Flashcards
march 16th monday
Cards in this deck (122)
- 1muscles of anterolateral abdominal wallexternal oblique
interanl oblique
transversus abdominus
rectus abdominus - 2external obliq originexternal surfaces of 5th-12th ribs
- 3anterior rectus sheath made fromexternal and internal oblique msucle
- 4posterior rectus sheath made fromtransversus abdominus muscle and internak oblique muscle
- 5Summary of abdominal wall muscles and membranes, from outside in:1. Skin
2. Fatty superficial fascia
(Camper’s fascia)
3. Membranous deep fascia
(Scarpa’s fascia)
4. Investing fascia over muscles
5. External oblique M
6. Internal oblique M
7. Transversus abdominis M
8. Transversalis fascia
(endoabdominal fascia)
9. Extraperitoneal fat
10. Parietal peritoneum - 6transversus abdominus m and rectus abdominus relationshipabove arcuate line, the transversus abdominus gives the posterior rectus sheath
below arcuate line, the transversus abdominus aponeurosis wraps above the rectus abdominus - 7all 3 of the muscles aponuerosis: Eo, IO, TAgo in front of rectus abdominus (as anterior sheath) and insert on linea alba
- 8so there is an anterior rectus sheath that is formed from the 2-3 muscles but the posterior rectus sheathwhich is behind rectus abdominus, becomes the tranversalis fasica and parietal peritoneum
- 9above arcuate line the muscles from front to backExternal oblique
Transversus thorasus
Internal oblique - 10below arcuate linethe 3 muscles aponeurosis give the anterior and posterior rectus sheaths
- 11umbbilicus is supplied byT10 dermatome
- 12topopgraph of msucles and neurobundleEO
IO
neurovascular bundle
Transversus abdominus - 13blood supply to abdomen superioryinternal throracic artery gives
musculuphrenic artery and superior spigastric artery - 14blood supply to abdomen laterallylower intercostal artery
subcostal artery
circumflex iliac artery - 15blood supply to abdomen inferiorlysuperficial epigastric artery
inferior epigastric artery - 16what arterys anastomos at posterior rectus sheaththe superior and inferior spigastric artery
- 17veins drain where in chest area?axillary and femoral v
- 18lymphatic drainage?inferiorly lymph goes to superficial inguinal nodes (below transumbilical plane)
superiorly it drains medially to parasternal lymph nodes and laterally to axillary lymoh nodes. (medial and lateral seperated by midclavicular plane) - 19umbilicus and gut relationshippast umbilicus there is no ventral mesentary and only a dorsal mesentery
- 20foregut hasdorsal and ventral mesentery
- 21midgut and hindgut hasdorsal mesentary
- 22Iliopubic tractinner and inferior part of inguinal
ligament (Poupart’s ligament)
wrapped around the bottom
of the inguinal canal - 23iliopectineal archcomes off the iliopubic tract to sperate the inginal canal into the lacuna musculorum and lacuna vasrum (retroingional space)
- 24lacuna vasorum is made of what ligamentspectineal ligament
(Cooper’s ligament)
lacunar ligament
(Gimbernat’s ligament) - 25lacunar ligamentfan of fibers from inguinal ligament to
superior pubis
function is to smoothen sharp corner to rpotect vessels coming thru lacuna vasorum - 26what goes thru lacuna vasorumexternal illiac artery and vein (becomes the femoral A and V once it passes the ingional ligament)
femoral ring (entrance to femoral canal) - 27purpose of femoral ringpassage way for lymohatics vessels
provides support to femoral vein (right below it) so it doesnt collapse when sitting - 28ventral mesentery becomes what?falciform ligament
- 29obliterated umbilical V becomes whatligamentum teres
- 30obliterated urachus becomes whatmediaN umbilical lig
- 31obliterated umbilical A becomes whatmediaL umbilical lig.
- 32unpaired/single structuresfalciform ligament
ligamentum teres
umbilicus
mediaN umbilical lig - 33paired struturesmediaL umbilical lig
lateral umbilical fold
(inferior epigastric A&V) - 34interfoveolar ligament (Hesselbach’s ligament)continuous with transversus abdominis M and attaches to
- 35deep inguinal ringnext to interfoveolar lig
lets female and male anatomy go thru - 36deep inguinal ring for males has whatductus deferens
testicular A&V
(internal spermatic vessels) - 37gubernaculuma band of connective tissue that pulls the
gonads down into the pelvis (both sexes) and eventually out of the body cavity into the scrotum (males only).
pulls down the layers of admonical cavity with the scortum - 38The extension of the peritoneal cavity is theprocessus vaginalis, and the body wall muscles and membranes become the layers of the spermatic cord in males
- 39IO and TA fuse to from back wall of ingional canal atconjoint tendon or inguinal
falx, formed by the fused aponeuroses of
the internal oblique M and transversus
adominis M.
