RCA: Abdomen 1

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  1. Give a general description of the abdomen and its margin, and visceral contents;
    • Margin: The inferior thoracic aperture forms the superior opening to the abdomen, and is closed by the diaphragm.
    • - Inferiorly, the deep abdominal wall is continuous with the pelvic wall at the pelvic inlet.
    • - Superficially, the inferior limit of the abdominal wall is the superior margin of the lower limb.
    • Viscera: Abdominal viscera are either suspended in the peritoneal cavity by mesenteries or positioned between the cavity and the musculoskeletal wall. Abdominal viscera include;
    • - major elements of the gastrointestinal system-the caudal end of the esophagus, stomach, small and large intestines, liver, pancreas, and gallbladder;
    • - the spleen;
    • - components of the urinary system-kidneys and ureters;
    • - the suprarenal glands; and
    • - major neurovascular structures.
    • Functions: House organs for protection and assisting breathing through dia and abdo muscles
    • Linea alba
    • Superficial fascia; 2 layers
    • - Camper’s fascia; fatty layer
    • - Scarpa's fascia; membranous layer
    • Median and paramedian areas
    • Rectus abdominis muscle; single muscular layer
    • Parietal peritonium
    • Transversalis fascia; overlying the extraperitoneal fat
    • 3 muscular layers; superficial to deep
    • - External oblique muscle
    • - Internal oblique muscle
    • - Transversus abdominis muscle
  2. What are the components of the abdominal wall?
    • Skin
    • Subcutaneous tissue
    • - Fatty (Camper's fascia)
    • - Membraneous (Scarpa's fascia
    • Deep fascia
    • External oblique
    • Internal oblique
    • Transverse abdominis
    • Transversalis fascia
    • Extraperitoneal fat
    • Parietal peritoneum
  3. The structures formed by the aponeuroses of the oblique and transverse abdominal muscles
    • Rectus sheath: (pictured is posterior) Is formed by the aponeuroses of external, internal and transverse abdominis muscles;
    • - it contains the rectus abdominis muscle;
    • - Has anterior and posterior walls at its upper ¾ and the anterior wall only at lower 1/4
    • - Is supplied by; Inf + superior Epigastric vessels, and Intercostal nerves.
    • Arcuate line: is the inferior free border of the posterior wall of the rectus sheath.
    • Linea alba: Is formed by the entwined aponeuroses of external oblique, internal oblique and transverse abdominis muscles at the midline;
    • - Has few blood and nerve supply.
    • Inguinal ligament: Is the inferior free border of the aponeurosis of the external oblique abdominis muscle,
    • - Is medially continuous with the lacular and pectineal ligaments, and forms the inferior wall of the inguinal canal.
  4. What is the inguinal canal?
    • Is a slit-like passage between the layers of the anterior abdominal wall. Is just above and parallel to the lower half of the inguinal ligament;
    • - Attaches to the; Anterior superior iliac spine and the pubic tubercle
    • Has two openings
    • - Superficial ring: aponeurosis of the external oblique muscle
    • - Deep ring: transversalis fascia
    • Transmits the spermatic cord in men and the round ligament in women.
  5. Describe the anatomy of the contents of the inguinal ligament
    - for males and females separately
    • Round ligament: extends forward through the inguinal canal for anterior support
    • Spermatic cord: Consists of structures passing between the abdominopelvic cavities and the testis.
    • Has three coverings;
    • - external spermatic fascia
    • - cremasteric fascia
    • - internal spermatic fascia
    • Three major constituents;
    • - Ductus deferens
    • - Testicular artery and veins (pampiniform plexus)
    • - Remnants of processus vaginalis; a vestige of development/ testicular descent
  6. Why does one feel pain in the gut when kicked in the nuts?
    • Post-ganglionic sympathetic fibres reach the testis by traveling with the testicular arteries from the pre-aortic plexus
    • Sensory nerves share the same pathway and have their cell bodies in the dorsal root ganglia of T10
    • - hence testicular pain can be referred to the umbilical area = T10 dermatomes
  7. Label this, and outline the areas where hernias can occur
    • Inferior epigastric artery and vein: the epigastric vessels go under the unpictured ureters = water under the bridge
    • Deep ring: with testicular blood vessels and ductus deferens entering
    • - left ascends way high and enters the renal vein, right into the IVC
    • Inguinal ligament
    • Ductus deferens
    • Inguinal triangle
    • External iliac artery and vein
    • Not as important structure;
    • - 1 = Rectus abdominis muscle
    • - 2 = Superficial inguinal ring
    • - 3 = Lacunar ligament
    • #
    • Firstly, is the hernia above or below the inguinal ligament? If above = inguinal, if below = femoral
    • - Inguinal is more common in general, and in men
    • Femoral hernia is when an abdominal organ protrudes through the femoral ring into the femoral canal
    • - femoral is more common in females because wider pelvis = wider femoral canal
    • An inguinal hernia is when the peritoneal sac (i.e. a piece of gut) enters the inguinal canal either:
    • - indirectly: lateral and through the deep inguinal ring; or
    • - directly: medial and through the posterior wall of the inguinal canal.
