Gross 3- test 2

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bbeckers88
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Gross 3- test 2
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2011-05-19 22:32:32
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Abdomen
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cards for the second test of gross anatomy 3
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  1. Abdominal Cavity
    • between thoracic diaphragm and pelvic inlet
    • lined by peritoneum (parietal and visceral with the peritoneal cavity between)
    • viscera include digestive organs, spleen, kidneys, and ureters
  2. Abdominopelvic cavity
    • between thoracic diaphragm and pelvic diaphragm
    • separated into abdominal and pelvic cavitys by a plane thru the superior pelvic aperature
  3. Anterolateral abdominal wall
    • inferior to ribs 7-10 costal cartilages and xiphoid
    • superior to inguinal ligament and pelvic bones
  4. superficial fascia later of anterolateral abdominal wall
    • superficial fatty layer (camper's fascia)
    • superficial fascia just below dermis
    • equal to hypodermis
    • deep membranous layer (scarpa's fascia)
    • thin layer of dense irregular CT
    • separated from deep fascia by a layer of loose CT for separate movements of the two layers
  5. deep fascia of anterolateral abdominal wall
    • investing fascia
    • dense irregular CT surrounding abdominal muscles
    • equal to epimysium
  6. Endoabdominal fascia
    • loose CT between muscles and parietal peritoneum
    • provides a potential surgical dissection plane
  7. liposuction
    removal of unwanted fat from superficial fatty layer
  8. which layer of fascia is sutured during surgeries
    deep membranous (scarpa's) too add strength
  9. External oblique muscle
    • most superficial, fibers oriented inferoanteriorly
    • O: ribs 5-12
    • I: linea alba, pubic tubercle, anterior 1/2 of iliac crest
    • N: T6-T11 thoracoabdominal N and Subcostal N
    • A: compress abdominal viscera, flex and rotate trunk
    • Aponeurosis: begins at Linea Semilunaris, decussates at linea alba. inferior margin thickens into inguinal ligament
  10. inguinal lig
    • thickening of inferior external oblique aponerosis
    • extends from ASIS to pubic tubercle
    • attachement for fascia lata
  11. Internal oblique muscle
    • intermediate layer, fibers fan out anteromedially
    • O: thoracolumbar fascia, anterior 2/3 of iliac crest and inguinal lig
    • I: ribs 10-12, linea alba, and pectin pubis
    • N: T6-T11 Thoracoabdominal N and Subcostal N
    • A: compress abdominal viscera, flex and rotate trunk
    • Aponeurosis: begins at linea semilunaris, join with fibers of transversus abdominis to form conjoint tendon
  12. Conjoint tendon
    • attaches to pubic crest and pectin pubis
    • fibers of transversus abdominis and internal oblique aponeurosis
  13. Transversus abdominis muscle
    • innermost layer, fibers run transversomedially
    • O: thoracolumbar fascia, costal cartilages 7-12, iliac crest and inguinal lig
    • I: linea alba, pubic crest, pectin pubis via conjoint tendon
    • N: T6-T11 Thoracoabdominal N and Subcostal N
    • A: compress and support abdominal viscera
    • apponeurosis: starts at linea semilunaris, forms conjoint tendon
  14. Rectus abdominis muscle
    • vertical muscle in anterior wall
    • O: puubic symphysis and pubic crest
    • I: xiphoid process and costal cartilages 5-7
    • N: T6-T11 Thoracoabdominal N and Subcostal N
    • A: flex trunk, compress abdominal viscera
    • Attached to anterior rectus sheath by 3 tendinous intersections
  15. Pyramidalis Muscle
    • small, triangular, overlapping inferior portion of Rectus Abdominis muscle
    • between pubis and linea alba
    • A: tense linea alba
  16. Rectus sheath and landmarks
    • surrounds rectus abdominis muscle
    • linea alba: midline
    • umbilical ring: defect, all aponeuroses fuse here
    • linea semilunaris: lateral edges
    • arcuate line: structural change in posterior sheath, 1/4 up from pubic crest
    • decussation: fibers intertwine at linea alba
  17. layers of ANTERIOR rectus sheath SUPERIOR to arcuate line
    external oblique aponeurosis and anterior portion of internal oblique aponeurosis
  18. layers of POSTERIOR rectus sheath SUPERIOR to arcuate line
    transversus abdominis aponeurosis, postior portion of internal oblique aponeurosis and endoabdominal fascia
  19. layers of ANTERIOR rectus sheath INFERIOR to arcuate line
    external oblique, internal oblique, and transversus abdominis aponeurosis
  20. layers of POSTERIOR recuts sheath INFERIOR to arcuate line
    endoabdominal fascia ONLY
  21. Combined function of anterolateral wall muscles
    • move trunk
    • maintain posture
    • protect abdominal viscera
    • compress abdominal viscera
  22. causes of an abdominal protuberance
    • food
    • fluid
    • feces
    • flatus
    • fat
    • fetus
    • -an everted umbilicus is a sign of increased intraabdominal pressure
  23. striae gravidarum
    stretch marks
  24. Congenital umbilical hernia
    due to incomplete aponeurotic fusion around umbilical ring
  25. acquired umbilical hernia
    • more common in women and the obese
    • occur as weakness in the anterior abdominal wall arises
  26. epigastric hernia
    • in midline between xiphoid process and umbilicus
    • consist of peritoneal sac covered by skin and fatty tissue
  27. Thoracoabdominal N
    • anterior branch of ventral rami T6-T11
    • between internal oblique and transversus abdominis
    • innervate lateral abdominal wall muscles and skin
    • branch to lateral cutaneous N and terminate as anterior cutaneous N
  28. Subcostal N
    • anterior ventral primary ramus of T12
    • innervates lateral abdominal wall muscles and skin over ASIS and hip
    • sensory for T12 dermatome via lateral and anterior cutaneous N
  29. Iliohypogastric N
    • superior terminal branch of ventral primary ramus of L1
    • -anterior cutaneous pierces External Oblique aponeurosis
    • innervates internal oblique and transversus abdominus muscle
