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what 2 planes are used to divide the abdomen into quadrants
the transumbilical and medial planes
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around what level is the umbilicus
L3/4
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what are the layered muscles of the lateral abdominal wall
deepest is transversus abdominus, internal oblique and external oblique
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what direction do the 3 muscles of the lateral abdominal wall run
- transversus abdominus - transversely
- internal oblique - same direction as internal intercostals (posteroinferiorly)
- external oblique - same as external intercostals (anteroinferiorly)
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which muscles contributes to the aponeurosis that covers rectus abdominus
external oblique
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what muscles form the anterior abdominal wall
rectus abdominus
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what fuses the 2 rectus abdominus muscles
the linea alba
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what are the 2 layers of superficial facia
campers fascia (fatty connective tissue), which is superficial to scarpas fascia (deeper membranous layer)
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describe the layers of fascia of the abdominal wall
first is superficial fascia, which consists of Campers fascia and then scarpa's fascia. then this rectus sheath, formed by a layering of the of the aponeurosis of the abdominal muscles. deep to the rectus sheath is the transversalis fascia and then the peritoneum.
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- A - superficial fascia
- B - campers fascia (fatty layer)
- C - scarpa's fascia (membranous)
- D - aponeurosis
- E - external oblique
- F - internal oblique
- G - transversus abdominis
- H - transversalis fascia
- I - parietal peritoneum
- J - visceral peritoneum
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where does the linea alba span
from the xiphoid process to the pubic symphysis
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describe the features of the rectus sheath
aponeurosis of the external and internal obliques and the transversus abdominis that enclose the rectus abdominus. completely encloses the upper 3 quaters and only covers the anterior portion of the lower quarter of the rectus abdominis muscles (so the posterior aspect of the rectus abdominis will be in direct contact with the transversalis fascia. in the upper 3 quarters, the aponeurosis of the external oblique is anterior to the rectus abdominis, the aponeurosis of the internal oblique surrounds the rectus abdominus on both sides and the aponeurosis of the transversalis abdominis is posterior. after the arcuate line, they all run anteriorly.
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what is the arcuate line
the point where the aponeurosis structure of the rectus sheath changes in the lower quarter. located between the umbilicus and the pubic symphysis.
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the aponeurosis of which muscle forms the inguinal ligament
external oblique
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where does the inguinal ligament attach
the anterior superior iliac spine (ASIS) and the pubic tubercle
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- A - IVC
- B - psoas major
- C - iliacus
- D - aorta
- E - L4
- F - L5
- G - inguinal ligament
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what is in the inguinal canal in males vs females
spermatic chord or round ligament of the uterus
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what are the 4 major muscles of the posterior abdominal wall
- psoas major
- iliacus
- psoas minor
- quadratus lumborum
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what forms the iliopsoas muscle
the iliacus and psoas major muscles, after they pass under the inguinal ligament
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- A - quadratus lumborum
- B - psoas minor
- C - psoas major
- D - iliacus
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what is the peritoneal cavity
the space between the parietal and visceral peritoneum, filled with a viscous lubricating fluid
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what provides blood supply to the abdominal wall
- superior: superficially is the musculophrenic artery and the superior epigastric (comes from internal thoracic artery)
- inferior: superficially is branches of the femoral and external iliac
- - superficial anterior inferior abdominal wall is from branches of the superficial epigastric and superficial circumflex iliac arteries
- - deep comes from inferior epigastric and deep circumflex
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which structures of the GI tract are retroperitoneal
duodenum, ascending and descending colons, pancreas and ureters
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where does the greater omentum attach
to the inferior curvature of the stomach and parts of the initial segment of the duodenum, then folds back to attach to the superior surface of the transverse colon
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where does the lesser omentum span
from the lesser curvature of the stomach to the posterior surface of the liver
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what 2 ligaments does the lesser omentum form
- the hepatogastric
- hepatoduodenal ligaments (encloses bile duct, hepatic artery and portal vein)
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what is the space behind the hepatoduodenal ligament called
the epiploic foramen
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- A - hepatogastric ligament
- B - hepatoduodenal ligament
- C - gall bladder
- D - omental foramen
- E - duodenum
- F - ascending colon
- G - liver
- H - lesser omentum
- I - lesser curvature of stomach
- J - stomach
- K - descending colon
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what are the 3 mesentaries
- 'the' mesentary - the fan shaped double layer peritoneum that surrounds the jejunum and ilium
- transverse mesocolon - horizontal fold that connects transverse colon to abdominal wall
- sigmoid mesocolon - inferiorly located fold that surrounds the sigmoid colon
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- A - liver
- B - stomach
- C - gall bladder
- D - greater omentum
- E - ascending colon
- F - gall bladder
- G - greater omentum
- H - transverse mesocolon
- I - mesentary
- J - lesser omentum
- K - transverse colon
- L - descending colon
- M - small intestine
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4 points of constriction of the oesophagus
where the pharynx connects to the oesophagus, the arch of the aorta, the passage of the left main bronchus, the oesophageal haitus
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what kind of muscle contraction moves the bolus
peristalsis
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what side is the stomach on
the left
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- A - cardiac notch
- B - oesophagus
- C - cardia
- D - body
- E - pylorus
- F - pyloric canal
- G - duodenum
- H - plytoric antrum
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where is the pyloric sphincter
the pyloric canal
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what are the 3 layers of muscle of the stomach
longitudinal (most superficial), circular, then oblique (most deep)
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what are the folds in the mucosa of the stomach called
rugae
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order of small intestine segments
duodenum, jejunum and ilium
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where does the duodenum end
the duodenojejunal flexure
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is the duodenum peritoneal or retroperitoneal
retroperitoneal (except for the very first section which is attached to the lesser omentum
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where does the bile duct empty into
the duodenum
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where is the gall bladder with respect to the duodenum
superior
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what quadrant is the duodenum mostly located in
upper right
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which is the largest portion of the small intestine
ileum
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which part of the small intestine has more folds and which is thicker - ileum or jejunum
jejunum has more folds and is thicker (both diameter and walls)
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what are the folds in the lumen of the small intestine called
plicae circulares
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what is the terminal portion of the ileum called
the ileocecal junction
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what is the intial part of the large intestine called
the cecum
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where does the appendix stem from
the cecum
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what is the transition between the ascending colon and the transverse colon
the right colic (hepatic) flexure
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what is the transition between the transverse and descending colon called
the left colic (splanchnic) flexure
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which part of the colon connects with the rectum
the sigmoidal colon
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what is the narrow band of longitudinal smooth muscle that helps to propel substances through the large intestines and where is it more prominent
the taeniae coli, more prominent at the cecum
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what are the bulges in the walls of the colon called
haustra
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is variation in the shape of the sigmoidal colon normal
yes
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role of appendix
not quite sure - but does contain lymphatic tissue and colonies of healthy gut bacteria (repopulate the microbiome?)
