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Anatomy of Abdomen
Soft Tissue Anatomy of the Abdomen-WVSOM Class of 2012
| Question | Answer |
|---|---|
| what is the potential space between visceral and parietal peritoneum? | peritoneal cavity |
| what fluid can exist in the peritoneal cavity? | ascites |
| cavity that would exist if all viscera were removed from the abdomen? | abdominal space |
| what fascia comprise the abdominal space? | transversalis and inferior phrenic |
| an organ entirely or almost entirely surrounded by peritoneum and is suspended by mesentery? | peritoneal or intraperitoneal organ |
| organs in this category have no free mesentery and have little mobility; only partially covered by peritoneum? | retroperitoneal organ |
| double layer of peritoneum that connects viscus to body wall? | mesentery |
| double layer of peritoneum that links viscus to body wall or to another organ? | peritoneal ligament |
| cutaneous layers of abdomen are innervated by what nerves? | lateral and anterior cutaneous nerves |
| where to lateral and cutaneous nerves of the abdomen originate? | thoracic region |
| first lumbar contribution of lateral and anterior cutaneous nerves happens where? which nerves are involved? | inguinal canal; iliohypogastric and ilioinguinal nerves |
| what veins exist in fascia near the inguinal canaL? | thoraco-epigastric veins |
| when the IVC is compromised, what venous system can provide collateral circulation? | thoraco-epigastric veins |
| thoraco-epigastric veins communicate with the portal systen where? | umbilicus |
| in cases of portal blockage, thoraco-epigastric veins can become dilated; what is this termed? | caput medusa |
| camper's fascia is consistend with what other fascia? | superficial fascia of thorax and thigh |
| scarpa's fascia blends with what superiorly and inferiorly? | superiorly: aponeurosis of external abdominal oblique; inferiorly: fascia lata 3cm distal to inguinal ligament |
| between what layers will urine be found in cases of urethral rupture? | scarpa's fascia and abdominal wall |
| where does external abdominal oblique arise from superiorly and inferiorly? | superiorly: from costal cartilage of lower 8 ribs; inferiorly: lateral margin of thoraco-lumbar fascia |
| what two places will the external abdominal oblique attach to? | linea alba and inguinal ligament |
| inguinal ligament is portion of external abdominal oblique that is found between what two bony landmarks? | ASIS and pubis |
| what is the sharp, medial margin of femoral ring, medial to lymphatics of thigh? | lacunar ligament |
| medial end of inguinal ligament attaches where? | superior pubic ramus |
| fibers of the lacunar ligament continue along pubic ramus and are called what? | pectineal ligament |
| spermatic cord exits from abdominal wall where? | medial end of inguinal ligament |
| what is the gap in the aponeurosis of the external oblique near the medial end of the inguinal ligament? what nerve emerges from here? | superficial inguinal ring; ilioinginal nerve |
| superficial inguinal ring is bounded superiorly by what? inferiorly by what? | medial crus; lateral crus |
| what passes between the medial and lateral crura, reinforcing the superolateral portion of superficial ring? | intercrural fibers |
| what two things are attached to the posterior body wall at the end of the 2nd month of development? | testis and mesonephros |
| what is the condensation of mesenchyme that extends from caudal pole of testis to inguinal region? | gubernaculum testis |
| testes will descend along what structure? | gubernaculum |
| the peritoneum evaginates into abdominal wall along course of gubernaculum into scrotal swellings forming what? | processes vaginalis |
| in females, descent of ovary into labium does not occur. what happens to gubernaculum? | it becomes the ligamentum teres uteri |
| what forms the inferior portion of the inguinal canal? | inguinal ligament |
| what layer splits to form the cremaster muscle and cremasteric fascia of spermatic cord? | internal abdominal oblique |
| conjoint tendon is formed from what two aponeuroses? | internal abdominal oblique and transversus abdominis |
| what forms the posterior wall of the inguinal canal? | inguinal falx (conjoint tendon) |
| where does the inguinal falx attach? | between pubic crest and pectineal line |
| inguinal falx reinforces what? how? | superficial inguinal ring from behind |
| deep inguinal ring is reinforced by what? | external abdominal oblique |
| contraction of what two muscles will reduce potential for hernia by compressing spermatic cord against inguinal ligament? | internal abdominal oblique and transversus abdominis |