    • innervates hypogastric skin and skin over iliac crest
  30. Ilioinguinal N
    • inferior terminal branch of L1 ventral ramus
    • -thru inguinal canal
    • innervates internal obliqu and transversus abdominis muscle
    • innervates skin of anterior scrotum/labia majora, mons pubis and medial thigh
  31. Segmental branches from Descending Aorta
    • Posterior intercostal As
    • Subcostal As
    • Lumbar As
    • supply lateral hypochondriac, flank, and lumbar regions
  32. Musculophrenic A
    • from internal thoracic A in 6th intercostal space
    • supplies hypochondriac region
  33. superior epigastric A
    • from internal thoracic A in 6th intercostal space
    • between posterior rectus sheath and rectus abdominis muscle
    • supplies rectus abdominis muscle and upper umbilical region
    • anastomoses with inferior epigastric A
  34. inferior epigastric A
    • from external iliac A
    • in transversalis fascia, enters rectus sheath inferior to arcuate line
    • supplies rectus abdominis muscle and lower umbilical region
  35. deep circumflex iliac A
    • from external iliac A
    • paralles inguinal lig toward ASIS
    • supplies deep inguinal region
  36. superficial circumflex A
    • from femoral A
    • paralles inguinal lig toward ASIS
    • supplies skin in inginal region
  37. superficial epigastric A
    • from femoral A
    • ascends in superficial fascia toward umbilicus
    • supplies skin in pubic and lower umbilical regions
  38. Venous drainage of anterolateral abdominal wall superior to the unbilicus
    • lateral thoracic V to axillary V to subclavian V
    • internal thoracic V to subclavian V
  39. Venous drainage of the anterolateral abdominal wall inferior to the umbilicus
    • inferor epigastric V to external iliac V
    • superficial epigastric V to great saphenous V to femoral V to external iliac V
  40. parumbilical Vs
    small superficial tributaries of hepatic portal V
  41. Thoracoepigastric V
    between lateral thoracic V and superficial epigastric V
  42. Lymphatics of anterolateral abdominal wall
    • superficial lymphatics into axillary nodes (some parasternal nodes)
    • superficial below unbilicus to superficial inguinal nodes
    • deep lymphatics to external iliac A nodes
  43. Abdominal palpation
    • done in supine position with thicks and knees bent to relax the abdominal wall
    • cold hands cause involunatary spasm called guarding
    • guarding also occurs when an organ is inflamed
  44. inguinal region
    • between ASIS and pubic tubercle
    • potential site for herniations
  45. Inguinal canal
    • parallel and just superior to inguinal lig
    • connects extraperitoneal space of abdomen to scrotum/labia majora
  46. what does the inguinal canal contain
    • males- spermatic cord
    • females- round lig of uterus
    • blood vessels, lymphatics, linioinguinal N
  47. Deep inguinal ring
    • internal opening of the canal
    • 1 cm superior to the middle portion of inguinal lig
    • lateral to inferior epigastric A
    • inferior to transversus abdominis muscle
    • location of evaginated trasversalis fascia
  48. superficial inguinal ring
    • external opening
    • in inferomedial portion of external oblique aponeurosis
    • superolateral to pubic tubercle
    • lateral margins are called CRURA
  49. crura of superficial inguinal ring
    • lateral crus- to pecting tubercle
    • medial crus- to pectin crest
    • internal crural fibers- between two crura
  50. walls of inguinal canal
    • anterior wall- external oblique aponeurosis
    • posterior wall- endoabdominal fascia and conjoint tendom
    • roof- internal obluiq and transversus abdominis muscle/aponeuroses
    • flool- inguinal lig
  51. development of male inguinal canal
    • testes develop in endoabdominal fascia on posterior abdominal wall
    • attached to anterior abdominal wall at deep ring by gubernaculum
    • -persists as scrotal lig
    • -pulls testes thru the canal into the scrotal sac
  52. processus vaginalis
    • peritoneum transversing the inguinal canal
    • carries things thru the canal and persists as fascia around the spermatic cord
    • distal sacular portion persistas as the tunica vaginalis
  53. development of female inguinal canal
    • ovaries develop in endoabdominal fascia of posterior abdominal wall
    • processus vaginalis protrudes into labia majora
    • gubernaculum- connects ovaries and uterus to labia majora
  54. remnants of female gubernaculum
    • ovarian lig- between ovary and uterus, prevents ovaries from descending
    • round lig of the uterus- between uterus and labia majora
  55. palpation of male superficial inguinal ring
    • superolateral to pubic tubercle
    • invaginate skin of upper scrotum, adjacent to spermatic cord with index finger
    • turn your head a cough
  56. spermatic cord
    • contains structures to/from the testis
    • begins at deep inguinal ring, thru inguinal canal and superficial ring, ends at testis
  57. Fascia layers of spermatic cord
    • external spermatic fascia- evaginated external oblique aponeurosis and investing fascia
    • cremasteric fascia- evaginated internal oblique investing fascia
    • internal spermatic fascia- evaginated transversalis fascia
  58. Cremaster M
    • evaginated internal oblique muscle
    • raises/lowers testis in response to temperature
    • innervated by genital branch of genitofemoral N (L1,2)
  59. cremaster reflex
    • contraction of muscle elicited by lightly stroking the skin of superomedial thigh (ilioinguinal N- L1)
    • highly active reflexes simulate undescended testes
  60. Ductus deferens
    • muscular tube
    • carries spermatozoa from tail of epidiymis to ejaculatory duct
  61. testicular A
    • branches from abdominal aorta inferior to renal A
    • retroperitoneal where it crosses the ureter and external iliac As
    • enters inguinal canal at deep inguinal ring, exits at superficial inguinal ring
    • supplies testis and epididymis
  62. ductus deferens A
    branched from inferior vesical A
  63. cremaster A
    from inferior epigastric A
  64. pampiniform venous plexus
