anatomy III: abdomen

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Opening in central tendon for IVC Through tendon not muscle bc of constriction of the Diaphragm so when you take a breath you don't want to constrict IVC, therefore T8 ivc goes through central tendon, does not contract remains stationary

(A) T8 Opening in ________ of the diaphragm for IVC through; not muscle bc of constriction of the Diaphragm so when you take a breath you don't want to constrict IVC, therefore does not contract remains stationary

ureter uterine artery water flows under the bridge - artery is above the ureter

*Note relation of ureter and uterine artery with each other water flows under the bridge - artery is above the ureter

The Perineum • Definition: A diamond- shaped region between the thighs and inferior to the pelvic diaphragm.

- Anal Triangle with the anal canal. - Urogenital Triangle with the outlets of the urinary and genital systems.

Diverticulosis -outpouchings of the colonic mucosa and submucosa through weaknesses of muscle layers in the colon wall -Complications include infection (diverticulitis) and fistulas (abnormal connections between colon and other parts of GI tract -Caused by chronic constipatin due to low fiber diets, which increases intra-luminal pressure

-outpouchings of the colonic mucosa and submucosa through weaknesses of muscle layers in the colon wall -Complications include infection (diverticulitis) and fistulas (abnormal connections between colon and other parts of GI tract -Caused by chronic constipatin due to low fiber diets, which increases intra-luminal pressure

varicocele - dilated veins of testicle

A 42 yo male comes to the hospital with complaints of a swollen testicle. On exam you examine the testicle which has a "bag of worms" sensation - what is going on?

muscles of the urinary bladder and urethra are hormonal sensitive - weaker after menopause

A 56 yo female recently underwent menopause and comes to you complaining of slight urinary leakage (incontinence), what can you tell her?

Constrictions along ureter - 3 places +Renal pelvis narrows to become the ureter +Ureter crosses over birfurcation of common iliac a and external and internal +Ureter enters bladder Kidney stone gets trapped in these places, causing referred pain around t12 and into lumbar region; Dull aching pain in back migrates to groin region

A patient comes to see you. He is sitting in the hallway waiting for you in obvious pain clutching his right flank. You ask him about the pain and he says its a dull aching pain radiating to his testicles. You know from experience, this must be a renal colic, where are the three places the stones are likely stuck?

A ruptured appendix may lead to... Peritonitis: inflammation of the parietal and visceral peritoneum. Peritonitis may be localized or generalized, and may result from infection or from a non-infectious process. The main manifestations of peritonitis are acute abdominal pain, abdominal tenderness, and abdominal guarding, which are exacerbated by moving the peritoneum, e.g. coughing (forced cough may be used as a test), flexing one's hips. Pressure over McBurney's point in the RLQ will cause maximum pain and rebound tenderness Abdominal guarding is the tensing of the abdominal wall muscles to guard inflamed organs within the abdomen from the pain of pressure upon them. The tensing is detected when the abdomen wall is pressed.

A ruptured appendix may lead to... ____________: inflammation of the parietal and visceral peritoneum. Peritonitis may be localized or generalized, and may result from infection or from a non-infectious process. The main manifestations of peritonitis are __________________, which are exacerbated by moving the peritoneum, e.g. coughing (forced cough may be used as a test), flexing one's hips. Pressure over McBurney's point in the RLQ will cause maximum pain and rebound tenderness ____________ is the tensing of the abdominal wall muscles to guard inflamed organs within the abdomen from the pain of pressure upon them. The tensing is detected when the abdomen wall is pressed.

Adrenals glands (cortex and medulla) are endocrine glands: Cortex - cortisol aldosterone androgens Medula- E and NE

Adrenals glands (cortex and medulla) are endocrine glands: _______ - cortisol aldosterone androgens _______ - E and NE Note: Crescent shaped left and pyramidal shaped right

Adrenals glands are endocrine glands Needs blood supply Each adrenal supplied with 3 pairs arteries: Superior off of inferior phrenic artery, Middle suprarenal are short branches off the aorta, inferior suprarenal arteries come off renal arteries

Adrenals glands are endocrine glands Needs blood supply; Each adrenal supplied with 3 pairs arteries: _________ off of inferior phrenic artery, Middle suprarenal are short branches off the ________, inferior suprarenal arteries come off _______ arteries

tunica albuginia

Apart from the bulbourethral muscle and the ischiocavernosus muscles, what helps the penis stay erect?

deep to superficial Female Perineum • Perineal membrane • Clitoris (erectile tissue) • Bulb of vestibule (erectile tissue) • Greater vestibular glands • 3 Superficial perineal muscles* invested by the deep perineal fascia of Gallaudet: • *Superficial transverse perineal • *Ischiocavernosus (over crura) • *Bulbospongiosus (over bulb) • Superficial perineal fascia (Colle's)

Are these in order deep to superficial or vice versa? Female Perineum • Perineal membrane • Clitoris (erectile tissue) • Bulb of vestibule (erectile tissue) • Greater vestibular glands • 3 Superficial perineal muscles* invested by the deep perineal fascia of Gallaudet: • *Superficial transverse perineal • *Ischiocavernosus (over crura) • *Bulbospongiosus (over bulb) • Superficial perineal fascia (Colle's)

Artial** supply to liver (25% of inflow)

Artial** supply to liver (25% of inflow) - hepatic artery proper -right hepatic artery -left hepatic artery

As chyme enters the duodenum: ●Carbohydrates and proteins are only partially digested ● No fat digestion has taken place Digestion continues in the small intestine: ● Chyme is released slowly into the duodenum ● Because it is hypertonic and has low pH, mixing is required for proper digestion ● Required substances needed are supplied by the liver ● Virtually all nutrient absorption takes place in the small intestine

As chyme enters the duodenum: ●Carbohydrates and proteins are _____ digested ● No ______ digestion has taken place Digestion continues in the small intestine: ● Chyme is released slowly into the ______ ● Because it is hypertonic and has low pH, mixing is required for proper digestion ● Required substances needed are supplied by the liver ● Virtually all nutrient absorption takes place in the __________

At rectosigmoid junction tenia coli spread out over entire surface of rectum

At rectosigmoid junction _______ spread out over entire surface of rectum

Autonomic (parasympathetic) input to hepatobiliary system - vagus nerve

Autonomic (parasympathetic) input to hepatobiliary system - ________

Autonomic (sympathetic) input to hepatobiliary system Preganglionic fibers: greater splanchnic nerve Post-ganglionic fibers: accompany blood vessels

Autonomic (sympathetic) input to hepatobiliary system Preganglionic fibers: _______ nerve Post-ganglionic fibers: accompany blood vessels

abdomen bones

Bony elements of abdomen: Lower ribs lumbar vertebrae and bony pelvis are included Lower ribs are part of posterior abd wall bc diaphragm attaches there Upper abdominal cavity is contained within thoracic cage Pelvis - lowest part abd cavity False pelvis is upper region Below circle is true pelvis - latter and reproductive organs

Nephrolithiasis - aka. Kidney stones Clinical Presentation: • Pain - Paroxysms of severe pain lasting 20-60 minutes - Originates in flank and radiates to groin • Location may vary as stone migrates • Hematuria - Gross or microscopic • Nausea/vomiting • Dysuria and urgency (less common)

Clinical Presentation: • Pain - Paroxysms of severe pain lasting 20-60 minutes - Originates in flank and radiates to groin • Location may vary as stone migrates • Hematuria - Gross or microscopic • Nausea/vomiting • Dysuria and urgency (less common)

Cortex - glomeruli, filtration, renal pyramids with long straight tubules Filter blood get urine CD converge on apex of each pyramid and urine comes out and is collected by minor calyces and urine goes to major c from minor to renal pelvis (upper dilated part of ureter)

Cortex - glomeruli, filtration, renal ______ with long straight tubules Filter blood get urine and collecting ducts converge on apex of each pyramid. urine comes out and is collected by ________ and urine goes to major calyx from and further to _____ (upper dilated part of ureter) prior to continuing to ureter

Divided into: ●Foregut ● Midgut ● Hindgut Based on blood supply

Divided into: ●Foregut ● Midgut ● Hindgut Based on ____________

iliocecal valve

During colonoscopy, the _________ is used, along with the orifice for the appendix, in the 40 identification of the cecum

External anal sphincter is contracted by voluntary motor stimulation from pudendal nerve Parasympathetic stimulation relaxes internal anal sphincter - which is normally contracted by sympathetic stimulation - when rectum is distended, and prepares for defecation

External anal sphincter is contracted by voluntary motor stimulation from _______ nerve Parasympathetic stimulation ___________ internal anal sphincter - which is normally contracted by sympathetic stimulation - when rectum is distended, and prepares for defecation

Anterior Division of arteries from the internal iliac artery: Internal pudendal, Middle rectal, Vaginal, with branch to bladder, Uterine, Umbilical, Superior vesical

Female _______ Division of arteries from the internal iliac artery: Internal pudendal, Middle rectal, Vaginal, with branch to bladder, Uterine, Umbilical, Superior vesical

Female Posterior Division of arteries from the internal iliac artery: lateral sacral superior and inferior gluteal

Female _______-__ Division of arteries from the internal iliac artery: lateral sacral superior and inferior gluteal

horseshoe kidney more common in males

Fusion of lower poles of kidney- instead of ascending, gets hooked under IMA Functioning kidney Would pick up in CAT scan - isthmus of kidney hooked under IMA

GI tract is made of smooth muscle: Autonomic nervous system ● parasympathetic (for peristalsis) ● sympathetic (for regulation of blood flow) - decreases peristalsis Enteric nervous system ● composed of ~100 million neurons ● intrinsic nerves composed of two plexuses Myenteric (Auerbach's)plexus - promotes GI motility Submucosal (Meissner's) plexus - controls secretions

