73 terms

Visceral Gross Exam #2

Abdominal and Inguinal regions
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Muscles of Anterior Abdominal
-Ext/Int Ab Oblique (EAO and IAO)
-Transversus Abdominis
-Rectus Abdominis
-Pyramidalis
Abdominal Muscle Innervation
-Thoracoabdominal nerves (T7-T11)
-In some cases subcostal nerve (T12 and L1)
Abdominal tendons and landmarks
-Linea Alba
-Linea semilunares
-Tendinous intersections
External Abdominal Oblique (EAO)
-Fibers run inferomedially
-Inf edge of EAO between ASIS and pubic tubercle is the inguinal ligament and is a free edge
Internal Abdominal Oblique (IAO)
-Fibers of IAO extend superomedially
-Aponeurosis of left and right IAO meet at the linea alba
Transversus Abdominis (TA)
-Fibers of TA extend medially and somewhat inferiorly towards the pelvis
-Aponeurosis of left and right TA meet at the Linea Alba
Rectus Abdominis (RA)
-Left and right RA extend from xiphoid process an costal cartilages of ribs 5-7 to pubic symphysis and pubic crest
-Vertically segmented by 3 or more tendinous intersections
-Left and right RA muscles are separated by linea alba
Pyramidalis m.
-Absent in about 20% population uni/bilaterally
-Small and triangular
-Anterior to rectus sheath
-<2"
-Extends from anterior pubis and anterior pubic ligament to linea alba
-Thickens superior to pubic symphysis
-Considered insignificant
Rectus Sheath
-RA muscles encased in Rectus sheath composed of aponeurosis of EAO, IAO, TA muscles
-Anterior layer of sheath complete
-Inf. 1/4 of posterior layer of sheath absent (here RA contacts transversalis)
-Inf. border of post. layer called the arcuate line
Components of Rectus Sheath (above arcuate line)
-Skin and superficial fascia
-EAO, IAO
-Rectus Abdominis
-Transversus abdominis
-Transversalis fascia
-Peritoneum
Components of Rectus Sheath (below arcuate line)
-Skin & superficial fascia
-EAO
-IAO
-Transversus abdominis
-Rectus Abdominis
-Transversalis fascia
-Peritoneum
Vessels of Anterior wall
-Ant. abdominal wall supplied by segmental vessels (lumbar arteries and veins
-These arise from abdominal aorta and drain into inferior vena cava and azygos system
Superior/Inferior epigastric aa.
-Superior epigastric and Inferior epigastric aa. (run between rectus abdominus and post. layer of rectus sheath)
Superior/Inferior epigastric vv.
-Run from external iliac v. within superficial fascia and anastomose with the thoracoepigastric vv. (blockage of these cause a condition called "Caput Medusae")
Posterior of Anterior abdominal wall
Following structures covered by parietal peritoneum:
-Arcuate lines
-Falciform ligament
-Umbilical v. = Ligamentum teres hepatis
-Urachus = Medial umbilical ligament
-Umbilical aa. = Medial umbilical ligaments (2)
-Lat. umbilical fold/ligaments (cover inf. epigastric vessels
-Iliopubic tract (thickening of transversalis fascia deep to inguinal ligament
-Ext. iliac vessels
-Ligamentum teres uteri of ductus
Inguinal ligament
Floor of inguinal canal which runs from the ASIS to the pubic tubercle
Deep inguinal ring
-Hole in the transversalis fascia, located 1/2 way along the canal and 1.5cm sup. to inguinal ligament
-Inferior epigastric vessels lie just medial to the deep inguinal ring
-Both the spermatic cord and round ligament w/ilioinguinal n. pass under the arched TA muscle
Deep inguinal ring (males)
Vas deferens and testicular vessels pass through the deep ring and pick up some internal spermatic fascia
Deep inguinal ring (females)
Round ligament of uterus passes through the deep inguinal ring
Inguinal Canal
On passing through the IAO m. the spermatic cord/round ligament is joined by the ilioinguinal n. which supplies sensation to the ant. portion of the scrotum/labia majora and adjacent medial thigh (as spermatic cord passes through the IAO it picks up the cremaster fascia and m.
Superficial inguinal ring
-A gap in the EAO m., is located slightly superior and slightly lateral to the pubic tubercle
-Fibers on medial side = Medial Crus
-Fibers on lateral side = Lateral Crus
-Connecting the 2 crura are the intercrural fibers
Conjoint tendon (inguinal falx)
Combined TA and IAO tendons at the pubic tubercle
Ilioinguinal n.
