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Abdomen
IUSM Exam Block II
366
Anatomy
Professional
09/29/2013

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Term
transpyloric plane
Definition
in tic-tac-toe division of abdomen
divides top from center sections
marked where lateral border of rectus m. intersects the costal cartilage
Term
intertubercular plane
Definition
in tic-tac-toe division of abdomen
divides center from bottom sections
marked by iliac crests
Term
right hypochondriac section
Definition
in tic-tac-toe division of abdomen
upper right
Term
epigastric section
Definition
in tic-tac-toe division of abdomen
upper middle
Term
left hypochondriac section
Definition
in tic-tac-toe division of abdomen
upper left
Term
right lumbar section
Definition
in tic-tac-toe division of abdomen
right middle
Term
umbilical section
Definition
in tic-tac-toe division of abdomen
middle middle
Term
left lumbar section
Definition
in tic-tac-toe division of abdomen
middle left
Term
right inguinal section
Definition
in tic-tac-toe division of abdomen
lower right
Term
hypogastric section
Definition
in tic-tac-toe division of abdomen
lower middle
Term
left inguinal section
Definition
in tic-tac-toe division of abdomen
lower left
Term
portal vein
Definition
in porta hepatis
collects from GI tract and spleen
carries blood to liver
deep-ish in abdomen
Term
lateral thoracic vein
Definition
dumps to axillary -> subclavian -> brachiocephalic -> IVC
drains the serratus ant. and pec. major
Term
lumbar veins
Definition
dump directly to IVC
run along inside of posterior abdominal wall
lumbar equivalents of posterior interosseus vv.
Term
superficial epigastric vein
Definition
eventually goes to IVC
different path for L and R
Term
paraumbilical veins
Definition
follow falciform ligament in liver and extend onto anterior plexus
originates in portal vein
emerges through umbilicus
vv. in caput medusa
Term
caput medusae
Definition
liver disease leads to increased blood in the paraumbilical vv.
Term
lumbar arteries
Definition
located lower back region
parallel the intercostal aa.
usually four on each side
direct branches from aorta
Term
inferior epigastric artery
Definition
supplies rectus abdominis m.
branch of external iliac a.
anastomoses with superior epigastric a.
Term
superior epigastric artery
Definition
supplies rectus abdominis m.
one of the terminal branches of the internal thoracic a.
anastomoses with inferior epigastric a.
Term
subcostal nerve
Definition
ventral primary rami of T12
innervates transversus abdominis, internal obliques, rectus abdominis
sensory innervation to skin over hip
Term
iliohypogastric nerve
Definition
superior branch of L1 ventral primary rami
rectus abdominis, external oblique, internal oblique, transversus abdominis
sensory to skin below umbilicus
Term
ilioinguinal nerve
Definition
inferior branch of L2 VPR
transversus abdominis, internal oblique, rectus abdominis
passes through inguinal canal to provide sensation to genitalia
Term
false pelvis
Definition
pelvic region above the pelvic brim
Term
pelvic brim
Definition
pubic crest, pubic tubercle, pectineal line, arcuate line of ilium, sacral ala, sacral promentery
Term
ilum
Definition
uppermost and largest bone of the pelvis
Term
iliac crest
Definition
superior border of the wing of ilium, superolateral margin of greater pelvis
Term
anterior superior iliac spine (ASIS)
Definition
bony projection of the iliac bone
provides attachment for inguinal ligament
Term
arcuate line of the ilum
Definition
smooth rounded border on the internal surface of the ilum
Term
auricular surface
Definition
anterior surface on the ala of the ilium
articulates with sacrum
covered with cartilage
Term
pectineal line
Definition
ridge runs back onto ilium
contiguous with arcuate line of ilium
part of pelvic brim
Term
pubic tubercle
Definition
prominent forward-projecting tubercle on the upper, medial border of pubis
attachment point for inguinal ligament
Term
pubic crest
Definition
extends from pubic tubercle to the medial end of the pubis bone
attachment for inguinal falx and external obliques
Term
pubic ramus
Definition
part of the pubic bone
articulate with opposing pubic bone
Term
Camper's fascia
Definition
fatty layer
superficial layer of superficial fascia
Term
Scarpa's fascia
Definition
membranous layer
anterior deep layer of superficial fascia
can be seen on CT (thin, white line)
holds sutures
Term
Colle's fascia
Definition
membranous layer
posterior deep layer of superficial fascia
contiguous with Scarpa's
posterior and superior to scrotum
Term
superficial penile (clitoral) fascia
Definition
covers penis
contiguous with Scarpa's and Colle's
Term
Dartos fascia
Definition
covers scrotum
contiguous with Scarpa's and Colle's
contains smooth m. fibers
gives it the wrinkled look
Term
axillary lymph nodes
Definition
collections from everything above "watershed" line
also collects from testes
Term
superficial inguinal lymph nodes
Definition
collects from everything below "watershed" line
scrotum, penis, labia
[NOT TESTES]
Term
"watershed" line
Definition
T10, umbilicus
Term
iliolumbar ligament
Definition
transverse porcess of L5 to iliac crest
Term
anterior sacral ligament
Definition
anterior surface of lateral sacrum to the margin of auricular surface of ilium
enforces nearly motionless sacral-ilium joint
Term
pectineal ligament
Definition
aka Cooper's ligament
extension of lacunar ligament
runs on pectineal line of pubic bone
holds sutures
thickening of peritoneum
Term
superior pubic ligament
Definition
connects two pubic bones superiorly
extends laterally as far as pubic tubercles
very strong
Term
inguinal ligament
Definition
ASIS to pubic tubercle
free lower border of external oblique m.
