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Block 3
Abdomin
130
Anatomy
Graduate
02/15/2011

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Cards

Term
Inguinal ligament
Definition
junction between abdomen and thigh
Term
Linea Alba
Definition
medial border of rectus sheath
Term
SemiLunar Line
Definition
lateral border of rectus sheath
Term
Pubic symphysis
Definition
The pubic symphysis is the midline cartilaginous joint (secondary cartilaginous) uniting the superior rami of the left and right pubic bones. It is located anterior to the urinary bladder and superior to the external genitalia; for females it is above the vulva and for males it is above the penis. In males, the suspensory ligament of the penis attaches to the pubic symphysis. In females, the pubic symphysis is intimately close to the clitoris.
Term
Umbilicus
Definition
surface landmark for anterior abdominal wall; a synonym for the navel or belly button
Term
ASIS
Definition
The anterior superior iliac spine (ASIS) is an important landmark of surface anatomy. It refers to the anterior extremity of the iliac crest of the pelvis, which provides attachment for the

inguinal ligament,
the sartorius muscle, and the
tensor fasciae latae.

A - Anterior (front, like the face)
S - Superior (towards the head, opposite to feet)
I - Iliac (Pelvis bone)
S - Spine
Term
Aponeuroses
Definition
Their primary function is to join muscles and the body parts the muscles act upon.

Flat expanded tendons.
Term
# Ipsilateral
Definition
(Latin ipse; self/same): on the same side as another structure. Thus, the left arm is ipsilateral to the left leg.
Term
Contralateral
Definition
Contralateral (Latin contra; against): on the opposite from another structure. Thus, the left arm is contralateral to the right arm, or the right leg.
Term
Hernia
Definition
A hernia is the protrusion of an organ or the fascia of an organ through the wall of the cavity that normally contains it.
Term
Identify the functions of the anterior abdominal wall.
Definition
Contract to increase intre-abdominal pressure

Distend considerably to accomodate expansions.
Term
Identify the boundaries of the anterior abdominal wall
Definition
Anterior is the thoracic diaphragm and extends into the thoracic cage to the 4th intercostal space. And Inferiorly to the plane of the pelvic inlet (not phys).
Term
The pelvic cavity
Definition
the pelvic cavity, the space enclosed by the pelvic girdle, subdivided into

* the greater or false pelvis (inferior part of the abdominal cavity) and
* the lesser or true pelvis which provides the skeleton for the perineum and the pelvic cavity (which are separated by the pelvic diaphragm),
Term
Osteology of Sacrum
Definition
Identify

Illiac crest
ASIS
Inguinal Ligament
Ala of Sacrum
Ilium
Arcuate Line
Pectineal Line
Pubic Tubercle
Articular (auricular) surface of sacroiliac joint
Pubis
Ischium
Term
What are the four quadrants of the abdomincal cavity and by what planes are they defined? (surface topography)
Definition
Right and Left Upper and Lower Quadrants.

1. Transverse Transumbilical Plane passes through the umbilicus and IV disc between L3 and L4.

2. Vertical Median Plane which passes longitudinally through the body.

These are used for general clinical descriptions
Term
Abdominal regions:

What are the transverse planes?
Definition
1. Subcostal Plane - passes through the inferior order of the 10th costal cartilage on each side to L3.

2. Transtubercular plane- passing through the iliac tubercles and the body of L5 tubercle.
Term
Transpyloric Plane
Definition
at 9th costal cartilage to L1
Term
Abdominal Regions
Definition
Based on two horizonal and two vertical planes. 9 regions

Midclavicular Lines to the point where the head of femur attaches

Right Hypochondral
Epigastric
Left Hypochondral
(these are all above the 10 costal cartilage...above the subcostal plane)

Right Lumbar AKA Flank
Umbilical
Left Lumbar
(these are all above the transtubercular plane)

Right Inguinal (Groin)
Hypogastric (Pubic)
Left Inguinal
Term
What is Guarding?
Definition
Involuntary spasms of the muscles (guards inflamed organs); intense guarding can be a sign of acute abdomen (appendicitis)/
Term
McBurney's Point
Definition
Traditional approach for an appendectomy

McBurney's point is on Spinoumbilical line. From the umbilicus to the ASIS. The incision would be made 2/3 from the umbilicus and 1/3 from the ASIS.