Colon: Has three unique features which distinguish it from small intestine: - Teniae coli - three bands of longitudinal smooth muscle in its muscularis - Haustra - pocketlike sacs caused by the tone of the teniae coli - Epiploic appendices - fat-filled pouches of visceral peritoneum

Has three unique features which distinguish it from small intestine: - Teniae coli - three bands of longitudinal smooth muscle in its muscularis - Haustra - pocketlike sacs caused by the tone of the teniae coli - Epiploic appendices - fat-filled pouches of visceral peritoneum

IVC formed by common iliac veins at L5 level, below where aorta splits to right and left common iliac artery

IVC formed by _________ at L5 level, below where aorta splits to right and left common iliac artery

If the obliterated process vaginalis allows water to pass it results in a hydrocele, or if it allows intestine thru, it is an indirect hernia

If the ___________(formed by perioneum) allows water to pass it results in a hydrocele, or if it allows intestine thru, it is an indirect hernia

both lateral fornixes (4 and 9 o'clock) sit close to some major vessels and can be a cause for acute blood loss if penetrated

If you are performing an operation on the vaginal canal and accidentally penetrate thru the cervical fornix and all of a sudden a lot of blood starts coming from the vagina, what fornix was likely penetrated?

posterior fornix (6 o'clock when looking at the cervix)

If you are performing an operation on the vaginal canal and accidentally penetrate thru the cervical fornix and find feces on your probe, which fornix was penetrated?

No it is unable to pass the fascia going down to the lower extremities

If you have a patient with extravasation of urine, it is possible for the urine to continue to the lower extremities?

Pudendal and Ilioinguinal Nerve Blocks

If you want to drain an abscess in the superficial perineum, what kind of nerve block is most appropriate?

celiac ganglia In transplanted livers, no sympathetic input is observed until 30 months; denervation is also tolerated

In transplanted livers, no sympathetic input is observed until 30 months; denervation is also tolerated

Irritation of diaphragm gives referred pain- phrenic c3-c5, dermatomes on shoulder

Irritation of diaphragm gives referred pain- _______ c3-c5, dermatomes on shoulder

Irritation of spleen - in posterior lateral quadrant of abdomen irritation to left shoulder Right side - under diaphragm is liver and gall bladder irritated gall bladder or liver, referred pain to right shoulder

Right adrenal almost directly behind IVC Need to remove right adrenal is bigger job since IVC more exposed

It is more difficult to remove which kidney and why? (Hint, location of veins)

L1, L2 make up the lumbar splanchnic nerves and the inferior mesenteric ganglion

perirenal space

L2 cross section; Kidneys not in ant post or coronal plane. They are 45 degree angle in gutter made by bulging of lumbar vertebrae. QL and PS form posterior bed for kidneys on right and left side. Parietal peritoneal - encloses retroperitoneal space behind

1: perineal membrane 2: Dorsal nerve of penis 3: superficial transverse perineal muscle

Label 1 2 and 3

1: common hepatic artery 2: celiac trunk 3: splenic artery 4: left gastric artery 5: 6: left gastroepiploic/gastroomentum artery 7: right gastric artery 8: right gastroepiploic/gastroomentum artery 9: 10: gastroduodenal artery

Label 1-10

1: descending aorta 2: celiac trunk 3: 4: 5: proper hepatic artery 6: right gastric artery 7: gastroduodenal artery 8: right gastroepiploic artery 9: common hepatic artery 10: left gastroepiploic artery 11: 12: splenic artery 13: left gastric artery

Label 1-13

1: liver 2: hepatoduodenal ligament (of lesser omentum) 3: stomach 4: lesser curvature 5: hepatogastric ligament (of lesser omentum) 6: greater omentum 7: lesser omentum

Label 1-7

1: right lobe 2: left lobe 3: quadrate lobe 4: caudate lobe (& papillary process) - tail like structure 5: bare area of the right lobe 6: IVC 7: gall bladder 8: ligamentum teres hepatis (round ligament) 9: ligamentum venosum Note: 8 & 9 make up the umbilical fissure

Label 1-9

16: true conjugate (obstetrical conjugate - 10cm) 17: pelvic inlet? 18: transverse (13.5cm) 19: oblique 20: pelvic outlet

Label 16-20

4: bladder 6: ureteric opening 7: sphincter urethrae muscle 8: levator ani 13: urethra 14: urethra venous plexus

Label 4, 6, 7, 8,13 14

A: left triangular ligament E: coronary ligament (crown?) F: "bare area" (adventitia) H: right triangular ligament S: visceral peritoneum

Label A, E, F, H, S

A: Liver B: lesser omentum (ventral mesentery) C: falciform ligament (ventral mesentary)

Label A-C

A: puborectalis (levator ani) B: pubococcygyeus (levator ani) C: iliococcygeus (levator ani) 1: Coccygeus (aka ischiococcygeus) 2: levator ani (3 parts) 3: urogenital hiatus 4: anal canal

Label A-C, 1-4

A: greater sciatic foramen B: sacrospinous ligament C: sacrotuberous ligament D: lesser sciatic foramen

Label A-D

A: prostate B: ejaculatory duct C: bulbourethral/cowper gland D: urethra

Label A-D

A: psoas magor B: quadratus laborum C: lateral arcuate ligament D: medial arcuate ligament arcuate ligament Thickening of fascia over psoas major muscle - median arcuate ligament is right behind the abd aorta

Label A-D where is the median arcuate ligament?

A: pancreas B: Gallbladder C: major duodenal papilla (Vater) = sphincter of oddi (CCK control) D: cystic duct E: Hepatic duct F: common bile duct G: accessory pancreatic duct (Santorini) H: main pancreatic duct (Wirsung)

Label A-H

A: inferior mesenteric artery B: superior rectal artery C: Left colic artery D: sigmoidal arteries

Label a-d

1: corpora cavernosa - center = deep artery and both are separated by the septum penis = both surrounded by tunica abuginea 2: corpus spongiosum - spongy urethra in the center outer layer: dorsal penile artery (superficial) - within the loose areolar tissue lower layer - center deep dorsal vein, dorsal penile artery , lateral = dorsal penile nerve = all within the deep penile (Buck)

Label one and two, also what are the vessels on top?

Liver pathology often leads to irreversible cirrhosis (scarring) 1) alcohol abuse 2) hepatitis infection 3) autoimmune disease 4) industrial solvents Presentation: -"hobnail" appearance: -splenomegaly (due to portal hypertension) -ascites

Liver pathology often leads to irreversible _______ (scarring) 1) alcohol abuse 2) hepatitis infection 3) autoimmune disease 4) industrial solvents Presentation: -"hobnail" appearance: -splenomegaly (due to portal hypertension) -ascites

Living donor liver transplants -Left or right lobe may be used (lobectomy) or segmentectomy -As much as 70% of donor liver can be removed without complications; regrowth to original size occurs within a few weeks

Male Pelvic Organs • 1. Ureter • 2. Urinary bladder • 3. Rectum • 4. Prostate • 5. Seminal vesicle • 6. Ductus deferens

Anterior Division of arteries from the internal iliac artery: Internal pudendal, Inferior vesical, Umbilical, Superior vesical, Middle rectal

Male _______ Division of arteries from the internal iliac artery: Internal pudendal, Inferior vesical, Umbilical, Superior vesical, Middle rectal

Posterior Division of arteries from the internal iliac artery: lateral sacral artery superior and inferior gluteal

Male ________ Division of arteries from the internal iliac artery: lateral sacral artery superior and inferior gluteal

Latissimus dorsi external oblique lumbar triangle (of petit) - Weak spot - bw anterior edge of lat dorsi and posterior edge of external oblique and middle part iliac crest posterolateral part abd wall - could get hernia

Name the muscles the green arrow are pointing to top to bottom and the space indicated by the lowest arrow. what is the clinical significance of this space?

Note that length of vasa recta and complexity of arcades changes from jejeunum to ileum

duodenum

Note the four sections of the duodenum - G shaped

zigzag Z line esophageal gastric juncture = border of two types of epithelium - simple columnar below

Note the location of the Z line - what is it made up of?

cricoharyngeus constriction

Note the locations of the cricopharyngeus constriction (C6), the broncho-aortic constriction, Left bronchus constriction (T4/5), lower esophageal sphincter (T10)

myenteric meissner plexus

Note the locations of the myenteric and submucosal (meissner) plexuses

Nothing is in the peritoneal cavity; neuro-vascular structures must pass to organs encased between two peritoneal layers (whose name varies with location)

Nothing is in the __________; neuro-vascular structures must pass to organs encased between two peritoneal layers (whose name varies with location)

Parasympathetic innervation: -Vagus nerve in GI tract up to prox 2/3 of transverse colon -Parasympathetic fibers from vagus will pass through ganglia WITHOUT synapsing and travel along BVs to reach ganglia in diff parts GI tract Long pre-gangionic and short post-ganglionic fibers -Parasympathetic innervation to hindgut (distal colon) and pelvic structures via pelvic splanchic nerves (Come from sacral region (S2,3,4)) -Intermediolateral cell columns give rise to pre- ganglionic parasympathetics: Travel by themselves or along BVs to reach their targets

Parasympathetic innervation: -Vagus nerve in GI tract up to prox 2/3 of transverse colon -Parasympathetic fibers from vagus will pass through ganglia WITHOUT synapsing and travel along BVs to reach ganglia in diff parts GI tract Long pre-gangionic and short post-ganglionic fibers -Parasympathetic innervation to hindgut and pelvic structures via pelvic splanchic nerves (Come from sacral region (S2,3,4)) -Intermediolateral cell columns give rise to pre- ganglionic parasympathetics: Travel by themselves or along BVs to reach their targets

Parasympathetic nerves: -stimulate bile production -stimulate glycogen synthesis But hormones control most functions: -CCK: gall bladder contraction -secretin: increases bile flow [In truncal vagotomy, hepatobiliary branches are lost; complications are minimal]

Parasympathetic nerves: -stimulate bile ________ -stimulate ________ synthesis But hormones control most functions: -CCK: _____________ -___________: increases bile flow [In truncal vagotomy, hepatobiliary branches are lost; complications are minimal]

the pudendal nerve is the main nerve of the perineum

Passing through 5 regions. It divides into 3 major branches. Supplies the skin, organs, and muscles of the perineum; concerned with micturition, defecation, erection, ejaculation, and in the female, parturition. This nerve has similar distribution in the female and male because the parts of the female perineum are homologs of those in the male.

