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410 Cards in this Set
- Front
- Back
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1- r hypochondriac
2- epigastric 3- l hypochondriac 4- r lumbar 5- umbilical 6- l lumbar 7- r inguinal 8- hypogastric 9- l inguinal |
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subcostal plane
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intertubercular plane
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what is #1?
what vertebral level is it? what structures does it intersect? |
1- transpyloric plane
L1, 9th costal cartilage pylorus of stomach, fundus of gallbladder, duodenaljejunal junction, neck of pancreas, hilum of kidneys |
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1- linea alba
2- linea semilunaris 3- tendinous intersections 4- umbilicus (vertebral L3/L4) 5- inguinal folds |
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1- anterior superior iliac spine
2- pectineal line 3- pubic tubercle 4- pubic crest 5- pubic symphysis |
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What vertebral level is the xiphoid process @?
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T9
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What makes up the costal margin?
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ribs 7-10 and the tips of 11-12
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What is the lowest vertebral level of the costal margin?
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L3
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What is the highest vertebral level of the iliac crest?
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L4
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What ligament attaches at the anterior superior iliac spine?
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The inguinal ligament
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What attaches at the pectineal line?
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pectineal ligament or Cooper's ligament
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Describe the two types of fascia in the inguinal region:
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Camper's - fatty and superficial
Scarpa's - membranous and continuous with Colles' fascia at perineum |
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List the superficial arteries of the abdominal region:
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- anterior perforating A from the superior and inferior epigastric A
- lateral cutaneous A from lower posterior intercostal A, subcostal A, and segmental lumbar A - femoral A branches to superficial circumflex iliac A, superficial epigastric A, superficial external pudendal A - branches from deep circumflex iliac A |
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1- superior epigastric A
2- inferior epigastric A 3- superficial circumflex iliac A 4- superficial epigastric A 5- superficial external pudendal 6- branches from deep circumflex iliac A |
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Where do anterior perforating veins drain?
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Superior/inferior epigastric veins
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Where do thoracoepigastric veins drain?
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Lateral cutaneous veins up to axillary veins or down to femoral veins
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Where do paraumbilical veins drain?
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Deep along the falciform ligament to the portal vein and liver.
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When are superficial veins visible on the surface?
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Pathological conditions that can cause blockage of vessels
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Where do superficial abdominal lymphatics drain?
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above the umbilicus - anterior axillary nodes
below the umbilicus - superficial inguinal nodes |
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Where do deep abdominal lymphatics drain?
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follow deep arteries to parasternal, lumbar, or external iliac nodes
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What cutaneous nerves are in the abdominal region?
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lateral cutaneous N from T7 to T12
anterior cutaneous N from T7 to T12 iliohypogastric and ilioinguinal N from L1 |
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Xiphoid process dermatome?
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T7
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Umbilicus dermatome?
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T10
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Inguinal ligament and pubic symphysis dermatome?
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L1
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Name the origin/insertion of the external oblique:
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o: lower 8 ribs
i: xiphoid process, linea alba, pubic crest, anterior 1/2 crest, ASIS, pubic tubercle |
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1- lateral crus
2- intercrural fibers 3- medial crus 4- inguinal ligament |
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Compare the location of the internal oblique to the external oblique:
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internal is deep
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Name o/i for internal obliques:
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o: lumbar fascia, anterior 2/3 of iliac crest, lateral 2/3 of inguinal ligament
i: lower 3 ribs, costal cartilage, linea alba, pubic crest |
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Name the o/i of the transversus abdominis:
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o: lumbar fascia, lower 6 ribs, anterior 2/3 of iliac crest, lateral 1/3 of inguinal ligament
i: xiphoid process, linea alba, pubic crest |
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The three anterolateral muscles contribute to the ___ canal
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inguinal
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The aponeuroses of the three anterolateral muscles contribute to the sheath of the _______
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rectus abdominis
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Name the o/i of the rectus abdominis:
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o: front of the pubic symphysis and crest
i: 5-6-7 costal cartilage, xiphoid process |
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Name the o/i of the pyramidalis:
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anterior of the rectus abdominis within the rectus sheath
o: pubis i: linea alba |
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Which is above, which is below the ASIS?
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1- above
2- below |
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What separates the above/below ASIS rectus sheath?
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Arcuate line
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Describe the route of the superior epigastric A:
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A terminal branch of the internal thoracic artery that enters the rectus sheath b/w sternal and costal parts of the diaphragm, descends deep to rectus abdominis.
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Describe the route of the inferior epigastric A:
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A branch of the external iliac A, runs through transversalis fascia to reach the rectus sheath @ arcuate line.
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Describe the path of lower intercostal N:
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Travel anterior and inferior b/w internal oblique and rectus abdominis,
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Describe the path of the subcostal N:
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courses similar to the intercostals but travels the entire length b/w anterior abdominal muscles
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List the branches of the first lumbar N:
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- Iliohypogastric
- Ilioinguinal |
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Describe the path of the iliohypogastric N:
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Pierces obliques to reach the skin above the superficial inguinal ring
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Describe the path of the ilioinguinal N:
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Ilioinguinal branch pierces internal obliques to run through the inguinal canal to the superficial inguninal ring
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What innervate the external obliques?
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T7 - L1
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What innervates the internal obliques?
