N&e Anatomy

Front 1

what's the purpose of abdominal regions

Back 1

to describe the site of abnormalities i.e masses

Front 2

Back 2

1. Right hypochondrium
2. Epigastric
3. Left hypochondrium
4. Right lumbar
5. Umbilical region
6. Left lumbar
7. Right iliac/inguinal
8. Pubic region9. Left iliac/inguinal 10. Midclavicular planes
11. Intertubercular plane
12. Subcostal plane

Front 3

2 horizonal lines that make up quadrants

Back 3

1. subcostal plane

2. Transpyloric plane

Front 4

2 Vertical lines and their positions

Back 4

L&R mid-clavicular passing through ipsilateral mid-inguinal point

Front 5

Location of transpyloric plane

Back 5

- between sternal notch and upper border of pubic symphysis
-L1

Front 6

transtubecular plane location

Back 6

-through iliac tubercles (lie on iliac crest forming its lateral part) at L3

Front 7

Organs in Right upper quandrant

Back 7

Liver
Gall bladder
R kidney and adrenal gland
Colon
Duodenum with head of pancreas
Small intestine
Bile duct
L GB KA C DP SI

Front 8

LUQ organs

Back 8

Stomach
Spleen
Pancreas
Kidney + Adrenal gland
Colon (splenic flexure )
JeJunum

Front 9

LRQ organs

Back 9

-colon ascending
-caecum
-appendix (mc burney's point)
-Ileum

Front 10

Left Lumbar Quadrant Organs

Back 10

-Colon- descending
-Sigmoid
-SI

Front 11

Is the liver palpable

Back 11

yes, just below costal margin

Front 12

Is the spleen palpable

Back 12

no- only when enlarged or in slender patients

Front 13

IS the GI tract palpable

Back 13

not normally but some of the colon can be palpitated if pathological

E.g sigmoid Colon in chronic constipation

Front 14

in what case are retroperitoneal organs such as kidney, spleen palpable

Back 14

when enlarged

Front 15

RHR organs

Back 15

Liver and Gall bladder
Kidney+ adrenal gland
Colon- hepatic flexure (ascending)

Front 16

Epigastric region

Back 16

liver
transverse C
abdominal aorta and IVC
Pylorus and Duodenum: first part

Front 17

LHR

Back 17

stomach
spleen
K+A
Colon

Front 18

RLR

Back 18

Kidney

Colon

small intestines

Front 19

Umbilical region

Back 19

T colon
pancreas and Duodenum
Ab aorta, vena caca
Small Intestine
Iliac vessels

Front 20

LLR

Back 20

Kidney
D colon
pancreas
Jejunum

Front 21

RIR

Back 21

caecum
appendix
Ileum

Front 22

Hypo R

Back 22

distendible organs of pelvis
SI
Iliac vessels
Spermatic cords

Front 23

LIR

Back 23

sigmoid colon

SI

Front 24

Position of the Liver

Back 24

-mostly R hypochondrium and epigastric
-upper border is at 5th rib

Front 25

Gall bladder location

Back 25

-tip of 9th costal cartilage on the right

- where lateral border of rectus abdominis crosses costal margin on transpyloric plane

Front 26

Rectus Abdominis: attachments, function, lateral border

Back 26

-A: inferior edges of 5-7th costal cartilages, xiphoid process, pubic symphysis, pubic crest
-F:flexes trunk, compresses abdominal viscera, controls tilt of pelvis
Lateral border: Linea semilunaris

Front 27

Stomach Location

Back 27

-pylorus (consistenly placed part) at transpyloric plane

-pylorus descends on supine position

-Fundus lies at 5th rib of midclavicular line

Front 28

the transpyloric plane marks the position of what organs?

Back 28

-gall bladder

-renal hila

-spleen Hilum

-origin of SMA

Front 29

Duodenum and pancreas location

Back 29

head: just below and right of pyloric position

Duodenum: curves from pylorus rightwards, downwards and leftwards to reach transpyloric plane

Front 30

Appendix Location

Back 30

Mcburney's point 2/3 between umbilicus and ASIS

Front 31

The mesentry location

Back 31

-root attached to posterior abdominal wall

-extends from 4th part of duodenum to Mcburney's point

Front 32

Colon regions

Back 32

Ascending: Mcburney's point to transpyloric plane

Transverse: hangs at umbilicus and rises to the left lumbar regions

Sigmoid: crosses to centre of hypogastric

Front 33

Spleen Location

Back 33

-between 9th and 10th ribs

-between erector sipnae muscle and midaxillary line

Front 34

Kidneys location

Back 34

Hila: transpyloric plane

Posteriorly: covered by 11th & 12th Ribs

positions change by 5 cm when supine

Front 35

Abdominal aorta palpitation

Back 35

can be felt by pulsing forcefully by the lumbar vertebrae bodies to the left of midline

Front 36

Desceding colon palpitation

Back 36

can be felt in L lumbar region due to solidity of its contents

Front 37

Liver palpitations

Back 37

-palpable in infants

Front 38

Spleen palpitation

Back 38

-palpable in infants as a mass descending from left hypochondrium
- cannot be felt in adults unless 3x its size

Front 39

GI tract palpitations

Back 39

- normally impalpable

-in chronic constipation S colon filled with faeces and can be felt in left iliac fossa

-caecum and S colon if inflamed can be palpated in left iliac fossa

Front 40

uterus and ovaries palpitations

Back 40

- common site for cancer, fribrois etc...

-masses can be felt in iliac fossae or hypochondrium

-uterus palpitated in 12th week of pregnancy

Front 41

Urinary bladder palpitations

Back 41

-can be palpitated in abdominal region in infants in hypochondrium when full (300-500ml)

-in Adults palpitable when full above pubic symphysis

Front 42

Why is suprapubic puncture of the distended bladder possible without damage to peritoneal cavity?

Back 42

Bladder is retroperitoneal

Front 43

If muscles are retracted nerves are also retracted why is that clinically useful ?

Back 43

.

Front 44

Where does the neurovascular plane of anterior abdominal wall lie ?

Back 44

between intermediate and deepest muscle. between Internal oblique and transversus abdominis

Front 45

how is the rectus sheath formed

Back 45

from aponeuroses of the 3 muscle layers

Front 46

where is the inguinal ligament located

Back 46

from ASIS to pubic tubercle

Front 47

what forms the lower border on the layers of the abdominal muscles

Back 47

Inguinal ligament

Front 48

Whats an aponeurosis

Back 48

tendinous sheath which connects/anchors muscles

Front 49

Functions of Anterior abdominal wall muscles

Back 49

- compress and support abdominal organs
-flex and rotate trunk
-expiration
-stabilises and controls tilt of pelvis

Front 50

NErve supply to skin and muscles of AAW

Back 50

- T7-T11 spinal nerves

- T12 subcostal nerve

- First lumbar nerves, Iliohypogastric and ilioingunal

-

Front 51

Which dermatome lies at the level of:

i) the xiphisternum?

ii) the umbilicus?

iii) the pubic tubercle?

Back 51

i) T7

II) T10

iii) L1

Front 52

What name is given to the fascia in the perineum continous with the scarpa's fascia ?

Back 52

Colles Fascia

Front 53

what is the name given to boundaries formed by ataching to colles fascia

Back 53

Superficial perineal pouch

Front 54

In which direction do external oblique fibres run ?

Back 54

downwards medially

Front 55

Which muscle's inferior border is thickened to form inguinal ligament

Back 55

External oblique

Front 56

where is the inguinal canal located ?

Back 56

superior to pubic tubercle

Front 57

superficial inguinal ring LOCATION

Back 57

-MARKS END OF INGUINAL CANAL AND LIES SUPERIOR TO PUBIC TUBERCLE

-TRIANGLE SHAPED OPENING FORMED BY INVAGINATION OF EXTERNAL OBLIQUE

Front 58

WHAT STRUCTURES PASS THROUGH INGUINAL RINGS ?

Back 58

SPERMATIC CORD OR ROUND LIGAMAMENT IN FEMALES
as well as blood vessels, lymphatic vessels, and the ilioinguinal nerve (which enters the canal from the side, rather than passing through the deep ring).

Front 59

How is the aponeurosis of external oblique arranged at THE POINT THEY FORM THE SUPERFICIAL INGUINAL RING ? Which component of thespermatic cord is formed from this aponeurosis?

Back 59

- EXTERNAL OBLIQUE FORMS ANTERIOR WALL IF THE RING

-IT DIVIDES TO FORM MEDIAL AND LATERAL CRURA FORMING SUPERFFICIAL iNGUINAL RING

-external oblique gives rise to external spermatic fascia

Front 60

fibres of internal oblique. In which direction do they run?

Back 60

upwards

Front 61

How do the fibres of internal oblique relate to the inguinal ligament?

Back 61

It originates from the lateral 2/3 of the inguinal ligament

Front 62

In which direction do the fibres of transversus abdominis run?

Back 62

transversally

Front 63

How do the fibres of transversus abdominis relate to the inguinal ligament?

Back 63

it originates from the 1/3 of the inguinal ligament

Front 64

What and where is the conjoint tendon?

Back 64

-combined insertion of transversus abdominis and internal oblique

-It is at the pectineal lines and pubic crest

Front 65

What and where is the transversalis fascia?

Back 65

the internal surface of the transversus abdominis

-It is continuous with the general fascia of the abdomen to the extent that it is regarded by some as a part of the extraperitoneal connective tissue.

Front 66

what is the Linea alba

Back 66

white line formed by the joining of aponeurises

Front 67

What is the linea smilunaris

Back 67

marks lateral border of rectus abdominis

Front 68

Arcuate line

Back 68

line between aponeurosis posterior wall and transversalis fascia of rectus sheath

Front 69

Which vessels run in the rectus sheath, deep to rectus abdominis muscle?

Back 69

superior and inferior epigastric arteries and veins

Front 70

Ingunal canal

Back 70

-lies above medial half of inguinal ligament

-extends from deep inguinal ring to superficial inguinal rings

-has spematic cord and round ligament in female

- It is the route by which the testis descends into the scrotum inthe male foetus

-forms weak point especially in males

Front 71

Testis and development

Back 71

-Testes push way into anterior abdominal wall

-as this happens testes and ductus vas defs acquire coverings of abdominal wall

Front 72

From what is the tunica vaginalis derived? How?

Back 72

-from peritoneum when testes descend to scrotum

Front 73

What is the cremasteric reflex?

