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229 Cards in this Set
- Front
- Back
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Intercostal level of SUPERIOR limit of ABDOMEN
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4th or 5th ICS
(level of diaphragm) |
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organs protected by inferior thoracic cage
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liver
spleen superior kidneys superior stomach |
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what cycle changes the volume of the abdominal cavity?
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respiratory
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MUSCLES of POSTERIOR abdominal wall
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quadratus lumborum
psoas major iliacus postero-medial fibers of TA, IAO and EAO |
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5 pairs of anterolateral abdominal wall muscles
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EAO
IAO TA RA pyrimidalis |
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what line marks point around which EAO, IAO and TA muscle pairs become aponeurotic?
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MCL
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midline of anterolateral abdominal wall aponeurosis thickens and interweaves in the midline, forming what structure?
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linea alba
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superior and inferior bounds of LINEA ALBA
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xiphoid process
pubic crest/pubic symphysisq |
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pre-natal homolog of umbilicus
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umbilical ring
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umbilical ring is a defect in what structure
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linea alba
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Actions of EAO, IAO and RA
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flex trunk
antagonistic to diaphragm compress viscera to increase intra-abdominal pressure |
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Innervation of EAO, IAO, TA
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primary rami of T7-T12 thoracoabdominal nn + L1
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Innervation for RA
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primary rami of T7-T12 thoracoabdominal nn
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NVP lies between what two muscle layers
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IAO and TA
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Nerves contained in NVP
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T7-T11 (thoracoabdominal nn)
T12 (subcostal n) L1 (ilioinguinal nn and iliohypogastric nn) |
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Vessels contained in NVP
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distal segments of T10 - T11 intercostal vessels
subcostal vessels lumbar segmental vessels deep circumflex iliac vessels |
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Transversalis fascia lies deep to ____ and _____
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Transversalis fascia lies deep to the TA and its aponeurosis
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Transversalis fascia contributes to the formation of the _____ AND _____
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femoral sheath
internal fascial layer of the spermatic cord |
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Endoabdominal fascia (especially the transversalis fascia subregion) is continuous with the ANTEIOR LAYER OF...
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Endoabdominal fascia continuous with the ANTERIOR LAYER OF THE THORACOLUMBAR FASCIA
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Anterior layer of the thoracolumbar fascia is the MOST POSTERIOR WALL OF....
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Anterior layer of the thoracolumbar fascia is the MOST POSTERIOR WALL OF THE RETROPERITONEAL COMPARTMENT
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Where is the extraperitoneal fat found?
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aka: extraperitoneal fascia
deep surface of endoabdominal fascia superifical to parietal peritoneum |
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Where is extraperitoneal fat/fascia NORMALLY most thick?
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along posterior wall, especially around KIDNEYS
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Serous fluid secreting mesothelium
deep to extraperitoneal fat/fascia |
parietal peritoneum
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Innervation of parietnal peritoneum
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GSAs that can precisely localize pain and inflammation
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space between parietal and visceral peritoneum, filled with fluid
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peritoneal cavity
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Superior 3/4 of rectus sheath
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IAO aponeurosis splits:
blends anteriorly with EAO aponeurosis blends posteriorly with TA aponeurosis |
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Inferior 1/4 of rectus sheath
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all three aponeuroses pass anterior to RA
NO POSTERIOR RS layer! (transversalis fascia + extraperitoneal fascia + parietal peritoneum comprise posterior tissue layer) |
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Line dividing superior vs. inferior regions of rectus sheath
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ARCUATE LINE
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superior and inferior bounds of MEDIAN umbilical fold
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umbilicus
apex of bladder |
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what does median umbilical fold cover?
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median umbilical ligament
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The median umbilical ligament is a remnant of what embryonic structure?
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URACHUS of embryonic bladder
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L&R mediaL umbilical fold covers...
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medial umbilical ligaments
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Medial umbilical ligaments are remnants of what fetal structures?
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umbilical arteries carrying blood from internal iliac aa through umbilicus to placenta
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L&R lateral umblical folds cover...