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T7 - L1
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What innervates the transversus abdominis
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T7 - L1
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What innervates the rectus abdominis?
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T7 - T12
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What innervates the pyramidalis?
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T12
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Which muscles laterally flex and rotate the trunk?
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External/internal obliques, transversus abdominis
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Which muscles stabilize the pelvis?
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Rectus abdominis
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What is the function of the pyramidalis?
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Stabilizing the pelvis
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When are abdominal muscles contracted?
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Forced expiration, defecation, parturition, micturition
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What is this region called?
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Inguinal
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Why do inguinal hernias occur more in men?
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Presence of spermatic cord
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What is the inguinal ligament?
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The inferior edge of the external abdominal oblique aponeuroses, spanning from the ASIS to the pubic tubercle.
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What is the pectineal ligament?
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On the pectineal line of the superior pubic ramus
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What is the lacunar ligament?
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Connects inguinal and pectineal ligaments
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Where is the superficial ring of the inguinal canal?
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b/w lateral and medial crura of external oblique aponeuroses and intercrural fibers
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Where is the deep ring of the inguinal canal?
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It is the evagination of the transversalis fascia, superior to the midpoint of the inguninal ligament, lateral to the inferior epigastric A and V
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What is in the inguinal canal?
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- ilioinguinal N
- Males: spermatic cord Females: round ligament of the uterus |
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Where is the inguinal canal?
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Parallel and superior to the medial half of the inguinal ligament.
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Testicular vessels + vas deferens and the round ligament of the uterus are ______ to the parietal peritoneum
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external
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What makes up the anterior wall of the inguinal canal?
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External oblique aponeurosis, internal oblique on lateral side
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What makes up the roof of the inguinal canal?
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Internal oblique, transversus abdominis
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What makes up the posterior wall of the inguinal canal?
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Transversalis fascia, medially reinforced by conjoint tendon
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What makes up the floor of the inguinal canal?
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Inguinal ligament, lacunar ligament
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What does the spermatic cord do?
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- travels to/from testis in scrotum
- begins at the deep inguinal ring - ends at the superficial inguinal ring |
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What makes up the spermatic cord?
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- vas deferens
- testicular, cremasteric, A to vas deferens - pampiniform plexus of veins - lymph vessels, sympathetic N, genital branch of genitofemoral N |
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1- deep inguinal ring
2- transversalis fascia 3- testicular vessels 4- iliopsoas muscle 5- vas deferens 6- inferior epigastric vessels |
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1- external spermatic fascia
2- cremasteric fascia 3- internal spermatic fascia |
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What does the internal spermatic fascia come from?
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Transversalis fascia at deep inguinal ring
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What does the cremasteric fascia derive from?
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Fascia of internal oblique, cremaster muscle, genital branch of genitofemoral N
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What does the external spermatic fascia derive from?
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External oblique aponeurosis and fascia
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What does the scrotum do?
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- a cutaneous pouch outside the body to maintain lower temp for sperm production
- contains the testis, epididymis, and spermatic cord |
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What is the tunica dartos continuous with?
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Fatty layer of superfical fascia of the lower anterior abdominal wall (Camper's)
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What is contained in the tunica vaginalis?
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Testis and epididymis
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Where does the head of the epididymis receive sperm from?
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seminiferous tubules of the testis via efferent ductules
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Where does the vas deferens begin?
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As a continuation of the tail of the epididymis
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Describe the path of the vas deferens:
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lower pole of testis - spermatic cord in the inguinal canal - through the deep ring - descends external to peritoneum in the pelvic cavity - medial to the ureter - expands to ampulla of the vas
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What forms the ejaculatory duct?
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ampulla of the vas + seminal vesicle duct
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Describe a vasectomy:
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Ligate/cut vas deferens in the scrotum
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1- end of spermatic cord
2- epididymis 3- testis 4- skin 5- tunica dartos 6- internal spermatic fascia 7- cremasteric fascia 8- external spermatic fascia |
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1- cremasteric A
2- testicular A 3- A of vas deferens |
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Where do the testicular A originate?
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The anterior surface of the abdominal aorta just inferior to the origin of the renal A
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Where does the cermasteric A originate?
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inferior epigastric A
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Where does the vas deferens A branch from?
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A vesical A supplying the urinary bladder
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Where does venous drainage from the testis and epididymis go?
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- the pampiniform plexus
- cools blood coming into scrotum |
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What is a varicocoele?
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- occurs when the testicular veins are obstructed
- veins become palpable in the scrotum |
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Where does the R testicular vein drain?
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IVC
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Where does the L testicular vein drain?
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L renal vein
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What can clamp the L renal vein?
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Superior mesenteric A and the abdominal aorta
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Which side develops more varicocoeles?
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The left side
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1- Iliohypogastric N
2- Ilioinguinal N 3- Genitofemoral N |
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When does the genitofemoral N divide?
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Just above the inguinal ligament
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What does the genital branch of the genitofemoral N do?
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Motor to cremaster muscle
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What does the femoral branch of the genitofemoral N do?
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Cutaneous to the skin of the superior anteromedial thigh
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What is the cremasteric reflex?
