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Abdomen 2


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Name two layers of superficial fascia
Campers and Scarpas
Linea alba
Line between two rectus abdominis muscles
Extends from xiphoid process to pubic symphysis
Formed by fusion of aponeuroses of external oblique, internal oblique and transverse muscles of abdomen
Rectus Sheath
Formed by fusion of aponeuroses of external oblique, internal oblique and transverse muscles
Encloses rectus abdominis and sometimes pyramidalis
-also contains superior and inferior epigastric vessels and ventral rami T7-T12
Anterior layer of rectus sheath
Above arcuate line - aponeuroses of external and internal oblique
Below arcuate line- aponeuroses of external, internal and transverse muscles
Posterior layer of rectus sheath
Above arcuate line - aponeuroses of internal oblique and transverse
Below arcuate line - rectus abdominis in contact with transversalis fascia
Boundaries of Hesselbachs triangle
Rectus abdominis
Inguinal ligament
Inferior epigastric
Hesselbachs triangle is site for
Direct inguinal hernia
Superficial ring
Triangular opening in aponeurosis of external oblique that lies just lateral to pubic tubercle
Deep inguinal ring
Lies in transversalis fascia, lateral to inferior epigastric vessels
Inguinal canal runs from..
Deep to superficial inguinal rings
Inguinal canal transmits
-Spermatic cord or round ligament of uterus
-genital branch of genitofemoral nerve
Also run through deep inguinal ring
Indirect inguinal hernia passes through
Inguinal canal
Does ilioinguinal nerve passe through inguinal canal
Yes, passes through the inguinal canal and superficial inguinal ring but does not pass through deep inguinal ring
Anterior wall of inguinal canal
Aponeuroses of external and internal oblique
Posterior wall of inguinal canal
aponeurosis of transverse abdominal and transversalis fscia
Superior wall (roof) of inguinal canal
Arching fibers of internal oblique and transverse muscles
Floor of inguinal canal
Lacunar and inguinal ligaments
Where does inguinal hernia occur
Superior to inguinal ligament
Medial to pubic tubercle
Pathway of indirect inguinal hernia
Through the deep inguinal ring, inguinal canal, superficial inguinal ring, descends in scrotum
Indirect inguinal hernia in relation to inferior epigastric vessels is..
Which side is indirect inguinal hernia usually on
Which hernia is more common
If indirect hernia is congenital, what caused it
Persistent processus vaginalis
Pathway of direct inguinal hernia
Goes directly through posterior wall of inguinal canal in triangle of Hasselbach but DOES NOT go to scrotum
Direct inguinal hernia in relation to inferior epigastric vessel
Spermatic cord is composed of
Ductus deferens
Testicular and cremastic arteries
Pampiniform plexus of testicular veins
Genital branch of genitofemoral and cremasteric nerves and testicular sympathetic plexus
Lymph vessels
External spermatic fascia is derived from
External oblique
Cremasteric fascia originates in
Internal oblique muscle
Internal spermatic fascia derived from
Transversalis fascia
Supravesical fossa
Depression on anterior abdominal wall between median and medial umbilical folds
Medial inguinal fossa
Depression on anterior abdominal wall between medial and lateral umbilical folds of peritoneum
-Lateral to supravesical fossa
-Site for direct inguinal hernias
Lateral inguinal fossa
Depression on anterior abd wall, lateral to lateral umbilical fold
Which umbilical fossas is site for direct inguinal hernia
Medial inguinal fosssa
Median umbilical ligament is a remnant of
Median umbilical ligament lies
Between transversalis fascia and peritoneum and extends from apex of bladder to umbilicus
Medial umbilical ligament is a remnant of
Umbilical artery
Medial umbilical ligament is located
Between transversalis fascia and peritoneum and extends from side of bladder to umbilicus
Lateral umbilical fold
Covers inferior epigastric vessels and extends from medial side of deep inguinal ring to arcuate line
Transversalis fscia
Lining fascia of entire abdomenopelvic cavity between parietal peritoneum and inner surface of abdominal muscles
What fascia forms deep inguinal ring
Nerves of anterior abdominal wall
Subcostal nerve is a ventral ramus of
12th thoracic nerve
Subcostal nerve innervates
external + internal oblique
rectus abdominis
Subcostal nerve has a branch. It is..
Lateral cutaneous branch - innervates skin of the side of the hip
Iliohypogastric nerve arises from
Iliohypogastric nerve innervates
internal oblique and transverse abdominal muscles
Iliohypogastric nerve has two branches. Name them, what do they supply
Lateral cutaneous branch supplies skin of lateral side of buttocks
Anterior cutaneous branch - supplies skin above pubis
Ilioinguinal nerve arises from
L1, pierces internal oblique near deep inguinal ring and accompanies spermatic cord through inguinal canal and then goes through superficial ring
Ilioinguinal nerve innervates
Internal oblique + transverse
Ilioinguinal nerve has two branches. Name them, what supply?