opens inferiorly to form superficial inguinal ring
Term
lacunar ligament
Definition
connects inguinal ligament to pectineal ligament
Term
external oblique
Definition
origin: ribs 5-12
insert: linea alba, pubic tuberl, ASIS
most superficial muscle of anterolateral wall
lateral portion muscle, central/anterior portion tendon
lower border is the inguinal ligament
Term
linea alba
Definition
fibrous midline structure
xiphoid process to pubic symphysis
formed by fusion of aponeurosis of abdominal mm.
separates left and right abdominal muscles
Term
internal oblique
Definition
origin: thoracolumbar fascia, iliac crest, inguinal ligament
insert: ribs (costal cartilage), linea albo, pubic symphysis, pubic crest
flank m.
central, ant. inf. forms part of conjoing tendon
Term
conjoint tendon
Definition
joining of aponeurosis of internal oblique with transversus aponeurosis
fusion near anterior, inferior parasagital (near pubic symphysis)
Term
transversus abdominis
Definition
origin: thoracolumbar fasica, iliac crest, inguinal ligament, costal cartilages
insert: linea alba, pubic crest
tendon contains arcuate line of abdominal wall
contributes portion to conjoint tendon
Term
arcuate line of abdominal wall
Definition
1-2" below umbilicus in tendon of transversus abdominis m.
slit in aponeurosis allows rectus m. to pass P to A
Term
rectus abdominis
Definition
origin: pubis
insert: costal cartilage of ribs 5-7, xiphoid process of sternum
contains insertion fibers that divide the muscle into 4 or 5 bellies
Term
linea semilunaris
Definition
lateral border of rectus abdominis
Term
McBurney's point
Definition
2/3rds distance between umbilicus and ASIS
approximate position of appendix
Term
functions of abdominal mm.
Definition
stabilize trunk
provide flexion
lateral flexion
torsion
abdominal compression
Term
inguinal canal (general description)
Definition
tunnel, runs obliquely, connects superficial and deep inguinal rings
Term
contents of inguinal canal
Definition
ilioinguinal n. (L1 branch)
(M) spermatic cord
(F) round ligament of uterus
Term
deep inguinal ring
Definition
superior border of canal "entrance"
midway between ASIS and pubic tubercle
oval form, long axis vertically oriented
bounded transversalis fascia (above and lateral) and inferior epigastric vessels (below and medial)
Term
superficial inguinal ring
Definition
inferior border of canal, "exit"
triangular
is formed by a hole in aponeurosis of external oblique and crest of pubis
Term
intercrural fibers
Definition
located superiro to superficial ring of inguinal canal
prevents banana peeling of canal coverings
series of curved tendinous fibers
Term
lateral crus
Definition
lateral border of superficial inguinal ring
formed by portion of inguinal ligament
strong crus of superficial inguinal ring
ASIS is considered part of this
Term
medial crus
Definition
medial border of superficial inguinal ring
broad, thin, flay band
attaches to front of pubic symphysis
interlaces with lateral crus
Term
gubernaculum
Definition
attaches to caudal end of gonads (ovary or testes) and guide descent during development
Term
processus vaginalis
Definition
extension of peritoneum that helps push through the anterior wall to form spermatic cord
mostly degenerates, leaving behind tunica vaginalis
Term
tunica vaginalis
Definition
distal remnant of processus vaginalis
pouch of serous membrane
invests the anterior and lateral surfaces of the testis
Term
internal spermatic fascia
Definition
derived from transversalis fascia
formed during descent of testis during development
Term
cremasteric fascia
Definition
derived from internal oblique tendon
formed during descent of testis during development
Term
cremaster m.
Definition
derived from internal oblique muscle
can raise and lower scrotum
formed during descent of testis during development
Term
external spermatic fascia
Definition
derived from external oblique tendon
formed during descent of testis during development
Term
Hesselbach's triangle
Definition
lateral border of rectus abdominis
inguinal ligament
inferior epigastric artery
Term
cryptochridism
Definition
usdescened testes at puberty
low androgen level
4% full term males
30% premature males
Term
hydroceles
Definition
accumulation of serous fluid around one or both testis
within tunica vaginals or processus vaginalis
Term
congenital hydrocele
Definition
processus vaginalis does not degenerate and remains open to superior peritoneum
Term
funicular hydrocele
Definition
cells in processus vaginalis reactivate and create a cyst between testis and above peritoneum
Term
vaginal hydrocele
Definition
tunica vaginalis over excretes serous fluid and creates a cyst near the testes
Term
indirect inguinal hernia
Definition
intestines come through when congenital hydrocele present
enteres through deep ring (lateral to Hesselbach's triangle)
can proceed all the way thru canal to scrotum or labium majora
Term
direct inguinal hernia
Definition
enters inside of Hesselbach's triagle
medial to epigastric artery
failure of conjoint tendon
Term
round ligament of ovary
Definition
remnant gubernaculum between ovary and uterus
Term
round ligament of uterus
Definition
remnant gubernaculum between uterus and external genitalia
Term
Canal of Nuck
Definition
when processus vaginalis does not properly degenerate in female
Term
epididymis
Definition
single, narrow, tightly-coiled tube connecting efferent ductules from the rear of each testicle to its vas deferns
Term
testis
Definition
male gonad
homolog of ovary
Term
head of epididymis
Definition
receives spermatozoa via efferent ducts of the mediastinum testis
thin myoepithelium
Term
tail of epididymis
Definition
thicker myoepithelium than head region
involved in absorbing fluid to make sperm more concentrated
Term
vas deferens
Definition
transport sperm from epididymis in anticipation of ejactulation
Term
aberrant ductules
Definition
blind-ended sacs from epididymis
expect 3-4 normal
function unknown
Term
efferent ductules
Definition
10 to 20
transmit sperm from rete testis to epididymis
Term
lobules of testis
Definition
organized seminiferous tubules (2-300)
glandular structure of testis
conical in shape
Term
mediastinum testis
Definition
network of fibrous connective tissue that extends from the upper to near lower extremity of the testis
Term
septae of testis
Definition
extensions of the tunica albuginea
separate the lobules
Term
tunica albuginia
Definition
tough covering of testis, white in color
give rise to the mediastinum testes and septae
Term
rete testis
Definition
network of delicate tubles located in the mediastinum testis
carries sperm form seminiferous tubules to the efferent ductules
Term
seminiferous tubules
Definition
site of meiosis and creation of gametes
contain Sertoli cells
Term
spermatozoa
Definition
gamete, initial sperm
Term
Sertoli cells
Definition
tall, columnar, cells line line the seminiferous tubules
Term
genital branch
Definition
of genitofemoral nerve
L1, L2 origins
motor to cremaster m.
