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Anatomy - The abdomen
N/A
222
Anatomy
Graduate
02/22/2011

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Cards

Term
Contents of which quadrant of the abdomen?
right lobe of liver, gallbaldder, pylorus of stomach, duodenem, head of pancreas, right suprarenal gland, right kidney, right colic flexure, superior ascending colon, right transverse colon
Definition
right upper quadrant (RUQ)
Term
Which quadrant?

Right lobe of liver
gallbladder
pylorus
1st-3rd parts of duodenum
head of pancreas
right kidney and suprarenal gland
right colic flexure
superior part of ascending colon
right half of transverse colon
Definition
RUQ
Term
Which quadrant?
Left lobe of liver
spleen
stomach
jejunum
proximal ileum
body and tail of pancreas
left kidney and suprarenal gland
left colic flexur
left transverse colon
superior descending colon
Definition
LUQ
Term
WHich quadrant?

cecum
appendix
most of ileum
inferior ascending colon
right ovary
right uterine tube
right ureter
right spermatic cord
uterus
urinary bladder
Definition
RLQ
Term
Which quadrant?

Sigmoid colon
inferior descending colon
left ovary
left uterine tube
left ureter
left spermatic cord
uterus
urinary bladder
Definition
LLQ
Term
Between which two layers of the abdominal wall is there a potential space?
Definition
Scarpa's fascia and superficial investing fascia
Term
What layer of the abdominal wall acts as a natural cleavage plane for separation of muscles during surgery?
Definition
endoabdominal fascia
Term
Rectus abdominis
Definition

Origin: pubic symphysis and pubic crest

Insertion: Xiphoid process and 5-7th costal cartilages

Innervation: Thoracoabdominal nerves

Action: Flexes trunk and compresses abdominal viscera. stabilizes &controls tilt of pelvis (antilordosis)

Term
Transverse Abdominal - Origin, Action, Insertion, Innervation
Definition

Origin: Internal surfaces of 7-12th costal cartilages, thoracolumbar fascia, iliac crest, laterla third of inguinal ligament

Insertion: linear alba with aponeurosis of ext oblique, pubic creast, pecten pubis via conjoint tendon

Innervation: Thoracoabdominal nerves

Action: Compresses and supports abdominal viscera

Term
Internal oblique
Definition

Origin: Thoracolumbar fascia, anterior 2/3 of iliac crest, lateral half of inguinal ligament

Insertion: Inferior borders of 10-12th ribs, linea alba, pecten pubis via conjoint tendon

Innervation: Thoracoabdominal nerves

Action: Compress and support abdominal viscera, flex trunk

 

Term
External oblique
Definition

origin: external surface of 5-12th ribs

Insertion: linea alba, pubic tubercle, anterior half of iliac crest

Innervation: thoracoabdominal nerves

Action: Pulls chest downward and compresses abodminal cavity

Term
Blood vessels and nerves to the anterior abdominal wall run between the ___ and ___.
Definition
Internal oblique and transversus abdominis
Term
Dermatomes of Abdomen

Xiphoid process
Umbilicus
Pubis
Definition
T7, T10, L1
Term
Lymphatic drainage superior to umbilicus and inferior to umbilicus. Deep?
Definition

Superior - to axillary nodes

Inferior - to Inguinal nodes

Deep - accompany deep veins: external iliac, common iliac, lumbar lymph nodes

Term
___ is a condition of superficial venous dilation in the abdomen
Definition
caput medusae
Term
What vein, in particular, acts as a collateral pathway should other veins get blocked?
Definition
Thoracoepigastric
Term
Why is abdominal protuberance physiological in children? What causes it in adults?
Definition

Children: normal due to GI tract containing significant air, large liver, and enlarged abdominal cavities for organ development

 

Adults: Six F's: Food, fat, fluid, feces, flatus,fetus

Term
What are two particularly high risk abdominal incisions?
Definition

Pararectus (lateral side of rectus abdominis) and Inguinal

 

These are both very close to nerves. Inguinal is close to ilioinguinal nerve

Term
5 umbilicalperitoneal folds and where they come from
Definition

Median umbilical fold - from remnant of urachus (joined apex of fetal bladder to umbilicus) - covers median umbilical ligament

 

two Medial umbilical folds - cover medial umbilical ligaments - formed by parts of the umbilical arteries

 

Two Lateral Umbilical folds - cover the inferior epigastric vessels and therefore bleed profusely if cut

Term
The ___ fossae are impressions above the bladder that allow for abdominal wall stretching as the bladder fills. The ___ fossae (AKA ____) are important areas for direct herniation and are bounded by the epigastric artery, lateral umbilical fold, and rectus abdominis. The ___ fossae are lateral to the lateral umbilical folds and contain the deep inguinal rings and are thus potential sites for indirect inguinal hernias.
Definition

Supravesical fossae

Medial inguinal fossae (Hesselbach Triangles)

Lateral inguinal fossae

Term
The ___ is the thick inrolled lower border of the ext oblique aponeurosis. It extends from ___ to ___. It's purpose is to give support to the ___ and ___, to keep them from being crushed when you sit down.
Definition

Inguinal ligament

From ASIS to pubic tubercle

Inguinal artery and vein

Term
Inguinal canal:

begins at ____, ends at ____.
Transmits ___ in males and ___ in females.
Created when testes & ovaries descend.
Definition

deep inguinal ring, ends at superficial inguinal ring

transmits spermatic cord and round ligament of uterus

 

Term
Deep inguinal ring:
Located Superior to the middle of the ___, and lateral to the ___ artery. It is an evagination of the ___ fascia.

Superficial inguinal ring:
Located just superiolateral to the ____, where the lateral crus attaches. The medial crus attaches to the ____.
Definition

inguinal ligament, inferior epigastric artery, trasversalis fascia

 

Pubic tubercle, pubic crest

Term
Two muscles in the testicles that contract to pull testicles upward in cold temperatures
Definition
cremasteric and dartos
Term
Internal structure of the testis:

Approximately (#) lobules, each one contains:

_-_ seminiferous tubules
About __ straight tubules
The mediastinum of the testis, called ____
__-__ efferent tubules

Epididymis
Definition

300 lobules:

1-4

25 straight

rete testis

15-20

Term
If the porcesses vaginalis persists in females, it forms a small peritoneal pouch, known as the ____. Cysts can develop here, which can turn into indirect hernias.
Definition
Canal of Nuck
Term
A ___ is the presence of excess fluid in a persistent processus vaginalis. It is a congenital anomaly. These can occur in what two places?
Definition
Hydrocele - can happen in testis or spermatic cord
Term
How do you tell the difference between a hydrocele and a hemocele in the testis?
Definition
Transillumination - blood won't transilluminate.
Term
A ___ is a retention cyst (collection of milky fluid) in the epididymis, usually near the head. A ___ is a collection of fluid anywhere in the epididymis.

___ is an enlargement of pampiniform plexus that makes the testicle feel like a "bag of worms". Occurs 99% of the time in the __ testicle because it makes a 90 degree angle with the Left renal vein.
Definition

Spermatocele, epididymal cyst

varicocele - left testicle

Term
Cancer of the testis generally metastasizes to the ___ lymph nodes. Cancer of the scrotum generally metastazies to the ___ lymph nodes
Definition

lumbar.

superficial inguinal

Term
What muscle?

Origin: transvere process of Lumbar vertebrae, bodies of T12-L5
Insertion: lesser trochanter of femur
Innervation: lumbar plexus via L2-L4
Action: flexes thigh, flexes vertebral column laterally, balance trunk, flexes trunk when sitting
Definition
Psoas major
Term
What muscle?

Origin: superior 2/3 of iliac fossa, ala of sacrum, anterior sacroiliac ligaments
Insertion: lesser trochanter of femur
Innervation: Femoral nerves L2-L4
Action: flexes thigh and stabilizes hip joint, acts with psoas major
Definition
Iliacus
Term
What muscle?