The conjoint tendon forms
the posterior wall of the inguinal canal,
and it is strong enough to be sutured
through in a hernia repair. - 40Hesselbach’s triangle (medial inguinal fossa)- lies posterior to superficial inguinal
ring, medial to inferior epigastric vessels - 41INdirect inguinal herniaPeritoneal contents pass through INguinal canal, including both deep and superficial rings.
inteestines might go thru canal to scortum
Ten times more common in males than in females, because of larger inguinal canal. - 42Direct inguinal herniaPeritoneal contents push through tear in
abdominal wall, most commonly emerging
through superficial inguinal ring
Accounts for ~25% of inguinal hernias, mostly in males older than 40 - 43Direct inguinal hernia causesNecessarily involves tearing or severely stretching the conjoint tendon (internal
oblique and transversus abdominis aponeuroses). May also involve external oblique aponeurosis if hernia proceeds through supravesical fossa. - 44Femoral herniaPeritoneal contents pass through femoral ring, emerge inferior to inguinal ligament.
May not involve any tearing of tissues.
More common in females than in males, because of wider bone structure of female pelvis. (Butinguinal hernias are still the most common hernia type in both sexes.) - 45Triangles of Pain and Doomare areas in which surgeons must exercise special care during laparoscopic hernia repairs. Sewing a mesh into the patient’s femoral nerve can cause severe pain and loss of function, and hitting the iliac vessels can cause a life-threatening internal bleed (femoral A and vein affected)
- 46Celiac Artery & Foregut distributiondistal Oesophagus
Stomach
½ duodenum (small bowel part 1 of 3)
Liver
Gall bladder
Pancreas
Spleen - 47The GI systemCommon theme of the GI system from the oesophagus down through the large bowel are the layers that make up the wall
1. Mucuos
2. Submucous
3. Muscular - 48muscular layer has 3 typescircular
longitudinal
oblique
purpose is to help with peristalsis and shuttling - 49OesphagusPosterior to Trachea
10” in length
Upper 1/3 striated muscle
Middle 1/3 mixed
Lower 1/3 smooth muscle
Upper & lower oesophageal sphincters (on the ends) - 50Oesphagus has a unique anastamosesdistally between Azygous v. (systemic), and left Gastric (portal).
- 51Lower Oesophageal Sphincter – LES/LOS pathologiesGERD
Hiatus hernia
Oesaphageal varices - 52GERDsquamous – columnar transition epithelium not protected from stomach pH
- 53Barrett’s OesophagitisAcid exposure many (5+) years
Metaplasia: mucosa of lower Oesophagus changes: squamous → gastric-type columnar epithelium - 54Hiatus HerniaBased on breakdown or lax of lower es spinchter or pressure can allow contents of abdomen to come up and cause hernia
- 55types of herniatraumatic
congenital
Bochdalek found posterolaterally
Morgagni found retrosternally - 56Oesphageal Varices can be helped bySengstanken–Blakemore
Tube – 3 way catherter tube
2 balloons
1 aspiration - 57StomachForm & position in living, unlike the flaccid bag seen in cadaver
In living when not distended stomach is contracted and its position varies with posture and with the degree of distension of the intestines
Erect posture with small amount of fluid , its form is J-shaped
Sac is closed off -
proximally from oesophagus by cardiac sphincter distally from duodenum by pyloric sphincter - 58antatomy of stomach1. Cardia
2. Pylorus
3. Fundus - 59fundushas air bubble there constantly in healthy individula so used as a landmark
if you dont see air bubble there means there is a hole/perforation - 60stomach arteriesRt & Lt gastric arts run along lesser curvature
Rt & Lt gastro-omental along greater curvature (gastroepiploic)
Short gastrics from splenic art to fundus - 61Most common cause of projectile vomiting in infantPyloric
sphincte - 62greater omentuma fold of peritoneum that contains a variable amount of fat. (It also contains blood vessels and nerves which are not seen here). It extends from the greater curvature of the stomach to nearby structures.