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what do we call the curvature of the rectum
the sacral curvature as it follows the curvature of the sacrum
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- A - right colic (hepatic) flexure
- B - transverse colon
- C - superior mesenteric artery
- D - haustrum
- E - ascending colon
- F - ileum
- G - ileocecal valve
- H - cecum
- I - appendix
- J - left colic (splanchnic) flexure
- K - transverse mesocolon
- L - descending colon
- M - taeniae coli
- N - sigmoid colon
- O - rectum
- P - anal canal
- Q - external anal sphincter
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role of liver
produces bile, processes/metabolises nutrients from the gut
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what quadrant is the liver in
upper right
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what are the 2 main surfaces of the liver
the diaphragmatic and visceral
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which part of the liver does not have peritoneum
the posterosuperior side where it is in direct contact with the diaphragm (the bare area of the liver)
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what ligament separates the left and right lobes of the liver
the falciform ligament
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describe the blood supply of the liver
receives oxygenated blood via the hepatic artery and receives a supply of deoxygenated blood through the hepatic portal vein, which both take blood to the hepatic sinusoids (which is where toxins are taken up by hepatocytes and broken down). nutrients and hepatocyte products are secreted back into circulation via the hepatic veins (which connect to the IVC)
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what are the main contributors to the hepatic portal vein
superior mesenteric vein (drains small intestine, ascending and transverse colon as well as stomach), inferior mesenteric vein (distant large intestine and rectum) and splenic vein (spleen, stomach and pancreas)
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3 regions of the gall bladder
neck, body, fundus
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describe the passage of bile from the liver into the gallbladder/duodenum
travels via the left and right hepatic ducts to the common hepatic duct, then the bile duct, which is formed by a fusion of the common hepatic duct an the cystic duct. bile duct enters the duodenum via the main duodenal papilla. if the sphincter of the duodenal papilla is closed, bile will build up and flow back into the cystic duct and the gall bladder
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role of pancreas
both digestive and endocrine functions -secretes digestive enzymes into small intestine and secretes hormones (such as glucagon, insulin, somatostatin, pancreatic polypeptide)
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where does the pancreas secrete to
digestive secretions are releases into the main pancreatic duct which joins with the bile duct, releasing its contents into the duodenum through the duodenal papilla. there is also an accessory pancreatic duct which opens into the minor duodenal papilla
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role of spleen
lymphatic organ
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where is the spleen located
upper left quadrant. sits on left colic flexure, on posterior aspect of stomach
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3 main branches of the abdominal aorta that supply the abdominal viscera
celiac, superior mesenteric, inferior mesenteric
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3 main branches of celiac artery
left gastric, splenic and common hepatic
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where do celiac and superior mesenteric arteries branch from the abdominal aorta
L1
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main branches of the superior mesenteric artery and what does it supply
colic, jejunal and ileal arteries. supplies midgut )duodenum, jejunum, ileum, cecum, appendix, ascending colon, transverse colon.
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- A - hepatic portal vein
- B - superior mesenteric vein
- C - inferior mesenteric vein
- D - splenic vien
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- A - right hepatic duct
- B - left hepatic duct
- C - cystic duct (smooth part)
- D - neck of gall bladder
- E - body of gall bladder
- F - fundus of gall bladder
- G - major duodenal papilla
- H - pancreatic duct
- I - bile duct
- J - common hepatic duct
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where does the abdominal receive parasympathetic innervation from
the vagus nerve
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explain the hormonal control of childbirth (positive feedback loop)
the placenta secretes a number of hormones, including oestrogen, which induces oxytocin receptors on the uterus.also secretes prostaglandins which stimulate more vigorous contractions of the uterus, which causes further release of oxytocin from the mothers posterior pituitary, which stimules the uterues to contract further wich stimulates the placenta to release more prostaglandins and so on
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where are the hormones that are secreted from the posterior pituitary made
the hypothalamus
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what are the 2 nuclei in the hypothalamus and what do they do and where do they synapse
- the paraventricular nucleus and suprachiasmatic nucleus
- neurons in these 2 areas produce oxytocin and anti-diuretic hormone
- their axons synapse with blood vessels in the anterior pituitary - they release their neurotransmitters directly into circulation
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how does the hypothalamus communicate with the anterior pituitary
the hypophyseal portal system - a specialised part of the circulatory system that runs through the anterior pituitary, stimulating the cells of the AP to secrete trophic hormones
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