    • 8-12 veins surrounding testicular A
    • anteror to ductus deferense
    • thermoregulator
    • converge to form testicular V
    • -R drains to inferior vena cava
    • -L drains to L renal V
  65. Autonomic N fibers
    • sypathetics (T10-11) to testicular A and ductus deferens
    • -efferent and visceral afferent
    • -contraction of ductus deferens during emission
    • parasympathetics (Vagus) to ductus deferens
    • -relaxes ductus deferens after emission
  66. Genital branch of Genitofemoral N
    innervates cremaster muscle
  67. lymphatics of the spermatic cord
    • drain testis and epididymis to lumbar lymph nodes
    • scrotum drainage goes to superficial inguinal nodes
  68. contents of spermatic cord
    • ductus deferens
    • testicular A
    • ductus deferens A
    • cremaster A
    • pampiniform venous plexus
    • autonomic nerve fibers
    • genital branch of genitofemoral N
    • lymphatics
  69. layers of the scrotum
    • skin- pigmented, hairless
    • dartos fascia- continuation of scarpas fascia and colles fascia
    • site for smooth muscle attachement
    • -contracts when cold
    • forms scrotal septum at scrotal raphe
  70. Tunica vaginalis
    • parietal and visceral layers
    • parietal layer fuses to internal surface of internal spermatic fascia
    • visceral layer fuses to external surface of testis and epididymis
    • -posterior surface is uncovered
    • mesorchium- from extensive tunica vaginalis, allows twisting of testis
  71. vasculature of scrotum
    • anterior scrotal A- off deep external pudendal A
    • posterior scrotal A- off perineal A
    • veins accompany As
  72. nerves of the scrotum
    • genital branch of genitofemoral N- (L1-2) to anterolateral surface of scrotum
    • anterior scrotal N- from ilioinguinal N (L1) to anterior surface of the scrotum
    • posterior scrotal N- from perineal N (S2-4) to posterior surface of the scrotum
    • posterior femoral cutaneous N- (S2-3) to inferior surface of the scrotum
  73. Epididymis
    • tightly convoluted duct on posterior surface of testis
    • covered by visceral tunica vaginalis
    • head is superiorly, tail is inferiorly
    • ductus deferens begins at the tail
    • connected to the testis by efferent ductules
    • function- storage/maturation of sperm
  74. Testis
    • ovoid organ suspended in scrotum by spermatic cord
    • -L is usually lower
    • tunica albuginea capsule covered by visceral tunica vaginalis
  75. cryptorchidism
    • undescended testis
    • usually located in inguinal canal
    • risk of malignancy is high if left uncorrected
  76. hydrocele
    • excess fluid in a processus vaginalis
    • -indirect inguinal hernia
    • excessive secretion by visceral tunica vaginalis
    • adjacent to testis or in the spermatic cord
  77. hematocele
    • blood between visceral/parietal tunica vaginalis
    • caused by traumatic injury
    • hematoma- accumulation of blood in any extravascular location
  78. varicocele
    • tortuous dilation in pampiniform venous plexus
    • valve insufficiency or venous return problems
    • -more common on L becuase of testicular V drainage
  79. vasectomy
    • bilateral excision of ductus deferens thru superioranterior scrotum
    • prevents sperm from passing
    • doesnt affect secretions from accessory glands
  80. parietal peritoneum
    • lining internal surface of abdominopelvic wall
    • somatic sensory innervation via dermatome
  81. visceral peritoneum
    • covering abdominopelvic viscera
    • no somatic sensory innervation
    • visceral afferent innervation causing refered pain
    • same as serosa
  82. peritoneal cavity
    • spave between parietal and visceral peritoneum
    • thin fil of peritoneal fluid to lubricate surfaces and fight infection
    • open to exterior in females via uterine tubes, uterus and vagina
    • completely closed in males
  83. intraperitoneal organs
    • almost completely covered by visceral peritoneum
    • NOT inside peritoneal cavity
    • embryonically suspended by mesentery and remain suspended
  84. retroperitoneal organs
    • partiall covered by parietal peritoneum, external to peritoneal cavity
    • primary retroperitoneal- embryonically behind peritoneun
    • secondary retroperitoneal- become retroperitoneal due to return of gut
  85. peritonitis
    • painful, inflammation of peritoneum
    • develop ascites (excess fluid)
    • fluid flows along paracolic gutters and is reabsorbed in pelvis (best resprtion in thoracic diaphragm)
    • commonly causes adhesions
  86. Umbilical folds of anterolateral abdominal wall
    • median umbilical fold- from apex of urinary bladder to umbilicus
    • contains median umbilical lig
    • medial umbilical fold- lateral to median fold
    • contains medial umbilical lig
    • lateral umbilical fold- lateral to medial fold
    • contains inferiro epigastric A/V
  87. depressions between umbilical folds
    • supravesical fossa- between median and medial folds
    • location of parietal peritoneum reflection to urinary bladder
    • medial inguinal fossa- between medial and lateral folds
    • site of a direct hernia out superficial inguinal ring
    • lateral inguinal fossa- lateral to lateral fold
    • site of indirect inguinal hernia thru deep inguinal ring into the spermatic cord
  88. femoral hernias
    • more common in females
    • protrusion inferior to inguinal lig thru the femoral ring and canal
    • extends into upper medial thigh
  89. Mesentary
    • double layer of peritoneum connecting intraperitoneal organ to posterior abdominal wall
    • froms as intraperitoneal organ invaginates into peritoneal cavity
    • contains nerves and vasculature to the organ
  90. lesser omentum
    • double layer of peritoneum from lesser curvature of the stomach and proximal duodenum to the liver
    • remnant of ventral mesentary
  91. hepatogastric lig
    lesser omentum from liver to lesser curvature of the stomach
  92. hepatoduodenal lig
    • thick right side of lesser omentum
    • from liver to proximal duodenum and surrounds the portal triad
  93. greater omentum
