BPK 326 - Abdomen & Pelvis Theory and OIAI Combined

Abdominal cavity rostral border

Diaphragm

Abdominal cavity inferior border

Opening of the top of the pelvis

Linea Alba

Creates the divisions of the left & right halves of the rectus abdominous

Flank = ?

Lateral surface of abdomen & pelvis

Abdominal wall layers from superficial to deep

Skin - Camper's Fascia - Scarpa fascia - Superficial investing fascia -External Oblique - Intermediate Investing Fascia - Internal Oblique - Deep Investing Fascia - Transverse Abdominus - Transverse fascia - Parietal Peritoneum

What is the relative postition of the Rectus abdominus?

Deep to the aponeurosis which is deep to skin

Posterior border of the abdomen

Quadratus lumborum

What runs through the inguinal canal

Spermatic cord

Structures that the inguinal ligament pins down

The femoral nerve, artery & vein

Inguinal Hernia

When a loop of intestine is pushed through the inguinal canal

Rectus sheath

Consists of the aponeurosis of EOs, IOs, & TA

RUQ Contains

Right lobe of liver

Gallbladder

Stomach : pylorus

Duodenum

Pancreas : head

Right adrenal gland

Right kidney

Right colic flexure

Ascending colon

Transverse colon

LUQ contains

Liver (left lobe)

Spleen

Stomach

Jejunum & proximal ileum

Pancreas : body and tail

Left kidney

Left adrenal gland

Left colic flexure

Transverse colon

Descending colon : superior part

RLQ contains

Cecum

Appendix

Most of ileum

Ascending colon : inferior part

Right ovary

Right uterine tube

Right ureter

Right spermatic cord

Uterus (if enlarged)

Urinary bladder (if very full)

LLQ Contains

Sigmoid colon

Descending colon : inferior part

Left ovary

Left uterine tube

Left ureter

Left spermatic cord

Uterus, (if enlarged )

Urinary bladder (if very full)

Peritonium

Is a double-walled lining the abdominal pelvic cavity and contains serous fluid.

3 Interior Divisions of the Abdomen

Retroperitoneal, Intraperitoneal, Infraperitoneal

Retroperitonal organs

Adrenal gland

Pancreas (except the tail)

Ureters

Colon (ascending and descending)

Kidneys

Esophagus

Rectum

Duodenum (second, third, and fourth parts)

Abdominal aorta

Inferior vena cava

Intraperitoneal organs

Liver

Gallbladder

Spleen

Stomach

Jejunum

Ilium

Transverse & sigmoid colon

Cecum (sometimes partially intraperitoneal)

Appendix

First part of the duodenum

Tail of the pancreas

Extraperitoneal organs

Bladder

Lower rectum

Male reproductive organs

2 Specializations of the Peritoneum

Mesentary & Omentum

Function of the Omentum

Protection

Allow the migration of immune cells into the peritoneal cavity.

Forms adhesions to physically wall off areas of inflammation

Source of tissue for wound repair

Esophagus structure

Has skeletal muscle, proximately and smooth muscle distally

Isn't uniform in width

Fundus

General term for the round part of any organ

Within stomach: often full of air

Cardia

Proximal part of the stomach

Pylorum

Distal part of stomach

Divided into pyloric antrum, pyloric canal & pyloric sphincter.

Movement of food through the stomach

Cardia >> body >> pyloric antrum >> pyloric canal >> pyloric sphincter >> duodenum

Greater Omentum

Extends from the greater curvature of the stomach

Hangs in a fold covering the small intestine

Attaches to the transverse colon

Lesser Omentum

Extends from the lesser curvature of the stomach

Attaches to both the liver and the duodenum

Haustra

Folds of the large intestine

Tenia Coli

Long ligament that helps to propel waste through the large intestine

Right Colic Flexure is known also as

The Hepatic Colonic Flexure

Diverticuli

Pouches in the wall of the colon. Tend to increase with aging.

Diverticulitis

Inflammation of the diverticula

Liver structure

2 lobes, right & left, separated by the Falciform Ligament. Ligament also tethers liver to the abdominal wall.

From inferior surface: caudate (anterior) & quadrate (posterior)

Gallbladder location

Inferior surface of the right lobe of the liver

Hepatic Triad

Hepatic portal vein, hepatic artery & bile duct

Hepatic portal vein

Oxygen poor but nutrient rich blood from digestive track to the liver

The flow of Bile

- Produced continuously in liver

- Gathered by left & right hepatic ducts which combine to form the Common Hepatic Duct (CHD)

- Bile travels via the CHD & drains into the Bile Duct (formed by both the CHD & the cystic duct)

- Then travels through the Hepatopancreatic Ampulla (formed by common bile & pancreatic ducts)

- Lastly enters the duodenum through the major duodenal papilla

- When sphincter at the duodenum is closed, bile Passively fills the Cystic duct thus filling the gallbladder

* Cystic duct has bidirectional flow

Function of the Minor Duodenal Papilla

An accessory pancreatic duct for emptying pancreatic secretions

Cholelithiasis?