Origin: medial half of inferior border of 12th ribs and tips of lumbar transverse processes
Insertion: iliolumbar ligament and internal lip of iliac crest
Innervation: anterior branches of T12-L4 nerves
Action: Extends and laterally flexes vertebral column, fixes 12th rib during inspiraiton
Definition
Quadratus Lumborum
Term
Retroperitoneal organs (8)
Definition

Kidneys

Suprarenal glands

Ureters

Pancreas

Descending, horizontal, and some ascending duodenum

Ascending and descending colon

Some portions of cecum

Rectum to the sacral flexure

Term
Parts of peritoneal cavity:

Greater sac
Lesser sac
Epiploic foramen (of winslow)
Supracolic compartment
Infracolic compartment
Paracolic gutters
Definition

1. Greater sac - everything that's not lesser

2. Lesser sac (omental bursa) - lies behind stomach

3. Epiploic Foramen - Between greater and lesser sacs, just above duodenum, between stomach, liver, inf vena cava, diaphragm, and lesser omental ligament

4. Supracolic compartment - above the transverse colon

5. Infracolic - below transverse colon

6. paracolic gutters - join supra and infracolic compartmets. can be site of pus/ascitis fluid accumulation and allow for migration between the two cavities. On sides of ascending and descending colons

 

 

 

** Supracolic and infracolic are divisions of the greater sac

Term
There are no organs in the ___ cavity, it is a potential space used for fetal development in women (it is closed in men). How does the body prevent pathogens from entering in women?
Definition

peritoneal

has mucus plug to prevent pathogens from entering, but allows sperm to enter

Term
Perforation of the posterior wall of the stomach results in the passage of stomach contents into the omental bursa. If the pancreas is inflamed, it's fluid can pass into the bursa, causing a ____.
Definition
pancreatic pseduo-cyst
Term
___ covers organs and attaches them to the body wall. 2 types:
1. ____: peritoneum that connects convolutions of the jejunum and ileum with the dorsal wall of the abdomen.
2 ___: extends obliquely from the dudodenojejunal flexure at the left side of the 2nd lumbar vertebrae to the right sacroiliac articulation, where it attaches to the body wall.

In the intestines, it has two parts:
1. ____: covers sigmoid colon, attaches to the pelvic wall.
2. ____: Covers transverse colon and attaches to dorsal wall of abdomen.
Definition

mesentry

 

1. mesentry proper (The Mesentry)

2. Root of mesentry

 

1. sigmoid mesocolon

2. transverse mesocolon

Term
Pleura that attaches between two organs (not to a body wall) is called?
Definition
omenta
Term
Differentiate between lesser and greater omentum
Definition

Greater (gastrocolic) - between transverse colon and greater curvature of stomach

Lesser (gastrohepatic) - between lesser curvature of stomach and inferior surface of liver

Term
Process of fluid removal in ascites is called ___.

___ is the infection and inflammation of the peritoneum. It often forms adhesions that limit the movements of the abdominal viscera and need to be removed via ____.
Definition

abdominal paracentesis

Peritonitis, adhesiotomy

Term
List the 10 abdominal viscera
Definition

abdominal aorta

esophagus

stomach

intestine

gallbladder

spleen

pancreas

suprarenal glands

Kidneys and ureters

 

Term
Branches of abdominal aorta: 3 ventral, 4 lateral, 2 dorsal
Definition

ventral: celiac trunk, superior mesentric, inferior mesentric

- supply esophagus to rectum

Lateral: inferior phrenic, suprarenal, renal, testicular or ovarian

- supply GU tract

Dorsal: lumbar, median sacral

- supply body wall and diaphragm

Term
Esophagus:

Pierces diaphragm at __
Esophagogastric junction at ___
The ___ ligament makes a ring around the esophagus and permits independent movement of diaphragm and esophagus during respiration and swallowing
The ___ is a jagged line where mucosa abruptly changes from esophageal to gastric
Definition

T10

T11

Phrenicoesophageal ligament

Z line

Term
The __ plexus supplies the esophagus and stomach. It is formed by the right and left ___ nerves.
The ___ supplies the anterior part of the esophagus and stomach, and is formed mainly by the left ___ nerve.
The ___ supplies the posterior part of the esophagus and stomach and is formed mainly by the right __ nerve.
Definition

esophageal plexus, vagus nerves

anterior vagal trunk, left vagus nerve

posterior vagal trunk, right vagus nerve

Term
___ are greatly enlarged submucosal veins in the esophagus that become distended and can rupture, causing life-threatening hemorrhage. They are commonly developed in alcoholics due to ___

___ is more commonly called heartburn, it is the result of regurgitaiton of small amounts of food or gastric fluid (acid) into the lower esophagus

___ is a weakening of the muscular part of the diaphragm caused by widening of the esophageal hiatus that results in abdominal visceral going through the diaphragm. In infants, this is more severe because it enters the space where the lungs should be forming and doesn't allow them room to do so.
Definition

Esophageal varices, due to portal hypertension

Pyrosis

Hiatal hernia

Term
___ are formed by the folding of the gastric mucosa, allowing the stomach to stretch. They are not present when your stomach is full
Definition
Rugae
Term
Why is gastric pain felt in epigastrium
Definition
because stomach is supplied by T6-T10 nerves
Term
Carcinoma of the stomach usually occurs in the ___ or ___. However if it occurs in the second spot, it is very bad, why?
___ is surgical removal of part of the stomach
Gastric ulcers mainly occur in which part of the stomach?
Pyloric stenosis is more common in women or men?
___ is failure of smooth muscle fibers encircling the pylorus to relax, and thus causes food not to pass into the duodenum.
Acid secretion is controlled by the ___ nerve, surgical excision of this nerve is called a ___.
Definition

Carcinoma: body and pylorus. hard to remove pylorus bc it has so many lymph nodes

gastrectomy

lesser curvature

men

vagus, vagotomy

Term
Derivatives from which embryologic structure will result in epigastric pain when they are inflamed?

Which result in periumbilical pain?

Which result in hypogastric pain?
Definition

Foregut derivatives result in epigastric pain: esophagus, stomach, pancreas, duodenum, liver and biliary ducts

 

Midgut derivatives result in periumbilical pain: small intestine distal to bile duct, cecum, appendix, ascending colon, most of transverse colon

 

Hindgut derivatives result in hypogastric pain: distal transverse colon, descending colon, sigmoid colon, rectum

Term
The jejunum and ileum are together 6-7m long, the ___ makes up the first 2/3, and the __ makes the second 1/3.
Definition
Jejunum, Ileum
Term
4 parts of the duodenum:

1st (superior) part is __cm long.

2nd part (descending) is __-__ cm long, and contains the ___, which enter through the posterior lateral wall

3rd part (horizontal)

4th part (ascending) - contains the ___ ligament, which holds it to the right crus of the diaphragm. Surgical landmark.
Definition

1st - 5cm

2nd - 7-10cm, hepatopancreatic ampulla (bile duct and pacreatic duct)

 

4th - suspensory ligament of Treitz

 

 

Term
65% of duodenal ulcers occur in which part?

Potential complications of duodenal ulcers?

___ hernias occurs in the paraduodenal fold and fossa, which is a large recess to the left of the ascending duodenum. Loops of intestine can enter here and strangulate the duodenum. Branches of the ___, __, and ___ are associated with this area.
Definition

posterior wall of superior (1st) part

 

perforations caused by duodenal uclers can cause it's contents to enter the peritoneal cavity and lead to severe peritonitis

 

paraduodenal ulcers - inf mesenteric artery and vein, left colic artery

Term
Two sources of blood supply to the duodenum, above and below the entry of the bile duct:

1. Above the bile duct: ____ (artery)- branches to the right gastroduodenal, superior pancreatico duodenal artery and ___ (vein)

2. Below the bile duct: ___ (artery)- branches to the inferior pancreaticoduodenal artery, and ___ and ___ (veins)
Definition

Above: Celiac trunk, portal vein

 

Below: Superior mesenteric artery, superior mesentery vein and splenic vein

Term
Blockage of the ____ by a gall stone can block both the biliary and pancreatic duct systems so neither juices can enter the duodenum. Bile can back up into the pancreatic duct and cause ____.
Definition

Hepatopancreatic ampulla

 

pancreatitis

Term
Which is the jejunum and which is the ileum?