Term
artery of the vas
Definition
branch of inferior vesical a.
supplies the vas deferens
Term
cremasteric a.
Definition
branch from inferior epigastric a.
supplies cremaster m.
Term
paniform plexus
Definition
network of small veins in spermatic cord
drains testis in male and ovaries in female
rises up cord --> testicular a (ovarian a.) --> IVC
Term
spermatoceles
Definition
caused by cysts in rete testis, efferent ductules and head of epididymis
cysts are distended with milkly fluid that contains sperm
asymptomatic except when large, causing testicular discomfort
can be transilluminated
Causes: epididymitis (infection), tubule diverticula that swell over tiem from spermatogenesis
Term
testicular variococeles
Definition
reduced venous return from testes via pandiform plexus
results in the enlargement of veins (looks and feels like bag of worms)
most common on left
usually develops slowly
usually no symptoms
common cause of infertility
Term
testicular torsion
Definition
spermatic cord gets twisted around the blood vessels, cutting of testicular bloody supply
mostly 12-18 y/o
usually sports injury related --> causes creamster m. to spasm
immediate paig
requires immediate treatment to save testis
Tx: untwist and suture to scrotal wall to prevent recurrence
Term
testes and epididymis lymph drainage
Definition
drain to lumbar lymph nodes
(special exception)
Term
peritoneum
Definition
membrane that forms the lining of the abdominal cavity or the intra-abdominal organ
composed of mesothelium and supported by connective tissue
supports abdominal organs and serves as conduit for blood and lymph vessels and nerves
Term
visceral peritoneum
Definition
completely invests and organ
Term
parietal peritoneum
Definition
lines the abdominal cavity
includes mesenteries, ligaments, coverings of retroperitoneal organs, and abdominal walls
Term
omentum
Definition
fold of peritoneum connecting stomach with other abdominal organs
Term
greater omentum
Definition
anterior covering of abdomen proper
attaches to greater curvature of stomach and transverse colon
consists of 4 layers
policeman of abdomen
Term
lesser omentum
Definition
connects lesser curvature of stomach to hepatis portis of liver
made by joining of hepatogastric ligament and hepatoduodenal ligament
has opening for greater/lesser sac communication
Term
mesentery
Definition
fold of peritoneum that attaches an intra-abdominal organ to the posterior wall of the abdomen
Term
peritoneal ligament
Definition
double layer of peritoneum connects a organ to another organ or to the abdominal wall
Term
falciform ligament
Definition
from liver to anterior abdominal wall
separates right and lift anatomic lobes of liver
Term
hepatogastric ligament
Definition
from lesser curvature of stomach to liver
portion of the lesser omentum
Term
hepatoduodenal ligament
Definition
from liver to first part of duodenum
is the right, thickened part of the lesser omentum
contains portal triad
Term
portal triad
Definition
portal vein, hepatic artery, bile duct
Term
gastrophrenic ligament
Definition
from stomach to inferior diaphragmatic surface
Term
gastrolienal ligament
Definition
from stomach to hilum of spleen
Term
gastrocolic ligament
Definition
from stomach, as greater omentum, to transverse colon
Term
splenorenal (leinorenal) ligament
Definition
from spleen to left kidney
Term
phrenicoccolic ligament
Definition
from left flexure of transverse colon to diaphragm
Term
lesser sac
Definition
Term
greater sac
Definition
main peritoneal cavity
Term
intraperitoneal organs
Definition
covered all the way (or almost) by peritoneum layer
Term
retroperitoneal organs
Definition
covered only on one side by periotoneum layer
Term
foramen of Winslow
Definition
opening between lesser sac and greater sac in the lesser omentum
aka epiploic foramen
Term
median fold
Definition
houses median umbilical ligament
urachus remnant
Term
urachus
Definition
primitive bladder during gestation
Term
medial folds
Definition
house obliterated umbilical arteries
Term
lateral folds
Definition
houses inferior epigastric vessels
Term
celiac trunk
Definition
comes off the aorta 1cm below diaphragm
T12 level
largest diameter of aorta branches
Term
left gastric artery
Definition
branch of celiac trunk
supplies superior lesser curvature of stomach
gives off esophageal arteries
Term
esophageal arteries
Definition
branches of left gastric artery
supplies distal esophagus
Term
splenic artery
Definition
branch of celiac trunk
runs along top of pancreas
very tortuous
gives off dorsal and great pancreatic arteries, short gastric aa, and left gastroepiploic arter
Term
dorsal pancreatic artery
Definition
branch of splenic artery
supplies body and tail of pancreas
anastomoses with superior pancreaticoduodenal arteries and inferior pancreatic artery
Term
great pancreatic artery
Definition
branch of splenic artery
supplies body and tail of pancreas
anatomoses with inferior pancreatic artery and caudal pancreatic artery
Term
short gastric arteries
Definition
branch of splenic artery
supply fundus of stomach
Term
left gastroepiploic artery
Definition
branch of splenic artery
Aka left gastro-omental artery
supplies greater curvature of stomach
Term
common hepatic artery
Definition
branch of celiac trunk
gives off gastroduodenal artery then becomes the proper hepatic artery
Term
gastroduodenal artery
Definition
branch off the common hepatic artery
gives off superior pancreaticoduodenal artery, retroduodenal artery, and right gastroepiploic artery
Term
superior pancreaticoduodenal artery
Definition
branch of gastroduodenal artery
has anterior and posterior branches
supplies most of duodenum and pancreas
Term
retroduodenal artery
Definition
aka supraduodenal artery
branch of gastroduodenal artery
supplies duodenum
Term
right gastroepiploic artery
Definition
branch of gastroduodenal
aka right gastro-omental artery
supplies greater curvature on right side
Term
proper hepatic artery
Definition
continuation of common hepatic artery after giving off gastroduodenal a.