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stimulate skin on inner thigh -> through femoral branch of genitofemoral N -> retracts testis and scrotum
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Describe the path of the ilioinguinal N
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- from Lumbar plexus - L1 to L4 and vpr of L1
- b/w internal oblique and transversus abdominis - pierces internal oblique anterior/inferior to ASIS - through inguinal canal - exits superficial ring |
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What does the ilioinguinal N supply?
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sensory to anterior scrotum or labia majora, skin at superficial ring
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Where do the gonads descend?
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Posterior to processus vaginalis through inguinal canal using the gubernaculum as a guide
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What does the gubernaculum become?
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round ligament or scrotal ligament
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What does the remaining processus vaginalis become?
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Tunica vaginalis around the testis and epididymis
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What is the thick white CT capsule of the testis?
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Tunica albuginea
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sinus of the epididymis
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hydrocele of tunica vaginalis
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serous fluid distending the tunica vaginalis
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hematocele of tunica vaginalis
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tunica vaginalis distended by blood
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hernia of tunica vaginalis
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What are the borders of Hesselbach's triangle?
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inferior epigastric A, rectus abdominis, inguinal ligament
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What differentiates indirect and direct inguinal hernias?
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indirect - through deep inguinal ring
direct - through inguinal triangle |
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What do indirect and direct inguinal hernias share?
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They both pass through the superficial inguinal ring
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Where does lymph drainage from the scrotum go?
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superficial inguinal nodes -> deep inguinal nodes -> external iliac nodes
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Where does lymph drainage from the testis go?
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lumbar (para-aortic) nodes
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list some serous sacs:
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pleural, pericardial, tunica vaginalis, peritoneal
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What is a serous sac?
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Enclosed cavities that are discontinuous with the outside environment
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1- transversalis fascia
2- extraperitoneal CT 3- parietal peritoneum |
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What are the upper and lower limits of the abdominal cavity?
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upper - respiratory diaphragm
lower - pelvic inlet |
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What does the parietal peritoneum cover?
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body wall, diaphragm, a few organs
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What are the pieces of peritoneum connecting organs to the abdominal wall called?
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peritoneal reflection
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What do peritoneal reflections do?
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physical support, reduce friction, vessels and nerves, store fat, divide cavity
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What is a fold of peritoneum supporting an abdominal organ?
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ligament
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What is a double layer of peritoneum enclosing organs?
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mesentery
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falciform ligament
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diaphragm to anterior abdominal wall and liver
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coronary ligament and triangular ligaments
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diaphragm to liver
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mesentery proper
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posterior abdominal wall to jejunum and ileum
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sigmoid mesocolon
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posterior abdominal wall to sigmoid colon
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transverse mesocolon
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pancrease to transverse colon
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ligament of Treitz
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suspensory ligament of the duodenum
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median umbilical fold
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covers the obliterated urachus (median umblical ligament)
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medial umbilical fold
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covers the obliterated umbilical artery (medial umbilical ligament) on each side of the median umbilical fold
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lateral umbilical folds
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contain inferior epigastric vessels
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intraperitoneal
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completely surrounded by visceral peritoneum
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retroperitoneal
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partially behind parietal peritoneum
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list intraperitoneal organs:
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stomach, 1 duodenum, jejunum, ileum, appendix, transverse colon, sigmoid colon, liver, spleen, tail of pancreas
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list retroperitoneal organs:
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kidneys, ureter, adrenal glands, aorta, ivc, 2-3-4 duodenum, ascending and descending colon, pancreas except the tail
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Where is the omental bursa?
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posterior to the stomach and the lesser omentum
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How do the greater and lesser peritoneal sacs communicate?
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through the epiploic foramen (foramen of Winslow) which is behind the hepatoduodenal ligament
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What's in the hepatoduodenal ligament?
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bile duct, hepatic artery, portal vein
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Where is the subphrenic space?
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b/w liver and diaphragm
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Where is the pouch of Morrison?
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b/w kidney and liver
the most posterior space of the abdominal cavity |
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Where is the duodenal fossae?
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left of the duodenojejunal flexure
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Where is the retrocecal fossae?
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posterior to cecum
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What is found in the retrocecal fossae?
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The distal end of the appendix
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Where is the intersigmoid fossae?
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posterior to the sigmoid mesocolon
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What ligaments are attached to the stomach?
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hepatogastric, hepatoduodenal, gastrophrenic, gastrosplenic, gastrocolic, greater omentum
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What are these examples of?
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paracolic gutters to allow fluid flow through the upper and lower abdominal cavities
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1- rib 11
2- lumbar vertebrae 3 3- sacrum 4- ilium of pelvic bone |
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Where do the r/l crura of the diaphragm attach?
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r - L1, 2, 3
l- L1, 2 |
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What ligament reinforces the aortic hiatus?
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median arcuate ligament
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1- T12
2- esophagus 3- median arcuate lig 4- rib 12 5- lateral arcuate lig 6- medial arcuate lig 7- right crus 8- left crus |
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Where does the psoas originate?
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bodies and transverse process T12 to L5
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Where does the iliacus originate?
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iliac fossa
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Where does the iliopsoas insert?
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lesser trochanter of femur
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What innervates the iliopsoas?
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iliacus - femoral N
psoas - v rami L1, 2, 3 |
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What does the iliopsoas do?
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flex thigh at hip
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Where does the quadratus lumborum originate?
