S2M2 anat

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sweetlu
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138443
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S2M2 anat
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2012-03-05 12:17:10
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S2M2 anat
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S2M2 anat
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  1. transpyloric plane
    • - passes thru tip of 9th cc
    • - transects pylorus when patient is recumbant
    • - often used with interspinous plane
    • - GB(fundus), origin of SMA, pylorus of stomach, duodenojejunal junction, pancreas(neck), kidneys(hilum) are all located on this plane
  2. Interspinous plane
    • - passes horizontally across both ASIS
    • - pairs with transpyloric plane
  3. Subcostal plane
    • - passes through lower border of 10th cc
    • - at level of L3
    • - pairs with intertubercular plane
  4. Intertubercular plane
    • - passes horizontally thru tubercles of iliac crest (~4-5 cm behind ASIS)
    • - transects body of L5
    • -pairs with subcostal plane
  5. 7 layers of abdominal wall
    • 1- skin
    • 2- superficial fascia (s- campers fat, d- scarpas)
    • 3- deep fascia
    • 4- muscular layer
    • 5- tranversalis fascia
    • 6- extraperitoneal fat
    • 7- parietal peritoneum
  6. external oblique
    • - outermost muscle
    • - hand in pocket fiber orientation
    • - T7-T11 spinal nerves and subcostal nerve
  7. internal oblique
    • - middle muscle
    • - hand on chest fiber orientation
    • - T6-L1
  8. conjoint tendon
    • - inferior aponeurotic fibers of internal oblique and transversus abdominis join to form this tendon
    • - inserts into pubic tubercle
  9. transversus abdominis
    • - deep muscle
    • - horizontal fiber orientation
    • - T6-L1
  10. rectus abdominis
    • - ab muscles
    • - T6-L1
  11. semilunar line
    • -a curved line along the lateral border of each rectus abdominis muscle and rectus shealth, marking the meeting of the aponeuroses of the internal oblique and transverse abdominal muscles(conjoint tendon)
    • - money maker line
    • - weak point-> spigelian hernia
  12. rectus sheath
    • -tough fibrous sheath a top rectus abdominis made of aponeurosis of obliques and transversus abdominis
    • - semilunar line is lateral border
    • - contents: rectus abdominis, pyramidalis, sup and inf epigastric vessels and lymphatics, ventral primary rami of T7-T12
  13. arcuate line
    • - aka linea semicircularis
    • - demarcates lower limit of posterior layer of rectus sheath
  14. vascular supply to anterior abdominal wall
    - internal thoracic-> superior epigastric and musculophrenic

    - external iliac-> inferior epigastric and deep circumflex iliac

    - femoral-> superficial epigastric and superficial circumflex iliac
  15. retroperitoneal organs
    • - SADPUCKER
    • -suprarenal glands, aorta/IVC, duodenum(2,3,4), pancreas(except tail), ureters, colon(A & D), kidneys, esophagus, rectum
    • -1,1 2,2 1,2 1,1,1
  16. epiploic foramen
    • - communication between greater and lesses sac
    • - aka foramen of Winslow
  17. Ligament of Treitz
    • -supports flexure of 4th part of duodenum attach to pyloric antrum
    • - anatomical cut off for GI bleeding
    • - below=lower GI= red blood stools
    • - above= upper GI= black blood stools
  18. splenic ligaments
    -lienogastric(gastrosplenic)- contains short gastric vessels and L gastroepiploic vessels

    - lienorenal(splenorenal)- contains splenic vessels and tail of pancreas
  19. liver biopsy
    • -performed at right 10th intercostal space in midaxillary line-
    • - have pt hold there breath in full expiration to lessen possiblilty of damaging lung and contaminating pleural cavity
  20. portal vein formation
    • - forms behind the NECK of the pancreas by the anastamosis of the SPLENIC v and SMv
    • (IMv joins splenic v)
  21. Portal-systemic anasomeses
    • 1- b/t esophageal veins (esophageal varisces)
    • 2- b/t rectal veins (hemorrhoids, rectal bleeding)
    • 3- paraumbilical veins (and small epigastric veins of anterior abdominal wall)
    • 4- twings of colic veins (portal & retroperitoneal veins)
  22. gall bladder location
    • - lies in gallbladder fossa of liver
    • - body in contact with TC and first part of duodenum (possible locations for stone jumping)
    • - fundus lies at tip of 9th ICC
  23. triangle of Calot
    • - cystohepatic triangle
    • - sup- liver, lat- cytic duct, med- common hepatic duct
    • - cystic artery(from right hepatic artery) runs thru center of triangle
  24. nervous supply to pancreas
    • - thoracic splanchnic nerves (T5-T9)
    • - carry pain sensation to DRG
  25. PNS innervation to the hindgut
    • - pelvic splanchnic (S2-S4)
    • - NOT vagus
  26. pain localization of GI
    - foregut- epigastric region

    - midgut- periumbilical

    - hindgut- pelvic region
  27. Jejunum
    • - LUQ
    • - deep red
    • - long vasa recta and few large arcades
    • - large, tall and tightly packed circular folds
  28. Ileum
    • - RLQ
    • - pale pink
    • - short vasa recta and many short arcades
    • - low and sparse circular folds
    • - many peyers patches
    • - abundant mesenteric fat
  29. anal canal innervation
    • -S4 (via pudendal n. to inferior rectal n)
    • - nerve to levator ani (S3-S4)
  30. neurovasculature of anus above pectinate line
    • - SMA
    • - portal vein
    • - internal iliac LN
    • - visceral innervation
  31. neurovasculature of anus below pectinate line
    • - internal iliac artery
    • - caval venous plexus
    • - superficial inguinal LN
    • - pudendal nerve (somatic)
  32. nerve supply of SI
    -SNS- greater splanchnic nerve (T5-T10) which synapses at celiac and SMA ganglion, accompany SMA periarterial branches

    - PNS- vagus posterior trunk
  33. nerve supply to LI (midgut)
    - SNS- lesser(T10-T11) and least(T12) splanchnic nerves, synapse at SMA ganglion

    PNS- vagus postrior trunk
  34. nerve supply to LI (hindgut)
    - SNS- Lumbar splanchnic nerves (L1-L2/3) thru inferior mesenteric plexus

    -PNS- pelvic splanchnic (S2-S4) thru inferior hypogastric plexus
  35. nerve supply to rectum
    - SNS- lumbar splanchnic nerves

    -PNS- pelvic splanchnic nerves (S2-S4)
  36. caput medussa
    • - seen in portal HTN
    • - extreme dilation of thoracic epigastric and superficial epigastric veins

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