Gross II Exam 3

How many regions is the abdomen divided into?

9

What are midclavicular planes?

vertical planes which extend inferiorly from the midpoints of the clavicles to the midpoints of lines joining the anterior superior iliac spine to pubic symphysis

What is the subcostal plane?

horizontal plane joining the lowest point of the costal margin on each side. Lies at inferior margin of rib 10 (L.V. 3 level)

What is the transtubercular plane?

horizontal plane which joins the tubercles of the iliac crests (L.V. 5 level)

How many quadrants is the abdomen divided into?

4

Where does the umbilicus lie?

L.V. 2 and L.V. 5

What is a thin fatty layer of fascia which is continuous with superficial fascia of the perineum and thigh?

Superficial layer (Camper’s Fascia)

What is a membranous layer of fascia which is firmly fastened to the fascia lata of thigh, just below the inguinal ligament?

Deep layer (Scarpa’s fascia)

What is it called when there’s a potential space where fluid can accumulate between scrapa’s fascia and deep fascia of abdomen?

Extravasation of Urine

What causes extravasation of urine?

rupture of spongy urethra

What direction can urine spread when extravasation of urine is present?

superior in anterior abdominal wall

Can’t spread inferiorly into thigh due to firm attachment of scrapa’s fascia to fascia lata

T/F Extravasation of urine is found almost exclusively in males because the urethra is longer more superficial, and more horizontally oriented.

True

What is the homologus muscle to external oblique muscle?

external intercostal muscle

What muscle is homologus to internal oblique muscle?

internal intercostal muscle

What muscle is homologus to transversus abdominis muscle?

innermost intercostal muscle

What muscle acts as an internal back brace?

Transversus Abdominis muscle

What muscle doesn’t insert to linea alba?

Rectus Abdominis muscle

What is formed by the aponeuroses of the external oblique, internal oblique, and transversus abdominis muscles and is “like an envelope?”

Rectus Sheath

What are the two layers of the rectus sheath above the arcuate line?

1. Anterior layer of rectus sheath: composed of the aponeuroses of the external and internal oblique muscles

2. Posterior layer of rectus sheath: composed of aponeuroses of the internal oblique and transversus abdominis muscles

T/F below the arcuate line, the aponeurosis of the internal oblique muscle splits to enclose the rectus abdominis

False- Above

What are the two layers of rectus sheath below the arcuate line?

1. Anterior layer of rectus sheath: composed of the aponeuroses of the external oblique, internal oblique, and transversus abdominis muscles

2. Posterior layer of the rectus sheath: formed by the transversalis fascia

What is each fold on the posterior surface of the anterior abdominal wall formed by?

parietal peritoneum, overlying a structure

What is the median umbilical fold?

extends from the apex of the bladder to the umbilicus

contains the urachus

What is the medial umbilical fold?

extends from the side of the bladder to the umbilicus

contains the obliterated umbilical artery

What is the lateral umbilical fold?

extends from the deep inguinal ring to the arcuate line

contains the inferior epigastric vessels

Where is the ligamentum teres?

lies above the umbilicus and contains the obliterated umbilical vein

What is the ligamentum teres?

the free edge of the falciform ligament, which is attached to the liver

What forms the inguinal ligament?

formed by the lower edge of the external oblique aponeurosis

T/F the inguinal canal is an oblique passage 3-5 cm in length through the anterior abdominal wall

True

The inguinal canal transmits:

1. Spermatic cord

2. Round ligament of the uterus

3. Ilioinguinal nerve

What is the conjoint tendon?

formed by the fusion of the aponeuroses of the internal oblique and transversus abdominis muscles

strengthens the posterior wall of the medial half of the inguinal canal

The superficial inguinal ring is formed by the splitting of the external oblique aponeurosis into two crura:

1. Lateral Crus: inserts to the pubic tubercle

2. Medial Crus: inserts to the pubic crest

T/F Deep inguinal ring is an opening within the transversalis fascia

True

What is an area of potential weakness in the anterior abdominal wall? Direct inguinal hernias occur here.

