At which vertebral level is the subcostal plane located?
Click to see answer
L3
Click to see question
At which vertebral level is the subcostal plane located?
L3
What is the outermost layer of the abdominal wall?
Skin
At which vertebral level is the transtubercular plane located?
L5
What layer lies directly beneath the skin in the abdominal wall?
Superficial Fascia
What types of muscles make up the 4 paired muscles of the abdominal wall?
3 flat muscles and 1 strap-like muscle
What is the innermost layer of the abdominal wall?
Parietal Peritoneum
What is the sixth layer of the abdominal wall?
Extraperitoneal fat
At which vertebral levels is the umbilicus located?
L3 - L4
What are the nine regions of the abdomen?
Right Hypochondriac, Epigastric, Left Hypochondriac, Right Lumbar, Umbilical, Left Lumbar, Right Inguinal, Hypogastric/Pubic, Left Inguinal
Which organs are considered secondary peritoneal organs part of the GIT?
Duodenum (2nd-4th), Pancreas, Ascending/descending colon, Middle rectum
Which layer of the abdominal wall is composed of dense connective tissue?
Deep fascia
What is the fourth layer of the abdominal wall?
Muscles
Which layer of the abdominal wall is located just above the extraperitoneal fat?
Transversalis fascia
What causes a hematocele and what is its primary characteristic?
A hematocele is caused by the accumulation of blood, resulting from the rupture of testicular blood vessels after trauma.
Through which anatomical structure may both types of inguinal hernias emerge?
The superficial inguinal ring.
Which type of inguinal hernia is lateral?
Indirect inguinal hernia.
How many paired muscles are there in the abdominal wall?
4 paired muscles
What is the space of Bogros used for in surgical procedures?
It is used for placing prostheses, such as Gore-Tex mesh, when repairing inguinal hernias.
Where is the arcuate line located?
Midway between the umbilicus and pubic crest.
Which veins are found in the spermatic cord?
Testicular veins (pampiniform plexus)
Which part of the rectum is extraperitoneal?
The inferior rectum.
What is a hydrocele and how is it usually diagnosed?
A hydrocele is the accumulation of serous fluid, usually from the persistence of the processus vaginalis. It is diagnosed with a positive transillumination test.
What is a varicocele and what causes it?
A varicocele results from dilatations of the tributaries of the testicular vein.
What is a varicocele and what causes it?
A varicocele results from dilatations of tributaries of the testicular vein.
Where is the Foramen of Winslow located in relation to the Hepatoduodenal ligament?
Immediately inferior to the Hepatoduodenal ligament.
Which organ follows the esophagus in the list of peritoneal organs?
Stomach
Which part of the duodenum is considered a peritoneal organ?
1st duodenum
What is an extraperitoneal organ?
An organ with no peritoneal covering at all, such as the inferior rectum.
What is the arcuate line?
A crescent-shaped line marking the inferior limit of the posterior layer of the rectus sheath, located midway between the umbilicus and pubic crest.
What are the three arteries contained within the spermatic cord?
Testicular artery, cremasteric artery, artery of vas deferens
What are the two 'other' structures found in the spermatic cord?
Vas deferens, processus vaginalis
What forms the free inferior margin of the external oblique muscle?
Inguinal ligament
Which type of inguinal hernia is medial?
Direct inguinal hernia.
What structure is formed by the aponeurosis of the internal oblique muscle?
Rectus sheath
Where are the peritoneum and viscera located?
In the abdomino-pelvic cavity.
With what does Camper's fascia merge?
Camper's fascia merges with the superficial fascia of the thigh and the superficial layer of the perineal fascia.
What is the scrotal derivative of the peritoneum in the abdomen?
Tunica vaginalis
Where do indirect inguinal hernias typically pass in relation to the inguinal ligament?
Superficial to the inguinal ligament.
Are there any organs in the peritoneal cavity?
No, there are no organs in the peritoneal cavity.
Which nerve's motor fibers cause the cremaster muscle to contract, elevating the testis?
Genital branch of the genitofemoral nerve
What is the function of the Marginal Artery of Drummond?
It provides a continuous arterial circle along the inner border of the colon, ensuring blood supply.
What is the function of the omentum in the abdomen?
The omentum connects the stomach with other viscera and is often referred to as the 'abdominal policemen'.
What structures are located anterior to the Foramen of Winslow?
Hepatoduodenal ligament, Portal vein, Hepatic artery, Bile duct.
What is liver cirrhosis?
Liver cirrhosis is the late stage of progressive hepatic fibrosis characterized by distortion of the hepatic architecture and the formation of regenerative nodules.
What causes portal hypertension?
Portal hypertension develops when there is resistance to portal blood flow and is aggravated by increased portal collateral blood flow; it often develops in the setting of cirrhosis, schistosomiasis, or extrahepatic portal vein thrombosis.
What is the function of the muscles of the abdominal wall?
They strengthen the abdominal wall and decrease the risk of protrusion of viscera.
Which organs are considered primary peritoneal organs not part of the GIT?
Kidney, Ureter, Urinary bladder, Uterus, Fallopian tube, Aorta, IVC, Suprarenal glands
What is the name of the convex lateral borders of the rectus abdominis?
Linea semilunaris
Which organs are listed under the 'ORGANS' category?
Pancreas, Ureter, Kidney, Inferior vena cava, Duodenum, Ascending Colon, Descending Colon, Abdominal Aorta, Suprarenal gland
What lymphatic structure is contained within the spermatic cord?
Testicular lymph vessels
What is a spermatocele and where does it develop?
A spermatocele is a retention cyst containing sperm that develops in the head of the epididymis.
With which muscles does the external oblique interdigitate?
Serratus anterior and latissimus dorsi
What structure is formed by the aponeurosis of the external oblique muscle?
Aponeurosis
Where is the peritoneal cavity located?
Within the abdominal cavity and continues into the pelvic cavity.