Femoral branch - innervates upper and medial thigh
Anterior scrotal - skin of root of penis and anterior scrotum
Cremasteric reflex
Drawing up of testis by contraction of cremaster muscle when skin on upper medial thigh is stroked
Lymphatics above umbilicus drain into
axillary lymph nodes
Lymphatics below umbilicus drain into
Superficial inguinal nodes
Superior epigastric artery arises from
Internal thoracic artery, enters rectus sheath and descends on posterior rectus abdominis
Superior epigastric artery anastomoses with
inferior epigastric within rectus abdominis
Inferior epigastric artery arises from
External iliac above inguinal ligament, enters rectus sheath and ascends between rectus abdominis and posterior layer of rectus sheath
Inferior epigastric anastomoses with
superior epigastric, providing collateral circulation between subclavian and external iliac
Inferior epigastric artery gives rise to..
Cremasteric artery which accompanies spermatic cord
Deep circumflex iliac artery arises from
External iliac and runs laterally along inguinal ligament and iliac crest between internal oblique and transverse muscles
Superficial epigastric artery arises from
Femoral and runs superiorly toward umbilicus over inguinal ligament
Superficial epigastric artery anastomoses with
branches of inferior epigastric
Superficial circumflex iliac artery arises from
Femoral artery
Peritoneum definition
Serous membrane lined by mesothelial cells
Peritoneum has 2 layers - name them
Visceral and parietal
Parietal peritoenum lines
Abdominal and pelvic walls and inferior surface of diaphragm
Parietal peritoneum is innervated by
Lower intercostal
Visceral peritoneum is innervated by
Visceral nerves that travel together with autonomic nerves
Lesser omentum
Double layer of peritoneum extending from porta hepatis of liver to lesser curvature of stomach and beginning of duodenum
Lesser omentum consists of
Hepatogastric and hepatoduodenal ligaments
Which vessels go in lesser omentum
Right and left gastric vessels
Lesser omentum has right free margin that contains
Proper hepatic artery
bile duct
portal vein
Greater omentum is derived from
dorsal mesentery
Greater omentum is located
hangs down like apron from greater curvature of stomach covering transverse colon and other abdominal viscera
Which vessels does greater omentum transmit
right and left gastroepiploic vessels
Why is greater omentum called "abdominal policeman"
Because it plugs the neck of hernial sac preventing entranc of small intestine
Adheres to areas of inflammation preventing peritonits
Which ligaments constitute greater omentum
Gastrophrenic ligament
Gastrocollic ligament
Mesentery proper
Fan shaped double fold of peritoneum that suspends jejunum and ileum from posterior abdominal wall and transmits nerves and blood vessels to and from small intestine
Falciform ligament
Sickle shaped peritoneal fold connecting liver to diaphragm and anterior abdominal wall
Falciform ligament contains
Ligamentum teres hepatis and paraumbilical vein
Round ligament of liver
lies in falciform ligament
Round ligament is a remnant of
Left umbilical vein
Coronary ligament
connection with bare area of the liver
Ligamentum venosum is remnant of
Ductus venosus
Peritoneal cavity
Potential space between parietal and visceral peritoneum
Is peritoneal cavity a completely closed sac
In males its completely closed, in females its open through uterine tubes, uterus and vagina
Peritoneal cavity has two parts- what are they
Greater and lesser sac
Lesser sac
Irregular space that lies behind liver, lesser omentum, stomach and upper anterior part of greater omentum
Name of communication between greater and lesser sacs
Epiploic foramen
Lesser sac has three recesses - what are they
Superior - behind stomach, lesser omentum, and left lobe of liver
Inferior - behind stomach extending to greater omentum
Paracolic gutters
Lie lateral to ascending colon (right) and lateral to descending colon (left)
Epiploic foramen
Natural opening between lesser and greater sacs
Borders of epiploic foramen
Superior - caudate lobe of liver
Inferior - 1st part of duodenum
Anterior - free edge of lesser omentum
Posterior - IVC
What forms stomach bed
Left kidney
Left suprarenal gland
Transverse colon+ mesocolon
Is stomach covered by peritoneum
4 regions of stomach
Fundus lies where
Inferior to apex of heart, level of 5th rib
Blood supply of stomach
Right and left gastric arteries
Right and left gastroepiploic arteries
Short gastric arteries
Name of longitudinal folds of mucous membrane of stomach
Small intestine extends from
pyloric opening to iliocecal junction
Duodenum is
C shaped tube , shortest of small intestine
Surrounds head of pancreas
Is duodenum retroperitoneal or peritoneal
Retroperitoneal, except for the beginning of the first part of duodenum
First part of duodenum is connected to liver by
Hepatoduodenal ligament
Blood supply of duodenum
Celiac + SMA
First part of duodenum is
Duodenal cap, into which pylorus invaginates
Second part of duodenum is
Descending, junction of foregut and midgut
Main pancreatic and common bile duct open into
descending (2nd) part of duodenum
Third part of duodenum is
Transverse part of duodenum crosses
IVC, aorta, vertebral column
