Anatomy Exam 2 Study Guide PDF

Definitions Inguinal Canal: Short passage that extends inferiorly and medially through the inferior part of the abdominal wall ○ Goes from abdominal wall → genitalia ○ Pathway that testes leave the abdominal cavity and go to the scrotum Gubernaculum: Fibrous cord that attaches the inferior portion o...

Definitions Inguinal Canal: Short passage that extends inferiorly and medially through the inferior part of the abdominal wall ○ Goes from abdominal wall → genitalia ○ Pathway that testes leave the abdominal cavity and go to the scrotum Gubernaculum: Fibrous cord that attaches the inferior portion of the gonad (testes or ovaries) to the future scrotum or labia Indirect inguinal hernia: hernia thru the inguinal canal Direct inguinal hernia: directly thru the abdominal wall Ligament of treitz: divides duodenum and jejunum so clinically it determines upper versus lower GI bleed, last portion of the duodenum, prevents reflux Mesentery: peritoneum that covers the blood supply of an organ and can move around Portal caval system: A type of anastomoses which occurs between the veins of portal circulation and veins of systemic circulation Male/Female What is the structure going through the inguinal canal in men? ○ Spermatic cord What is the structure going through the inguinal canal in women? ○ Round ligament Muscles of the abdominal wall and directionality ○ External oblique → runs inferomedially (down and in) Muscle fibers are down and in (superior and lateral to inferior and medial) ○ Internal oblique → runs superomedially (up and in) ○ Transverse abdominis → runs horizontally and in (fans out) ○ Rectus abdominis → runs vertically ○ Pyramindalis → runs vertically ○ Superior to the umbilicus at the arcuate line = anterior and posterior sheath ○ Inferior to the arcuate line = changes Linea Semilunaris line and arcuate line meet at the point below the umbilicus? ○ Spigelium Hernia at junction of semilunaris and semicircularis? ○ Speglian hernia There is no posterior sheath below? ○ Arcuate line = where the posterior sheath ends When 3 oblique come together, investing fascia comes together then splits and goes around the? ○ Rectus abdominis Dermatome/location of nipples? T4 Dermatome/location of superpubic area? T12 ○ ○ Types of hernias Direct inguinal hernia: above the inguinal ligament → directly through abdominal wall ○ Pushes through the abdominal wall in the inguinal triangle ○ Where the peritoneal sac enters the inguinal canal through the posterior wall of the inguinal canal. ○ Caused by weakening in abdominal musculature ○ Rearley enters the scrotum ○ Site: Hasselbach's triangle ○ Protrusion of abdominal contents through the transversalis fascia Indirect inguinal hernia: most common type, swelling above the inguinal ligament → ○ Enters through the deep inguinal ring before the triangle ○ Where the peritoneal sac enters the inguinal canal through the deep inguinal ring ○ Abdominal contents through the internal inguinal ring, often into the scrotum ○ Cause = congenital patency of the processus vaginalis and weakening of the transversalis fascia around the internal ring Femoral hernia: least common, passes below the inguinal ligament ○ Never enters the scrotum ○ Inguinal canal is empty ○ Protrude inferior to the inguinal ligament through a defect in the transversalis fascia into the femoral canal Spigelian hernia: hernia through the spigelian fascia ○ Speigelian fascia: aponeurotic layer between the rectus abdominis muscle medially and semilunar line laterally Muscles of the back Quadratus lumborum → can get hernias (rare) Muscles in the back of the abdomen that flex the leg ○ Psoas major → joins with the iliacus muscle to form the iliopsoas ○ Positive Psoas sign (pain with stretching the iliopsoas) = acute appendicitis Where does a femoral hernia occur ○ North of the inguinal ligament, intestine protruding femoral ring ○ Below inguinal ligament = femoral space = leg ○ Above inguinal ligament = abdomen Where does the iliac artery become the femoral artery? ○ At the inguinal ligament Hernias in the diaphragm → common in kids ○ Foramen in the