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172 Cards in this Set

  • Front
  • Back
What is the vertical midline feature of the abdominal wall that intersects the umbilicus?
Linea alba
In the quadrant system, where is the appendix located?
Lower right quadrant
In the quadrant system, what is the landmark for the two perpendicular lines?
umbilicus
In the quadrant system, where is the liver located?
Upper right quadrant
In the quadrant system, where is the stomach located?
Upper left quadrant
What is the bony component of the abdominal wall inferiorly?
The pelvis (ilium, pubis, sacrum)
How many lumbar vertebrae are there?
5
Which ribs supports the posterior abdominal wall posteriorly?
11 & 12
What is the name of the thick fatty layer on the abdominal wall?
Camper's fascia
What is the clinical significance of Scarpa's fascia?
Forms the wall for a potential space between the superficial fascia of the skin and the underlying abdominal wall
How do the lateral abdominal muscles compare to the intercostal muscles?
They are three in number, innervated mostly by thoracic nerves, helps control pressure in body cavity
What are the collective functions of the abdominal muscles?
Protection, flex trunk, helps control intra-abdominal pressure
What is the makeup of the anterior rectus sheath above the arcuate line?
In general the anterior rectus sheath is composed of the aponeuroses of the external oblique and the internal oblique above the arcaute line, and all three aponeuroses below the arcuate line. The posterior rectus sheath above the arcuate line is composed of the aponeuroses of the transversus abdominis and internal oblique, and below the arcuate line only transverses fascia.
How do the lateral abdominal muscles differ in innervation from the anterior abdominal muscles?
The three lateral muscles are innervated by T7-L1, the rectus abdominis is supplied by T7-T12.
How do the nerves and vessels reach the rectus abdominis?
They run between the two inner lateral muscle layers and pierce the rectus sheath laterally.
What makes up the inguinal ligament?
The thickened lower margin of the external oblique aponeurosis.
What forms the anterior wall of the inguinal canal?
External oblique aponeurosis.
What runs through the inguinal canal in the male? The female?
Spermatic cord.
Round ligament
What muscle layer gives rise to the cremasteric fascia?
Internal oblique, rarely transverses abdominis too.
What is the name given to the testicular vein in the spermatic cord?
Pampiniform plexus
What is the name of the sperm duct?
Vas deferens, or ductus deferens.
What is the name of the peritoneal sack located in the scrotum, anterior to the testes?
Tunica vaginalis
What is the thick coat of the testes called?
Tunica albugenia
What structure is responsible for storing sperm, once produced by the testes?
Epididymus
In performing a vasectomy, what layers are incised to reach the vas deferens?
Skin, Colles fascia, dartos muscle, external spermatic fascia, cremasteric fascia/muscle, internal spermatic fascia, extraperitoneal fat
What is the relationship of the hernia neck of a indirect hernia to the inferior epigatric vessels?
The neck of the indirect hernia lies lateral to the inferior epigastric vessels.
What is the most common age groups for occurrence of indirect inguinal hernias?
Young males: mostly new born and toddlers less than 1 yr of age
What is the most common age groups for occurrence of direct inguinal hernias?
Middle aged to old males, with weak abdominal muscles.
What is the difference between hematocele vs hydrocele?
The tunica vaginalis contains blood in a hematocele, but peritoneal-like fluid in a hydrocele.
On which side is a varicocele most common found?
left
A patent processes vaginalis is a ready made path for which type of inguinal hernia?
indirect
What is the initial lymphatic drainage of the testes and why is it different from that of the scrotum?
testis lymphatics follow testicular vessels toward the para-aortic (lumbar); scrotal lymphatics follow external pudendal vessels toward the superficial inguinal lymph nodes. Difference due to fact that testes develop high on the posterior abdominal wall and descend into the scrotum, unlike scrotum that develops from anterior abdominal wall. Generally, lymphatics follow the vessels that supply the organ or region
What is the name of the peritoneum lining the GI tract organs?
Visceral peritoneum
How does the peritoneum compare to the pleura?
It is the same, except for location.
Name three functions of the mesenteries.
Support, fat storage, transmits vessels, nerves & lymphatics
What is the name of the mesentery that drapes off the greater curvature of the stomach?
Greater Omentum
Why is it referred to as the “Policeman of the abdomen”? (greater omentum)
It adheres to inflamed tissue and tends to separate it from the rest of the peritoneal cavity.