Back 73

contraction of the cremastor muscle by lighty stoking the medial aspect of the thigh

Front 74

what structures run in spermatic cord

Back 74

testicular artery, ductus dus deferens, cremasteric artery, genital pempiniform venous, venous plexus, sympathetic nerve fibres, genitofemoral nerve, lymphatic vessels, vestige of process vaginalis.

Front 75

where is the deep inguinal ring located ?

Back 75

superior to inguinal ligament + lateral to inferior epigastric artery

Front 76

Boundaries of canal?

Back 76

-The anterior wall is formed by the aponeurosis of the external oblique, and reinforced by the internal oblique muscle laterally.

-The posterior wall is formed by the transversalis fascia.

-The roof is formed by the transversalis fascia, internal oblique and transversus abdominis.

-The floor is formed by the inguinal ligament and thickened medially by the lacunar ligament

Front 77

What is the approximate length of the inguinal canal?

Back 77

4 cm

Front 78

What are the boundaries of the superficial inguinal ring?

Back 78

pubic crest and tubercle

Front 79

Which nerve enters the inguinal canal through the deep ring? What does it supply?

Back 79

Genitofemoral nerve
-crematoric muscle
-skin of scrotum
-mons pubis
-upper anterior thigh

Front 80

How does the ilioinguinal nerve enter the inguinal canal? What does it supply?

Back 80

- enters obliquely

- supplies upper medial thigh, roof of penis, anterior surface of scrotum, mons pubis, labium majus.

Front 81

What is a hernia

Back 81

protrusion of parietal peritoneum and viscera through a normal or abdominal opening from cavity in which they belong

Front 82

difference between Direct and Indirect

Back 82

Direct: weakness of anterior abdominal wall muscles. lateral to edge of conjoint tendon in the inguinal triangle and rarely descends into scrotum. lies medial to inferior epigastric

artery and protruds forward to superficial inguinal ring, rarely through. acquired and develops after birth

Indirect: patency of processus vaginalis. passes through deep inguinal ring, inguinal canal, and superficial inguinal ring and descends to scrotum. lies lateral to inferior epigastric vessels. it is congenital

Front 83

what is a reducible hernia

Back 83

it can be returned back to its normal place in peritoneal cavity

Front 84

a cruciate incision:

Back 84

A vertical incision just to the right of the midline, from the costal margin to the pubis.

• A horizontal incision through the umbilicus, running laterally on each side for about 10cm

Front 85

Parietal peritoneum

Back 85

-lines abdominal wall cavities
-clothes anterioir and posterior abdominal walls

Front 86

What is the nerve supply of the parietal peritoneum?

Back 86

-thoracolumbar nerves T7-11

-Subcostal nerve (T12)

-iliohypogastric and inguinal nerves (L1)

Front 87

The visceral peritoneum

Back 87

-continuous with the parietal peritoneum

-leaves posterior abdominal wall to invest in viscera

-passes in front of organs in some cases e.g duodenum

- in some cases t forms a mesentry (2 layers)


-The upperparts of the pelvic organs (rectum, uterus, bladder) project into the abdominal cavity and aretherefore covered by visceral peritoneum which hangs down in depressions or pouchesbetween them.

Front 88

What characteristic does suspension by a mesentery confer on the suspended organ?

Back 88

- Neurovascular and lymphatic communication

-organ mobility

Front 89

When in situ, which of the following organs lie retro-peritoneally on the posterior abdominalwall?

Back 89

duodenum, pancreas, rectum (middle third, ascending and desceding colon

Front 90

falciform ligament which runs from the anterior wall ofthe abdominal cavity to the liver. Its free border contains the ligamentum teres.Of what is the ligamentum teres a remnant?

Back 90

Umbilical vein

Front 91

Where is the ligamentum teres

Back 91

in the free border of the falciform ligament

Front 92

What is an adhesion?

Back 92

Abdominal adhesions are bands of scar tissue that form between abdominal tissues and organs, causing them to stick together.

Front 93

What is attached to the posterior surface of the greater omentum

Back 93

transverse colon

Front 94

what structure divides abdominal cavity into dividing the abdominal cavity into a supracolic compartment and aninfracolic compartment

Back 94

mesocolon AKA mesocolic shelf

Front 95

where is the hepatic flexure located

Back 95

on the right handside under the liver

Front 96

splenic fexure

Back 96

on left handside under spleen

Front 97

what lies between liver and diaphragm

Back 97

the subphrenic space

Front 98

The subprenic space is divided into 2 parts by what ligament

Back 98

falciform ligament

Front 99

What ligament stops your hand running all the way through the subphrenic space

Back 99

coronary ligament

Front 100

what structure bounds the bare area of the liver

Back 100

coronary ligament

Front 101

where is the sub hepatic channel

Back 101

-under the liver
-its inferior limit is the transverse mesocolon

Front 102

what is on the right of the subhepatic channel by the right kidney

Back 102

hepato-renal pouch (ofRutherford Morison).

Front 103

what structure is continuous with the paracolic gutter

Back 103

hepato-renal pouch (ofRutherford Morison).

Front 104

The hepato-renal pouch is of surgical importance. Why?

Back 104

INtraperitoneal fluid can collect here

-common site for subphrenic abscess.

-infects can spread from gall bladder and other neighbouring organs

Front 105

Lesser omentum

Back 105

-suspends lesser curvature of the stomach and first part pf duodenum

Front 106

Free margin of lesser omentum

Back 106

lies immediately anterior to epiploic foramen ( space under lesser omentum )

-free border of lesser omentuis is AKA duodenohepatic ligament forming anterior boundary of epiploic foramen

The lesser omentum consists of two layers of peritoneum. Between these two layers, at the free border, pass the portal vein, the hepatic artery, the hepatic, cystic, and common bile ducts, and the nerves and lymphatics.

Front 107

What is the embryological origin of the lesser omentum?

Back 107

VEntral mesentry

Front 108

lesser sac

Back 108

- lies posterior to the stomach and lesser omentum

-connects with the greater sac via epiploic foramen

- space enclosed between the anterior and posterior layers of the greater omentumis part of the lesser sac.

Front 109

what makes up the anteriorn posterior, superior and inferior margins of epiplpoic foramen

Back 109

--anterior margin: hepatoduodenal ligament/ free border of lesser omentum ( with portal triad)

-posterior margin: IVC, diaphragm

-superior margin: covering of caudate lobe

-inferior margin: peritoneum covering of duodenum (first part)

Front 110

How many layers of peritoneum make up the greater omentum:a) as it runs between the greater curvature of the stomach and the transverse colon?

Back 110

4 layers

Front 111

How many layers of peritoneum make up the greater omentum: b) inferior to the transverse colon?

Back 111

2

Front 112

whats the gastrocolic ligament

Back 112

The part of the greater omentum between the greatercurvature and the transverse colon

Front 113

ligament between greater omentum and spleen

Back 113

gastrosplenic ligament

Front 114

in what ligamnet does the terminal part of the splenic artery run into

Back 114

lienorenal ligament

Front 115

where is the lineorenal ligament located

Back 115

From the pleen, this same fold continues to the posterior abdominal wall where it attaches in theregion of the left kidney, forming the lienorenal ligament.

Front 116

The infracolic compartment

Back 116

- is of greater sac

-lies below transverse mesocolon

-contains main mass of intestinal coils

-contains iliolumbar fossa

Front 117

which is higher hepatic flexure or splenic flexure

Back 117

splenic flexure, hepatic is lower due to bulk of liver

Front 118

the phrenico-colic ligament.

Back 118

the small transverse fold of peritoneum between the splenicflexure and the diaphragm

Front 119

wheres the beginning of the ascending colon

Back 119

iliac fossa

Front 120

why are the communications of the paracolic gutters important

Back 120

- there is no communication between left paracolic gutter and the left subphrenic space because of the phrenicocolic ligament

-on the right there is a communicatin which is clinically significant because the connection aids spread infection

Front 121

does the duodenum have a mesentry ?

Back 121

nope

Front 122

what mesentry suspends the SI

Back 122

the mesentry proper

Front 123

where does the attachment of the mesentry of the small intestine begin?

Back 123

s at the duodenojejunal flexure and slopes downwardsand to the right sacroiliac joint

Front 124

where is the root of the mesentry proper

Back 124

The line of attachment of the mesentery to the posteriorabdominal wall

Front 125

Which side of the infracolic compartment communicates with the pelvis?

Back 125

left infracolic compartment

Front 126

where does the SI terminate

Back 126

right iliac fossa

Front 127

what does the mesoappendix contain

Back 127

-appendicular artery + vein,iliocoic vein, lymph nodes and nerves

Front 128

sigmoid colon in the pelvis is suspended by what

Back 128

It is suspended by the sigmoidmesocolon, which attaches it to the pelvic wall in an inverted “V” arrangement over thedivision of the left common iliac artery.

Front 129

Sensation from viscera can be crudely divided into “normal” (usually associated withmotility and/or distension) and “abnormal” (i.e. painful). “Normal” sensory information from an organ is generally transmitted through visceralsensory fibres that accompany the parasympathetic motor fibres supplying that organ.What is the parasympathetic motor supply to:(i) the fore- and midgut?(ii) the hindgut?(iii) the bladder?

Back 129

i ) the fore- and midgut? : T9-10 and 11 (thoracic splanchnic nerves)
(ii) the hindgut? L1+L2 (lumbar nerves)
(iii) the bladder? S2-S4 (sacral plexus

Front 130

sympathetic supply to bladder

Back 130

T11 to L2

Front 131

“Painful” sensory information from an organ (usually as a result of abnormaldistension of the organ) is generally transmitted through visceral sensory fibres thataccompany the sympathetic motor fibres supplying that organ.

What is the sympathetic motor supply to the abdominal and pelvic viscera?

Back 131

T5-L3

Front 132

through what visceral sensory fibres is “Painful” sensory information from an organ (usually as a result of abnormaldistension of the organ) is generally transmitted

Back 132

through visceral sensory fibres thataccompany the sympathetic motor fibres supplying that organ.

Front 133

wher eare painful sensations from viscera vaguely localised despite location of viscus

Back 133

Painful sensations from the viscera are vaguely localised to the median plane, no matterwhat the location of the viscus.

Front 134

Why does pain from parietal layers localise well ?

Back 134

because parietal layers are innervated by sensorybranches of somatic nerves.

Therefore, if the pathology comes to include the parietalmembranous layer, the pain now localises well, because it signals through thesomatic systems.

Front 135

Which somatic nerves supply the parietal peritoneum?

Back 135

Spinal :

thoracolumbar : t7-11

subcotal nerves: T12

iliohypogastric +ilioinguinal L1

Front 136

1. when only the vermiform appendix and visceralperitoneum are inflamed where is the pain felt ?