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transverse process L5 and iliac crest
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Where does the quadratus lumborum insert?
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transverse process of L1 to 4 and rib 12
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What innervates the quadratus lumborum?
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v rami T12 L1-4
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What does the quadratus lumborum do?
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lateral bending of trunk
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Describe the path of the abdominal aorta:
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Begins at T12 aortic hiatus and ends at L4 where it bifurcates to the 2 common iliac arteries. Branches to paired and unpaired organs.
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1- T12 inferior phrenic A
2- L1 middle suprarenal A 3- L1/L2 renal A 4- L2 gonadal A 5- L1 to 4 lumbar segmental A 6- common iliac A |
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1- T12 celiac trunk
2- L1 superior mesenteric A 3- L3 inferior mesenteric A 4- L4 median sacral A |
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What arteries supply the gut?
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foregut - celiac trunk
midgut - superior mesenteric A hindgut - inferior mesenteric A |
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As you transition from midgut to hindgut, how does N supply change?
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midgut - paraS is CNX
hindgut - sacral cord |
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1- inferior phrenic V
2- 3 hepatic V 3- R suprarenal V 4- 2 renal V 5- R gonadal V 6- 2 common iliac V |
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Where does venous blood from the GI go?
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Via portal V to liver
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1- ascending lumbar V
2- lumbar V 3- ivc 4- ascending lumbar V 5- lumbar V 6- iliolumbar V |
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What forms the lumbar plexus?
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vpr L1-4
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1- T12 subcostal N
2- L1 iliohypogastric N 3- L1 ilioinguinal N 4- L1 2 genitofemoral N 5- L1 3 lateral femoral cutaneous N 6- L2 4 femoral N 7- L2 4 obturator N |
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Where do preG fibers of the symp trunk originate?
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T1 to L2
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What is this?
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sympathetic chain
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What nerves go through the sympathetic chain but don't synapse there?
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greater, lesser, least splanchnic nerves, and lumbar splanchnic nerves
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Where do greater splanchnic N originate?
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T5-9
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Where do lesser splanchnic N originate?
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T10-11
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Where do least splanchnic N originate?
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T12
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Where do lumbar splanchnic N originate?
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L1-2
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What A do greater splanchnic N follow?
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celiac
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What A do lesser splanchnic N follow?
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superior mesenteric
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What A do least splanchnic N follow?
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aorticorenal
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What A do lumbar splanchnic N follow?
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inferior mesenteric
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1- greater splanchnic
2- lesser splanchnic 3- least splanchnic 4- lumbar splanchnic |
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Where are paraS ganglia?
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Within or near wall of viscera
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Where do paraS N to the abdomen come from?
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Anterior/posterior vagal trunks and S2-4
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What vertebral level are the kidneys?
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T12 - L3
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Where do renal vessels and ureter enter the kidney?
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hilus
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How are structures oriented that enter the hilus?
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anterior to posterior
renal vein, artery, ureter |
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What covers the outer layer of the kidney?
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A smooth fibrous CT capsule
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What is the fat in the renal sinus called?
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perinephric fat
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The space that the ureter occupies in the hilus is known as:
|
Renal sinus
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What is the renal pelvis?
|
The expansion of the ureter in the renal sinus
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1- pyramid in renal medulla
2- renal cortex 3- renal papilla 4- renal sinus 5- minor calyx 6- renal column |
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What happens at the renal papilla?
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Urine leaves the kidney to enter the renal pelvis and ureter
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1- glomerulus
2- proximal tubule 3- descending thin loop of henle 4- ascending thick loop of henle 5- distal convoluted tubules 6- connecting tubules 7- collecting duct |
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Compare the position of the IVC and aorta in the abdominal cavity:
|
IVC is right of midline
Aorta is left of midline |
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What runs on top of the L renal V?
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Superior mesenteric A
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What veins drain into the L renal V?
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L suprarenal V
L gonadal V |
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What is the most important thing to remember about renal A branches?
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They never anastomose so they're susceptible to hypoxic infarcts
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List the order of renal A branches:
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lobar (5 segmental) - interlobar - arcuate - interlobular - afferent arterioles - glomerular capillaries
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Describe the orientation of the segmental renal A in comparison to the ureter:
|
4 anterior, 1 posterior
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What are ureters?
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10 in long retroperitoneal muscular tubes from renal pelvis to urinary bladder
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List the 3 constrictions of ureters:
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1- renal pelvis joins ureter
2- ureter crosses pelvic brim 3- ureter pierces wall of bladder |
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What supplies blood to the ureters?
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upper 1/3 - renal A
middle 1/3 - testicular or ovarian A lower 1/3 - common/internal iliac A |
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What N supply the kidneys?
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symp - least/lumbar splanchnics from T12 to L2
paraS - S2-4 through hypogastric plexus |
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Why do kidneys receive N from S2-4 instead of vagal N?
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Because the kidney ascends during development
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Where would you feel kidney visceral pain?
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T12-L2 so loin to groin
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How are the two adrenal glands shaped?
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L - crescent, superior-medial aspect of kidney
R - pyramid, superior aspect of kidney, behind IVC |
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What A supply the adrenal glands?
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Superior adrenal A from inferior phrenic A
Middle adrenal A from aorta Inferior adrenal A from renal A |
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What V supply the adrenal glands?