How does the peritoneal cavity communicate with the exterior of the body in females?
Through the uterine tubes, uterine cavity, and vagina.
What are the three main branches of the inferior mesenteric artery?
Left Colic, Sigmoid, Superior Rectal
What does it mean if an organ is extraperitoneal, retroperitoneal, or subperitoneal?
It is outside, external, or posterior to the parietal peritoneum and partially covered with peritoneum, usually on one surface.
What is the function of the mesentery?
The mesentery supports hollow viscera to the body wall and provides a means for neurovascular communication between the organ and the body wall.
What are the two recommended areas of abdominal wall entry for paracentesis?
2cm below umbilicus in the midline (through the linea alba) and 5cm superior and medial to the anterior superior iliac spines on either side (in update 3cm).
How many layers does the greater omentum have?
4 layers
What are the two layers of the superficial fascia of the anterior abdominal wall?
The two layers are the Fatty Layer (Camper's fascia) and the Membranous Layer (Scarpa's fascia).
Into what does the deep fascia continue over the penis?
The deep fascia continues over the penis as the deep fascia (Buck's fascia) and perineum as deep perineal fascia.
What are the tributaries of the portal vein?
Left gastric vein, right gastric vein, cystic veins, posterior superior pancreaticoduodenal vein
Which part of the rectum is peritoneal?
The superior rectum.
What are the two types of inguinal hernias?
Indirect and direct.
What does the peritoneal cavity contain?
A thin layer of peritoneal fluid that keeps the surfaces moist and lubricates, enabling the viscera to move over each other without friction.
What is a spermatocele and where does it develop?
A spermatocele is a retention cyst containing sperm that develops in the head of the epididymis.
What action stimulates the sensory fibers of the femoral branch of the genitofemoral nerve in the cremasteric reflex?
Stroking the skin of the superior and medial thigh
What is the Foramen of Winslow also known as?
Epiploic Foramen
What does the gastrocolic ligament connect?
Greater curvature and transverse colon
Which organ is the first part of the digestive tract listed as a peritoneal organ?
Esophagus
What is the sequence of layers pierced in the midline during paracentesis?
Skin → Superficial fascia → Deep fascia → Linea alba → Transversalis fascia → Extraperitoneal fat → Parietal peritoneum.
What is the sequence of layers pierced lateral to the inferior epigastric artery and above the deep circumflex artery during paracentesis?
External oblique → Internal oblique → Transversus abdominis → Transversalis fascia → Extraperitoneal fat → Parietal peritoneum.
What are the branches of the gastroduodenal artery?
Right gastroduodenal artery, superior anterior pancreaticoduodenal artery
Which artery gives rise to the cystic artery?
Right branch of the proper hepatic artery
What is the smaller part of the peritoneal cavity called?
Lesser Sac or Omental Bursa
At what vertebral level does the esophagus start?
C6 vertebra
Which nerves supply the anterior abdominal wall?
Ventral rami of the lower six thoracic nerves and First Lumbar nerve (T7 - T12 + L1).
What is the scrotal derivative of the transversus abdominis in the abdomen?
None
Which part of the rectum is retroperitoneal?
The middle rectum.
What is the extent of the linea alba?
It extends from the xiphoid process to the pubic symphysis.
In which direction do the fibers of the external oblique muscle run?
Obliquely downward and medially
What causes a hematocele and what does it involve?
A hematocele is caused by the accumulation of blood, resulting from the rupture of testicular blood vessels after trauma.
What mnemonic can help remember the positions of indirect and direct inguinal hernias?
Lateral – Indirect, Medial – Direct (M.D.).
What is formed by the aponeurotic fibers of the internal oblique and transversus abdominis?
Conjoint tendon
At which vertebral level does the inferior mesenteric artery originate?
L3
What are the tributaries of the portal venous system?
Superior mesenteric, Splenic, Inferior mesenteric, Left/Right gastric, Paraumbilical
What is the mesentery?
The mesentery is a 2-layered extension of the visceral peritoneum that supports hollow viscera to the body wall and provides a means for neurovascular communication between the organ and the body wall.
Which artery is associated with the lesser curvature of the stomach and may be eroded?
The left gastric artery.
What veins are involved in a porta-caval shunt?
The portal vein and the anterior wall of the inferior vena cava (IVC)
What are the derivatives of the foregut?
Thyroid, Parathyroid glands, Tympanic cavity, Trachea, bronchi, lungs, liver, gallbladder, pancreas
What structure is located inferior to the Foramen of Winslow?
Superior part of the Duodenum.
What mnemonic is commonly used to remember the retroperitoneal organs?
SAD PUCKER
What does the deep fascia of the anterior abdominal wall cover?
The deep fascia covers the muscles.
What is the innermost flat muscle of the abdominal wall that ends in an aponeurosis and contributes to the conjoint tendon?
Transversus abdominis
What is the scrotal derivative of the superficial fascia in the abdomen?
Dartos muscle
What veins form the portal vein behind the neck of the pancreas?
Superior mesenteric vein and splenic vein
What is the linea alba?
A tendinous median raphe between the two rectus abdominis muscles, formed by the fusion of the aponeuroses of the external oblique, internal oblique, and transversus abdominis muscles.
What is the peritoneal cavity?
A potential space between the parietal and visceral layers of the peritoneum.
In which direction do the fibers of the internal oblique muscle run?
Upward and medial
Where does the lymph from the region below the umbilicus drain?
Into the Superficial Inguinal nodes.
What is the afferent limb of the cremasteric reflex?
Femoral branch of the genitofemoral nerve
What may develop in the head of the pancreas if the celiac artery is occluded?
Collateral circulation may develop by way of anastomoses between the pancreaticoduodenal branches of SMA and gastroduodenal.
What are the three main branches of the celiac trunk?
Left gastric artery, splenic artery, common hepatic artery
Which parts of the gut tube are included in the foregut?
