abdomen lecture

what is the abdomen

flexible container for most of the organs of the GI and GU system

what is the abdomen bound by

musculo-aponeurotic wall anterolaterally

diaphragm superiorly

pelvic muscles inferiorly

what is the abdomen lined by

serous membrane

the abdomen is continuous with ___

pelvic cavity

what separates the abdomen and pelvic cavity

pelvic inlet

what covers the external abdominal muscles

superficial, intermediate, and deep layers of investing fascia

Inferior to umbilicus the deepest part of subcutaneous tissue is reinforced by

abundant elastic and collagen fibers

* 2 layers of fascia

superior to the umbilicus subcutaneous tissue is continuous with

that found elsewhere

layers from superficial to deep in abdomen

skin

superficial fat layer (camper fascia)

deep membranous layer (scarpa fascia)

investing fascia (3 layers)

the ____ abdominal muscles are bilaterally ____ in anterolateral wall with

5, paired

what are the 3 flat muscles of the abdomen

external oblique, internal oblique, transversus abdominus

what do the 3 flat muscles share

midline aponeurosis (rectus sheath)

what are the 2 vertical muscles of the abdomen

rectus abdominis and pyramidalis

vessels of the abdominal wall

superior and inferior epigastric arteries (anastomose)

where does the superior epigastric artery branch from

internal thoracic artery which branches from the right subclavian artery

where does the inferior epigastric artery branch from

external iliac artery

lymphatics in the abdomen accompany

superficial veins

where does lymph superior to the transumbilical plan drain

axillary nodes

where does lymph inferior to the transumbilical plan drain

superficial inguinal nodes

venous system in abdomen is ____

complex - there are many anastomoses of thoraco-epigastric vein and superficial epigrastric vein

well planned abdominal incisions decrease _____ and ____ and nerve ____

muscle damage, necrosis, paralysis

what incisions are preferred for exploratory surgeries (give more room)

longitudinal (midline) incision

midline incisions are easily made without cutting ______

muscles, major blood vessels or nerves

large incision = ____ recovery and ____ risk of infection and scarring

long, high

oblique/transverse incisions are smaller and used for

specific and targeted exposure

what is important with oblique/transverse incisions

avoiding muscle fibers and nerves as much as possible

what are endoscopic incisions used for

minimally invasive surgeries done with a laparoscope - only few incisions needed

benefits of endoscopic incisions

decreased nerve damage, less risk of hernia, less infection risk, faster healing

inguinal region extends between

ASIS and pubic tubercle

inguinal region is clinically relevant because of

hernia potential

inguinal region is anatomically relevant because

this is where structures enter/exit the abdomen

testes are located in the ____ postnatally but develop in the _____

perineum, abdomen

inguinal ligament is

superficial

iliopubic tract is

deep to the inguinal ligament

what makes up the flexor retinacula of the hip joint

inguinal ligament and iliopubic tract *spans a weak area of abdominopelvic wall

inguinal canal

oblique passage 4cm long directed inferomedially through the inferior part of anterolateral abdominal wall

what is housed in the inguinal canal

spermatic cord in males

round ligament of uterus in females

where do testes develop

in the extraperitoneal CT on the superior lumbar region of posterior abdominal wall

where are the testes at week 12

in the pelvis

where are the testes at week 28

close to the developing inguinal ring, begin to descend

where do ovaries develop

superior lumbar region of posterior abdominal wall

where do the ovaries relocate to

lateral wall of the pelvis

why do ovaries not relocate to the inguinal region

ovarian ligament

where does the round ligament of the uterus pass through/attach

pass through inguinal canal and attaches to subcutaneous tissue of the labia

what is the spermatic cord

a bundle of nerves, ducts, and blood vessels connecting the testicles to the abdominal cavity

the spermatic cord runs from where to where

abdomen --> deep inguinal ring --> inguinal canal --> superficial inguinal ring --> scrotum