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L adrenal V into L renal V
R adrenal V into IVC |
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What does the adrenal cortex produce?
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Mineralocorticoids, glucocorticoids, androgens
|
|
|
What does the adrenal medulla produce?
|
Epi/NE
|
|
|
What cells develop into adrenal cortex?
|
Mesoderm
|
|
|
What cells develop into adrenal medulla?
|
Neural crest
|
|
|
Where do the adrenal glands develop?
|
The superior portion of the posterior body wall
|
|
|
Why is the fetal adrenal:renal ratio so much higher?
|
Infants have a fetal-specific cortex that is replaced after 2 wks
|
|
|
What N supplies the adrenals?
|
Cortex - preG symp fibers from greater splanchnic in preaortic or aortico-renal ganglia
Medulla - preG symp fibers from adrenal medulla |
|
|
1- capsule
2- medulla 3- medullary vein 4- cortex |
|
|
What are the 3 layers of the adrenal cortex?
|
outer to inner
zona glomerulosa - zona fasciculata - zona reticularis |
|
|
1- zona glomerulosa
2- zona fasciculata 3- zona reticularis 4- medulla |
|
|
What does the zona glomerulosa do?
|
Stim'd by angioII to produce aldosterone
|
|
|
What does the zona fasciculata do?
|
Stim'd by ACTH to produce cortisol
|
|
|
What does the zona reticularis do?
|
Stim'd by ACTH to produce androgens
|
|
|
Which layer makes up the bulk of the adrenal cortex?
|
Zona fasciculata
|
|
|
Which adrenal cortex layer has round aggregates of cells?
|
Zona glomerulosa
|
|
|
What are cells in the zona fasciculata called?
|
spongiocytes
|
|
|
What are the cells in the zona reticularis like?
|
small, acidophilic (eosinophilic), and arranged in a net-like array
|
|
|
What are chromaffin cells?
|
Cells of the adrenal medulla
|
|
|
What are 80% of chromaffin cells?
|
Epi-producing
|
|
|
What are chromaffin cells innervated by?
|
Symp preG fibers
|
|
|
What do medullary arterioles do?
|
Carry oxygenated blood directly from capsular A to the medulla
|
|
|
What cortical capillaries do?
|
Transports cortical products to the medulla
|
|
|
Which muscles do the ureters run next to?
|
psoas (also next to vertebrae transverse processes)
|
|
|
Which kidney is lower?
|
R due to liver
|
|
|
What effect does inspiration have on abdominal organs?
|
Moves them down
|
|
|
List the layers that must be pierced to reach the kidneys:
|
thoracolumbar fascia, latissimus dorsi, external and internal obliques, transversus abdominis, lateral border of quadratus lumborum, para-renal fat, renal fascia, peri-renal fat, kidney CT capsule
|
|
|
What is peri-renal fat?
|
Fat surrounding kidney, invades renal sinus
|
|
|
What is renal fascia?
|
It separates peri/para renal fat
|
|
|
What is para-renal fat?
|
Mostly posterior to kidneys, it's continuous with extraperitoneal fat
|
|
|
What is the main stabilizing structure on the kidneys?
|
Renal vessels
|
|
What does the kidney contact?
|
1- R suprarenal gland
2- liver 3- descending part of duodenum 4- R colic flexure 5- small intestine |
|
What does this kidney contact?
|
1- L suprarenal gland
2- stomach 3- spleen 4- pancreas 5- L colic flexure 6- descending colon 7- jejunum |
|
|
Where does the R ureter descend?
|
posterior to 2duodenum, R colic vessels, terminal ileum, crosses bifurcation of common iliac A
|
|
|
Where does the L ureter descend?
|
posterior to sigmoid vessels, sigmoid mesocolon, and lateral to the inferior mesenteric V
|
|
|
What do pre-aortic lymph nodes drain?
|
GI tract vessels
travel via intestinal trunk |
|
|
What do para-aortic lymph nodes drain?
|
kidney, adrenals, gonads, common iliac nodes, abdominal wall vessels
travel via lumbar trunk |
|
|
cisterna chyli
|
receives lymph from 2 para-aortic and pre-aortic lymph ducts to go to the thoracic duct
|
|
|
What forms the esophageal hiatus?
|
R crus of the diaphragm
|
|
|
What is found posterior to the esophagus in the abdomen?
|
L crus, aorta, R vagal trunk
|
|
|
What is found anterior to the esophagus in the abdomen?
|
L vagal trunk, liver
|
|
|
What happens at the Z line of the esophagus?
|
Epithelial mucosa changes from squamous to secretory columnar
Z line is the gastroesophageal sphincter |
|
|
What kind of sphincter is the gastroesophageal sphincter?
|
physiologic, not anatomic
|
|
|
Gastrin
|
Hormone secreted by stomach epithelial cells in response to food, induces contraction of GE sphincter to prevent reflux
|
|
|
Hiatal hernia
|
stomach hernia into esophagus
|
|
|
What are the two stomach notches?
|
cardiac - next to esophageal entrance
incisura angularis - b/w body and pyloric region |
|
|
What are the 4 parts of the stomach?