Pelvic Floor • Floor made up of muscles. - pelvic diaphragm - urogenital diaphragm • Bears weight and pressure of abdominopelvic viscera.

Pelvic Floor • Floor made up of muscles. - _________ - _________ • Bears weight and pressure of abdominopelvic viscera.

Perirenal space- inside fascia Pararenal space - around fascia

Perirenal space- _______ fascia Pararenal space - _______ fascia

Post abdominal wall behind posterior peritoneum projects far anteriorly Back muscles vertebrae, psoas major protect posterior abdomen, anterior only protected by thin layer of muscles

Referred pain: greater splanchnic nerve - epigastric lesser splanchnic nerve - periumbilical least splanchnic nerve - hypogastric lumbar splanchnic nerve - hypogastric/inguinal

Referred pain: greater splanchnic nerve - ________ ____________ - periumbilical least splanchnic nerve - ____________ ______________ - hypogastric/inguinal

Small bowel has valvulae conniventes (plicae circulares), mucosal folds that extend across the entire diameter of the bowel

Small bowel has valvulae conniventes (__________), mucosal folds that extend across the entire diameter of the bowel The circular folds slow the passage of food along the intestines, and afford an increased surface for absorption. They are covered with small fingerlike projections called villi.

Some GERD manifestations: -esophagitis -esophageal strictures -Barrett's esophagus

Superficial inguinal and deep inguinal lymph nodes connect to channels along common illiac nodes that drain to para aortic nodes

Superficial inguinal and deep inguinal lymph nodes connect to channels along ____________ nodes that drain to para aortic nodes

Superior Rectal Vein drains to Portal vein Middle and Inferior rectal veins drain to Internal Iliac veins and to IVC superior rectal vein - - to Inferior mesenteric vein - to Portal vein middle rectal vein - to internlal iliac vein inferior rectal rectal vein - to internal pudendal vein to internal iliac vein

Superior Rectal Vein drains to _________ Middle and Inferior rectal veins drain to Internal Iliac veins and to IVC superior rectal vein - - to Inferior mesenteric vein - to Portal vein middle rectal vein - to internlal iliac vein inferior rectal rectal vein - to internal pudendal vein to internal iliac vein

Superior mesenteric Artery supplies the midgut Contains: 3rd, 4th parts of duodenum, part of pancreas jejeunum, ileum cecum appendix ascending colon, proximal 2/3 of transverse colon

Superior mesenteric Artery supplies the ________ Contains: 3rd, 4th parts of duodenum, part of pancreas jejeunum, ileum cecum appendix ascending colon, proximal 2/3 of transverse colon

Sympathetic innervation: - prevertebral ganglia Celiac, Superior Mesenteric, aortic, or renal ganglia - symp innervation Inferior mesenteric ganglion - lies along origin of inferior mesenteric artery Sympthatic nerves synapse in these ganglia then travel along branches of celiac trunk, sup mesenteric a, renal a, IMA s to constrict BVs going to GI tract or kidneys

True: Most cases of hemorrhoids are not due to portal hypertension - hard stool or constipation causes increased pressure in rectum which compresses rectal veins - need to eat more fiber and drink more fluids!

T/F: Most cases of hemorrhoids are not due to portal hypertension - hard stool or constipation causes increased pressure in rectum which compresses rectal veins - need to eat more fiber and drink more fluids!`

False: the portal vein brings blood into the liver while the hepatic vein takes blood from the liver

T/F: The hepatic vein brings blood into the liver while the portal vein takes blood away from the liver

True: The liver also conveys lipids as lipoproteins (indirectly from GI via lymphatics)

T/F: The liver also conveys lipids as lipoproteins (indirectly from GI via lymphatics)

True: Functional liver lobes differ from these morphological lobes; functional lobes are defined by their dual blood supply

T/F: Functional liver lobes differ from morphological lobes; functional lobes are defined by their dual blood supply

True: Lumbar hernias are rare compared to other hernia types; CT small loop of small intestine going through lumbar triangle (of petit) out posterolaterally mostly secondary to trauma or surgery

T/F: Lumbar hernias are rare compared to other hernia types; CT small loop of small intestine going through lumbar triangle (of petit) out posterolaterally

True; the cervix is the least mobile part of the pelvis but it does move with bladder fullness

T/F; the cervix is the least mobile part of the pelvis but it does move with bladder fullness

TB can infiltrate the spinal cord and travel to the psoas fascia where pus accumulates to form a psoas abscess

TB can infiltrate the spinal cord and travel to the __________ where pus accumulates to form a ______

Pelvic axis is curved (line joining the center points of the inlet and outlet)

The ______ is curved (line joining the center points of the inlet and outlet); it is the pathway the head of the baby follows

The anorectal angle is maintained by the puborectalis muscle - prevents feces from entering anus and is under voluntary control. Dr Kwan will discuss in more depth later.

The ________ is maintained by the puborectalis muscle - prevents feces from entering anus and is under voluntary control. - 80 degrees

The true conjugate (obstetrical conjugate) is the narrowest fixed diameter through which the head of the baby must pass in a vaginal delivery.

The __________ (1) is the narrowest fixed diameter through which the head of the baby must pass in a vaginal delivery.

The small intestine is an intraperitoneal structure - loops of jejeunum and ileum are suspended from posterior abdominal wall my a mesentery

The __________ is an intraperitoneal structure - loops of jejeunum and ileum are suspended from posterior abdominal wall my a mesentery

The duodenum is a retroperitoneal structure - the small intestine is intraperitoneal. The junction between them (duodenojejeunal junction) is marked by the ligament of Treitz, an extension of the right crus of the diaphragm

The ______________ is a retroperitoneal structure - the small intestine is intraperitoneal. The junction between them (duodenojejeunal junction) is marked by the ligament of Treitz, an extension of the right crus of the diaphragm

The aorta branches into the common iliac arteries at L4 which then divide each into internal and external iliac arteries. The external iliac arteries continue to form the femoral arteries which go under the inguinal ligament. The internal iliac arteries supply structures in pelvis (repro organs bladder prostate uterus) - the gluteal arteries also come off these arteries

The aorta branches into the _________ at L4 which then divide each into internal and external iliac arteries. The ______ iliac arteries continue to form the femoral arteries which go under the inguinal ligament. The ________ iliac arteries supply structures in pelvis (repro organs bladder prostate uterus) - the gluteal arteries also come off these arteries

The developing liver forms within a ventral mesentery* - this forms the adult lesser omentum & falciform ligament

The developing liver forms within a _____________ - this forms the adult lesser omentum & falciform ligament

The internal pudendal artery is the main blood supply of the perineum The pudendal nerve is the main nerve of the perineum. They travel through the pudendal canal

The internal pudendal artery is the main blood supply of the perineum The pudendal nerve is the main nerve of the perineum. They travel through the _____________.

The liver is divided by hepatic arteries, portal veins (& bile ducts) horizontally and hepatic veins vertically, giving rise to 8 segments

The liver, gall bladder & pancreas develop from an outgrowth from the 2nd part of the duodenum (thus explaining the common duct opening at this location in the adult)

The liver, gall bladder & pancreas develop from an outgrowth from the 2nd part of the __________ (thus explaining the common duct opening at this location in the adult)

The pelvic joint ligaments loosen under the action of relaxin during pregnancy

The pelvic joint ligaments loosen under the action of ______ during pregnancy

The suprarenal medulla is directly innervated by preganglionic sympathetic fibers via splanchic nerve (T10-L1), causing a systemic sympathetic response. (The suprarenal (adrenal) medulla is modified nerve tissue. Activation of it causes the release of norepinephrine and/or epinephrine, which enter the blood stream and cause the systemic response.) However, postganglionic neurons from the celiac ganglion reach the cortical tissue of the suprarenal glands to innervate the suprarenal blood vessels.

The suprarenal medulla is directly innervated by _____ganglionic via splanchic nerve sympathetic fibers, causing a systemic sympathetic response. (The suprarenal (adrenal) medulla is modified nerve tissue. Activation of it causes the release of norepinephrine and/or epinephrine, which enter the blood stream and cause the systemic response.) However, _____ganglionic neurons from the celiac ganglion reach the cortical tissue of the suprarenal glands to innervate the suprarenal blood vessels.

