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79 Cards in this Set

  • Front
  • Back
4 Features of the ilium
-ASIS
-Iliac crest (L4)
-Iliac tubercle (L5)
-PSIS (S2)
5 features of the pubis
-body & sup/inf pubic rami
-pubic symphysis
-pubic tubercle
-pubic crest
-pectineal line
superior boundries of the abdominal wall
Xiphisternal junction (T9) & costal margin
9 regions of exterior abdomen
&
reference planes delineating regions
-left & right hypochondriac regions
-left and right lateral regions
-left & right inguinal regions
-epigastric
-umbilical
-hypogastric

vertical lines are midclavicular

horizontal lines
-subcostal plane passes through inferior border of costal cartilage 10
-transtubercular plane passes through the iliac tubercles at L5
7 fascial layers in abdominal wall from superficial to deep
-skin
-superficial fascia (2 layers)
a. Camper's fascia
b. Scarpa's fascia (inf to umb)
-Deep fascia
-transversalis fascia
-Extraperitoneal fat
-parietal pertoneum
pyramidalis muscle
small triangular musle that lies inferior to rectus abdominus
-spans from linea alba to pubs
5 muscles of anterior abdominal wall
-external oblique
-internal oblique
-transversus abdominus
-rectus abdominus
-pyramidalis
2 ligament specializations of the external oblique
Inguinal ligament
-from ASIS to pubic tubercle

Lacunar ligament
-extension of inguinal ligament at its medial border that reflects posteriorly (connects inguinal ligament to pectineal ligament)
arcuate line
-midway between umbilicus and pubic symphasis

rectus sheath above line
-anterior layer is made up of aponeurosis of external oblique mm & anterior lamina of aponeurosis of internal oblique mm
-posterior layer is made up of posterior lamina of aponeurosis of internal oblique mm & aponeurosis of transveralis fascia

rectus sheath below the line
-anterior layer made up of aponeurosis of all 3 abdominal muscles
-posterior layer made up of only transversalis fascia
4 arteries of anterior abdominal wall
Posterior intercostal arteries (10-11) & subcostal artery (12)
-descend along abdominal wall between transversus abdominis and internal oblique

Superior epigastric arteries
-branches of internal thoracic arteries
-located within rectus sheath posterior to rectus abdominis

Inferior epigastric arteries
-branches of ext. iliac aa
-anastomose with sup epigastric arteries

Superficial epigastric
-branches of femoral artery
-located in sup. fascia
2 regions of lymphatic drainage of abdominal wall
Axillary lymph nodes
-recieve lymph from vessels level of umbilicus (L4)

Superficial inguinal lymph nodes
-recieve lymph from vessels below umbilicus (L40
boundaries of inguinal canal
anterior wall
-aponeurosis of the external oblique mm

posterior wall
-transversalis fascia

roof
-fibers of internal oblique & transversus abdominis muscles

Floor
-inguinal ligament
scrotal ligament
-remnant of the gubernaculum

-anchors testes to skin of scrotum
adult derivitives of the gubernaculum in females
round ligament of the uterus
-between uterus & labia majora

Ovarian ligament
-between ovary & uterus
inguinal canal contents
spermatic cord/round ligament of uterus

ilioinguinal nerve

genital branch of genitofemoral nerve
2 layers of scrotum
skin

Dartos fascia
-smooth mm contracts to wrinkle skin in response to cold
female homologous structure to mail scrotum
labia majora
-outgrowth of anterior abdominal wall
-full of fat & smooth mm
3 contents of scrotum
spermatic cord
-begins at deep inguinal ring & ends at posterior border of testes

testes

Epididymis
-highly coiled tube connecting testes to ductus deferens
3 fascial coverings of spermatic cord
external spermatic fascia
-derived from external oblique apneurosis

cremastoric fascia (muscle)
-derived from internal oblique muscle (sk mm)

Internal spermatic fascia
-derived from transversalis fascia
tunica vaginalis
closed peritoneal sac full of serous fluid. surrounding the testes
tunica albuginea
white tough fibrous covering of testes
path of sperm within the testes
-seminiferous tubules
-rete testes
-efferent ductules
-epididymis for storage
3 parts of the epididymis
head
-attached to testes

body
-long part

tail
-continuous with ductus deferens
cryptorchidism (clinical note)
1 or both of testes have not completely descended
hydrocele (clinical note)
patency of processus vaginalis can result in an accumulation of excess serous fluid

-can be transiluminated

-can be localized to scrotum or confined to spermatic cord
Hematocele (clinical note)
blood within tunica vaginalis