Fourth part of duodenum is
What fixes in position duodenojejunal junction
Suspensory ligament of Treitz
Circular folds of jejunum
Plicae circularis
Which part of small intestine contains Peyers patches
Compared to ileum, arterial arcades of jejunum
Are less prominent
Is vasa recta longer in jejunum or ileum
Meckels diverticulum is located
2 feet proximal to ileocecal junction
Which percent of population has Meckel diverticulum
Meckels diverticulum is a remnant of
Yolk sac
Large intestine consists of
Anal canal
FUnction of large intestine
Convert liquid contents to semisolid feces by absorbing water, salts and electrolytes
Is colon retroperitoneal
Ascending and descending parts are retroperitoneal
Sigmoid and transverse have peritoneum covering called mesocolon
Innervation and blood supply of ascending and transverse colons
SMA + vagus nerve
Innervation and blood supply of descending and sigmoid colon
IMA + pelvic splanchnic nerves
3 distinctive features of colon
Teniae coli - narrow bands of outer muscular coat
Haustra -sacculations
Epiploic appendages - peritoenum covered sacs of fat
Cecum definition
Blind pouch of large intestine
Cecum lies in
right iliac fossa
Is cecum surrounded by peritonum
McBurneys point is located
at junction of lateral 1/3 of line between right anterior superior iliac spine and umbilicus
Mcburneys point is clinically significant because
its the point of max tenderness during appendicitis
Which organ is the largest organ and the body and largest gland
Is liver surrounded by peritoneum
Yes, except bare area
Liver is attached to diaphragm by ligaments - name them
Coronary and falciform
Left and right triangular
Blood supply of liver
Oxygenated blood from hepatic artery
Deoxygenated blood from portal vein
Venous blood of liver is drained by
Hepatic veins into IVC
Portal triad consists of
Portal vein
Hepatic artery
Bile duct
Right lobe of liver has two segments - name them
Anterior and posterior
Left lobe has two segments - name them
Medial and lateral
Superior medial part of left lobe is called
Caudate lobe
Inferior medial part of left lobe of liver is called
Quadrate lobe
Quadrate lobe of liver receives blood from?
Drains to?
Left hepatic artery and drains into left hepatic duct
Caudate lobe of liver receives blood from
Right and left hepatic arteries
Drains into right and left hepatic ducts
Liver cirrhosis causes
Portal hypertension
Portal hypertension results in
Esophageal varices (dilated veins in lower esophagus)
Hemoroids (dilated veins around anal canal)
Caput medusa (dilated veins around umbilicus)
Gallbladder is located
Junction of right ninth costal cartilage and lateral border of rectus abdominis
Gallbladder is in contact with
Dudodenum and transverse colon
Where is gallbladder located in respect to liver
Between right and quadrate lobes
Pancreas is located
FLoor of lesser sac
Is pancreas retroperitoneal
Yes, except for small portion of tail
If tumors are present in head of pancreas, what will clinical presentation be
Blood supply of pancreas
Branches of splenic artery
Superior and inferior pancreaticoduodenal arteries
What kind of gland in pancrease
Both endocrine and exocrine
Name two ducts of pancreas
Main and accesoory
What drains bile from liver
Right and left hepatic ducts
Righ and left hepatic ducts form
Common hepatic duct
What accompanies common hepatic duct
Proper hepatic artery+ portal vein
What is common site of impaction of gallstones
Cystic duct
Common bile duct is
Common hepatic + cystic ducts
Ampulla of Vater is
Common bile duct + main pancreatic duct opens into 2nd part of duodenum through papillae
Sphincter of Oddi
sphincter of ampulla of VAter
Is spleen a digestive organ
No, lymphatic organ
Location of spleen
Ribs 9-11
Ventral mesentery forms
Lesser omentum
Falciform, coronary and triangular ligaments of liver
Dorsal mesentery forms
Greater omentum, mesentery of small intestine, mesoappendix, transverse and sigmoid mesocolons
Celiac trunk arises from
Front of abdominal aorta immediately below aortic hiatus of diaphragm, between right and left crura
Celiac artery divides into
Left gastric, splenic and common hepatic arteries
Left gastric artery is
Smallest artery of celiac trunk
Left gastric artery has two branches - name them
Esophageal and hepatic
Left gastric artery runs within
lesser curvature of stomach
Largest branch of celiac trunk
SPlenic artery
Common hepatic artery gives rise to
Proper hepatic artery
Right gastric artery
Gastroduodenal artery
Proper hepatic artery gives rise to
right and left hepatic arteries
SMA arises from
Aorta behind neck of pancreas
Portal system
System of vessels in which blood collected from intestinal capillaries passes through portal vein and then through liver capillary sinusoids before reaching to IVC
Portal vein drains
abdominal part of gut
Portal vein is formed by
SMV + splenic vein
What kind of blood does portal vein carry
Deoxygenated contains nutrients
SMV accompanies
Aorta passes through aortic hiatus of diaphragm at level of
Where does aorta bifurcates in right and left common iliac arteries
IVC is formed
on right side of L5 by union of two common iliac veins
where does IVS pass through diaphragm
Subcostal nerve level

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