THINGS TO KNOW EXAM 3

ASIS- more  
PSIS- more  

What are the retroperitoneal organs?

Pubic symphysis- [projects anteriorly]- firm resistance found at the end of   in   aspect of   plane

Pubic tubercle- bony landmark  cm laterally of the . Where the   attaches / insert

Iliac crest- extends   from  . The iliac tubercle can be palpated  cm posterior to  

Xyphoid process- inferior border of sternum found at  

Linea semilunaris-curved line (  laterally) that extends from the   to the  . It is located   cm from the median plane. Represents the lateral border of the   muscle

Linea alba-  that’s  - divides abdomen into right and left sides. Goes from the   process to  

Inguinal ligament-   folded over onto itself  

Tendinous intersections-  over rectus   (six pack)

Gallbladder is found on the   in the   of the  of the liver. You palpate the  .

Stab wound to the right 5th-10th rib?

Stab wound between T11-L2 posterolateral?

Stab wound between T7-T11 posterolateral, left?

Midline Stab Wound (7 layers)

Midaxillary Stab Wound (9 layers)

Paramidline/Midclavicular (superior to arcuate line (RUQ/LUQ) - 11 layers

Paramidline/Midclavicular (inferior to arcuate line (RLQ/LLQ) - 10 layers

Subcostal plane- Vertebral level  : Joins the inferior margins of the  

HIGH YIELD
Transpyloric Plane
-Found at vertebral level  
-  costal cartilage
-Many organs are found there-  ,  ,  ,  ,   and  , ,  ,  

Transumbilical plane- vertebral level  

Transtubercular plane- Vertebral level  . Through the  

Caval opening (T )
Contents:  

Esophageal opening (T )
Contents:  

Aortic opening (T )
Contents:  

What is the blood supply of the abdominal muscle?

What is the origin of the EOM?

What is the insertion of the EOM? (3)

What is the nerve supply of the abdominal muscles? EOM has what extra supply?

What is the action of the EOM?

What 3 structures does the EOM form?

What is the orientation of the fibers of the EOM?

What is the origin of the IOM? (3)

What is the insertion of the IOM? (3)

What is the action of the IOM?

What stucture does the IOM form? What structure does it insert on?

What is the orientation of the fibers of the IOM?

What is the origin of the transversis abdominus? (3)

What is teh insertion of the transversis abdominus?

What structure does the transverisis abdominius insert on?

What is the orientation of the fibers of the transversis abdominus?

Which two sturctures insert on the conjoint tendon?

What is the origin of the rectus abdominus?

ASIS- more  
PSIS- more  

What is the function of the rectus abdominus? (2)

What is teh orientation of the ribers of the rectus abdominus?

Where is an esophageal hernia most likely to occur?

Hiatal hernias- abdominal organs slip through the   into the thoracic cavity. May result in  

Rectus abdominis muscle sheath- made up of the aponeurosis of the ,   and   as they insert into the  .

Superior epigastric artery [comes from  ]
Enters the rectus sheath superior LH just inferior the the  

***HY
Inferior epigastric artery [comes from  ]
Runs superior LH on the transversalis fascia and enters the   to gain the  

Superficial epigastric artery [ ]

Above the arcuate line (upper 2/3) is between the   and the  

Below the arcuate line (lower 1/3) is between the   and  

What are the two approaches to paracentesis?

Below the ubilicus paracentesis approach (6 layers)

RLQ or LLQ paracentesis approach (9 layers)

Superior to the umbilicus theres is the large median fold AKA  

The large median fold goes from ligament to diaphragm. It has a free edge called the   which has  

Inferior to the ubilicus:
Median Umbilical Fold=  

Inferior to the umbilicus:
Medial Umbilical Fold=  

Inferior to the umbilicus:
Lateral Umbilical Fold=   *****ONLY ONE THAT IS STILL USED

What is the site where injuinal hernias pass through called?

What is the inferior, lateral, and medial border of Hasselbach's/inguinal triangle?

What aponeurosis does the inguinal region come from?

What are the contents of the inguinal region in males? Females?
Male:  
Female:  

What does the deep/internal ring give rise to?

What is the inguinal canal?

Indirect inguinal hernias cavity   to the inferior epigastric vessels, traverse the deep inguinal ring, inguinal canal, and superficial inguinal ring.

Indirect inguinal hernias are within the  because they follow the route taken by the testes and is covered by 3 layers: ,  , and  

Indirect inguinal hernias can be palpated lateral to   and are   than direct

Direct inguinal hernias protrude anteriorly through the posterior wall of the and leave the abdominal cavity  to the inferior epigastric vessels.