|
cardia - area near esophagus
fundus - above esophageal entrance (gas) body - b/w fundus and pylorus pylorus - rt of incisura angularis |
|
|
list the 2 parts of the pylorus
|
antum
canal - more constricted |
|
|
What does the pyloric sphincter do?
|
Controls the rate of chyme exiting the stomach and entering the duodenum
|
|
|
Rugae
|
Longitudinal folds in the stomach, not present in the fundus, stretchable
|
|
|
What are the 3 layers of smooth muscle on the stomach?
|
longitudinal - mostly along curvatures
circular - body and pylorus, forms pyloric sphincter oblique - from fundus on down |
|
|
What kind of sphincter is the pyloric?
|
Anatomic and physiologic
|
|
|
What is the typical stomach shape?
|
J
|
|
|
What shape stomach do shorter heavier people have?
|
steerhorn
|
|
|
1- hepatogastric ligament
2- hepatoduodenal ligament 3- duodenum 4- transverse colon 5- R colic flexure 6- ascending colon 7- gastrosplenic ligament 8- splenocolic ligament 9- greater omentum |
|
|
What is in the greater omentum?
|
Vessels that supply the stomach
|
|
|
What structures are anterior to the stomach?
|
anterior abdominal wall muscles
left costal margin left diaphragm left lung left pleural cavity left lobe of liver |
|
|
What structures are posterior to the stomach?
|
diaphragm
spleen L adrenal L kidney splenic A pancreas transverse colon transverse mesocolon |
|
|
1- celiac trunk
2- superior mesenteric A 3- inferior mesenteric A |
|
|
What does the celiac trunk supply?
|
lower esophagus
stomach liver gallbladder spleen duodenum pancreas |
|
|
What does the superior mesenteric A supply?
|
small intestine
ascending and transverse colon |
|
|
What does the inferior mesenteric A supply?
|
descending colon
sigmoid colon upper rectum |
|
What 5 A supply the stomach?
|
1- L gastric A
2- short gastrics 3- L gastroepiploic 4- R gastroepiploic 5- R gastric |
|
|
Which 2 V primarily contribute to the portal V?
|
splenic and superior mesenteric
|
|
|
Where does the inferior mesenteric V drain to?
|
splenic V
|
|
|
Where do R/L gastric V drain to?
|
Directly to portal V
|
|
|
Where do the short gastric V and L gastroepiploic V drain to?
|
splenic V
|
|
|
Where does the R gastroepiploic V drain to?
|
superior mesenteric V
|
|
|
What is characteristic about the C shape at the beginning of the duodenum?
|
It wraps around the pancreas and receives bile + enz.
|
|
|
What happens to the duodenum after the first inch?
|
Becomes retroperitoneal
|
|
|
What structures are anterior to the first part of the duodenum?
|
quadrate lobe
gallbladder |
|
|
What structures are superior to the first part of the duodenum?
|
epiploic foramen
hepatoduodenal part of lesser omentum |
|
|
What structures are posterior to the first part of the duodenum?
|
gastroduodenal A
common bile duct portal V IVC |
|
|
What structures are inferior to the first part of the duodenum?
|
head of pancreas
|
|
|
What structures are anterior to the second part of the duodenum?
|
R lobe of liver
fundus of gallbladder transverse mesocolon transverse colon |
|
|
What structures are posterior to the second part of the duodenum?
|
hilus of R kidney
psoas R ureter |
|
|
What structures are medial to the second part of the duodenum?
|
head of the pancreas
|
|
|
How does the pancreatic duct enter the duodenum?
|
It joins the bile duct into a major duodenal papilla
|
|
|
Plica circularis
|
transverse folds in the duodenum
|
|
|
What structures are lateral to the second part of the duodenum?
|
hepatic flexure
|
|
|
What structures are superior to the third part of the duodenum?
|
pancreas
|
|
|
What structures are anterior to the third part of the duodenum?
|
root of mesentery
superior mesenteric vessels |
|
|
What structures are posterior to the third part of the duodenum?
|
IVC
aorta |
|
|
What structures are inferior to the third part of the duodenum?
|
jejunum
|
|
What structure is this, broadly speaking?
|
duodenum
|
|
|
What structures are anterior to the fourth part of the duodenum?
|
root of mesentery
|
|
|
What structures are posterior to the fourth part of the duodenum?
|
aorta
psoas border |
|
|
What is the paraduodenal recess?
|
Where the duodenum goes from retroperitoneal to intraperitoneal at the duodenojejunal junction
|
|
|
What does the ligament of Treitz do?
|
Attach the gut to the posterior abdominal wall at the duodenojejunal junction
|
|
|
What A supply the duodenum?
|
superior pancreatico-duodenal A from gastroduodenal
inferior pancreatico-duodenal A from superior mesenteric |
|
|
Where does the superior pancreaticoduodenal V drain to?
|
portal V
|
|
|
Where does the inferior pancreaticoduodenal V drain to?
|
superior mesenteric V
|
|
|
What is anterior to the spleen?
|
ribs 9 10 11
R lungs and pleura |
|
|
What does the visceral surface of the spleen touch?
|
stomach
kidney left colic flexure tail of pancreas |
|
|
What ligaments are associated with the spleen?
|
gastrosplenic
leinorenal |
|
|
What is in the gastrosplenic ligament?
