Abdominal Wall And Cavity

Front 1

Boundaries of the abdominal cavity

Back 1

TV12 to LV5 posteriorly
Ala wings of sacrum and illeum, inferiorly and laterally (sometimes called the false pelvis)

Front 2

Bony Boundaries of the true pelvis

Back 2

Sacrum Posteriorly
Ischiopubic rami and ischial spines laterally.

Front 3

Soft tissue boundaries

Back 3

Diaphram superiorly, pelvic Diaphram inferiorly

Abdominal musculature between rib cage and pelvic girdle

Front 4

skin with the ubilicus and vertebral level

Back 4

LV4 and dermatome t10

Front 5

Superficial fascia two layers

Back 5

Camper's-fatty
Scarpa's -membranous and deeper

Front 6

External abdominal oblique att.

Back 6

attaches from lower 8 ribs, the fibers run inferiorly and anteriorly to attach to the aponeurosis forming the external lamella of the rectus sheath

Front 7

external oblique midline attachment and Inferior attachemnt-

Back 7

attach to the linea alba and to crest of the illeum

Front 8

Inferior extent of the external oblique gives rise to the

Back 8

the inguinal ligament (form anterior posterior spine to pubic tubercle

Front 9

Lacunar ligament is the

Back 9

medial end of the inguinal ligament which is rolled under the spermatic cord

Front 10

Pectineal ligament continues (cooper)

Back 10

laterally from the lacunar ligament along the pectineal line of the pubis (Strongest ligament of the body)

Front 11

The three ligamnets described are used during surgery

Back 11

for anchor points during hernia repair surgeries

Front 12

internal abdominal oblique att.

Back 12

attaches from the lateral 1/2 inguinal ligament and to the anterior 2/3 of the illiac crest. Fibers course superiorly and anteriorly. Superior attachment is the lower 3 or 4 ribs and to rectus sheath

Front 13

internal abdominal oblique abaove the arcuate line

below arcuate line

Back 13

splits into anterior and posterior lamellae

entire aponeurosis courses anterior to the rectus

Front 14

Transversus Abdominis

Back 14

fibers begin from the lateral 1/3 of the inguinal ligament and anterior 3/4 of the of the illiac crest, from the thoracolumbar fascia, and from the lower 6 ribs.

Front 15

Transversus abdominus facia and arcuate line

Back 15

attaches to posterior lamellae of the rectus sheath above the arcuate line and to the anterior lamella of the rectus sheath below

Front 16

Rectus Abdominis muscle mm.

Back 16

a paired muscle on either side of the linea alba. Fibers run vertically, attach to the cartilages of ribs 5-7 superiorly, and the crest of the pubis inferiorly. Three horizontal tendinous intersections usually subdivide the mm. into 4 segments.

Front 17

Actions of muscles of abdominal wall

Back 17

compress the abdomen

Front 18

Blood supply to abdomen:

what courses horizontally between the internal oblique and transversus abd. and anastomose to supply abdominal wall

Back 18

the lower 5 intercostals aa., the subcostal a., and the lumbar aa. course nearly horizontal between these muslces

Front 19

superior and inferior epigastric course vertically and supply the rectus abdominis mm.

Back 19

yes they do, and also form an important anastomotic connection deep to the muscles

Front 20

Important vein of abdominal wall

Back 20

is the thoracoepigastric vein in the superficial fascia and forms important anastomosis with the lateral thoracic vv. superiorly paraumbilical, superficial epigastrics, and circumflex illiac

Front 21

It is critical to know that the rectus abdominis

Back 21

receives blood supply from the inferior and superior epigastric aa. This artery courses vertically then horizintally to supply the obligues.

Front 22

umblicus vertebral level

Back 22

L4, t10 dermatome

Front 23

suprapubic dermatome

Back 23

L1,

Front 24

LV4

Back 24

umblicus, illiac crest, and dorsal aorta bifurication

Front 25

Falciform ligament

Back 25

ventral mesentary derivaative that is continuous with the parietal periteneum and the anterior abdominal wall of the diaphram

Front 26

Umbilical ligaments

from peritoneal folds over umb. aa

from peritoneal over urachus

Back 26

not true ligaments

medial umbilical-

median umbilical

Front 27

lateral umbilical ligaments

Back 27

formed by periteneum overlying the inferior epigastric vessels as they course through the deep surface of the rectus

Front 28

inferior epigastric aa.

Back 28

are branches of the external illiac aa.

Front 29

inferior epigastric vein

Back 29

terminate in the exteranl illiac vein

Front 30

Inguiunal Triangle

Back 30

medial to the inferior epigastric muscles and is the site of a direct hernia. Leads directly to the superficial ring.

Front 31

Boundaries of Hasselbach's ring

Back 31

lateral-inferior epigastric vessels
medial-lateral edge of rectus abdominis m
Inferior-inguinal ligament

Front 32

direct inguinal hernia

Back 32

it leads directly to the superficial inguinal ring

Front 33

indirect inguinal hernias

Back 33

occur lateral to the inferior epigastric vessels. This is the site of the deep inguinal ring.

Front 34

scrotum

Back 34

has kinky hairs

Front 35

Dartos tunic

Back 35

scrotal layer devoid of fat, but it is continuous with dartos fascia of the penis and the superficial fascia of the groin and the perineum, the thigh and the abdomen (scarpa's).

Front 36

Dartos muscle

Back 36

under sympathetic controlo regulates temperature of the testes.