    • aprom from greater curvature of sotmach and then folding back on itself to transverse colon
    • remnant of dorsal mesentary
    • prevents abdominal viscera from adhearing to anterolataeral wall, protection
  94. gastrocolic lig
    • largest portion of greater omentum
    • from greater curvature of stomach to transverse colon
  95. gastrosplenic lig
    from greater curvature of stomach to spleen
  96. gastrophrenic lig
    from greater curvature of stomach to thoracic diaphragm
  97. greater sac of the peritoneal cavity
    • main, large portion
    • supracolic compartment- anterosuperior to greater omentum and transverse colon (stomach, liver, spleen)
    • infracolic compartment- posteroinferior to greater omentum and transverse colon, right and left sides (small intestine, up and down colon)
    • paracolic gutters- grooves between lateral sides of up/down colon and posterolateral abdominal wall
  98. lateral sac of peritoneal cavity
    • posterior to stomach and lesser omentum
    • superiorly behind liver and up to diaphragm
    • inferiorly between superior layers of gastrocolic lig
  99. Epiploic foramen
    • communication between greater and lesser sacs
    • posterior to hepatoduodenal lig
  100. Esophagus
    • muscular tube from pharynx to stomach
    • follows curvature of vertebral column
    • covered by adventitia above diaphragm, serosa below
  101. upper esophageal sphincter
    crossed by cricopharyngeus muscle
  102. lower esophageal sphincter
    passes thru diaphragm
  103. esophageal hiatus
    • thru right crus of the diaphragm at T10
    • phrenicoesophageal ligs- esophagus to diaphragm at hiatus, allow independent movement and seal off cavities
  104. esophagogastric junction
    • left of midline at T11
    • right border is continuous with lesser curvature of the stomach
    • left border separated by cardiac notch
    • cardiac sphincter prevents gastric reflux
  105. arterial supply to esophagus
    • esophageal branch of L gastric A
    • left inferior phrenic A
  106. venous drainage of esophagus
    • superiorly thru esophageal Vs (to azygos veins)
    • inferiorly thru L gastric Vs (to hepatic portal v)
  107. lymphatic drainage of esophagus
    primary nodes are LEFT GASTRIC LYMPH NODES
  108. innervation of esophagus
    • from esophageal plexus
    • parasympathetics via vagal trunks
    • sympathetic via greater splanchnic N
    • -presynaptic- ciliac ganglion
    • -postsynaptic- periarterial plexus
  109. esophageal varices
    • enlarged submucosal Vs with portal hypertension
    • rupture is a potentially fatal condition
    • associated with cirrhosis
  110. pyrosis
    • heartburn
    • acid reflux thru cardiac sphincter
  111. stomach
    • intraperitoneal in uppermost left adbominal quadrant
    • food blender, resorvoir, initiates digestion
    • gastric juice begins digesting into chyme
    • adult stomach holds 2-3 liters
    • newborn stomach holds 30 mls
  112. regions of stomach
    • cardai- T11, entrance of esophagus
    • fundus- under left dome of diaphragm
    • cardiac notch- between esophagus and fundus
    • body
    • pyloris- exit of stomach
    • lesser curvature- right side
    • angular incisure- indentation at junction of body and pyloris
    • greater curvature- longer left side
  113. Pyloric part of stomach
    • pyloric antrun- funnel- shapped extension of body
    • pyloric canal- leading to sphincter
    • pyloric sphincter- regulates exit
  114. hiatal hernia
    protrusion of stomach into mediastinum via esophageal hiatus
  115. sliding hiatal hernia
    • esophagus, cardia and parts of fundus slide thru esophageal hiatus
    • associated with acid reflux
  116. paraesophageal hiatal hernia
    • esophagus and cardia normal
    • pouch of peritoneum extends thru hiatus
    • acid reflux not an issue
  117. Arterial supply to stomach
    • left gastric A- primary, along lesser curvature
    • R gastric A- anastomoses with L gastric along lesser curvature
    • R gastroepiploic A- greater curvature, in greater omentum
    • L gastroepiploic A- anastomoses with R gastroepiploic A
    • Short gastric As- 4-5, supplying fundus
  118. venous drainage of stomach
    • parallel arteries
    • drain to liver
    • L/R gastric Cs to hepatic portal V
    • short gastric and gatroepiploic to splenic C
    • r gastroepiploic to superior mesenteric V
  119. lymphatic drainage of stomach
    • primary gastric nodes on lesser curvature
    • gastroepiploic nodes on greater curvature
    • ciliac nodes secondary
  120. innervation of stomach
    • parasymapthetic presynaptic- from vagal trunks. enter abdomen via esophageal hiatus, synapse on myenteric/submucosal ganglia
    • sympathetic presynaptic- via greater splanchnic. synapse on postsynaptic neurons in ciliac ganglion. pass in tunica adventitia of arterial vessels into stomach
  121. stomach cancer
    • if in body or pyloric part may be palpable
    • evaluated by gastroscopy
    • extensive lymphatic drainage and number of nodes creates surgical problems
  122. gastrectomy
    • total is uncommon
    • partial may be done
    • extensive arterial anastomoses provides good vascular support
  123. gastric ulcers
    • 90% caused by infection with helicobater pylori and treatable by antibiotics
    • -gastric mucous breaks down
    • -if complete perforation occurs, peritonitis may be life threatening
    • acid secretion by parasympathetic innervation
    • vagotomy at esophageal hiatus is sometimes done for chronic ulces
  124. Duodenum
    • pylorus to duodenaljejunal junction
    • -C shaped around head of pancreas
    • mostly retroperitoneal
  125. Superior duodenum
    • ascends slightly from pylorus
    • retroperitoneal
    • attached to liver by hepatoduodenal lig
  126. descending duodenum
    • curves around right side of head of pancreas
    • major duodenal papilla- internal opening of common bild duct and main pancreatic duct at hepatopancreatic ampulla
  127. inferior duodenum
    • crosses to left side of body
    • superior mesenteric A/V- anterior to this portion
  128. ascending duodenum
    • ends at duodenojejunal junction