Pharynx, Esophagus, Stomach, Proximal duodenum (2nd part)
Where may pain be referred if there is erosion of the celiac artery branches?
Pain may be referred in the shoulder.
What artery supplies the midgut?
Superior Mesenteric Artery
What vessels are contained in the gastrosplenic ligament?
Short gastrics, left gastroepiploic vessels
Which part of the rectum is listed as a peritoneal organ?
Superior rectum
What does the gastrosplenic ligament separate?
Greater and lesser sacs on the left
What does the lesser omentum connect?
Lesser curvature of the stomach, duodenum, and proximal part of the duodenum to the liver
What ligament forms when fibers attach to the superior pubic ramus lateral to the pubic tubercle?
The Gimbernat lacunar ligament forms when fibers attach to the superior pubic ramus lateral to the pubic tubercle.
What is Cooper's ligament?
Cooper's ligament is formed by the most lateral fibers of the inguinal ligament that continue to run along the pectin pubis.
Where do indirect inguinal hernias protrude through?
Through the anterior abdominal wall lateral to inferior epigastric vessels, entering the deep inguinal ring and appearing at the superficial ring.
Which muscle is absent in 20% of people, tenses the linea alba, and serves as a useful landmark for median abdominal incisions?
Pyramidalis
What is the scrotal derivative of the extraperitoneal fat in the abdomen?
None
How many structures are contained within the spermatic cord?
Nine
Which is the largest and most superficial muscle of the abdominal wall?
External oblique
Which muscle is located deep to the external oblique?
Internal oblique
After the Superficial Inguinal lymph nodes, where does the lymph ultimately drain?
Into the External iliac nodes and ultimately to the Lumbar nodes.
What is the efferent limb of the cremasteric reflex?
Genital branch of the genitofemoral nerve
What condition is frequently accompanied by congestive enlargement of the spleen?
Portal hypertension
What arteries are contained in the gastrocolic ligament?
Gastroepiploic arteries
What structure is located posterior to the Foramen of Winslow?
Inferior Vena Cava (IVC).
What structure is located superior to the Foramen of Winslow?
Caudate lobe of the liver.
Which sections of the small intestine are listed as peritoneal organs?
Jejunum and ileum
Name the three parts of the greater omentum.
Gastrophrenic, Gastrosplenic, Gastrocolic
What is the function of the esophagus?
Carries food and water but no digestion and absorption
Which artery does the Superficial Epigastric artery originate from?
Femoral artery
What are the two recesses of the Lesser Sac?
Superior recess and Inferior recess
Which vein does the superior epigastric vein drain into?
Internal thoracic vein
Which vein does the inferior epigastric vein drain into?
External iliac vein
Which vein does the deep circumflex iliac vein drain into?
External iliac vein
Which vein does the superficial epigastric vein drain into?
Femoral vein
What symptom might patients with an aortic aneurysm exhibit?
A pulsating mass at the midline.
Where do direct inguinal hernias protrude through?
Through the posterior wall and medial to inferior epigastric vessels.
Which artery is associated with the lesser curvature of the stomach?
The left gastric artery.
Do direct inguinal hernias enter the scrotum?
No, they never enter the scrotum.
What structures form the posterior wall of the inguinal canal?
The transversalis fascia and the conjoint tendon (inguinal falx).
Into what does the deep fascia continue over the spermatic cord?
The deep fascia continues over the spermatic cord as the External spermatic fascia.
What is the scrotal derivative of the skin in the abdomen?
Skin
Which muscle is the principal vertical muscle of the abdomen, located on either side of the linea alba, and has tendinous intersections?
Rectus abdominis
What is the scrotal derivative of the external oblique in the abdomen?
External Spermatic Fascia
What is the scrotal derivative of the internal oblique in the abdomen?
Cremaster muscle
What is the scrotal derivative of the transversalis fascia in the abdomen?
Internal Spermatic Fascia
What are the two nerves found in the spermatic cord?
Autonomic nerves, genital branch of genitofemoral nerve
What is a hydrocele and how is it usually diagnosed?
A hydrocele is the accumulation of serous fluid, usually from persistence of processus vaginalis, and it is diagnosed with a positive transillumination test.
Which spinal nerve's ventral ramus is involved in the cremasteric reflex?
L1 spinal nerve
What are intraperitoneal organs covered with?
Visceral peritoneum.
Which artery may be eroded by the contents of a penetrating ulcer of the posterior wall of the stomach?
The splenic artery.
Are viscera with mesentery mobile?
Yes, viscera with mesentery are mobile.
What is the gastrocolic ligament a derivative of?
Dorsal mesentery
What part of the omentum is the gastrocolic ligament part of?
Greater omentum
From where does the greater omentum extend?
Greater curvature of the stomach and proximal part of the duodenum
Which artery does the Superior Epigastric artery originate from?
Internal thoracic artery
How many layers does the lesser omentum have?
2 layers
What are the clinical presentations of liver cirrhosis?
Palmar erythema, spider angioma, icterus, hepatomegaly, splenomegaly, skin excoriations, signs of hyperestrogenemia (gynecomastia, testicular atrophy, loss of male-pattern hair distribution).
Where is the esophagus located in the neck?
Behind the trachea
Through which structure does the esophagus enter the abdomen?
Esophageal hiatus of the diaphragm
At what vertebral level does the esophagus enter the abdomen?
T10
Which artery supplies blood to the ileum and the cecum?
Ileo-colic artery
What are the main arteries supplying blood to the esophagus?
Left gastric artery and inferior phrenic arteries
In which age group are indirect inguinal hernias more common?
Children and young adults.
Where is the neck of the hernial sac located in indirect inguinal hernias?
Lateral to inferior epigastric vessels.
Name the lateral paired abdominal branches of the abdominal aorta.
Inferior phrenic, Lumbar
Which artery may be eroded by the contents of a penetrating ulcer of the posterior wall of the stomach?