Front 37

Covering's of spermatic cord and testis

Back 37

kwas 3:

exernal spermatic fascia-EAO
cremaster muscle and fascia = IAO
Internal Spermatic Fascia= transversalis fascia=deep ring

Front 38

3 arteries

Back 38

cremasteric a. - off inf. epigastric

testicular a. - off aorta



artery to vas deferens -off inf. vesicular

Front 39

3 nerves

Back 39

ilioinguinal-L1, cutaneous to skin of anterior scrotum as anterior scrotal nn.

genital br. of genitofemoral n. (l1, l2) to cremaster muscle for cremaster reflex, uses l1 for distribution to the medial thigh as afferent limb of the reflex.

autonomics to testes, dartos and to the blood vessels

Front 40

3 other structures

1)

Back 40

pampiniform plexus of veins which drain the testis and give rise to the testicular v., which terminates in the left renal vein on the left or in the inferior vena cava on the right

Front 41

2) ductus deferens

Back 41

which is continuous with the epidymis, courses as the most posterior strucutre in the spermatic cord and joins seminal vescile

Front 42

3) lymphatics

Back 42

paralles venous drainage. This is why tumor metastasis from the testis is clinically very important, since it goes to the posterior abdominal wall

Front 43

Testis:

a-H

Back 43

next cards

Front 44

A

Back 44

retroperitoneal-develops along the urogenital ridge between layers which become transversalis fascia and parietal peritoneum

Front 45

B

Back 45

processus vaginalis-is an outpocketing of peritoneum into scrotum which proceeds the descent of the testis

Front 46

C

Back 46

Descent into scrotum goes along the course of the process vaginalis through superficial and deep ingiunal rings, gaining all coverings of the cord

Front 47

D

Back 47

Descent into scrotum

Front 48

D. hydrocele

Back 48

is a fluid filled sac as a remnant of the lumen of the processus vaginalis

Front 49

E. coverings

Back 49

the testes are covered by visceral and parietal layers of tunica vaginalis

Front 50

F. Efferent ducutules

Back 50

15 to 20, which are continuous with the seminferous tubules at the superior pole of the testis and drain into the epidymis

Front 51

G. the convulted epidymis

Back 51

used for sperm storage, drains into the vas deferens, goes to ejaculatory duct through the prostrate

Front 52

H. Tunica Albuginea

Back 52

dense white covering which forms the capsule of the testis

Front 53

Hernia follows

Back 53

cards

hernia is a protrusion into no no land

Front 54

Hernia contains

Back 54

periteneum enclosing a lopp of intestines

10% of population

Front 55

Inguinal hernia

Back 55

7:1 to male prevalence

Front 56

indirect:

Back 56

75% of male hernias, congenital, in young males at deep ring, lateral to inferior epigastric

Front 57

direct:

Back 57

25% aquired in older males at superficial ring. Through inguinal canal at superficial ring. Through inguinal triangle medial to inferior epigastric

Front 58

umbilical

Back 58

About 14% of hernias, and more common in females at region of umbilicus

1.7 to 1

Front 59

femoral

Back 59

5% of total hernias
more common in females than males

1.8 to 1

Front 60

obturator

Back 60

at obturator foramen

Front 61

epigastric

Back 61

at linea alba

Front 62

spigelian

Back 62

in posterior rectus sheath below arcuate line

Front 63

Lumbar

Back 63

On back of lumbar traingle

Front 64

Perineal

Back 64

through or between muscles of pelvic diaphram

Front 65

Diagphragmatic

Back 65

at a hiatus in diaphragm

Front 66

Repair of Hernia's

Back 66

necessary to prevent strangulation

Retract abdominal contents and strengthen wall

suture to pectineal or inguinal ligament

Front 67

pareintal peritoneum and pain

Back 67

receives same innervation as the overlying musculature; thus somatic peritoneal pain will be well localized and defined (referred c3-c5)

Front 68

visceral periteneum

Back 68

same innervation, vasc, and lymph as the organ it invests: relatively insensitive; vague visceral pain referred to epigastric, preumbilical, falnk, and pelvic domains derms

Front 69

peritoneal formations

Back 69

following cards

Front 70

mesentary

Back 70

double layer of peritoneum reflected off dorsal abdominal wall to viscera containg neurovasc, and lymph, fat

Front 71

mesentary proper

Back 71

is a braod fan like mesentary suspending the small bowel to the posterior abdominal wall, obliquely from the duodenojejunal fold to the right of the illiac fossa

Front 72

transverse mesocolon

Back 72

dorsal mesentary to the transverse colon

Front 73

sigmoid mesocolon

Back 73

attaches to the sigmoid colon to the posterolateral abdomino pelvic wall

Front 74

OMENTUM:

Back 74

double layer extension or fold of periteneum

Front 75

lesser ommentum

Back 75

ventral mesenteric derivative from the lesser curvature of the stomach and duodenum to the liver

Front 76

greater omentum

Back 76

dorsal mesenteric, from greater curvature of the stomach, draping over abdominl viscera, and back to transverse colon mesentary

Front 77

Ligament of tritz

Back 77

suspends the duodenal fold from the diaphram

Front 78

omental bursa

Back 78

refer to picture but space behind stomach and bounded by the liver

Front 79

subphrenic space

Back 79

above liver and but below diaphram

Front 80

paraduodenal recesses

Back 80

lateral to ascending duodenum

Front 81

Hepatorenal

Back 81

sub hepatic space above the right kidney; frequent abcess

Front 82

Esophagus

Back 82

right border continuous with the lesser curvature, and left border with greater curvature. Phrenico-eso. ligs attach. crura function as lower esophageal sphincter . terminates in cardiac sphincter of the stomach