Inguinal Triangle

What is the most common pathology of the anterior abdominal wall?

inguinal hernia

T/F In inguinal hernias, abdominal viscera protrude through the inguinal region

True

Are inguinal hernias more common in males or females?

Males

What are some features of indirect inguinal hernia?

1. Passes through the deep inguinal ring, inguinal canal, and superficial inguinal ring

2. Passes lateral to the inferior epigastric vessels

3. may be congenital

4. accounts for 75% of inguinal hernias

What are some features of direct inguinal hernias?

1. punches directly through the posterior wall of the inguinal canal

2. passes medial to the inferior epigastric vessels

3. causes general bulging of the anterior abdominal wall

4. is always acquired

5. accounts for 25% of inguinal hernias

What are some features of the femoral hernia?

1. passes through the femoral canal

2. occurs inferior to the inguinal ligament

3. MC in females

What are some features of umbilical hernia?

1. results from incomplete closure of the anterior abdominal wall after ligation of the umbilicus at birth

2. occurs due to defects in the linea alba

What are the three layers of fascia that cover the spermatic cord?

1. External spermatic fascia: derived from the external oblique aponeurosis

2. Cremasteric fascia: derived from internal oblique aponeurosis- can be recognized by presence of cremaster muscles

3. Internal spermatic fascia: derived from transversalis fascia

What is the function of the cremaster muscle?

temperature regulation of sperm- sperm can’t survive long at body core temperature

What are the structures of the spermatic cord?

1. Ductus deferens

2. Testicular artery

3. Pampiniform plexus of veins

4. Artery to the ductus deferens

5. Cremasteric Artery

6. Genital branch of genitofemoral nerve

7. Remnant of Processus Vaginalis

8. Autonomic nerves

9. Lymphatics

T/F The ilioinguinal nerve accompanies the spermatic cord and is a part of it

False- is not a part of it

What are the parts of the scrotum?

1. the testes

2. the epididymis

3. the lower part of the spermatic cord

What scrotum layer is continuous of the subcutaneous tissue layer of the anterior abdominal wall?

Dartos Muscle

What scrotum layer is continuous with the external oblique muscle?

external spermatic fascia

What scrotum layer is continuous to the internal oblique muscle?

cremasteric fascia

What scrotum layer is continuous to transversus abdominis muscle?

No continuation

What scrotum layer is continuous to the transversalis fascia?

Internal spermatic fascia

What scrotum layer is continuous to the extraperitoneal fascia?

no continuation

What scrotum layer is continuous to the peritoneum?

tunica vaginalis

What is Hydrocele?

accumulation of fluid within the cavity of the tunica vaginalis

What are the functions of the testis?

1. production of spermatozoa

2. secretion of androgens

What is tunica albuginea?

fibrous outer covering of the testis. Lies deep to the visceral layer of the tunica vaginais

What is the flow of sperm?

Seminiferous tubules-Straight tubules-Rete testis-efferent ductules-epididymis

What is the epididymis?

C-shaped structure attached to the superior and posterior aspect of the testis

function is to store sperm until they mature

What is the lymphatic drainage for the testis and scrotum?

1. Testis drains into the lumbar nodes

2. Scrotum drains into the superficial inguinal nodes

T/F The testes develop in the lumbar region inside the abdominal cavity

True

What is the gubernaculum testis?

a ligament present in the fetus which connects the testis to the scrotum

What is a remnant of the gubernaculum?

scrotal ligament

What is cryptochidism?

testes are undescended at birth

Most Commonly found in inguinal canal

If no descent, infertility results and increased risk of cancer

What are the parts of the peritoneum?

1. Parietal peritoneum

2. Visceral peritoneum

   connected by mesentery

What is the peritoneal cavity?

a potential space between the parietal and visceral peritoneum

T/F In the female, the peritoneal cavity communicates with the exterior through the uterine tubes. This is how infections to the vagina spread

True

What are the functions of the peritoneum?

