Abdomen/Lower Limb/Etc: Lev Quiz

Iliac Fossa

Surrounded by the cecum, appendix, and descending colon

Pelvic Fascia

Surrounds the prostatic fascia (i really don't know the purpose-- protection?)

Medial Circumflex Artery

The location of the anastamose between the obturator and internal pudendal arteries

deep iliac circumflex artery

The location of the anastomose of the external and internal iliac arteries

Hypogastric Region

urinary bladder, small intestine, sigmoid colon, female reproductive organs

Left Gastroepiploic Artery

A branch of the splenic artery (which is a branch of the celiac trunk, meta) which runs along the *greater curvature of the stomach*

External Urethral Sphincter

A voluntary skeletal muscle structure that allows for urination. Controlled b y the *pudendal nerve*

Prostate

Attached to the posterior inferior surface of the bladder, 3 lobes

Indirect inguinal hernia

Most common type. The hernia passes down the inguinal canal and exits at the deep inguinal ring into the scrotum. Most common in children and young adults

Celiac Trunk Location

Next to the stomach, under diaphragm fibers. Specifically: between 2 crura of diaphragm --> *can be compressed by right crus*

Occlusion of Common Hepatic Artery

Not dangerous because blood flow is still possible via the superior mesenteric artery

Arcuate Line

On the posterior rectus sheath, marks the inferior border, where inferior epigastric vessels perforate the rectus abdomins

prostatic capsule

Outer protective layer of the prostate, important in stopping spread of prostatic cancer

Right Lumbar Region

ascending colon of large intestine

Epiploic Foramen of Winslow

communication between the greater and lesser sacs of the peritoneum Location: Posterior to lesser omentum, anterior to IVC If you put in 2 fingers --> inferior vena cava

prostatic venous plexus

covers prostate. anastamoses with vesical venous plexus. drains into vesical veins (allows for venous drainage of prostate)

Left Lumbar Region

descending colon of large intestine

Umbilical Region

gallbladder, large and small intestines

Left Inguinal Region

initial part of sigmoid colon

right hypochondriac region

liver, gallbladder

Lesser Sac

peritoneal pouch located between the gaster and greater omentum, coming from the greater curvature of the gaster. Posteriorly will see pancreas/other retroperitoneal organs

Paraduodenal Recess

Area where coils of jejunum can herniate through (accounts for 50% of internal hernias)

Sacral Plexus

Arises from L4-S4 - Serves the buttock, lower limb, pelvic structures, and perineum

Right Inguinal Region

Cecum and appendix

Broad Ligament of Uterus

Mesovarium, mesosalpinx, mesometrium

Rectouterine pouch (of Douglas)

-Anteriorly you have the posterior fornix o the vagina, posteriorly you have the rectum -Ovaries are related to the recto-uterine pouch -Blood can pool here

Ileum (compared to jejunum)

-More arcades -Large amount of fat in mesentery of ________ -*Peyer's Patches* are found here (no where else!)

Cecum Functions

-Resevoir for liquids -Absorption of salts -Lubrication of waste -Cellulose digestion (note posterior appendix attachment!)

Jejunum (compared to ileum)

-Upper left quadrant -Large diameter and thicker wall -Longer vasa recta -More prominent plicae circulares -Needs more blood vessels (more red!) because site of more intense absorption -Anything there is absorbed immediately, hence empty in cadavers

Specific To Colon

1) Tenia Coli: Longitudinal muscle bands 2) Haustrations: little bands on colon 3) Fatty tags: Characteristic fatty tags along tube

Paramesonephric Remnants (males)

1) Appendix of testes (small cap of tissue associated with the testes) 2) Prostatic urethra (small blind opening in the urethra)

Mesonephric remnants (females)

1) Epophoron (near the ovaries) 2) Gartner's Duct

Right Gastric Artery

A branch of the hepatic artery proper (which is of common hepatic which is of celiac trunk), this *supplies blood to lesser curvature of stomach*

Duodenujejunal Flexure

4th part of duodenum, fibers from the right crus of the diaphragm keep this in place.

Common Hepatic Artery

A branch of the celiac trunk, divides into a) Hepatic Artery Proper b) Gastroduodenal Artery

Femoral Artery

A branch of the external iliac artery

Infraperitoneal Position

All organs of the lesser pelvis have a ___________________.