2.as soon as parietalperitoneum in the right iliac fossa is involved, the pain localises to what ?

Back 136

1. pain is felt in the central abdomen

2. to the fossa

Front 137

in appendicitis does one feel pain in appendix

Back 137

no

Front 138

whats the gastrocolic ligament

Back 138

ligament ie. that part of the greater omentum running to thetransverse colon.

Front 139

Define the boundaries of the lesser sac.

Back 139

anterior wall

-peritoneum of lesser omentum

-posterior surface of stomach

-anterior two layers of greater omentum

posterior wall

-peritoneum that covers the diaphragm, pancreas, left kidney and adrenal gland, and duodenum

-posterior two layers of the greater omentum

Front 140

Is the cardiac orifice an "anatomical" sphincter?

Back 140

no, serves as physiological sphincter relaxing muscles as food enters stomach

Front 141

is pylorus an "anatomical" sphincter?

Back 141

yes has circular muscle layers controls discharge of food into duodenum

Front 142

At what vertebral level does the pylorus normally lie? This is the level of the “transpyloricplane”.

Back 142

L1

Front 143

branches of which nerve sink in muscular wall of stomach

Back 143

vagus

Front 144

How does the left vagus come to lie anteriorly on the stomach and the right vagusposteriorly?

Back 144

l. vagus from L vagal trunk enters abdomen on anterior surface of oesophagus. it divides into branches whiich supply anterior part of stomach

R. Vagus forms posterior v. trunk which divides from posterior oesophagus to supply posterior stomach

Front 145

Anterior relations of stomach

Back 145

Ant abdominal wall

l. costal margin

L pleura and L lung

lobe of liver

Front 146

posterior relations of stomach

Back 146

lesser sac, diaphragm, spleen, adrenal gpand, upper part of kidney, splenic arterty, pancreas, transverse colon

Front 147

What is a hiatus hernia?

Back 147

protrusion of upper par of stomach into thorax through a tear/weakness in oesophageal hiatus

Front 148

How does a hiatus hernia differ from a congenital diaphragmatic hernia?

Back 148

diaphragmatic hernia is congenital usually in new borns involves the small intestine

Hiatus hernia is acquired (sliding hernia- stomach slides through oesophageal sphincter)

Front 149

what does the coeliac trunk supply

Back 149

Supplies foregut, liver pancreas, and spleen

Front 150

Branches of coeliac trunk

Back 150

Left Hand Side (LHS)

Left gastric artery]

Hepatic artery

Splenic arter

Front 151

what does the SMA supply

Back 151

midgut

Front 152

what does IMA supply

Back 152

hindgut

Front 153

at what level vertebra is the coeliac trunk given off

Back 153

T2

Front 154

Left gastric artery course

Back 154

-enters at lesser omentum

-runs along lesser curvature of stomach

Front 155

components of midgut

Back 155

lower duodenum, jejunum, ileum, caecum, appendix, 2/3 of transverse colon

Front 156

The superior mesenteric artery supplies the midgut, list the components of the midgut

Back 156

- duodenum (3&4)

- jejunum

- ileum

- cecum

- appendix

- ascending colon

- transverse colon (1st half)

Front 157

list below five points that will enable a surgeon todetermine the level of a loop of small intestine during an operation.

Back 157

-jejunum has greater diameter

-jejunum has thicker walls

-jejunum has larger more numerous circular folds and villi

-Jejunum is longer and is a deeper red/pink

-Jejunum has less fat in mesentry

Front 158

What is Meckel’s diverticulum?

Back 158

is a slight bulge in the small intestine present at birth and a vestigial remnant of the omphalomesenteric duct (also called the vitelline duct or yolk stalk)

Front 159

Where are diverticuli common

Back 159

sigmoid colon

Front 160

What is diverticulosis?

Back 160

–Multiplefalse diverticula formed from evaginations of colonic mucosa- common in sigmoid collon

Front 161

What is diverticulitis?

Back 161

–Inflamed/infectedand/or ruptured diverticula

can erode arteries and cause hamorrhage and can lead to faecal matter in peritoneum causing peritonitis

Front 162

how far can can the retrocaecal fossa be extended

Back 162

liver

Front 163

where is the vermiform appendix attached

Back 163

posteromedial wall of caecum below ileocaecal junction.

Front 164

why is it dangerous to use laxative in suspected appendicitis

Back 164

vigorous contraction of the gut wall often ruptures theinflamed appendix, precipitating peritonitis).

Front 165

point of maximum tenderness during appendicitis

Back 165

mc burneys point.

This lies at the junction of the lateral one-third with the medial twothirdsof a line joining the anterior superior iliac spine to the umbilicus.

Front 166

in what % of adults is the appendix retrocaecal

Back 166

65

Front 167

where does the appendix lie in 25% of people

Back 167

hangs over pelvic brim

Front 168

The colon is most easily freed from itslateral side. Why?

Back 168

because it possesses a short mesentry allowing it to move

Front 169

the ascending colon rums from------ to ------

Back 169

It runs from the right iliac fossa to the hepatic flexure underthe right lobe of the liver

Front 170

At what vertebral level is the superior mesenteric arterygiven off?

Back 170

L1

(*inferior= L3)

Front 171

Where does the superiorpancreatico-duodenal artery come from?

Back 171

gastro-duodenal artery

Front 172

From which side of the superior mesenteric artery do the following vessels arise?

• jejunal;

• ileal;

• ileocolic;

• right colic;

• middle colic

Back 172

• jejunal; left

• ileal; left

• ileocolic; right

• right colic; right

• middle colic. right

Front 173

List the components of the hindgut.

Back 173

- the distal third of the transverse colon and the splenic flexure,

-the descending colon,

-sigmoid colon and rectum.

Front 174

Which vessels contribute to the formation of the marginal artery? What does it supply?

Back 174

IMA ,Middle colic, left colic, sigmoid arteries and superior sigmoid. they sypply transverse colon

Front 175

Attempt to explain why this gradual obstruction of the IMA doesn’t impair gutfunction.

Back 175

because blood can still get to the gut from other arteries such as the colic artery and marginal arteries arising from SMA

-Aneurysm repair often involves ligation or obstruction of the inferior mesenteric artery, againusually without impairing gut function.

Front 176

the colon

Back 176

has haustra, taeniae coli,

Front 177

at what vertebra leve l does sigmoid colon continue as rectum

Back 177

S3

Front 178

at what junction are the taenia coli and appendices epiploicae are no longer present on the surface of the largeintestine.

Back 178

From the rectosigmoid junction

Front 179

What is a sigmoid volvulus? Why is it a serious condition?

Back 179

This occurs in cases of long-standing chronic constipation where patients develop a large, elongated, relatively atonic colon. a large sigmoid loop full of faeces and distended with gas twists on its mesenteric pedicle to create a closed-loop obstruction. If uncorrected, venous infarction leads to perforation and faecal peritonitis, and ischaemia

Front 180

describe course of rectum

Back 180

runs from the rectosigmoid junction to the ano-rectal junction which lies at thelevel of the pelvic floor

Front 181

How do the peritoneal attachments of the rectum differ from those of the sigmoid colon?

Back 181

upper= peritoneal

Mid: sub peritoneal

lower: retroperitoneal

Front 182

Label vessels A, B and C on the following diagram of the rectal arteries. Where does eachof these vessels originate

Back 182

a- superior rectal a. is from IMA

b- middle rectal arteries from internal iliac

c. inferior rectal arteries from internal pudendal

Front 183

What is the definition of a portal vein? Are there any other examples elsewhere in the body?

Back 183

-blood flow that bypasses the heart

-splenic portal vein, left gastric, superior rectal

Front 184

midgut drainage

Back 184

Each branch of the superior mesentericartery is accompanied by a vein. All these veins ultimately flow into the superiormesenteric vein, a large trunk which lies to the right of the artery. Superior mesenteric veinunites with the splenic vein posterior to the neck of the pancreas to form the portal vein.

Note that it is named portal vein above and superior mesenteric vein below the level of entryof the splenic vein, but the two represent a single continuous trunk. Remember that theportal vein runs in the free edge of the lesser omentum.

Front 185

where does the protal vein run

Back 185

in free edge of lesser omentum

Front 186

what drains the hindgut

Back 186

IMV

Front 187

IMV drainage

Back 187

receives tributaries identicalto the branches of the inferior mesenteric artery. The inferior mesenteric vein runssuperiorly, well to the left of the corresponding artery, and usually joins the splenic veinbehind the body of the pancreas, just before the union of the splenic vein with superiormesenteric vein.

Front 188

What is the purpose of the portal circulation?

Back 188

to supply the liver with metabolic substrates which it detoxifies before reaching systemic circulation

Front 189

where do oesophageal veins drain

Back 189

azygous vein

Front 190

Portosystemicanastomoses

Back 190

A.Betweenportal left gastric vein and systemic submucosal oesophageal veins

B.Between portal superior rectalvein and systemic inferior and middle rectal veins

C.Betweenportal paraumbilical veins and systemic epigastricveins

D.Between twigs of portal visceralveins in bare areas of secondarily retroperitoneal organs and systemicretroperitoneal veins draining posterior abdominal wall or diaphragm

Front 191

Portosystemic anastomoses, What is their clinical significance?

Back 191

they can become congested and cause portal hypertension

A.Inportal hypertension (from alcoholic liver disease) flow reverses causingenlargement of submucosal oesophageal systemic veins whichcan rupture causing lifethreatening haemorrhage

B.Normal appearance is varicose. Ifrectal mucosa prolapses, haemorrhoids result

C.Theseanastomoses are responsible for caput medusae sign in alcoholic liver diseaserelated to portal hypertension

D.If tumour or liver disease causesobstruction to flow in valveless portal vein and branches, blood can reach IVC via twigs of visceralveins at bare areas of secondarily retroperitoneal organs (including at liver)m

Front 192

Lymph drainage of the gastrointestinal tract

Back 192

From virtually the whole length of the gastrointestinal tract, the lymph vessels pass backalong the course of the arteries to lymph nodes that lie in front of the aorta at the origins ofthe coeliac, superior and inferior mesenteric arteries. These are called the coeliac, superiorand inferior mesenteric groups of lymph nodes.

Front 193

what are preaortic nodes, where do they drain?

Back 193

The coeliac, superior mesenteric and inferior mesenteric lymph nodes are also termed preaorticnodes. They drain into each other from below upwards, the coeliac group itselfdraining into the cisterna chyli.

Front 194

Which lymphatic channel originates from the cisterna chyli? Where does this channel runand where does it empty its contents?