|
short gastric A
L gastroepiploic |
|
|
What is in the leinorenal ligament?
|
splenic and pancreatic vessels
|
|
|
Describe the path of the splenic A:
|
Through the superior pancreas and through the lienorenal lig to the hilus, gives 6 branches to stomach
|
|
|
What drains into the celiac lymph nodes?
|
liver
gall bladder stomach spleen upper duodenum |
|
|
What drains into the superior mesenteric lymph nodes?
|
lower duodenum
|
|
|
What N supply the abdominal viscera?
|
CNX
greater splanchnic N |
|
|
What N are sensory for abdominal viscera?
|
T5-9
|
|
|
Where would you feel abdominal visceral pain?
|
torso area
|
|
|
Where does the jejunum begin?
|
duodenojejunal flexure
|
|
|
What plane is the duodenojejunal flexure at?
|
transpyloric plane
|
|
|
What is the jejunum:ileum ratio?
|
2:3
|
|
|
Where does the ileum end?
|
Ileocecal junction
|
|
|
Where is the jejunum located?
|
ULQ
|
|
|
Where is the ileum located?
|
LRQ
|
|
|
Compare the color of the jejunum to the ileum:
|
deep red/pale pink
|
|
|
Compare the caliber of the lumen of the jejunum to the ileum:
|
wider/thinner
|
|
|
Compare the mucosa of the jejunum to the ileum:
|
large, tall, densely packed/low, sparse, absent
|
|
|
Compare the lymphoid elements of the jejunum to the ileum:
|
few/many Peyer's patches
|
|
|
Compare the root of the mesentery of the jejunum to the ileum:
|
superior, L of aorta/inferior, R of aorta
|
|
|
Compare the mesenteric fat of the jejunum to the ileum:
|
scant near the wall, windows/heavy throughout
|
|
|
Compare the arcades and vasa recta of the jejunum to the ileum:
|
1-2 loops/4+
|
|
|
Jejunum/Ileum: which is smoother?
|
Ileum
|
|
|
What are Peyer's patches?
|
lymphoid nodules
|
|
|
What are plicae circulares?
|
Circular folds in the jejunal mucosa
|
|
|
1- jejunum
2- ileum |
|
|
What are vasa rectae?
|
Short vessels running from arterial arcades to the intestine
|
|
|
What is the arterial supply to the small intestine?
|
superior mesenteric A
|
|
|
What is the venous supply to the small intestine?
|
Ileocolic V - Intestinal V - Superior meseneteric V - portal V
|
|
|
What is the lymphatic supply to the small intestine?
|
superior mesenteric nodes - celiac nodes - intestinal lymphatic trunk - cysterna chyli
|
|
|
Describe the path of the superior mesenteric V:
|
On the R side of the artery - anterior to 3duodenum - posterior to tail of pancreas
|
|
|
What is Meckel's diverticulum?
|
- the remnant of the vitelline duct
- only exists in 2% - 2' from the ileocecal junction - 2" |
|
|
What part of the large intestine is intraperitoneal?
|
transverse colon, appendix, sigmoid colon
|
|
|
What are teniae coli?
|
The longitudinal muscle layer forming 3 bands on the large intestine
|
|
|
What are haustra coli?
|
Large intestine sacs formed by teniae coli
|
|
|
What are the folds on the inner surface mucosa of the large intestine?
|
semilunar folds
|
|
|
What are epiploic appendices?
|
Fat tags on outer surface of the large intestine
|
|
|
Where is the opening to the vermiform appendix?
|
posteromedial side of the cecum
|
|
|
Where is the superior ileocecal fold?
|
Superior to the ileum b/w cecum and mesentery
|
|
|
Where is the inferior ileocecal fold?
|
Inferior to the ileum b/w cecum and mesentery
|
|
|
retrocecal fossa
|
|
|
1- superior/inferior ileocolic A
2- anterior/posterior cecal A 3- appendicular A |
|
|
What is McBurney's position?
|
Base of appendix
|
|
|
What 2 locations are most common for the tip of the appendix?
|
75% retrocecal
20% pelvic |
|
|
What causes appendicitis?
|
Occlusion of the orifice
|
|
|
Where is appendicitis pain felt initially?
|
T10 dull
|
|
|
Where does appendicitis pain progress to?
|
McBurney's point
RLQ |
|
|
What is anterior to the ascending colon?
|
small intestine
greater omentum |
|
|
What is posterior to the ascending colon?
|
muscles of posterior abdominal wall
lower pole of R kidney |
|
|
How long is the ascending colon?
|
5"
|
|
|
How long is the transverse colon?
|
15"
|
|
|
What is characteristic about the splenic flexure?
|
- higher than the hepatic
- transition of mid to hindgut |
|
|
What attaches the transverse colon to the posterior abdominal wall?
|
transverse mesocolon
|
|
|
What is posterior to the transverse colon?
|
jejunum and ileum
|
|
|
What attaches the splenic flexure to the diaphragm?
|
phrenicocolic ligament
|
|
|
What supplies the large intestine?
|
R and middle colic A from the superior mesenteric A
L colic A and sigmoid branches from the inferior mesenteric A |
|
|
What does the marginal artery of Drummond do?