gives rise to right gastric artery, right hepatic artery and left hepatic artery
Term
right gastric artery
Definition
branch of proper hepatic artery
much smaller than left gastric artery
runs in greater omentum to supply lesser curvature of the stomach
Term
right hepatic artery
Definition
branch of proper hepatic artery
gives rise to cystic artery
supplies right physiologica lobe of liver
Term
cystic artery
Definition
branch of right hepatic artery
supplies the gallbladder
Term
left hepatic artery
Definition
branch of proper hepatic artery
supplies left physiologica lobe of liver
Term
cardiac notch (of stomach)
Definition
junction of esophagus and fundus
Term
cardium (of stomach)
Definition
initial stomach area where esophagus enters
Term
lesser curvature
Definition
small curve of stomach on right side
Term
pyloric sphincter
Definition
circular smooth m. sphincter between stomach and duodenum
regulates chyme flow
Term
pylorus (of stomach)
Definition
inferior, distal portion of stomach
divided from body by the angular incisure line
Term
fundus (of stomach)
Definition
dome-shaped part of stomach
superior, proximal
separated from body by the cardiac notch line
Term
body (of stomach)
Definition
middle part of stomach
marked inferiorly by angular incisure and superiorly by cardiac notch
Term
pyloric canal
Definition
opening between stomach and duodenum
Term
angular incisure
Definition
small notch on stomach on lesser curvature near pyloric end
Term
intermediate sulcus
Definition
dimple on greater curvature
1/2 the way of pyloric canal
Term
pyloric antrum
Definition
intial pyloric part of stomach, proximal to pyloric sphincter
Term
rugae
Definition
convoluted topography of stomach
folds in mucosal layer
increases SA for increased secretion
Term
greater curvature
Definition
larger curve of stomach on the left side
Term
peptic ulcers
Definition
lesion on the lining of the stomach or duodenum
abdominal (epigastric) pain, nausea, vomiting
Term
H. pylorus infection
Definition
common cause of peptic ulcers
secretes enzymes that neutralize acid
ammonia by-product and bacterial cytokines kill epithelial lining
Term
esophagus
Definition
pearly, pink surface
Term
phrenico-esophageal ligament
Definition
keeps esophagus and stomach junction in same plane as diaphragm
Term
Z-line
Definition
esophagus and stomach junction; phrenico-esophageal ligament
Term
lower esophageal sphincter (LES)
Definition
physiologic, not anatomic
failure of sphincter associated with heart burn
no muscles
open and closes by diaphragm movement and stomach pressure
Term
rolling hiatal hernia
Definition
part of stomach herniates out of gastroesophageal junction
due to failure of phrenico-esophageal ligament
medical emergency
Term
sliding hiatal hernia
Definition
failure of phrenico-esophageal ligament
gastroesophageal junction rises just above diaphragm
results in LES not closing properly and acid in the esophagus
not a medical emergency
Term
duodenal cap
Definition
superior, 1st part of duodenum
Term
lesser duodenal papilla
Definition
injection port for pancreatic juices into duodenum
located in 2nd part of duodenum
Term
descending part (of duodenum)
Definition
2nd part of duodenum
Term
greater duodenal papilla
Definition
injection port for bile and pancreatic juices
located in second part of duodenum
Term
horizontal part (of duodenum)
Definition
3rd portion of duodenum
Term
ascending part (of duodenum)
Definition
4th portion of duodenum
Term
duodenal-jejunal flexure
Definition
made by tension in suspensory ligament of duodenum
part of ascending duodenum
Term
ligament of Treitz
Definition
aka suspensory ligament of duodenum
marks juction of duodenum and jejunum
tension causes the duodenal-jejunal flexure
contains skeletal m. (diaphragm), peritoneum (posterior wall), and smooth m. (gut tube)
Term
common bile duct
Definition
courses down from gallbladder & liver through the head of pancrease
merges with main pancreatic duct
travels with MPD to greater duodenal papilla
part of the portal triad
Term
main/chief pancreatic duct
Definition
run through body and tail, dives inferior at head into uncinate process
joints with common bile duct to drain into greater duodenal papilla
Term
uncinate process
Definition
derivative of ventral pancreas during development
inferior-most portion of pancreas
Term
head (of pancreas)
Definition
right-most superior portion of pancreas
Term
body (of pancreas)
Definition
middle superior portion of pancreas
Term
tail (of pancreas)
Definition
left-most superior portion of pancreas
Term
accessory pancreatic duct
Definition
branches off of main pancreatic duct at junction of head and body
drains to the lesser duodenal papilla
Term
exocrine function of pancreas
Definition
secretion of digestive enzymes into gut
Term
endocrine function of pancreas
Definition
secretion of insulin and glucagon into blood stream
Term
caudal pancreatic arter
Definition
supplies tail of pancreas
anastomoses with great pancreatic a. and inferior pancreatic a.
Term
inferior pancreatic artery
Definition
supplies body of pancreas
anastomoses with dorsal, great, and caudal pancreatic aa.