Back 194

thoracic duct at L2

l. of head, neck, chest, upper limb and chest wall

l. internal jugular and subclavian

Front 195

What are Peyer's patches?

Back 195

aggregatedlymphoid nodules, they form an important part of the immune system by monitoring intestinal bacteria populations and preventing the growth of pathogenic bacteria in the intestines

Front 196

Nerve supply of the gastrointestinal tract

Back 196

-All parts of the gut and its derivatives are innervated by parasympathetic and sympatheticnerves.

-These fibres modify the activity of the intrinsic nerve plexuses of the gut

Front 197

In which layers of the gut wall are the intrinsic (myenteric) nerve plexuses located?

Back 197

between circular and longitudinal layers

Front 198

Most of the autonomic fibres to the gut travel via.......although the parasympathetic fibres to the hindgut (which originate fromsacral segments of the spinal cord) travel via t............

Back 198

1. the coeliac plexus, which is located aroundthe coeliac trunk

2.he inferior hypogastric (pelvic) plexus

Front 199

The coeliac plexus receives its parasympathetic input from the two vagus nerves. What is their function?

Back 199

The function of the vagus nerve is to stimulate smooth muscle contraction and glandular secretions in these organs. For example, in the stomach, the vagus nerve increases the rate of gastric emptying, and stimulates acid production. so increases peristalsis

Front 200

Where do splanchnic arise? How do they reach the abdomen?

Back 200

-arise from sympathetic trunk

-pierces through diaphragm and descends on vertebral colum

- R trunk lies posterior to inferior vena cava and L beside aorta
-each give off 5 lumbar ganglia

-give rise to lumbar splanchnic nerves which join celiac, intermesenteric, and superior hypogastric plexuses. Both sympathetic trunks continue into the pelvis anterior to the sacrum.

pelvic splanchnic nerves (s2-4_

Front 201

Where would a patient feel pain referred from

• foregut?

• midgut?

• hindgut?

Back 201

1. foregut: lower thorax + epigastric pain

2.midgut:umbilical region

3. hindgut: L+R lumbar regions , lateral and anterior thighs

Front 202

Pain from the gall bladder is sometimes referred to the shoulder. Attempt to explain this.

Back 202

due to irritation of diaphragm

Front 203

What structure is found in the free edge of the falciform ligament?

Back 203

ligamentum teres

Front 204

Locate the porta hepatis and name the structures going through it.

Back 204

-liver hium

-portal triad: proper hepatic artery, common bile duct and hepatic portal vein

Front 205

Name two other factors that will contribute to the support of the liver.

Back 205

falciform and coronary ligaments

Front 206

which lobe of the liver is larger

Back 206

right

Front 207

What is the function of the gall bladder?

Back 207

store and concentrate bile produced by the liver by absorbing salts and water

Front 208

what manufactures bile

Back 208

liver cells

Front 209

where is bile collected

Back 209

It is collected into microscopic canaliculi

Front 210

where do microscopic canaliculi drain

Back 210

left and right hepatic ducts

Front 211

what forms the common hepatic duct

Back 211

l + R hepatic ducts

Front 212

whats formed once the common hepatic duct joins the cystic duct

Back 212

common bile duct

Front 213

At this stage, remind yourself of the structures that run in the freeedge of the lesser omentum. What is their relationship one to another?

Back 213

portal triad runs in the free edge of lesser omentum and joins the liver

Front 214

Where does the common bile duct run after it leaves the edge of the lesser omentum?

Back 214

passes posterior to 1st part of duodenum and head of pancreas to hepatopancreatic ampulla of vater

Front 215

What is the hepatopancreatic ampulla (of Vater) and where is the sphincter of Oddi?

Back 215

It is formed by the union of the pancreatic duct and the common bile duct.

The ampulla is specifically located at the major duodenal papilla.

The sphincter of Oddi is asphincter muscle, a circular band of muscle at the bottom of the biliary treewhich controls the flow of pancreatic juices and bile into the second part of the duodenum.

Front 216

If a gallstone became lodged at the sphincter of Oddi, which other organ would be affected?

Back 216

the pancreas

Front 217

If a gallstone became lodged at the sphincter of Oddi, which other organ would be affected?

Back 217

the pancreas

Front 218

Why do patients with biliary obstruction appear yellow? Such patients also have pale faecesand dark urine. Why?

Back 218

bile enters systemic circulation

pale faeces are due to lack to bile in GIT

dark urine is due to bile in the kidneys filtered in renal system

Front 219

describe parts of duodenum

Back 219

•1st or superior part – L1–Onlypart that has peritonealised part•2nd or descending part –L2/3–Plicae circularesbegin–Receives common bile duct andmain pancreatic duct at hepatopancreatic ampulla (of Vater)•3rd or horizontal part – crosses L3 at midline–SMAcrosses anterior and IVC and aorta posteriorly•4th or ascending part –up to L2–Suspensory muscle (ligament of Treitz)attaches it to posterior body wall (from left crus to duodenum)•Supports duodenojejunaljunction at duodenojejunalflexure•

Front 220

Which vessels provide the blood supply to the duodenum? From which vessels do theyoriginate? Why does the arterial supply to the duodenum have this dual origin?

Back 220

gastroduodenal artery from superior and inferior pancreaticoduodenal artery.

-dual supply because arterial originates from 2 arteries which are SMA and caeliac trunk

Front 221

where does duodenum terminate

Back 221

at the duodeno-jejunal flexure.

Front 222

what mesentrey is attched to anterior surface of pancreas

Back 222

transverse mesocolon

Front 223

what is the uncinate process

Back 223

The uncinate process is the formed prolongation of the angle of junction of the lower and left lateral borders in thehead of the pancreas.

Front 224

Which vein is formed behind the neck of the pancreas?

Back 224

Portal Vein

Front 225

In what ligament does the tail of the pancreas pass to reach the spleen

Back 225

lienorenal ligament

Front 226

whats the exocrine component of the pancreas responsible for ?

Back 226

secretion of digestive enzymes into pancreatic duct

-pancreatic ducts joins common bile duct at the hepatopancreatic ampulla (of Vater)

-ampula opens into duodenum at the major duodenal papilla

Front 227

whats the endocrine component of the pancreas responisble for

Back 227

hormone secretion

Front 228

where does the accessory pancreatic duct drain and what does it drain

Back 228

The accessory pancreatic duct (drainingthe uncinate process) also opens in the duodenum, about 2cm proximal to the majorduodenal papilla

Front 229

The major duodenal papilla marks the boundary between which two subdivisions of the gut

Back 229

foregut and midgut

Front 230

What is the blood supply of the pancreas?

Back 230

-large splenic artery- branch of caeliac trunk

-branches from gastroduodenal artery + SMA

Front 231

relations of pancreas.

Back 231

Head: extends to SMA and attaches to transverse and descending colon

Neck: Ant. art adjacent to pylorus, where hepatic portal vein forms

Body: ant. part lies on floor of omental bursa (lesser sac)

Tail:ant to left kidney passes through splenorenal ligament

Front 232

What effects might you expect from a carcinoma of the head of the pancreas?

Back 232

extrahepatic obstruction of biiliary ducts, jaundice and severe back pain. ductila carcinoma

Front 233

Why is this condition often inoperable?

Back 233

has extensive drainage to innaccesible lymph node it also metastasizes to the liver. pancreatic cancer is not easily detectable.

Front 234

Why pancreatic cancer condition often inoperable?

Back 234

has extensive drainage to innaccesible lymph node it also metastasizes to the liver. pancreatic cancer is not easily detectable.

Front 235

to which ribs is the spleen related

Back 235

9th to 11th ribs

Front 236

The hilum of the spleen lies at the level of

Back 236

L1 vertebra transpyloric plane.

Front 237

where does the outer concavity of the spleen lie

Back 237

on diaphragm

Front 238

where does hilum of spleen lie

Back 238

in the angle between the stomach andthe left kidney.

Front 239

The splenic artery reaches the hilum where it divides into four or fivebranches before entering the spleen. Branches from the splenic artery supply the stomach. Which ones?

Back 239

short gastric arteries

(-left gastroduodenal artery (greater curvature)

-anastmoses with righ of the hapatic artery supplying lesser curvature )

-

Front 240

relations of spleen

Back 240

Anterior: stomach

posterior: part of diaphragm separating it from pleura + lung

Inferior: left colic flexure

medially: left kidney

Front 241

Between which vertebral levels does the abdominal aorta extend?

Back 241

T12-L3/4

Front 242

At what vertebral level does this occur?

Back 242

L4

Front 243

where does the external iliac artery pass to become the femoral artery of the lower limb

Back 243

The external iliac artery passes deep to the inguinal ligament to become thefemoral artery of the lower limb

Front 244

what is the inferior epigastric artery a branch of ?

Back 244

external iliac artery

Front 245

Identify inferior epigastric artery. What vessel does this artery anastomose with?

Back 245

superior epigastric artery

Front 246

Work outsuch a collateral route involving the inferior epigastric artery.

Back 246

The superior epigastric arteries, inferior epigastric arteries, internal thoracic arteries and left subclavian artery and right subclavian artery / brachiocephalic arecollateral vessels to the thoracic aorta and abdominal aorta.

Front 247

The internal iliac artery supplies most of the pelvic viscera, the pelvic and lower abdominalwalls and the perineum, as well as sending branches to the lower limb.Which other arteries supply structures in the pelvis?

Back 247

IMA and rectal arteries

Front 248

what does the internal iliac artery supply ?

Back 248

most of the pelvic viscera, the pelvic and lower abdominal walls and the perineum, as well as sending branches to the lower limb.

Front 249

The visceral branches of the internal iliac artery supply all of the pelvic organs except the_________

Back 249

gonads `

Front 250

branches of internal iliac (SUIM)

Back 250

Superior vesical artery (there may be several of these)

Inferior vesical artery (males)/vaginal artery (females)

Uterine artery (females)

Middle rectal artery

Front 251

what is the first branch of the internal iliac a.

Back 251

superior vesical vessels

(becomes obliterated as it heads towards anterior abdominal wall)

Front 252

what is the embryological remnant of the obliteration of superior vesicle as it goes to AAB and whats the name given to the fold of peritoneum which it raises?

Back 252

This is the remnant of the foetal umbilical artery, and the fold of peritoneumwhich it raises on its way to the umbilicus is the medial umbilical ligament.

Front 253

What forms the median and lateral umbilical ligaments?