| what artery reaches deep surface of rectus abdominis at the arcuate line? | inferior epigastric artery |
| what forms the inguinal triangle? | lateral border:inferior epigastric a.; inferior border: inguinal ligament; medial border: rectus abdominis muscle |
| what passes across the inguinal triangle? where does it attach? | conjoint tendon; attaches to pubic crest and pectin pubis |
| define direct inguinal hernia? indirect? | direct is when gut is pushed directly through the superficial ring; indirect is when it goes through entire inguinal canal |
| cremaster and fascia are derived from what abdominal layer? | internal abdominal oblique |
| internal spermatic fascia corresponds to what abdominal layer? | transversalis fascia |
| what artery and vein pass in the spermatic cord? | testicular |
| what structure serves as a countercurrent heat exchange mechanism to lower blood temperature to testes? | pampiniform plexus |
| what nerve is located at the deep inguinal ring? | genitofemoral nerve |
| what nerve passes through inguinal canal, supplying scrotal sckin through anterior scrotal nerves? | genital branch of genitofemoral nerve |
| femoral branch of genitofemoral nerve exits pelvis along with what artery? what does it supply? | external iliac artery; skin on medial thigh |
| what nerve passes through the superficial inguinal ring and supplies skin of anterior superior scrotum through anterior scrotal nerves? | iliolinguinal nerve |
| in testicular cancer, metastasis is to which nodes first? | para-aortic lymph nodes |
| tunica vaginalis has what two layers? | parietal and visceral layers |
| what is the duct system of the testis? | epididymis |
| what is the visceral layer that covers the connective tissue capsule of the testis? | tunica albuginea |
| 3 parts of epididymis? | head, body, and tail |
| tail of epididymis becomes what structure? | ductus deferens |
| laterally, epididymis is separated from the testis by what? | sinus epididymis |
| the round ligament of the uterus connects with what structure internally? | ovarian ligament |
| what does the genital branch of the genitofemoral nerve supply in females? | labia majora |
| what are the origins of the internal abdominal oblique? | posterior layer of thoracolumbar fascia, iliac crest, and lateral 2/3 of inguinal ligament |
| cranial fibers of internal abdominal obliques insert where? caudal? | costal margin and linea alba; linea alba and pecten pubis |
| transversus abdominis originates where? | costal margin, thoracolumbar fascia, iliac crest, and lateral 2/3 of inguinal ligament |
| direction of cranial fibers of transversus abdominis? caudal fibers? | transverse to abdomen; parallel to internal abdominal oblique |
| insertion of superior and inferior fibers of transversus abdominis? | superior: linea alba; inferior: linea alba, forms conjoint tendon, inserts on pecten pubis |
| origin of rectus abdominis muscle? | pubic symphysis and crest |
| insertion of rectus abdominis muscle? | costal cartilage of 5-7 ribs and xyphoid process |
| what biomechanics can be seen in the abdominal muscles when twisting? | right external abdominal oblique with left internal abdominal oblique will twist to the left |
| what arteries are on the deep surface of inferior and superior rectus abdominis muscles? what do these form from that is superior? | inferior and superior epigastric arteries; internal thoracic arteries |
| arcuate line also known as what? | linea semicircularis |
| round ligament of liver is remnant of what structure? | umbilical vein |
| falciform ligament is remnant of what structure? | ventral mesentery |
| falciform ligament and round ligament of the liver run from where to where? | liver to umbilicus |
| a patent round ligament of the liver can be used for what? | injection site |
| median umbilical fold is formed from what structure? where is it found? | urachus; between umbilicus and bladder |
| medial umbilical fold is formed from what structure? where is it found? | umbilical arteries; between umbilicus and common iliac arteries |
| lateral umbilical fold is formed from what structure? | inferior epigastric vessels passing from external iliac vessels to rectus abdominis muscle |
| urachus once formed connection between what two structures? | bladder and allantois |
| what is the most anterior structure of the peritoneal cavity? | greater omentum |
| what 4 organs are in the epigastric region? | liver, gallbladder, stomach, transverse colon |
| hypochondriac regions are lateral to what region? | epigastric region |
| liver margins ventrally? | 6th costal cartilage on left to 10th rib on right |