Term
anular pancreas
Definition
ventral migration of ventral pancreatic bud during development (pancreas surrounds duodenum)
can results in duodenal stenosis (obstruction via constriction)
fix: surgery to free duodenum
Term
Roux-En-Y surgery
Definition
disconnect digestive tract after cardium of gomach
reattach lower to jejunum to maintain food flow, but bypas stomach to decrease caloric intake
attach lower duodenum into lower jejunum to maintain enzymatic juice flow
Term
Whipple surgery
Definition
removal of part of pancreas, the duodenum, and the gallbladder
attach remaining pancreas to start of jejunum to maintain enzyme flow
attach pyloric region of stomach to part of jejunum to maintain food flow
attach common bile duct to jejunum to maintain bile flow
Term
gallbladder
Definition
smooth muscle bag
stores and secretes bile on demand
bile helps with fat metabolism
contracts to secrete bile
Term
cystic duct
Definition
bile duct between gallbladder and common bile duct
has spiral folds
Term
fundus (of gallbaldder)
Definition
part of gallbladder
bulb shape, points anteriorly
Term
hepatopancreatic ampulla (vater)
Definition
place of mixing for bile and pancreatic juice before entering the graat duodenal papilla
Term
sphincter of Oddi
Definition
surrounds hepatopancreatic ampulla
regulates flow of pancreatic juices and bile into duodenum
Term
right and left hepatic duct
Definition
drain bile from liver respective physiolgic lobes to the common bile duct
Term
choledochal sphincter
Definition
sphincter of bile duct
regulates flow of bile into ampulla
Term
Triangle of Calot
Definition
later: cystic duct
medial: common bile duct
superior: liver
contains: right hepatic artery, cystic artery
Term
cystic artery branch off
Definition
75% right hepatic, posterior to bile duct
13% right hepatic, anterior to bile duct
6% left hepatic, anterior to bile duct
2.5% gastroduoneal, anterior to bile duct
2% proper hepatic, anterior to bile duct
Term
cholesterol gallstones
Definition
white to yellow
too much cholesterol/unit detergent
undissolved and clumped cholesterol
Term
pigment gallstones
Definition
brown to black
bilirubin build up and combine with other bile components
Term
right anatomic lobe of liver
Definition
right of falciform ligament
Term
left anatomic lobe of liver
Definition
left of flaciform ligament
Term
caudate anatomic lobe of liver
Definition
posterior and superior
Term
quadrate anatomic lobe of liver
Definition
posterior and inferior
Term
left physiologic lobe of liver
Definition
left anatomic lobe + caudate + quadrate
Term
right physiologica lobe of liver
Definition
right anatomic lobe - caudate - quadrate
Term
coronary ligament
Definition
single layer of peritoneum that reflects off the surface of the diaphragm to cover superior liver
Term
falciform ligament
Definition
joining of coronary ligaments to form double layer of peritoneum and divides the right and left anatomical lobes
Term
right triangular ligament
Definition
extension of the coronary ligament that comes to a point on the right, superior part of the liver
Term
left triangular ligament
Definition
extension of the coronary ligament that comes to a point on the left, superior part of the liver
Term
round ligament of the liver
Definition
remnant of fetal umbilical vein
degenerative piece of ligament that extends from the free end of the falciform ligament
Term
ligamentum venosum
Definition
remnant of ductus venosum that bypassed liver during fetal development
usually attached to left branch of portal vein within the porta hepatis
Term
hepatic veins
Definition
right, middle, left
drain directly to IVC
hold liver and IVC close
Term
superior mesenteric vein
Definition
joins to splenic v. to form the portal v.
drains blood from small intestines
Term
inferior mesenteric vein
Definition
variable in placement and drainage entrance to portal system
drains blood from large intestines
Term
splenic vein
Definition
joins with SMV to form portal v.
drains blood from the spleen
Term
portal vein
Definition
board and short, 3" long
where splenic and SMV meet
intersegmentally supplies functional segments of the liver
Term
cirrhosis
(define)
Definition
disorder of the structure of the liver from continuing liver damage over a prolonged period of time
can cause blockage of portal system backup
Term
causes of cirrhosis
Definition
alcholism, prolong hepatitis (B,C,D) infection, autoimmune liver disease, excess iron, obesity
Term
clinical signs of cirrhosis
(reroutes)
Definition
reroute to left gastric v --> esophageal varices
reroute to paraumbilical vv --> caput medusae
reroute to superior rectal v. --> internal hemroids
Term
spleen
Definition
largest lymphatic organ
eliminates senescent and damaged cells from circulation
filters antigens in blood
posterior, under rib cage, T10 ICS
Term
superior mesenteric artery
Definition
supplies midgut derivatives
comes off aorta about 1cm below CT
found near pancreas and duodenal felxure
gives rise to inferior pancreaticoduodenal artery, middle colic artery, right colic artery, ileocolic artery, and intestinal arteries
Term
inferior pancreaticoduodenal artery
Definition
branch of SMA
anterior and posterior branches
anatomoses with superior pancreaticoduodenal aa.