In what quadrant is the liver located?
Upper right.
What are the three parts of the small intestine?
Duodenum, jejunum, ileum
What part of the GI tract “frames” the small intestine?
Large intestine (colon)
In what quadrant of the abdomen would you find the appendix?
Lower right
What is the name of the mesentery to the sigmoid colon? the small intestine?
Sigmoid mesocolon;
Mesentery proper
What is the location of the spleen?
Left side, posterior to the mid-axillary line, oriented along the long axis of the 10th rib.
What is the name of the colic flexure where the transverse colon turn into the descending colon?
Left colic flexure or splenic flexure
What is the characteristic shape of the stomach?
J
What part of the stomach usually contains swallowed air?
fundus
What is the name of the mucosal folds in the stomach?
rugae
What is the name of the sphincter that lies between the stomach and duodenum?
pyloric
How is the first part of the duodenum like the last part of the stomach?
It has a smooth mucosa
What empties into the 2nd part of the duodenum?
Major duodenal papillae
What is the characteristic shape of the duodenum?
C
What lies nestled in the curve of the duodenum?
Head of pancreas
What is the name of the mucosal folds in the small intestine?
Plicae circularae
Name 5 ways the ileum differs from the jejunum?
Ileum is smaller in size, has fewer and lower plica, is less vascular, has more encroaching mesenteric fat, has shorter vasa recti, more complicated arcades, have Peyer patches, possible Meckel’s diverticulum.
What is the name of the part of the large intestine that connects to the ileum and the appendix?
cecum
What is McBurney’s Point?
Surface projection onto anterior abdominal wall of the location where the appendix originates from the cecum
What characteristics distinguish the large intestine from the small intestine?
The presence of tenia coli, plica semilunares, haustra, and epiploic appendages.
What is the key characteristic of the lumen of the esophagus following barium swallow?
Monotonously smooth.
When the patient is lying on his/her back, what part of the stomach is most posterior and thus fills with barium after a partial barium swallow?
Fundus
What internal structures are obvious on partial emptying of the stomach?
Rugae
What characteristic shape does the first part of the duodenum exhibit on barium filling?
Arrow head or Christmas tree.
Where is the anatomical location of the duodeno-jejunal junction?
Posterior to the stomach
What is the characteristic appearance of the lumen of the jejunum on barium swallow study?
feathery
The ileum is mostly located in the lower abdomen and loops fall into the....
pelvic cavity
On barium enema of the large intestine what are bulges/segments of the gut called?
haustra
Because of the motility of the sigmoid colon, it is often _____ on itself and rectum on barium study.
superimposed
To study the lining of the large intestine, a small amount of barium is used to coat the gut lining when placed under......
pressurized gas.
On excretory or retrograde cystogram, the contents of the bile duct and pancreatic duct can be seen emptying into the....
duodenum
On CT: the normal liver appears as a ________mass in the upper right abdominal cavity.
homogenous
On CT: the pancreas appears as a lightly ______ elongated tissue that stretches across the left posterior and middle abdominal wall.
lobulated
On CT: ___is considered the radiologist’s “friend” because it provides a dark outline to most soft tissue organs.
Fat
On CT: the _____ can be seen on the posterior abdominal cavity wall on the left upper quadrant.
Spleen
On CT: the kidneys lie in the posterior abdominal region in a _______ position, surrounded by radiolucent.....
retroperitoneal; perirenal fat
On Ultrasound gallstones appear as white (hyperechoic) objects surrounded by .......
dark (anechoic) bile
On SMA arteriogram, the intestinal branches are mostly found ____ of the midline.
left
Arteriogram reveals that the two largest branches of the celiac artery are the ________ and __________.
common hepatic; splenic arteries
IMA arteriogram revealed that the _________ is a continuation of the IMA after the sigmoidal arteries come off.
superior rectal
Venogram of the IVC shows that there are _____ hepatic veins that drain the liver to the IVC.
three
On excretory urogram the __________ is also normally filled with excreted dye.
urinary bladder
What does the muscular component of the diaphragm attach to “centrally”?
central tendon of the diaphragm
What passes through the diaphragm at the level of the 10th thoracic vertebral body? What other structure accompanies it?
esophagus; vagus nerves
What is the effect on diaphragm function if the right phrenic nerve is damaged?
Right hemidiaphragm is paralyzed – expansion of lung on affected side more difficult.