1. greater vascularity supply, long vasa recta, a few large loops of arcades, less fat in mesentery

2. less vascularity, short vasa recta, many short loops of arcades, more fat in mesentery.
Definition

1. jejunum

2.ileum

Term
In the jejunum and ileum, arteries come from the ____, and veins go to the ____ and ultimately the ___.
Definition

Superior mesenteric artery

superior mesenteric vein - portal vein

 

Term
64% of appendices are located where?

Pain from appendicitis is located where?
Definition

Lateral 1/3 of McBurney's point

 

Right lower quadrant, referred pain in umbilicus

Term
____ is inflammation of the colon or rectum. 2 common diseases of this are?

___ is evaginations of the mucosa of the colon. It happens most in middle aged and elderly people, and most in the sigmoid colon. Prevention is eating a diet high in fiber.
Definition

Colitis - ulcerative colitis, crohn's disease

 

Diverticulosis

Term
The __ is the pelvic part of the large intestine. The terminal part is dilated as the ___, a reservoir for stool.

The rectosigmoid junction lie anterior to which vertebrae?

The anal canal begins at the tip of the ___.

3 Lateral flexures of the rectum?
Definition

Rectum, ampulla

 

S3

 

Coccyx

 

Superior, inferior, intermediate

Term
What structures can be felt during a rectal exam?
Definition

Men: Prostate and seminal glands

Females: cervix

Term
2 sphincters of the anal canal
Definition

Internal - superior - constricted except during defecation - involuntary

 

External - inferior - voluntary - constricted when it's closed

Term
Which rectal arteries form anastomoses? What is the importance of this?
Definition
Middle rectal arteries form anastomoses between portal and systemic veonous systems
Term
A __ is a slit-like lesion in the anus, usually located in the posterior midline inferior to the anal valves. Very painful.

A __is an abnormal canal that opens into the anal canal and allows infection to get into canal.

___ are elarged and engorged blood vessels (varicosities) in or around the anus. These may be associated with pain, bleeding, itching, and feels as if a lump is hanging down. Are internal or external ones more painful?
Definition

Anal fissure

Anal fistula

Hemorrhoids (piles). external are painful

Term
The __ is the largest gland in the body, weighing appx ___ gm and making up __% of the adult body weight. It is located in which parts of the abdomen? It is enclosed by a thin fibrous capsule called the ____.
Definition

Liver

1500

2.5%

right hypochondrium, epigastrium, left hypochondrium

hepatic capsule (of Glisson)

Term
Liver:

Diaphragmatic surface is covered with ____
___ is the part of the diaphragmatic surface that is not covered
___ is the protrusion of the peritoneal cavity between liver and diaphragm
___ is the space between the liver and right kidney
____ contains the fossa for the gall bladder and portal triad, it is devoid of peritoneum
Definition

peritoneum

bare area

subphrenic recess

hepatorenal recess/subhepatic space/hepatorenal pouch

visceral surface

Term
If infection lodges in subphrenic recesses, a ___ may occur, such as with appendicitis or duodenal ulcers
Definition
subphrenic abscess
Term
The bare area of the liver is formed by the 2 ___ ligaments, which unite to form the ___ ligament.

the ___ ligament holds the liver to the anterior body wall.
Definition

coronary -- triangular

falciform

Term
Parts of the portal triad
Definition

hepatic artery

portal vein

bile duct

Term
Explain the functional lobes of the liver
Definition

Right and left lobes are considered the functional lobes because they have separate biliary drainage and vacular supply (portal triad)

Quadrate lobe is part of left lobe because it receives the left portal triad

Caudate lobe is functionally part of left and right lobe - considered a third liver

Term
What serves as a guide between liver segments in a segmentectomy?

How many segments are there?
Definition

intersegmental hepatic veins

8

Term
The ___ forms during the 4th week of development as the head, tail, and lateral folds incorporate the ddorsal part of the umbilical vesicle into the embryo. It is closed at it's cranial end by the ____ membrane (____) and at its caudal end by the ___ membrane (___).

It is divided into three sections: __, __, and ___.
Definition

primordial gut

oropharyngeal membrane (stomodeum) = primordial mouth

Cloacal membrane (proctodeum) = primordial anus

foregut, midgut, hindgut

Term
In the primordial gut, the endoderm gives rise to what 2 things?

The ectoderm gives rise to what 2 things?
Definition

endoderm: epithelium and glands (liver, pancreas, gall bladder)

ectoderm: stomodeum and proctodeum (epithelium of cranial and caudal ends of the alimentary tract)

Term
Forgut derivatives
Definition
oral cavity, pharynx, tongue, tonsils, salivary glands, upper resp tract, lower resp tract, esophagus, stomach, proximal half of duodenum, liver, and pancreas, biliary apparatus
Term
The ___ septum divides the forgut into esophagus and trachea
Definition
tracheoesophageal septum
Term
The distal part of the foregut is initially a simple tubular structure. Around the middle of the fourth week, a slight dilation indicates the site of the primordium of the ____.

It is initially oriented in the ___ plane.

During the next two weeks, the dorsal border of this structure grows faster than the ventral border, which becomes the ____.

As it enlarges, it acquires its final shape. It rotates 90 deg in a clockwise direction along its longitudinal axis, which creates the ___.

The ___ gets it's C-shaped from the rotation described above and because of its located between the foregut and midgut.
Definition

stomach

median

greater curvature of stomach

omental bursa (lesser peritoneal sac)

duodenum

Term
The pancreas develops from two outgrowths of the endodermal epithelium, the (a) and (b). during the rotation of the gut, these two come together to form a single pancreas.

The (b) forms the __ and __ of the pancreas, while the (b) forms the __, __, and __ of the pancreas. The ducts of (a) and (a) join together to form the ___, but the proximal part of the duct of the (a) may persist as an _____.
Definition

a = dorsal pancreatic bud

b = ventral pancreatic bud

ventral bud forms uncinate process and part of the head

dorsal bud forms head, body, and tail.

main pancreatic duct

accessory pancreatic duct

Term
The liver develops from endodermal cells that forms the (a). As it grows, the (a) divides into a cranial part, which forms the ___ of the liver, and a caudal part, which forms the ___ and ___.

The hemopoietic cells, kupffer cells, and connective tissue of the liver are derived from mesenchyme in the ____.

Blood formation (hemopoiesis) begins in the liver during the __ week of development, and bile formation begins in the ___ week.
Definition

a = hepatic diverticulum

parenchyma

gall bladder, cystic duct

septum transversum

6th week, 12th week

Term
What condition is described?

Overgrowth of the longitudinal muscle fibers of the pylorus creates a marked thickening of the pyloric region of the stomach. The resulting stenosis (Gk. severe narrowing) of the pyloric canal obstructs passage of food into the duodenum, and as a result after feeding the infant expels the contents of the stomach with considerable force (projectile vomiting). This condition affects approximately 1/150 male infants, but only 1/750 female infants.
Definition
Congenital hypertrophic pyloric stenosis
Term
What condition is described?

During development, the ventral and dorsal pancreatic buds form a ring aroudn the duodeunum, thereby obstructing it.
Definition
Annular pancreas
Term
The midgut communicates wtih the yolk sac via the ____.

As the midgut forms, it elongates into a U-shaped loop called the ____.

The cranial limb of the midgut elongates rapidly during development and forms the ___ and cranial portion of the ____.

The caudal limb forms the ___, ___, ___, ___, and ___. The caudal limb is easily recognized by the presence of the ____.

The midgut loop rotates 270 deg counter clockwise around the ____ artery as it retracts into the abdominal cavity during the tenth week of development.
Definition

yolk stalk

midgut loop

jejunum and ileum

cecum, appendix, caudal part of ileum, proximal 2/3 of transverse colon

cecal diverticulum

superior mesenteric

Term
The hidgut is defined to begin where the blood supply changes from the ___ artery to the ___ artery at the distal 1/3 of the transverse colon.