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inferior epigastric vessels
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which umbilical folds will bleed if cut?
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lateral umbilical folds
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bounds of medial inguinal fossa
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medial and lateral umbilical folds
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Inguinal triangle is found within which space?
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medial inguinal fossa
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Location of lateral inguinal fossae
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lateral to lateral umbilical folds
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What nerve plexus is found on the anterior surface of the quadratus lumborum?
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Lumbar nerve plexus
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The _____ fascia found on the anterior surface of the QL is the posterior boundary of the _____
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The THORACOLUMBAR fascia found on the anterior surface of the QL is the posterior boundary of the RETROPERITONEAL COMPARTMENT
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Action of QL
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trunk stabilization
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The lumbar nerve plexus is found on the anterior surface of what muscle?
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quadratus lumborum
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The superior epigastric artery anastamoses with the ____ artery within the belly of the ___ muscle
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The superior epigastric artery anastamoses with the INFERIOR EPIGASTRIC ARTERY within the belly of the RA muscle.
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Lateral border of inguinal triangle
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inferior epigastric artery
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Veins that eventually drain into SVC
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superior epigastric vv
T10-T11 intercostal vv subcostal vv |
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Veins that eventuall drain in to IVC
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segmental lumbar vv
inferior epigastric vv deep circumflex iliac vv superfical circumflex vv superficial epigastric vv |
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Where are thoracoepigastric vv found?
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superficial abdominal fascia (do not accompany arteries)
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Thoracoepigastric vv form V-V-a linkages among...
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femoral v and superficial epigastric v.
lateral thoracic v axillary v |
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Function of thoracoepigastric vv
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provide collateral routes to heart from lower limbs if IVC is blocked
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What venous network accompanies round ligament of the liver?
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Paraumbilical venous network
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In which fascial layer is the paraumbilical venous network found?
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superficial fascia
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The round ligament of the liver is a remnant of what fetal structure?
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umbilical vein
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The paraumbilical venous network forms V-V-a linkages among...
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hepatic portal v
superior epigastric vv inferior epigastric vv (or external iliac vv) |
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Name for varicosity of paraumbilical vv
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caput medusae
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Etiology of caput medusae
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blockage of portal circulation, stopping blood from most of the GI tract from returning to IVC through the liver
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Superficial lymphatics superior to umbilicus drain to...
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Axillary lymph nodes
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Superficial lymphatics inferior to umbilicus drain to...
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superficial inguinal lymph nodes
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Skeletal muscle layers drain lymph to...
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deep lymphatics associated with external iliac, common iliac and lumbar nodes
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Nerve transmitting GSAs from anterior abdominal skin
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thoracoabdominal nn (T7-T11)
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nerve transmitting GSAs from skin over ASIS and hip
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Subcostal nerve (T12)
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Nerve transmitting GSAs from skin over hypogastric region and iliac crest
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iliohypogastric n (L1)
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Nerve transmitting GSAs from anterior superior thigh
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Femoral branch of genitofemoral n.
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Nerve transmitting GSAs from skin of scrotum/labia majora, mons pubis, medial superior thigh
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Ilioinguinal n (L1)
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Nerve transmitting GSAs from skin of anterior scrotum/labia majora
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Genital branch of genitofemoral n.
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Major branches of Lumbar Plexus
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Iliohypogastric (L1)
Ilioinguinal (L1) Genitofemoral (L1-L2) Lateral femoral cutaneous (L2-L3) Obdurator (L2-L4) Femoral n. (L2-L4) Lumbosacral trunk (L4-L5) |
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T10 dermatome
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contains umbilicus
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Regions contained in T12/L1 dermatome
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hypogastric region & inguinal region
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Visceral-origin pain is sensed and carried by ____ to the ____
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Visceral-origin pain is sensed and carried by GVAs to the CNS
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Somatic-origin pain is sensed and carried by ____ to the _____
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Somatic origin pain is sensed and carried by GSAs to the CNS
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Visceral-origin pain often refers to the ____
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midline
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Visceral-origin pain is usually due to ____
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stretching of the VISCERAL PERITONEUM
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Somatic-origin pain is usually due to ___
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inflamed organ irritating adjacent parietal peritoneum
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Somtic origin pain can usually be localized...