Three parts are recognized: gastrophrenic lig. (to diaphragm), gastrosplenic lig. (to spleen), and gastrocolic lig. (to transverse colon). - 63The gastrocolic lig. hangs like an apron over not only the transverse colon but also coils of small intestine..
- 64Stomach nervesParasympathetics
Lt vagus to anterior surface- LA
Rt vagus to posterior surface- RP
Sympathetics – T5-9
coeliac plexus
all Extrinsic Innervation - 65Peptic ulcer can refer togastric or duodenal regions
Peptic ulcers occur most commonly in the first part of the duodenum (duodenal ulcers), called the duodenal bulb. - 66Gastric ulcers refers tostomach, Duodenal ulcers-duodenum
- 67Transpyloric Planein forgut region or L1
- 68L1 hasCoeliac Trunk - upper L1
SMA – lower L1
Gall Bladder
Pancreas
Spleen
Duodenum
Pylorus (of stomach) - 69duodenum has 4 partssuperior/cap/bulb
descensing
inferior
ascending - 70superior part is whereduodenal ulcers can happen
- 71Duodenum artery supplySuperior pancreaticoduodenal - coeliac
Inferior pancreaticoduodenal - SMA - 72DuodenumDuodenum - 25cm long
Horse shoe or C shaped
Divided into 4 parts
Surrounding head of the pancreas
Retroperitoneal except for the 1st part - 731st part duod1st - 5cm long,
superior (duodenal cap, ulcers) - 742nd duod8cm long, descending vertical portion, contains junction of the foregut and midgut, where the bile duct and main pancreatic duct share a common opening called the greater or major duodenal papilla guarded by the sphincter of Oddi
accessory pancreatic duct opens into the duodenum a little above the papilla - 75SpleenAlthough not a derivative of the foregut
Size of the cupped hand
Lies under the lt 9,10,11 ribs - 76spleen part 2Has the gastrosplenic ligament passing from it to the greater curvature of the stomach (carrying the short gastric arteries)
Has the lienorenal ligament passing to the posterior abdominal wall carrying the splenic vessels and tail of the pancreas - 77Spleen artery and venous supplyArterial supply - splenic artery
Venous drainage - splenic vein which is joined by the superior mesenteric vein to form the portal vein - 78PancreasEndocrine and exocrine gland
Lies retroperitoneally at the L1 level
Has a head, uncinate process, neck, body and tail - 79pancreas lies acrossaorta with superior mesenteric artery coming out from its inferior border
- 80part 2Main duct extends transversely and opens into 2nd part of duodenum in common with the bile duct
The common part is dilated (ampulla of Vater) and surrounded by a sphincter (of Oddi) - 81LiverLargest gland in the body
Upper right abdominal cavity immediately below diaphragm…myth!!!
Norm is to be in both upper Rt & Lt quadrants - 82Falciform ligamentattaches at diaphragm and separates right and left liver and gives off Ligamentum teres hepatis or left umbilical vein if theres still lumen
- 83portal triad of liver hasbile/hepatic duct
portal vein
hepatic artery - 84liver ligaments5 in number
4 are composed of peritoneum - 85the 4Falciform
Triangular ligaments
Coronary ligaments
Ligament teres – round ligament - 86Falciformattached to diaphragm and anterior abdominal wall as far as the umbilicus
Behind to anterior surface of liver
Inferior free edge encloses – The ligamentum teres –Lt umbilical vein…if obliterated becomes round ligament. - 87Triangular ligamentsRight and Left
Extend from the sides of the diaphragm to the posterior border of the liver. - 88Coronary ligamentsContinuous with the Rt triangular ligament and attaches the upper part of the inferior surface of the Rt lobe of the liver to the diaphragm
- 89Ligament teresAn obliterated Left Umbilical vein and contained within posterior or free edge of falciform ligament.
- 90liver fissuresLongitudinal fissure
Divides the organ descriptively into Rt and Lt lobes
Is separated into 2 parts by its union with the porta hepatis - 91Right & Left lobes of liver seperated from each other byfissure for ligamentum teres on inferior surface and posteriorly by the fissure for the ligamentum venosum.