The (a) is the expanded terminal part of the hindgut.

The ___ membrane separates the (a) from the proctodeum.

During develoment, a sheet of mesenchyme called the ___ develops to divide the (a) into a ventral and dorsal portion called the ___ and ___.

By week seven, the urorectal septum reaches the cloacal membrane, dividing it into the ___ and ___ membranes (ventral and dorsal portions).
Definition

SMA and IMA

cloaca

cloacal membrane

urorectal septum, urogenital sinus, anorectal canal

urogenital membrane, anal membrane

Term
The epithelium of the superior 2/3 of the anal canal is derived from the endodermal _____. The inferior 1/3 is from the ectodermal ____.

The junction of these two epithelia is indicated by the ____, which also indicates the approximate former site of the anal membrane that normally ruptures during the 8th weeks of development.
Definition

hindgut, proctodeum

 

pectinate line

Term
What condition?

A remnant of the proximal part of the yolk stalk that fails to degenerate during the early fetal period results in a finger-like blind pouch that projects from the ileum. While this condition occurs in about 1/50 people, it is usually asymptomic and only occasionally leads to abdominal pain and/or rectal bleeding.
Definition
Ileal diverticulum (Meckel's Diverticulum)
Term
What disorder?

The anal membrane fails to break down before birth. The anus must be reconstructed surgically, with severity depending on the thickness of the intervening tissue.
Definition
Imperforate anus
Term
What is a subhepatic cecum and appendix and why does it matter clinically?
Definition
During the fetal period, the cecum and appendix adhere to the inf surface of the liver and are thus carried upward with it. May result in difficulty diagnosing appendicitis bc it is not where it should be anatomically
Term
Failure of recanalization of ileum during the solid stage of development leads to narrowing or complete obstruction of the intestinal lumen. Can be caused by an infarction of fetal bowel, owing to imairment of its blood supply
Definition
Stenosis & atresia of the small intestine
Term
How does hepatomegaly occur and what are some common causes?
Definition

The IVC and hepatic veins lack valvces, so any rise in central venous pressure is directly transmitted to the liver.

 

Causes: CHF, bacterial and viral diseases (hepatitis), tumor

Term
Situation: broken rib, abdominal hemorrhage, right upper quadrant pain.

Possible cause?
Definition
ruptured liver
Term
Cirrhosis of the LIver:

Progressive destruction of hepatocytes, which are replaced by ___ and ___, creating a "hobnail" appearance.

May be caused by ____ or ____ (most common cause)

Creates ____, impeding the circulation of blood vessels and biliary ducts.
Definition

fat and fibrous tissue

industrial solvents (carbon tetrachloride) or alcoholism

portal hypertension

Term
In a liver biopsy, where is the needle usually inserted?
Definition
10th ICS in the midaxillary line. Done on full inspiration to reduce costodiaphragmatic recess and lessen possibility of injuring the lung.
Term
Variations in hepatic arteries:

In __% the right hepatic artery runs posterior to the common hepatic duct

in __%, the right hepatic artery runs anterior to the common hepatic duct

In __%, the right hepatic artery arises from the SMA and does not cross the hepatic duct

In __%, the right hepatic artery runs anterior to the portal vein

In __%, the right hepatic artery passes posterior to the portal vein

Why is it important to know these variation?
Definition

64

24

12

91

9

 

Important to know because these arteries could be damaged during surgeries like cholecystectomy, fundoscopy, or laparoscopy

Term
A common variety of right hepatic artery is that it may be replaced by an accessory artery arising from the ____

The most common replacement of the left hepatic artery is the ____.
Definition

SMA

left gastric

Term
The ___ is the major lymph-producing organ

Superficial lymphatics of the liver: __ and __ nodes, where do they drain?

Deep lymphatics of the liver: ___ nodes to the ___.
Definition

liver

phrenic to mediastinal nodes

hepatic to celiac nodes to chyle cistern

Deep lymphatics surround portal triad: hepatic nodes to chyle cistern

 

Term
Gall bladder:

6-10 cm long, 45ml capacity. Pear-shaped lying on the inferior surface of the liver in a fossa between the __ and __ lobes.

What are it's functions?

3 parts?

The neck gives rise to the ___ duct with ___ valves, and it may contain a pundulous sacculation called _____, or the ampulla of the gallbladder.
Definition

between right and quadrate lobes

 

Fxns: receives bile, concentrates it, release it during digestion

 

3 parts: fundus, body, neck

 

Neck: cystic duct with spiral (Heister's) valves.

Hartmann's pouch = ampulla

Term
The ___ is 3-4 cm long and connects the neck of the gall bladder to the common hepatic duct.
Definition
cystic duct
Term
Gall stones:

More common in women or men?

What percent are "silent" (asymptomatic)?

Where do they tend to collect? (3 places)

Blockage of the ___ can cause cholecystitis because of bile accumulation in the gallbladder. Pain starts in the ___ and moves to the ____. Also produces thoracic wall & right shoulder pain due to diaphragm irritation. If bile cannot leave gallbaldder, it enters the blood and ___ results.

What two other places outside the gallbladder can gallstones collect?
Definition

women

50%

infundibulum, hepatic and cystic ducts

cystic duct, epigastrium --> hypochondrium, jaundice

superior duodenum & transverse colon

Term
Gall bladder arterial supply:

right hepatic artery --> cystic artery --> gallbladder

The right hepatic artery arises from the cystohepatic triangle (Triangle of Calot). What are the borders of this triangle?
Definition

Superior border: visceral surface of the liver

Inferior border: cystic duct

Medial border: common hepatic duct

Term
Hepatic portal vein:

Formed by the convergence of the ___ and ___, posterior to the neck of the pancreas at the level of ___.


conveys all venous blood and bloodborne nutrients from the __ to the ___.

After the liver, the blood drains to the ___.
Definition

SMA and Splenic vein at L2

from GI tract to Liver

IVC

Term
3 portal-systemic anastomoses
Definition

1. submucosa of inf esophagus

2. submucosa of anal canal

3. Paraumbilical region

Term
Cirrhosis causes scarring and fibrosis which can obstruct the _____ in the liver, this causes a pressure rise in the portal system, resulting in ____.

Large volumes of blood flow from the portal system to the systemic system at anastomose sites can cause ____, especially in the lower esophagus, called ____.

In severe portal obstruction, veins in anterior abdominal wall anastomose wtih paraumbilical veins and may become ___ and look like small snakes around the umbilicus, called ____.
Definition

Portal vein, portal hypertension

 

varicose veins, esophageal varices

 

varicose, caput medusae

Term
___ are a common method for reducing portal hypertension.

They create communication between the ____ and the ___ and thus divert blood away from the portal system to the systemic venous system.
Definition
Portosystemic shunts, portal vein to IVC
Term
Pancreas:

Accessory digestive gland, lies retroperitoneally and transversely across the posterior abdominal wall, posterior to the stomach between the ___ on the right and the ___ on the left.

Exocrine secretion: ___ through acinar cells, which enter the duodenum through ____ ducts

Endocrine secretion: __ & __ by islets of Langerhans. enters blood.
Definition

between duodenum and spleen

 

exocrine: pancreatic juice, main accessory pancreatic ducts

 

Endocrine: glucagon and insulin

Term
What might cause rupture of the pancreas and what are some possible effects?

____ is the most common type of pancreatic cancer (90% of cases). Why is it so deadly?

___ is removal of most of the pancreas. It is sometimes performed in what condition? The head of the pancreas is impossible to remove, why?
Definition

Pancreatic rupture is rare due to its central placement in the body. Rupture require sudden, severe, forceful compression of the abdomen and it usually tears the duct system, resulting in leakage of pancreatic juice, which can digest surrounding tissues.

 

Ductal adenocarcinoma. Surgical resection is useless and it metastasizes quickly via the portal vein

 

Pacreatectomy - chronic pancreatitis. head is impossible to remove bc the blood supply, bile duct, and duodenum are all in it

Term
Spleen:

Largest lymphatic organ

Located in what quadrant? Associated with what ribs?