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precisely, by the primary somatosensory cortex
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Organs referring pain to R. shoulder
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liver, gallbladder and duodenum - resulting from irritation of the diaphragm
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Stomach pain can refer to ____
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middle of upper back (between scapulae)
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Guarding reflex =
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GSAs reflexively excite GSEs from the same spinal cord segment that innervate the skel. mm overlying the inflamed parietal pertioneum secondary to peritonitis
causes muscle spasms or complete rigidity of trunk mm |
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Inferior boundary of middle inguinal canal =
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inguinal ligament
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Inguinal ligament is a thickened, rolled under portion of the ____
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aponeurosis of EAO
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Pectineal ligament (of Cooper) is a specialization of _____
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pectin pubis periosteum
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site of suture attachment in procedures to relieve urinary stress incontinence
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pectineal ligament
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lacunar ligament (of Gimbernat) spans between...
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inguinal ligament and pectineal ligament
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medial border of femoral ring
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lacunar ligament
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inferior boundary of medial inguinal canal =
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lacunar ligament
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Iliopubic tract
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a specialized thickening of transversalis fascia running parallel and deep to inguinal ligament
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function of iliopubic tract
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reinforces inferior and posterior wall of lateral 1/2 of the inguinal canal
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medial attachment of iliopubic tract
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superior-medial pubic bone
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deep inguinal ring opens into ____
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peritoneal cavity
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location of deep inguinal ring relative to
- mid-inguinal ligament - lateral umbilical fold - femoral ring |
Deep inguinal ring is
1/2 inch SUPERIOR to mid-inguinal ligament immediately LATERAL to lateral umbilical fold SUPERIOR-LATERAL to femoral ring |
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deep inguinal ring is formed from
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an outpouching of transversalis fascia
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superficial iguinal ring is a defect in the
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EAO aponeurosis
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edges and roof of superficial inguinal ring
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lateral crus
medial crus intercrural fibers |
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Conjoint tendon
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fused common tendinous insertion of TA and IAO muscles into the superior pubic ramus
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Conjoint tendon contributes to which boundaryof medial inguinal canal?
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posterior
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Superior boundary of medial 1/3 of inguinal canal
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medial crus of EAO aponeurosis
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Anterior boundary of Medial 1/3 of inguinal canal
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intercrural fibers
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Posterior boundary of medial 1/3 of inguinal canal
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conjoint tendon
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Inferior boundary of medial 1/3 of inguinal canal
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lacunar ligament - continuation of inguinal ligament
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Superior boundary of middle-lateral 2/3 of inguinal canal
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arching fibers of IAO and TA muscles
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Anterior boundary of middle-lateral 2/3 of inguinal canal
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lateral crus of EAO aponeurosis
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Posterior boundary of middle-lateral 2/3 of inguinal canal
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lateral crus
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Inferior boundary of middle-lateral 2/3 of inguinal canal
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inguinal ligament
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Nerve running through inguinal canal in both sexes
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ilioinguinal
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direct inguinal hernias
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bowel pushes into inguinal triangle
runs parallel and superficial to spermatic cord; rarely enters scrotum |
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indirect inguinal hernials
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bowel enters inguinal canal at deep ring
travels though inguial canal within spermatic cord may exit superficial ring and enter scrotum |
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Femoral sheath is an outpouching of
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transversalis fascia
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Femoral structure NOT enclosed in femoral sheath
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femoral nerve
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Femoral hernias
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least common hernia
bulge presents inferior to inguinal ligament bowel enters femoral canal |
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Where is the arcuate line found?
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About 1/2 way between the umbilicus and the pubic symphysis.
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The _____ and ____ merge to form the hepatic vein posterior to the _____.