| how can liver hemorrhage be controlled? | pinching hepatoduodenal ligament of lesser omentum |
| left lobe of liver contacts cardiac stomach where? | left midclavicular line |
| what two structures meet up superiorly to liver? | falciform and coronary ligaments |
| what forms the bare area of the liver? | right portion of coronary ligament meets up with right triangular ligament; large separation leaves superior surface without peritoneum |
| what is the lesser omentum? | mesenteric connection between liver and stomach |
| what lies in the lesser omentum? | common hepatic duct, hepatic artery proper, and portal vein |
| what are the 3 borders of the quadrate lobe of liver? | gallbladder, round ligament, and lesser omentum |
| hepatoduodenal ligament is what exactly? what is within it? | lesser omentum presents a free margin on the right; common bile duct, hepatic artery proper, and portal vein |
| opening deep to the hepatoduodenal ligament is what? what does this opening lead to? where exactly does this lie? | omental foramen; omental bursa (lesser sac); space between stomach and pancreas |
| in hollow viscera, what does fundus refer to? | portion furthest from entrance of the organ |
| hepatogastric ligament runs between what structures? | lesser curvature of the stomach and the liver |
| greater omentum is made up of how many layers of peritoneum? | 4 |
| very short portion between stomach and colon is what? this is actually just part of what? | gastrocolic ligament; greater omentum |
| posterior gastric ulcer will cause stomach contents to enter what structure? eventually it will irritate where? referred pain to where? | lesser sac; underside of diphragm; left shoulder pain |
| left colic flexure is what relation to spleen? | inferior |
| gastrosplenic ligament lies between where and where? | greater curvature of stomach and lower pole of spleen |
| what vessels travel within the gastrosplenic ligament? | short gastric arteries |
| second part of duodenum's relationship to the transverse colon? | transverse colon is anterior to second part of duodenum |
| foregut develops into what structures? | esophagus, trachea, lung buds, stomach, and duodenum (up to the bile duct) |
| proximal duodenum gives rise to what structures embryonically? | liver, biliary system, and pancreas |
| how do the left and right vagal trunks become anterior and posterior vagal trunks in adult? | rotation so that left stomach becomes anterior, right stomach becomes posterior |
| pancreas originally developed as what? | dorsal and ventral pancreatic bud |
| longitudinal columns of muscle on external surface of colon? | tenia coli |
| sacculations of the colon are: | haustra |
| small pouches of fat-filled peritoneum hanging from surface of colon? | omental appendges |
| tenia coli meet up where? | vermiform appendix |
| appendix sits in what recess? | retrocecal recess |
| appendix is suspended by what? | mesoappendix (mesentery of ileum) |
| ascending colon is fixed to the posterior wall, making it what? | retroperitoneal |
| transverse colon is what kind of peritoneal organ? | intraperitoneal |
| what connects the colon to the diaphragm? where is this at ? | phrenicocolic ligament; inferior to spleen at left colic flexure |
| descending colon is what kind of peritoneal organ? | retroperitoneal |
| transverse colon mobile or not? | mobile |
| portion of small intestine that connects to cecum? what is name of juncture? | ileum; ileocecal junction |
| ileum vs. jejunum? which has long vasa recta? | jejunum |
| point where mesentery meets posterior wall? | root of mesentery |
| what is the course of the third part of the duodenum? | crosses midline inferior to superior mesenteric artery in root of mesentery, can be palpated through peritoneum |
| as duodenum emerges from retroperitoneal location, it becomes what? what is this called? | jejunum; duodeno-jejunal flexure |
| what is the structure that suspends the duodeno-jejunal junction? | suspensory ligament of the duodenum |
| majority of adult gut tube derived from what? what organs are included? | midgut; most of duodenum, small intestine, appendix, cecum, colon up to 2/3 of transverse portion |
| what happens to small intestine during development? | it is herniated out through umbilicus, then retracted and rotated 270 degrees around the superior mesenteric artery |
| what happens to the ascending colon during development? | falls back on posterior wall, loses free mesentery and becomes retroperitoneal |
| what forms the boundary of the greater and lesser sacs? | attachment of transverse mesocolon to posterior wall |
| what suspends the sigmoid colon? | sigmoid mesocolon |
| where does sigmoid colon become rectum? | at the pelvic inlet |