Most commonly injured abdominal organ.

It is entirely surrounded by peritoneum except for the ___.

Relations to the spleen:
Anterior to the spleen is the ____
Posterior is the ___, which separates it from the pleura, lung, and 9-11 ribs.
Inferior is the ____
Medial is the ___

____ is like a small lymph node found around the hilum. Found in __% of the population.
Definition

Left hypochondrium, 9-11th ribs

hilum

 

anterior: stomach

posterior: diaphragm

Inferior: left colic flexure

Medial: left kidney

 

Accessory spleen, 10% of pop

 

Term
What are some common ways to rupture the spleen?
How do you treat a ruptured spleen?

Splenomegaly:
Normal spleen is how big?
Enlarged spleen can be how big?
If the lower border is palpable under the costal margin at the end of inspiration, it is about __x its normal size.
Causes of enlarged spleen?
Definition

Rupture: severe left sided blow that fractures one of the 9-12th ribs, blunt trauma to abdomen. Results in intraperitoneal hemorrhage and shock. Treatment: total/partial splenectomy

 

Splenomegaly:

Normal: 7 oz, not palpable bc it's behind the ribs

Enlarged: can be 10x normal size and weigh 100g

3x

Causes: hypertension, granulocytic leukemia, certain anemias

Term
The kidney:
lies at the level of __-__
Which kidney lies lower than the other?
It is invested by ____ and surrounded by ___ fascia and ___ fat
Definition

T12-L3

Right lower than left

fibrous renal capsule, perirenal fascia, pararenal fat

 

Term
___ is AKA "dropped kidney"

What causes it?
What happens to the adrenal galnds?
What happens to ureters?
Pain?
Definition

Nephrotosis

Caused by lack of inferior support of kidneys in fascia so they descend more than the normla 3cm when the person stands

 

adrenal glands stay in place

 

ureters coil and have kinks (insignificatn)

 

Pain is from stretch of renal vessles, releived by lying down

Term
Renal Transplantation:

When is it done? Where is the transplant site and why?
Definition

Done for select cases of chronic renal failure

Transplant site is iliac fossa of greater pelvis bc there's more supprt, major blood vessels are near, easy access to bladder

 

The renal artery and vein are jointed to the external iliac artery and vein

The ureter is attached to the bladder

Term
What is contained in the renal hilum?
Definition
Anterior to posterior: renal vein, renal artery, renal pelvis (becomes ureter)
Term
Nephron and collecting schema of the kidney (follow path of urine)
Definition

Bowman's capsule -- proximal convoluted tuble -- loop of henle -- distal convoluted tubule -- collecting duct

 

distal convoluted tubule of each kidney empties into central collecting duct

Term
3 components of the renal cortex:


Renal cortex extends between renal pyramids as ____

Renal medulla consists of what 4 things?
Definition

renal corpuscles, proximal convoluted tubules, distal convoluted tubules

Renal columns (of bertini)

 

medulla: 9-13 renal pyramds (of malpighi), straight tubules, loop of henle, collecting ducts

Term
What i the basic functional unit of the kidney?

Each ____ (apex of the renal pyramid) opens into a cup shaped end of a ____, from which the urine is excreted.

Collecting system:
a. ____: fuse together to form 2-4 ____.
b. ____ joint to form the funnel-shaped ____.
c. The ____ narrows to form the ureter.
Definition

Fxn unit: renal pyramid

renal papillae, minor calyx

 

minor calyx, major calyx

major calyx, renal pelvis

renal pelvis, ureter

Term
___ is a major cause of renal failure. it is an autosomal dominant trait. symtpoms include enlarged kidenys, distorted by cysts up to 5cm.
Definition
polycystic disease of the kidneys
Term
How are the right and left adrenal (suprarenal) gland shaped?

What do the different parts secrete?
Definition

Right: pyramidal shaped

Left: crescent-shaped

 

Cortex: secretes androgens and corticosteroids

medulla: adrenaline and noradrenaline

Term
Renal arteries:

Arise from ____ at the __-__ IV level
The right/left is longer.
Divide into __ segmental arteries, which distribute into each renal segment and make them surgically resectible

Suprarenal arteries:
Superior suprarenal arteries (6-8) arise from?
Middle suprarenal arteries arise from?
Inferior suprarenal arteries arise from?

Renal vein drains to?
Reight suprarenal vein drains to?
Left suprarenal vein drains to?
Definition

abdominal aorta at L1-L2

Right is longer

5 segments

 

superior: inferior phrenic

middle: abdominal aorta

Inf: renal arteries

 

IVC

IVC

Inferior phrenic to left renal vein

Term
How long are the ureters?

3 physiologic constrictions

What is the purpose of the costriction?
Definition

25-30 cm

 

junction of renal pelvis and abdominal part of ureter

at pelvic brim

where it enters the urinary bladder

 

significance: doesn't let urine return to kidney from bladder

Term
___ are vulnerable to injury when the ovarian vessels are ligated during an ovariectomy due to their close proximity to each other as they cross the pelvic brim

It is also in danger of being injured during a hysterectomy because it crosses inferiorly to the uterine artery, 2cm above the ischial spine.
Definition
ureter
Term
Arterial supply to ureters (venous drainage follows arterial supply)

Abdominal ureters: 4 arteries

Pelvic ureters: 3 arteries

Terminal ureters: 2 arteries
Definition

Abdominal: renal, gonadal, abdominal, common iliac

Pelvic: common iliac, internal iliac, ovarian

Terminal: uterine, inferior vesicle

Term
Bladder:

Superior apex points toward the superior edge of the ____
The fundus lies ___ to the apex
The ___ is inferiorly placed and is funnel-shaped. The wall of it is made up by the ___ (smooth) muscle
Internall, the bladder is regose, except for a small posterior triangle, the ____.
(a) lie at the superior angles of the trigone, and the ____ is at its apex.
(a) are encircled by loops of detrusor muscle, which prevent reflux of urine into the ureters when the bladder contractss
Definition

pubic symphysis

opposite

neck, detrusor

trigone

(a) = uteric orifices, internal urethral orifice

 

Term
2 biggest differences between the female and male urinary bladder
Definition

Involuntary, internal sphincter where the bladder meets the urethra: males have it, females don't

 

Ligments that secure the neck of the bladder:

females = pubovesical ligaments

males = puboprostatic ligaments

Term
Arterial supply to the bladder, venous draina1ge
Definition

Arterial supply: superior and inferior vesical, supplemented by obturator, inf gluteal, and vaginal artery (females)

 

venous: prostatic (male) or vesical (female) plexus empties into the internal iliac vein

Term
___ is a hernia of the bladder

Mainly happens in females, due to damage/prolapse of the ___ or their associated fascia during childbirth, which results in bladder herniation into vaginal wall

Rupture of the bladder may cause urine to escape intra or extraperitoneally, and often also tear the peritoneum
Definition

cystocele

peritoneal muscles

Term
___ is puncture of a distended bladder as it extends superiorly above the pubic symphysis into the loose areolar tissue between the peritonium and the anterior abdominal wall. done to remove cyst of foreign body from bladder

A ___ is used to examine the interior of the bladder and its three orifices. Done during a transurethral resection of a tumor where a high-frequency electrical current is used to remove the tumor in small fragments that are washed from the bladder with water.
Definition

suprapubic cystotomy

 

cystoscopy

Term
The urethra conveys urine from the ___ to the ___.

Female urethra: __cm long and only the proximal part is intra-pelvic. It lies anterior to and in the same axis as the vagina. The (a) opens anterior to the vagina. The ___ (homologous to the prostate) provides lubrication and open on each side of the (a).
Definition

internal urethral orifice to the external urethral orifice

 

4, external urethral orifice (a), paraurethral glands

Term
Male urethra: coveys __ and __. Is __-__cm long.