|
Provides an artery for anastomoses near the large intestine
|
|
|
1- superior mesenteric V
2- inferior mesenteric V |
|
|
Describe the lymph drainage of the large intestine:
|
inferior mesenteric nodes - intestinal trunk - superior mesenteric nodes - celiac nodes - cysterna chyli
|
|
|
1- T5 to 9, greater splanchnic via celiac and superior mesenteric plexus
2- T10 to 11 via superior mesenteric plexus 3- L1 to 2, lumbar splanchnics via inferior mesenteric plexus 4- vagus trunks via celiac and superior mesenteric plexus 5- S2 to 4 |
|
|
Which surface of the liver is smooth and convex?
|
diaphragmatic
|
|
|
On the liver, what separates the R/L subphrenic spaces?
|
falciform ligament
|
|
|
Where does the visceral surface of the liver face?
|
posteroinferior
|
|
|
What enters the hilum of the liver?
|
Porta hepatis
|
|
|
What does the L liver lobe contact?
|
stomach, lesser omentum, pancreas
|
|
|
What does the R liver lobe contact?
|
duodenum, hepatic flexure, kidney, adrenal gland
|
|
|
What is the ductus venosus?
|
A fetal shunt from the umbilical V past the liver to the IVC
|
|
|
Where is the ligamentum teres hepatis?
|
In the free margin of the falciform ligament
|
|
|
Where is the ligamentum venosum?
|
b/w the caudate and L lobes of the liver
|
|
|
What does the lesser omentum contain?
|
hepatogastric and hepatoduodenal ligament
|
|
|
What is posterior to the hepatoduodenal ligament?
|
epiploic foramen
|
|
|
What part of the liver is not covered with visceral peritoneum?
|
The bare area, where it contacts the diaphragm
|
|
|
What surrounds the bare area?
|
coronary ligament
|
|
|
1- L triangular
2- bare area 3- R triangular 4- superior leaf 5- inferior leaf |
|
|
1- L
2- R 3- quadrate 4- caudate |
|
What plane is marked in red?
|
principal plane
|
|
|
Hepatic V are ___segmental
|
inter
|
|
|
Where is the fundus?
|
b/w R lateral rectus abdominis and costal margin
|
|
|
Pain in the RUQ = ?
|
gallstones
|
|
|
1- neck
2- body 3- fundus 4- R hepatic duct 5- L hepatic duct 6- common hepatic duct 7- common bile duct |
|
|
What is the posterior gallbladder contacting?
|
1 2 duodenum
|
|
|
What is inferior to the gallbladder?
|
hepatic flexure
|
|
|
What is a cholecystenteric fistula?
|
An abnormal opening from gallbladder to colon
|
|
|
gallstone ileus
|
gallstone impacted at ileocecal valve
|
|
|
What supplies blood to the liver?
|
common hepatic A
|
|
|
What supplies blood to the gallbladder?
|
common hepatic A - R hepatic A - cystic A
|
|
|
What are common variations to liver blood supply?
|
L hepatic from L gastric or R hepatic from SMA
|
|
|
What borders make up the cystic traingle of Calot?
|
liver, cystic duct, common hepatic duct
|
|
|
What vertebral level is the pancreas?
|
L1 to 2
|
|
|
What part of the pancreas is intraperitoneal?
|
tail, in lienorenal ligament
|
|
|
What structures are anterior to the pancreas?
|
omental bursa (lesser sac)
stomach 1duodenum L liver lesser omentum transverse mesocolon |
|
|
What structures are posterior to the pancreas?
|
SMA
SMV aorta suprarenal glands |
|
|
Where does the pancreas excrete to?
|
2duodenum into ampulla of Vater
|
|
|
What is another name for the major pancreatic duct?
|
Wirsung
|
|
|
What is another name for the hepatopancreatic ampulla?
|
ampulla of Vater
|
|
|
What is the Kocher surgical maneuver?
|
Cutting the peritoneum lateral to the duodenum and rotating it
|
|
|
What controls flow through the major duodenal papilla?
|
Smooth muscle sphincter of Oddi
|
|
|
Cholecystokinin
|
Promotes gallbladder contraction and bile release into the duodenum
|
|
|
What is obstructive jaundice?
|
pancreatic cancer can obstruct bile
|
|
|
1- splenic A
2- dorsal pancreatic A 3- gastroduodenal A 4- superior pancreaticoduodenal A 5- SMA 6- inferior pancreaticoduodenal A |
|
|
Which pancreatic A anastomose?
|
superior/inferior pancreaticoduodenal A
|
|
|
Where does the splenic V drain into?
|
inferior mesenteric V to portal V
|
|
|
Which ribs protect the spleen?
|
9 to 11
|
|
|
Which surface of the spleen is convex?
|
diaphragmatic
|
|
|
What stabilizes the spleen?
|
phrenicocolic, gastrosplenic, and splenorenal ligament
|
|
|
What is the blood supply to the spleen?
|
splenic A
|
|
|
Describe a splenic rupture:
|
usually result of physical trauma to LUQ, splenectomy with few consequences
|
|
|
What causes a splenomegaly?
|
reticuloendothelial diseases
|
|
|
Where does liver lymph drain?
|
hepatic nodes - celiac nodes
posterior mediastinal nodes |
|
|
Where does splenic lymph drain?
|
celiac or superior mesenteric nodes
|