Front 83

Stomach:

Back 83

intra-peritoneal, cardia surrounds the cardiac orfice. refer to feits for pic:

cards below

Front 84

lesser curvature:

Back 84

concave, facing liver, lesser omentum associated: to porta hepatis forms ventral wall

Front 85

Ligaments of the greater omentum

Back 85

flaciform, coronary, triangular ligaments, -Hepatic:
Splenic: Lieno renal, gastro-splenic to right kidney and stomach
Duodenum; ligament of treitz suspending duodenal fold
Colon: phrenico colic ligment

Front 86

subphrenic space

Back 86

above liver below diaphram

Front 87

hepatorenal

Back 87

subhepatic space above the right kidney, frequent abcess formation

Front 88

paracolic gutters

Back 88

lateral spaces along the asc. dsc colon

Front 89

paraduodenal recess

Back 89

lateral to ascending duodenum, duodenjejual fold; frequent abcess formation

Front 90

lower esophageal sphincter

Back 90

the crus of the diaphram

Front 91

duodenum

Back 91

from pylorus to dudodejunal fold, c shaped loop around of pancreas; lv1-lv3,4. mostly fixed, retroperitoneal location.

Front 92

Superior portion of duodenum

Back 92

related to gall bladder and liver (LV1) ventrally, heptaduodenal ligament, gastrodudenal artery. common bile duct portal vein and pancreas dorsally

Front 93

descending

Back 93

lv1 to lv4, covered ventrally by peritenuem. relationship with right kidney, IVC and psoasm. dorsally. Transverse colon. liver and jejunal loops are ventral. Common bile and pancreatic duct enter this portion about 7cm dorsal to the pyloric at the hepatopancreatic duct. and dudodenal papilla.

Front 94

Horizontal

Back 94

crosses lv3 lv4 area. head of pancrea superiorly.

Front 95

Ascending

Back 95

ascends to the duodenodal flecure left of LV2 and aorta. Transverse mesocolon and lig of trietz superiorly. Sup. mesenteric passes over top.

Front 96

duodenal ulcers

Back 96

occur close to pylorus most in posterior wall. massive hemorhage may result by eating through wall to the pancreas, gall bladder, or pancreaduodenal arteries.

Front 97

Lymphatics of duodenal region

Back 97

follow the arterial circulation and drain in to the pancreatic duodenal, superior mesenteric and celiac lymph nodes.

Front 98

Jejunum

Back 98

locted in the upper right and. has larger diameter, thicker wall and more vasculature. more mucosal folds.

Front 99

Illeum

Back 99

terminates at the illeocecal valve in cecal wall.

Front 100

small bowel mesentary

Back 100

contains the superior mesenteric artery and vein. visceral periteneum in this.

Front 101

lymphatics

Back 101

lacteal in mucosa drain to the mesenteric lymphs and. Abundant nea r antimesenteric border of illeum are called peyer' patches

Front 102

appendix

Back 102

also called the veriform appendage and contains lymphatics. Variable location in relation to the cecum

Front 103

ascending colon

Back 103

extends to the right colic flexure. just ventral to the kidney

Front 104

transverse colon

Back 104

from right hepatic flexure to splenci flexure

Front 105

liver

visceral surfaces

saggital fossae

Back 105

porta hepatis-fissure for the portal vsin hepatic artery and hepatic bile duct ad lymphatics. attachemnt of heptaduodenal ligament and gastro hepatic ligament

relief for the ligamentum venosus, and the round ligament (ligamnetum teres). Boundaries of the caudate and quadrate hepatic

Front 106

lobes of the liver seperated by

Back 106

falciform ligamament

Front 107

caudate lobe

Back 107

where vena cava and and liver asscoaite

Front 108

spleen impressions

Back 108

gastric, splenic flexure, pancreatic and renal impressions

has a central hilum

Front 109

Sympathetics

Back 109

T5-9-greater splanchnic
lesser-t9-t12
least t12
lumbar l1-l3

Front 110

Celiac arteries

Back 110

arises at t12 just caudal to the aortic hiatus, has three main forgut branches

Below

Front 111

Left Gastric artery

Back 111

supplies blood to 3 organs, esophagus (via esophageal branches), stomach ( along the lesser curvature via dorsal and ventral branches which anastomese with the branches of the right gastric a.) and liver via an accesory or abberant hepatic

Front 112

Splenic artery

Back 112

will explain in next few what it supplies

Front 113

Pancreas

Back 113

via twig branches caterogized into dorsal pancreatic, pancreatic magna, and caudal pancreatic

Front 114

Stomach

Back 114

via the left gastroepiploic usually the largest branch off the splenic. It courses through the pancreaticlieinal and gastrolienial ligamnets to reach the greater curvature of the stomach via the anterior aspect of the greater omentum. The short gastric aa. are 5-7 in number.-they reach the left side of the greater curvature of the stomach via the gastrolienal ligament. Here the anastomese with the left gastric and gastroepiploic.

Front 115

Spleen

Back 115

main branch to spllen via the superior and inferior branches at the hilum.

Front 116

New-Common Hepatic Artery

Back 116

it courses horizontally from left to right along the superior edge of the head of the pancrea to the first part of the duodenam. It gives three branches to be discussed in next 3.