The testes and ovaries are supplied by gonadal arteries - sympathetic fibers from T11, T12 supply these arteries and have visceral afferent fibers travelling retrogradely with them referred pain would NOT be in scrotal area but in lower abdomen Compression of groin would feel pain in lower abdomen Pain from scrotum skin pudendal n - not visceral but somatic pain Carried by pudendal from S2-s4 SC levels, dermatomes in pernieum/pudendal area

The testes and ovaries are supplied by gonadal arteries - sympathetic fibers from T__,T___ supply these arteries and have visceral afferent fibers travelling retrogradely with them therefore: referred pain would NOT be in scrotal area but in ________. Pain from scrotum skin _______ nerve - not visceral but somatic pain Carried by _______ nervefrom S2-s4 SC levels, dermatomes in pernieum/pudendal area

Urogenital Diaphragm: Critical in controlling urinary continence - able to strengthen with kegal excercises

This is the ________: its main job is what? DEEP: Superior Fascia of deep perineal muscles ------------------------- - Deep transverse perineal muscles - Compressor urethrae - Sphincter urethrae / urethrovaginal muscle --------------------------- - Perineal membrane= inferior fascia of deep perineal muscles = - fascia diaphragmatis urogenitalis inferior (inferior view) SUPERFICIAL

Transverse and sigmoid colons have a mesentery - intraperitoneal structures Ascending and descending colons have no mesentery - secondarily retroperitoneal structures

Transverse and sigmoid colons have a mesentery - ____________ structures Ascending and descending colons have no mesentery - ___________ structures

Ureter conveys urine by peristalsis - rhythmic contraction; it has its own enteric NS, peristalsis is modified by para NS from branches upper part vagus and pelvic splanchic n near bladder

Ureter conveys urine by peristalsis - rhythmic contraction; it has its own enteric NS, peristalsis is modified by para NS from branches upper part _______ nerve and pelvic ________ nerve near bladder

• Transverse cervical ligament (Cardinal, Mackenrodt's) • Uterosacral • Pubovesical • Round ligament • Broad ligament all support the uterus

Weakened support of what ligaments leads to uterine prolapse?

A: segmantal arteries B: renal artery Kidney supplied by renal artery but divides to smaller branches - segmental arteries smaller then to capillaries surrounding glomeruli, have filtration

What is A and B? what is the role of A?

cirrhosis - nodules: contraction of scar tissue and hepatic cellular regeneration (hobnail appearance)

What is this condition of the liver called? what is the appearance of the liver surface called?

Whether cancer cells spread first to the superficial nodes or to the iliac nodes depends on the embryonic and fetal developmental paths of the organs involved.

most common urethral trauma - false passage recall: the male system also has a curve you need to be aware of (female does too)

You have a 72 yo male suffering from extreme BPH so he has to chronically use a catheter, what is your biggest concern for injury?

Pelvic Diaphragm - Critical in maintaining fecal continence

You have a 72 yo woman come to see you with complaints of progressively worsening of uncontrollable passing of stool. She is dependent on diapers. Where is the problem localized to most likely?

spinal damage - pelvic diaphragm nerves from S3/4 and damage to these can cause incontinence sacral plexus: - S2, 3, 4 = pudendal nerve - pelvic diaphragm nerve S3/4

You have a patient come in after a trauma to her back with complaint of incontinence, what are you most nervous for?

TB ---> psoas abcess If person tries to walk, extend thigh, pain - Sense through branches of lumbar plexus

You have a patient who has recently been having pain with walking especially extending the thigh. He also notes he moved from india recently and has had an episode or two of hemoptysis. what is your concern?

Pre-aortic nodes - lie celiac, sup. along origin of celiac trunk, SMA, IMA - drain GI system Lateral aortic nodes - lie along aorta, IVC - drain structures in posterior abdominal wall, pelvis, lower limb

______ nodes - lie celiac, sup. along origin of celiac trunk, SMA, IMA - drain GI system ________ nodes - lie along aorta, IVC - drain structures in posterior abdominal wall, pelvis, lower limb

Spinous processes and iliac crest - lat dorsi, attach humerus External oblique -fibers attach ribs and attach anterior iliac crest, and linea alba Deep to lat dorsi and is next to internal oblique (90 degrees to ext o) - Deep to is tendon of trans abdominal

______: attach spinous processes and iliac crest, attach humerus _______: fibers attach ribs and attach anterior iliac crest, and linea alba Deep to lat dorsi and is next to internal oblique (90 degrees to ext o) - Deep to is tendon of trans abdominal - external oblique - lat dorsi

Psoas Sign - Pain on passive extension of the right thigh. Patient lies on left side. Examiner extends patient's right thigh while applying counter resistance to the right hip (asterisk) inflamed appendix is in a retroperitoneal location in contact with the psoas muscle, which is stretched by this maneuver

_______ - Pain on passive extension of the right thigh. Patient lies on left side. Examiner extends patient's right thigh while applying counter resistance to the right hip (asterisk) inflamed appendix is in a retroperitoneal location in contact with the psoas muscle, which is stretched by this maneuver

greater (celiac ganglion T5-T9), lesser (superior mesenteric ganglion T11,10), and least (aorticorenal ganglion, T12) splanchnic nerves are formed by ventral primary rami T5-T12

________ (celiac ganglion T5-T9), _______ (superior mesenteric ganglion T11,10), and ___________ (aorticorenal ganglion, L1,2) splanchnic nerves are formed by ventral primary rami T5-L2

Female Pelvic Organs • 1.Ureter • 2.Urinary bladder • 3.Rectum • 4.Ovaries • 5.Oviduct • 6.Uterus • 7.Vagina

________ Pelvic Organs • 1.Ureter • 2.Urinary bladder • 3.Rectum • 4.Ovaries • 5.Oviduct • 6.Uterus • 7.Vagina

Internal hemorrhoids - rectal mucosa prolapses due to abnormally enlarged veins of the internal venous plexus Pain-free due to visceral innervation External hemmorhoids - blood clots form outside anal canal Painful due to somatic innervation from pudendal nerve

________ hemorrhoids - rectal mucosa prolapses due to abnormally enlarged veins of the internal venous plexus Pain-free due to visceral innervation _______ hemmorhoids - blood clots form outside anal canal Painful due to somatic innervation from pudendal nerve

Ileopsoas is main hip flexor - flex thigh at hip joint, crosses hip joint anteriorly

________ is main hip flexor - flex thigh at hip joint, crosses hip joint anteriorly

right kidney - a little lower due to the liver pushing it down - there is a hepatosplenal recess which is the lowest spot when laying down b/w the liver and right kidney

________ kidney - a little lower due to the liver pushing it down - there is a hepatosplenal recess which is the lowest spot when laying down b/w the liver and right kidney

Left renal vein - crosses midline under Superior Mesenteric Artery Left gonadal veins (left testicular or left ovaraian) don't empty directly to IVF first comes up and empties to left renal vein then across right into IVC - same with the left renal vein

________ vein - crosses midline under Superior Mesenteric Artery ____________ veins (left testicular or left ovaraian) don't empty directly to IVF first comes up and empties to left renal vein then across right into IVC - same with the ________ vein

Iliacus Its tendon joint psoas major Form ileospasas tendon, inserts on lesser trochanter InnervationFemoral nerve - L2 - L4 Action: flexes thigh at hip

________: Its tendon joint psoas major Form ileospasas tendon, inserts on lesser trochanter InnervationFemoral nerve - L2 - L4 Action: flexes thigh at hip

AAA Large abdominal aorta (usually 2.5 cm), if over 3cm aneurysm- can grow 4-5cm Danger can get rupture

________: Large abdominal aorta (usually 2.5 cm), if over 3cm aneurysm- can grow 4-5cm Danger can get rupture Rupture: 90 % mortality

Perineum: area of the surface of the trunk between the thighs and the buttocks, and the shallow compartment lying deep to this area and inferior to the pelvic diaphragm. Includes the anus and external genitalia.

________: area of the surface of the trunk between the thighs and the buttocks, and the shallow compartment lying deep to this area and inferior to the pelvic diaphragm. Includes the anus and external genitalia.

the duodenum is secondarily retroperitoneal

_________ is secondarily retroperitoneal

Genitofemoral nerve is only nerve to come straight through psoas major muscle Lateral cutaneous nerve of thigh crosses iliacus muscle Femoral nerve runs lateral to psoas major

_________ nerve is only nerve to come straight through psoas major muscle (13) _________ nerve of thigh crosses iliacus muscle __________ nerve runs lateral to psoas major (12)

Vagus nerve provides parasympathetic innervation up to proximal 2/3 of transverse colon

_________ provides parasympathetic innervation up to proximal 2/3 of transverse colon

Hydronephrosis refers to distension and dilation of the renal pelvisand calyces, usually caused by obstruction of the free flow of urine from the kidney. Untreated, it leads to progressive atrophy of the kidney. In cases of hydroureteronephrosis, there is distention of both the ureter and the renal pelvis and calices.

_________ refers to distension and dilation of the renal pelvisand calyces, usually caused by obstruction of the free flow of urine from the kidney. Untreated, it leads to progressive atrophy of the kidney. In cases of hydroureteronephrosis, there is distention of both the ureter and the renal pelvis and calices.