The splenic artery.
In which age group are direct inguinal hernias more common?
Elderly.
Where does the lymph from the region above the umbilicus drain?
Into the Axillary Lymph nodes.
Is the peritoneal cavity completely closed in males?
Yes, the peritoneal cavity is completely closed in males.
Which lymph nodes receive lymph from the lower abdominal wall, buttocks, penis, scrotum, labia majora, and the lower parts of the vagina and anal canal?
Superficial Inguinal lymph nodes.
What is a common surgical intervention for portal hypertension?
Porta-caval shunts
Which artery gives rise to the esophageal branches?
Left gastric artery
What are the branches of the splenic artery?
Branches to the spleen, branches to the body and tail of the pancreas, short gastric branches, left gastro-omental artery
Which artery branches into the right gastric artery and the proper hepatic artery?
Common hepatic artery
What are the complications of portal hypertension?
The complications of portal hypertension include variceal hemorrhage and ascites.
What is the gastrosplenic ligament a derivative of?
Dorsal mesentery
At which vertebral level does the Superior Mesenteric Artery originate?
L1
What does the 'P' in SAD PUCKER stand for?
Pancreas (except tail)
Which artery supplies blood to the ascending colon?
Right Colic artery
What does the 'C' in SAD PUCKER stand for?
Colon (ascending & descending)
What does the 'K' in SAD PUCKER stand for?
Kidneys
What does the 'E' in SAD PUCKER stand for?
Esophagus
What is a common site for an aortic aneurysm?
Just proximal to the bifurcation of the aorta at the level of L4 vertebra.
What provides collateral pathways when flow in the superior or inferior vena cava is obstructed?
Anastomoses between the tributaries of systemic veins, such as the thoraco-epigastric vein
What are the components of the Portal triad conducted by the hepatoduodenal ligament?
The Portal triad consists of the Portal vein (lying posterior), the Common bile duct (lying anterior and to the right), and the Hepatic artery (lying anterior and to the left).
Which artery is associated with the posterior wall of the first part of the duodenum?
The gastroduodenal artery.
What are the two openings of the inguinal canal?
The deep inguinal ring (hole in fascia transversalis) and the superficial inguinal ring (hole in external oblique aponeurosis).
What is the origin of the falciform ligament?
The falciform ligament is a derivative of the ventral mesentery.
What are the contents of the rectus sheath?
Rectus abdominis, Pyramidalis, Superior epigastric vessels, Inferior epigastric vessels, Lower 5 intercostal and subcostal vessels & nerves (T7-T12)
What is the Pringle maneuver?
The Pringle maneuver involves compressing the hepatoduodenal ligament manually or with a vascular clamp in the omental foramen to control bleeding from the hepatic inflow source.
What is the most dependent space in the peritoneal cavity?
Pelvic space
What does the hepatogastric ligament connect?
The hepatogastric ligament connects the liver to the lesser curvature of the stomach.
What is the rectovesical pouch and where is it located?
The rectovesical pouch is a peritoneal fold between the rectum and urinary bladder in males. It is the most dependent space in the peritoneal cavity.
What separates the left paracolic gutter from the left infra-mesocolic space?
Descending colon
When does the testis enter the scrotum during fetal development?
Approximately 4 weeks after passing through the inguinal canal.
At what vertebral level is the cardiac orifice located?
Level T10
What arteries supply blood to the abdominal esophagus?
Left gastric artery and inferior phrenic arteries
Name three organs that are almost totally covered by visceral peritoneum.
Stomach, liver, spleen.
What does the Foramen of Winslow connect?
It connects the Greater sac to the Lesser sac (Omental bursa).
What is the blood supply for the foregut?
Celiac trunk
Which artery may be eroded at the posterior wall of the 1st part of the duodenum?
The gastroduodenal artery.
Which vein may be anastomosed to the left renal vein after removing the spleen?
The splenic vein
What are the clinical manifestations of portal hypertension?
The clinical manifestations of portal hypertension include splenomegaly, abdominal wall collateral circulation, and thrombocytopenia.
Which parts of the large intestine are considered peritoneal organs?
Cecum and appendix, transverse colon, sigmoid colon
What does the 'S' in SAD PUCKER stand for?
Suprarenal gland (adrenals)
Where is the Lesser Sac located?
Posterior to the stomach and lesser omentum
Which artery supplies blood to the inferior part of the pancreas and the duodenum?
Inferior Pancreaticoduodenal artery
Which artery supplies blood to the transverse colon?
Middle Colic artery
What are the symptoms of inflammation of the parietal peritoneum?
Symptoms include sharp, localized pain, rebound tenderness, and guarding.
What covers indirect inguinal hernias?
Peritoneum and layers of the spermatic cord.
What is ascites?
Ascites is the accumulation of fluid in the peritoneal cavity due to peritonitis from congestion of the venous drainage of the abdomen.
What is paracentesis?
Paracentesis is the surgical puncture of the peritoneal cavity for aspiration or drainage of fluid.
Which arteries are classified as lateral paired visceral branches of the abdominal aorta?
Suprarenal, Renal, Gonadal
What does the hepatoduodenal ligament conduct?
The hepatoduodenal ligament conducts the Portal triad.
Which artery supplies the right gastric, right and left hepatic, and gastroduodenal arteries?
Hepatic artery
Where might pain be referred if there is erosion of the celiac artery branches?
Pain may be referred to the shoulder.
What forms the anterior wall of the inguinal canal?
The aponeurosis of the external oblique muscle (EOM).
Into which vein do the right, left, and intermediate hepatic veins drain?
Inferior VENA CAVA
What structures are contained within the hepatoduodenal ligament?
The hepatoduodenal ligament contains the portal triad: proper hepatic artery, portal vein, and common bile duct.
What are the boundaries of the Epiploic Foramen?