Appendix is mobile; in right lower quadrant. It is attached to the cecum.
Appendix in mobile; in right lower quadrant.
Term
Incisions
Definition
-Longitudinal (Most commonly used large abdomincal incision and good for laparotomy)

Midline
Paramedian
Transrectal

What incision is used is dependent on speed, (i.e., during hemorrhage); previoud adbominal surgery; potential placement for stomas.
Term
Incisions:

Oblique

Transverse

Combined
Definition
-Oblique
Subcostal
McBurney’s; parallel to ext oblique muscle
-Transverse
Pfannenstiel- used by gynecologists and urologists
-Combined
Thoraco-abdominal
Term
Lines of Langer
Definition
normal lines of tension of the skin
parallel incision:
will heal faster
less possibility of scarring and formation of postoperative hernia
a vertical incision leads to:
cutting motor nn, leading to atrophy of muscle
bad scarring
breakdown of sutures and infection
bad cosmetics, debilitation, and possible lawsuits by patient
Term
List the Abdominal Fascia on Upper Abdomen (above umbilicus)
Definition
Skin > Superficial fascia > Deep Fascia
Term
Abdominal Fascia on Lower Abdomen (below umbilicus)
Definition
Skin > Fatty Fascia (Camper) > Membranous Fascia (Scarpa) > Deep Fascia
Term
MEMBRANOUS FASCIA (SCARPA’S FASCIA)
Definition
Scarpa’s fascia becomes Colle’s fascia in perineum.

Membranous layer extends down into the perineal (genital) region, however it does not go into the thigh.
Term
In males, what happens when the dartos tunic ruptures?
Definition
Urine can extravasate into abdominal wall.
Term
Layers of Fascia and what do they do for the muscles?
Definition
-Skin

- Superficial Fatty Layer (Camper fascia)

- Deep Membranous Layer (Scarpa Fascia)

- Superficial investing Fascia

- External Oblique Muscle

- Intermediate Investing Fascia

- Internal Oblique Muscle

- Deep Investing Fascia

- Transverse Abdominis

- Endoabdominal (Transversalis) Fasica

- Extraperitoneal Fat

- Parietal Peritoneum

- Parietal Layer

- Visceral Layer

- Fascia allow the muscles to work independently, without friction.
Term
Camper Fascia
Definition
Campers fascia goes over the inguinal ligament and is continuous with the superficial fascia of the thigh. In men it is continuous with the dartos fascia in scrotum and in women, it retains its fat and is continuous with a component of the labia majora.
Term
Scarpa’s fascia
Definition
contains little fat and can hold a suture. It fuses with the fascia lata of the thigh. It continues into the anterior part of the perineum where it is referred to as the superficial perineal fascia (Colles’ fascia).
Term
What are the two major groups of muscles in the abdomin?

What is their Function?
Definition
Flat layered muscles

2 Vertical Rectus Abdominis

Muscles protect the viscera and play a role in quiet and forced expiration.
Term
What are the directions which the muscles of the abdomen lie?
Definition
External Oblique: Hands in the pockets

Internal Oblique: Hands out

Transversus Abdominis: Horizonatal
Term
What is the name of the deep fascia that lies on the abdominal muscles?
Definition
Gallaudet's fascia
Term
Linea Alba
Definition
External, internal oblique and transverse abdominis end anteriorly in a strong aponeurosis.
Term
PYRAMIDALIS M.
Definition
Absent in ~20% of people
Lies in rectus sheath anterior to the inferior part of the rectus abdominis. It ends in the linea alba and tenses it.
Term
What is in the Rectus Sheath?
Definition
Contents:
Rectus abdominis
Pyramidalis
Sup and Inf epigastric arteries and veins
Lymphatics
Ant rami of T7-T12
Term
Rectus Abdominis Muscle
Definition
The rectus muscle has attachments to the anterior layer of the sheath called tendinous intersections. The rectus muscle has been removed on the left side to expose posterior wall of the sheath. The arcuate line represents a change in the layers of the sheath.
Term
Describe the rectus sheath above the arcuate line
Definition
Anterior: EO and 1/2IO

Posterior: 1/2IO and Transversus Abdominis (TA)
Term
Describe rectus sheath below the arcuate line
Definition
Anterior: EO + IO + TA