Back 253

median- obliteraded urachus

Lateral: inferior epigastric arteries

Front 254

what does the inferior vesical artery supply in the male

Back 254

-fundus of bladder

-prostate gand, seminal vesicles and ductus vas deferens and part of the ureter

Front 255

Which branches of internal iliac artery pass out of the pelvis? Which area does each of thesebranches supply?

Back 255

1. Lateral sacral artery- exists through greater sciatic notch and supplies piriformis muscle and gluteal m.

2.Obturator a. --> supplies obturator muscle and femoral head, adductor thigh muscles

3.internal Pudendal artery: gives off rectak artery which suplies rectum and anal canal

a. perineal brancheal to prostate

b. scrotal to skin of prostate

c. deep and dorsal arteries to penis and clitoris

4.inferior gluteal --> supplies glut maximus and pelvic floor muscles

Front 256

Which branches of internal iliac artery pass out of the pelvis? Which area does each of thesebranches supply?

Back 256

1. Lateral sacral artery- exists through greater sciatic notch and supplies piriformis muscle and gluteal m.


2.Obturator a. --> supplies obturator muscle and femoral head, adductor thigh muscles

3.internal Pudendal artery: gives off rectak artery which suplies rectum and anal canal
a. perineal brancheal to prostate
b. scrotal to skin of prostate

c. deep and dorsal arteries to penis and clitoris
4.inferior gluteal --> supplies glut maximus and pelvic floor muscles

Front 257

where is the internal pudendal distributed

Back 257

perineum and external genitalia

Front 258

Why is the internal pudenal vessel called internal pudendal rather than just pudendal?

Back 258

its the termonal branch of anterior division of internal iliac artery

Front 259

Which branches of the internal pudendal artery supply the erectile tissue of the penis inmales and of the clitoris and vestibule in females?

Back 259

deep and dorsal arteries

Front 260

Most of the pelvic viscera are surrounded by networks of veins, into which they drain. Fromthese networks, venous blood passes via vessels which mirror the arteries to reach theinternal iliac veins.The gonads are an exception to this. Into which vessels do the gonadal veins drain?

Back 260

l gonad drains into renal vein

R gonad drains into IVC

Front 261

Lymph from most of the pelvic viscera drains to internal iliac lymph nodes.Where do the internal iliac nodes then drain?

Back 261

they drain to common iliac nodes → lateral aortic → then lumbar

Front 262

Into which nodes do the gonads drain?

Back 262

lateral aortic

Front 263

The nerves present in the pelvis

Back 263

the obturator nerve, the sacral plexus and its branchesand sympathetic and parasympathetic autonomic nerves.

Front 264

behind which structure in the female does the obturator nerve run

Back 264

ovary

Front 265

through which opening does the obturator nerve leave

Back 265

obturator canal and enters the thigh

Front 266

what forms the sacral plexus

Back 266

-the ventral rami of the first four sacral nerves

-It alsoreceives a contribution from the ventral rami of the fourth and fifth lumbar nerves.

Front 267

what is the pudendal nerve a branch of

Back 267

sacral plecuses

Front 268

which nerves leave the pelvis via greater sciatic foramen

Back 268

sciatic nerve and the pudendal nerve

Front 269

what nerves are responsible for genital erection

Back 269

splanchnic nerves

Front 270

what forms the pelvis splanchnic nerves

Back 270

2nd, 3rd and 4th sacral segmental nerves

Front 271

Sympathetic fibres to pelvic viscera are supplied by the........

Back 271

thoracic and lumbar splanchnicnerves, which branch off the sympathetic chain and travel down into the pelvis via a numberof midline plexuses, eventually joining the pelvic plexus

Front 272

What nerve controls the external urethral sphincter?

Back 272

-its is voluntary (skeletal muscle)

-somatic nerves from S2-Se pass through pudendal nerve

Front 273

•Describe the role of the autonomic and somatic nervous system in micturition: Activity in which nerve fibres results in contraction of the detrusor muscle in the bladder walland emptying of the bladder?

Back 273

parasympathetic fibres are motor to detrusor muscle and inhibitory to internal unrethral sphincter

Front 274

where does the piriformis m arise from and exit from

Back 274

the anterior aspect of the sacrum and passing out of thegreater sciatic foramen.

Front 275

where does the obturator internus originate from ?

Back 275

originates from thedeep surface of obturator membrane and the bone surrounding the obturator foramen. Thetendon of obturator internus passes out of the pelvic cavity via the lesser sciatic foramen

Front 276

Where is the obturator canal? What travels through it?

Back 276

-opening in fascial obturator membrane -

obturator vein, nerve and artery

Front 277

where do tendons of obturator internus insert ?

WHATS ITS ACTION ?

Back 277

INSERTION: Middle part of medial aspect of greater trochanter of femur

ACTION: laterally rotates and stabilizes hip

Front 278

PIRIFORMIS INSERTION AND ACTION

Back 278

INSERTION: Anterior part of medial aspect of greater trochanter of femur

ACTION: laterally rotates and stabilizes hip

Front 279

The pelvic floor or pelvic diaphragm is a sheet of muscle that separates what ?

Back 279

the pelvic cavityabove from the perineum below

Front 280

what muscle forms pelvic flor

Back 280

levator ani

Front 281

The two levator ani muscles are attached laterally to the pelvic wall; to which structures?

It is formed by the levator ani muscle anteriorly and thecoccygeus muscle posteriorly on each side

Back 281

-pelvic aspect of obturator membrane + pelvic bones

-rotates external thigh laterally : abducts fixed thigh at hip

Front 282

lev.ani and coccygeus converge in the midline. How are they arranged?

Back 282

-they blend together posterior to vagina and around anal aperture (both F&M)

-they come together at anococcygeal ligament and attach to coccyx

Front 283

What is the perineal body? What is its function?

Back 283

-cental tendon of perineum at mid junction of urogenital triangle and anal triangle
-maintain integrity of pelvic floor

Front 284

What are the attachments of coccygeus muscle? .

Back 284

ORIGIN:

Attaches from the spine of the ischium and the sacrospinous ligament.

INSERTION: Anococcygeal body and coccyx

ACTIONS: supports pelvic viscera

Note that coccygeus is adherent on its gluteal surface to the sacrospinous ligament

Front 285

puborectalis muscle

Back 285

-subdivision of levator ani

-forms sling around rectum pulling gut tube anteriorlyso that the anal canal descends at an angle of approximately 900 to therectum.

Front 286

Why is this arrangement of puborectalis muscle important?

Back 286

plays a role in maintaining faecal continence

Front 287

What is the PERINEUM

Back 287

- The perineum is the area inferior to the pelvic floor, bounded by the pelvic outlet and limitedinferiorly by the skin.

Front 288

in both sexes anal triangle contains....

Back 288

s the anal canal with the ischioanal fossa and itscontents on each side.

Front 289

Where does the rectum become the anal canal?

Back 289

at anorectal junction

Front 290

What is an episiotomy? When and why is it carried out?

Back 290

- a cut in peritoneum and inferoposterior vaginal wall it sis carried out during child birth when child develops foetal distress( increased heart rate before delivery or during) allows baby to come out more easily

Front 291

What consequences does this dual origin have for epithelial lining, blood supply, lymphaticdrainage and innervation of the anal canal?

Back 291

Front 292

decribe the mucose of anal canal

Back 292

arranged in longitudinal folds/anal columns
- theinferior ends are linked by ridges called anal valves

Front 293

whats the name given to ring formed by anal valves and what does it mark

Back 293

the pectinate line
marks the approximate boundary between the embryologically different regions of the anal canal

Front 294

where abouts is the internal sphincter

Back 294

The internal sphincter, around the upper two-thirdsof the canal, is the thickened lower end of the circular smooth muscle of the rectum

Front 295

decribe the external sphincter

Back 295

Theexternal sphincter of striated muscle surrounds the lower two-thirds of the canal.

-Itcomprises subcutaneous, superficial and deep parts.

-The deep part is related posteriorlyto the fibres of puborectalis (part of levator ani muscle).

Front 296

What is the nerve supply to: the internal anal sphincter?

Back 296

hypogastric and superior rectal plexuses

Front 297

What is the nerve supply to: the external anal sphincter?

Back 297

pudendal nerve (2+3) + branches from S4

Front 298

what are haemorrhoids

Back 298

piles

prolapse of rectal mucosa containing dilated veins of rectal venous plexuses

Front 299

ischial anal fossae

Back 299

-These are wedge shaped spaces in the lateral parts of the anal triangle.
-They Unite posteriorly, behind the anal canal, and anteriorly they extend into the urogenital triangle,above the urogenital diaphragm
-The ischioanal fossae are largely filled with fat and are a common site for infection, resultingin abscesses which may rupture to produce a fistula.

Front 300

Which structures form the medial, lateral and inferior borders of the ischioanal fossae

Back 300

Lateral: ischium & inferior part of obturator in ternus

M: external sphrincter & sloping superomedially

Front 301

What is a fistula?

Back 301

abnormal passage

Front 302

what travels in the ischioanal fossa

Back 302

The pudendal nerve and internal pudendal vessels travel in a fascial canal, the pudendalcanal, in the lateral wall of each ischioanal fossa as they pass anteriorly to supply thestructures of the perineum.

Front 303

By what route does the pudendal neurovascular bundle reach this pudendal canal? Whatbranches come off as the structures traverse the ischioanal fossa?

Back 303

- leaves greater sciatic foramen to travel in gluteal region and re-enter sciatic foramina.

Front 304

How and why would you carry out a pudendal nerve block?

Back 304

- anaesthetic injection into tissues surrounding pudendal nerve when nerve crosses internal aspect

For vaginal deliveries and vaginal operations. Stops sensory and motor innervation to the perineum

Nerve targeted as it enters the lesser sciatic foramen

Front 305

THE UROGENITAL TRIANGLE

Back 305

- divided into deep and superficial by urogenital diaphragm

-

Front 306

what is the urogenital diphragm

Back 306

a triangular layer of muscle and dense fascia (the fascial componentis termed the perineal membrane) that extends between the inferior ischiopubic rami and merges with the perineal body posteriorly. It is pierced by the urethra in both sexes and bythe vagina in the female.

In both sexes, muscles within the urogenital diaphragm form theexternal urethral sphincter

Front 307

What branches come off the pudendal neurovascular bundle as it travels forwards in theurogenital triangle?

Back 307

IPA: perineal arteries giving off posterior scrotal labia

dorsal arteries arteries of the penis, clitoris

IPN:deep --> superficial perineal nerve

posterior scrotal

Front 308

What is the nerve supply to the external urethral sphincter (* in diagram below)?

Back 308

pudendal nerve (S2+S3) + branch of S4

Front 309

Which vessel does external pudendal artery branch off? What does it supply?