1. minimize friction between organs

2. resist infection

3. fat storage

What are retroperitoneal organs?

Lie posterior to the peritoneum and are covered by peritoneum only on their anterior surface (ex: kidney)

What is ascities?

accumulation of fluid within peritoneal cavity

In a healthy person, peritoneum is highly absorbent

Causes:

1. Malnutrition

2. Congestive heart failure

3. Liver failure

4. Kidney failure

5. Peritonitis

What is peritonitis?

inflammation of peritoneum

Causes:

1. Trauma

2. Inflammatory bowel disease

3. Vaginal infections

   Peritonitis results in adhesions between parietal and visceral peritoneum

T/F The parietal peritoneum is not sensitive to pain

False- very sensitive to pain

What ligaments are associated with the greater omentum?

1. Gastrophrenic ligament

2. Gastrosplenic ligament

3. Gastrocolic ligament

What ligaments are associated with lesser omentum?

1. hepatogastric ligament

2. Hepatoduodenal ligament

What is the double layer of peritoneum which connects the jejunum and ileum to the body wall?

mesentery proper

What connects the appendix to the mesentery of the ileum?

mesoappendix

What attaches the left colic flexure to the diaphragm?

phrenicocolic ligament

What portion of the greater sac is lateral to the ascending colon?

right paracolic gutter

What portion of the greater sac is lateral to the descending colon?

left paracolic gutter

What are the boundaries of the omental foramen?

1. Liver

2. First part of the duodenum

3. Free edge of the lesser omentum

4. Peritoneum covering the inferior vena cava

What structures pass through the porta hepatis and are surround by lesser omentum?

1. Bile Duct

2. Hepatic Artery proper

3. Portal vein

What are the three parts of the GI tract?

Foregut: forms the distal esophagus, stomach, and part of the duodenum

Midgut: begins at the entrance of the bile ducts and ends at right 2/3 of the transverse colon

Hindgut: begins at left 1/3 of the transverse colon, ends at upper part of the anal canal

Blood supply to the GI Tract

Foregut: celiac trunk

Midgut: superior mesenteric artery

Hindgut: inferior mesenteric artery

Sympathetic innervation of GI tract

Foregut and Midgut: greater splanchnic nerves (T5-T9) and lesser splanchnic nerves (T10-T11)

Hindgut: lumbar splanchnic nerves (L1-L2)

Parasympathetic innervation of GI Tract

Foregut and Midgut: vagus nerve

Hindgut: pelvic splanchnic nerves

What are the four layers of the gut wall?

1. Mucosa

2. Submucosa

3. Muscularis externa

4. Serosa

What is the function of the submucosal plexus?

mucus secretions

What is the function of the myenteric plexus?

stimulate peristalsis

What is peristalsis? reverse peristalsis?

Peristalsis: propulsive movement of the gut

Reverse peristalsis: vomiting

What is the pylorus marked externally by?

the pyloric constriction

What is congenital hypertrophic pyloric stenosis?

tumor like increase in size of pyloric sphincter, which reduces size of pyloric canal

Treatment of newborns with antibiotic erythromycin can increase the risk for ___

congenital hypertrophic pyloric stenosis

What is pylorospasm?

spasmodic contraction of pyloric sphincter

food doesn’t pass easily from stomach to duodenum

stomach becomes overly full, results in vomiting may be projectile

What is a gastric ulcer?

crater like depression in mucosa of stomach

stomach secretes alkaline mucus which is viscous and forms a barrier between stomach acid and mucosa

secretion of gastric acid is controlled by vagus nerve

What is the largest branch of the celiac trunk?

Splenic artery

What arteries go to the fundus of the stomach?

Short gastric arteries

What is the first unpaired branch from the abdominal aorta?

celiac trunk

Where does the bile duct lie?

to the right of hepatic artery proper and the portal vein lies behind it

What artery supplies the gall bladder?

cystic artery

Where are the brunner glands?

duodenum

What is the function of brunner glands?

secrete dilute alkaline mucus- neutralize stomach acid