Front 117

Gastro duodenal a.

Back 117

branches to stomach,
duodenam via supraduodenal, alonf the superior surface of the duodenam and the superior pncreatic duodenal artery which forms a ring of anast. around the head of the pancreas and duodenum.

Front 118

proper hepatic

Back 118

has the right, left, and cystic branches

Front 119

right hepatic-

Back 119

functional right lobe of the liver,

Front 120

Left hepatic

Back 120

to both lobes, sometimes originates from the left gastric a

Front 121

cystic

Back 121

usually a branch of the righ hepatic and course through the cystic triangle either anterior or posterior(%75.

Front 122

triangles of Calot

Back 122

right-cystic duct, left-common hepatic duct, superior-liver

Front 123

rt. gastric.

Back 123

supplies the lesser curvature of the stomach and comes from the proper hepatic or common

Front 124

Superior mesenteric at lv1 courses _______ to the left renal vein, the uncinate process, and _____ part of the duodenum.

Back 124

Anterior to all that

Front 125

inferior pancreaticoduodenal a.

Back 125

anterio and posterio branches anastomose with the anterior and posterior branches of the posterior superior pancreaticoduodenal aa. around the head of the pancreas and 2nd part of duodenum.

Front 126

ileocolic

Back 126

most causal branch to the terminal illeum and cecum,

Front 127

right colic

Back 127

to the ascending colon.

Front 128

middle colic a

Back 128

first branches of the superior mesenteric.

Front 129

Inferior mesenteric

Back 129

left colic, sigmoid colic, and superior rectal.

Front 130

left colic

Back 130

descending colon

Front 131

sigmoid branches

Back 131

2 or 3 that supply the terminal part of descending colon and sigmoid pelvic colon

Front 132

superior rectal

Back 132

terminal ima that gives rise to the the anterior and posterior branches which anastomose with the middle rectal(from internal illiac) and the inferior rectal from the internal pudendal.

Front 133

colic aa. and connections with clinically important ________ a. are all interconnected by

Back 133

marginal artery is seen coursing near the colon.

Front 134

arc of Rhiolin

Back 134

interconnects the s middle collic and the left colic aa. This vessel becomes visible when the sma or ima becomes blocked. It is more proximal than the marginal artery.

Front 135

common hepatic

Back 135

formed by the union of the right and left hepatic ducts which drain the functional right and left lobes of the liver. Common hepatic joins with ___

Front 136

the cystic duct which

Back 136

supplies or drains the gall bladder and forms the _____________

Front 137

common bile duct which

Back 137

passes posterio to the 1st part of the duodenum and drains into the 2nd part of the duodenam in conjuction with the main pancreatic duct.

Front 138

liver lies in the

Back 138

right hypochondrium and superior part of the epigastrium.

Front 139

right lobe of liver is divided into

Back 139

anterio and posterior portions by segmental vesels and ducts. Each segment is then divided into anterior and superior

Front 140

left lobe is divided

Back 140

by medial and lateral segments which have superior and inferior segemnts.

Front 141

caudat lobe

Back 141

has left and right divisions.

Front 142

portal vein formation and path

Back 142

is formed by the union of the splenic and superior mesenteric veins and divides into right and left for lobes

Front 143

liver innervation

Back 143

liver and bile tract from sympathetic splanchnics from t7-t9. and paras from the left and right vagal truncks. Symps synapse in the celiac ganglion and innervate hepatic and portal vessels.

Front 144

symps of liver are __________ to the gall blader and bile ducts

Back 144

inhibitory while vagus is stimulatory

Front 145

hepatoduodenal ligament

Back 145

is free edge of the lesser omentum. Attaches to the hilum of the liver and contains the triad components (common bile duct, proper hepatic, portal vein,autonomics, and lymphatics. This lig. forms ant. boundary of the epiploic foramen (winslow). Inderior cava is posterior to foramen.

Front 146

portal system

Back 146

all major veins of the digestive tract are part of the portal system except the hepatic vein.

Front 147

portal vein

Back 147

breaks into radicles that end in the liver sinusoids

Front 148

superior mesenteric v. drains

Back 148

recieves drainage from the stomach via right gastroepiploic v.. pancreas and duodenum. all of jej. and ill., the cecum and appendix, the ascending colon. all or most of the transverse colon. Parralels the artery. End behind pancreas with splenic to form portal vein

Front 149

Inferior Mesenteric

Back 149

receieves the left colic, sigmoid, and superior rectal tributaries, and tus drains non sma transverse, the descending colon, sigmoid colon, and much of the rectum, plus the left part of the transverse colon.

Front 150

Splenic vein

Back 150

is formed by radicles from the spleen, recieves short gastric vv. and the left gastroepiploic v as it runs behind the pancreas vv. ALso recieves the inferior mesenteric vv. and ends by joining the superior mesenteric v. to form the portal vein.

Front 151

Esophageal varix

Back 151

blockage of blood flow through portal v. forces bloo back up into the veins around the esophagus causing them to enlarge as it flows from portal system to the azygos system. Veins involved are the eso. tribs of th eleft gastric vein.

Front 152

Hemorroids

Back 152

sup rectal of inf. mesenteric -portal system, communicates with the mid and inf. rectal vv. of int. illiac and int. pudendal respectively. These enlarge.

Front 153

Caput medusae

Back 153

vv in the falciform and the ligamentum teres connect to the epigastric vv. on the anterior body wall and drain toward the inguinal region or the axilla.