Direct inguinal hernias pass through  

Direct inguinal hernias  the spermatic cord

Hesselbach’s triangle is located   to the superficial inguinal ring

What are the coverings of the spermatic cord and what gives rise to its coverings?
1.   (from  )
2.   (from  )
3.   (from  )

In males, the spermatic form beings at the  and ends at the  

CONTENTS OF SPERMATIC CORD
1)Vas Deferens= muscular duct that transports sperm from the epididymis to the urethra
2)Testricular artery ( )
3)Testiculuar veins- they begin in the testes as an extensive venous plexus ( )
4)Lymphatic vessels - drain into  
5)Autonomic Sympathetic nerves- run w/ the  
6)Remnant of the processus vaginalis
7)Cremasteric artery (inferior epigastric a.)- supplies  
8)Genital branch of the genitofemoral n (L1-2)- supplies the  
9)Arteries of the vas deferens from the  

Pampiniform Plexus
-The right testicular vein leaves the plexus as a single vein and drains directly into the   at  
-The left testicular vein leaves the plexus as a single vein and drains into the   at  .(it then empties into )

The  is NOT A CONTENT of the spermatic cord.

What are the anterior, posterior, superior, and inferior boundaries of the epiploic foramen of Winslow?

What are the contents of the anterior boundary of the epiploic foramen of Winslow?

What part of the abdominal cavity is behind the epiploic foramen of Winslow?

In supine position, pylorus lies at the   at level of  ,   cm   of midline

What are the ligaments of the lesser omentum?
1.  : Contains  
2.  

What are the boundaries of the traingle of calot?
Superior:  
Lateral:  
Medial:  

What are the contents of the triangle of Calot?

TQ: Short gastric artery supplies what organ?
 

What are the 3 branches of the celiac trunk?

What are the 3 branches of the left gastric artery and what do they supply?

What are the 3 branches of the common hepatic?

What are the branches of the gastroduodenal?

The right gastric artery supplies the   and  

What are the 3 branches of the proper hepatic?

What are the 4 branches of the superior mesenteric artery SMA and SMV?

What are teh 3 branches of the inferior mesenteric artery (IMA) and IMV?

The 3 blood supplies of the stomach are the  , the  , and the  

Blood Supply and Different Parts of Stomach
(1) Anterior part:  
(2) Proximal part of distal curvature:  
(3) Distal part of lesser curvature (pyrlorus):  
(4) Greater curvature distal:  
(5) Greater curvature proximal:  
(6) Behind the stomach (fundus):  

Right gastroomental artery [ ] anastomoses with the left gastroomental artery [ ] midway along the  of the stomach

 and   anastomose at the   and form the marginal arteries

What is the blood supply of the duodenum?
- 
- 

Blood supply of the pancreas is the   (from the   of celiac trunk)

Blood supply of spleen is the   and the  

Blood supply of liver
(1)  
(2) 

If patient has ulceration on the posterior wall of the stomach:
a.Between fundus and body of stomach that goes through the wall- the   will be affected
b.At pyloric sphincter- the   would be affected

The SMA/SMV ride over the   portion of the  part of the  .

SMA Syndrome: Loss of fat between the   and the   leads to compression of the  

  forms behind the head/neck of the pancreas from the union of the   and the  

The quadrate lobe is associated with the  

The caudate lobe is related to the  

Both the quadrate and caudate lobes are part of the   of the liver.

What are the posterior, right, and left contents of the portal triad? **Be able to identify

If an ulcer perforates the  , contents will empty into the  

What arteries supply the fundus of the stomach? Where do they come from?
1.  
2.  

What is the flow of bile throught the liver?

(Right + Left Hepatic Duct =  ) to (  +   = ) to (  +  =  ) to ( )

What is the blood supply of the gall baldder?

Gallbladder is located in and between the   and the  at the  

What are the anterior/superior, posterior, and inferior relationships of the gallbaldder?

Anterior and superior:  
Posterior:  
Inferior:  

What are the 4 parts of the stomach?

Test Question
The cardiac part of the stomach lies posterior to the  costal cartlage,   from the   at level of  .

The fundus is   to the cardiac orifice

The fundus is related to the  of the diaphram

The fundus lies posterior to the   rib in the  

The body of the stomach has a wide portion (pyloric  ) and narrow portion (pyloric  )

The pyrlorus has the pyloric  

In supine position, pylorus lies at level of   costal cartilage at the level of  ,  cm   of  . In erect position, it is at  .

Where is the accessory spleen present (if it is there at all)?

What are the 2 ligaments of the spleen?

Main pancreatic duct drains the   of pancreas and joins the  to empty into the   into the  

Accessory pancreatic duct drains the   of the pancreas and empties into the   into the   (superior to the )

Where does the hepatiopancreatic duct drain?

