Planes of the Abdomen



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Anatomy – Whole Block Review
Planes of the Abdomen


  • To divide the abdomen into 4 quadrants, what two planes are used?

  • What are the four quadrants called?

    • Right Upper Quadrant (RUQ)

    • Left Upper Quadrant (LUQ)

    • Right Lower Quadrant (RLQ)

    • Left Lower Quadrant (LLQ)

  • To divide the abdomen into 9 areas, what three planes are used?

    • Transpyloric Plane

    • Transtubercular Plane

    • Medial Plane

  • What are the 9 Areas called?

    • Right Hypochondriac, Epigastric, Left Hypochondriac

    • Right Lumbar, Umbilicus, Left Lumbar

    • Right Inguinal, Hypogastric, Left Inguinal

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Anterior Abdominal Wall


  • What are the three muscles of the Anterior Abdominal Wall?

    • External Oblique

    • Internal Oblique

    • Transversus Abdominus

  • What way do the fibers run for the three muscles of the Anterior Abdominal Wall?

    • External Oblique – Hands in pockets – Inferior/Medial

    • Internal Oblique – Hands on tits – Superior/Medial

    • Transversus Abdominus – Transverse/Horizontal

  • What muscles’ aponeurosis forms the Inguinal Canal?

    • External Oblique

  • How are the muscles of the Anterior Abdominal Wall functioning?

    • They are muscles of forced expiration.

  • What is the Conjoint tendon formed from? What is the clinical significance?

    • It is formed from the Internal Oblique and the Transversus Abdominis.

    • It can protect from Direct Inguinal Hernias.

  • What structures go through the Inguinal Canal?

    • Ilioinguinal Nerve

    • Spermatic Cord (Males)

    • Round Ligament of Uterus (Females)

  • What are the Rectus Abdominis muscles sectioned by?

  • What are the layers of tissue starting with the skin and ending before the muscles?

    • Camper’s Fascia – fatty

    • Scarpas Fascia – membranous

    • Transversalis Fascia

    • Peritoneum

  • What do the fascia layers become?

    • T: Transversalis Fascia  I: Internal Spermatic Fascia

    • I: Internal Oblique Fascia  C: Cremasteric Fascia

    • E: External Oblique Fascia  E: External Spermatic Fascia

  • What does the Peritoneum become?

    • Tunica Vaginalis

  • What does the Scarpa’s Fascia become?

    • Colle’s Fascia

    • Darto’s Fascia

  • What is the Linea Alba?

    • The fibrous band that extends in the mid-line of the body, where the aponeurosis of the muscles insert

  • What is the Linea Semilunaris?

    • Two lines (one on each side) lateral to the Rectus Abdominis, where the aponeuroses also fuse.

  • How are the fascia organized above and below the Arcuate Line?

    • ABOVE:

      • External Oblique

      • ½ Internal Oblique

      • Rectus Muscle

      • ½ Internal Oblique

      • Transversus Abdominis

      • Transversalis Fascia

      • Peritoneum

    • BELOW:

      • External Oblique

      • Internal Oblique

      • Transversus Abdominis

      • Rectus Muscle

      • Transversalis Fascia

      • Peritoneum

  • Two arteries in the Anterior Abdominal Wall anastomose. What are these arteries, and where do they come from?

    • Superior Epigastric Artery (from Internal Thoracic  Subclavian  Aorta)

    • Inferior Epigastric Artery (External Iliac  Common Iliac  Aorta)

  • What are the nerves that are located in the Anterior Abdominal Wall?

    • T7-T8-T9-T10-T11

    • T12 – Subcostal

    • L1 – Iliohypogastric & Ilioinguinal

    • Genitofemoral Nerve (L1-L2)




Muscle

Origin

Insertion

Nerve

External Oblique

Ribs 5-12

Linea Alba, Iliac Crest, Pubic Tubercle

T7-T12

Internal Oblique

Iliac Crest, Inguinal Ligament

Linea Alba, Pubic Crest

T7-T12

L1


Transversus Abdominis

Iliac Crest, Inguinal Ligament

Linea Alba, Pubic Crest

T7-T12

L1


Rectus Abdominis

Pubic Crest

Xiphoid Process

T7-T12


Peritoneal Landmarks:


  • What does the Median Umbilical Fold come from?