Posterior: Direct contact with Transversalis Fascia
Term
Where is the extraperitoneal fascia
Definition
viscera in this fascia are retroperitoneal
Term
Parietal Peritoneum: what is the difference among men and women?
Definition
Peritoneal cavity is closed in men but has 2 openings in women (uterine tubes)
Term
What is the INNERVATION?
Definition
MOTOR

Netters 257

Lateral Cutaneous Branches of Intercostal Nerve (T2-11)

Anterior Cutaneous Branches of Intercostal Nerve (T1-11)

Lateral and Anterior Cutaneous Branches of subcostal nerve (T12)

Lateral cutaneous branch of Iliohypogastric N (L1)

Ilioinguinal nerve (L1) and its anterior scrotal branch

Femoral branches of genitofermoral nerve (L1, 2).

Intercostal nerves btw internal oblique and transversus abdominis.
Term
What are the imp dermatomes of the abdominal wall?
Definition
T7 = xiphoid process

T10=umbilicus

T12=suprapubic region

L1=upper medial thigh
& genitalia
Term
ARTERIES of the Ant. Abdominal wall
Definition
Netters 255

Intercostal arteries (5)
Subcostal arteries
Lumbar arteries (4)
Superior epigastric artery—internal thoracic artery
Inferior epigastric artery -external iliac artery
Deep iliac circumflex artery- external iliac artery
Term
Superficial Venous Drainage

What are these veins called
Definition
Superficial (unpaired) veins drain the superficial fascia to the axillary, femoral and paraumbilical veins

paraumbilical vvs drain into the portal system, Paraumbilical v anastomose with superficial epigastric v, which forms a portal-caval anastomoses.

superior epigastric v and superior circumflex iliac drain into femoral v.
Term
What do the deep veins drain into?
Definition
Deep veins travel with the arteries in the previous slide and drain to the IVC, azygos, subclavian and external iliac veins.
Term
Lateral thoracic v and thoracoepigastric
Definition
drain into subclavian v

netters 256
Term
What is Caput Medusae?
Definition
is the appearance of distended and engorged paraumbilical veins, which are seen radiating from the umbilicus across the abdomen to join systemic veins.
Term
What causes Caput Medusae?
Definition
It is a sign of severe portal hypertension that has decompressed by portal-systemic shunting through the paraumbilical veins.
Term
Lymph Deep drainage: Anterior
Definition
Intercostal Lymphatic Nodes
Parasternal Lymphatic Nodes
Term
Lymph Deep drainage: Middle
Definition
Lumbar Lymphatic Nodes
Term
Lymph Deep drainage: Lower
Definition
External Iliac Lymphatic Nodes
Term
What are the borders of the Triangle of Hasselbach?
Definition
Lat: Inf. Epi Vessels

Med: Semilunar line of rectuc sheath

Inf: Inguinal ligament from ext. oblique aponeurosis.

Potential sites for the less common direct inguinal hernias
Term
Lateral umbilical ligaments contains....
Definition
Inferior epigastric vessels; branches of external iliac vessels
Term
Falciform ligament
Definition
(ventral mesentery)

Attaches to the liver

Becomes canalised if the individual is suffering from portal hypertension, due to the increase in venous congestion blood is pushed down from the liver towards the anterior abdominal wall and pools resulting in periumbilical bruising.
Term
Ligamentum teres
Definition
(obliterated umbilical vein; to paraumbilical vein)
Term
Medial umbilical ligaments
Definition
(obliterated umbilical arteries)

It may be used as a landmark for surgeons exploring the medial inguinal fossa during laparoscopic inguinal hernia repair.
Term
Median umbilical ligament
Definition
(obliterated urachus)