Differences between Jejunum and Ileum

(  + ) Anastamose→ Forms the Marginal Artery→ branches into many vasa recta

Blood Supply of Colon
Distal ileum, Cecum, and Prox Asending Colon =  
Mid-distal ascending colon =  
Right Colic Flexure =  
Transverse =  
Desending colon =  
Sigmoid =  
Rectum =  

SMA anastamose with  ,  ,  

IMA anastamose with ,  ,  

Marginal arteries anastomoses the   and 

Vasa recta are small arteries from   to colon

TEST QUESTION BE CAREFUL OF WORDING
The appendix is located 1/3 of the way between the   and 

The   on the cecum converge to point to the location of the appendix

The appendix is  . It lacks   and 

What are the signs and symptoms of portal hypertension?
i. - distended superficial epigastric veins
ii. 
iii. 
iv. - backup drainage of the left gastric vein into the esophagus due to the anastomosis
v. 
vi. - CNS dysfunction due to failure of liver to detox CNS toxic agents (can be caused by alcoholism, o structure, liver disease)

Esophageal vein- via   (systemic) anastomose with  (portal)

Superior rectal vein (portal) anastamose with   (into pudendal vein-Systemic) and  which drain into   (systemic)

Paraumbilical veins (portal) anastamose with veins connected to   which drain into the  

Veins of colon, pancreas, liver (drain into portal) anastamose with  ,   and   (systemic)

Portal vein is formed by the union of the   and 

Tributaries of the portal vein: Splenic Vein

Tributaries of the portal vein: IMV

Trubutaries of the Portal Vein: SMV

Tributaries of the portal vein: Pyloric vein (runs along the   of the stomach)

Tributaries of the portal vein: Cystic vein (drains the   and accompanying )

The 6 trubutaries of the portal vein are

Draw through blood supply diaphram. Note which are oxygenated and which are deoxygenated.

What is Nuckcracker Syndrome?

The kidneys are  

The   is longer and higher than the  

In the erect position, the kidneys are from  . In the supine position, they are from  

The kidneys are supported by peritioneal fat and renal vessels and when this support it lost, there will be  kidneys will be lower)

What are the anterior, middle, and posterior boundaires of the renal hiatus? What else is present?

What is the flow of urine through the kidney and to the urethra?
R enal papilla of Renal pyramid -> ->  -> ->   ->   ->  

What is the most posterior structure of the renal hiatus?

What is superior to the kidneys?

What 5 things are posterior to the kidneys?

Review image of kidneys and which organs would need to be retracted?

What are the 3 arterial supplies of the adrenal glands?

What are the 2 venous supplies of the adrenal gland? Where do they drain?

What are teh 4 blood supplies of the ureter?

What are the 3 constricted points?

A kidneyreter stone (nephrolithiasis) can occur at any of these points and is treated with  (extracorporeal shock wave lithotripsy)

Recall that the   jets right behind the  ; that is, it passes  to the 

The abdominal cavity extends superiority into the osteocartilaginous thoracic cage to about the   intercostal space in the supine position

  (skin over upper inguinal region (groin), skin over iliac crest)

  (skin over the superomedial aspect of the thigh, skin of the lower inguinal region, mons pubis, anterior scrotum, labia majora)

Superior to the medial part of the inguinal ligament, there is a triangular opening in the aponuerosis called the  

Superficial inguinal ring has two crura on its side:
 - inserts on the pubic tubercle
 - inserts on the pubic symphysis

What is the acronym for the boundaries of the inguinal ligament? What are the boundaries?

Infracolic compartment contains gutters that slope   and  , so when fluid accumulates in the peritoneal cavity, it will follow the gutters to the   part of the abdomen when the patient is  

The abdominal esophagus measure   cm from the groove in the left lobe of the liver and enters the stomach at the cardiac orifice posterior the the   costal cartilage

  is suspended by the ligament of Treitz (extends from the upper aspect of the   to the   and the tissue around the celiac trunk)

Right colic flexure-more   than left side. lie deep to ribs   and are overlapped by the  

Left colic flexure- more  , acute and less   than the right colic flexure. Anterior to the left  

The   and   are enclosed by the head of the pancreas

The tail of the pancreas ends near the  

The splenic artery runs on the   surface of the pancreas and the splenic veins runs   to the pancreas

The liver is covered by the peritoneum except at the   area. It is on the visceral surface on the   aspect of the  lobe. The  is associated with it

When the falciform ligament gets to the visceral surface of the liver, it changes names:
  ligament- anterior/posterior
  ligament- right/left

Arterial supply of Kidney:  arteries (branch off the abdominal aorta just below SMA)
-Left: may be  
-Right: renal artery splits into  ,  and   posterior branches

Venous supply of Kindey:   veins (empty into the IVC)
Left: receives tributaries from , ,   and  
Right: There may be  

Nerve supply of the kidney: aorticorenal plexus, inter mesenteric plexus, thoracic and lumbar splanchnic nerves
-Pain fibers form the   refer pain to the testis, labia majora, and to the lumbar region of the back

Ureters: in females, near the ischial spine, they turn  , and  below the uterine vessels and they are about 1.5-2 cm from the cervix

Right Cruz of diaphragm arises from the sides of the bodies of  and intervertebral discs and it splits to enclose the  

Left crus of diaphragm arises from the sides of the bodies of and the intervertebral disk

Lateral to the crura, the diaphragm arises from the  and  

Medial arcuate ligament extends from the side of the   to the  

Lateral arcuate ligament extends from the   to