- 92right lobe of liverlarger
Contains the porta hepatis and fissure for the IVC
Subdivided into 3
Quadrate – bounded by the fissure for lig teres
Porta hepatis
Fossa for Gall Bladder - 93Quadrate lobe and most of Caudate lobe belong functionally toleft half of the liver
- 94liver artery systemHepatic artery from coeliac trunk enters porta hepatis and divides into 2 branches for the Rt & Lt lobes
The Rt branch runs behind the cystic duct and gives off the cystic artery to the gall bladder
Subsequent branches accompany the branches of the portal vein. - 95liver vein systemPortal Vein
Behind the hepatic artery and bile duct, ascends between the layers of the lesser omentum, in front of the opening of the lesser sac, to the porta hepatis - 96part 2Portal Vein and Hepatic artery break up into interlobular vessels from which blood passes into the sinusoids
The blood is then collected by the intralobular veins, which are tributaries of the hepatic veins, collecting blood from the liver. - 97Gastroduodenal artery is important is becus lot of duodenal ulcers can go thru here and cause black stool.
- 98The hepatic veins pass out of the liver in the depths of the fissure for the IVC and immediately join that vessel There are 3– Right, Middle, Left
- 99liver ductsright and left lobes form a right and left hepatic duct which join to form the common hepatic duct
- 100The cystic duct from the gall bladder joinsthe common hepatic duct to form the common bile duct
- 101Morrisons PouchWhere fluid in the abdomen is most likely to collect, due to its position
- 102gallbladder location9th coastal cartilage at midclavicular line
- 103GallbladderA conical bag placed in a fossa on the inferior surface of the Right lobe of the liver.
Its surfaces are invested by peritoneum reflected from the adjacent surface of the liver.
CONCENTRATES bile - 104gallbladder artery supply***cystic artery from Right hepatic artery
- 105Gall Stones- may be asymptomatic
[common in 4F’s - fat overweight, fertile, female, forty-fifty];
can cause colic or acute cholecystitis - 106Biliary colicusually caused by spasm of the smooth muscle of the gall bladder in an attempt to expel the gall stones
- 107Acute cholecystitispain in right upper quadrant ---> may cause sub diaphragmatic parietal peritoneum irritation, which is supplied by the phrenic nerve [referred pain ---> right shoulder]
Visceral pain fibers---> greater splanchnic nerve - 108Biliary SystemRight & left hepatic ducts form the common hepatic duct; joined by the cystic duct to form the common bile duct
- 109BD passes posterior to the 2nd part of duodenum, joins the pancreatic duct to open into the major duodenal papilla.
- 110Triangle of Calotknow as the hepatocystic triangle. It is bounded to the right by the cystic duct; to the left by the common hepatic duct and above by the liver.
It is very important to identify the triangle identifying the cystic artery found within it - 111Murphy’s Signmid-clavicular line – 9cc ito find gallbladder
breath in and you compress
pt will feel pain which will show postive murphys sign and show inflammed gallbladder - 112Early Gut Tube FormationUnder normal circumstances, the gut epithelial cells of the endoderm (yellow in diagram) multiply until they completely occlude lumen.
- 113Under normal circumstances, small vacuoles form as the gut tube expands. These cavities fuse together until the gut eventually forms a tube with a single lumen.
- 114Abnormal recannalization of gut tube.In some cases, one point will have too few vacules in it, and in one or two locations can develop only a narrow lumen (a stenosis; e.g., pyloric stenosis).
On rare occasion, one spot may not have any such vacuoles and consequently no lumen will form in that spot, creating an atresia. Example, pyloric atresia (which can be in one limited spot or over a broad area). - 115Recannalization errorscysts and duplications
- 116Oropharyngeal plateopens up and becomes the stomach
- 117Omphaloenteric (Vitelline) Ductconnects to yolk sac before the 6th week; after that, the yolk sac detaches.
- 118Pyloric stenosisNarrowing of the pyloric valve; sometimes associated with muscular hypertrophy, other times to developmental malfunction and failure of it to expand enough.
Chyme can not get through valve, or at least passes through very slowly. - 119Esophageal atresiaresults in immediate spit-up of first meal; not terribly violent but accompanied by lots of coughing; no bile present.
- 120Pyloric stenosisAfter a while, manifests in projectile vomiting of feedings; no bile present
- 121Duodenal stenosis/atresiaAfter meal is over, find vomiting (not excessively violent) with bile present;
usually in 3rd or 4th part of duodenum, so bile duct is proximal to stenosis. - 122Adult mesenteries derived from the ventral mesogastriuimTriangular ligament of the liver
Falciform ligament
Lesser Omentum
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- Flashcards on march 16th monday, created by Shylla T on 16/03/2020.
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