Anterior: Free border of the lesser omentum (hepatoduodenal ligament), Posterior: Inferior vena cava, Superior: Caudate lobe of the liver, Inferior: 1st part of the duodenum
What does the gastrosplenic ligament connect and contain?
Connects the spleen to the fundus of the stomach and contains the short gastric artery.
What do the medial and lateral umbilical folds overlie?
The medial umbilical fold overlies the medial umbilical ligament, and the lateral umbilical fold overlies the inferior epigastric vessels.
What does the phrenicosplenic ligament connect?
Connects the spleen to the diaphragm.
What is the function of the parietal peritoneum?
The parietal peritoneum lines the walls of the abdominal and pelvic cavities.
What are the functions of the peritoneum?
The peritoneum suspends the organs within the peritoneal cavity, fixes some organs within the abdominal cavity, helps peritoneal covering of the intestine stick together in infection, and secretes peritoneal fluid for the gliding of mobile viscera over one another.
What is the most important layer that reabsorbs the peritoneal fluid?
Subdiaphragmatic parietal peritoneum.
What is the nickname given to the greater omentum?
Abdominal policemen
Which parts of the gut tube are included in the midgut?
Proximal duodenum to right half (upper 2/3) of transverse colon
What artery supplies the hindgut?
Inferior Mesenteric Artery
Which parts of the gut tube are included in the hindgut?
Left half (lower 1/3) of transverse colon to upper part of anus
What does the 'D' in SAD PUCKER stand for?
Duodenum (2nd & 3rd part)
What are the clinical presentations of portal hypertension?
Ascites, edema, encephalopathy, coagulopathy, esophageal varices.
What does the 'U' in SAD PUCKER stand for?
Ureters
Which part of the duodenum is supplied by the foregut?
The proximal part of the second part of the duodenum is supplied by the foregut.
Which part of the duodenum is supplied by the midgut?
The distal part of the second part of the duodenum is supplied by the midgut.
Which part of the transverse colon is supplied by the midgut?
The upper 2/3 or right side of the transverse colon is supplied by the midgut.
What does the 'R' in SAD PUCKER stand for?
Rectum (middle)
Which artery branches into the left gastric, splenic, and hepatic arteries?
Celiac artery
What does the parietal peritoneum line?
The internal surface of the abdomino-pelvic wall.
Where are the peritoneum and viscera located?
In the abdominopelvic cavity.
To which dermatomes is irritation of the parietal peritoneum often referred?
C3-C5 dermatomes over the shoulder.
How is pain localized in the visceral peritoneum?
Pain is poorly localized.
What is the other name for the Epiploic Foramen?
Foramen of Winslow
What is the function of the mesoappendix?
Supports the appendix and contains the appendiceal artery.
What anatomical feature does the hepatoduodenal ligament border?
The hepatoduodenal ligament borders the omental foramen, which connects the greater and lesser sacs.
Which muscles are part of the anterior flat muscle of the abdominal wall?
Rectus abdominis, External Oblique, Internal Oblique, Transversus abdominis
Into which vein does the right colic vein drain?
SUPERIOR MESENTERIC VEIN
What is the origin of the hepatogastric ligament?
The hepatogastric ligament is a derivative of the ventral mesentery.
Which nerve innervates the central part of the diaphragmatic parietal peritoneum?
Phrenic nerve.
What is the origin of the external oblique muscle?
External surfaces of ribs 5–12
Where does the external oblique muscle insert?
Linea alba, pubic tubercle, anterior half of iliac crest
What are the main actions of the external oblique muscle?
Compresses and supports abdominal viscera, flexes and rotates trunk
Which veins are classified as Lateral Abdominal veins of the Inferior Vena Cava?
The Lateral Abdominal veins of the Inferior Vena Cava are the inferior phrenic and lumbar veins.
What nerves innervate the transversus abdominis muscle?
Ventral rami of six inferior thoracic and first lumbar nerves
What arteries supply blood to the rectus abdominis muscle?
Superior and inferior epigastric arteries
Where does the Quadratus lumborum muscle insert?
Iliolumbar ligament, internal lip of iliac crest
What does the gastrosplenic ligament connect?
Greater curvature and spleen
What is the first digestive organ that enters the abdominal cavity?
Esophagus
What are the boundaries of the inguinal triangle (Hesselbach Triangle)?
The boundaries of the inguinal triangle are the inferior epigastric artery (superior and lateral), the inguinal ligament/Poupart ligament (inferior and lateral), and the rectus abdominis (medial).
What does the 'A' in SAD PUCKER stand for?
Abdominal aorta / IVC
What are the derivatives of the hindgut?
Urinary bladder
Name the two ligaments that are part of the lesser omentum.
Hepatoduodenal ligament and Hepatogastric ligament
Which artery does the Superficial Circumflex Iliac artery originate from?
Femoral artery
What structures are located right lateral to the abdominal aorta?
IVC, Cisterna chyli
Which arteries originate from the Aorta?
Intercostal and subcostal arteries
Which arteries originate from the External iliac artery?
Inferior epigastric and Deep circumflex arteries
What are the anterior unpaired visceral branches of the abdominal aorta?
Celiac, Superior mesenteric, Inferior mesenteric
What is the structure of ligaments in the abdominal region?
Ligaments are 2 layered and connect viscera to each other or to the body wall.
What can develop if the celiac artery is occluded?
Collateral circulation may develop in the head of the pancreas by way of anastomoses between the pancreaticoduodenal branches of SMA and gastroduodenal.
What does the visceral peritoneum invest?
Organs/viscera.
How is pain generally localized in the parietal peritoneum?
Pain is generally localized.
What structures are contained within the falciform ligament?
The falciform ligament contains the ligamentum teres hepatis (a derivative of the fetal umbilical vein) and patent paraumbilical veins.
What type of vasculature and nerve supply serves the visceral peritoneum?
The same blood and lymphatic vasculature and same visceral nerve supply as the organs it covers.