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SMV and the splenic v
posterior to the NECK of the pancreas |
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IVC is posterior to the _____ (organ)
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liver
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2 "buddies" of hepatic portal vein
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proper hepatic artery
common bile duct |
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does the IVC run with any other vessels?
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no - "lone wolf"
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preganglionic sympathetics in abdomen come from which spinal levels?
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T5 - L2
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greater splanchnic nerve innervates derivatives of which embryological region?
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foregut
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foregut structures
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stomach, duodenum, liver, pancreas, biliary apparatus
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celiac trunk supplies blood to derivatives of which embryological region?
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foregut
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midgut structures
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intestines
from duodenum distal to pancreatic duct through proximal 1/2-2/3 of transverse colon |
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SMA supplies derivatives of which embryological region?
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midgut
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artery and nerve supplying derivatives of the foregut
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celiac trunk
greater splanchnic nerve |
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phyiological herniation
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midgut grows into umbilical ring during development in order to obtain room to grow
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week at which midgut normally retracts out of umbilicus?
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10th
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IMA supplies structures derived from which embryological region?
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hindgut
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hindgut derivatives
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distal 1/2-1/3 of transverse colon through anal column
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visceral pain from hindgut structures localizes to...
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hypogastric region
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congenital hypertrophic pyloric stenosis
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marked thickening of pyloris
causes constriction -- causes projectile vomiting from accumulation in stomach tx = surgery |
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congenital omphalocele
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midgut does not fully retract from umbilicus and anterior abdominal wall does not close around opening
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gastrochisis
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viscera hanging outside the body
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how many degrees does the midgut ultimately rotate?
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270*
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which direction does the gut rotate
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CCW
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malrotation
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gut rotates in CW direction - structures wind up on opposite side of body from normal location
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congenital ileum diverticulum
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persistant vittaline duct (proximal part of yolk sac)
if inflamed, can mimic appendicitis |
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peritoneal space
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wafer-thin space between visceral and parietal peritoneum
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definition of true retroperitoneal organs
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NEVER had a mesentery
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definition of secondarily retroperitoneal organs
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had a mesentery at some point, but don't by the end of embryological development
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4 persistent structures of VENTRAL mesentery
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lesser omentum
falciform ligament round ligament of liver coronary ligament |
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only gut tube structures that do NOT have persistent DORSAL mesentary
|
duodenum
ascending and descending colons |
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secondarily retroperitoneal organs (list)
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most of pancreas
most of duodenum ascending and descending colon |
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anterior vagal trunk innervates _____ derived structures
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foregut
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posterior vagal trunk innervates ____ and ____ derived structure
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foregut and midgut
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from which spinal levels do NO autonomic nerves emerge?
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L3-S1
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No visceral pain is referred to which dermatomes, scleratomes or myotomes?
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L3-S1 (no GVAs!)
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GVAs travel with which efferents?
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parasympathetic GVEs
(nausea, hunger, distention travel along vagus) |
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anterior vagal trunk innervates _____ derived structures
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foregut
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posterior vagal trunk innervates ____ and ____ derived structure
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foregut and midgut
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from which spinal levels do NO autonomic nerves emerge?
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L3-S1
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No visceral pain is referred to which dermatomes, scleratomes or myotomes?
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L3-S1 (no GVAs!)
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GVAs travel with which efferents?
|
parasympathetic GVEs
(nausea, hunger, distention travel along vagus) |
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vertebral level of pylorus
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L1
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costal level of TPP
|
9th costal cartilage
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origin and destination of L. gastric a.
|
L gastric artery
origin: celiac trunk destination: LESSER curvature |
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origin and destination of R. gastric a.
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R. gastric artery
origin: often from common hepatic a. destination: LESSER curvature |
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origin and destination of R. gastro-omental a.
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L. gastro-omental (epiploic) a.
originates from gastroduodenal a. destiation: GREATER curvature |
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origin and destination of L. gastro-omental a.