diaphragm ○ Foramen bochdalek hernia → back of the diaphragm ○ C3, C4, C5 → phrenic nerve controls the diaphragm (moves it) Peritoneum Intraperitoneal = completely covered in peritoneum ○ Locations = Greater and lesser sac, stomach, jejunum, ilium, ascending (4th portion - has the ligament of treitz) and 1st part of the duodenum, cecum (appendix), transverse colon, sigmoid colon Extraperitoneal = not completely covered ○ Descending (2nd portion) and inferior duodenum (3rd portion, duodenal sweep) , rectum, ascending and descending colon Descending duodenum allows for bile and pancreatic fluids to join the GI tract Which organ doesn’t move much ⇒ pancreas, doesn’t move when take a deep breath Retroperitoneal = stuck and doesn’t move (Ex. pancreas) Visceral peritoneum = covers the organs Parietal peritoneum = lines the cavity Peritoneal space → filled with fluid that helps with movement and reducing friction What are important recesses (spaces that can accumulate fluid) that happen in the abdomen? ○ Morrison’s pouch → right upper quadrant (by the liver) ○ Pouch of Douglas → located anterior to the rectum ○ Lesser sac → located posterior to the stomach, in front of the pancreas ○ Greater sac → extends from the diaphragm to the pelvic cavity What’s it called when blood supply is covered by the peritoneum? ○ Mesentery If something has a mesentery it is? ○ Intraperitoneal, free flowing What type of peritoneum is in the large intestine? ○ Both intraperitoneal and extraperitoneal ○ Cecum → intraperitoneal ○ Contains the appendix → intraperitoneal ○ Ascending colon → extraperitoneal ○ Transverse colon → intraperitoneal ○ Descending colon → extraperitoneal ○ Sigmoid colon → intraperitoneal ○ Rectum → extraperitoneal Intraperitoneal contents can twist and are known as? ○ Volvulus Where does volvulus happen? ○ Cecum, transverse, sigmoid colon Quadrants and regions of the abdomen What are the 9 regions of the abdomen ○ Right and left hypochondriac (under the ribs) ○ Right and left lumbar (flanks) ○ Right and left inguinal (groin) ○ Epigastric (over the stomach) ○ Umbilical ○ Pubic/Hypogastric (under the stomach) What lies in the Right Hypochondriac ○ Liver, Gallbladder, Small Intestine, Ascending/Transverse Colon Right Kidney, Right Adrenal Gland Right Ureter What lies in the Left Hypochondriac ○ Stomach, Liver (tip), Pancreas (tail), Small Intestine, Transverse/Descending Colon, Spleen, Left Kidney, Left Adrenal Gland, Left Ureter What lies in the Epigastric ○ Esophagus, Stomach, Liver, Pancreas, Small Intestine, Transverse Colon R/L, Kidneys R/L, Adrenal Glands, R/L Ureters What lies in the Right Lumbar: ○ Liver, Gallbladder, Small Intestine, Ascending Colon, Right Kidney/Ureter What lies in the Umbilical: ○ Stomach, Pancreas, Small Intestine, Transverse Colon, R/L Kidneys/Ureters What lies in the Left Lumbar: ○ Small Intestine Descending Colon Left Kidney/Ureter What lies in the Right Iliac: ○ Small Intestine, Appendix, Cecum/Ascending Colon, Right Ovary/Fallopian Tube What lies in the Hypogastric: ○ Small Intestine, Sigmoid Colon/Rectum, R/L Ovaries/Fallopian Tubes, Urinary Bladder, Uterus, Vas Deferens/Seminal Vesicles, Spermatic Cord Prostate What lies in the Left Iliac: ○ Small Intestine, Descending/Sigmoid, Colon, Left Ovary/Fallopian Tube What is in the LLQ? ○ left ovary (in females), the ureter, the uterus (in females), and the small and large intestines What is in the LUQ? ○ the spleen, stomach, the body of the pancreas, left kidney, adrenal gland, splenic flexure of the colon, parts of the transverse, and descending colon What is in the RLQ? ○ Appendix, first part of large bowel What is in the RUQ? ○ the liver, the gallbladder, duodenum, the upper portion of the pancreas, and the hepatic flexure of the colon Your patient presented with generalized pain but is now able to palpate exactly where their pain lies, where has inflammation spread? ○ From visceral peritoneum to Parietal peritoneum ○ Why? Because the parietal peritoneum has the same dermatomes Major blood supply to the stomach? ○ Left gastric = Branch of the celiac artery ○ Superior mesenteric artery Where do