Omentum: -double layer of peritoneum between the stomach and another organ

_________: -double layer of peritoneum between the stomach and another organ mobile structures; they do not apply to "retroperitoneal" organs that are fixed in position

rupture of diaphragm man who fell 45 ft from scaffolding, through plate glass windows, and onto the ground. Intraoperatively, he had a completely avulsed diaphragm on the left side ressure and herniated stomach - elevated left hemidiaphragm

_________: man who fell 45 ft from scaffolding, through plate glass windows, and onto the ground. Intraoperatively, he had a completely avulsed diaphragm on the left side ressure and herniated stomach - elevated left hemidiaphragm

Pelvic Plexus: - Pelvic splanchnic (S2- 4) with parasympathetic f. - Hypogastric plexuses, mixed

__________: - Pelvic splanchnic (S2- 4) with parasympathetic f. - Hypogastric plexuses, mixed

kidneys - filter blood, remove excess fluid - primarily retroperitoneal - never had mesentery, developed behind peritoneum in retroperitoneal space

__________: - filter blood, remove excess fluid - primarily retroperitoneal - never had mesentery, developed behind peritoneum in retroperitoneal space

Ligament: -double layer of peritoneum between organs or between an organ and the abdominal wall

__________: -double layer of peritoneum between organs or between an organ and the abdominal wall mobile structures; they do not apply to "retroperitoneal" organs that are fixed in position

colitis: chronic inflammation of the large intestine, often starting at the rectum, typical symptoms include diarrhea (hematochezia possible), pain, weight loss, and inflammation of other organs. also higher risk of colorectal carcinoma

__________: chronic inflammation of the large intestine, often starting at the rectum, typical symptoms include diarrhea (hematochezia possible), pain, weight loss, and inflammation of other organs. also higher risk of colorectal carcinoma

Perirenal Peril: -Stone in the mid right ureter obstructs the collecting system -The right kidney is swollen with stranding in the perinephric fat & a dilated collecting system (hydronephrosis)

___________: -Stone in the mid right ureter obstructs the collecting system -The right kidney is swollen with stranding in the perinephric fat & a dilated collecting system (hydronephrosis)

Superior hypogastric plexus Consists of sympathetic fibers from lumbar splanchnic nerves (L1 - L2/3). Contributes to sympathetics to inferior and hypogastric nerves.

___________: Consists of sympathetic fibers from lumbar splanchnic nerves (L1 - L2/3). Contributes to sympathetics to inferior and hypogastric nerves.

eventration of diaphragm: Elevation of diaphragm due to congenital malformation or phrenic nerve interruption from birth or operative trauma Liver bulges up abnormally below right hemididiaph

___________: Elevation of diaphragm due to congenital malformation or phrenic nerve interruption from birth or operative trauma Liver bulges up abnormally below right hemididiaphragm

Visceral sensation: • often unconscious; if conscious: dull, poorly-localized parasympathetic nerves • cell bodies in dorsal root ganglion • nerve ending in viscera • distension, blood gas, blood pressure, cramping, irritants Somatic sensation: • conscious, sharp, well-localized • touch, pain, temperature, pressure, proprioception

____________ sensation: • often unconscious; if conscious: dull, poorly-localized parasympathetic nerves • cell bodies in dorsal root ganglion • nerve ending in viscera • distension, blood gas, blood pressure, cramping, irritants ________ sensation: • conscious, sharp, well-localized • touch, pain, temperature, pressure, proprioception

Quadratus lumborum O: post part iliac crest Attach to 12th rib and to tips of transverse processes l1-l3 Contracts and stabilizes lower ribs when we contract diaphragm, inspire Prevents ribs from moving upward Helps flex bend lumbar spine one side to other if acting one side, lateral flexor lumbar spine Innervation : unnamed branches of ventral primary rami L1-L4

____________: O: post part iliac crest Attach to 12th rib and to tips of transverse processes l1-l3 Contracts and stabilizes lower ribs when we contract diaphragm, inspire Prevents ribs from moving upward Helps flex bend lumbar spine one side to other if acting one side, lateral flexor lumbar spine Innervation : unnamed branches of ventral primary rami L1-L4

The Organ of Zuckerkandl is a chromaffin body derived from neural crest located at the bifurcation of the aorta or at the origin of the inferior mesenteric artery. It can be the source of a pheochromacytoma

____________: is a chromaffin cells derived from neural crest located at the bifurcation of the aorta or at the origin of the inferior mesenteric artery. It can be the source of a pheochromacytoma (aka cells ectopically placed from the adrenal)

Meckel's Diverticulum - failure of vitelline duct (yolk stalk) to completely regress once midgut loop retracts back into the abdomen Syndrome of 2's: 2% population, 2 inches long, 2 feel proximal to ICJ, 2 types of mucosa, 2 times more common in males, 2% symptomatic

_____________ - failure of vitelline duct (yolk stalk) to completely regress once midgut loop retracts back into the abdomen Syndrome of 2's: 2% population, 2 inches long, 2 feel proximal to ICJ, 2 types of mucosa, 2 times more common in males, 2% symptomatic

Pancreas is considered part of both foregut and midgut because it is supplied by both the celiac trunk and the SMA

_____________ is considered part of both foregut and midgut because it is supplied by both the celiac trunk and the SMA

Inferior mesenteric Artery supplies the hindgut contains: distal 1/3 of transverse colon Inferior mesenteric Artery descending colon, sigmoid colon rectum

_____________ supplies the hindgut, contains: distal 1/3 of transverse colon Inferior mesenteric Artery descending colon, sigmoid colon rectum

Mesentery: -double layer of peritoneum between body wall (usually posterior) and organ

_____________: -double layer of peritoneum between body wall (usually posterior) and organ mobile structures; they do not apply to "retroperitoneal" organs that are fixed in position

colon carcinoma: malignant tumors of the colon and rectum are some of the most frequent - more than 90% occur in patients over the age of 50. Blood in the stool is incriminating • Mass protruding into lumen usually arising from mucosa • Neoplastic, hyperplastic, or inflammatory in etiology

_____________: malignant tumors of the colon and rectum are some of the most frequent - more than 90% occur in patients over the age of 50. Blood in the stool is incriminating • Mass protruding into lumen usually arising from mucosa • Neoplastic, hyperplastic, or inflammatory in etiology

Lesser omentum connecting liver to the stomach and upper duodenum, composed of the hepatoduodenal ligament inferiorly and the hepatogastric ligament superiorly; the hepatoduodenal ligament contains the portal triad and forms the roof of the epiploic forament of Winslow (connecting the greater and lesser sacs)

______________ (highlighted) connecting liver to the stomach and _______________, composed of the hepatoduodenal ligament (contains the portal triad and forms the roof of the epiploic forament of Winslow (connecting the greater and lesser sacs)) inferiorly and the hepatogastric ligament superiorly

Diaphragmatic Hernia ● Incidence ~1 in 2,500 live births. ● 80% in the left side, 20% in the right. Rarely bilateral. ● Cause is unknown. Failure of normal closure of the pleuroperitoneal canal (Bochdalek type) in the developing embryo. ● Abdominal contents herniate and compress the ipsilateral developing lung, causing pulmonary hypoplasia and hypertension.

______________ hernia: ● Incidence ~1 in 2,500 live births. ● 80% in the left side, 20% in the right. Rarely bilateral. ● Cause is unknown. Failure of normal closure of the pleuroperitoneal canal (Bochdalek type) in the developing embryo. ● Abdominal contents herniate and compress the ipsilateral developing lung, causing pulmonary hypoplasia and hypertension.

Psoas major muscle - originates lumbar vertebrae from transverse processes -Fibers extend down lower abdomen into false pelvis where they Join fibers of iliacus muscle -Fills the iliac fossae on either side, flat muscle -Together form ileopsoas tendon crosses hip ant and inserts on femur prominence (lesser trochanter) Innervation: ventral rami of L1 - L3 Action: flexes thigh at hip

______________: - originates lumbar vertebrae from transverse processes -Fibers extend down lower abdomen into false pelvis where they Join fibers of iliacus muscle -Fills the iliac fossae on either side, flat muscle -Together form ileopsoas tendon crosses hip ant and inserts on femur prominence (lesser trochanter) Innervation: ventral rami of L1 - L3 Action: flexes thigh at hip

Inferior mesenteric plexus Preganglionic sympathetic fibers in the lumbar splanchnic nerves (L1 - L2/3) synapse at ganglia around the inferior mesenteric artery. Preganglionic parasympathetic fibers from the pelvic splanchnic nerves (S2 - S4) pass through the inferior hypogastric plexus, and synapse on ganglia within the walls of the abdominal viscera. They reach their targets directly or via arteries to supply the hindgut

______________: Preganglionic sympathetic fibers in the lumbar splanchnic nerves (L1 - L2/3) synapse at ganglia around the inferior mesenteric artery. Preganglionic parasympathetic fibers from the pelvic splanchnic nerves (S2 - S4) pass through the inferior hypogastric plexus, and synapse on ganglia within the walls of the abdominal viscera. They reach their targets directly or via arteries to supply the hindgut

Appendicitis • Obstruction of appendiceal lumen leads to inflammation and/or rupture • Typically present with fever, nausea/vomiting, and periumbilical/right lower quadrant pain • Presence of calcified appendicolith (7-15%) and abdominal pain = 90% probability of acute appendicitis

______________: • Obstruction of appendiceal lumen leads to inflammation and/or rupture • Typically present with fever, nausea/vomiting, and periumbilical/right lower quadrant pain • Presence of calcified appendicolith (7-15%) and abdominal pain = 90% probability of acute appendicitis

Retroperitoneum: -anterior surface covered by visceral peritoneum (serosa) continuous with parietal peritoneum - posterior surface covered by connective tissue (adventitia) - nearly transparent parietal peritoneum covering these organs

_______________: -anterior surface covered by visceral peritoneum (serosa) continuous with parietal peritoneum - posterior surface covered by connective tissue (adventitia) - nearly transparent parietal peritoneum covering these organs

Liver: -largest gland in body (2.5% of body weight) -processes all digested materials * & venous blood from spleen & pancreas -secretes bile for emulsification of lipids (to permit transfer to lymphatics) -occupies most of RUQ & into epigastrium -displaced several inches with excursions of diaphragm during respiration (6-12 cm in mid clavicular line)

_______________: -largest gland in body (2.5% of body weight) -processes all digested materials & venous blood from spleen & pancreas -secretes bile for emulsification of lipids (to permit transfer to lymphatics) -occupies most of RUQ & into epigastrium -displaced several inches with excursions of diaphragm during respiration (6-12 cm in mid clavicular line)