| what organs arise from the hindgut? | 1/3 of transverse colon, sigmoid colon, rectum, and superior portion of anal canal |
| what is the inferior portion of anal canal formed from? | ectoderm |
| what innervates inferior portion of anal canal? | internal pudendal nerve |
| where is the pyloric sphincter palpated? | 6-7 cm superior to umbilicus |
| where is sphincter of oddi palpated? | 5-6 cm superior and right of umbilicus |
| where is duodeno-jejunal juncture palpated? | 5-6 cm superior and to left of umbilicus |
| where is ileocecal valve palpated? | 2-3 cm inferior to mcburney's point |
| where is mcburney's point? | 1-2 inches superomedially to ASIS |
| relationship of common bile duct, hepatic artery proper, and portal vein? | duct is to right of artery; duct and artery are anterior to vein |
| cystic artery usually arises from what vessel? | right hepatic artery |
| celiac trunk conveys what nerves to the organs it supplies with blood? what nerves travel along with these? | postganglionic sympathetic fibers from greater splanchnic nerves; preganglionic parasympathetic fibers to the stomach |
| what nerves are found on either side of the celiac trunk? what is this all called? | celiac ganglia; celiac plexus |
| what nerve trunk meets up with the celiac plexus and is distributed with it? where is thie located? | posterior vagal trunk; gastro-esophageal junction |
| what trunk does not enter the celiac plexus but instead runs to the liver and stomach? where does it travel? | anterior vagal trunk; travels along lesser curvature of stomach |
| esophageal branches originate from what vessel? where? | left gastric artery; near gastro-esophageal junction |
| what vessel drains the lesser curvature of the stomach and the inferior portion of esophagus? | left gastric (coronary)vein |
| esophageal branches of left gastric veins connect to what other esophageal branches? why are these important? | azygous-hemiazygous system; when portal vein is blocked, these are used as a shunt and can become enlarged and burst |
| anterior and posterior superior pancreatico-duodenal artery anastomose with arteries from what? | superior mesenteric artery |
| in general, what does the superior mesenteric artery supply? | intestine from duodenum to left colic flexure |
| superior mesenteric ganglia make up what? | superior mesenteric plexus |
| how do nerves run to the superior mesenteric ganglia? | receive preganglionic fibers from the lesser splanchnic nerves and distribute postganglionic fibers along superior mesenteric artery and inferiorly along aorta |
| in addition to receiving preganglionic lesser splanchnic nerves, the superior mesenteric plexus also receives fibers from where? | lumbar splanchnic nerves |
| first branch of the superior mesenteric artery is usually what? | inferior pancratico-duodenal artery |
| describe artery flow to jejunum and ileum? | jejunal arteries->arcades->vasa recta |
| what arteries from the superior mesenteric artery supply the proximal colon? | ileocolic and right colic arteries |
| what are the 4 branches of the ileocolic artery? | anterior and posterior cecal branches, appendicular, and ileal branches (direct to ileum, no arcades) |
| through what structure does the middle colic artery travel? | transverse mesocolon |
| inferior mesenteric artery supplies what structures in general? what is the embryological portion this refers to? | left colic flexure to rectum; hind gut |
| left colic artery supplies what structure? | descending colon |
| the marginal artery is most likely to be compromised at what portions? | left colic flexure and cecum |
| the further distally on the small intestine, what two things occur? | number of arcades increase, vasa recta are shorter |
| superior mesenteric vein drains what structures? | distal duodenum, jejunum, ileum, ascending colon, transverse colon |
| inferior mesenteric vein drains what structures? | descending and sigmoid colons and superior rectum |
| inferior mesenteric vein empties into either of which two veins? | superior mesenteric or splenic veins |
| portal vein is formed at what point? | splenic and superior mesenteric veins join together |
| portal vein branches into right and left portal veins at what point? | porta hepatis |
| the liver drains through what veins? these enter what vessel? where? | right and left hepatic veins; IVC; as it passes through the thoracic diaphragm |
| what are the 4 places that portal and systemic venous systems communicate? | gastric and esophageal veins; umbilical and epigastric veins; superior rectal and middle rectal veins; between veins draining a viscus lying against a body wall and the veins of the body wall |