Aka Gallstones

Splenomegaly?

Enlarged spleen

Functions of Spleen

Largest immunological organ

Produces antibodies, recycles RBCs, phagocytosis

Contains big reservoir of monocytes

Organs the Spleen is in Contact with

Splenic flexure of large intestine

Left kidney

Stomach

Spleen Rupture

Due to its superficial position

Most commonly caused by blunt, abdominal trauma (car, crash, high-speed collision)

Distictive feature of the superior border of the spleen

Has notches

High variability

Spleen is made of:

A tough fibrous capsule

Soft pulpy inside

Capsule doesn't need to break for rupture to occur

Spleen Blood Supply

Splenic artery (branch of the celiac trunk)

Abdominal Aorta Location & Bifurcation

Abdominal aorta travels anterior & left to IVC & splits into L & R common iliac arteries

3 Branches of the Abdominal Aorta

- Celiac Trunk : Splits into the Common Hepatic Artery (supplies the duodenum), Splenic Artery (supplies pancreas) & Left Gastric Artery (distal esophagus)

- Superior Mesenteric Artery

- L & R Renal Arteries

- Inferior mesenteric artery is inferior to all 3

Superior Mesenteric Artery

Supplies digestive tract from lower duodenum to 2/3 of the transverse colon, & pancreas

Splenic flexure is the division from the supply of the superior to the inferior mesenteric arteries

Inferior Mesenteric Artery

Supplies the descending and sigmoid colon, & part of the rectum

Urinary tract consists of:

Ureters

Bladder

Urethra

Kidneys

Kidney blood flow

Receives 25% of cardiac output

Supplied to by branches of abdominal aorta, which enter the kidney with the ureter at the renal hilum

Vein enters anterior to artery & ureter is inferior to both

Kidney's Function

Regulates pH, osmolarity & blood pressure

Facilitates removal of toxins

Adrenal/Suprarenal Glands Produce?

- Adrenal Cortex (superficial) makes cortisol, androgens & aldosterone

- Adrenal Medulla (interior) makes epinephrine & norepinephrine

Site of filtration?

Renal cortex

Renal cortex contains:

Renal corpuscles

Distil & proximal renal tubules

Smallest functional unit of the Kidney

Nephron

Renal Medulla is made of

Renal columns & pyramids

Pyramids have base & apex

Apex = Renal Papilla

What do renal columns contain

Urinary tubules

Blood vessels

Connective tissues that help maintain kidney structure & make sure the cortex adheres to the medulla

Urine production & flow

Produced in nephron >> go into papilla >> minor calyces >> major calyces > renal pelvis >> ureter >> bladder >> urethra

Renal & Ureteric Calculi

AKA Kidney stones

Stones larger than lumen of ureter cause pain

Roles of Pelvic Floor Muscles

Create a muscular floor to support the pelvis organs

Crucial to continence (bladder & bowel control) & sexual function

3 groups of Pelvic Diaphragm Muscles

Pelvic Diaphragm (proper)

The Urogénital Diaphragm

The Sphincters & Erectile muscles of the urogenital tract

Significant muscle of the Pelvic Diaphragm Proper

Levator Ani Group

3 Muscles within Levator Ani Group

Puborectalis

Pubococcygeus

Iliococcygeus

Medial 2 are immediately adjacent to vaginal canal & are vulnerable during delivery.

Pelvic Floor Injury

Common in vaginal delivery

Puborectalis & Pubococcygeus are most common muscles damaged

Uterus

Contains developing fetus during gestation

50-200g to ~1kg

Fundus is connected to ovaries via Fallopian tubes

Cervix is connected to vagina

Complications of Pregnancy & their Cause

Complication: Shortness of breath, heartburn, reduced stomach capacity, impaired intestinal transit & constipation

Cause: expanding uterus compresses adjacent organs, compromising function.

Broad Ligament

A sheet-like fold of peritoneum

Extends from the sides of the uterus to lateral wall & floor of pelvis. Holds uterus in position.