-doens't transilluminate
canal lf nuck cysts (clinical concern)
persistant processus vaginalis in female can result in patent inguinal canal
-cysts can develop in canal
-can produce bulge in labium majora
torsion of spermatic cord (clinical concern)
-twisting of spermatic cord can lead to necrosis of testes if untreated due to compressed vessels

-usually occurs in adolescence
cancer of testes/ scrotum / uterus (clinical concern)
testes
-metastasizes to lumbar lymph nodes

scrotum
-metastasizes to superficial inguinal lymph nodes

Uterus
-can metastasize to either
cremasteric reflex (clinical concern)
-stimulation of interior thigh can raise testes
-can test L1-L2 spinal cord segments
-reflex is very active in young, hyperactivity can stimulate undescended testes
Inguinal triangle
area of weakness & common site for direct inguinal hernia

borders
-inferior epigastric artery/vein
-lateral border of rectus sheath
-inguinal ligament
2 types of inguinal hernias
indirect (congenital)
-most common 75%
-herniates through inguinal canal into scrotum
-mass will have all 3 coverings of spermatic cord

direct (acquired)
-passes through inguinal triangle
-enters inguinal canal through posterior wall
-does not typically enter scrotum
-lies parallel to spermatic cord not inside it
4 structures associated with the parietal peritoneum and the anterior abdominal wall
Lateral umbilical folds
-formed by peritneum covering inferior epigastric vessels

medial umbilical folds
-covering umbilical ligaments

Median umbilical fold
-covering median umbilical ligament

Round ligament of the liver (ligamentum teres)
-covering remnant of umbilical vein
7 specific messenteries
Mesentery proper
-small intestine

Root of the mesentery
-attaches messentery proper to posterior wall

Transverse mesocolon
-mesentery of transverse colon

Mesoappendix

Sigmoid mesocolon

Lesser omenta

Greater omenta
peritoneal ligament of liver
falciform ligament
-contains teres hepatis
-to ant abdominal wall
2 ligaments of the lesser omentum
gastro hepatic ligament

Hepatoduodenal ligament
-conducts portal triad
4 ligaments of greater omentum
gastrophrenic ligament

gastrosplenic ligament

gastrocolic ligament
-stomach to transverse colon

splenorenal ligament
supracolic compartment portion of the greater sac contains all or part of the...
stomach

spleen

liver
infracolic compartment portion of the greater sac contains all or part of the ...
ascending & descending colon

small intestine
4 abdominal recesses
hepatorenal recess
-between lobe of liver & right kidney

subphrenic recess
-between liver & diaphragm

left & right paracolic sulci (gutters)
-ascening & descending colon imprints
spaces where peritoneal fluid can accumulate in pelvic portion of abdominal cavity
males
-rectovesical pouch

females
-vesicouterine pouch & rectouterine pouch
inflammatory exudate (clinical concern)
can flow along paracolic gutters spreading infection or cancer etc
ascites (clinical concern)
excess fluid that builds up in perioneal cavity

-usually in response to infection
Foregut
derivatives:
blood supply:
reffered pain:
lymphatics:
derivatives: esophagus, stomah, proximal duodenum, liver & part of pancreas

blood supply: celiac trunk

reffered pain: epigastric region

lymphatics: celiac nodes
midgut
derivatives:
blood supply:
reffered pain:
lymphatics:
derivatives: part of pancreas, distal duodenum, jejunum, ileum, cecum, appendix, ascending colon, proximal 2/3 of transverse colon

blood supply: SMA

reffered pain: umbilical region

lymphatics: superior mesenteric nodes
hindgut
derivatives:
blood supply:
reffered pain:
lymphatics:
derivatives: distal 1/3 of transverse colon, descending colon, sigmoid colon, rectum, upper portion of anal canal

blood supply: IMA

reffered pain: hypogastric region

lymphatics: inferior mesenteric nodes
hiatal hernias
sliding hiatal hernia
-esophagus slides through hiatus so that esophagial junction is above the hiatus

paraesophageal hernia
-fundus of stomach herniates through hiatus side by side with esophagus
3 parts of gall bladder
fundus

body

neck
hepatopancreatic ampulla of vader
formed by the union of the pancreatic duct and the common bile duct. The ampulla is specifically located at the major duodenal papilla.
sphincter of oddi
collection of sphincters at ampulla of vater
Triangle of calot
contains cystic artery

boundaries
-common hepatic duct
-cystic duct
-liver
biliary ducts
sphincter of oddi is fed by
-common bile duct
-pancreatic bile duct

common bile duct is fed by
-cystic duct
-common hepatic duct

-common hepatic duct is fed by
-right & left hepatic ducts
4 anatomical portions of the pancreas
head
-lies in c shaped curve of duodenum

neck
-lies posterior to pylorus of stomach

body
-lies anterior to aorta

tail
-close to spleen
3 branches of celiac trunk
Left gastric artery
-supplies lesser curvature of stomach & esophagus

common hepatic artery
(-branches)
-gastroduodenal artery (*branches)
*right gastro-omental artery
*ant/post superior pancreatic duodenal arteries
-Proper hepatic artery (*branches)
*right gastric
*right/left hepatic arteris
*cystic artery