What are the two muscles in the posterior abdomen that forms the chief flexor of the thigh?
Iliacus & psoas
Where does the kidneys originate during development?
In the pelvis
What is the order of structures at the hilum of the kidney?
Vein, artery, ureter/renal pelvis
What are the major structures in the kidney medulla?
Renal pyramids
Into what structure does the renal papillae empty urine?
Minor calyx
What is the name of the fatty “encasement” that surrounds the kidney?
Perirenal fat
Why are accessory/aberrant renal arteries common?
During its ascent out of the pelvis, the kidneys lose & re-establish their arterial supply and thus may have multiple branches rather than just one renal artery to each kidney.
How can accessory/aberrant renal arteries lead to hydronephrosis?
Accessory arteries to the inferior pole of the kidney can compress the ureter, thus restricting urine flow and eventual dilation of the collecting system within the kidney with backed up urine
What are end arteries and give 4 examples.
Arteries that do not anastomose with other arteries. Ex: vasa recti, segmental renal arteries, segmental hepatic arteries, segmental pulmonary arteries, the appendicular artery (which is a named vas recti)
What is the shape of the left suprarenal gland?
crescent
Where is the hilum of the suprarenal gland?
Where the suprarenal vein exits the gland.
Name four different paired arteries off the abdominal aorta , from superior to inferior?
Inferior phrenic, renal , testicular/ovarian, lumbar, common iliac.
At what lumbar vertebral level does the aorta bifurcate?
L4
Into what venous structure does most of the veins of the retroperitoneum drain on the right vs the left side?
Right – IVC, Left – left renal vein
On the left side, what does the vein in Q17 pass over to reach the inferior vena cava?
Aorta
What nerves of the lumbar plexus are involved in the cremaster reflex?
The cremaster reflex tests the integrity of L1-L2 spinal cord level. By stroking the skin over the femoral triangle, the cremaster muscle reflexly contracts, raising the testicle. The nerve involved is mostly the genitofemoral nerve, but some sensory from ilioinguinal nerve.
What are the two lumbar plexus nerves that innervate the thigh?
Femoral & obturator
What nerve gives parasympathetic innervation to most of the GI tract?
Vagus
What is the result of parasympathetic innervation to the gut?
Increased peristalsis, increased secretion of digestive juices, sphincter control
What are visceral afferents and what is the characteristic of the pain associated with them compared to somatic afferents?
Sensory nerves of the GI tract. Visceral afferents that carry pain perception are through stretch receptors. It is perceived as dull, achy, poorly localized pains over general areas either referred to the midline or over the affected solid organs.
In the gut, what does increased sympathetic tone result in the GI tract?
Vasoconstriction of vessels to the gut
In the abdominal cavity, the GI tract drains into which set of lymph nodes?
Preaortic / intestinal nodes
The Retroperitoneum and lower extremities drains into which set of lymph nodes?
Para-aortic /r lumbar nodes
In general, the lymphatic drainage of the abdomen and its contents follows the path of what other system?
Blood vessels
Into which lymph nodes do the testes/ovary drain?
Para-aortic/lumbar nodes
Into which lymph nodes does the scrotum initially drain into?
Superficial inguinal nodes
What is the demarcation between the false and true pelvis?
The pelvic brim, following along the superior margin of the pubic symphysis, pectin of the pubis, arcuate line of the ilium, ala of the sacrum and sacral promontory.
What are the three bones that make up the hip bone?
Ilium, ischium, and pubis.
What is the structure where the two hip bones unite anteriorly?
Pubic symphysis
What part of the sacrum unites with the hip bones posteriorly?
The ala of the sacrum articulate with the ilium and are held in place by strong sacroiliac ligaments. There is actually a joint which is reasonably nonmotile, the sacroiliac joint.
What ligaments and bony prominences are involved in the formation of the greater and lesser sciatic foramina?
The sacrotuberous and sacrospinous ligaments that connect the ishial tubosity and ishial spine to the sacrum. The space between the sacrotuberous and sacrospinous ligaments is the lesser sciatic foramen.
In the anatomic position what two bony features of the pelvis lie on the same vertical plane?
The anterior part of the pubic symphysis and the anterior superior iliac spine.
What is the pouch of Douglas and what is its clinical significance?
