-
transpyloric plane
- - passes thru tip of 9th cc
- - transects pylorus when patient is recumbant
- - often used with interspinous plane
- - GB(fundus), origin of SMA, pylorus of stomach, duodenojejunal junction, pancreas(neck), kidneys(hilum) are all located on this plane
-
Interspinous plane
- - passes horizontally across both ASIS
- - pairs with transpyloric plane
-
Subcostal plane
- - passes through lower border of 10th cc
- - at level of L3
- - pairs with intertubercular plane
-
Intertubercular plane
- - passes horizontally thru tubercles of iliac crest (~4-5 cm behind ASIS)
- - transects body of L5
- -pairs with subcostal plane
-
7 layers of abdominal wall
- 1- skin
- 2- superficial fascia (s- campers fat, d- scarpas)
- 3- deep fascia
- 4- muscular layer
- 5- tranversalis fascia
- 6- extraperitoneal fat
- 7- parietal peritoneum
-
external oblique
- - outermost muscle
- - hand in pocket fiber orientation
- - T7-T11 spinal nerves and subcostal nerve
-
internal oblique
- - middle muscle
- - hand on chest fiber orientation
- - T6-L1
-
conjoint tendon
- - inferior aponeurotic fibers of internal oblique and transversus abdominis join to form this tendon
- - inserts into pubic tubercle
-
transversus abdominis
- - deep muscle
- - horizontal fiber orientation
- - T6-L1
-
-
semilunar line
- -a curved line along the lateral border of each rectus abdominis muscle and rectus shealth, marking the meeting of the aponeuroses of the internal oblique and transverse abdominal muscles(conjoint tendon)
- - money maker line
- - weak point-> spigelian hernia
-
rectus sheath
- -tough fibrous sheath a top rectus abdominis made of aponeurosis of obliques and transversus abdominis
- - semilunar line is lateral border
- - contents: rectus abdominis, pyramidalis, sup and inf epigastric vessels and lymphatics, ventral primary rami of T7-T12
-
arcuate line
- - aka linea semicircularis
- - demarcates lower limit of posterior layer of rectus sheath
-
vascular supply to anterior abdominal wall
- internal thoracic-> superior epigastric and musculophrenic
- external iliac-> inferior epigastric and deep circumflex iliac
- femoral-> superficial epigastric and superficial circumflex iliac
-
retroperitoneal organs
- - SADPUCKER
- -suprarenal glands, aorta/IVC, duodenum(2,3,4), pancreas(except tail), ureters, colon(A & D), kidneys, esophagus, rectum
- -1,1 2,2 1,2 1,1,1
-
epiploic foramen
- - communication between greater and lesses sac
- - aka foramen of Winslow
-
Ligament of Treitz
- -supports flexure of 4th part of duodenum attach to pyloric antrum
- - anatomical cut off for GI bleeding
- - below=lower GI= red blood stools
- - above= upper GI= black blood stools
-
splenic ligaments
-lienogastric(gastrosplenic)- contains short gastric vessels and L gastroepiploic vessels
- lienorenal(splenorenal)- contains splenic vessels and tail of pancreas
-
liver biopsy
- -performed at right 10th intercostal space in midaxillary line-
- - have pt hold there breath in full expiration to lessen possiblilty of damaging lung and contaminating pleural cavity
-
portal vein formation
- - forms behind the NECK of the pancreas by the anastamosis of the SPLENIC v and SMv
- (IMv joins splenic v)
-
Portal-systemic anasomeses
- 1- b/t esophageal veins (esophageal varisces)
- 2- b/t rectal veins (hemorrhoids, rectal bleeding)
- 3- paraumbilical veins (and small epigastric veins of anterior abdominal wall)
- 4- twings of colic veins (portal & retroperitoneal veins)
-
gall bladder location
- - lies in gallbladder fossa of liver
- - body in contact with TC and first part of duodenum (possible locations for stone jumping)
- - fundus lies at tip of 9th ICC
-
triangle of Calot
- - cystohepatic triangle
- - sup- liver, lat- cytic duct, med- common hepatic duct
- - cystic artery(from right hepatic artery) runs thru center of triangle
-
nervous supply to pancreas
- - thoracic splanchnic nerves (T5-T9)
- - carry pain sensation to DRG
-
PNS innervation to the hindgut
- - pelvic splanchnic (S2-S4)
- - NOT vagus
-
pain localization of GI
- foregut- epigastric region
- midgut- periumbilical
- hindgut- pelvic region
-
Jejunum
- - LUQ
- - deep red
- - long vasa recta and few large arcades
- - large, tall and tightly packed circular folds
-
Ileum
- - RLQ
- - pale pink
- - short vasa recta and many short arcades
- - low and sparse circular folds
- - many peyers patches
- - abundant mesenteric fat
-
anal canal innervation
- -S4 (via pudendal n. to inferior rectal n)
- - nerve to levator ani (S3-S4)
-
neurovasculature of anus above pectinate line
- - SMA
- - portal vein
- - internal iliac LN
- - visceral innervation
-
neurovasculature of anus below pectinate line
- - internal iliac artery
- - caval venous plexus
- - superficial inguinal LN
- - pudendal nerve (somatic)
-
nerve supply of SI
-SNS- greater splanchnic nerve (T5-T10) which synapses at celiac and SMA ganglion, accompany SMA periarterial branches
- PNS- vagus posterior trunk
-
nerve supply to LI (midgut)
- SNS- lesser(T10-T11) and least(T12) splanchnic nerves, synapse at SMA ganglion
PNS- vagus postrior trunk
-
nerve supply to LI (hindgut)
- SNS- Lumbar splanchnic nerves (L1-L2/3) thru inferior mesenteric plexus
-PNS- pelvic splanchnic (S2-S4) thru inferior hypogastric plexus
-
nerve supply to rectum
- SNS- lumbar splanchnic nerves
-PNS- pelvic splanchnic nerves (S2-S4)
-
caput medussa
- - seen in portal HTN
- - extreme dilation of thoracic epigastric and superficial epigastric veins
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