4 parts:
1. ___
2. ____: bears the urethral crest. The ___ is the roudned eminence at the middle of the urethral crest. The crest has the orifice of the prostatic utricle. Paired ___ ducts open laterla to the utricle. Two grooves on the sides of the urethral crest are the two prostatic sinuses.
3. ___: located behind the pubic symphysis, is the least dilatable part. ___ glands lie on each side.
4. ____: penile part of the urethra. Is __cm long. 2 dilations?
Definition

urine and semen

18-22cm

 

1. pre-prostatic

2. prostatic: seminal colliculus, ejaculatory ducts

3. intermediate: bublourethral glands

4. spongy: 15cm, commencement of intrabulbular fossa, within glands penis to form the navicular fossa

Term
Arterial supply and venous drainage of male and female urethra:

Male: pre-prostatic and prostatic parts: prostatic branches of inferior vesical and middle rectal arteries
Intermediate and spongy parts: branches of dorsal artery of the penis
Veins follow arteries

Female:
Internal pudendal and vaginal arteries
Veins follow arteries
Definition
Term
3 purposes of catheterization
Where is it likely that perforation could occur during catheterization?

What is a urethral stricutre?
Definition

inability to micturate, irrigate bladder, collect uncontaminated urine

intermediate urethra of male

 

stricture: external trauma or infection, causing stenosis

Term
Autonomic innervation of the abdomen and pelvis
Definition

Autonomic innervation supplies viscera

Parasympathetic: vagus nerve - supply stomach to ascending colon, S2-S4 (pelvic splanchnic nerves) - supply descending colon to genitalia

 

Sympathetic: Sympathetic trunk (C8-L2) branches to supply viscera, thoracic, lumbar, and sacral splanchnic nerves, prevertebral sympathetic ganglia, abdominal aortic plexus and periarterial plexus

Term
Abdominaopelvic autonomic plexuses

1. ___ plexus
PS fibers from right and left vagus nerves
Symp fibers from greater and lesser splanchnic

2. ___ plexus
Branch of (1.)
lesser and least splanchnic nerves
Sometimes first lumbar ganglion of ST

3. ___ plexus
from the intermesenteric plexus
Lumbar ganglia of sympathetic trunks

4. ___ plexus
continuous with the intermesenteric plexus an dinferior mesenteric plexus

5. ___ plexus
from superior sacral sympathetic ganglia and pelvic parasympathetic splanchnic nerves

The right and left ___ nerves join the superior hypogastric plexus to the inferior hypogastric plexus
Definition

1. celiac plexus

2. superior mesenteric plexus

3. inferior mesenteric plexus

4. superior hypogastric

5. inferior hypogastric

 

hypogastric nerves

Term
Subplexuses of the celiac ganglionic plexus

Subplexuses of mesenteric plexus

subplexuses of inferior mesenteric plexus

Subplexuses of superior hypogastric plexus

Subplexuses of inferior hypogastric plexus

Subplexuses of suprarenal and renal plexus
Definition

Hepatic, gastric, splenic, pancreatic

 

Superior mesenteric: no subplexuses

 

Inferior mesenteric: superior rectal plexus

 

Superior hypogastric: branches to ureter and genital organs

 

Inferior hypogastric: middle and inferior rectal, prostatic, deferential, uterovaginal, vesical, ureteral

 

Suprarenal and renal - ureteral

Term
Parasympathetic innervation:

Vagus nerves supply...

Pelvic splanchnic nerves supply...
Definition

Vagus: abdominal viscera to left colic flexure

 

Pelvic splanchnic: pelvic viscera

 

Term
Sensory innervation of abdomen/pelvis:

Proximal to middle of sigmoid colon:
Afferent fibers convey pain sensation to ___ sesnory ganglia
Afferent fibers conveying reflex info to ___
Definition

Proximal to sigmoid colon:

Pain: thoracolumbar spinal sensory ganglia

Reflex: vagal sensory ganglia

 

Distal to sigmoid colon:

Pain & sensory impulse: S2-S4 soensory ganglia and spinal cord levels

Term
The ____ plexus is formed from the ventral rami of nerves L1-L3, L4, and some fibers from T12. Forms what 6 nerves?
Definition

Lumbar plexus

 

iliohypogastric, ilioinguinal, genitofemoral, lateral femoral cutaneous, femoral nerve, obturator nerve

Term
What do the ilioinguinal and iliohypogastric nerves are formed from what vertebrae? what do they innervate?

Genitofemoral nerve is formed from which vertebrae? innervate what?
Definition

iliohypogastric and ilioinguinal: From L1, often parts of T12. Abdominal muscles and skin of the inguinal and pubic regions

 

genitofemoral: L1, L2. Sensory for skin of upper medial thigh

Term
The __ is made up of the right and left hip bones (coxa or pelvic bones) and the sacrum. In anatomical position, the ASIS's and the ___ lie in the same plane.
Definition

pelvic girdle (bony pelvis)

ASIS and pubic symphysis in same plane

Term
The pelvic brim is created by what 5 things?

The pelvic brim encloses a space called the ____ that divides the pelvis into greater and lesser pelvis.

The ____ is an incomplete boundary that is closed by the pelvic diaphragm.
Definition

Brim: sacral promontory, sacral alae, arcuate lines, pectineal lines, pubic crests

 

Pelvic inlet (superior pelvic aperture)

 

Pelvic outlet

 

Greater pelvis (false pelvis)

Lesser pelvis (true pelvis)

 

 

 

 

Term
Major differences between male and female bony pelvis
Definition

Pelvic outlet: smaller in men than women

Pubic arch and subpubic angle: narrow in men, wide in women

Term
THe ___ pelvis shape is the normal female type. It's pelvic inlet typically has a rounded oval shape and a wide transverse diameter.


The ___ (masculine/funnel-shaped) pelvis in a woman may present hazards to successful vaginal delivery of a fetus
Definition

gynecoid

 

android

Term
Crucial obstetric diameters:


The ___ diameter from the middle of the sacral promontory to the posterosuperior margin of the pubic symphysis. it is the narrowest fixed distances through which the baby's head must pass in a vaginal delivery.

The ___ diameter is from the sacral promontory to the level of the inferior margin of the pubic symphysis> it must be at least __ cm.

The ___ diameter is normally the narrowest part of the pelvic canal. Must be three fingers side by side.
Definition

true conjugate diameter

diagonal conjugate - 11 cm

interspinuse

Term
Weak places where pelvis fractures may occur (4)

What are common causes of pelvic fractures?
Definition

pubic rami

acetabulum

Si joints

alae of ilium

 

Direct trauma as in a car accident

Forces transmitted to bones from lower limbs during falls on feet

Term
The pubic symphysis is a cartilaginous joint between the pubic bones with an intervening ____, which is thickest in women. What 2 ligaments stabilize this joint?
Definition

interpubic disc, superior pubic and inferior arcuate pubic ligaments

 

Term
___ and ___ joints stabilize the pelvic girdle.

The ___ closes the obturator foramen except for a superior slit, the obturator canal, that transmits the ____.
Definition

lumbosacral (L5 and Si) and sacrococcygeal (S5 and Co1)

 

obturator membrane, obturator canal

Term
Relaxation of pelvic ligaments during pregnancy:

During the latter half of pregnancy, ___ causes increased flexibility of pubic symphysis, sacroiliac joints, and coccyx

The transverse diameter increases __-__%
What happens to the true diameter?

Why does it matter that relaxation is systemic?
Definition

relaxin

transverse diameter

true diameter is unaffected

systemic relaxation increases possibility of joint dislocation

Term
Muscles of pelvic floor and wall:

Obturator internus: Origin, insertion, innervation

Piriformis: origin, insertion, innervation

Coccygeous (Ischiococcygeous): origin, insertion, innervation
Definition

Obturator internus:

O: ischium, ileum, obturator membrane

I: femur

I: nerve to obturator internus and superior gemellus

 

Piriformis:

O: sacrum, rim of greater sciatic notch, sacrotuberous ligament.