Front 154

Kidney and adrenal vertebral level

Back 154

tv12-lv3

Front 155

renal arteries and veins are at level

Back 155

lv2

Front 156

renal artery divides in kidaney to;;;;

Back 156

the 5 different segmental supplying the five different lobes of the arteries

no anastomotic connections between these arteries.

Front 157

segemntals of kidneys branch at the

Back 157

junction of the cortex and the medulla (the arcuates) that then supply the functional unit the nephron

Front 158

right gonadal v. empties

Back 158

into the inferior vena cavs

Front 159

left gonadal vein

Back 159

empties directly into the left renal vein

Front 160

psoas major muscle att.

Back 160

transverse process of lumbar vertebrae, bodies and discs of t12-l5 and to the lesser trochanter of the femur

Front 161

psoas inn.

Back 161

ventral braches of l2, l3, l4

Front 162

psoas actions

Back 162

with the iliacus flexes the thigh superiorly

also w/ illacus flexes the trunk inferiorly

Front 163

illacus att.
inn.
act.

Back 163

attached to illiac fossa and alla of sacrum to the lesser trochanter and shaft of femur (l2-4)
flexes the thigh and stabililzes the hip.

Front 164

Quadrutus lumborum

inn.
act.

Back 164

attached superiorly to the medial 1/2 of the inferior border of rib 12 and tip of lumbar transverse process.
Attached inferiorly to the iliolumbar ligament and illiac crest.
t12-lv4. Extends and leterally flexes the vertebral column; important inspiration.

Front 165

Diaphram

Back 165

attached to lumbar vertebrae via the musculotendinous crura which define the aortic hiatus with the median arcuate ligament

Front 166

lateral to the crura

Back 166

are the thoracolumbar fascia

Front 167

medial arcuate ligaments-

lateral arcuate ligamnets

Back 167

over the psoas muscle

over the q. lumborum m.

Front 168

openings in the diaphram from anterior to posterior

Back 168

8 10 12

Front 169

Lumbar Plexus

Back 169

l1-l4

Front 170

l1 superior branch are

Back 170

iliohypogastric, ilioinguinal

Front 171

inferior branches of l1 are

Back 171

genitofemoral with superior branch of l2

Front 172

ilioinguinal path

Back 172

transverses the inguinal canal; supplies medial upper thigh and anterior part of the scrotum

Front 173

genitofemoral emerges on psoas at

Back 173

passes through psoas muscle, emerging on its ventral surface at the level of LV4;

Front 174

genitofemoral then

Back 174

descends under the psoas fasia

Front 175

Genitofemoral -genital

Back 175

enters the inguinal canal; supplies the cremaster

Front 176

genitofemoral -femoral

Back 176

goes under the inguinal ligamnent supplies skin of medial thigh

Front 177

lateral femoral cutaneous

Back 177

l2,l3

Front 178

obturaotor

femoral

lumbrosacral trunk

Back 178

l2, l3, l4

l2-l4

l4, l5 contributes to saccral plexus

Front 179

referred pain below cards

Back 179

fuckin a hairy pussy while she takes a shit is an east tennessee spahetti with meatballs

Front 180

heart
aff.
spinal nerves
referred to

Back 180

=middle inf. cradiac n. and thoracic splanchnic
=t1-t4 and cervical ganglia
=arm, high/mid thorax, neck, jaw

Front 181

diaphragm
a
s
r

Back 181

phrenic n.
3-5
root of neck and shoulder

Front 182

esophagus, stomach. liver and gallbladder, bile duct, sup. duodenum
a
s
r

Back 182

celiac plexus, greater splanchnic
t5-59
low thorax and epigastric region

Front 183

inf. duodenum, jejunum, trans. colon
a
s
r

Back 183

SM plexus, lesser splanchnic
t9-t11
umbilical region

Front 184

kidneys, high ureter, gonads
a
s
r

Back 184

=aorticorenal plexus, least splanchnic, upper lumbar splanch
=t12-l1
=lumbar, inguinal regions

Front 185

desc sigmoid colon, midureter, uterus
a
s
r

Back 185

aortic plexus, lumbar splanchnics
l1, l2
pubic, inguinal, ant scrotum, labia, upper thigh

Front 186

cervix, bladder, low ureter, rectum

Back 186

pelvic plexus, pelvic splanchnics
s2-4
leg, foot, perineum

Front 187

Bony pelvis consists of the

Back 187

right and left hip bone sacrum and coccyx. The hip bone consists of three parts; ilium, ischium and pubis.

Front 188

pelvic brim

Back 188

divides the pelvis into a greater and false pelvis.

Front 189

pelvic inlet

Back 189

defined the pelvic brim

Front 190

pelvic outlet

Back 190

is define by the boundaries of the perneum.

Front 191

perineum

Back 191

a diamond shaped area inferior to the pelvic diaphram, not as yet defined. It is defined into the three areas.

Front 192

superficial perineal pouch

Back 192

superior perineal mb., inferior-Colle's fascia (which is a continuation of Scarpa's fascia in the abdomen and Dartos fascia in the scrotum and penis).

Front 193

contents of the pouch male

Back 193

left and right crura and bulb of the penis. Muscles covering the erectile tissue. Ischiocavernous covering the crura and bulbospongious m. covering the bulb. ALso included is the superficial transverse perineal muscle.

