RCEM Primary Abdomen Lecture Notes

Detailed vocabulary flashcards for RCEM Primary preparation covering abdominal anatomy, vasculature, innervation, and clinical relations.

Foregut Artery

Celiac artery

Foregut Sympathetic Innervation

Preganglionics: thoracic splanchnic nerves $T5-T9$; Postganglionic cell bodies: celiac ganglion

Foregut Referred Pain

Epigastrium

Foregut Derivatives

Esophagus, Stomach, Duodenum (first and second parts), Liver, Pancreas, Biliary apparatus, and Gallbladder

Midgut Artery

Superior mesenteric artery

Midgut Parasympathetic Innervation

Vagus nerves

Midgut Referred Pain

Umbilical region

Midgut Derivatives

Duodenum (second, third, and fourth parts), Jejunum, Ileum, Cecum, Appendix, Ascending colon, and the proximal two-thirds of the Transverse colon

Hindgut Artery

Inferior mesenteric artery

Hindgut Sympathetic Innervation

Preganglionics: lumbar splanchnic nerves, $L1-L2$; Postganglionic cell bodies: inferior mesenteric ganglion

Hindgut Referred Pain

Hypogastrium

Hindgut Derivatives

Transverse colon (distal third), Descending colon, Sigmoid colon, Rectum, and Anal canal (above pectinate line)

Splenic Flexure

The most common site of bowel ischemia

Abdominal Aneurysm common site

The area between renal arteries and the bifurcation of the abdominal aorta

Celiac Trunk Branches

Left gastric artery, Splenic artery, and Common hepatic artery

Gastroduodenal Artery Erosion

Subject to erosion by a penetrating ulcer at the posterior wall of the $1st$ part of the duodenum

Superior Mesenteric Artery branches

Inferior pancreaticoduodenal, Intestinal (jejunal and ileal), Ileocolic, Right colic, and Middle colic arteries

Marginal Artery

Anastomosis between the superior and inferior mesenteric arteries providing collateral supply to the colon

Inferior Vena Cava ($IVC$) Formation

Formed at the $L5$ level by the union of the common iliac veins

Left Renal Vein Drainage

Receives the left suprarenal vein and the left gonadal vein before draining into the $IVC$

Lumbar Plexus Roots

Anterior and posterior rami of $L1$ to $L4$

Genitofemoral Nerve roots

$L1-L2$; supplies the cremaster muscle and skin of the anterior thigh

Abdominal Wall Fascia Layers

$Skin$, $Camper's$ fascia (fatty), and $Scarpa's$ fascia (membranous)

Linea Alba

A midline structure extending from the xiphoid process of the sternum to the pubic symphysis

Inguinal Ligament

Formed by the free inferior border of the external oblique aponeurosis

Arcuate Line

Demarcation one-third the distance between the umbilicus and the pubis where the posterior rectus sheath ends

Contents of the Rectus Sheath

Rectus abdominis, Pyramidalis muscles, Superior and Inferior epigastric vessels, and Posterior Intercostal nerves

Inguinal Canal Location

Parallel and just above the lower half of the inguinal ligament; extends from the deep inguinal ring to the superficial inguinal ring

Mid-Inguinal Point

Between the Pubic symphysis and the ASIS (Anterior Superior Iliac Spine); location of the femoral artery

Indirect Inguinal Hernia

Passes through the deep inguinal ring lateral to the inferior epigastric vessels; follows the same course as the spermatic cord

Direct Inguinal Hernia

Bulges through weakened fascia of the posterior wall of the inguinal canal medial to the inferior epigastric vessels

Richter's Hernia

Involves only the antimesenteric border of the intestine; involves only a portion of the wall circumference

Spigelian Hernia

Arises at the lateral edge of the rectus muscle and the arcuate (semilunar) line; prone to incarceration

SAD PUCKER

Mnemonic for retroperitoneal organs: Suprarenal gland, Aorta/$IVC$, Duodenum (half), Pancreas, Ureters, Colon (asc/desc), Kidneys, Esophagus, Rectum

Stomach relations: Posterior

Lesser sac, Pancreas, Transverse mesocolon, Transverse colon, Left kidney/suprarenal gland, and Spleen/splenic artery

Meckel's Diverticulum

True diverticulum containing all $3$ layers of the intestinal wall; inflammation mimics appendicitis

McBurney's Point

$\frac{2}{3}$ of the way from the umbilicus to the ASIS; location of base of appendix

Morison's Pouch

The hepatorenal space between the liver and right kidney assessed during a $FAST$ scan

Portacaval Anastomosis: Esophagus

Left gastric vein (portal) and Esophageal veins (caval, drainage into azygos system); results in esophageal varices

Portacaval Anastomosis: Rectum

Superior rectal veins (portal) and Inferior rectal veins (caval); results in internal hemorrhoids

Portacaval Anastomosis: Umbilicus

Paraumbilical veins (portal) and Superficial veins of the anterior abdominal wall (caval); results in caput medusae

Ampulla of Vater

Formed by the union of the common bile duct and the main pancreatic duct (of $Wirsung$)

Pancreas Endocrine Functions

Insulin (Beta cells), Glucagon (Alpha cells), Somatostatin (Delta cells), and Pancreatic polypeptide (F-cells)

Psoas Major Muscle nerve supply

Lumbar plexus; actions include flexing the thigh on the trunk and sitting up

Renal Hilum Content

Renal artery, vein, and pelvis

Ureteric Constrictions

$PUJ$ (ureteropelvic junction), Crossing of common iliac vessels at the pelvic brim, and $VUJ$ (vesico-ureteric junction)

Micturition Nerve Supply

Sympathetic ($T10-L2$ hypogastric nerve), Parasympathetic ($S2-S4$ pelvic splanchnic nerve), and Somatic (pudendal nerve)

Denonvilliers' Fascia

Strong rectovesical fascia separating the prostate and rectum; prevents local spread of carcinoma

Prostate Malignancy on PR Examination

Irregular contour and hard texture

Ectopic Pregnancy site

Most common site is the Ampulla ($75\%$), followed by the Isthmus ($25\%$)

Testicular Lymph Drainage

Drains into para-aortic lymph nodes

Scrotal Lymph Drainage

Drains into superficial inguinal lymph nodes

Tunica Albuginea

Capsule surrounding the testes

Buck's Fascia

Deep fascia enclosing the body of the penis