Lateral to the spermatic cord/round ligament as they exit the superficial inguinal ring
Spermatic cord and Testes
-Testicular a. and pampiniform plexus v.
-Tunica vaginalis vs. tunica albuginea
-Ductus deferens, epididymis and tubules
-Gubernaculum function in adult
Pathway of the testis
-As testis passes through ant. abdominal wall, it pulls layers of the wall around it. These layers become the converings of the spermatic cord.
-Path of gubernaculum, testis, and processus vaginalis through the ab wall define the inguinal canal
Processus of vaginalis
-Eventually degenerates leaving a bubble of peritoneum, AKA tunica vaginalis (visceral and parietal layer)
Hydrocele
Accumulation of excess fluid in the tunica vaginalis
Scarpa's fascia (Colle's fascia)
Fused to the deep fascia of the thigh just below the inguinal ligament and between the thighs
Gubernaculum (in females)
-Pulls ovary to position between fallopian tube and uterus and becomes ovarian ligament and ligamentum teres uteri
-The round ligament is the main structure occupying the female inguinal canal - accompanied by ilioinguinal nerve
Gubernaculum (in males)
-Pulls testis into scrotum and anchors it
-Spermatic cord contains: Testicular a, pampiniform plexus, ductus deferens, ilioinguinal n., cremasteric m. and fascia
Abdominal wall herniations
-Herniation = protrusion of a part of a structure of the entire structure through the tissues normally containing it.
-Abdominal hernias occur in area of weakness: Umbilical region, arcuate line, linea alba, incesions, hesselbach's triangle (Inguinal ligament (and underlying iliopubic tract and RA m.)
Hernias of inguinal canal
DIRECT inguinal hernias:
-Occur when loops of bowel push directly through the anterior abdominal wall in an area of relative weakness
-These originate medial to the ant. epigastric arteries and pass through the superficial inguinal ring ONLY
Hernias of inguinal canal
INDIRECT inguinal hernias:
-Occur when loops of bowel follow the path of the inguinal canal inferior to the epigastric vessels and enter the deep inguinal ring
-They pass through the inguinal canal and exit the superficial inguinal ring
-Represent 75% of all inguinal hernias
-More common in men than in women
-May be caused by a patent processes vaginalis
Dorsal Cavity
Cranial & Vertebral Cavity
Membrane: Meninges
Ventral Cavity
Thoracic and Abdominopelvic cavity
Membranes: Serous membranes, Thorax (pleura, pericardium), Abdomen (Peritoneum)
Abdominal Regions
R Hypochondriac/Epigastric/L Hypochondriac
R Lumbar/Umbilical/L Lumbar
R Iliac/Hypogastric/L Iliac
Peritoneum
2 layers = Visceral and Parietal
Greater omentum
-Double-layer peritoneal fold
-Hangs down from greater curvature of stomach
-Connects to transverse colon, spleen, diaphragm
-Typically extends to pelvis
-Houses extraperitoneal fat
Lesser Omentum
-Connects less curvature of stomach and duodenum to liver
-Directly associated with the porta hepatis
Mesentery
Anchors intestines and colon
Layers of alimentary canal
4 Layers of GI tract:
1)Mucosa (forms lumen)
2)Submucosa (vasculature for mucosa)
3)Muscularis (2 layers of smooth muscle - inner circular, outer longitudinal)
--Stomach has 3
--Mouth, pharynx, superior 1/2 of esophagus and external anal sphincter are skel muscle
4) Serosa (serous membrane)
Digestive Organs
Organs found in head & neck, thoracic cavity, abdominal
Ailmentray Tract (aka GI tract)
-Muscular tube extending from mouth to anus
-Primarily in abdomen
-Approx 20-30 ft long
-True GI = organs make up actual tube that food must pass through
Accessory GI organs
-Either do not touch food or are unnecessary for digestion
-Often assist in digestion through chemical secretions
Small Intestines (Duodenum)
Shortest, receives substances from pyloric sphincter of stomach, and from common bile duct and main pancreatic duct
Small Intestines (Jejunum)
Middle portion, almost 2/5 length
Small Intestines (Ileum)
Final segment, 3/5 of length, fewest number of plicae circulares,
connects to large intestine through ileocecal valve
Internal structures of S.I.