Back 309

anterior scrotal/labia larteries supplies labia and scrotum

Front 310

MALE UROGENITAL TRIANGLE

Back 310

in the male, there is a space superficial to the perineal membrane, between it and themembranous layer of superficial fascia (Colles’ fascia), called the superficial perinealpouch

Front 311

what does the superficial perineal pouch contain ?

Back 311

testes, vas and root of penis

Front 312

Explain why rupture of the urethra in the bulb of the penis leads to swelling of the scrotum,penis and lower abdominal wall.

Back 312

urine goes in the superficial perineal pouch and passes over scrotum beneath colles' fasci --> urine escapes into deep perineal pouch -> upwards around prostate/bladder or downward into superficial perineal pouch

Front 313

Which structures do the bulb of the penis and the crura of the corpora cavernosa attach to?

Back 313

deep penile fascia

Front 314

What are the actions of bulbospongiosus and ischiocavernosus muscles? What is theirnerve supply?

Back 314

-bulbospongiosus- compresses bulb of penis + corpus spongiosum

nerve: branch of pudendal (s2-s4)

Front 315

Which arteries supply the penis?

Back 315

artery to bulb of penis, urethral artery, deep artery of penis, dorsal artery of penis

ischiovernosus artery: forces blood from cavernous spaces in crura into distal parts of corpa cavernosa

Front 316

What is the mechanism of penile erection?

Back 316

1. Upon erotic stimulation, arteriovenous anastomoses, through which blood normally bypasses the erectile tissue of corpora cavernosa, are closed.

2. Smooth muscle in the fibrous trabeculae and coiled helicine arteries relaxes, due to parasympathetic stimulation.

3.This causes the helicine arteries to straighten, dilate their lumen and allow increased blood to flow in the sinuses of the corpora cavernosa.

4. The bulbuspongiosus and ischiocavernosus muscles compress the veins that drain corpora cavernosa, thus impeding the return of blood outside the penis.

5.As a result, all three erectile bodies are engorged with blood at venous pressure causing them to become enlarged and rigid, thus causing an erection.

Front 317

What is the sensory nerve supply to the skin of the scrotum?

Back 317

anterior scrotal nerves, posterior scrotal, pudendal and posterior cutaneous

Front 318

From what is the tunica vaginalis derived? How?

Back 318

processus vaginalis, formed as peritoneum closes off during development.

Front 319

testes and development

Back 319

During development, the testis pushes its way through the anterior abdominal wall, trailing itsductus deferens. As this happens, the testis and ductus deferens acquire a succession ofcoverings derived from the layers of the abdominal wall.

Front 320

What is the cremasteric reflex?

Back 320

ascent of testis when thigh is stroked

Front 321

In addition to the ductus deferens, what other structures run in the spermatic cord?

Back 321

nerves, arteries, lymphatics + glands

Front 322

Suggest why urinary tract infections are more common in females than in males.

Back 322

shorter urethra closer to anus

Front 323

Deep to the skin and fat of each labium major lies a mass of............ which is attached to ...............

Back 323

1. erectile tissue called the bulb ofthe vestibule

2. the underlying perineal membrane.

Front 324

what do the vaginal bulbs overlie

Back 324

e the greater vestibular glands and are themselves covered with thin sheetsof muscle, the bulbospongiosus muscles.

Front 325

the vaginal vestibule bulbs join with ____________ to form glans of the clitoris

Back 325

externalopening of the urethra

Front 326

Two other masses of erectile tissue also contribute to the formation of the clitoris. Whatname is given to these masses? Which part of the clitoris do they form? How is the clitorisanchored in the perineum?

Back 326

1. 2 crura and 2 corpora carvernosa

2. root and body

3. anchored posteriorly by the corpora cavernosa embedding it in the perinium

Front 327

What is the function of the vestibular glands (also known as Bartholin’s glands)? Infection ofthese glands is not uncommon – a Bartholin’s cyst is formed.

Back 327

secrete mucus into vestibule during sexual arousal

Front 328

To which nodes does lymph from perineal structures drain?

Back 328

*superficial inguinal lymph nodes --> external iliac---> lumbar

*deep + external iliac lymph nodes

Front 329

label the female inguinal region canal

Back 329

1 Aponeurosis of external abdominaloblique muscle

5 Superficial inguinal ring with fat pad

7 Round ligament (ligamentum teres uteri)

11 Inguinal ligament

15 External pudendal artery and vein

16 Position of deep inguinal ring

17 Ilio-inguinal nerve

18 Internal abdominal oblique muscle

20 Genital branch of genitofemoral nerve

23 Sheath of round ligament(inguinal canal)

24 Transversalis fascia

Front 330

label male inguinal canal

Back 330

1 Aponeurosis of external abdominaloblique muscle

2 Internal abdominal oblique muscle(divided and reflected)

3 Transversus abdominis muscle

5 Superficial inguinal ring with fat pad

7 Round ligament (ligamentum teres uteribranch of ilio-inguinal nerve

11 Inguinal ligament

19 Pubic branch of inferior epigastricartery20 Genital branch of genitofemoral nerve

21 Fat pad of inguinal canal

22 Ilio-inguinal nerve

Front 331

1.

2.

3.

4.

5.

12.

13.

14

15

16-19

Back 331

1 Aponeurosis of external abdominal oblique muscle

2 Superficial circumflex iliac vein

3 Inguinal ligament

4 Lateral crus of inguinal ring

5 Superficial epigastric vein

12 Superficial inguinal ring

13 Spermatic cord and genital branchof genitofemoral nerve

14 Penis with dorsal nerves and deep dorsal veinof penis

15 Aponeurosis of external abdominal obliquemuscle (divided and reflected)

16 Internal abdominal oblique muscle

17 Ilio-inguinal nerve

18 Anterior cutaneous branches of iliohypogastricnerve

19 Superficial external pudendal veins

Front 332

label the abdomina wall muscles

Back 332

1 Rectus abdominis muscle2 Tendinous intersection3 Internal abdominal oblique muscle4 External abdominal oblique muscle(reflected)5 Anterior superior iliac spine6 Ilio-inguinal nerve7 Spermatic cord8 Costal margin9 Superior epigastric artery10 Thoraco-abdominal (intercostal)nerves11 Posterior layer of rectus sheath12 Transversus abdominis muscle13 Semilunar line14 Arcuate line15 Inferior epigastric artery16 Inguinal ligament

Front 333

Back 333

6 Rectus abdominis muscle

7 Tendinous intersection

8 External abdominal oblique muscle

9 Lateral femoral cutaneous nerve

10 Femoral vein

11 Great saphenous vein

12 Medial supraclavicular nerves

13 Pectoralis minor muscle (reflected)and medial pectoral nerves

14 Axillary vein

15 Long thoracic nerve and lateralthoracic artery

16 Internal thoracic artery

17 Intercostal nerves

18 Lateral cutaneous branches ofintercostal nerves

19 Superior epigastric artery

20 Thoraco-abdominal (intercostal)nerves

21 Transversus abdominis muscle

22 Posterior layer of rectus sheath

23 Inferior epigastric artery

24 Lateral femoral cutaneous nerve

25 Inguinal ligament and ilio-inguinalnerve26 Femoral nerve

27 Femoral artery

28 Spermatic cord

Front 334

Back 334

1 Costal margin

2 Rectus abdominis muscle

3 External abdominal oblique muscle(reflected)

4 Thoraco-abdominal (intercostal) nerveswith accompanying vessels

5 Internal abdominal oblique muscle

6 Arcuate line (arrow)

7 Inferior epigastric artery and vein

8 Ilio-inguinal nerve

9 Position of deep inguinal ring

10 Superficial inguinal lymph nodes

11 Great saphenous vein

12 Linea alba

13 Iliohypogastric nerve

14 Pyramidal muscle

15 Spermatic cord

16 Fundiform ligament of penis

Front 335

label kidney

Back 335

1 Esophagus2 Cardial notch3 Cardial part of stomach4 Lesser curvature of stomach5 Pyloric sphincter6 Angular notch (incisura angularis)7 Pyloric canal8 Pyloric antrum9 Fundus of stomach10 Greater curvature of stomach11 Body of stomach

Front 336

Back 336

1 Liver

2 Hepatic artery proper

3 Hepatic duct

4 Cystic duct

5 Pylorus6 Gastroduodenal artery

7 Gallbladder

8 Duodenum

9 Transverse colon (cut)

10 Ascending colon

11 Spleen

12 Cardia

13 Splenic artery

14 Common hepatic artery

15 Portal vein16 Pancreas (body)

17 Duodenojejunal flexure18 Kidney (with capsula adiposa)19 Ureter20 Superior mesenteric artery and vein21 Aorta (abdominal part)22 Common bile duct23 Lesser duodenal papilla24 Greater duodenal papilla25 Pancreatic duct

Front 337

Back 337

1 Fundus of gallbladder

2 Peritoneum (cut edges)

3 Cystic artery

4 Cystic duct

5 Right lobe of liver

6 Inferior vena cava

7 Bare area of liver

8 Notch for ligamentum teres andfalciform ligament

9 Ligamentum teres

10 Falciform ligament of liver

11 Quadrate lobe of liver

12 Common hepatic duct

13 Left lobe of liver

14 Hepatic artery proper

15 Common bile duct Portal triad

16 Portal vein

17 Caudate lobe of liver

18 Ligamentum venosum

19 Ligament of inferior vena cava

20 Appendix fibrosa (left triangularligament)

21 Coronary ligament of liver22 Hepatic veins

Front 338

si arteries

Back 338

1 Greater omentum2 Middle colic artery3 Right colic artery4 Duodenum5 Ascending colon6 Ileum7 Transverse colon8 Celiac ganglion9 Duodenojejunal flexure10 Superior mesenteric vein11 Superior mesentericartery12 Jejunum13 Jejunal arteries14 Ileal arteries

Front 339

Back 339

1 Lung
2 Liver (visceral surface)
3 Lymph node
4 Inferior vena cava
5 Ligamentum teres (reflected)
6 Right branch of hepatic artery proper
7 Diaphragm
8 Common hepatic duct (dilated)
9 Cystic duct and artery
10 Gallbladder
11 Probe in epiploic foramen
12 Right lobe of liver
13 Portal vein
14 Right gastric artery
15 Duodenum
16 Pylorus
17 Right colic flexure
18 Right gastro-omental (gastro-epiploic) artery
19 Transverse colon
20 Abdominal part of esophagus (cardiac part of stomach)
21 Fundus of stomach
22 Esophageal branches of left gastric artery
23 Lumbar part of diaphragm
24 Left gastric artery
25 Celiac trunk
26 Splenic artery
27 Pancreas
28 Common hepatic artery
29 Left gastro-omental (gastro-epiploic) artery
30 Gastroduodenal artery
31 Pyloric part of stomach
32 Greater curvature of stomach
33 Gastrocolic ligament
34 Superior pancreaticoduodenal artery
35 Short gastric arteries
36 Aorta
37 Spleen
38 Caudate lobe of liver
39 Left branch of hepatic artery proper
40 Descending part of duodenum (cut)
41 Left inferior phrenic artery
42 Suprarenal gland
43 Kidney
44 Transverse mesocolon