    • supported by suspensory muscle of duodenum, facilitates movement upon contraction
  129. arterial supply to duodenum
    • superior pancreatioduodenal A- from gastroduodenal A. supplies proximal to major duodenal papilla
    • inferior pancreaticoduodenal A- from superior mesenteric A. supplies distal to major duodenal papilla. anastomoses with ciliac trunk and superior mesenteric A
  130. Celiac trunk
    • supplies distal esophagus to major duodenal papilla
    • artery of the foregut
  131. superior mesenteric A
    • supplies major duodenal papilla to near left colic flexure
    • arter of the midgut
  132. venous drainage of duodenum
    hepatic portal v
  133. lymphatic drainage of duodenum
    • anteriorly: pancreaticoduodenal nodes to pyloric nodes
    • posteriorly: superior mesenteric nodes
    • secondary: celiac nodes
  134. innervation of duodenum
    • parasympathetic- posterior vagal trunk
    • sympathetic- greater and lesser splanchnic thru celiac and superior mesenteric plexuses
  135. Liver
    • largest gland
    • upper right quadrant
    • critical metabolic organ
  136. diaphragmatic surface of the liver
    • subphrenic recess- extension of greater sac between liver and diaphragm, separated by falciform lig
    • hepatorenal recess- inferir extension of greater sac b/t liver and right kidney. bare area of the liver posteriorly
    • coronary lig- anterior and posterior peritoneal reflections
    • -triangular lig- right is anterior and posterior coronary ligs, left is falciform lig and lesser omentum
  137. visceral surface of the liver
    • posteriorinferior flat/concave aspect
    • visceral peritoneum
    • porta hepatis
    • transverse fissure between caudate and quadrate lobes
  138. liver lobes
    • left lobe
    • right lobe
    • caudate lobe- between ligamentum venosum and IVC
    • -caudate process- extension of caudate lobe connecting it to the right lobe
    • quadrate lobe- b/t gall bladder fossa and ligamentum teres
  139. ligamentum teres
    • remnant of fetal umbilical V
    • on free edge of falciform lig
  140. ligamentum venosum
    • remnant of fetal ductus venosus
    • on visceral surface between caudate lobe and left lobe
  141. blood delivery to liver
    • hepatic portal v- 75% of blood to liver
    • nutrient rich, bilirubin rich, pooly oxygenated
    • confluence of superior mesenteric V and splenic V
    • proper hepatic A- 25% of blood
    • highly oxygenated
    • off of common hepatic A, splits into right and left hepatic As
  142. Blood removal from liver
    • right, middle, and left hepatic vs
    • drain into IVC
  143. lymphatic drainage of liver
    • primary nodes= hepatic nodes
    • secondary nodes= celiac nodes
  144. innervation of liver
    • via celiac plexus
    • sympathetics- greater splanchnic N, synapse in celiac ganglion
    • parasympathetics- vagal trunk
    • visceral afferents- T6-9 cord levels, via R greater splanchnic N
  145. Cirrhosis of the liver
    • loss of hepatocytes and their replacement with fibrous CT
    • surface appears nodular
    • seen in chronic alcoholics
    • associated with hepatomegaly and portal hypertension
  146. biliary duct systems
    • produces bile continuously
    • gall bladder stores and concentrates bile
  147. components of biliary duct system
    bile canaliculi to bile ducts to R/L hepatic ducts to common hepatic duct. joins with cystic duct to form common bile duct
  148. gallbladder
    • in gallbladder fossa on visceral surface of liver
    • at junction of R/L functional lobes
    • on superior part of duodenum
  149. structur of gallbladder
    • fundus- projecting from anteroinferior border of liver, just below tip of right 9th costal cartilage
    • body- adjacent to visceral surface of liver
    • neck- narrow, mucosa in this section spirals to form the spiral valve of the gallbladder
    • cystic duct- neck of gallbladder to common hepatic duct
  150. arterial supply to gallbladder
    cystic A off of right hepatic A
  151. venous drainage of gallbladder
    cystic Vs to hepatic portal v
  152. lymphatic drainage of gallbladder
    • primary nodes= cystic and hepatic nodes
    • secondary nodes= celiac nodes
  153. innervation of the gallbladder
    • via celiac plexus
    • parasympathetics- vagal trunk
    • sympathetics- greater splanchnic N, synapse in celiac ganglion
    • visceral afferents- in splanchnic nerves back to T6-9
  154. gallstones
    • cholesterol based
    • small stones are most problematic because they get out of the gallbladder and get stuck somewhere
    • cause jaundice and pancreatitis
    • stones may be lodged in cystic duct causing liliary colic
    • large stones usually asymptomatic
  155. cholecystectomy
    gallbladder removal
  156. spleen
    • largest lymphatic organ
    • intraperitoneal
    • filters blood
    • not vital
  157. Gastrosplenic lig
    from spleen to greater curvature of stomach
  158. splenorenal lig
    from spleen to posterior wall near kidney
  159. arterial supply to spleen
    • splenic A
    • largest branch off celiac trunk
  160. venous drainage of spleen
    • splenic v
    • joined by inferior mesenteric V to superior mesenteric V to form hepatic portal v
  161. lymphatic drainage of spleen
    • primary nodes= pancreaticosplenic nodes
    • secondary nodes= celiac or superior mesenteric nodes
  162. innervation of spleen
    • via celiac plexus
    • sympathetics- greater splanchnic N (synapse in celiac ganglion)
    • no parasymp innervation
  163. rupture of spleen
    • protected by ribs 9-12
    • injured due to trauma or rib fracture
    • if ruptured= hemorrhage= bad
  164. splenectomy
    • surgical repair of ruptured spleen is difficult
    • some regeneratio possible if only partially removed
    • functions taken over by liver and bone marrow
  165. accessory spleen
    one or more usually present near hilum in 10%
  166. pancreas
    • retroperitoneal
    • exocrine function: digestive enzymes into duodenum
    • endocrine function: insulin/glucagon secretion to blood
  167. structure of pancreas
    • head- right side, surrounded by duodenum.