It may be used as a landmark for surgeons who are performing laparoscopy, such as laparoscopic inguinal hernia repair.
Term
ABDOMINAL MUSCULAR WALL PRESSURIZES ABDOMEN when...
Definition
Cough
Sneeze
Urinate
Defecate
Birth
Lifting
Term
MIDLINE
Definition
Aorta
Uterus (if enlarged)
Bladder (if distended)
Term
RIGHT UPPER QUADRANT (RUQ )
Definition
Liver
Gallbladder
Duodenum
Head of pancreas
Right kidney and adrenal
Hepatic flexure of colon
Part of ascending and transverse colon
Term
LEFT UPPER QUADRANT (LUQ)
Definition
Stomach
Spleen
Left lobe of liver
Body of pancreas
Left kidney and adrenal
Splenic flexure of colon
Part of transverse and descending colon
Term
RIGHT LOWER QUADRANT (RLQ)
Definition
Cecum
Appendix
Right ovary and tube
Right ureter
Right spermatic cord
Term
LEFT LOWER QUADRANT (LLQ)
Definition
Part of descending colon
Sigmoid colon
Left ovary and tube
Left ureter
Left spermatic cord
Term
Incisional hernia
Definition
a protrusion of omentum (fold of periotonuem) or an organ thru a surgical incision. If the mmuscular and aponeurotic layers of the abdomen do not heal properly....
Term
indirect hernia
Definition
congenital onset

protrudes through the inguinal ring and is ultimately the result of the failure of embryonic closure of the internal inguinal ring after the testicle passes through it

covered by internal spermatic fascia

lateral to the inferior epigastric vessels
Term
Direct hernia
Definition
adult onset

enters through a weak point in the fascia of the abdominal wall (Hesselbach triangle); NOT covered by internal spermatic fascia; medial to inferior epigastric vessels
Term
Lymphatics in the region above the umbilicus
Definition
Drain into the axillary lymph nodes
Term
Lymphatics in the region below the umbilicous
Definition
Drain into the superficial inguinal nodes
Term
From where do the Superficial inguinal lymph nodes receive their lymph?
Definition
Lower abdominal wall
Buttocks
Penis
Scrotum
Labium Majus
Lower parts of the vagina
Anal Canal

These nodes have vessels which enter the external iliac nodes and ultimately the lumbar (aortic) nodes.
Term
Retroperitoneal
Definition
Organs are retroperitoneal if they only have peritoneum on their anterior side.
Term
Peritoneum
Definition
Thin membrane that lines the walls of the abdominal cavity and covers much of its viscera.
Term
Parietal peritoneum
Definition
lines the cavity; somatic innervation; well localized pain.
Term
Visceral peritoneum
Definition
covers the viscera; visceral afferents; diffuse pain
Term
Falciform Ligament
Definition
Attached the liver to the diaphragm
Term
Somatic innervation of the parietal peritoneum
Definition
phrenic
lower intercostal
subcostal
iliohypogastric
ilioinguinal nerves
Term
What does the greater omentum cover?
Definition
It hangs down from the greater curvature of the stomach.

It covers the transverse colon and other abdominal organs, transverse colon and small intestine (jejunum and ileum).
Term
How is the Rt Testicular vein diff from the LT?
Definition
Rt comes off of the IVC while LT comes off of the LT RV
Term
What are the veins of the testes?
Definition
Pampiniform plexus; testicular vein
Term
What and from where is the artery supplying the testes?
Definition
Testicular Arteries from the AA just below renal artery @ L2
Term
Where is SMA located?
Definition
L1
Term
What veins do the testicular veins anastomose with?
Definition
Vas, cremasteric,
Term
Where does the lymph drain into from the testis?
Definition
Into the Lumbar/Para-aortic nodes.

These are on the AA
Term
What nerves and through which spinal cord segment innervate the testis?
Definition
Sympathetic Lesser and least splanchnic nerves and T10-T12.
Term
What is the function of the pampiniform plexus?
Definition
Countercurrent heat exchanger
Term
What is the function of the cremaster muscle?
Definition
Pulls up and down the testis
Term
What is the function of the Dartos Muscle?
Definition
Causes wrinkling of the skin
Term
What is in the spermatic cord?
Definition
Testis, Epididymus, Das Deferens, Artery to DD, testicular A, Cremasteric A,

Tunica Albugenia
Tunica Vaginalis
Term
What are the layers of coverings of the tests and spermatic cord?
Definition
1. External Spermatic Fascia
2. Cremaster Fascia
3. Internal Spermatic Fascia
4. Tunica Vaginalis
Term
What are the glands that derive from ducts and urethra?
Definition
- prostate
- bulbuourethral (cowper's gland)
- Seminal vesicles/glands
Term
What is the Florence's test?
Definition
COnfirmation of rape.