Front 194

Female perineal pouch

Back 194

left and right crura covered by the ischiocaernous m. the bulbs of the vestibules are covered by the bulbospongious muslce. Puch also contains the the superficial transverese perinei muscles. ALso the great vestibular gland.

Front 195

Deep perineal pouch or urogenital diaphram

Back 195

superior- superficial fascia of the urogenital diaphragm lying just under the pelvicdiaphgram; inferior- perineal membrane or inferior fascia of the urogenital diaphgram

Front 196

contents of the male deep pouch

Back 196

membranous urethra, urethral sphincter muscle and deep transverese perinei mm. Also bulbouretral glands (cowper's glands).

Front 197

Contents of the female deep pouch

Back 197

same as male except no bulbourethral galnd and the vagina pierces this layer just posterior to the membranous urethra

Front 198

penis consists of the

Back 198

root and body

Front 199

root of the penis

crus of penis

Back 199

bulb of the penis - bulbospongius m.

ischiocavernous mm.

Front 200

Body of the penis

Back 200

corpus spongiusom - no muslce

corpus cavernosum-no muscle

Front 201

clitoris

Back 201

consists of a root and a body but two vestibules surrounding the vaginal opening. Body conisists of two corpora cavernosa and a glans.

Front 202

wht is different about the clitoris and penis in regards to the urethra

Back 202

the clitoris not traveresed by the urethra and therefor has no corpus spongiosum

Front 203

Erection

Back 203

vaginas cause an increase of parasympathathetic stimulatino to smooth muscle of helicine arteries. As a result these artereis straighten their lumen and enlarge allowing more blood into the cavernous spaces. These enlarge the spaces and compress the veins draining blood from the erectile tissue to the deep dorsal vein.

Front 204

after the deep dorsal vein is blocked what happens?????

Back 204

the three corpora become enlarged and penis erect. After ejaculation the symps kick in and reverse these phenomenon by diminishing blood going into the erectile tissue resulting

Front 205

ejaculation

Back 205

sympathetic stimulation of smooth muscle in the deferent ducts, seminal vesicles and prostrate makes the emmisison of sperm and semen into the urethra.

Front 206

Ejaculation after emmissio of sperm

Back 206

results from stimulation of the bulbospongius muscle by the perineal nerve

Front 207

perineum nerve supply

Back 207

from the pudendal nerve. This innervates all of the muscles of the superficial and deep pouches.

Front 208

Dorsal nerve of the penis

Back 208

carries sensory innervation to the shaft and the glans of the penis.

Front 209

internal pudendal artery and vein

Back 209

supply and drain the blood from the perineum.

exceptions on the next cards

Front 210

deep arteries of the penis

Back 210

supply both the corpora cavernosa

Front 211

arteries to the bulb

Back 211

continue to carry the blood to the corpus spongiosum

Front 212

single deep dorsal vein of the penis

Back 212

draining to the prostatic venous plexus in the male and vesicle plexus of the female.

Front 213

obturator internus muslce

Back 213

attaches around the obturator foramen within the pelvis.Fibers converge and exit through the lesser sciatic foramen forming a tendon that attaches to the greater trochanter of the femur. Innervation- nerve to the obturator internus (l5, s1, s2.

Front 214

piriformis muscle

Back 214

attaches to the anterolateral edge of the sacrum. Its fibers converge towards the greater sciatic foramen and the tendon attaches to the greater trochanter of the femur. S1 and S2 nn.

Front 215

Levator ani muscels

Back 215

from the pelvic floor.

Front 216

pubococcygeus

Back 216

attaches to the body of the pubis and runs posterolaterally to insert into the coccyx and anococcygeal ligament.

Front 217

pubococcygeus continued (muscel fibers)

Back 217

puborectalis and levator prostate form from the medial fibers of this muslce/ In females this new subset from the medial fibers is pubocaginalis.

Front 218

illiococcygeus m.

Back 218

is a levaot ani like pubbococcygeus and attaches to the obturator fascia and the ischial spine. These muslces pass posteriorly and attach to the coccyx and annococcygeal ligament. Perineal nerve inn.

Front 219

perinneal n. branch of pudendal 2, 3, 4, innervtes illiococcygeus on the

Back 219

inferior surface ; the superior surface is innervated by twigs form the 3rd and 4th sacral ventral rami.

Front 220

coccygeus muscle

Back 220

attaches to the ischial spine and sacrospinous ligament. Its medial attachment is the coccyx and SV5. Innervation-branches of the s4 and s5 rami.

Front 221

pelvic diaphgram is made by the

Back 221

two coccygeus muscles and the levator ani muscles. muslces of the pelvic diaphragm support the pelvis.

Front 222

ishiorectal fossa

Back 222

this is a wedge shape around the base of the anal canal. Fossa is filled with loose con. tissue and fat with inferior rectal nerves, arteries, and veins crossing it in a lateral to medial direction.

Front 223

ishiorectal fossa does what

Back 223

allow the anal canal to expand unobstructed for defecation

Front 224

boundaries of the ischiorectal canal

Back 224

superior-an apex created by the attachment of the iliococcygeus ligament. to the arcus tendineous.
inferior-perinanal skin
medially-anal canal, and pelvic diaphragm
laterally- obturator muscle

Front 225

two sources of NO

Back 225

helicine artery endothelial cells and postganglionic parasympathetic fibers.

Front 226

viagra

Back 226

stops the breakdown of cGMP in the helicine arteries.