3 coverings of the spermatic cord

Internal spermatic fascia

Cremasteric fascia

External spermatic fascia

what does the spermatic cord contain

Ductus deferens

testicular artery

artery of ductus deferens

cremasteric artery

pampiniform venous plexus

nerves

lymphatic vessels

what is the ductus deferens

45cm muscular tube that conveys sperm from epididymis to the ejaculatory duct

testicular artery arises from the

aorta

cremasteric artery arises from the

inferior epigastric artery

how many veins make up the pampiniform venous plexus

12

spermatic cord contains sympathetic nerve fibers for the _____

vessels - ejaculation

spermatic cord contains parasympathetic nerve fibers for the _____

ductus deferens - erection

what nerve supplies the cremaster muscle

genital branch of genitofemoral nerve

2 layers of scrotum

pigmented skin and dartos fascia

what is dartos fascia

contains dartos smooth muscle that gives external wrinkled appearance

what divides the scrotum into right and left halves

septum

what is scrotal raphe

ridge that divides the sides of the scrotum externally - line of fusion of embyronic labioscrotal swellings

2 things testes produce

sperm and testosterone

testes are suspended by the ______ within the ______

spermatic cord, scrotum

surface of each testis is covered by a visceral layer of the ____

tunica vaginalis

what layer lies directly upon the testes

tunica albuginea - tougher fibrous layer

septa from the tunica albuginea extend inward to _____

divide the testes internally

septa contain

seminiferous tubules - produce sperm

drainage of seminiferous tubules

straight tubules --> rete testis and efferent ductules --> epididymis

what is the epididymis

elongated convoluted tubular structure that stores sperm as they mature and await ejaculation

sperm are moved by ____ within the epididymis

fluid currents

head of epididymis

superior expanded part that is composed of lobules formed by the coiled ends of 12-14 efferent ductules

body of epididymis

major part consisting of the tightly convoluted duct of the epididymis

tail of epididymis

tapering continuation with the ductus deferens

site of storage for majority of sperm until peristalsis moves it to ductus deferens during ejaculation

tail of epididymis

direct inguinal hernia

bulge from the posterior wall of the inguinal canal

*risk of incidence increases with age

direct inguinal hernias pass ___ to inferior epigastric vessels

medial

indirect inguinal hernia passes ____ to inferior epigastric vessels

laeral

indirect inguinal hernia

bulge passes through inguinal canal or groin

*difficult to feel due to external obliques

umbilical hernia occurs at

the navel

umbilical hernia

most common hernia in neonates

common in obese females

epigastric hernia

found between umbilicus and xyphoid process

*most commonly at linea alba

inguinal hernias account for ____% of abdominal hernias

75

___% of inguinal hernias occur in men

86

cryptorchidism

undescended testicles, usually unilateral

tx of cryptorchidism

surgery

cryptorchidism has increased risk of

testicular cancer and poor fertility of affected testicle

hydrocele of testis/cord

presence of fluid from visceral layer of tunica vaginalis

varicocele

swelling in veins of the spermatic cord

varicoceles are visualized when ____ and referred to as _____

standing, bag of worms

testicular torsion

twisting of the spermatic cord obstructing venous drainage --> edema --> decreased arterial supply

testicular torsion is a surgical emergency due to

risk of necrosis

peritoneum

continuous serous membrane that lines abdominopelvic cavity investing the viscera

intraperitoneal =

within the peritoneal cavity

extraperitoneal =

outside peritoneal cavity

retroperitoneal organs

SAD PUCKER

suprarenal (adrenal) glands

aorta/IVC

duodenum (most)

pancreas

ureters

colon (ascending/decending only)

kidneys

esophagus

rectum

mesentary

double layer of visceral peritoneum anchored to body wall

mesentery provides a ____ route to the organ

neurovascular

omentum

double layered extension of peritoneum that passes from stomach to other abdominal organs

cervical construction of esophagus

caused by cricopharyngeus muscle that acts as upper esophageal sphincter

thoracic construction of esophagus

near aortic arch

diaphragmatic construction of esophagus

as it passes through the diaphragm via esophageal hiatus, muscular diaphragm acts as a passive inferior esophageal sphincter to prevent acid/gastric reflux

abdominal esophagus is ____cm long as it descends from diaphragm to ______ of the stomach (___)

1.25, cardiac orifice, T11