    • Urachus

  • What does the Medial Umbilical Fold come from?

    • Umbilical Artery

  • What does the Lateral Umbilical Fold come from?

    • Inferior Epigastric Artery and Vein

  • What does the Ligamentum Teres (of the Falciform Ligament) come from?

    • Umbilical Vein



Dermatomes:


  • What are the names of the following dermatomes?

    • T7 – Xiphoid Process

    • T10 – Umbilicus

    • T12 – Suprapubic Region

    • L1 – Upper Medial Thigh and Genitalia

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Retroperitoneal Organs:


  • What does retroperitoneal mean?

    • The organ lies on the Posterior Abdominal Wall, and is only covered with peritoneum on the anterior surface.

  • What does intraperitoneal mean?

    • The organ lies directly inside of the abdominal cavity, and is suspended by mesentery.

  • Which organs are Retroperitoneal?

    • S: Suprarenal Gland

    • A: Aorta (IVC)

    • D: Duodenum (2nd and 3rd)

    • P: Pancreas (not the tail!)

    • U: Ureters

    • C: Colon (Ascending and Descending)

    • K: Kidneys

    • E: Esophagus

    • R: Rectum

  • There are 5 major peritoneal folds. What are they?

    • Greater Omentum

    • Lesser Omentum

    • Mesentery

    • Falciform Ligament

    • Mesocolon

  • The Greater Omentum divides into the Supracolic and the Infracolic. Where are these divisions?

    • Supracolic – above the transverse colon

    • Infracolic – below the transverse colon

  • What two ligaments make up the Lesser Omentum?

    • Hepatoduodenal Ligament

    • Gastrohepatic Ligament



Kidneys


  • Discuss the path of urine from the arteries to the ureter.

    • Renal Artery  Segmental Artery  Interlobar Artery  Arcuate Artery  Interlobular Artery  Radiate Artery  Capsular Artery  Glomerulus  Proximal Convoluted Tubule  Loop of Henle  Distal Convoluted Tubule  Collecting Duct  Papilla  Minor Calyxes  Major Calyxes  Renal Pelvis  Ureter

  • What is another name for the Adrenal Gland?

    • Suprarenal Gland

  • The Suprarenal Gland has three different blood supplies. What are they, and what do they originate from?

    • Superior Suprarenal Artery  Inferior Phrenic Artery

    • Middle Suprarenal Artery  Aorta

    • Inferior Suprarenal Artery  Rental Artery

  • What is the Renal Fascia a continuation of?

    • Transversalis Fascia

  • Which kidney is lower and why?

    • The right kidney is lower because the liver is in the way on the right side.

  • The ureters run from the kidneys to the bladder. How does it run in relation to the Psoas Muscle? What vessel does it cross over?

    • Media to Psoas Muscle

    • Crosses over Common Iliac Vessels



The Pancreas:


  • What are the alternate names for the Main Duct and the Accessory Duct of the Pancreas?

    • Main Duct – Wirsung Duct

    • Accessory Duct – Duct of Santorini

  • Where do the Main Duct and the Accessory Duct drain into before going to the Duodenum?

    • Main Duct – Major Papilla

    • Accessory Duct – Minor Papilla

  • What is the “hole” called in the duodenum where the contents from the Main Pancreatic Duct pour through?

    • Ampulla of Vater

  • What is the sphincter called at the site of pancreatic (and biliary) drainage into the duodenum?

    • Sphincter of Oddi

  • What is the landmark that separates the Foregut and the Midgut in the Pancreas?

    • The Sphincter of Oddi



Posterior Abdominal Wall:


  • What are the four muscles that make up the Posterior Abdominal Wall?