Front 227

seminal vesicle

Back 227

60% of fluid-contains high concentrations of fructose which acts as anenergy supply to sperm

Front 228

prostate

Back 228

30% of fluid, -- has alkaline buffers to help neutralize the high acidity of the vagina

Front 229

bulbourethral glands

Back 229

contained within the deep perineal pouches and secretes a mucilagionus substance that acts a lubricant during intercourse

Front 230

male most inferior point

female

Back 230

rectovesicle pouch

vesicuterine and rectouterine pouches (recto most inferior)

Front 231

micturition

Back 231

as bladder fills parasymp aff. with pelvic splanchnics reach a threshold level of activation thus initiating the spinal reflex. Parasymp motor carried by pelvic splanchnics complete the efferent limb of this reflex. The motor fibers stimulate detrusor to contract but also relax sphincter vesicle of bladder.

Front 232

seminal vesicle

Back 232

60% of fluid-contains high concentrations of fructose which acts as anenergy supply to sperm

Front 233

prostate

Back 233

30% of fluid, -- has alkaline buffers to help neutralize the high acidity of the vagina

Front 234

bulbourethral glands

Back 234

contained within the deep perineal pouches and secretes a mucilagionus substance that acts a lubricant during intercourse

Front 235

male most inferior point

female

Back 235

rectovesicle pouch

vesicuterine and rectouterine pouches (recto most inferior)

Front 236

micturition

Back 236

as bladder fills parasymp aff. with pelvic splanchnics reach a threshold level of activation thus initiating the spinal reflex. Parasymp motor carried by pelvic splanchnics complete the efferent limb of this reflex. The motor fibers stimulate detrusor to contract but also relax sphincter vesicle of bladder.

Front 237

sphincter urethrae

Back 237

consists skeltal muscle innervated by s234

under voluntary control

Front 238

defection relfex

Back 238

parasymp aff. of pel. splnchs are stretch as shit fills. this initates a reflex. para efferents then stimulate smooth muslce of the rectal wall to contract but have the opposite effect on the sphincter and internus

Front 239

somatics of defecation

Back 239

puborectalis m., as well as internal and external sphincters. these muslces are innervated by the perineal n. and inferior rectal nerves respectively, both are branches of the pudendal nerve. puborectalis relaxes rectum and anal canal made linear. Sphincter relaxes.

Front 240

pprostate shape

Back 240

somewhat conical in shape with its apex pointed inferiorly. Divided into lobes.

Front 241

lobation is created by the;

Back 241

relative posistions of the prostatic urethra and ejaculatory ducts.

Front 242

men over 45

Back 242

median lobe hypertrophies. Compromises prostatic urethra and weakens stream.

Front 243

posterior lobe

Back 243

most frequent site of prostate cancer. Easily palpated.

Front 244

umbilical artery

Back 244

remnant of the fetal umbilical artery. It retains it lumen for a short while beyond the internal illiac artery giving off the superior vesical arteries. Beyond this is the cord. or medial ligament. All below are branches of the internal illiac.

Front 245

inferior vesical artery.

Back 245

distributed to the bladder, the prostate and the seminal vesicle

Front 246

middle rectal artery

Back 246

may arise in common with the inferior vesicle artery goes to rectum and anal canal.

Front 247

rectum blood supply

Back 247

from the ima via superior rectal, inferior rectal from the pudendal,

Front 248

renal fascia is a derivative of the

Back 248

transverse alis facia

Front 249

obturator artery

Back 249

arises from the internal illiac and runs on the lateral wall of the pelvis to the obturator canal. Sometimes n accessory obturator goes through the canal.

Front 250

internal pudendal artery

Back 250

supplies the perineum. leaves through the greater sciatic foramen just superior to the ischial spine. then reneter by passing across the surface of the spine and then back thorugh the lesser sciatic foramen. goes through pudendal canal to accompany pudendl nerve.

Front 251

iliolumbar a.

Back 251

posterio to obturator nerve and the external illiac vessels to the medial border of the psoas major muscle. Divides into a lumbar and an illiac branch.

Front 252

lateral sacral arteries

Back 252

gives branches to the sacral canal and to skin and muscles on the dorsal surface of the sacrum.

Front 253

superior gluteal artery

Back 253

is the largest branch of the internal illiac. passes between the lumbosaccral trunk and the first saccral nerve out of the pelvis above the superior border of the piriformis to enter the gluteal region.

Front 254

inferior gluteal artery

Back 254

also supplies the gluteal region. It arises from the internal iliac and usuaully passes between the 1st and 2nd sacral nerves to go between the piriformis and coccygeus muscles through the lower sciatic foramen.

Front 255

illioihypogastric n.

Back 255

l1, and runs medially and inferiorly between the internal abdominal and transverse abdominal muscle

Front 256

anterior cutaneous nerves

Back 256

t7-t11, subcostal, and ilioinguinal

Front 257

caput medusae

Back 257

superficial epigastric veins with the lateral thoracic vein in the superficial fascia.