Seminal vesicles produce the seminal fructose (alkaline)
Term
What is the male and female version of water under the bridge?
Definition
The ureter is the water under the bridge of vas deferens.

The uterine artery is the bridge ontop of the ureter
Term
What is the fibromuscular component of the prostate gland?
Definition
1/3 fibromuscular
2/3 glandular
Term
What is special about the anterior lobe o the prostate?
Definition
is anterior to prostatic urethra – fibromuscular
Term
What is special about the posterior lobe of the prostate?
Definition
posterior to prostatic urethra & inferior to ejaculatory duct (ED) – predisposed to malignant transformation
Term
What is special about the lateral lobes of the prostate?
Definition
involved in benign prostatic hypertrophy/hyperplasia (BPH),
Term
What is special about the middle (median = Albarran's) lobe of the prostate?
Definition
BOO = bladder outlet obstruction due to valve-like effect of the enlarged gland), mainly glandular – benign prostatic hypertrophy (BPH) in 80% of all men by 80 years of age,

Also is the only one not palpable per rectum
Term
What is the peripheral zone and central zone respectively of prostate the site of?
Definition
cancer

central zone is primary site for benign prostatic hypertrophy/hyperplasia
Term
Why is the verumontanum in prostatectomy an imp lanmark?
Definition
Is is here where the surgons can reach the median lobe with a laser by resectting from there to neck of bladder.
Term
What is between the true and false capsules?
Definition
between the true & false capsules is the prostatic venous plexus continuous with deep dorsal vein of penis & vesical venous plexus
Term
Prostatectomy approaches?
Definition
transurethral, retropubic, transvesical
Term
Is the bladder retroperitoneal?
Definition
Yes
Term
What is Eneuresis?
Definition
urinary incontinence (involuntary loss of urine) at any age when continence is considered normal (generally after 5 years)
Term
WHat is the verumontanum/Seminal colliculus?
Definition
In upper part of urethral crest
Term
What arteries supply the prostate?

What veins supply?

What is the lymphatic drainage of prostate?

What are its innervations>
Definition
ARTERIES : inferior vesical , deferential (from inferior vesical) & inferior rectal arteries
VEINS: prostatic venous plexus at base of prostate between the 2 prostatic capsules, & sacral
LYMPHATICS : lymph drains into internal iliac & sacral nodes
NERVES : inferior hypogastric plexus
Term
What does the inferior vesical artery supple?
Definition
EPIDIDYMIS/DUCTUS DEFERENS :
EJACULATORY DUCT
SEMINAL GLANDS
BLADDER
LOWER URETER
Term
What is Male Sterilzation called?
Definition
DEFERENTECTOMY
REVERSIBLE BUT...
Term
What is special about the seminal colliculus or verumontanum?
Definition
During the procedure an eye should be kept on the seminal colliculus or verumontanum – the resectoscope should be kept above this structure in order not to damage the urethral sphincter open prostatectomy – retropubic, transvesical
Term
What is the function of PUBO-PROSTATIC (M) OR PUBOVESICAL (F) LIGAMENTS?
Definition
On lateral surface of bladder and anchor it.
Term
What is the support of the Bladder?
Definition
PELVIC DIAPHRAGM ,
UROGENITAL DIAPHRAGM ,
ENDOPELVIC FASCIA ,
MEDIAN UMBILICAL LIGAMENT ,
MEDIAL UMBILICAL LIGAMENT
Term
What about the Base (fundus) of the bladder?
Definition
TRIANGULAR
UPPER PART COVERED BY PERITONEUM
4 DUCTS REST HERE : VAS CROSS URETERS & SEPARATE SEMINAL VESICLES,
RECTOVESICAL POUCH / SEPTUM (M) ,
VESICOVAGINAL POUCH (F).
Term
What is special about the neck of the bladder?
Definition
LOWEST & ONLY PART WHERE BLADDER IS FIXED
3 SURFACES MEET AT BASE OF PROSTATE ,
PIERCED BY URETHRA
HELD IN PLACE BY LIGAMENTS ,
HERE SMOOTH MUSCLES FIBERS OF BOTH PROSTATE & BLADDER ARE CONTINUOUS,
Term
What about the detrusor muscle?
Definition
Sympathetic- Hypogastric N (T10-L2)

Parasympathetic- Pelvic N(S2-4)