What are the contents of the inguinal canal in males?
The spermatic cord.
Into which vein does the right gastroepiploic vein drain?
Superior MESENTERIC VEIN
What is the structure that connects the greater curvature of the stomach to the transverse colon?
Greater omentum
Is there a posterior layer of the rectus sheath below the arcuate line?
No, there is no posterior layer of the rectus sheath below the arcuate line.
What structures are contained within the hepatogastric ligament?
The hepatogastric ligament contains the gastric vessels.
Into which vein does the left colic vein drain?
INFERIOR MESENTERIC VEIN
Where is the recto-uterine pouch located and why is it significant?
The recto-uterine pouch is located between the rectum and uterus in females. It is more dependent than the vesico-uterine pouch.
What is the vesico-uterine pouch and where is it found?
The vesico-uterine pouch is a peritoneal fold located between the bladder and uterus in females.
What does the splenocolic ligament connect?
Connects the spleen to the splenic flexure of the colon.
Which nerves supply the visceral peritoneum?
Autonomic afferent nerves.
At what vertebral level does the Inferior Vena Cava pierce the diaphragm?
The Inferior Vena Cava pierces the diaphragm at the level of the 8th Thoracic vertebra.
What arteries supply blood to the internal oblique muscle?
Superior and inferior epigastric and deep circumflex iliac arteries
What nerves innervate the rectus abdominis muscle?
Ventral rami of six inferior thoracic nerves
Where does the Psoas minor muscle insert?
Pectineal line, iliopectineal eminence
What is the main and larger part of the peritoneal cavity called?
Greater Sac
Where does the Greater Sac extend from and to?
From the diaphragm to the pelvis
Which artery does the Inferior Epigastric artery originate from?
External iliac artery
What is the significance of the inguinal region?
The inguinal region is significant because it is where structures exit and enter the abdominal cavity, making it a potential site for herniation.
What part of the omentum is the gastrosplenic ligament part of?
Greater omentum
Which organ involved in the immune system is listed as a peritoneal organ?
Spleen
What is the normal route of blood flow in the portal venous system?
Portal vein → liver → hepatic vein → IVC
What is a common complication of liver cirrhosis that can also be caused by thrombosis?
Portal hypertension.
What are signs of hyperestrogenemia in liver cirrhosis?
Gynecomastia, testicular atrophy, loss of male-pattern hair distribution.
What structures are contained in the splenorenal ligament?
Splenic artery and vein, tail of pancreas
What structures are located anterior to the abdominal aorta?
Pancreas, splenic vein, left renal vein, 3rd part duodenum, mesentery, nodes, autonomic plexus, lesser sac, stomach, omentum, small bowel
Which part of the transverse colon is supplied by the hindgut?
The lower 1/3 or left side of the transverse colon is supplied by the hindgut.
Which part of the anal canal is supplied by the hindgut?
The upper part of the anal canal is supplied by the hindgut.
What are the terminal branches of the abdominal aorta?
Common iliac, Median sacral
Which artery supplies the right gastroepiploic and superior pancreaticoduodenal arteries?
Gastroduodenal artery
Where is the inguinal canal located in relation to the inguinal ligament?
Parallel and immediately above the inguinal ligament.
What does the mesentery of the jejunum and ileum contain?
Branches of the superior mesenteric artery and tributaries of the superior mesenteric vein.
What are the two spaces above the transverse colon?
Right and Left Subphrenic spaces
Into which vein do the left gonadal and left suprarenal veins drain?
LEFT RENAL VEIN
What structures bound the abdominal cavity superiorly and inferiorly?
Superiorly: Respiratory Diaphragm; Inferiorly: Levator Ani and Coccygeus Muscles (Pelvic Diaphragm)
Into which vein does the left gastroepiploic vein drain?
SPLENIC VEIN
What does the median umbilical fold cover?
The median umbilical fold covers the median umbilical ligament.
Why might the hepatogastric ligament be cut during surgery?
The hepatogastric ligament may be cut during surgery to access the lower sac.
On which side of the Aorta does the Inferior Vena Cava ascend?
The Inferior Vena Cava ascends on the RIGHT side of the Aorta.
Where does the internal oblique muscle insert?
Inferior borders of ribs 10–12, linea alba, pubis via conjoint tendon
Where does the transversus abdominis muscle insert?
Linea alba with aponeurosis of internal oblique, pubic crest, and pecten pubis via conjoint tendon
What nerve innervates the Iliacus muscle?
Femoral nerve
What nerve innervates the pyramidalis muscle?
Iliohypogastric nerve
Which organ associated with bile production is a peritoneal organ?
Liver, biliary tree
Which artery does the Deep Circumflex Iliac artery originate from?
External iliac artery
What causes inflammation of the parietal peritoneum?
It is caused by an enlarged gastrointestinal structure or by the escape of fluid, resulting in sharp, localized pain over the affected area.
Which arteries originate from the Internal thoracic artery?
Musculophrenic and Superior epigastric arteries
What can perforation of a duodenal ulcer, rupture of the gallbladder, or perforation of the appendix lead to?
It can lead to the formation of an abscess in the subphrenic recess.
Which arteries supply blood to the jejunum and ileum?
Jejunal-Ileal arteries
Which arteries originate from the Femoral artery?
Superficial circumflex and Superficial epigastric arteries
Which vein does the superficial circumflex iliac vein drain into?
Femoral vein
Which part of the anal canal is derived from the ectoderm?
The lower part of the anal canal is derived from the ectoderm.
How do arteries supplying GI structures differ from those supplying non-GI structures in terms of branching?
Arteries supplying GI structures are single and branch anteriorly, whereas arteries supplying non-GI structures are paired and branch laterally and posteriorly.
Where is the neck of the hernial sac located in direct inguinal hernias?
Medial to inferior epigastric vessels.
What primarily stimulates the visceral peritoneum?
Stretching.