The rectouterine space or peritoneal space between the uterus and anterior rectum. Clinically it is an important area adjacent to the posterior fornix of the vagina. The thin vaginal wall is all that separates the peritoneal cavity from the outer environment. It can easily be punctured thus transmitting infection to the peritoneal cavity.
What is the sacral plexus?
The sacral plexus is composed of ventral primary rami of segments S1 to S5 and the lumbosacral trunk from L4-5. These nerves combine to form the major nerves that leave the pelvis to supply the lower limb.
What are the major nerves derived from the sacral plexus?
Sciatic, superior and inferior gluteal, pudendal, posterior femoral cutaneous, and pelvic splanchnics. (Don’t worry about which segments supply each nerve.)
What are the two sources for sympathetic nerves in the pelvis?
Sacral sympathetic trunk (or chain) and the hypogastric plexus.
What is the origin of the parasympathetic innervation to the pelvic viscera?
Pelvis splanchnics from S2-S4.
What are the chief arteries off the internal iliac artery?
Superior and inferior gluteal arteries, umbilical supplying superior vesicular branches, obturator, middle rectals, internal pudendals, uterine and vaginal branches
What arteries in the pelvis are unique to females?
Uterine and vaginal branches off the internal iliac, and ovarian from the lumbar aorta.
What is the origin for the common variation of the obturator artery?
It may arise off the inferior epigastric branch from the external iliac and pass over the pelvic brim to the obturator canal (20% occurrence).
On a rectal exam, what can be palpated anteriorly in the female?
cervix of uterus
What is the muscular sheet found at the pelvic outlet? What are its components?
Pelvic diaphragm; levator ani and coccygeus muscles.
What is the name of the medial part of the levator ani that keeps the “kink” in the anus?
Puborectal sling.
What is the path for the ureters? Where are the three constrictions or narrowed areas in the ureters?
They pass down the posterior abdominal wall, over the pelvic brim, along the posterior wall of the pelvis and then anterior to the enter posterior wall of the bladder. Three constrictions are 1) at the renal pelvis, 2) where they cross the external iliac artery and pass over the pelvic brim, and 3) as they pass through the bladder wall. These areas are where large calculi, ‘kidney stones’, often are stopped and then cause increased pain. Small stones may pass with little or no pain.
As the ureters approach the uterus, what structure crosses immediately over them?
Uterine artery.
What is the smooth area in the bladder where the ureters pierce the bladder wall?
Trigone, outlined by the inlets of the ureters and inferiorly by the outlet of the bladder.
What is the name of the smooth muscle found in the urinary bladder wall?
Detrusor muscle.
What is the ring of smooth muscle called at the neck of the urinary bladder?
Internal sphincter.
On rectal exam what can be palpated anteriorly in the male?
Prostate and seminal vesicles.
Where is the membranous urethra located in both sexes?
Within the urogenital diaphragm.
What is the pathway for sperm after passing through the superficial inguinal ring?
In the vas deferens the sperm pass through the inguinal canal, then through the deep inguinal ring, over the pelvic brim, along the lateral aspect of the bladder, join the duct of the seminal vesicle to form the ejaculatory duct, passes through the prostate gland, and enter the prostatic urethra on the posterior aspect along the colliculus seminalis.
Into what do the ejaculatory ducts empty?
Prostatic urethra, along the side of the colliculus seminalis.
What nerve group functions during ejaculation?
Parasympathetics, cause contraction of urethral muscles. Sympathetics, cause movement of sperm down the vas and secretion of glands (emission).
How does the prostate empty into the urethra compared to the ejaculatory ducts?
Numerous small ducts open into the prostatic urethra.
What is the name for the longest part of the urethra in males?
Spongy urethra (since it enclosed by the corpus spongiosum.
The female urethra opens into what space?
Vestibule.
What arteries supply the rectum?
Superior rectal from inferior mesenteric, middle rectal form internal iliac, and inferior rectal from internal pudendal artery.
What are the boundaries of the perineum?
It is a diamond formed by the pubic symphysis, pubic rami, ishial rami, ishial tubosities, sacrotuberous ligaments, and coccyx.
What are its two subdivisions, and in general what is found in each?
Anal triangle; anal canal, external anal sphincter, and ishiorectal fossa. Urogenital triangle; UG diaphragm, scrotum/labia, penis/clitoris, vestibule.
What are the boundaries of the ischiorectal fossae? With what is it normally filled?
Perineal body anteriorly, laterally obturator internus muscle, levator ani. They are filled with fat.