supplies head of pancrease and part of duodenum
Term
middle colic artery
Definition
branch of SMA
supplies majority of transverse colon
Term
right colic artery
Definition
branch of SMA
supplies most of ascending colon
Term
ileocolic artery
Definition
branch of SMA
supplies inferior portion of ascending colon and cecum via branches
give rise to colic branch and ileocecal branch
Term
colic branch
Definition
branch of ileocolic artery
supplies lower ascending colon
Term
ileocecal branch
Definition
branch of ileocococic artery
supplies cecum and appendix via branches
give rise to cecal arteries and appendicular artery
Term
cecal arteries
Definition
branch of ileocecal branch
anterior and posterior branches
supply the cecum
Term
appendicular artery
Definition
branch of ileocecal branch
supplies the appendix
Term
intestinal arters
Definition
aka jejunal and ileal arteries
branches of the SMA
supply jejunum and ileum via arcades and vasa recta
Term
arterial arcades
Definition
loops of arteries around jejunum and ileum from the SMA
less in number in jejunum and more in ileum area
Term
vasa recta
Definition
straight arteries coming from arterial arcades in the mensentery of the jejunum and ileum
longer in jujunal area than in ileal area
Term
marginal artery
Definition
aka artery of Drummond
anastomotic network through branches of SMA and IMA
Term
SMA nutcracker
Definition
aneurysm of SMA
obstruction of duodenum and left renal vein
resect ligament of Treitz frees the duodenum
Term
jejunum (characteristics)
Definition
few tiers of arterial arcades
long vasa recta
greater vascularity in intestinal wall
more plicae ciculares (circular folds)
thicker wall
fewer Peyer's patches
Term
ileum (characteristics)
Definition
multiple tiers of arterial arcades
short vasa recta
less vascularity in intestinal wall
fewer plicae circulares
thinner wall
more Peyer's patches
Term
Peyer's patches
Definition
organized lymphoid nodules
Term
Meckel's diverticulum
Definition
persistenc of vitelline duct (yolk sac)
fibrous cord extends from intestinal wall
Rule of 2's
Term
Rule of 2's
Definition
rule for Meckel's Diverticulum
2% of population
2ft from ileocecal junction (in ileum)
2" long
2 times as likely in male
Term
incompletely obliterated vitelline stock
Definition
tether's intestinal wall to abdominal wall
fibrous band remnant
causes volvulus if the intestine moves around and gets twisted around the band
Term
umbilical fistula
Definition
peristence of vitelline duct that is opening between intestines and abdominal wall
potential for intestinal contents or intestine themselves to come out of umbilicus
Term
cyst in vitelline duct
Definition
persistance of vitellien duct that secretes serous fulid into sac
felt as a lump
painful
cyst is between intestinal wall and abdominal wall
Term
semilunar folds
Definition
small conttrictions along large intestine that form the haustrae
Term
haustrae
Definition
series of saculations or outpouchings seen from outside of colon
Term
epiplic appendages
Definition
fat encasing the peritoneum of the large intestines
Term
tenia coli
Definition
longitudinal smooth muscels
gathered into three strips
go along length of colon
merge at appendix
Term
cecum
Definition
beginning of large intestine
Term
ileocecal valve
Definition
papillose with sphincter muscle situated at junction of small and large intestines
Term
fenulum
Definition
fold, running from the junction of the two commissure of the ileocecal valve on either side along the inner wall of ileocecal junction
Term
mesoappendix
Definition
portion of the mesentery connecting appendix to ileum
Term
appendix
Definition
blind-end sace connected to cecum
5-20cm in length
lymphatic structure
variable postioning
Term
frequency of appendix locations
Definition
64% retrocecal
32% pelvic
2% lateral
1% medial
0.5% retroileal
Term
appendicitis
Definition
inflammation/infection of the appendix
begins as dull, visceral pain in umbilcal region
rupture results in sharp, well-localized, somatic pain adjacent to appenix
Term
Obturator Test
Definition
test for appendicitis of a pelvic appendix
supine position, flex hip and knee 90*
examiner internally rotates femur, patients tries to resist
if pain --> appendicitis
Term
Psoas Test
Definition
test for appendicits in retrocecal appendix
lay on left side, examiner hyperextends hip
stretches psoas muscle
if pain --> appendicitis
Term
intussusception
Definition
"telescoping intestine"
intestine folds in on itsefl
common at ileocecal junction
results in obstructed bowel and compromised blood supply
95% in children
requires surgical treatment (usually)
Term
volvulus
Definition
twisting of intestine upon itself
midgut twisting = children (malrotation during development)
hingut twisting = adult (hypermobility of sigmoid colon with age)
Term
inferior mesenteric artery
Definition
contained within mesentery
comes off about 4" below SMA
direct branch of abdominal aorta
gives rise to left colic artery, sigmoid arteries, rectosigmoid arteries, and superior rectal artery
Term
left colic artery
Definition
branch of IMA
has an accompanying ascending branch
supplies most of descending colon
Term
sigmoid arteries
Definition
branches off the IMA
3-5
supply part of descending colon and sigmoid colon
Term
rectosigmoid arteries
Definition
branches of the IMA
3-4
supply part of sigmoid colon and rectum
Term
superior rectal artery
Definition
continuation of IMA after giving off sigmoid arteries
supplies the rectum
Term
diverticulosis
Definition
ballooning or herniation of the circular smooth muscles along the colon
Term
diverticulitis
Definition
infection and inflammation of herniation of the circular smooth muscles along the colon
results of a poor diet (low in fiber)
chyme dehydration --> hardder --> poop rocks --> shoved up against wall
poop rocks can be surgically removed
50% of patients over 60
Term
intestinal polyps
Definition
symptoms: rectal bleeding, constipation or diarrhea (more than week), blood in stool
sessile worse than pedunculated
large worse than small
Term
pedunculated polyps
Definition
polyp on stem or stalk
Term
sessile polysp
Definition
polyps grow directly on colon wall
spilled paint appearance
Term
paracolic gutters
Definition
pathways from pelvis to upper abdomen on sides of the ascending and descending colons
Term
white line of Toldt
Definition
lateral paracolic gutters as seen on CT
Term
vagus nerve (role in abdomen)