    • uncinate process- inferomedial extension of head
    • Neck- short
    • body- elongated left side
    • tail- anterior to L kidney, near hilum of spleen
  168. exocrine duct system of the pancreas
    • main pancreatic duct- from tail to head of pancreas
    • merges with common bile duct at hepatopancreatic ampula
    • opens into duodenum at major duodenal papilla
    • accessory pancreatic duct- may be pressent
  169. arterial supply of pancreas
    • pancreatic As- along splenic A, supply body and tail
    • anterior/posterior superior pancreaticoduodenal A- off gastroduodenal A, supplys superior head
    • anterior/posterior inferior pancreatioduodenal A- off superior mesenteric, supplys inferior head
  170. venous drainage of pancreas
    pancreatic veins- drain to plenic V and superior mesenteric V
  171. lymphatic draingae of pancreas
    • primary nodes= pancreaticoplenic nodes
    • secondary nodes= celiac, superior mesenteric and hepatic nodes
  172. innervation of pancreas
    • sympathetics- greater and lesser splanchnic N, synapse in celiac and superior mesenteric ganglia
    • parasympathetic- vagal trunks and celiac and superior mesenteric plexuses
    • -most secretions stimulated via hormones
  173. pancreatitis
    • inflammation of pancreas/blockage of pancreatic duct
    • pancreatectomy is performed
    • -impossible to completely remove the head of the pancreas
  174. pancreatic cancer
    • leads to obstructive jaundice
    • causes duct obstruction
  175. jejunum
    • beings at duodenojejunal flexure
    • intraperitoneal
  176. ileum
    • ends at ileocecal junction
    • suspended in mesentary
    • absorption of food stuffs
  177. arterial supply to jejunum and ileum
    • superior mesenteric A- off abdominal aorta, in mesentery
    • -jejunal/ileal As- 15-18 brances off left side of superior mesenteric
    • -unite to form arcades
    • -branches off arcades are vasa recta
  178. venous drainage of jejunum and ileum
    superior mesenteric V
  179. lymphatic drainage of jejunum and ileum
    • primary nodes= mesenteric nodes
    • secondary nodes= superior mesenteric nodes
  180. innervation of jejunum and ileum
    • perivascular nerve plexus to arteries
    • sympathetics- greater lesser splanchnic N. synapse in celiac and superior mesenteric ganglia
    • parasympathetic- vagal trunks, synapse in myenteric and submucosal plexuses
    • visceral afferents to T8-10
  181. ileal diverticulum
    • remnant of omphaloenteric duct
    • fingerlike puch on anterior ileum
  182. large intestine
    • completes absorption, compacts and stores feces
    • tenia coli- 3 longitudinal strips of smooth muscle
    • haustra- sacculations in wall of colon
    • epiploic appendages- fatty projections on outside of large intestine
  183. cecum
    • beginning of large intesting
    • pouch at inferior portion of scending
    • at ileocecal junction
    • intraperitoneal
  184. appendix
    • intestinal diverticulum on cecum
    • contains large amounts of GALT
    • mesoappendix- short triangular mesentery of appendix
  185. appendicitis
    • inflammation of appendix
    • obstruction leads to swelling and pain
    • rupture results in peritonitis, nausea, pain
    • appendecomy to remove
  186. arterial supply to cecum and appendix
    • ileocolic A- terminal branch of superior mesenteric A
    • -appendicular A- branch off ileocolic
  187. venous drainage of cecum and appendix
    ileocolic V- to superior mesenteric V
  188. lymphatics of cecum and appendix
    • primary nodes= ileocecal nodes
    • secondary nodes= superior mesenteric nodes
  189. innervation of cecum and appendix
    • sympathetics- lesser splanchnic N, synapse of superior mesenteric ganglion
    • parasympathetics- vagal trunks, synapse in myenteric and submucosal plexuses
    • visceral afferents- to T10
  190. Ascending colon
    • right colic flexure- bend into transverse colon
    • retroperitoneal
  191. arterial supply to ascending colon
    • right colic A- from superior mesenteric A
    • -marginal A- paralles inner length of colon
    • ileocolic A- terminal branch of superior mesenteric A
  192. venous drainage of ascending colon
    ileocolic V and right colic V to superior mesenteric V
  193. lymphatic drainage of ascending colon
    • primary nodes= paracolic, ileocolic, right colic nodes
    • secondary nodes= superior mesenteric nodes
  194. innervation of ascending colon
    • sympathetics- lesser splanchnic N, synapse in superior mesenteric ganglion
    • parasympathetics- vagal trunks, synapse in myenteric and submucosal plexuses
    • visceral afferents- T10
  195. transverse colon
    • largest portion
    • right colic flexure to left colic flexure
    • suspended transverse mesocolon
  196. arterial supply to transverse colon
    middle colic A- branch from superior mesenteric, helps form marginal A
  197. venous drainage of transverse colon
    middle colic V drains to superior mesenteric V
  198. lymphatic drainage of transverse colon
    • primary nodes= middle colic nodes
    • secondary nodes= superior mesenteric nodes