Front 340

Back 340

1 Lung 2 Liver (visceral surface) 3 Lymph node 4 Inferior vena cava 5 Ligamentum teres (reflected) 6 Right branch of hepatic artery proper 7 Diaphragm 8 Common hepatic duct (dilated) 9 Cystic duct and artery 10 Gallbladder 11 Probe in epiploic foramen 12 Right lobe of liver 13 Portal vein 14 Right gastric artery 15 Duodenum 16 Pylorus 17 Right colic flexure 18 Right gastro-omental (gastro-epiploic) artery 19 Transverse colon 20 Abdominal part of esophagus (cardiac part of stomach) 21 Fundus of stomach 22 Esophageal branches of left gastric artery 23 Lumbar part of diaphragm 24 Left gastric artery 25 Celiac trunk 26 Splenic artery 27 Pancreas 28 Common hepatic artery 29 Left gastro-omental (gastro-epiploic) artery 30 Gastroduodenal artery 31 Pyloric part of stomach 32 Greater curvature of stomach 33 Gastrocolic ligament 34 Superior pancreaticoduodenal artery 35 Short gastric arteries 36 Aorta 37 Spleen 38 Caudate lobe of liver 39 Left branch of hepatic artery proper 40 Descending part of duodenum (cut) 41 Left inferior phrenic artery 42 Suprarenal gland 43 Kidney 44 Transverse mesocolon

Front 341

female retroperitooneal organs

Back 341

1 Kidney2 Ureter3 Inferior vena cava
4 Abdominal aorta
5 Ovary
6 Uterine tube
7 Uterus
8 Round ligament and inguinal canal
9 Urinary bladder
10 Vagina

Front 342

label structures

Back 342

1 Diaphragm

2 Inferior vena cava

3 Suprarenal gland

4 Kidney

5 Superior mesenteric artery

6 Ureter

7 Right spermatic

Psoas majormuscle

9 Spleen

10 Cardiac part ofstomach

11 Abdominal aorta

12 Splenic artery

13 Celiac trunk andceliac ganglion

14 Renal artery and vein

15 Left spermatic vein

16 Ilio-inguinal nerve

17 Superior hypogastricplexus and ganglion

18 Left common iliacartery19 Sigmoid colon

Front 343

on which side is the SMA and what what level

Back 343

right side

Front 344

describe the branches of the SMA and what they supply

Back 344

From top to bottom gives off:

1. 1. Inferior pancreaticoduodenal a.

o Anastomoses w/ a branch of gastroduodenal a. offthe common hepatic a.

2. 2. Middle colic artery

o Anastomoses w/ l. colic a.

3. 3.R colic a

4. 4. Iliocolic a.

o Splits into superior and inferior

o Superior anastomoses w/ right colic àsupplies a. colon

o Inferior branch splits into 4 branches

1. Ilial àileum

2. Caecal àcaecum

3. Appendicular àappendix

4. Colic (ascending) àa. colon

5. 5. Jejunal and ilial vessels on the R side

o They form arcades and vasa recta

Front 345

where is the IMA given off ?

Back 345

L3 from abdominal aorta

Front 346

describe branches of IMA and what they supply

(IMA is LESS)

Back 346

3 main branches

1. L. colic artery àvascularises distal 1/3 of transverse colon and descending branch

· Anastomoses with middle colic artery

2. Sigmoidal arteries

· Form arcades supply sigmoid colon

3. Superior rectal artery

· Supplies proximal colon

· Crosses over common iliac artey to enter pelviccavity

· Divides at S3

Front 347

Caeliac trunk branches and what they supply

Back 347

- 3 main branches ( left Hand Side)

-Left gastric artery

-common hepatic

-splenic artery

Left gastroepiploic :

supplies lesser curvature of stomach ( can come off proper or common hepatic artery)

Common hepatic ( GoD PRops)

god makes pain alright

-gastroduodenal artery

- superior pancreaticoduodenal

-right gastroepiploic artey

Props- common to be properly rightcys

- common hepatic, proper hepatic, L&R hepatic and cyctic artery (from right hepatic)

Side: SPLEEN PLS

splenic artery

- pancreatic branches

-left gastro epiploic

short gastric arteries

Front 348

descrite the internal iliac artery and its anterior and posterior branches

Back 348

S: superior vesical artery (branch of umbilical 2nd branch off anterior internal iliac)

O: obturator artery (first branch, exists via obturator canal and runs along obturator m.)

IV: inferior vesical artery (vaginal in females) ( arises individually from ant trunk sometimes)- supplies bladder, ureter, and seminal vesicles and vas deferns like superior vesicle.

U: uterine artery

MR: middle rectal artery

P: pudendal (internal) artery- exists g sciatic foramen between ichiococcygeus and piriformis and descends to enter periinal region via lesser sciatic foramen

IG: inferior gluteal artery

Front 349

whiich fold overlies the inferior epigastric artery ?

Back 349

lateral umbilical fold

Front 350

branches of external iliac artery

Back 350

inferior epigastric

deep circumflex artery

Front 351

what are the anterior and posterion relations of external iliac artery ?

Back 351

-anteriorly (at origin) - gonadal vessels, genital branch of the genitofemoral nerve, deep circumflex iliac vein, round ligament

-posteriorly - iliac fascia, psoas muscle

Front 352

Back 352

1. Abdominal aorta

2. Celiac trunk

3. Left hepatic artery

4. Cystic artery

5. Proper hepatic artery

6. Right gastric artery

7. Gastroduodenal artery

8. Right gastro-omental (gastroepiploic) artery

9. Common hepatic artery

10. Left gastro-omental (gastroepiploic) artery

11. Short gastric arteries

12. Splenic artery

13. Left gastric artery

Front 353

pain from epigstric region refer to what dermatomes ?

Back 353

T5-9 or T10 spinal levels.

Front 354

laerge intestine arteries

Back 354

1. Superior mesenteric artery2. Middle colic artery3. Straight arteries (arteriae rectae)4. Marginal artery5. Right colic artery6. Ileocolic artery (Colic branch; Ileal branch)7. Appendicular artery8. Superior rectal artery9. Sigmoid arteries10. Left colic artery11. Inferior mesenteric artery12. Jejunal and ileal (intestinal) arteries

Front 355

why are anastomoses of inferior and superior MAs important ?

Back 355

If the blood flow from one bowel region is compromised, collateral flow from anastomotic branches usually can assist in supplying blood tothe compromised region.

Front 356

Back 356

1. Inferior phrenic arteries
2. Celiac trunk with common hepatic, left gastric, and splenicarteries
3. Middle suprarenal artery
4. Right renal artery
5. 1st to 4th right lumbar arteries6. Common iliac arteries
7. Internal iliac artery
8. External iliac artery
9. Inferior epigastric artery
10. Inferior mesenteric artery
11. Abdominal aorta
12. Testicular (ovarian) arteries

Front 357

at what level does Ab aorta enter abdominal cavity

Back 357

T12 and it bifurcates at L4

Front 358

Back 358

1. Inferior phrenic veins2. Inferior vena cava3. Right renal vein4. 1st to 4th right lumbar veins5. Common iliac vein6. External iliac vein7. Internal iliac vein8. Common iliac vein9. Ascending lumbar veins10. Ovarian (testicular) veins

Front 359

portal veins and anastomoses

Back 359

1. Paraumbilical Veins
2. Right gastric vein
3. Hepatic portal vein
4. Superior mesenteric vein
5. Middle colic vein6. Right colic vein
7. Ileocolic vein
8. Inferior rectal veins
9. Middle rectal veins
10. Left and right superior rectal veins
11. Left colic vein
12. Inferior mesenteric vein
13. Splenic vein
14. Left gastric vein
15. Esophageal veins

Front 360

Back 360

1. Common hepatic duct2. Cystic duct3. Superior (1st) part of duodenum
4. Hepatic ducts (Right; Left)
5. Cystic duct (Spiral fold; Smooth part)
6. Common bile duct.
7. Pancreatic duct
8. Hepatopancreatic ampulla (of Vater)

Front 361

route of bile to gallblader

Back 361

Bile leaves the liver by the right and left hepatic ducts,draining into a common hepatic duct. The latter drains via the cysticduct into the gallbladder, which concentrates and stores bile.

Front 362

Back 362

1. Coronary ligament

2. Fissure for ligamentum venosum

3. Porta hepatis

4. Gallbladder

5. Quadrate lobe

6. Bare area

7. Round ligament (ligamentum teres) of liver (obliterated umbilicalvein) forming free border of falciform ligament

8. Falciform ligament

Front 363

Back 363

1. Greater omentum (cut away)2. Transverse colon3. Omental (epiploic) appendices (fat)4. Ascending colon5. Ileal orifi ce6. Cecum7. Appendix8. Rectum9. Sigmoid mesocolon10. Sigmoid colon11. Taenia coli12. Descending colon13. Haustra14. Semilunar folds

Front 364

Back 364

1. Liver2. Lesser omentum3. Omental bursa (lesser sac)4. Transverse mesocolon5. Transverse colon6. Small intestine7. Urinary bladder8. Rectum9. Inferior (horizontal, or 3rd) part of duodenum10. Pancreas

Front 365

abdomen at T12

Back 365

1. Liver2. Falciform ligament3. Portal vein4. Inferior vena cava5. Omental bursa (lesser sac)6. Right kidney7. Abdominal aorta8. Left suprarenal (adrenal) gland9. Splenorenal ligament with splenic vessels10. Spleen11. Gastrosplenic ligament with short gastric vessels12. Stomach13. Rectus abdominis muscle (in rectus sheath)14. Lesser omentum

Front 366

what is common about right and left kidneys, suprarenal(adrenal) glands, aorta, and inferior vena cava.