    • Psoas Major

    • Psoas Minor

    • Iliacus

    • Quadratus Lumborum

  • Two of these muscles that make up the Posterior Abdominal Wall come together in the upper thigh to function as a major hip flexor. What are these two muscles?

    • Psoas Major

    • Iliacus

    • Become Iliopsoas

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Lymphatic Drainage:


  • If the drainage is occurring above the umbilicus, what lymph nodes drain it?

    • Axillary Lymph Nodes

  • If the drainage is occurring below the umbilicus, what lymph nodes drain it?

  • The Inferior Mesenteric, Superior Mesenteric, and Co-Iliac Nodes are all connected to drain into one location. What is this location? What main duct does it drain into?

    • Cysterna Chyli  Thoracic Duct

  • Where does the Thoracic Duct drain?

    • Into the junction of the Left Subclavian and Left Internal Jugular Veins



The Gut





Foregut

Midgut

Hindgut

Description

Mouth  2nd Part of Duodenum

2nd Part of Duodenum  2/3 of Transverse Colon

1/3 of Transverse Colon  Rectum

Arterial Supply

Celiac Trunk

Right Colic/Middle Colic (SMA)

Left Colic (IMA)

Sympathetic Nerves

(PAIN)

Pre: Greater Splanchnic (T5-T9)

Post: Celiac Ganglion



Pre: Lesser Splancnic (T11-T12)

Post: Superior Mesenteric Ganglion



Pre: Lumbar Splanchnic (L1-L2)

Post: Inferior Mesenteric Ganglion



Referred Pain

Epigastrium

DRG: T5-T9



Umbilical

DRG: T10-T11



Hypogastrium

DRG: L1-L2



Parasympathetic Nerve

(REFLEX GUT)

Vagus

Vagus

Pelvic Splanchnic

S2-S4





  • What are the 4 main layers of the wall of the GI Tract?

    • Serosa

    • Muscularis

    • Submucosa

    • Mucosa

  • At what level does the Esophagus pierce the diaphragm?

    • T10

  • There are 4 main parts to the stomach – what are they?

    • The Cardia

    • The Fundus

    • The Body

    • The Pylorus

  • How many parts make up the duodenum?

    • 4

  • Which part of the duodenum is where the Accessory Pancreatic Duct and the Bile Duct enter?

    • 2nd Part

  • Which part of the duodenum is constricted in SMA Syndrome?

    • 3rd Part

  • The duodenum makes a C-shape. What (specific part) organ sits in this area?

    • The Head and Uncinate Process of the Pancreas

  • How much of the small intestine is made up by the Jejunum and the Ileum?

    • Jejunum: 2/5

    • Ileum: 3/5

  • What is the difference in the vascularization of the Jejunum vs Ileum?

    • Jejunum: Long Vasa Recta, Few Arcades

    • Ileum: Short Vasa Recta, Many Arcades

  • Starting with the Ileocecal Junction and ending at the Rectum, what is the order of the Large Intestine?

    • Cecum (with Appendix)  Ascending Colon  Hepatic Flexure  Transverse Colon  Splenic Flexure  Ascending Colon  Sigmoid Colon  Rectum

  • There are three distinguishing features on the Large Intestine – what are they?

    • Epiploic Appendages – fatty tags

    • Haustrae Coli – segmented walls

    • Taenia Libera – ribbons of smooth muscle

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Gallbladder


  • What does the Gallbladder do?

    • Stores bile

  • When a Gall Stone is passed through the Common Bile Duct, what is its path?

    • Cystic Duct  Bile Duct  Major Papilla  Ampulla of Vater  2nd Part of the Duodenum  Small Intestines  Ileocecal Junction (usually lodges)

  • When a Gall Stone breaks through the body of the Gall Bladder, what is its path?

    • 2nd Part of the Duodenum  Small Intestines  Ileocecal Junction (usually lodges)

  • When a Gall Stone breaks through the Fundus of the Gall Bladder, what is its path?

    • Transverse Colon  Passed via Feces

  • What artery supplies the Gall Bladder?