Colonic intussusception A section of the bowel tunnels into an adjoining section, like a collapsible telescope Causes include: ●benign or malignant growths ● adhesions (scarlike tissue) ● surgical scars in the small bowel or colon ● motility disorders (problems with the movement of food through the digestive tract) ● long term diarrhea Mat interrupt normal blood flow and necrosis of colon

_______________: A section of the bowel tunnels into an adjoining section, like a collapsible telescope Causes include: ●benign or malignant growths ● adhesions (scarlike tissue) ● surgical scars in the small bowel or colon ● motility disorders (problems with the movement of food through the digestive tract) ● long term diarrhea Mat interrupt normal blood flow and necrosis of colon

Secondarily peritoneal: Once had mesentery (intraperitoneal) and lost in development; now plastered to post and wall covered only ant surface Ascending & descending colon, duodenum, part of the rectum, pancreas whereas Intraperitoneal include: Stomach transverse colon small intestine sigmoid colon, gallbladder and bile duct

_______________: Once had mesentery (intraperitoneal) and lost in development; now plastered to post and wall covered only ant surface Ascending & descending colon, duodenum, part of the rectum, pancreas whereas ____________ include: Stomach transverse colon small intestine sigmoid colon, gallbladder and bile duct

Superior mesenteric plexus Preganglionic sympathetic fibers in the lesser splanchnic nerve (T10 - T11) synapse at ganglia around the celiac artery. Preganglionic parasympathetic fibers in the Vagus nerve pass through the SMA plexus, and synapse on ganglia within the walls of the abdominal viscera. They reach their targets directly or via arteries

_______________: Preganglionic sympathetic fibers in the lesser splanchnic nerve (T10 - T11) synapse at ganglia around the celiac artery. Preganglionic parasympathetic fibers in the Vagus nerve pass through the SMA plexus, and synapse on ganglia within the walls of the abdominal viscera. They reach their targets directly or via arteries

Inferior hypogastric plexus: Innervates pelvic viscera including the rectum. Consists of parasympathetics from pelvic splanchnic nerves (S2 - S4) and lumbar sympathetics splanchnics that pass through hypogastric nerves from superior hypogastric plexus to supply the hindgut

________________: Innervates pelvic viscera including the rectum. Consists of parasympathetics from pelvic splanchnic nerves (S2 - S4) and lumbar sympathetics splanchnics that pass through hypogastric nerves from superior hypogastric plexus to supply the hindgut

Celiac plexus Preganglionic sympathetic fibers in the greater splanchnic nerve (T5 - T9) synapse at ganglia around the celiac artery. Preganglionic parasympathetic fibers in the Vagus nerve pass through (without synapsing in) the celiac plexus, and synapse on ganglia. They reach their targets directly or via arteries

________________: Preganglionic sympathetic fibers in the greater splanchnic nerve (T5 - T9) synapse at ganglia around the celiac artery. Preganglionic parasympathetic fibers in the Vagus nerve pass through (without synapsing in) the celiac plexus, and synapse on ganglia. They reach their targets directly or via arteries

Marginal Artery of Drummond - A series of anastamosing arcades between branches of the iliocolic, right colic, middle colic, left colic and sigmoidal arteries which provide collateral circulation between the SMA and the IMA

_________________: - A series of anastamosing arcades between branches of the iliocolic, right colic, middle colic, left colic and sigmoidal arteries which provide collateral circulation between the SMA and the IMA

hischsprung's disease: ● Congenital absence of enteric parasympathetic ganglia in distal colon →Absence of peristalsis → denervated region is tonically constricted and proximal regions become distended → Constipation, failure to pass meconium, distension of abdomen ● 1 case / 5000-7000 births

_________________: ● Congenital absence of enteric parasympathetic ganglia in distal colon →Absence of peristalsis → denervated region is tonically constricted and proximal regions become distended → Constipation, failure to pass meconium, distension of abdomen ● 1 case / 5000-7000 births

Symptoms of congenital pyloric stenosis ● Non-bilious Vomiting (projectile) ● Abdominal pain ● Dehydration ● Failure to gain weight Another cause of obstruction in the foregut - Congenital Pyloric Stenosis

_________________: ● Non-bilious Vomiting (projectile) ● Abdominal pain ● Dehydration ● Failure to gain weight

Congenital Hypertrophic Pyloric Stenosis ●Marked thickening of the pylorus ●Results in narrowing of the pyloric canal and obstruction to passage of food ●Stomach becomes markedly distended and infants expel food with nonbilious projectile vomiting ●Progressive loss of fluid, H-, Cl- leads to metabolic alkalosis and dehydration ●Can be treated surgically with pylorotomy

_____________________ ●Marked thickening of the pylorus ●Results in narrowing of the pyloric canal and obstruction to passage of food ●Stomach becomes markedly distended and infants expel food with nonbilious projectile vomiting ●Progressive loss of fluid, H-, Cl- leads to metabolic alkalosis and dehydration ●Can be treated surgically with pylorotomy

Superior Mesenteric Artery Syndrome ● Compression of the 3rd part of Duodenum by SMA ● Causes dilation of 1st, 2nd parts ● Causes bilious vomiting, (curdled milk mixed with bile), nausea ● SMA may also compress left renal vein ● May be relieved by having patient lean forward when eating

_______________________ ● Compression of the 3rd part of Duodenum by SMA ● Causes dilation of 1st, 2nd parts ● Causes bilious vomiting, (curdled milk mixed with bile), nausea ● SMA may also compress left renal vein ● May be relieved by having patient lean forward when eating

likely obstruction of paraurethral/glands of skin UTI i suppose is also possible

a 19 yo girl comes to see you with complaints of vaginal pain and swelling, you notice she localizes pain to her urethra, what is likely happening?

cisterna chyli

aortic aneurysm could compress _________ and stop lymph drainage up into Thoracic duct - edema leaks out in abd cavity

Male Perineum Superficial Perineal Space DEEP • /Perineal membrane/ • Root (bulb and crura) of penis • *Ischiocavernosus muscle • *Bulbospongiosus muscle • *Superficial transverse perineal muscle • * invested by deep perineal fascia of Gallaudet • Superficial perineal fascia (Colle's) SUPERFICIAL

are these arranged deep to superficial or vice versa? Male Perineum Superficial Perineal Space • /Perineal membrane/ • Root (bulb and crura) of penis • *Ischiocavernosus muscle • *Bulbospongiosus muscle • *Superficial transverse perineal muscle • * invested by deep perineal fascia of Gallaudet • Superficial perineal fascia (Colle's)

chronic shunting of blood via -esophageal veins -rectal veins -paraumbilical veins -retroperitoneal veins in seen in portal hypertension can lead to: -esophageal veins: esophagial varicies (main - azygous via L gastric vein and short gastric vein) -rectal veins: hemorrhoids (inferior mesenteric vein) -paraumbilical veins: caput medusa (via round ligament) -retroperitoneal veins: colonic varices (much less common than esophageal - descending colon bc retroperitoneal)

chronic shunting of blood via -esophageal veins -rectal veins -paraumbilical veins -retroperitoneal veins in seen in portal hypertension can lead to: -esophageal veins: _______ (main - azygous via L gastric vein and short gastric vein) -rectal veins: _______ (inferior mesenteric vein) -paraumbilical veins: ______ (via round ligament) -retroperitoneal veins: _______ (much less common than esophageal - descending colon bc retroperitoneal)

complications of gall stones include: -cholecystitis -jaundice -pancreatitis

complications of ______ include: -cholecystitis -jaundice -pancreatitis

female pelvis; • Female measurements longer • Bones thinner • Inlet oval and rounded; wide • Outlet larger • Pubic arch and angle wider. ♀ >80°♂ <70° • Iliac wing more flared • Ischial tuberosity more apart

does this pelvis belong to a male or female? how do you know?

male pelvis; -thicker bones -shorter oblique, transverse, and true conjugate measurements -the outlet is smaller - Pubic arc angle is less than 70 degrees iliac wing less flared and ishial tuberosities are closer together

does this pelvis belong to a male or female? how do you know?

a caudal epidural block which anestheizes subperitoneal plus somatic areas of the pudendal nerve (pudenal block only somatic) pelvic pain line - s2/4?

during child birth would you give a caudal epidural block or a pudendal nerve block?