Verumontanum

Also called the seminal colliculus, an elevation on the posterior wall of the prostatic urethra. 2 openings: ejaculatory duct 1 opening: prostatic utricle

Arc of Riolan

Anastamose between the middle colic artery and left colic artery

Common Splenic Artery and Common Hepatic Artery

Anastamose via the *gastroepiploic arteries* along the greater curvature

Celiac Trunk and Superior Mesenteric Artery

Anastamose via the *pancreaticoduodenal arteries* at the head of the pancreas

Venous Plexuses

Characteristics: 1) Have thin walls and few/no valves 2) Communicate freely and anastamose with their parietal branches 3) Give rise to visceral tributaries of internal iliac vein List: Rectal, prostatic, vesical, uterine, vaginal

right gastroepiploic artery

Comes from gastroduodenal (branch of common hepatic-->celiac trunk) *supplies greater curvature of stomach*

Prostatic Urethra

Coming from the bladder, this is located inside the prostate, with 2 ejaculatory ducts (seminal vesicle + vas deferens) joining and entering

Suspensory Ligament of Ovary

Contains ovarian blood vessels and nerves (aka the ovarian artery which branches from the aorta). Note: Also where there is anastamose between the ovarian and uterine arteries

Urogenital Triangle

Contains roots of external genitalia (vaginal and urethral openings in women)

Inferior Epigastric and Deep Circumflex Iliac Artery

Both branches of the external iliac artery which supply the inferior part of the abdominal wall

superior pancreaticoduodenal artery

Branch of gastroduodenal artery to supply the *anterior and posterior head of the pancreas*

Gastroduodenal Artery

Branch of the common hepatic artery, divides into a) Right gastroepiploic artery b) Superior Pancreaticoduodenal artery

Splenic Artery

Branches from the celiac trunk, travels towards the *posterior surface of the pancreas* before giving off the left gastroepiploic artery and connecting to the *right gastroepiploic artery*

Left Gastric Artery

Branches vertically from the celiac trunk to reach the esophagus at the *cardio-esophageal junction* before looping back down to supply *lesser curvature of stomach*

Bladder Contraction

Controlled by parasympathetic innervation by the pelvic splanchnic nerves at S2, 3, and 4

Enteric Nervous System

Controls motility of the GI tract

Fracture of 10th Rib

Causes splenic bleeding because the spleen is related to the *left colic flexure* --> heavy bleeding, drop in blood pressure, spleen must be removed

Cavernous Nerve

Contains both sympathetic and parasympathetic nerves, controls erections

Pancreas

Covered partly in parietal peritoneum, has a retroperitoneal position, close to the posterior surface of the gaster (stomach)-- note: only the tail, the renolineal ligament, is covered NOTE: tail is accompanied by *splenic artery*

3rd Part of Duodenum

Crosses the midline to approach the left side, uncinate process of the pancreas found here

Internal Urethral Sphincter

Involuntarily controlled by hypogastric nerves. Must be closed during ejaculation or semen would retrograde flow into the bladder. If _______________ is paralyzed, you'll have cloudy urine after ejaculation (due to sperm in urine)

Left Hypochondriac Region

Diaphragm and spleen

Spread of Disease from Lower Abdomen

Disease can travel through the right to left subhepatic spaces through the *epiploic foramen* (lower abdomen to left side of liver/lesser sac)

Helicine Arteries

During erection, blood is filled into small spaces of the corpus cavernosum via ______________. The ______________ are coiled arteries which then relax under parasympathetic innervation, making them straight and able to be filled with blood.

germinative epithelium

Epithelium (which ISN'T parietal) that covers the ovary. Note: Malignant tumor of ovaries usually comes from this epithelium.

Ovarian Ligament

Extends from the inferior pole of the ovary to the uterus (is a remnant of the gubernaculum)

Celiac Trunk (T12)

First (proximal) artery, supplies blood to *foregut*, including the esophagus, stomach, and proximal half of duodenum. Also included: stomach, liver, spleen Branches from: abdominal aorta

inferior pancreaticoduodenal artery

First branch of the superior mesenteric artery, anastomoses with superior pancreaticoduodenal at the *head of the pancreas and duodenum*

Duodenal Cap

First part of duodenum, pyloric orifice --> neck of gallbladder. Passes anteriorly to bile duct, portal vein, IVC *most duodenal ulcers occur here* (due to gastric secretions of stomach)

Severed Vagus Nerve

If you have a ______________, you will have decreased secretion of gastric juice by the mucosa of gaster, but mobility of the small intestine will remain normal

Superficial Perineal Pouch

In females, essentially all external genitalia are located here

Bulbourethral Glands

In males, _____________ are found in the deep perineal pouch

preprostatic urethra

Initial part of urethra, where it pierces the bladder. Contains the internal urethra sphincter that is composed of smooth muscle. Innervated by sympathetic fibers.