Plicae circulares, Villi
Jejenum and Ileum
Made up of Vasa recta and vascular arcade (both smaller in ileum)
Large Intestine (parts)
-Cecum
-Vermiform appendix
-Ascending colon
-Transverse colon
-Descending colon
-Sigmoid colon
-Rectum
Large Intestine (features)
-Ileocecal valve
-Tenia coli
-Haustrum
-Plicae Semilunares
-Appendices epiploica
-Hepatic flexure
-Splenic flexure
Anus
-Anal canal
-Internal/External sphincter
Liver
-Largest gland, Second largest organ
-Four lobes (R, L, Quadrate, Caudate)
-Ligaments: Flaciform, ligamentum teres hepatus, R&L coronary ligaments, Ligamentum venosum
-Bare area
Gall bladder
-Small sac on posterioinferior surface of liver (quadrate lobe)
-Stores bile
Pancreas
-Retroperitoneal gland (Endocrine, Exocrine)
-3 parts: Head, Body, Tail
-2 main ducts for secretion: Main pancreatic duct/Accessory pancreatic duct
Bile duct system (Liver)
-R/L hepatic ducts
-Common hepatic duct
-Cystic duct (from gallbladder)
-Common Bile duct (Joins main pancreatic duct at hepatopancreatic ampulla & papilla)
Pancreatic duct system
-Main pancreatic duct (joins with common bile duct at hepatopancreatic ampulla & Sphincter
--Empties into duodenum at major duodenal papilla
-Accessory pancreatic duct
--Empties into duodenum at minor duodenal papilla
Spleen
-Organ of lymphatic system (not digestive)
-Highly vascular (recycles blood cells, provides immunity)
Embryonic origins of GI tract (Foregut)
Foregut
-Supplied by branches of celiac trunk
-Forms esophagus, stomach, part of duodenum, liver, gallbladder and upper pancreas
-Drains into hepatic portal vein
Embryonic origins of GI tract (Midgut)
Midgut
-supplied by branches of superior mesenteric artery
-Forms duodenum to proximal 2/3 of transverse colon, including lower pancreas
-Drains into hepatic portal vein
Embryonic origins of GI tract (Hindgut)
Hindgut
-Supplied by branches of inferior mesenteric artery
-Forms distal 1/3 of transverse colon to superior rectum
-Drains into hepatic portal vein
The celiac trunk
Left Gastric a., Splenic a., Common hepatic a.
The superior mesenteric artery
-Intestinal aa.
-Ileocolic a.
-Right colic a.
-Middle colic a.
The inferior mesenteric artery
-Superior rectal a.
-Sigmoid aa.
-Left colic a.
Hepatic portal vein
Drains GI tract to liver
Formed from:
-Superior mesenteric v.
-inferior mesenteric v.
-Splenic v.
-Gastric v.
Hepatic vein
Drains from liver back to IVC
Peritoneal ligaments (off liver)
-Falciform ligament (liver to ant. abdominal wall
-Hepatogastric ligament (membranous portion of lesser omentum
-Hepatoduodenal ligament (free edge of lesser omentum...houses portan triad=portal v., hepatic a., common bile duct)
Peritoneal ligaments (off stomach)
Attachments to greater curvature and part of greater omentum
-Gastrophrenic ligament (inf. diaphragm)
-Gastrosplenic ligament (covers hilum of spleen)
-Gastrocolic ligament (to transverse colon)
Subdivisions of Peritoneal
-Greater sac (large, main compartment)
-Omental Bursa (lesser sac-like cavity - posterior to stomach/lesser omentum, permits smooth movement of stomach against posterior structures
Subdivisions of peritoneal (continued)
Omental foramen
-Epiploic foramen
-Foramen of winslow
-Communication b/t lesser and greater sacs
-Boundaries = superior/liver, inferior/superior duodenum, post/IVC and right crus of diaphragm, anterior/hepatoduodenal ligament
Bare areas and folds
-Intraperitoneal organs still need an area that is not covered by peritoneum
-Allows for nerves and vessels to enter or exit the organ
-A fold is where peritoneum is raised by vessels, ducts, or ligaments
Muscles of Post. abdominal wall
-Diaphragm
-QL
-*Psoas major/minor
-*Int. abdominal oblique
-*Iliacus
* - these 3 fuse after passing under inguinal canal and insert on the femur as iliopsoas complex
Diaphragm
-Dome-shaped muscle w/central tendon
-Openings: Aortic hiatus (T12), Esophageal hiatus (T10), Caval hiatus (T8-T9), Sternocostal triangle
-Ligaments: Medial(over psoas)/Lat arcuate(QL)/Median(aorta)/Suspensory muscle of duodenum
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