Pelvic Floor During Childbirth: Bulbospongiosus, Levator ani may be torn (especially the pubococcygeus)

during childbirth, which two muscles will likely be torn?

labia minora and majora, clitoris and prepuce

during sexual stimulation, which external structure is engorged in blood in the female?

flexion of the cervix is movement in relation to the body of the uterus and the cervix Version is defined by the angle b/w axis of the cervix against the vagina

pelvic wall

good picture

noted

good to know

internal thoracic artery over anterior thorax - split and come down as superior epigastric and other branches that come down and stay in thoracic cavity - musculophrenic arteries Blood supply to abdominal surface - inferior phrenic and thoracic surface from musculophrenic artery

internal thoracic artery over anterior thorax - split and come down as ________ and other branches that come down and stay in thoracic cavity - musculophrenic arteries Blood supply to abdominal surface - inferior phrenic and thoracic surface from musculophrenic artery

dorsal ventral mesentary

know the difference b/w dorsal and ventral mesentaries

1: subcostal nerve (T12) 2: iliohypogastric nerve (L1) 3: ilioinguinal nerve (L1) 4: lateral cutaneous nerve (L2, L3) 5: femoral nerve (L2,3,4) 6: obturator nerve (L2,3,4) 7: lumbosacral nerve

label 1-7

posterior and anterior superior pancreatico-duodenal arteries (from the celiac trunk) - anterior and posterior inferior pancreatico-duodenal arteries (from the sma)

note the locations of the posterior and anterior superior pancreatico-duodenal arteries (from the celiac trunk) - anterior and posterior inferior pancreatico-duodenal arteries (from the sma)

lesser sac

note this picture

laying down - hepatorenal pouch (right abdomen) or rectovesical/rectouterine pouch if in the pelvis in women

recumbent means? where would blood flow if you were in a trauma and you were in this position?

reduced portal blood flow due to portal hypertension may cause shunting to: -esophageal veins -rectal veins -paraumbilical veins -retroperitoneal veins

reduced portal blood flow due to portal hypertension may cause shunting to: - - - -

some mothers have especially difficult deliveries in which the head of the baby cant pass the muscle, for this a Episiotomy: surgical incision to widen external orifice of birth canal can be perfomed

some mothers have especially difficult deliveries in which the head of the baby cant pass the muscle, for this a ________ surgical incision to widen external orifice of birth canal can be perfomed

mcburneys point; The main manifestations of peritonitis are acute abdominal pain, abdominal tenderness, and abdominal guarding, which are exacerbated by moving the peritoneum, e.g. coughing (forced cough may be used as a test), flexing one's hips. Pressure over McBurney's point in the RLQ will cause maximum pain and rebound tenderness

tenderness over this area is indicative of what?

the left hepatic artery supplies the left lobe, quadrate lobe, and 1/2 the caudate lobe the right hepatic artery supplies the right lobe, 1/2 the caudate, and the gall bladder

the _____ hepatic artery supplies the left lobe, quadrate lobe, and 1/2 the caudate lobe the ______ hepatic artery supplies the right lobe, 1/2 the caudate, and the gall bladder

the gonadal artery is a direct branch from the aorta and supplies blood to the ovary

the _______ artery is a direct branch from the aorta and supplies blood to the ovary

Right kidney is under liver while the Left kidney is relative to tail of pancreas and spleen is behind and stomach is kind of over it

the _______ kidney is under liver while the _______ kidney is relative to tail of pancreas and spleen is behind and stomach is kind of over it

the internal iliac artery (female) provides blood via uterine artery, vaginal artery, internal pudendal artery

the ________ (female) provides blood via uterine artery, vaginal artery, internal pudendal artery

the celiac trunk supplies the foregut Contains: Lower Esophagus Stomach Celiac Trunk Spleen Accessory organs of the GI system: The GI Tract Liver Gall Bladder 1st, 2nd parts of duodenum, part of pancreas

the ____________ supplies the foregut: Contains: Lower Esophagus Stomach Celiac Trunk Spleen Accessory organs of the GI system: The GI Tract Liver Gall Bladder 1st, 2nd parts of duodenum, part of pancreas

the accumulation of ascities, pus, endometriosis, etc in a female body is likely to be found in the rectouterine pouch of douglas (cul-de-sac)

the accumulation of ascities, pus, endometriosis, etc in a female body is likely to be found in the __________ (cul-de-sac)

the bladder sits in the fossa for the gallbladder in the right sagittal fissure - acts as the right boundary of the quadrate lobe

the bladder sits in the fossa for the gallbladder in the ________ fissure - acts as the right boundary of the _________ lobe

the esophageal hiatus occurs at the level of T10 - with the esophagous passes the vagus nerve

the esophageal hiatus occurs at the level of T10 - with the esophagous passes the ______ nerve

the first part of the duodenum is the superior (duodenal cap), followed by the 2nd, descending. Third is the inferior part and fourth is the ascending just prior to endering the jejunum at the duodenaljejunal flexure

the first part of the duodenum is the ______ (duodenal cap), followed by the 2nd, descending. Third is the _______ part and fourth is the ________ just prior to endering the jejunum at the ___________

the lesser sac is made up of two ligaments: - hepatogastric ligament (of lesser omentum) - hepatoduodenal ligament (of lesser omentum)

the lesser sac is made up of two ligaments: 1) 2)

the major papillae (Vater) marks the end of the foregut and the begining of the midgut

the major papillae (Vater) marks the end of the _______ (blood supply = celiac trunk) and the begining of the ______ (blood supply SMA)

the muscles of the deep perineal space control urinary flow: - external urethral sphincter - compressor urethrae - deep transverse perineal muscle -urethrovaginal sphincter - smooth muscle

the muscles of the Female _________ control urinary flow: - external urethral sphincter - compressor urethrae - deep transverse perineal muscle -urethrovaginal sphincter - smooth muscle

ischiocavernousus

the muscles of the superficial pouch in females are: -ischiocavernosus -bulbospongiosus (median raphe) -superifical transverse (perineal muscle) -perineal membrane -perineal body -anus -external sphincter

the pelvic diaphragm is made up of 2 main muscles: 1) Levator ani (3 parts): Puborectalis Pubococcygeus Iliococcygeus 2) Coccygeus (aka ischiococcygeus) and the urogenital diaphragm - Connective tissue

the pelvic diaphragm is made up of 2 main muscles: 1) 2) and the urogenital diaphragm - Connective tissue

ischioanal fossae

the rectum is suspended by fat on both sides

the sphincter of oddi/major duodenal papilla (Vater) is where the the main pancreatic duct (wirsung) and the common bile duct join and enter the duodenum - entering the small intestine is under control of CCK

the sphincter of oddi/__________ (Vater) is where the the ___________ (wirsung) and the common bile duct join and enter the duodenum - entering the small intestine is under control of ______

pheochromocytoma

tumor of the chromaffin cells of adrenal medulla is called __________

upper kidneys are deep to the ribs, but the lower are exposed - vulnerable to blunt trauma

Venous supply* to liver (75% of inflow via "portal" vein)

venous supply to liver (note all are valveless) acounts for 75% of liver inflow - splenic vein - superior and inferior mesenteric vein - hepatic portal vein

walls of the pelvic cavity - • Lateral: - Obturator internus muscles

walls of the pelvic cavity - • _________: - Obturator internus muscles

walls of the pelvic cavity - • Anterior: - Pubis bone and pubic symphysis

walls of the pelvic cavity - • __________: - Pubis bone and pubic symphysis

walls of the pelvic cavity: • Inferior: - Pelvic floor

walls of the pelvic cavity: • ________: - Pelvic floor

walls of the pelvic cavity: • Posterior: - Piriformis muscles

walls of the pelvic cavity: • _________: - Piriformis muscles

ruggae

what are the red arrows pointing to?

perineal body - Central point of perineum; attachment of the perineal muscles.

what area is this called? what does it mark?

left colic artery

what aretery is the arrow pointing to?

proper hepatic artery - foregut

what artery is labeled?

splenic artery - foregut

what artery is the arrow pointing to?

middle colic artery - branches off the superior mesenteric artery

what artery is the blue arrow pointing to? what is it branching off from?

the internal pudendal artery is the main supply of the perineum

what artery is the main supply of the perineum?

common hepatic artery - foregut

what artery is this?

gastroduodenal artery - foregut

what artery is this?

left gastric artery - foregut

what artery is this?

right gastric artery - foregut

what artery is this?

left gastroepiploic artery - foregut, the right is the same artery on the opposite side of the stomach near the duodenum

what artery is this? be specific

Median sacral a comes off bifurcation of aorta into right and left common iliac arteries (L4); Comes off lower lumbar vertebrae into pelvis along sacrum, anastamoses with internal iliac a branches

what artery is this? where does it go?

caput medusae of periumbilical veisn due to portal hypertension. Note: if there are dilations to lateral abdomen = thoraco-epigastric veins (TE) and around the nipple are due to = lateral thoracic veins (LT)

what condition is this? what is it idicitive of? what vessels are making these specifically?

Branches of the Abdominal Aorta Inferior phrenic aa. (2) Celiac trunk Middle suprarenal aa. (2) Lumbar aa. (4) Superior Mesenteric a. Renal aa. (2) Testicular/Ovarian aa. (2) Inferior mesenteric a. Median sacral a. Common iliac aa. (2)

what do all these arteries have in common? Inferior phrenic aa. (2) Celiac trunk Middle suprarenal aa. (2) Lumbar aa. (4) Superior Mesenteric a. Renal aa. (2) Testicular/Ovarian aa. (2) Inferior mesenteric a. Median sacral a. Common iliac aa. (2)

hepatopancreatic ampulla

what is A indicating? where all the secretions build up - CCK allows it to open up (Not the sphincter of oddi nor major papillae)

iliocolic artery directly above: right colic artery, above that: the middle colic artery

what is above it?

Gerota's fascia = renal fascia separates kidney from outer space (pararenal space) Perirenal space- bw kidney and renal fascia is this space filled with fat

what is another name for Gerota's fascia

hepatorenal recess = pouch of morison b/w liver and right kidney its it the lowest part of the abdomen when laying flat - most likely to find fluid here if there is abdominal pathology/trauma (blood)

what is another name for this area? What is its significance?

extravasation of urine - b/w scarpa's fascia and the abdominal aponeurosis

what is condition called? where is the urine?

cardiac notctch - note the phrenicoesophageal ligament is just above where this starts at the crossing of the diaphragm

what is highlighted in red?

right crus of the diaphragm

what is labeled by 13?

vesical venous plexus - part of the urogenital diaphragm - controls out put

what is labeled by H? what is its function?

pectinate line

what is labeled by four?