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L. gastro-omental a.
origin: splenic artery destination: GREATER curvature |
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Short gastric aa
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short gastric aa
origin: splenic a. destination: GREATER curvature |
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L & R. gastric vv drain into ____
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Hepatic Portal vein
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L. gastro-omental and short gastric vv drain into ______
|
splenic vein
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R. gastro omental v drains into _____
|
SMV
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parasympathetic innervation to ANTERIOR stomach
|
anterior and posterior vagal trunk
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parasympathetic innervation to POSTERIOR stomach
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posterior vagal trunk ONLY
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preganglionic sympathetics destined for stomach emerge from which spinal levels?
|
T6 - T9
|
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preganglionic sympathetics from T6-T9 form which nerves?
|
greater splanchnic
|
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Where do pre- and post-ganglionic sympathetic GVEs synapse before reaching the stomach?
|
celiac ganglia
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GVAs from stomach refer to which dermatomes in which regions?
|
T6-T9 dermatomes in
epigastric or L. hypogastric regions |
|
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Is the spleen intra-, retro- or secondarily retroperitoneal?
|
Intraperitoneal
|
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Which ribs typically protect the spleen?
|
8 - 11
|
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Contents of Gastrosplenic ligament
|
short gastric vessels
L. gastro-omental vessels & accompanying autonomic nerve fibers and lymphatics |
|
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Contents of Splenorenal ligament
|
splenic vessels
autonomic neurons lymphatics |
|
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Relation of splenic vessels to PANCREAS?
|
Splenic artery runs SUPERIOR to pancreas
Splenic vein runs POSTERIOR to pancreas |
|
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Sympathetic innervation of spleen
|
T6 - T8 through R&L greater splanchnic nerves
|
|
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Spleen refers pain to which dermatomes
|
T6 - T8
and C3 - C5 through irritation of diaphragm |
|
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Deepest section of gut tube
|
duodenum
|
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Descending part of duodenum
vertebral levels neighboring structures |
L1 - L3
between IVC (right) and pancreas (left) |
|
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Major duodenal papilla is found in which part of the duodenum
|
2nd part (descending)
|
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third (horizontal) part of duodenum
vertebral level neighboring structures |
L3
runs anterior to aorta and IVC runs inferior to HEAD of pancreas |
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Sympathetic innervation of duodenum
fiber type nerves spinal levels |
GVEs
splanchnic nerves T7/T8 - T12 |
|
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Source of parasympathetic innervation for foregut and midgut
|
vagus nerve
|
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Duodenal ulcers can refer pain to which quadrant and why?
|
RLQ
fluid moves from omental bursa down paracolic gutter - presents like appendicitis |
|
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What artery can duodenal ulcer erode and where may pain refer?
|
gastroduodenal artery
L. hemidiaphragm irritation may refer to shoulder/neck |
|
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3 structures posterior to HEAD of pancreas
|
IVC
R renal vessels common bile duct |
|
|
pancreas NECK is anterior to what vein(s)?
|
SMV and splenic vein merge to form hepatic portal vein
|
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spinal levels - innervation of pancreas
|
T6 - T9
|
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Caudate lobe is next to what (extrahepatic) structure?
|
IVC
|
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Quadrate lobe is next to what (extrahepatic) structure?
|
gallbladder
|
|
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What does the hepatic portal vein carry to the liver?
|
Low O2-nutrient-rich blood
|
|
|
porta hepatis
|
cross bar of the H
on visceral side of liver |
|
|
portal triad
|
hepatic portal v
proper hepatic a common bile duct |
|
|
4 portal-systemic venous anastamoses
|
esophageal PSVA
paraumbilical PSVA retroperitoneal PSVA rectal PSVA |
|
|
Liver innervation - sympathetic
|
T6 - T9
greater splanchnic nerve to celiac ganglion post-synaptics follow hepatic a. |
|
|
Basic function of gallbladder
|
stores bile
|
|
|
Order of biliary ducts from liver on out
|
Hepatic bile duct
Common hepatic duct Cystic duct Common bile duct |
|
|
Which biliary duct goes to gallbladder?