What does the transverse mesocolon support?
The transverse colon and the middle colic vessels.
What structure separates the right and left subphrenic spaces?
Falciform ligament
What forms the posterior rectus sheath above the arcuate line?
Transversus abdominis (TA) aponeurosis and internal oblique (IO) aponeurosis
What is the function of the greater omentum?
It acts as an 'abdominal policeman' and hangs down like an apron in front of the coils of the small intestine, folded back on itself to be attached to the transverse colon.
What are the components of the lesser omentum?
Hepatoduodenal ligament, hepatogastric ligament, hepatoesophageal ligament
What is the function of the mesentery?
Two-layered folds of peritoneum connecting and supporting parts of intestines to the posterior abdominal wall, containing the neurovascular structures that supply the organs it supports.
Where does the lymph from the left gastric drain?
Celiac lymph node
What is the role of the greater omentum?
The greater omentum stores a large amount of fat in the peritoneal ligaments and acts as the policemen of the abdomen to prevent the spread of infection.
Which organs are classified as secondary retroperitoneal organs?
2nd, 3rd, 4th duodenum, ascending colon, descending colon, rectum (middle 1/3), pancreas (head and body).
What is the origin of the Iliacus muscle?
Superior 2/3 iliac fossa, ala of sacrum, anterior sacro-iliac ligaments
Where does the pyramidalis muscle insert?
Linea alba
What is the origin of the Psoas minor muscle?
Vertebral margins of T12 – L1 vertebrae, corresponding intervertebral disc
What is the blood supply to the Quadratus lumborum muscle?
Iliolumbar artery
What function does the Lesser Sac permit?
Permits free movement of the stomach on adjacent structures
What structure is located left lateral to the abdominal aorta?
Sympathetic chain
What does the splenorenal ligament connect?
Spleen to left pararenal space
What structures are located both lateral to the abdominal aorta?
Azygos veins, para-aortic nodes, coeliac ganglia
What is the splenorenal ligament a derivative of?
Dorsal mesentery
What structures are located posterior to the abdominal aorta?
T12-L4 vertebrae, left lumbar veins
Do indirect inguinal hernias enter the scrotum?
Yes, they can enter the scrotum.
Which artery supplies the left gastroepiploic and short gastric arteries?
Splenic artery
What is a common cause of acquired direct inguinal hernias?
Weak abdominal wall.
What type of vasculature and nerve supply serves the parietal peritoneum?
The same blood and lymphatic vasculature and same somatic nerve supply as the region of the wall it lines.
What is the main peritoneal compartment extending from the respiratory diaphragm to the pelvic diaphragm?
Greater peritoneal cavity/sac
What forms the inferior (floor) of the inguinal canal?
The inguinal ligament.
What forms the anterior rectus sheath above the arcuate line?
External oblique (EO) aponeurosis and internal oblique (IO) aponeurosis
What is the role of the coronary ligaments?
Attaches the superior surface of the liver to the inferior surface of the diaphragm and demarcates the bare area of the liver.
What do the right and left triangular ligaments connect?
Connects the liver beneath the surface of the diaphragm.
At what week does the testis lie close to the developing deep inguinal ring?
By the 28th week (7th month).
What anatomical feature does the hepatogastric ligament separate?
The hepatogastric ligament separates the greater and lesser sacs on the right.
What are the median and medial umbilical ligaments remnants of?
The median umbilical ligament is a remnant of the urachus, and the medial umbilical ligament is a remnant of the obliterated umbilical arteries.
What nerves innervate the external oblique muscle?
Ventral rami of six inferior thoracic nerves
Why is pelvic inflammatory disease more common in female patients?
Because the peritoneal cavity in females communicates with the exterior through the uterine tube/fallopian tubes, uterus, and vagina.
Which veins are classified as veins of origin of the Inferior Vena Cava?
The veins of origin of the Inferior Vena Cava are the right and left common iliac veins and the median sacral vein.
What is the origin of the rectus abdominis muscle?
Pubic symphysis, pubic crest
What is the origin of the pyramidalis muscle?
Body of pubis
What are the main actions of the Psoas major muscle?
Acting superiorly with iliacus, flexes hip; acting inferiorly, flexes vertebral column laterally; used to balance trunk in sitting position; acting inferiorly with iliacus, flexes trunk
What is the origin of the Quadratus lumborum muscle?
Medial half of inferior border of 12th rib, tips of Lumbar transverse processes
Where does the esophagus eventually enter in the stomach?
Cardiac orifice
What is a common cause of congenital indirect inguinal hernias?
Patent processus vaginalis.
What is the lymphatic drainage pathway of the esophagus?
Left and right gastric lymph nodes → celiac lymph nodes → cisterna chyli
At which vertebral level does the celiac artery originate?
T12
What are the two continuous layers of the peritoneum?
Parietal peritoneum and visceral peritoneum.
What covers direct inguinal hernias?
Only by external spermatic fascia.
What sensations is the parietal peritoneum sensitive to?
Pressure, pain, heat, and cold.
What does the falciform ligament connect?
The falciform ligament connects the liver to the anterior abdominal wall.
Where is the lesser peritoneal cavity/sac (omental bursa) located?
Behind the lesser omentum and stomach, in front of the posterior abdominal wall and pancreas (head and body)
What does the mesosigmoid support and contain?
Supports the sigmoid colon and contains the sigmoid vessels.
What are the contents of the inguinal canal in females?
The round ligament of the uterus.
At what week is the testis in the pelvis during fetal development?
By the 12th week.
What is the parietal peritoneum sensitive to?
Pain, pressure, temperature, and touch.
How long does it take for the testis to pass through the inguinal canal?
Approximately 3 days.
What are the four small pockets of the duodenal recess?
The four small pockets of the duodenal recess are the superior duodenal recess, inferior duodenal recess, paraduodenal recess, and retroduodenal recess.
What is the visceral peritoneum sensitive to?