I: exits greater sciatic foramen to insert on femur

I: nerve to piriformis

Is used to locate sciatic nerve

 

Coccygeous:

O: ischial spine

I: inferior sacrum

I: nerve to lavator ani

Forms posteiror pelvic diaphragm

 

 

Term
Muscles of Levator Ani:

Puborectalis: Arises from ___ and unites with its counterpart posterior to the ___. It forms the ____. Function?

Pubococcygeous: origin, insertion, action

Iliococcygeus: Arises fromt he ___ and ___ and meets its counterpart posteriorly to form the ____.

The ___ and ___ muscles encircle and support the urethra, bvagina, and anal canal.

All levator ani muscles form the ____> They are all innervated by the ___
Definition

puborectalis: arises from pubic bone, unites posteterior to anorectal jxn, forms puborectal sling. Maintains fecal continence

 

Pubococcygeous:

O: posterior aspect of pubic bones and anterior tendinous arch.

I: coccyx + turns fibrous to form the midline anococcygeal body (levator plate)

 

iliococcygeous: Arises from posterior tendious arch and the ischial spine and meets its counterpart posteriorly to form the anococcygeal body

 

pubococcygeus and puborectalis

 

form pelvic diaphragm

innervated by nerve to levator ani

Term
What two muscles are most often torn during childbirth?

What problems might that cause?
Definition

pubococcygeus and puborectalis

 

may cause urinary stress incontinence (dribbling of urine when intraabdominal pressure is raised)

Term
Only the ___ and ___ are intraperitoneal, all other pelvic viscera are not completely ensheathed by the peritoneum, but peritoneum is reflected and goes over the rest of the organs (but doesn't ensheath them)
Definition
ovaries and uterine tubes
Term
Pelvic puches and fossae

1. The ___ is formed by peritoneum reflecting onto the superior surface of the bladder.

2. Peritoneum covers the convex superior surface of the bladder and slopes down the sides of the roof to ascend the lateral wall of the pelvis, creating the ____.

3. Peritoneum reflects from bladder and seminal glands onto rectum, forming the ____ (men only - uterus is here in women)

4. (3) extends laterally and posterioraly to form a ___ on each side of the rectum
Definition

1. supravesical fossa

2. paravesical fossa

3. rectovesical pouch

4. pararectal fossa

Term
Anterior divisions of the Internal iliac
Definition

umbilical - superior vesical

obturator

uterine - vaginal

middle rectal

internal pudendal

inferior gluteal

Term
posterior divisions of internal iliac
Definition

superior gluteal

lateral sacral

iliolumbar

Term
Pelvic venous drainage
Definition

internal iliac vein

superior rectal to IMA to hepatic portal

lateral sacral to internal vertebral

Term
Lymphatic drainage of pelvis:

1. superior parts of middle to anterior pelvic organs
2. inferior pelvic viscera, deep perineum, and gluteal regions - drain into common iliacs
3. posteroinferior pelvic viscera and drain into either internal or common iliacs
Definition

external iliac nodes

internal iliac nodes

sacral nodes

Term
Sacral plexus:

Includes ventral rami of spinal nerves __ - ___
Major nerves of the sacral plexus include the ___ and ___.

The ___ is the main nerve of the perineum and the chief sensory nerve of the external genitalia. It leaves the pelvis through the ___ and then hooks around the ischial spine and enters the perineum through the ____.
Definition

L4-S4

pudendal nerve, sciatic nerve

pudendal nerve

greater sciatic foramen, lesser sciatic foramen

Term
Coccygeal plexus:

anterior rami of __ and __ and the coccygeal nerves

Supplies what two muscles and one joint?

The ___ nerves supply a small area of skin between the tip of the coccyx and the anus.

How are the pelvic nerves most commonly injured?
Definition

S4-S5

coccygeus muscle, part of levator ani, sacrococcygeal joint

anococcygeal nerves

fetal head can compres sacral plexus, esp obturator nerve

Term
what is the normal uterine position?

In what position would prolapse be most likely?
Definition

normal: anteverted, anteflexed

retroverted - most likely to prolapse

Term
3 functions of vagina
Definition

birth canal

conduit for menstrual flow

copulatory organ

Term
Supports of vagina - upper, middle, and lower thirds
Definition

upper: levator ani & transverse cervical, pubocervial, and sacrocervical ligaments

middle: UG diaphragm

Lower: perineal body

Term
hegar sign
Definition
softening of uterine isthmus - early sign of pregnancy
Term
How does the vagina distend during birth? How does that affect the fetus?
Definition

Vagina distends mainly in AP direction.

Lateral distension is limited by ischial spines and sacrospinous ligaments.

This causes fetus' shoulders to rotate into the AP plane during delivery

Term
A ___ is an abnormal passage that connects the vagina to other pelvic organs such as the bladder, urethra, rectum, or perineum, resulting in leakage of urine or feces into vagina
Definition
vaginal fistula
Term
2 tests for patency of uterine tubes:

1. ____: water-coluble radiopaque material is injected into the uterus and the path is traced

2. ___: thin fiberoptic telescope is inserted through the cervix. visualization of the uterus and fallopian tube is viewed
Definition

hysterosalpingography

hysteroscopy

Term
____ - an endoscopic examination of the female pelvic viscera by means of an endoscope introduced into the pelvic cavity through posterior vaginal fornix. Used to identify what?

___ - extraction of fluid from the rectouterine pouch posterior to the vagina through a needle. Used to identify what?
Definition

culdoscopy - tubal pregnancy

culdocentesis - pelvic abscess, ruptured ectopic pregnancy, suspected ovarian cyst

Term
Uterus:
Main arterial supply?
Collateral arterial supply?

Venous drainage?

Vagina:
superior, middle, and inferior arterial supply?
venous drainage?
Definition

uterus: uterine arteries and ovarian arteries

uterine vein - drains to internal iliac

 

vagina: superior: uterine arteries, middle & inf: vaginal and internal pudendal arteries

uterovaginal veinous plexus - drains to uterine vein, then internal iliac

Term
Where are sperm produced?
Definition
seminiferous tubules
Term
The two ___ glands lie posteroloateral to the intermediate part of the urethra. the ducts open through minute apertures into the proximal part of the spongy urethra. their mucus-like secretions enter the urethra during sexual arousa
Definition
bulbourethral (cowper) glands
Term
____ is a smooth muscle tube that conveys seminal fluid. It dilates at the ___ and ends by joining the duct of the seminal gland to form the ____.

What is in seminal fluid?

____: paired, elongated, sacculated glands are obliquely placed superior to the prostate. secrete thick, alkaline fluid with fructose (energy source for sperm) and a coagulating agent.

___: paired ducts, each formed by the union of the ampula of the vas and the seminal gland duct. opens in prostatic part of urethra.
Definition

ductus deferens, ampulla, ejaculatory duct

seminal glands/vesicles

ejaculatory ducts

Term
The prostatic ducts open into the ___, on either side of the ____. They carry ____, a thin milky fluid that adds 20% of the volume of semen to the ejaculate
Definition
prostatic sinus, seminal colliculus, prostatic fluid
Term
Boundaries of the perineum:

Anterior:
Anterolateral:
lateral:
posterolateral:
posterior:
Definition

Anterior: pubic symphysis

Anterolateral: inferior pubic rami and ischial rami

lateral: ischial tuberosities

posterolateral: sacrotuberous ligametns

Posterior: inferiormost sacrum and coccyx

Term
The urogenital triangle is closed by the ___ membrane.

The ___ is a fibromuscular mass located in the median plane. Important in females because it is the final support of the pelvic viscera.