Definition
parasympathetic
cranial nerve X
innervates foregut and midgut derivatives
Term
foregut derivatives
(list, blood supply, APS nerve, lymph drainage)
Definition
esophagus, stomach, duodenum (prox. 1/2), liver, gallbladder, pancreas, spleen
supplies by celiac trunk
innervated by vagus nerve
lymph drainage to celiac nodes
Term
midgut derivatives
(list, blood supply, APS nerve, lymph drainage)
Definition
duodenum (distal 1/2), jejunum, ileum, cecum, appendix, ascending colon, hepatic flexure, transverse colon (prox. 2/3)
SMA blood supply
vagus nerve
lymph drain to superior mesenteric nodes
Term
hindgut derivatives
(list, blood supply, APS nerve, lymph drainage)
Definition
transverse colon (dist. 1/3), splenic flexure, descending colon, sigmoid colon, rectum
IMA blood supply
innervated by pelvic splanchnics
lymph drainto chyle cistern
Term
pelvic splanchnic (role in abdomen)
Definition
parasympathetic
S2, S3, S4
innervates hindgut derivatives
Term
Myenteric (Auerbach's) plexus
Definition
parasympathetic ganglion cell network
located between circular and longitudinal muscle layers of colon
Term
submucosal (Meissner's) plexus
Definition
parasympathetic ganglion cell network
located just beneath muscularis mucosa in colon
Term
Hischsprung's disease
Definition
lack of Auerbach's or Meissener's plexuses
usually congenital; can be acquired
lack of parasym input --> don't move stuff along --> causes swelling upstream
Tx: resection of portion w/o parasym input
Term
sternal portion of diaphragm
Definition
small left and right strips that arise form the posterior surface of the xiphoid process
Term
costal portion of diaphragm
Definition
consists of six slips that arise from rib 7 to rib 12 and their costal cartilages
Term
central tendon of diaphragm
Definition
insertion point of diaphragm, shaped like three leaves
partially fused with pericardium superiorly
Term
lumbar portion of diaphragm
Definition
arises by means of vertical columns and from arcuate ligaments
Term
lumbocostal trigone
Definition
window into costodiaphragmatic recess
kidneys sit anterior to this
if puncture wound here, could casue pneumothorax
Term
medial arcuate ligament
Definition
free inferior border of diaphragm
L1 body to L1 transverse process
Term
lateral arcuate ligament
Definition
free inferior border of diaphragm
L1 transverse process to rib 12 tip
Term
right and left crura
Definition
sling up and around esophagus down around aorta (continuous)
gives rise to skeletal m. in ligament of Treitz
Right: L1-L3
Left: L1-L2
Term
caval aperture
Definition
opening in diaphragm
IVC passes through
usually in part of central tendon
at the T8 level
Term
esophageal aperture
Definition
opening in the diaphragm
esophagus and vagal trunks pass through
lower esophageal sphincter
at T10 level
Term
aortic hiatus
Definition
opening in diaphragm
aorta and thoracic duct pass through
posterior wall = T12 vertebra
Term
inferior phrenic arteresi
Definition
supply inferior surface of diaphragm
branches off the aorta
Term
iliacus
Definition
origin: internal iium
insert: lesser trochanter of femur
nerve: femoral n. branches (L2, L3)
action: hip flexion
joins with psoas at pubic ramus to form iliopsoas m.
Term
psoas major
Definition
origin: lumbar vertebrae bodies, discs, and transverse processes
insert: lesser trochanter of femur
nerve: femoral n. branches (L2, L3)
joins with iliacus at pubic ramus to form the iliopsoas m.
Term
iliopsoas
Definition
formed by joining of iliacus and psoas major m.
Term
quadratus lumborum
Definition
origin: rib 12, lumbar vertebrae transverse processes
nervE: subcostal, iliohypogastric, ilioinguinal, and L2,L3 VPR
action: lateral flex (unilateral), spine extension (bilateral)
Term
lumbar plexus
Definition
somatic innervation
sits in psoas major
VPR of T12-L5
innervates lower limb and inguinal region
Term
sucostal nerve
Definition
VPR T12
part of lumbar plexus
innervates flank mm.
innervates skin on lower abdominal wall
Term
iliohypogastric nerve
Definition
VPR L1
part of lumbar plexus
innervates flank mm.
innervates skin to inguinal region
Term
ilioinguinal nerve
Definition
VPR L1
part of lumbar plexus
innervates flank mm.
innervates skin around scrotum/labia majora
enters inguinal canal, but not at deep ring
Term
genitofemoral nerve
Definition
VPR of L1, L2
part of lumbar plexus
genital and femoral branches
Term
genital branch of genitofemoral nerve
Definition
VPR L1, L2
part of lumbar plexus
innervates cremaster m.
Term
femoral branch of genitofemoral nerve
Definition
VPR L1, L2
part of lumbar plexus
innervates skin on lateral thigh
just deep to psoas then heads straing for ASIS
Term
femoral nerve
Definition
VPR of L3, L4
part of lumbar plexus
knee extension/hip flexion
innervates skin on anterolateral thigh and medial leg
very thick; find at lateral border of psoas
Term
obturator nerve
Definition
VPR L2-L4
part of lumbar plexus
innervates thigh adductors
innervates skin on medial thigh
Term
lumbosacral trunk
Definition
VPR L4, L5
part of lumbar plexus
contributes to sacral plexus (mainly sciatic)
connects lumbar and sacral plexuses
Term
cremasteric reflex
Definition
stroking skin on medial side of the thigh niext to scrotum (femoral branch)
stimulates motor fibors of genital branch
results in contraction of cremaster on ipsilateral side
testis rises
mainly a pediatric test
Term
somatic distribution of sympathetic innervation
Definition
synapse in sympathetic chain (paravertebral ganglia) at level from which they will exit
Term
visceral distribution of sympathetic innervation
Definition
enter and exit sympathetic chain without synapsing
emerge from gray ramus as splanchnic contribution
synapse in collateral (prevertebral ganglia) along arteries that supply the same region
Term
greater splanchnic nerve
Definition
originates from T5-T9
visceral sympathetic innervation
synapses at celiac ganglia
innervates same organs as celiac trunk supplies
(some branches to SMG)
Term
celiac ganglia
Definition
visceral sympathetic innervation
synapse site for greater splanchnic nerve
located at base of celiac trunk
Term
lesser splanchnic nerve
Definition
visceral sympathetic innervation
originates from T10-T11
synapses at aorticorenal ganglia
innervates kidneys
(some branches to SMG)
Term
aorticorenal ganglia
Definition
visceral sympathetic innervation
synapse site for lesser splanchnic nerve
found at base of renal aa.