  8. Describe the relationship between the abdominal, peritoneal cavities and visceral organs. What features does the peritoneum form?
    • All the abdominal organs are in the abdominal cavity, but
    • The peritoneal cavity DOES NOT contain any organs
    • Peritoneum: is made of a layer of mesothelium overlying loose connective tissue.
    • - It secretes and absorbs fluid. It is important in allowing the spread of disease (infection, cancer).
    • - Peritoneum is divided into the parietal peritoneum and visceral peritoneum.
    • #
    • Peritoneum forms
    • - Mesentery: suspends viscera from body wall and conveys blood vessels, etc.; e.g. transverse mesocolon (mesentery of the transverse
    • colon)
    • - Omentum: peritoneal folds associated with stomach; e.g. greater and lesser omentum
    • - Ligaments: peritoneal folds, e.g. hepatoduodenal ligament, falciform ligament;
    • - Folds: reflection of the peritoeum covering vessels or duct, e.g. median, medial and lateral unbilical folds.
  9. What are the main divisions of the peritoneum. How do these compartments communicate?
    • Lesser sac / omental bursa: is an extensive sac-like cavity that lies posterior to the stomach, lesser omentum, and adjacent structures. The omental bursa has;
    • - superior recess, limited superiorly by the diaphragm and the posterior layers of the coronary ligament of the liver,
    • - inferior recess between the superior parts of the layers of the greater omentum.
    • The omental bursa communicates with the greater sac through the omental foramen (epiploic foramen), an opening situated posterior to the free edge of the lesser omentum (hepatoduodenal ligament).
    • #
    • The transverse mesocolon (mesentery of the transverse colon) divides the abdominal cavity into;
    • - supracolic compartment: containing the stomach, liver, and spleen
    • - infracolic compartment: containing the small intestine and ascending and descending colon
    • The infracolic compartment lies posterior to the greater omentum and is divided into right and left infracolic spaces by the mesentery of the small intestine
    • Free communication occurs between the supracolic and the infracolic compartments through the paracolic gutters, the grooves between the lateral aspect of the ascending or descending colon and the posterolateral abdominal wall.
  10. Name the branches of the abdominal aorta
    • Inferior phrenic
    • Suprarenal
    • Renal (L and R)
    • Lumbar
    • Median sacral
    • Celiac
    • Superior mesenteric
    • Subcostal
    • Left gonadal (testicular or ovarian)
    • Inferior mesenteric
  11. Branches of the abdominal aorta: Sort them into the 4 planes and give general functions
    • Anterior midline: unpaired visceral vessels for the digestive tract. Branches include;
    • - Celiac T12
    • - Superior mesenteric L1
    • - Inferior mesenteric L3
    • Lateral: Paired visceral arteries for urogenital and endocrine organs
    • - Suprarenal L1
    • - Renal L1
    • - Gonadal (testicular or ovarian) L2
    • Posterolateral: Paired parietal (segmental), to supply the diaphragm; body wall
    • - Subcostal L2
    • - Inferior phrenic T12
    • - Lumbar L1–L4
    • Celiac trunk/artery: give rise to;
    • - Left gastric artery
    • - Splenic artery
    • - (Common) Hepatic artery
    • Hepatic portal vein
    • (Proper) hepatic artery
    • Common bile duct
    • Right margin of the lesser omentum
    • Superior mesenteric artery: from abdominal aorta at L1 level. It branches off into;
    • - Jejunal artery
    • - Ileal artery
    • - Ileocolic artery
    • - Right colic artery
    • - Middle colic artery (cut)
    • Inferior mesenteric artery
    • Left colic artery
    • Sigmoid arteries
    • Superior rectal artery
    • #
    • Marginal artery: anastomosis between the middle and left colic arteries
    • Esophageal artery
    • Azygos vein; where the oesophageal veins drain to
    • Thoracic aorta
    • Oesophageal venous plexus, some of which also drains into the;
    • - Left gastric vein (where the oesophageal branches are indicated in purple)
    • Splenic vein; accompanies splenic artery
    • - inferior mesenteric vein (black arrow) usually joins with splenic vein
    • Superior mesenteric veins; which accompany (and drain) branches of superior mesenteric artery
    • Hepatic portal vein runs in lesser omentum to hilum of liver and divides into right and left branches. It is formed by the joining of the;
    • - Splenic vein
    • - Superior mesenteric vein
    • Middle colic vein
    • Right colic vein
    • Ileocolic vein
    • Inferior mesenteric vein; made from the left colic, sigmoid arteries, and superior rectal artery joins.