  199. innervation of transverse colon
    • sympathetics- lesser splanchnic N and superior mesenteric plexus
    • parasympathetics- vagal trunks and superior mesenteric plexus
  200. descending colon
    from L colic flexure to left iliac fossa where it transitions to sigmoid colon
  201. sigmoid colon
    s shaped segment, transitions to rectum where mesentery dissapears
  202. arterial supply to descending and sigmoid colon
    • L colic A- branches from inferior mesenteric A to descending colon. Marginal A connects to middle colic
    • sigmoidal As- branch from inferior mesenteric A
  203. venous drainage of descending and sigmoid colon
    inferior mesenteric V- to splenic V and then hepatic portal V
  204. lymphatic drainage of descending and sigmoid colon
    • primary nodes= paracolic or left colic nodes
    • secondary nodes= inferior or superior mesenteric nodes
  205. innervation of descending and sigmoid colon
    • sympathetic= least and lumbar splanchnic N, synapase in superior or inferior mesenteric ganglia
    • parasympathetic= pelvic splanchnic N
  206. kidney
    • retroperitoneal, right lower than left
    • removes salts and waste from blood
    • maintains water balance in body
    • creates urine
  207. perirenal fat
    located inside renal fascia
  208. suprarenal gland
    • superomedially to each kidney in perirenal fat
    • produce corticosteroids, androgens, epinephrine, and norepinephrine
  209. pararenal fat
    located outside the renal fascia
  210. renal transplantation
    • donor kidney might be removed
    • suprarenal gland left in place
    • transplanted kidney placed in iliac fossa
  211. Structures of the kidney
    • hilum- on medial surface entry of renal V, renal A, ureter
    • renal sinus- fat filled space housing renal pelvis
    • renal pelvis- origin of ureter, collects urine from major calyces, minor calyces, medulla, renal pyramids, and renal columns
  212. arterial supply to the kidney
    renal a- branches from abdominal aorta, right side longer, posterior to IVC, divides to anterior and posterior
  213. venous drainage of kidey
    • renal v- union of intrarenal veins.
    • -L recieves left inferior phrenic v, left suprarenal v, and left gonadal v
    • -on right these drain to IVC
  214. lymphatic drainage of kideny
    primary drainage= lumbar lymph nodes
  215. innervation of kidney
    • sympathetic- renal plexus supplied by lesser and least splanchnic N, synapse in aorticorenal ganglion
    • parasympathetics- renal plexus supplied by poserior vagal trunk
  216. ureter
    muscular duct from kidney to urinary bladder, retroperitoneal
  217. arterial supply to abdominal ureter
    renal A, gonadal A, abdominal A
  218. venoud drainage of abdominal ureter
    renal v, gonadal v
  219. lymphatic drainage of abdominal ureter
    primary nodes= lumbar or common iliac nodes
  220. innervation of abdominal ureter
    sympathetics- T11-L2
  221. renal and ureteric calculi
    • stones in kidney, ureter, and urinary bladder
    • cause fluid backup= hydornephrosis
    • refered pain from T11-L2 dermatomes depending on location of stone
    • lithotripsy- shockwaves that break up stones
  222. bifid pelvis and ureter
    duplication of induction process causing double
  223. horseshoe kideny
    • inferior poles of the kidneys fuse together forming one horseshoe shaped kidney
    • at L3-5 level
  224. ectopic pelvic kidney
    • kidney fails to ascend out of kidney
    • may be injured during pregnancy
    • blood from common iliac A
  225. suprarenal gland
    • between kidey and thoracid diaphragm
    • enclosed by perirenal fat
    • right- pyramidal shaped
    • left- semilunar shaped
  226. suprarenal cortex
    • secretes corticosteroids and androgens
    • endocrine related activites
  227. suprarenal medulla
    • secretes epinephrine and norepinephrine
    • sympathetic activities
    • regulated by sympathetic innervation
    • presynaptic sympathetics innervate medullary cells directly
  228. arterial supply to suprarenal gland
    • superior suprarenal A- off inferior phrenic
    • middle suprarenal A- off abdominal aorta
    • inferior suprarenal A- off renal A
  229. venous drainage of suprarenal gland
    • suprarenal V
    • R to IVC, L to L renal V
  230. lymphatic drainage of suprarenal gland
    efferent only to lumbar nodes
  231. innervation of suprarenal gland
    • sympathetics- lesser and least splanchnic N and celiac plexus
    • parasympathetic- posterior vagal trunk and celiac plexus
  232. thoracid diaphragm
    • b/t abdominal and throacic cavities
    • primary muscle for inspiration
    • parietal pericardium attaches to central part of diaphragm by pericardiacophrenic lig
  233. muscular regions of thoracic diaphragm
    • sternal part- 2 slips of muscle to posterior aspect of xiphoid process
    • costal part- wide muscular slips to internal surface of inferior 6 costal cartilages, forms domes of diaphragm
    • lumbar part- muscular crura
  234. Crura of thoracic diaphragm
    • right crus- larger and longer
    • L1-3
    • encircles seophageal hiatus, right side of aortic hiatus