Superior Mesenteric Artery Syndrome ● Compression of the 3rd part of Duodenum by SMA ● Causes dilation of 1st, 2nd parts ● Causes vomiting, nausea ● SMA may also compress left renal vein (Nutcracker Syndrome) ● May be relieved by having patient lean forward when eating SMA crosses over left renal vein SMA syndrome (SMA over third part of duod causing distention of first and second parts of duod) SMA can also compress of left renal vein Directly under SMA and anteior to aorta

what is superior mesenteric artery syndrome?

unicate process pancreas *projects posterior to the superior mesenteric vein (& sometimes superior mesenteric artery)

what is the arrow pointing to? *projects posterior to the superior mesenteric vein (& sometimes superior mesenteric artery)

epiploic foramen/foramen of winslow - it is an opening to the lesser sac (omental bursa), going behind the lesser omentum (both hepatogastric and hepatoduodenal ligaments) *only place you can enter the lesser sac

what is the arrow pointing to? what happens here?

true (lesser) in blue, false (greater) pelvis in red

what is the difference of regions b/w red and blue?

renal fascia

what is the highlighted area?

parauretral (skene's glands) - homologs of the male prostate -lubrication but can become infected which is very painful (?G spot nerves?)

what is the purpose of parauretral (skene's glands)?

transverse cervical ligament (cardinal Macenrodt's) - ancors the uterus Supportive Ligaments of the Uterus

what is the purpose of this ligament?

rectovesical fossa - lower point in the male pelvis = accumulation of pus, fluids, blood, etc.

what is this area called? what is its' significance?

porta hepatis ("doorway to the liver")

what is this area? note the proximity to the portal triad

this is the puborectalis "sling" - formed by the puborectalis wrapping around the rectum "Sling" around the anorectal junction, maintains the anorectal/perineal flexure need to think about this to relax and allow passage of feces

what is this called? what muscle forms it? Hint: there is an anorectal angle formed that is around 80 degrees

varicocele - valves of the veins are compromised therefore there is no exchange resulting in warmer blood - spermatogeneisis issue

what is this condition called? what is the pathology? what are you concerned for?

fascia of Gallaudet = deep perineal fascia

what is this layer called? Note the location of colles fascia

Mesometrium: over uterus

what is this ligament called? note that is a part of the broad ligament

mesosalpinx: over uterine tube

what is this ligament called? note that is a part of the broad ligament

mesovarium: over ovary

what is this ligament called? note that is a part of the broad ligament

paracolic gutter

what is this space?

ductus deferens - typically covered with the spermatic cord 1/4 of the way down - surrounds the testes

what is this structure called? is it typically exposed like this anatomically?

falciform ligament

what is this structure?

ligament of treitz it connects the duodenum and the jejeunum (jejeunum is a mobile structure)

what is this structure?

Ligamentum teres = obliterated umbilical vein passing in lower free edge of falciform ligament

what is this structure? what was it in fetal life?

inferior phrenic artery - off the aorta - above the celiac trunk

what is this?

L3 cross section abdominal cavity lined with pareital peritoneum - inside with intraperotoneal organs red = peritoneal cavity inside parietal peritoneum blue = retroperitoneal cavity

what level is this? what is inside the red border? and the blue?

pubovesical ligament Supportive Ligaments of the Uterus

what ligament is this?

uterosacral ligament Supportive Ligaments of the Uterus

what ligament is this?

round ligament of the uterus gives support but most from the cardinal ligament

what ligament is this? Hint: cord thru the inguinal canal to the labia majora - pulls the ovary

ischiocavernosus muscle - bulbosponguiosus muscle - help males keep an erection

what muscle is this? what about the one surrounding the penile shaft? what do they do?

lower esophageal sphincter - lower diaphragm and inner muscle

what occurs here? what is it made of?

Renal functions: ●Removal of waste products and excess H2O from blood ●Excretion of metabolic waste products in urine ●Regulation of ion concentration (Na+, K+ , H+ etc.) ●Regulation of acid-base balance ●Regulation of blood pressure (renin) ●Regulation of red blood cell production (erythropoeitin) ●Vitamin D metabolism

what organ performs these tasks? ●Regulation of acid-base balance ●Regulation of blood pressure (renin) ●Regulation of red blood cell production (erythropoeitin) ●Vitamin D metabolism

portal lymphadenopathy - huge nodes with lymphadenitis

what pathology is this?

Pouch of Douglas = rectovesical (retrouterine) pouch - lowest part of the body in the pelvis in women

what space is this?

haustra - pocketlike sacs caused by tone of teniae coli Colon has sacculations called haustra as teniae coli are shorter than the colonic wall

what structure is circled?

epiploic appendicies - fal filled pouches of visceral peritoneum

what structure is the blue arrow pointing to?

small intestine mesentary

what structure is this?

teniae coli - three bands of longitudinal smooth muscle in its muscularis

what structure is this?

intravenous pyelogram

what type of imaging is this?

Hiatal hernias sliding hernia - unable to use the diaphragm to close anymore - Common in patients with GERD (R. crus is weakened, allowing herniation, reflux) Paraesophageal hernia - does not change the sphincter muscle but can become necrotic - Uncommon. Normal Z-line and cardia; herniation of fundus; warrants concern since herniated portion may become strangulated

which of these is more common? what kinds of patients get the sliding hernia? whats the concern of the paraesophaheal hernia?

The kidneys begin to develop in the pelvis and "ascend" to their adult position in the upper lumbar region. As they ascend, they acquire renal arteries and normally shed lower ones. However, some of these early- developing arteries may persist as an "accessory renal artery"

why is there an extra artery? what is it called? is it pathologic?

iscial tuberosity

you are sitting down and the chair breaks below you, you fall directly down onto the ground in exact sitting position - what bone could be broken?

I would expect not to see any dye coming out of the ends of the fallopian tubes - suggestive of ahesions which may cause infertility

you have a 27 yo married patient come in who has been trying to have children but has not been successful on any medications, and her husband has been checked. What do you expect if you inject dye into her uterus? why?

Nutcracker syndrome - left renal vein (nut) and SMA/aorta (cracker) Block blood flow from right kidney compromises function of left kideny Left gonadal/testicular v or l ovarian empties to left renal vein and left adrenal gland Venous drainage from these would also be affected with nutcracker syndeome Edema around left testis or ovary results

you have a patient who comes in complaining of testicular/ovarian swelling, and pain down left flank and left gonad. You notice on exam a distended left gonadal vein. What is likely the pathology?

hyster- = uterus

your patient underwent a hysterectomy, what was removed?

oophoro- = ovary

your patient underwent a oophoroectomy, what was removed?

salpingo- = oviduct

your patient underwent a salpingoectomy, what was removed?

• Cecum is a small sac (blind pouch) at lower end of ascending colon • Valve prevents a back up of fecal matter to ileum • Appendix-Lymph tissue neutralizes bacteria

Colon • Has larger diameter (usually) • Is about 5 feet in length • Extends from ileocecal junction to upper part of anal canal • Most material has been digested by the time it reaches Large Intestine • 12-24 hours in large bowel Transverse colon • Performs some absorption, especially water, electrolytes and vitamin K Descending colon • Its major function is propulsion of fecal material toward the anus • Though essential for comfort, the colon is not essential for life • Components - Ascending colon - Transverse colon - Descending colon - Sigmoid to rectum and anus

• Has larger diameter (usually) • Is about 5 feet in length • Extends from ileocecal junction to upper part of anal canal • Most material has been digested by the time it reaches Large Intestine • 12-24 hours in large bowel Transverse colon • Performs some absorption, especially water, electrolytes and vitamin K Descending colon • Its major function is propulsion of fecal material toward the anus • Though essential for comfort, the colon is not essential for life • Components - Ascending colon - Transverse colon - Descending colon - Sigmoid to rectum and anus

• Pelvic Inlet (Open) - Pelvic brim - Sacral promontory to superior margin of pubic symphysis - True pelvis below • Pelvic Outlet (Closed) - Inferior margin of pubic symphysis to tip of coccyx - Closed by pelvic diaphragm and urogenital diaphragm.

• Pelvic _____ (Open) - Pelvic brim - Sacral promontory to superior margin of pubic symphysis - True pelvis below • Pelvic ____ (Closed) - Inferior margin of pubic symphysis to tip of coccyx - Closed by pelvic diaphragm and urogenital diaphragm.

• Prostate,Seminal Vesicles, Bulbourethral Glands - Accessory sex glands, secretions contribute to the semen • Penis - Copulatory organ - Passage for sperms - Passage for urine

• _______ Glands (3) - Accessory sex glands, secretions contribute to the semen • ________: - Copulatory organ - Passage for sperms - Passage for urine

• BroadLigament: - 2 layers of peritoneum, ant, & post. aspects of uterus draped over each other. - Mesosalpinx: over uterine tube - Mesovarium: over ovary -Mesometrium: over uterus

• ________: - 2 layers of peritoneum, ant, & post. aspects of uterus draped over each other. - Mesosalpinx: over uterine tube - Mesovarium: over ovary -Mesometrium: over uterus

• Ovary - Production of gametes (eggs) - Production of female hormones • Uterine Tube - Transport of gametes - Site of fertilization - Transport of zygote to uterus

• ________: - Production of gametes (eggs) - Production of female hormones • _________: - Transport of gametes - Site of fertilization - Transport of zygote to uterus

• Testis - Production of male gametes (sperms) - Production of male hormones • Epididymis - Maturation of sperms • Ductus Deferens - Transportation of sperms

• ________: - Production of male gametes (sperms) - Production of male hormones • _________: - Maturation of sperms • __________: - Transportation of sperms

• Uterus - Site of implantation & fetal development -Menstrual bleeding • Vagina - Copulatory organ - Birth canal

• ________: - Site of implantation & fetal development -Menstrual bleeding • _________: - Copulatory organ - Birth canal

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