|
cystic duct
|
|
|
artery supplying gallbladder
|
cystic artery
|
|
|
venous drainage from ileum and jejunem goes to
|
SMV
|
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sympathetic innervation to iliojejunem
|
T8 - T12
splanchnic nerves synapse in superior MESENTERIC plexus |
|
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structure that "cinches" colon
|
tenia coli
|
|
|
haustra
|
pouches caused by colon cinching as a result of tenia coli
|
|
|
pathology related to ileocecal valve
|
ileocecal valve is incompetent (normally)
allows retrograde flow of feces --> vomit feces |
|
|
where do all three tenia coli converge?
|
at appendix
|
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Superior limit of LEFT paracolic gutterr
|
phrenicocolic ligament
|
|
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Which paracolic gutter is limited superiorly?
|
left
(right paracolic gutter allows communication between subphrenic space and pelvic cavity) |
|
|
vertebral level of rectosigmoid junction
|
S3
|
|
|
origin of rectum defined by...
|
loss of sigmoid mesocolon
|
|
|
sigmoid colon: intra- retro- or secondarily retroperitoneal?
|
intraperitoneal
|
|
|
intersigmoid fossa
|
defined by upside-down "V" of sigmoid mesocolon
at level of pelvic brim |
|
|
In intersigmoid fossa, the L. ureter runs anterior to _____
|
bifurcation of L. common iliac artery
|
|
|
Marginal artery anastamoses which arteries?
|
SMA and IMA
|
|
|
boundaries of inguinal triangle
|
inferior epigastric - lateral
semilunar line - medial inguinal ligament - inferior |
|
|
superficial to deep, anterolateral abdominal wall
|
skin
Camper's fascia (superficial superficial) Scarpa's fascia (deep superficial) Deep investing fascia of: EAO IAO TA transversalis fascia parietal peritoneum |
|
|
venous drainage of large intestine
|
SMV receives from proximal
IMV receives from distal |
|
|
referred pain from cecum
|
hypogastric region
LLQ (accompany SYMPATHETIC GVEs) |
|
|
referred pain from distal rectum
|
perineal region (S2 - S4 dermatome)
accompany (PARASYMPATHETIC GVEs) |
|
|
intrarenal collecting system
|
minor calyces
major calyces infundibula renal pelvis (--> ureter) |
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R. renal artery passes ____ to the IVC
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posterior
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tributaries of L. renal vein
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L. upper lumbar v.
combined L. inferior phrenic v. and L. suprarenal v. L. gonadal v. |
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origin of ureter
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uretopelvic junction
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relationship of ureter to renal vessels
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ureter passes POSTERIOR to renal vessels
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where does ureter cross pelvic brim?
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near bifurcation of common iliac artery
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Water under the bridge
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ureter passes UNDER vas deferens
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Water under the bloody bridge
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ureter passes UNDER the uterine vessels
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3 locations where kidney stones are likely to lodge
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ureteropelvic junction
where ureter passes iliac vessels at pelvic brim ureterovesical juntion |
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besides the vagina, what do the vaginal arteries supply?
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urinary bladder
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spinal levels of SYMPATHETIC innervation to bladder
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L1-L2
(lumbar and sacral splanchnics) |
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spinal levels of PARASYMPATHETIC innervation to bladder
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S2-S4
(pelvic splanchnics) |
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general bladder distention
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is inferior
refers pain to S2 - S4 dermatome, including glans penis |
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myofascial fibers contributing to superior boundary in of inguinal canal
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TA and IAO
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structures visible from a laparoscopic view from wthin abdominal cavity
(as during hernia repair) |
deep inguinal ring
iliopubic tract |
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layer immediately deep to transversalis fascia of lateral abdominal wall
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endoabdominal fascia
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medial boundary of femoral ring
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lacunar
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contents of subinguinal space (may not be complete!)
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isiopsoas muscle
femoral nerve femoral blood vessels iliacus muscle lateral femoral cutaneous nerve external iliac vessels |