the splanchnic beds go to ○ Small and large intestines Where do the splanchnic veins travel to ○ Portal system = Blood coming back to the heart gets processed in the LIVER first Where are the 4 places in the body where the caval and portal systems both drain ○ Rectum → hemorrhoidal veins ○ End of esophagus → debilitation of veins can cause esophageal varices ○ Retroperitoneum ○ Around umbilicus Caput medusae → swelling of veins around umbilicus What is the dermatome/location of umbilicus? T10 Where does the caval system/systemic venous system returns blood to ○ RA of the heart Hypertension of the caval system causes debilitation of veins, which can cause ○ Esophageal varices, bleeding of rectum, caput medusae What is Mcburney's point? ○ Halfway the distance from the umbilicus to the right anterior superior iliac spine, or the bony projection of the right hip bone (base of the appendix) Aorta divides into the? ○ Left and right common iliac arteries Left and right common iliac arteries divide into? ○ Internal and external iliac arteries (at level L4, at the umbilicus) What veins comprise the portal circulation ○ Coalesce/made up of mesenteric veins and splenic veins Which two veins come together to form the portal vein ○ Mesenteric and splenic veins Portal vein goes into the __ next to the common bile duct and hepatic artery, and makes up the __? ○ Hiatus of the liver, portal triad The portal triad is made up of? ○ Common bile duct, hepatic artery, portal vein Pancreas drains into the second portion of the duodenum at the? ○ Papilla Vater The papillary Vater has a sphincter that prevents it from draining all the time called? ○ Sphincter of Oddi Two pancreatic ducts are? ○ Major duct → duct of Wirsung ○ Minor duct → duct of Santorini The major and minor pancreatic ducts and the common bile duct drain through the? ○ Sphincter of Oddi When the major and minor pancreatic ducts and the common bile duct DON’T drain together this is called? ○ Pancreatic divisum (5% of people) The major pancreatic duct opens into the __, and the minor pancreatic duct opens into the __ ○ Ampulla of Vater, Minor papilla What is the function of the Greater Omentum? ○ Fat storage, immune functions, padding, gets stuck on inflamed or infectious items in the abdomen “policeman of the abdomen” If you were to look at the intestine, can you tell what “makes it jejunum and/or ileum”? ○ You can tell by the difference in blood supply ○ Jejunum = direct rays that come out of the superior mesenteric artery ○ Ilium = different arcades (branches off of the superior mesenteric artery, followed by more branches) The ileocolic artery, middle colic artery, left colic artery connect at an arcade called the? ○ marginal artery of drummond The ileocolic artery branches into the __ ○ Right colon to the Appendix → transverse colon and left colon What is an arcade? ○ Where blood vessels are joined together How do we continue to get blood supply when one of the arteries isn’t working? ○ Due to the marginal artery of drummond Stomach What is the stomach composed of ○ Fundus, body, antrum, cardia (near the esophagus) When you lay down, where does the air in the stomach go? ○ Antrum (anterior) When you stand up, where does the air in the stomach go? ○ Air fills the fundus of the stomach (superior) General Where is the hernia sac? ○ Parietal peritoneum What is it called when the peritoneum dips down into the inguinal canal to let a testes go through? ○ Tunica vaginalis → Same as a hernia sac Which kidney is higher? ○ Left kidney Where is the Papilla Vater? ○ Second portion of the duodenum What is it called when you have bunching of the mucous lining of the stomach and it increases surface area? ○ Rugae Where does the greater omentum attach ○ Greater curvature of the stomach and the transverse colon What is an excess in abdominal fluid called ○ Ascites Superior mesenteric artery → ileocolic artery → goes to ilium, right colon, appendicular artery Middle colic artery → transverse colon Left colic artery → comes from the inferior mesenteric artery Foramen of winslow → connection between the greater and lesser sac of the abdomen