    • Falciform ligament and Umbillicus/ belly button
    • #
    • The numbers demarcate other areas of portacaval anastomoses. This is why we see systemic signs when we have portal hypertension
    • 1: Esophageal
    • 2: Para-umbilical
    • 3: Rectal
    • 4: Retroperitoneal; heaps of them
    • Clinical importance: when flow of blood in portal vein is obstructed (e.g. cirrhosis of liver) and provides a route for blood to be carried to the heart
    • Hilum; or "Porta hepatis". Structures include the "portal triad"; (enclosed by the lesser omentum)
    • - Hepatic portal vein and artery proper
    • - Common hepatic and bile duct
    • Fissures for ligamentum teres
    • Fissures for ligamentum venosum
    • - These ligaments separate the L and R lobes of the liver on the visceral surface
    • Caudate (anterior) and Quadrate (posterior) lobes: Visible from the visceral surface.
    • Inferior vena cava:* hepatic veins which take blood from the liver drain it to the IVC
    • Round ligament of the liver
    • Coronary ligament; there is an upper and lower layer
    • Attachment of lesser omentum; hepatic artery, bile duct, portal vein in its right free margin
  12. What are the borders of the epiploic foramen?
    • Anteriorly the PV (hepatoduodenal lig.)
    • Posteriorly the IVC
    • Superiorly the liver
    • Inferiorly the duodenum
  13. Identify the organ and give its function
    • Gallbladder comprised of the;
    • - Fundus
    • - Body
    • - Infundibulum
    • - Neck of the gallbladder
    • Function: main function is to store and concentrate bile
    • Cystic duct;
    • - Spiral fold; which acts as the valve
    • - Smooth part
    • Left and right hepatic ducts
    • - draining into the common hepatic duct, before the common bile duct
    • - later meeting with the pancreatic duct
    • #sorry for reusing colours#
    • Pictured is the " Hepatopancreatic ampulla " formed by joining of;
    • - Common bile duct
    • - Pancreatic duct
    • Duodenum
    • Choledochal sphincter; i.e. Sphincter of (common) bile duct
    • Hepatopancreatic ampulla sphincter
    • Major duodenal papilla; the orifice where the duct contents are discharged into the duodenum
  14. Describe the blood supply of the gallbladder and surrounding structures
    • Cystic artery: normally arising from the right hepatobillary artery supplies the gallbladder
    • Hepatobillary triangle: formed by cystic duct, common hepatic duct, and inferior surface of the liver
    • Cholecystectomy: is a common operation and is undertaken for patients who get gallbladder pain or other biliary tract symptoms from gallstones
    • - the surgeon must ligate and divide the cystic artery
    • and cystic duct. Variations in the origin and course of the cystic artery and duct are common. Most errors in gallbladder surgery result from failure to appreciate these anatomical variations.
    • - The hepatobiliary triangle serves as a useful reference point for defining the anatomy before ligating any structures.
  15. Label the parts of this organs and give its function
    • (Common) bile duct
    • Pancreatic duct; may be a sphincter (pancreatic sphincter) around terminal part
    • Accessory pancreatic duct
    • #
    • Function: of the pancreas can be divided into Digestive (exocrine) or systemic (endocrine)
    • Digestive (Exocrine): secretes enzymes that are conveyed via a duct system to 2nd part of duodenum;
    • – via. the main pancreatic duct (enters at major duodenal papilla) or the accessory pancreatic duct (enters at minor duodenal papilla)
    • Systemic (Endocrine): secretes the hormones insulin and glucagon
  16. Annotate this diagram of the gallbladder and bile ducts to state the clinical condition caused by a gallstone impacted in (a) the neck of the gallbladder, (b) the common bile duct and (c) the hepatopancreatic ampulla.
    • Acute cholecystitis: inflammation of the gallbladder causing upper abdominal pain
    • Obstructive jaundice: and abdominal pain
    • Acute pancreatitis: inflammation of the pancreas from obstruction of the pancreatic duct causing severe abdominal pain (and obstructive jaundice)

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RCA: Abdomen 1
2015-10-03 01:08:52

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