Back 366

they are retroperitoneal organs

Front 367

abdomen at L2

Back 367

1. Ileum2. Ascending colon3. Right paracolic gutter4. Psoas major muscle5. Inferior vena cava6. Abdominal aorta7. Intervertebral disc (between L2 and L3 vertebral bodies)8. Descending colon9. Loops of jejunum10. Internal oblique muscle11. Greater omentum12. Omental appendices (fat)13. Linea alba14. Transverse colon

Front 368

bones and ligaments of pelvis

Back 368

1. Iliolumbar ligament2. Supraspinous ligament3. Posterior sacroiliac ligaments4. Greater sciatic foramen5. Sacrotuberous ligament6. Anterior longitudinal ligament7. Posterior sacrococcygeal ligaments8. Iliac fossa9. Iliac crest10. Anterior sacroiliac ligament11. Anterior superior iliac spine12. Sacrospinous ligament13. Lesser sciatic foramen14. Pectin pubis15. Pubic tubercle16. Pubic symphysis

Front 369

what is this muscle what forms it

Back 369

-Levator ani (Puborectalis; Pubococcygeus; Iliococcygeus)

-innervation: s3-s4

-supports pelvic floor
It helps maintainthe integrity of the uterus and vagina, as well as support therectum and assist in defecation by straightening the anorectaljunction in both sexes.

Front 370

Back 370

1. (Ischio-)coccygeus

Innervation: Ventral rami of S4 and S5.

Front 371

Back 371

1. Ischiocavernosus muscle
2. Bulbospongiosus muscle
3. Perineal membrane
4. Superfi cial transverse perineal muscle
5. Perineal body
6. Parts of external anal sphincter muscle
7. Levator ani muscle (Pubococcygeus; Puborectalis; Iliococcygeus)
8. Gluteus maximus muscle

Front 372

Male perineum

Back 372

1. Bulbospongiosus muscle
2. Ischiocavernosus muscle
3. Perineal membrane
4. Perineal body
5. Superfi cial transverse perineal
6. Parts of external anal sphincter muscle
7. Levator ani muscle (Pubococcygeus; Puborectalis; Iliococcygeus)
8. Gluteus maximus muscle

Front 373

The muscles of the male perineum are skeletal in natureand are innervated by what nerve aand its branches

Back 373

the pudendal nerve and its branches.

Front 374

female nerves

Back 374

1. Sympathetic trunk and L2 ganglion2. Lumbar splanchnic nerves3. Sacral splanchnic nerves (sympathetic)4. Pudendal nerve5. Pelvic splanchnic nerves (parasympathetic)6. Inferior hypogastric (pelvic) plexus7. Superior hypogastric plexus

Front 375

male nerves

Back 375

1. Perineal nerves (Superfi cial; Deep)2. Inferior anal (rectal) nerves3. Pudendal nerve4. Perineal nerve5. Superfi cial and deep branches of perineal nerve6. Dorsal nerve of penis (continuation of pudendal nerve supplyingmuscles on superior aspect of perineal membrane)

Front 376

female pelvic arteries

Back 376

1. Superior gluteal artery
2. Obturator artery
3. Umbilical artery (patent part)
4. Internal pudendal artery
5. Inferior gluteal artery
6. Uterine artery
7. Inferior rectal artery
8. Superior vesical arteries
9. Umbilical artery (occluded part)
10. Internal iliac artery
11. Right common iliac artery

Front 377

pelvic drainage

Back 377

Veins draining the corresponding structures are similarly identifi edand named. These veins drain into the internal iliac vein and into thecommon iliac vein on each side.

Front 378

branches of IPA in perineum

Back 378

In the perineum, the internal pudendal artery gives off the inferiorrectal artery and the perineal artery. Branches of the perineal arterysupply the bulb of the vestibule and clitoris.

Front 379

female arteries

Back 379

1. Posterior labial artery
2. Perineal artery
3. Perineal artery
4. Internal pudendal artery in pudendal (Alcock’s) canal
5. Inferior rectal artery
6. Artery to bulb of vestibule
7. Dorsal artery of clitoris

All branches of internal pudendal artery

Front 380

Arteries and Veins of Male Pelvis

Back 380

1. Right obturator vessels
2. Superior vesical artery
3. Umbilical artery (occluded part)
4. Superfi cial dorsal vein of penis
5. Pampiniform (venous) plexus
6. Inferior rectal artery
7. Internal pudendal artery
8. Inferior gluteal artery
9. Superior gluteal artery
10. Internal iliac vessels

Front 381

where does the cremastor muscle arise from?

Back 381

middle of inguinal ligament

Front 382

Back 382

1. Testicular vessels and genital branch of the genitofemoral nerve
2. Inferior epigastric vessels
3. Medial umbilical ligament (occluded part of umbilical artery)
4. Rectus abdominis muscle
5. Median umbilical ligament (urachus)
6. Superfi cial inguinal rings
7. Intercrural fibers
8. Inguinal ligament (Poupart’s)
9. Cremasteric muscle
10. Spermatic cord
11. Internal spermatic fascia (from transversalis fascia at deepinguinal ring)
12. External abdominal oblique muscle
13. Internal abdominal oblique muscle
14. Transversus abdominis muscle
15. Transversalis fascia
16. Peritoneum

Front 383

male perineum

Back 383

1. Inferior rectal artery
2. Internal pudendal vessels and pudendal nerve (cut) in pudendal(Alcock’s) canal (opened up)
3. Internal pudendal artery passes superior to perineal membrane
4. Perineal artery and vein
5. Posterior scrotal arteries

Front 384

Back 384

1. Glans penis
2. Deep (Buck’s) fascia of penis
3. Ischiocavernosus muscle (cut away)
4. Superfi cial transverse perineal muscle
5. Perineal body
6. External anal sphincter muscle7. Levator ani muscle and inferior fascia of pelvic diaphragmroofi ng ischioanal fossa
8. Gluteus maximus muscle
9. Anus

Back 385

1. Glans penis
2. Deep (Buck’s) fascia of penis
3. Ischiocavernosus muscle (cut away)
4. Superfi cial transverse perineal muscle
5. Perineal body
6. External anal sphincter muscle7. Levator ani muscle and inferior fascia of pelvic diaphragmroofi ng ischioanal fossa
8. Gluteus maximus muscle
9. Anus

Front 386

Back 386

1. External oblique muscle2. Internal oblique muscle
3. Transversus abdominis muscle
4. Transversalis fascia
5. Extraperitoneal fascia
6. Parietal peritoneum
7. Superficial fascia—membranous layer (Scarpa’s fascia)
8. Superficial fascia—fatty layer (Camper’s fascia)
9. Skin

Front 387

Back 387

1. Linea alba
2. Rectus abdominis muscle
3. External oblique muscle
4. Internal oblique muscle
5. Transversus abdominis muscle
6. Transversalis fascia
7. Parietal peritoneum

Front 388

Back 388

1. Ductus deferens
2. Testicular artery and pampiniform plexus of veins
3. Parietal peritoneum
4. Extraperitoneal fascia
5. Transversalis fascia6. External oblique aponeurosis
7. Internal oblique muscle
8. Transversus abdominis muscle
9. Deep inguinal ring
10. Superficial inguinal ring
11. Internal spermatic fascia
12. Cremasteric fascia
13. External spermatic fascia
14. Conjoint tendon
15. Inferior epigastric vessels

Front 389

Back 389

1. Celiac trunk2. Left gastric artery3. Esophageal artery4. Splenic artery5. Short gastric arteries6. Spleen7. Left gastro-omental artery8. Stomach9. Right gastro-omental artery10. Transverse colon11. Marginal artery12. Inferior mesenteric artery13. Left colic artery14. Descending colon15. Sigmoid arteries16. Sigmoid colon17. Superior rectal artery18. Rectum19. Appendix20. Appendicular artery21. Ascending colon22. Ileocolic artery23. Marginal artery24. Right colic artery25. Middle colic artery26. Abdominal aorta27. Inferior pancreaticoduodenalartery28. Anterior pancreaticoduodenalartery29. Superior mesenteric artery30. Posterior pancreaticoduodenalartery31. Duodenum32. Supraduodenal artery33. Gastroduodenal artery34. Right gastric artery35. Common hepatic artery36. Hepatic artery proper37. Cystic artery38. Right hepatic artery39. Left hepatic artery40. Marginal artery

Front 390

Back 390

1. Left gastric vein2. Splenic vein3. Inferior mesenteric vein4. Superior mesenteric vein5. Portal vein

Front 391

Back 391

1. Anterior trunk of internal iliac2. Inferior gluteal3. Middle rectal4. Internal pudendal5. Inferior vesicle6. Superior vesicle7. Obturator8. Umbilical

Front 392

Back 392

1. Urogenital triangle2. Anal triangle3. Perineal membrane4. Opening for urethra in perineal membrane5. Opening for vagina in perineal membrane6. Levator ani muscle7. Bulb of vestibule8. Corpus cavernosum of clitoris9. Glans clitoris

Front 393

Back 393

1. Urogenital triangle2. Anal triangle3. Perineal membrane4. External urethral orifice5. Bulb of penis6. Corpus cavernosum of penis7. Glans penis8. Levator ani muscle9. Sacrotuberous ligament

Front 394

Back 394

1. Anal column2. Anal valve3. External anal sphincter4. White line5. Pectinate line6. Anal sinus

Front 395

Back 395

1. Pelvic bone2. Sacrum3. Coccyx4. Anterior superior iliac spine5. Pubic tubercle6. Pubic symphysis7. Ischial tuberosity8. Obturator foramen9. Ischial spine10. Pelvic inlet

Front 396

Back 396

3. Sacrotuberous ligament4. Lesser sciatic foramen5. Pubic symphysis6. Coccyx7. Inferior pubic ramus

Front 397

Ilioinguinal Nerves pass through the inguinal canal and Innervate what?

Back 397

Labia and scrotum (anterior labial in females)

Front 398

Inferior border of rectus sheath posteriorly

Back 398

Arcuate line

Front 399

Conjoint tendon

Back 399

Attachment of internal oblique and transversus abdominis

Front 400

Iliohypogastruic nerves provides sensory innervation to what?

Back 400

Skin in Lower abdomen upper hip and thigh

Front 401

Genitofemoral nerve provides innervation to what?

Back 401

Anterior scrotum, labia majora and upper medial thigh

Front 402

Brances of the sacral plexuses

Back 402

Interested in getting lunch on friday

iliohypogastric and ilioinguinal from 1

genital femoral from 1/2

lateral femoral from 2/3

Obturator & femoral 2-4

Front 403

internal pudendal arteries branches

(I Pee Pee But Don’t Dump!)

Back 403

Inferior rectal

Perineal

Posterior scrotal (or labial)

Bulb

Deep artery

Dorsal artery