male vag) and the openings of the ejaculatory ducts




Prostatic Sinuses- on either side of urethra with prostatic ducts (contribute to seminal fluid)

Scrotal Ductus Deferens

starts at the testes

Inguinal Ductus Deferens

travels in the inguinal canal, superior to the deep inguinal canal

Abdomino -Pelvic Ductus Deferens

Enters at the deep inguinal canal > lateral to the inferior epigastric > over the external iliac vessels> pelvic brim> descends on the lateral wall of the pelvis (medial to ureter, umbilical artery, obturator vessels) posterior to the bladder

Seminal Glands

Lateral to the Ductus ampulla. They join posterior to the prostate and enter urethra through the ejaculatory ducts.

Prostate

Walnut sized


Anterior- puboprostatic lig. and pubic symphysis


Posterior - Ampulla of Rectum


Inferior Lateral - Levator Ani


Superior - neck of bladder


inferior - EXTERNAL URETHRAL SPHINCTER

Lobes of the prostate

Anterior - ant. to urethra


Right and Left - on either side of the urethra


Middle - Subdivisions of R/L that lie posterior to the Urethra and above ejaculatory ducts

Zones of the Prostate



Peripheral - outside, 70% cancer


Central - (middle lobe) - resistant to cancer


Transitional - around urethra - Benign Prostic Hyperplasia


Periurethral - right around urethra -similar to transitional.