    • left crus- L1-2
    • left side of aortic hiatus
  235. arcuate ligaments of thoracic diaphragm
    • median arcuate lig- over anterior aspect of abdominal aorta, unites R and L crura
    • medial arcuate lig- superior to psoas major, from L1 body to transverse process
    • lateral arcuate lig- superior to quadratus lumborum muscle, L1- 12th rib
  236. aperatures inthroacic diaphragm
    • caval opening- for IVC, in central tendon, T8/9 IVD, diaphragm facilitates venous return
    • esophageal hiatus- in right crus, T10, forms lower esophageal sphincter
    • aortic hiatus- posterior to diaphragm, T12
  237. action of thoracic diaphragm
    • contraction
    • diaphragm descent compresses abdominal viscera, decreases intrathoracic pressure, air into lungs
  238. arterial supply to diaphragm
    • superior surface: pericardiacophrenic A, musculophrenic A, superior phrenic A
    • inferior surface: inferior phrenic A
  239. venous drainage of diaphragm
    • inferior phrenic V
    • -Right side drains to IVC
    • -Left side drains to left suprerenal V
  240. lymphatic drainage of diaphragm
    • abdominal surface main absorption for peritoneal fluid
    • primary nodes= anterior/posterior diaphragmatic nodes
    • secondary nodes= parasternal and posterior mediastinal nodes
  241. innervation of diaphragm
    • motor- phrenic N
    • central sensory- phrenic N
    • peripheral sensory- intercostal N and subcostal N
  242. paralysis of hemidiaphragm
    • due to injury of phrenic N
    • permanent elevation and paradoxical movement
    • -elevation of paralyzed diaphragm during contraction
  243. psoas major muscle
    • fusiform, lateral to lumbar vertebra
    • O: TPs, bodies, IVDs of T12-L5
    • I: lesser trochanter of femur with iliacus
    • deep to inguinal lig
    • A: flexes thigh, flexes trunk, balance trunk
    • N: L1-L3
  244. iliacus muscle
    • triangular, lateral to inferior psoas major
    • O: ala of sacrum, iliac fossa, saroiliac lig
    • I: lesser trochanter
    • A: flex thigh, stabalize hip
    • N: femoral N
  245. quadratus lumborum muscle
    • O: R12, lumbar TPs
    • I: iliolumbar lig, iliac crest
    • A: depress/stabilize R12, laterally flex trunk
    • N: T12-L4
  246. Endoabdominal fascia
    • between parietal peritoneum and musculature
    • continuous with transversalis fascia
  247. thoracolumbar fascia
    • transparent in thoracic region
    • stron in lujbar region
    • spans from R12 to iliac crest
  248. posterior abdominal pain
    • iliopsoas muscle
    • movement causes pain
    • iliopsoas test
    • patient lays on side, extends affected leg against resistance
  249. fascial abscesses
    • disease or infection may spread to psoas sheath
    • fascia thickens and becomes taut
    • pus spreads throughout compartment
    • causes pain
  250. subcostal N
    • ventral rami T12
    • to external oblique and T12 dermatome
  251. lumbar spinal Ns
    • dorsal rami to back muscles
    • ventral rami thru psoas major from lumbar plexus
  252. lumbar plexus of nerves
    • ventral rami L1-4
    • postsynaptic from gray rami communicantes
  253. iliohypogastric and ilioinguinal Ns
    • ventral rami T1
    • innervate abdominal oblique muscles and L1 dermatome
  254. lateral femoral cutaneous N
    • L2-3 ventral rami
    • under inguinal lig
    • sensory to anterolateral thigh
  255. femoral N
    • L2-4 ventral rami
    • to iliacus, hip flexors and knee extensors
  256. genitofemoral N
    • L1-2 ventral rami
    • genital branch- thru deep inguinal ring
    • sensory to anterolateral skin of scrotum/labia majora
    • motor to cremaster muscle
    • femoral branch- along external iliac A
    • sensory over femoral triangle
  257. obturator N
    • L2-L4 ventral rami
    • innervates adductor thigh muscles
  258. lumbosacral trunk
    • L4-5
    • joins wiht S1-4 to form sacral plexus of nerves
  259. lumbar sympathetic trunk
    • 4 paravertebral ganglia
    • presynaptic- lateral horn as low as L2-3
    • postsynaptic- thru gray rami communicantes
  260. Abdominopelvic splanchnic N
    • presynaptic sympathetics- T5-L2
    • pass thru sympathetic trunk without synapsing
  261. anterior/posterior vagal trunks
    • from esophageal plexus thru esophageal hiatus
    • presynaptic parasympathetics
    • innervate lower esophagus to splenic flexure of colon and viscera
  262. pelvic splanchnic N
    • ventral rami S2-4
    • keep the feces off the floor
  263. celiac plexus
    • via greater and lesser splanchnic N, posterior vagal trunk
    • mainly to foregut
  264. superior mesenteric plexus
    • lesser and least splanchnic, posterior vagal trunk
    • mainly to midgut
  265. inferior mesenteric plexus
    • lumbar splanchnic, pelvic splanchnic
    • mainly to hindgut
  266. superior hypogastric plexus
    • lumbar splanchnic, pelvic splanchnic
    • to ureteric and gonadal plexuses
  267. inferior hypogastric plexus
    • lumbar and pelvic splanchnic
    • to pelvic viscera
  268. abdominal aorta aneurysm
    enlargement of abdominal aorta

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