Front 258

left ima vein to ima artery

Back 258

ascends to the left of artery

Front 259

mesoappendix

Back 259

appendicular artery

Front 260

splenic vein

Back 260

posterio to pancreas inferior to the spenic artery

Front 261

porto caval anastomosis

Back 261

left gastric vein/esophageal/ azygos

anorectal-superior rectal vein/middle and inferior rectal veins
paraumbilical-paraumbilical veins/superficial epigastric
retroperitoneal -colic/retroperitoneal veins

Front 262

right and left testiculars a relationship

Back 262

inferior to the renal (just) lv2

Front 263

left renal vein

Back 263

crosses anterior to the renal arteries and aorta

Front 264

renal palvis

Back 264

most posterior in hilum

Front 265

right kidney contacts

Back 265

colic flexures, visceral liver, duodenum

Front 266

left kidney contacts

Back 266

spllen stomach, spleen, and panc

Front 267

sacroilliac articulation strenghten

Back 267

anterior and posterior sacroilliac ligaments

Front 268

membranous portion of the urethra

Back 268

in the deep pouch

Front 269

seminal vesicle to the ampulla

Back 269

lateral

Front 270

ejaculatory duct

Back 270

is formed from the seminal vesicle duct and the ductus deferens and empties into the porstatic urethra at the seminal colliculus

Front 271

ampula of the rectum

Back 271

where the puboccoccygeus surrounds

Front 272

anal columns

Back 272

contains superior rectal artery and vein

Front 273

anal valves

Back 273

forms anal sinuses

Front 274

pectinate formed

Back 274

by anal valves

Front 275

internal hems

Back 275

superior rectal and anas. with middle

Front 276

abberant obterator

Back 276

is at risk when repairing femoral hernia because of location at pelvic brim

Front 277

inferior vesicel artery

Back 277

not in female

Front 278

internal pudendal artery

Back 278

exits pelvic cavity by passing inferior to the piriformis through the greater sciatic foramen. often arises with the inferior gluteal.

Front 279

inferior gluteal artery

Back 279

usually passes between ventral rami s2 and s3. INferior to piriformis

Front 280

middle rectal

Back 280

arises in common with the inferior vesciel often. off internal illiac

Front 281

illiolumbar

Back 281

passes posteriorly then ascends between the lumbosaccral trunk and the obterator nerve. May arise with the lateral sacral.

Front 282

lateral sacral artery

Back 282

gives rise to a superior and an inferior branch. INferior branch passes anterior to the sacral ventral rami

Front 283

superior gluteal artery

Back 283

passes between the lumbosaccral trunk and the ventral ramus of s1

Front 284

prostatic, vesical and rectal drain to the internal illiac

Back 284

yes

Front 285

somatic plexus of pelvis are

Back 285

sacral and coccygeal plexus

Front 286

inferior hypogastric plexus

Back 286

primary visceral plexus of the pelvic cavity

Front 287

lumbosacral trunk l4-l5

Back 287

joins sacral plexus which is (l4 to s4)

Front 288

s2 and s3 arise

Back 288

bewtten the proxiamal attachemnt of the piriformis

Front 289

sciatic nerve

Back 289

l4 to s3, usually inferior to the piriformis

Front 290

pelvic splanchnics

Back 290

s234, carry preganglionic paras

Front 291

sacral portion of the symp trunk

Back 291

is medial to the ventral rami.

Front 292

umbilical

Back 292

at region of belly button

Front 293

femoral

Back 293

below inguinal ligament through femoral ring

Front 294

obturator

Back 294

through obturator foramen

Front 295

epigastric

Back 295

at linea alba

Front 296

spigelian

Back 296

in posterior rectus sheath below arcuat eline

Front 297

perineal

Back 297

through muscls of the pelvic diaphgram

Front 298

diapghragmatic

Back 298

hiatuses

Front 299

mesentary proper

Back 299

from the duojejunal fold to the right illiac fossa

Front 300

phrenicocolic

Back 300

diaphram to to left colic flexure

Front 301

trietz

Back 301

duodojenal flexure to the diaphram

Front 302

phrenicoesophageal ligaments

Back 302

esophagus

Front 303

crura

Back 303

lower esophageal sphincter

Front 304

lymphatics to gastric celiac nodes

Back 304

esophagus

Front 305

duodenal ulcers

Back 305

right next to the pylorus and pancreas, gall bladder and pancreaticoduodenal arteries

Front 306

lymphaticss of duo

Back 306

pancreaticoduodenal, mesenteric and celiac lymphs

Front 307

jejunum vs. illeum

Back 307

larger dia, thicker wall, longer vasa recta, more prominent plica (mucous folds) illeum has rich vascular arcade structure

Front 308

PEYERS

Back 308

ANTIMESENTERI LYMPHS

Front 309

MECKELS

Back 309

1 METER PROXIMAL TO THE ILEOCECAL VALVE ON ANTI MESENTERIC

Front 310

LYMPHATICS OF CONLN DRAIN TO SUPERIOR AND INFERIOR MESENTERIC NODES TO THE

Back 310

CISTERNA CHYLAE

Front 311

LYMPHATICS OF LIVER

Back 311

SUPERFICIAL IN GLISSON'S CAPSULE, DRAIN ALON TRIAS AND HEPATIC VEINS TO HEPATIC AND CELIAC LYMPHS, CYSTERNAE CHILI, MEDIASTINAL GO TO RETROSTERNAL VENTRALLY

Front 312

GALL BLADER

Back 312

9TH COSTAL CARTILAGE

Front 313

FUNDUS,

BODY

Back 313

ANTERIOR ABD. AND TRAN COLON

DUODENUM

Front 314

SACRAL PARA AND PAIN

Back 314

FOR RECTAL AND ANAL

Front 315

PAIN FROM VISCERAL PERITENUEM

Back 315

EPIGASTRIC, PERI UMBLICAL, FLANK, AND PELVIC REGIONS