Round Ligament

True ligament

Extends from lateral aspect of uterus to the external labia (labium majorum)

Round Ligament Pain

Pain in pelvis & labia due to baby kicking or uterus being weighed down

Uterine Prolapse

Uterus collapses into vagina or outside the vagina

Happens when ligaments or pelvic Floor muscles are damaged

Fallopian Tubes Divisions

Intramural (medial)

Isthmus

Ampulla

Infundibulum (to lateral)

Ectopic Pregnancy's Most Common Form

Tubal pregnancy. Results in death of embryo & potentially the mom.

If it occurs in right uterine tube, can be misdiagnosed as appendicitis.

Tubal Ligation

A surgical method of birth control

Released ova simply degenerate & are absorbed

Vagina

AKA birth canal

A fibro-muscular tube

7-10cm

Facilitates childbirth, menstruation, sexual intercourse & pleasure

Cervix

Clinically important

Dilates during labour to admit baby into vagina

Checked routinely for changes indicative of cervical cancer via Pap smear

Cervical Os is the small & round opening

Appearance changes with progression of HPV & cancer

Vulva

Collective term for the external female genitalia

Tumescence =

Erection

Penis consists of mainly

Erectile bodies (tissues that have vascular spaces that can become engorged with blood)

Corpora Cavernosa (corpus caversonum when singular)

Primary erectile bodies of the penis

Big

Dorsal

Has large vascular sinuses

Make up the largest proportion of the penis

Crura are the base

Corpus Spongiosum

Ventral

Contains the urethra

Has large vascular sinuses

Continuous with the glans

Has less tunical covering relative to the corpus covernosum

Bulb is the base

Prepuce

The foreskin

Covers majority of the glans

Attaches to fascia overlying the body of the penis

Circumcision

+ = reduces risk of urinary tract infection, STIs

- = infection, permanent disfiguration, impaired sexual pleasure or function

Urethra

Extends from the internal urethral orifice of the bladder to the external urethral orifice of the glans

Prostatic Urethra

A division of the urethra where prostatic fluid enters

Contains the Urethral Crest where the Prostatic Ducts open bilaterally

Contains the Seminal Colliculus where Ejaculatory Ducts open bilaterally

Affected by Benign Prostatic Hyperplasia

Benign Prostatic Hyperplasia

A non-cancerous increase in prostate size

Sx:

Waking up in night to pee

Urinary hesitancy

Intermittent Urinary flow

Bulbourethral Glands / Cowper's Glands

Located bilaterally along the spongy urethra near the base of penis

Eject lubricating fluid into the urethra

2 Openings that Increase Size of Urethra

Ampulla (proximally)

Navicular Fossa (distally)

Vas Deferens Ligation

Commonly called Vasectomy

The surgical form of birth control in males

Flow of Sperm (Production to Secretion)

Produced in testes, mature in epididymis.

Travel through vas deference, which merges with ejaculatory duct.

Ejaculatory duct has sperm & seminal vesicle secretions & goes through the prostate which inserts its secretions. After taking secretions from bulbourethral gland it then becomes the urethra.

External obliques

Origin: Ribs 5-12, sternum; Insertion: Iliac crest, inguinal ligament, linea alba, pubic tubercle; Action: Bilaterally: anterior flexion of the trunk and compression of the abdomen; Unilaterally: lateral flexion of the trunk and rotation to the opposite side.

Internal obliques

Origin: Iliac crest, Inguinal ligament, thoracolumbar fascia; Insertion: Ribs 10-12, pectineal line, linea alba and abdominal aponeurosis (fuses with external oblique to become the rectus sheath); Action: Bilaterally: anterior flexion of the trunk and compression of the abdomen; Unilaterally: lateral flexion of the trunk and rotation to the same side.

Transverse abdominis

Origin: Iliac crest, thoracolumbar fascia, Costal cartilage of ribs 7-12; Insertion: Abdominal aponeurosis (and other midline structures); Action: Compression and tension of abdominal wall.

Rectus abdominis

Origin: Pubic crest, tubercle and symphysis; Insertion: Costal cartilages 5-7, Xiphoid process; Action: Flexion of the trunk.

Quadratus lumborum

Origin: Iliac crest; Insertion: Transverse processes L1-L5; rib 12; Action: Bilaterally: Extension of the trunk - but likely primarily contributes to stability of lumbar spine; Unilaterally: lateral flexion.

Puborectalis

Origin: anteriorly, from the pubic symphysis; posteriorly, encircling the anorectal junction; Action: inhibits defecation.

Pubococcygeus

Origin: pubic bone (lateral to the origin of puborectalis); Insertion: Coccyx; Action: Control urine flow; contract during orgasm. (pubo)