Splenic artery (-branches)
-left gastro-omental artery
-short gastric arteries
-pancreatic branches
2 systems of venous drainage of the abdomen
Caval (IVC)

Portal (liver)
-70%
4 portal caval anastomoses
esophageal varices
-esophageal veins drain into either left gastric vein (portal) or azyogs vein (caval)

Rectal varices or hemorrhoids
-sup rectal vein (portal)
-inf/middle rectal veins (caval)

Caput medusae
-paraumbilical veins anastomose with portal veins & epigastric veins (caval)

Hidden varices
-colic veins (portal) anastomose with retroperitoneal veins (caval)
Hepatic portal vein collects blood from (4 veins)
right/left gastric veins

splenic vein

superior mesenteric vein
Celiac lymph nodes
(9) from:
to:
from:
-R/L gastro-omental nodes
-R/L gastric nodes
-Splenic nodes
-Pyloric nodes
-Pancreatico splenic nodes
-hepatic nodes

To:
-cysternal chyli which then goes to the thoracic duct
4 parts of duodenum
Superior part (L1)
-mostly intraperitoneal

Descending part (L1-3)
-2ndrly retroperitoneal
-ampulla of vater

Horizontal Part (L3)
-2ndrly retroperitoneal

Ascending part (L3-2)
-2ndrly retroperitoneal
-suspensory muscle of duodenum (ligament of trietz) sk mm band coming from diaphragm
Jejunum vs ileum
length:
location:
vascular supply:
Jejunum
length:2/5 of total jejunal length
location: left upper quadrant
vascular supply:1-2 rows of arcades with long vasa recta

Ileum
length: 3/5 jejunoileal length
location: lower right quadrant
vascular supply: multiple rows of arcades with short vasa recta
ileal diverticulum
remnant of vitiline duct (connection between yolk sac and developing duct)

-may involve ileal cyst, ligament, or fistula

-can be infected and mistaken for appendicitus
referred pain of duodenum
midgut
length of jejunoileal intestine and legth of colon
jejunoileal is 6-7 m long

colon is 1.5 m long
cecum
round pouch like proximal end of colon
-ileocecal valve
-appendix
teniae coli
bands of smooth mm that course along length of colon
epiploic appendices
small fatty projections of omentum
haustra
sacculations of colon defined by semilunar folds
vertebral level of superior colon
S3
Superior messenteric artery
Inferior pancreaticoduodenal arteries

jejunal & ileal arteries
-15-20 branches from left side of SMA
-Anastomosing arcades with short vasa recta

Colic arteries (contribute to marginal artery)
-ileocolic artery (most inferior branch)
-right colic artery
-middle colic artery
Inferior messenteric artery
Level L3

Left colic artery

sigmoid arteries

superior rectal artery
Greater splanchnic nerve
from:
to:
arises from T5-9
-preganglionic sympathetic fibers
goes to celiac ganglia
lesser splanchnic nerve
from:
to:
from:
-T10-11

To:
- aorticorenal & superior messenteric ganglia

preganglionic sympathetic fibers
least splanchnic nerve
from:
to:
From:
-T12

To:
-renal & aorticorenal ganglia in renal plexus

preganglionic sympathetic fibers
Lumbar splanchnic nerves
from:
to:
from:
-L1-2

To:
-inferior mesenteric ganglion and superior hypogastric plexus

preganglionic sympathetic fibers
Celiac Ganglia
from:
to:
from:
-sympathetic gagnlia at base of celiac trunk

To:
-along periarterial plexuses of celiac branches to foregut target organs

postganglionic sympathetic fibers
Superior mesenteric ganglia
from:
to:
from:
-sympathetic ganglia at bases of SMA

to:
-along periarterial plexuses of SMA to target mid gut organs

postganglionic sympathetic fibers
Inferior mesenteric ganglia
from:
to:
from:
-sympathetic ganglia at bases of IMA

to:
course along periarterial plexuses of IMA to midgut target organs

Postganglionic sympathetic nerve fibers
Vagus Nerve (CNX)
from: brain
to:
carries preganglionic parasympathetic fibers to foregut & midgut viscera
Pelvic splanchnic nerves
from:
to:
from:
-S2-4

To:
-hindgut viscera

preganglionic parasympathetic fibers