Forms the Internal urethreal sphincter
Term
The Bladder wall is made up of what cells?
Definition
Folds of mucous membrane (transitional epithelium) , except at the trigone,
Term
What is the function of the URETERO-VESICAL VALVE and where is it on the ureter?
Definition
NO REFLUX ,
ONE OF THE NARROW POINTS OF THE URETER .
Term
What is the difference in genders when it comes to the EUS?
Definition
1. Upper part in male compromised by prostate, but lower part maintains competence
Upper part in females fairly circumferencial, but lower part is compromised by vagina (urethrovaginal sphincter) : hence continence is compromised.
Term
What about the EUS should I know?
Definition
Skeletal muscle
Innervated by Pudendal nerve
Separated from pelvic diaphragm
Tube-like
Term
Subcostal T12 innervates what?
Definition
EO,IO, Transverse, Rectus Abdominis, Pyramidalis M

Penetrates the transverse abdominal muscle and runs btw it and IO.
Term
What about the penile and scrotal raphe?
Definition
It fused
Term
What is the relationship between corpus cavernosum penis and corpus spongiosum penis?
Definition
corpus spongiosum penis is inside sorpus cavernosum penis like a hotdog
Term
What is the fundiform ligament?
Definition
Remeber the Scarpa part of it!

The fundiform ligament is a specialization, thickening, of the superficial (Scarpa's) fascia extending from the linea alba of the lower abdominal wall.

It runs from the level of the pubic bone, laterally around the sides of the penis like a sling, and then unites at the base of the penis before going to the septum of the scrotum.

It is just superficial to the suspensory ligament.

Although rarely mentioned, this ligament is also found in females.
Term
What is the functions of the corpus spongiosum penis?
Definition
The function of the corpus spongiosum in erection is to prevent the urethra from pinching closed, thereby maintaining the urethra as a viable channel for ejaculation. To do this, the corpus spongiosum remains pliable during erection while the corpora cavernosum penis becomes engorged with blood.
Term
What fascia is the suspensory ligament made from?
Definition
Gallaudets
Term
Impeding of what veins is responsible for the turgidity of the penis during erection?
Definition
Deep dorsal vein of corpus cavernosa
Term
The tunica albuginea covers the 3 cylinders of the cavernous tissue, why is it more lose on the spongiosum?
Definition
Allows easy passage of the ejaculate during ejaculation.
Term
What are the arteries of the scrotum?
Definition
External and internal pupendal arteries
Term
What are the nerves of the scrotum?
Definition
Pudendal (post), Ilioinguinal (ant), genito-femoral (a-lat), posterior femoral cutaneous.
Term
What are the 3 coverings, arteries, nerves and other structures of the spermatic cord?
Definition
3 COVERINGS ; external, cremasteric & internal spermatic fasciae,
3 ARTERIES : testicular, cremasteric & vas (ductus)
3 NERVES : ilioinguinal, genital branch of genitofemoral, & sympathetic on vessels
3 OTHER STRUCTURES : vas (ductus) deferens, pampiniform plexus of veins, lymphatics
Term
What is the vasculature and innervation of the vulva?
Definition
VESSELS :
1. ARTERIES:
- internal pudendal
- external pudendal
2. VEINS: VENAE COMMITANTES
3. LYMPHATICS : Superficial inguinal Nodes
NERVERS :
1. SOMATIC: ilio-inguinal nerve, pudendal nerve, posterior femoral cutaneous nerve,
2. AUTONOMIC: pelvic splanchnic nerves – from sacral plexus.
Term
What nerves are responsible for erection, emission, and ejaculation?
Definition
ERECTION : mediated by nitric oxide (NO)-releasing pelvic splanchnic nerves PSN = S2-4), which causes relaxation of smooth muscles of helicine arteries (vasodilatation)
EMISSION : lumbar splanchnic nerve mediated delivery of semen from all sources to the prostatic urethra by testicular tubules,
EJACULATION : expulsion of ejaculate from prostatic urethra ; mediated by sympathetic, parasympathetic & somatic nerves :
- sympathetic (L1-2): closure of internal urethral sphincter,
- ?parasympathetic (PSN) : contraction of urethral smooth muscle,
- somatic (pudendal) : contraction of bulbospongiosus & ischiocavernosus.
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