Round Ligament of Uterus

Ligament which travels through the inguinal canal (also a remnant of the gubernaculum)

Pudendal Nerve (S2-S4)

Location: Leaves the pelvic cavity through the greater sciatic foramen Function: Innervates the perineum, including the external and internal urethral sphincters Comprised of: Somatic motor, sensory, and postganglionic sympathetic fibers Notes: Target for nerve blocks in vaginal delivery and/or for minor surgeries on the perineum and vagina

Posterior Wall of Inguinal Canal

Made of Transversalis Fascia (which will contribute to the spermatic cord or round ligament of uterus)

Anterior Wall of Inguinal Canal

Made of aponeurosis of external oblique muscle

Roof of Inguinal Canal

Made of internal oblique and transversus abdominus muscles

Lateral Enforcement of Inguinal Canal

Made of medial fibers of the internal oblique muscle. These add a covering over the deep inguinal ring

Floor of Inguinal Canal

Made of the *inguinal ligament*, it's formed by the thickened free edge of the external oblique aponeurosis. Passes between ASIS (laterally) and Pubic Tubercle (Medially)

Gubernaculum

Males: Pathway for testes into the scrotum Females: Ovaries travel without use of the ____________, which eventually is obliterated and the remnants are seen in the round and ovarian ligaments

Direct Inguinal Hernia

Peritoneal sac enters the medial end of the inguinal canal through a weakened posterior wall. Bulging occurs in Hesslebach's Triangle More common in adults

Membranous Urethra

Portion of the urethra which pierces the perineal membrane (urogenital diaphragm). Contains a sphincter composed of somatic skeletal muscle fibers -- the *external urethral sphincter*. *IMPORTANT*: This is a site of damage from trauma/external forces

Inguinal Hernia

Protrusion/passage of a peritoneal sac (with or without abdominal contents) through a weakened part of the abdominal wall in the groin

Thoracic, Lumbar, Sacral Splanchnic Nerves

Provide the sympathetic innervation for the stomach. Note: Travel along sympathetic train but do NOT synapse (*pre-ganglionic*) Second Note: Travel with *visceral sensory fibers* (pain), so you anesthetisize the sympathetic nerves to prevent pain in abdomen!

Vagus Nerve

Provides parasympathetic innervation down to the proximal 2/3 of the transverse colon Note: Really only causes *secretion by mucosa of gaster* because the rest of the stomach is controlled by the enteric nervous system

Pelvic Splanchnic Nerves (s2-s4)

Provides parsympathetic innervation for distal part of GI tract, from descending colon down to rectum Contributes to: Pelvic plexus

Penis/Clitoris

Receive sensory innervation from the *dorsal nerves* given off by the pudendal nerve and sympathetic from the *inferior hypogastric plexus*

Superior Mesenteric Artery (L1)

Second artery, supplies blood to the distal half of the duodenum, small intestine, part of large intestine (to the proximal 2/3 of transverse colon)

Descending Duodenum

Second part of duodenum, receives ducts from the liver and pancreas (through major and minor duodenal papilla). Head of pancreas here, kidney to the right.

Ileum Herniation

Seen in the superior and inferior ileocecal recesses, hesselbach's triangle, and inguinal hernias

Penile Urethra

Spongy urethra which recieves bulbo-urethral ducts which secrete sticky fluid to isolate the spermatozoa from the acid of urea traces in the urethra

Hepatic Artery Proper

Structure: Formed from common hepatic artery, divides into the right and left hepatic arteries, gives off *right gastric artery* Function: Supplies blood to the liver and gallbladder

Denoviller's Fascia

Superficial fascia which separates the rectum from the posterior bladder *IMPORTANT* Prevents the spread of pathology in the antero-posterior direction

Bulbourethral Artery

Supplier of blood to the corpus spongiosum, urethra, and glans of penis. Branches from the *internal pudendal artery* Occlusion of the _____________, blood flow to the glans of the penis will be insufficient for erection

Inferior Mesenteric Artery (L3)

Supplies blood to the bottom of the large intestine and to the rectum

cavernous artery

The deep dorsal artery of the penis, branch of the *internal pudendal artery*. Occlusion of this artery won't affect the spongiosum of the penis.

Occlusion of Hepatic Artery Proper

Very dangerous because all blood flow to the liver would be blocked

Parietal Peritoneum

What is the arrow pointing to? Note: Everything EXCEPT ovaries because we need to liberate the ovum from the surface of the ovary

epigastric region

Where gaster is mostly located (note: almost all stomach below, liver above)

prostatic urethra

Wide channel of urethra, where it receives contents from 2 ejaculatory ducts

Ejaculation; Erection

________________ is controlled by sympathetic fibers via the pudendal nerves acting on the bulbospongiosus muscle and ischiocavernous muscle (?) ; ____________ is controlled by parasympathetic fibers

Inguinal Canal Contents

a) Genital Branch of Genitofemoral Nerve b) Spermatic cord (men) and round ligament of uterus (women) NOTE: Ilio-inguinal is CLOSE to the canal, but not inside