What is the UG diaphragm and how does it differ from the pelvic diaphragm?
It stretches between the inferior pubic rami. It lies superficial to the pelvic diaphragm and contains the external sphincter of the urethra.
What pierces the UG diaphragm in the female? The male?
Female – urethra and vagina. Male - urethra
What is found in the deep perineal space?
The urogenital diaphragm
What is the superficial perineal space? And what is found there?
It is the area superficial to the UG diaphragm. It contains the structures associated with the penis and scrotum, or structures of the vestibule, clitoris, and labia, plus all the associated nerves and vessels.
What is the difference between the external and internal urethral sphincter?
The external sphincter is under voluntary control while the internal sphincter is controlled by autonomic nerves.
What is the chief nerve supply to the perineum?
Pudendal nerve and its branches.
What is the origin of the inferior rectal nerves & vessels?
Pudendal nerve and internal pudendal artery and veins.
What are the names of the nerves and arteries on the dorsum of the body of the penis? What is the function of the nerves found here?
Deep dorsal vein, dorsal arteries, and dorsal nerves. Sensory to the surface.
The crura and bulb of the penis make up what basic part of the penis?
Root of the penis
What is the muscle layer that lies over the bulb of the penis? What is its function?
Bulbospongiosus, compresses the bulb and assists erection.
How does the path of the urethra differ between the sexes?
The male urethra consists of prostatic and spongy components that are not found in the female. The membranous component is common in both.
The bulb of the penis is continuous with what structure in the shaft of the penis?
Corpora spongiosum.
What is the mechanism of erection?
Upon stimulation the smooth muscle in the trabeculae and arteries of the corpora relax because of parasympathetic stimulation (via pelvic splanchnics). The arteries straighten and enlarge allowing increased blood flow into the cavernous spaces. The bulbospongiosus and ishiocavernosus muscles compress the venous drainage at the periphery of the corpora and impede outflow of blood. As a result the corpora become enlarged and rigid and erection occurs.
How do the drainage patterns for the superficial veins of the perineum differ from that of the deep dorsal vein?
The perineum is drained via the internal pudendal veins back toward the lesser sciatic foramen while the deep dorsal vein drains through a defect in the UG diaphragm directly into a plexus of veins surrounding the prostate gland.
What is the name of the end of the uterine tube that drapes over the ovary?
Fimbrae, which sweep over the surface of the ovary and pick up ovulated oocytes.
What is the origin of the ovarian arteries?
They pass into the pelvis over the pelvic brim. They originate as paired arteries off the aorta.
What is the peritoneal sheet that attaches the uterus to the lateral pelvic wall?
Broad ligament of the uterus.
What is the ligamentous structure within broad ligament that contains the ovarian vessels?
Suspensory ligament of the ovary.
What ligament supports the cervix/uterus within the broad ligament?
Transverse cervical or ‘cardinal’ ligament.
What is the usual orientation of the uterus in relationship to the bladder?
Anteflexed anteriorly over the bladder.
At what uterine anatomic landmark does the uterine artery approach the uterus?
It approaches at the uterine cervix from both sides and then its branches go superiorly and inferiorly to supply the uterus.
What are the vaginal spaces around the end of the cervix?
Anterior, lateral, and posterior fornices (fornix is singular).
The crura of the clitoris make up what structure in the body?
Corpora cavernosa
What is the skeletal muscle that lays over the crura of the clitoris? What is its function?
Ishiocavernosus muscle. Its function is to help maintain erection in the clitoris.
What is the nerve supply to the female perineum?
Perineal branches of the pudendal nerve.
What is the surgical procedure called that prevents the UG diaphragm from ripping during childbirth?
Episiotomy. It is done to enlarge the vaginal orifice and prevent a jagged tear in the perineum. This heals more quickly and can prevent damage to important structures such as the perineal body that have consequences later in life in support of pelvic viscera.
In the pudendal nerve block, what bony feature does the clinician use as a guide to anesthetize the pudendal nerve?
Ishial spine.
To where do the lymphatics for the cervix drain?
They pass along the uterine vessels to the internal iliac nodes and then superior along the aorta.
To where do the lymphatics for the scrotum/labia drain initially?
They drain to the superficial inguinal nodes.
To where do the lymphatics of the ovary/testes drain?
The lymphatics follow the ovarian and testicular blood vessels and ascend to the lumbar lymph nodes.