Stretch and tearing.
What is the potential space between the parietal and visceral peritoneum filled with?
Peritoneal/ascitic fluid.
Which veins are classified as Anterior Visceral veins of the Inferior Vena Cava?
The Anterior Visceral veins of the Inferior Vena Cava are the right and left hepatic veins.
What nerves innervate the internal oblique muscle?
Ventral rami of six inferior thoracic and first lumbar nerves
What arteries supply blood to the transversus abdominis muscle?
Deep circumflex iliac and inferior epigastric arteries
What is the blood supply to the Iliacus muscle?
Iliac branches of iliolumbar artery
What artery supplies blood to the pyramidalis muscle?
Inferior epigastric artery
What is the visceral peritoneum insensitive to?
Touch, heat, and cold.
What forms the superior (roof) of the inguinal canal?
The internal oblique (IO) and transversus abdominis (TA) muscles.
Into which vein do the right gonadal and right suprarenal veins drain?
Inferior VENA CAVA
Where is the subhepatic space (Morison’s pouch) located?
Between the right lobe of the liver, right kidney, and right colic flexure
What common structure is found in the inguinal canal in both males and females?
The ilioinguinal nerve.
What separates the right infra-mesocolic space from the left infra-mesocolic space?
The mesentery of the jejunum and ileum
What structures are located posteriorly and posterolaterally in the abdominal cavity?
Posteriorly: Lumbar vertebra, Sacrum; Posterolaterally: Quadratus lumborum, Psoas major & psoas minor, Illiacus
What does the lesser omentum connect?
Lesser curvature of the stomach, duodenum, and esophagus to the liver
Which nerves supply the parietal peritoneum?
Lower 6 thoracic nerves (T7 - T12) and 1st lumbar nerve (L1).
What is the length of the abdominal esophagus?
1.5 - 2.5 cm
Which nerve innervates the pelvis parietal peritoneum?
Obturator nerve.
What is the function of the visceral peritoneum?
The visceral peritoneum covers the organs inside the abdominal cavity.
What nerves supply the abdominal esophagus?
Vagus and sympathetic nerves
Which organs are classified as primary retroperitoneal organs?
Kidney, ureters, urinary bladder, suprarenal gland, abdominal aorta, inferior vena cava, renal and gonadal vessels.
What are the main actions of the transversus abdominis muscle?
Compresses and supports abdominal viscera
What are the main actions of the Iliacus muscle?
Flexes hip and stabilizes hip joint; acts with psoas major
What is the blood supply to the Psoas minor muscle?
Lumbar branch of iliolumbar artery
What does the hepatoduodenal ligament connect?
The hepatoduodenal ligament connects the liver to the duodenum.
What structures does the hepatoduodenal ligament support?
Common bile duct, hepatic artery, portal vein
What does the falciform ligament connect?
Connects the liver to the anterior abdominal wall.
What forms the anterior rectus sheath below the arcuate line?
Aponeurosis of external oblique (EO), internal oblique (IO), and transversus abdominis (TA)
What separates the right paracolic gutter from the right infra-mesocolic space?
Ascending colon
What does the splenorenal ligament connect?
Connects the spleen to the left kidney.
What are the three small pockets of the cecal recess?
The three small pockets of the cecal recess are the superior ileocecal recess, inferior ileocecal recess, and avascular retrocecal recess.
Where is the intersigmoid recess located?
The intersigmoid recess is situated at the apex of the inverted V-shaped root of the sigmoid mesocolon, with its mouth opening downward.
What arteries supply blood to the external oblique muscle?
Superior and inferior epigastric arteries
Which veins are classified as Lateral Visceral veins of the Inferior Vena Cava?
The Lateral Visceral veins of the Inferior Vena Cava are the right suprarenal, right and left renal, and right gonadal veins.
Which organ is classified as an extraperitoneal organ?
Inferior rectum.
Where does the Iliacus muscle insert?
Lesser trochanter of femur and shaft inferior to it, and to psoas major tendon
What nerve innervates the Psoas major muscle?
Ventral rami of first four lumbar nerves
What nerve innervates the Psoas minor muscle?
Ventral rami of first lumbar nerve
What forms the Inferior Vena Cava?
The Inferior Vena Cava is formed by the union of 2 Common Iliac veins behind the right Common Iliac artery at the level of the 5th Lumbar vertebra.
How is the peritoneal cavity divided in surgery?
In surgery, the peritoneal cavity is divided into mesocolic spaces, which are separated by the transverse colon and transverse mesocolon into the supra-mesocolic compartment and infra-mesocolic compartment.
What is the origin of the internal oblique muscle?
Thoracolumbar fascia, anterior 2/3 of iliac crest, lateral half of inguinal ligament
What are the main actions of the internal oblique muscle?
Compresses and supports abdominal viscera, flexes and rotates trunk
Where does the rectus abdominis muscle insert?
Xiphoid process, costal cartilages 5–7
What is the origin of the Psoas major muscle?
Transverse processes of Lumbar vertebrae, sides of bodies of T12 – L5 vertebrae, intervening intervertebral discs
What is the blood supply to the Psoas major muscle?
Lumbar branches of iliolumbar artery
What nerve innervates the Quadratus lumborum muscle?
Ventral rami of T12 and first four lumbar nerves
What is the origin of the transversus abdominis muscle?
Internal surfaces of costal cartilages 7–12, thoracolumbar fascia, iliac crest, lateral third of inguinal ligament
What are the main actions of the rectus abdominis muscle?
Flexes trunk, compresses abdominal viscera
Where does the Psoas major muscle insert?
Lesser trochanter of femur
What is the main action of the pyramidalis muscle?
Tenses linea alba
What are the main actions of the Psoas minor muscle?
Flexes pelvis on vertebral column
What are the main actions of the Quadratus lumborum muscle?
Extends and laterally flexes vertebral column, fixes 12th rib during inspiration