Contents of the anal triangle

Technically, the area below the pelvic diaphragm is the ____.
Definition

perineal membran

perineal body

anal canal and anus

perineum

Term
contents of the pudendal canal
Definition
pudendal nerve, internal pudendal vein and artery
Term
3 superficial muscles of UG region, 2 deep muscles
Definition

superficial: ischocavernosus, bulbospongiousus, superficial transversus perini

 

Deep: sphincter urethrae, deep transversus perinei

Term
Female: what glands secrete mucus during arousal?
Definition
vestibular glands
Term
Fxn of bulbospongiosus and ischiocavernosus muscles
Definition

sphincter of vagina and assists in erection of clitoris

 

Term
3 parts of perineum
Definition

external genitalia, perineal muscles, anal canal

 

Term
3 parts of penis
Definition

root, body, glans penis

 

Term
3 erectile tissues in penis

The ___ covers the glans penis
Definition

2 corpora cavernosa

single corpus spongiosum - contains spongy urethra and glans penis

 

prepuce

Term
The ___ is the voluntary sphincter muscle of the urethra
Definition
sphincter urethrae
Term
arteries of penis:

deep arteries supply ____
___ arteries wrap around corpus cavernosus
artery of the bulb supplies ____
Definition

corpus cavernosus,

deep artery

corpus spongiosus

Term
Inital distension of bulbospongiosus and transverse perineal muscles cause involunatry spasms of perivaginal and levator ani muscles. can cause dyspareunia (painful intercourse) and can prevent vaginal penetration.
Definition
vaginismus
Term
___ is when the dorsal and ventral pancreatic buds (during development) form a ring around the duodenum, constricting it.

The caudal limb of the midgut is easily recognized during development becauseo f the presence of the ____.

The ___ is defined to begin where the blood supply changes from the __ to the ___.

The ___ is the expanded terminal part of the hindgut.
Definition

annular pancreas

 

cecal diverticulum

 

hindgut

 

cloaca

Term
The epithelium of the superior 2/3 of the anal canal is derivd from the endodermal hindgut, the inferior 1/3 develops from the ectodermal protodeum. The junction of these two epithelia is indicated by the ____.
Definition
pectinate line
Term
Arterial supply to the foregut, midgut, and hindgut
Definition

foregut: celiac artery

midgut: SMA

Hindgut: IMA

Term
___ is a remnant of the proximal part of the yolk stalk that fails to degenerate during the early fetal period. It resultsin a finger=like blind pouch that projects from the ileum.

___ is when the anal membrane fails to break down before birth. the anus must be reconstructed surgivally.
Definition

ileal diverticulum (Meckel's diverticulum)

 

imperforate anus

Term
During folding of the embryo in the horizontal plane, intermediate mesoderm is carried ventrally and loses its connection with the somites. A longitudinal elevation of mesoderm fors called the ____. The part of this structure giving rise to the urinary system is the ____.
Definition

Urogenital ridge

nephrogenic cord

Term
3 sets of kidneys develop sequentially in the embryo, called _____, ____ , and ____

Which ones remain as permanent adult kidneys?

Which ones remain as the wolffian duct?
Definition

pronephros

mesonephros - remain as wolffian duct

metanephros - remain as adult kidney

 

Adult kidney a combination of metanephros and uteric bud

Term
___ form when the inf poles of the kidneys fuse together. the combined kidney is not able to ascned to its adult physiological location bc it gets "hung up" on the IMA

A ___ is a kidney that has failed to migrate to it's adult physiologic position
Definition

horseshoe kidney

pelvic kidney

Term
Male and female morphologic characteristics do not develop until what week?

The early genital systems in the two sexes are similar, which is knows as the ___.
Definition

7

indifferent state of development

Term
In female embryos: the ___ ducts develop into most of the female genital tract


In males, the testes secrete ____ which inhibits development of these ducts. instead, the ___ ducts develop.
Definition

paramesonephric ducts/mullerian ducts

 

mullerian inhibiting substance, mesonephric

Term
External genital develoment: A gential tubercle elongates into a ____.
Definition
phallus
Term
___: incomplete fusion of the UG folds creates abnormal openings of the urethra on the ventral aspect of the penis.

___: failure of testes to descend into scrotum.

___: failure of one paramesonephric duct to develop. results in a single uterine tube and horn of the uterus.
Definition

hypospadias

cryptochordism

unicornuate uterus

Term
____: the transitional region betweent he trunk and free lower limb

___: extends from gluteal, abdominal, and perineal region proximally and knee distally.
Definition

gluteal region

Thigh/femoral region

Term
Angle of inclination:

125 degress is normal

106 degrees is ____

140 degrees is ____
Definition

coxa vara

coxa valga

Term
A femoral neck fx happens when you fall down on your feet .. the ___ artery can be occluded and cause necrosis of the femoral head

A femoral shaft fx happens in ____

Where do tibial/fibular fractures typically occur?

A ___ fx (stress fx) often occurs in runner

A ___ fx (boot top fx) can cause shortening of the leg due to overriding fracture fragments. It is through the fibula and tibia.
Definition

 

medial circumflex femoral artery

severe accident

middle and superior 1/3

 

march

bumper

Term
____ is when the tibial tuberosity is elongated and fragmented with overlying soft tissue swelling

Ankle fxs (distal tibia/fibula) are typically due to excessive ___ or ___
Definition

osgood schlatter

eversion or inversion

Term
7 bones of the tarsus

How many metatarsals?

How many phalanges?
Definition

calcaneus

talus

navicular

cuboid

3 cuneiforms

 

5 metatarsals

 

14 phalanges

Term
3 arches in the foot:

___: made up of calcaneus, talus, navicular, 3 cuneiforms and 3 metatarsals

___: made up of calcaneus, cuboid, and 4-5th metatarsals

___: cuneiforms and cuboid

Flat foot doesn't have which of these arches?
Definition

medial longitudinal arch

lateral longitudinal arch

transverse arch

 

 

flat foot = no medial longitudinal arch

 

 

Term
____: fascia that covers the thigh
Iliotibial tract: condensation of fascia formed by ____ and ____ that attaches to the gerdy tubercle and limits ___ (action)
Definition

fascia lata

 

IT tract: gluteus maximus and tensa fascia lata - limits hyperadduction

Term
At the ankle, the ___ fascia condenses to form retinacula for the extensor, flexor, and peroneal muscles

The fascia at the ankle/foot is called ___, which covers muscles and tendons

the ___ is the fascia at the ankle that forms the tarsal tunnel.
Definition

crural

retinaculum

flexor retinaculum

Term
The ___ holds the parts of the foot together, helps protect the sole from injury, and helps support the longitudinal arches.
Definition
plantar fascia/deep fascia/plantar aponeurosis
Term
___ is the chief flexor of the hip joint.
Definition
iliopsoas
Term
Taylors Muscles: ___ & ___ - acting together, they cross the legs
Definition
pectineus and sartorius
Term
___ is the longest muscle in the body
Definition
sartorius
Term
The 4 quadriceps femoris muscles have differnet origins but a common insertion...
Definition

Rectus femoris: ASIS

Vastus Lateralis: lateral edge of the linea aspera

vastus medialis: medial edge of linea aspera

Vastus intermedius: anterior surface of femur

 

common insertion: all unite to form patellar ligament

Term
A person with paralyzed ___ muscles cannot extend the lef against resistance.

Weakness of the ___ or ____, resulting from arthritis or trauma to the knee joint can result in abnormal patellar moement and loss of joint stability
Definition

quadriceps

vastus medailis & vastus lateralis

Term
____: soreness and aching around or deep to patella + patellar instability. results from quadriceps imbalance. AKA runners knee.
Definition
chondromalacia patellae
Term
Adductor longus and brevis both originate at the ___ and insert at the ___.

___ artery and ___ nerve run between these muscles
Definition

 

pubic bone

linea aspera

 

deep femoral artery & anterior branch of obturator nerve

Term
____: Ossification that sometimes occurs in adductor longus tendons in horseback riders
Definition
rider's bones
Term
Adductor magnus, 2 parts:

Action together?
Actions separately?
Definition

together: adducts thigh

 

Adductor part: flexes thigh

Hamstring part: extends thigh

Term
Because the ___ is a relatively weak member of the adductor group, it can be removed and transplanted wihout noticeable loss of action.
Definition

gracilis

 

Term
What muscle?

Origin: margin of obturator membrane
insertion: trochanteric fossa of femur
Action: laterally rotates theigh, steadies head of femur in acetabulum
Definition
obturator externus
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