EXAM 03 - CHEST, ABDOMEN, AND PELVIS ANATOMY

anterior abdominal wall

anterior abdominal wall (contents)

• skin

• subcutaneous fat

• aponeurotic/tendinous sheaths

• rectus abdominus

• transversalis fascia

• linea alba

skin

subcutaneous fat

aponeurotic (tendinous) sheaths

encase muscles and tendons

rectus abdominus

transversalis fascia

fascial layer deep to rectus abdominus

linea alba

semilunar line

anterolateral abdominal wall

anterolateral abdominal wall (contents)

• skin

• subcutaneous fat

• aponeurotic/tendinous sheaths

• external oblique

• internal oblique

• transversus abdominis

• transversalis fascia

external oblique

internal oblique

transversus abdominis

transversalis fascia

posterior abdominal wall

posterior abdominal wall (contents)

• psoas

• quadratus lumborum

• latissimus dorsi

• deep muscles of back

• thoracolumbar fascia (anterior, middle, posterior layers)

psoas

quadratus lumborum

thoracolumbar fascia (1. anterior layer, 2. middle layer, 3. posterior layer)

latissimus dorsi

deep muscles of back

indirect inguinal hernia

• pelvic contents travel through deep inguinal ring into inguinal canal

• located lateral to inferior epigastric artery

• may extend into scrota sac/labia majora

• more common in males

indirect inguinal hernia

direct inguinal hernia

• pelvic contents bulge through a weak part of pelvic wall fascia called the Inguinal (Hesselbach’s) triangle

• located medial to inferior epigastric vessels

• may extend through superficial inguinal ring

direct inguinal hernia

intraperitoneal

completely surrounded by visceral peritoneum

retroperitoneal

• partially covered by parietal peritoneum

• posterior to intraperitoneal structures

extraperitoneal

• partially covered by parietal peritoneum

• inferior to intraperitoneal structures

intraperitoneal structures

• stomach

• 1st portion duodenum

• jejunum

• ileum

• transverse colon

• sigmoid colon

• liver

• spleen

• uterus

• ovaries

retroperitoneal/extraperitoneal structures

• 2nd, 3rd, 4th portions duodenum

• cecum

• ascending colon

• descending colon

• pancreas

• kidneys

• abdominal aorta

• bladder

intraperitoneal

stomach is…

intraperitoneal

1st portion duodenum is…

intraperitoneal

jejunum is…

intraperitoneal

ileum is…

intraperitoneal

transverse colon is…

intraperitoneal

sigmoid colon is…

intraperitoneal

liver is…

intraperitoneal

spleen is…

intraperitoneal

uterus is…

intraperitoneal

ovaries are…

retroperitoneal

2nd, 3rd, 4th portions duodenum are…

retroperitoneal

cecum is…

retroperitoneal

ascending colon is…

retroperitoneal

descending colon is…

retroperitoneal

pancreas is…

retroperitoneal

kidneys are…

retroperitoneal

abdominal aorta is…

extraperitoneal

bladder is…

lesser omentum (composition)

fat, vessels, and lymphatics extending from stomach to liver

lesser omentum (function)

• contains collections of macrophages

• physical barrier to prevent spread of disease

lesser omentum

lesser omentum

greater omentum

fat extending from anterior aspect of stomach which folds in on itself and connects to transverse colon

greater omentum

perirenal space

(green space)

anterior pararenal space

(purple space)

posterior pararenal space

(blue space)

parietal peritoneum

(red outline)

Gerota’s fascia (anterior renal fascia)

(green outline)

Zuckerkandl’s fascia (posterior renal fascia)

(white outline)

transversalis fascia

(light blue outline)

lateroconal fascia

(yellow outline)

retroperitoneal spaces

• perirenal space

• anterior pararenal space

• posterior pararenal space

retroperitoneal space boundaries

• parietal peritoneum

• Gerota’s fascia

• Zuckerkandl’s fascia

• transversalis fascia

ascend (move superiorly and rotate 90°)

kidneys ____ during development

kidney ascension

• kidneys move superiorly, rotate 90°

• vascular supply/drainage changes during this process

excessive renal arteries

change in vascular supply of kidneys during ascension can result in…

accessory renal artery

• may result in obstruction of ureter at uretero-pelvic junction and hydronephrosis

• important in living kidney donors

retroperitoneal

kidneys are ____ structures

2 layers of fat

kidneys are surrounded by…

fascia

fat layers separated by…

Gerota’s fascia

fat layers are separated by ______ anteriorly

Zuckerkandl’s fascia

fat layers are separated by ______ posteriorly

renal sinus (contents)

• fat

• arteries

• veins

• nerves

• lymphatics

hilum

entry point into the renal sinus

capsule

• envelops kidney

• enclosed potential space

• important in hemorrhage originating from the kidney

composed of the same structures

renal cortex and columns are…

renal papilla

empty urine into calices

ureter

forms a tunnel in the bladder wall

closed off

as urine expands the bladder, ureter is…

vesicoureteral reflux

abnormal angle/length of the tunnel (uretero-vesical junction) prevents closure and results in…

vesicoureteral reflux

tunnel closure (urine expansion of bladder)

intra- and extraperitoneal

bladder is… (peritoneum relation)

intraperitoneal

dome of bladder is…

bladder trigone

• developmental remnant of obliterated structures

• ureteral orifices at upper corners of upside-down triangle

bladder

empties via contraction of detrusor muscle

contraction of detrusor muscle

parasympathetic response to stretch sensors in bladder wall

male urethral segments

• intramural/preprostatic

• prostatic

• membranous

• spongy urethra

intramural urethral segment (males)

associated with internal sphincter

membranous urethral segment (males)

• highest risk of traumatic injury because it’s fixed

• associated with external sphincter

segments of spongy urethra (males)

• bulbous

• penile/pendulous

• fossa navicularis

female urethral segments

• no organization of detrusor muscle to form internal sphincter

• no segmental divisions

• paraurethral (Skene) glands homologs of prostate

• greater vestibular (Bartholins) glands homologs of Cowper glands

retroperitoneal

adrenal glands are…

superomedial

adrenal gland location relative to kidneys

adrenal gland shapes

• pyramidal on right

• crescentic on left

• flat if kidney doesn’t ascend

adrenal cortex

• secretes corticosteroids and androgens

• comprised of zona glomerulosa, zona fasciculata, and zona reticularis

zona glomerulosa

secretes aldosterone (Na⁺ regulation —> BP regulation)

zona fasciculata

secretes glucocorticoids (e.g. cortisol)