Term
least splanchnic nerve
Definition
visceral sympathetic innervation
originates from T12
synapses at superior mesenteric ganglia
Term
superior mesenteric ganglia
Definition
visceral sympathetic innervation
at the root of SMA
synapse site for least splanchnic nerve
and some branches from greater and lesser splanchnics
Term
lumbar splanchnic nerve
Definition
visceral sympathetic innervation
originates form L1-L2
synapses at inferior mesenteric ganglia
innervates smooth m and glands of pelvic viscera and hindgut
Term
inferior mesenteric ganglia
Definition
visceral sympathetic innervation
located at base of IMA
synapse site for lumbar splanchnic nerve
Term
referred pain from gallbladder
Definition
superior right shoulder
Term
referred pain from liver/gallbladder
Definition
right abdomen, transpyloric plane
Term
referred pain from stomach
Definition
left abdomen, transpyloric plane
Term
referred pain from small intestine
Definition
umbilicus region
Term
referred pain from large instestine
Definition
hypogastric region
Term
referred pain from pancreas
Definition
epigastric/umbilical region, same area on posterior
Term
referred pain from bladder
Definition
pubic region
Term
referred pain from kideny
Definition
lumbar/inguinal regions, similar area on posterior
Term
referred pain from ureter
Definition
lower inguinal regiosn to pelvic laterally
Term
hilum of kidney
Definition
entry to recess of kidney
Term
fibrous (renal) capsule
Definition
tough fibrous layer surrounding the kideny
Term
renal fascia
Definition
anterior and posterior sections
layer of connective tissue encapsulating the kidneys and suprarenal glands
Term
parareanl fat
Definition
collection of adipose tissue located superficial to the renal fascia
Term
perirenal fat
Definition
structure between renal fascia and renal capsules
Term
renal sinus
Definition
cavity withing the kidney
contains renal pelvis, renal calyces, blood vessels, nerves, and fat
Term
renal cortex
Definition
made of glomeruli and convoluted portions of the renal tubules
external layer of parenchyma
surrounds the medulla
gives rise to renal columns
Term
renal columns
Definition
extensions of renal cortex
separate pyramids of medulla
Term
renal medulla
Definition
inner layer of kidney parenchyma
descending and ascending limbs of renal tubules, collecting tubules organized into several pyramids
Term
renal pyramids
Definition
consist of ascending and descending limbs of renal tubules and collecting tubules
have openings into calyces
Term
renal papillae
Definition
opening of pyramids into calyces
transmit urine out of pyramids
Term
minor calyces
Definition
opening just outside of pyramids and papillae
join to form major calyces
Term
major clyces
Definition
formed by junction of smaller minor calyces
join to form renal pelvis
Term
renal pelvis
Definition
funnel-like dilated proximal part of the ureter in kidney
formed by joining of major calyces
Term
ureter
Definition
tube made of smooth muscle
propel urine from kidneys to urinary bladder
Term
calyceal fornix
Definition
recess around papilla of each renal pyramid
Term
sphincter fornicis
Definition
thickened smooth m. at the base of fornix
Term
sphincter calicis
Definition
thickened smooth m. at base of calyx
Term
sphincter pelvicis
Definition
thickened smooth m. at base of renal pelvis
Term
3 constrictions of ureter
Definition
renal pelvis-ureter junction
pelvic brim
entry to bladder
Term
kidney stones
Definition
nephrolithiasis
form hardened mineral deposits in kidny
asymptomatic until they become lodged
Term
horseshoe kidney
Definition
spans the abdomen from side to side
not two separate kidneys
functions normal
1/500 people
Term
Brodel's line
Definition
important surgical plane for procedures
avascular zone of kidney
cutting here minimizes bleeding
Term
pelvic kidney
Definition
kidney fails to migrate up during development
functions normal
also a common place for transplanted kidneys
Term
adrenal cortex
Definition
secretes corticosteroids and androgens
Term
adrenal medulla
Definition
secretes adrenaline
Term
superior suprarenal a.
Definition
branch of the inferior phrenic a.
supplies suprarenal gland
Term
middle suprarenal a.
Definition
branch of the aorta
supplies the suprarenal gland
Term
suprarenal vv.
Definition
drain the suprarenal glands
right side drains to IVC
left side drains to left renal v. or left inferior phrenic v.
Term
cisterna chyli
Definition
lymph duct dilation
collects from intestinal trunk, righ tan dleft lumbar trunks
Term
intestinal lymph trunk
Definition
contains celiac nodes and superior mesenteric nodes
dumps to cisterna chyli
Term
celiac lymph nodes
Definition
collect from stomach, spleen, duodenum, liver, gallbladder, and pancreas
located at base of celiac trunk on aorta
Term
superior mesenteric lymph nodes
Definition
collect from jejunum, ileum, appendix, cecum, ascending colon, right flexure, part of transverse colon
located at base of SMA on aorta
Term
right lumbar lymph trunk
Definition
contains the right lumbar nodes
dumps to cisterna chyli
Term
right lumbar lymph nodes
Definition
drains testis, kidney, suprarenal gland, and ovary
located inferior to right renal a.
Term
left lumbar lymph trunk
Definition
contains the inferior mesenteric nodes and the left lumbar nodes
dumps to cisterna chyli
Term
inferior mesenteric lymph nodes
Definition
drains part of transverse colon, left flexure, descending colon, sigmoid colon, and rectum
located at base of IMA on aorta
Term
left lumbar lymph nodes
Definition
drain testis, kidney, suprarenal gland and ovary
located inferior to left renal a.
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