    • Cystic Artery

  • What is Hartmann’s Pouch?

    • A pouch by the neck of the Gallbladder where stones could possibly lodge, causing no problems in the patient. (It would go undetected)

  • What duct combines with the Cystic Duct to form the Bile Duct?

    • Hepatic Duct



Nerves
Lumbar Plexus





Root

Function

Innervation

Clinical Correlate

Iliohypogastric

L1

Sensory

Skin above pubis

----

Ilioinguinal

L1

Sensory

Skin of Penis

Through inguinal canal (hernias)

Genitofemoral

L1/L2

Both

Scrotal Sac/ Upper Anterior Thigh

Cremasteric Reflex

Lateral Femoral Cutaneous

L2/L3

Sensory

Lateral Thigh

Calvin Klein Syndrome (Meralgia Paresthetica)

Femoral

L2/L3/L4

Both

Anterior Thigh

Does not go through Femoral Sheath

Obturator

L2/L3/L4

Both

Medial Thigh

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  • Where does the Femoral Nerve, and the Ilioinguinal Nerve run in relation to the Inguinal Canal?

  • In the Anterior Abdominal Wall, everything is innervated by T6-T12, what two muscles do most of these nerves lie in between?

    • Internal Oblique and Transversus Abdominis.


Cremasteric Muscle & Reflex


  • What is the Cremasteric Reflex?

    • It pulls the testicles upwards and into the body.

  • What is the significance of the reflex?

    • It protects the testicles

    • It regulates external temperature changes

    • It moves them out of the way during intercourse.

  • What nerve is involved in this reflex?

    • Genitofemoral

  • What branches of the Lumbar Plexus are the roots of the Genitofemoral Nerve?

    • L1/L2

  • What are the two branches of the Gentiofemoral Nerve? Are they motor or sensory?

    • Genital – Motor

    • Femoral – Sensory



Arteries


  • At what level does the Aorta pierce the diaphragm?

    • T12

  • What are the three branches of the Celiac Trunk? What does the Celiac Trunk come off of?

    • Branches:

      • Left Gastric Artery

      • Splenic Artery

      • Common Hepatic Artery

    • Comes off of the Aorta

  • What ligament does the Splenic Artery run through?

    • Spleno-Renal Ligament

  • What ligament does the Right and Left Gastric Arteries run through?

    • Gastrohepatic Ligament

  • What ligament does the Right and Left Gastroepiploic Arteries run through?

    • Gastrosplenic Ligament

  • What is the branch off of the Left Gastric Artery?

    • Esophageal Artery

  • What are the branches off of the Splenic Artery?

  • What are the branches off of the Common Hepatic Artery?

    • Proper Hepatic Artery  L&R Hepatic Arteries and Cystic Artery

    • Right Gastric Artery

    • Gastroduodenal Artery

  • What are the Branches off of the Gastroduodenal Artery?

    • Right Gastroepiploic Artery

    • Superior Pancreaticoduodenal Artery (Anterior and Posterior)

  • What are the branches of the Superior Mesenteric Artery (SMA)? – Include sub-branches

    • Middle Colic Artery (Ascending and Descending)

    • Right Colic Artery (Ascending and Descending)

    • Ileocolic Artery (Iliocecal and Appendicular Branches)

    • Inferior Pancreaticoduodenal Artery

    • ** Also includes arteries going directly to the Jejunum and Ileum **

  • What are the braches of the Inferior Mesenteric Artery (IMA)?

    • Left Colic Artery

    • Sigmoidal Artery

    • Superior Rectal Artery

  • What are the braches of the Internal Iliac Artery? (Posterior and Anterior)

    • Anterior:

      • Umbilical Artery

      • Obturator

      • Uterine/Ductus Deferens

      • Vaginal/Inferior Vesicle

      • Middle Rectal

      • Inferior Gluteal

      • Interal Pudendal

    • Posterior:

      • Iliolumbar

      • Lateral Sacral

      • Superior Gluteal


ARTERIES OF THE ILIAC VESSELS


  • What two Iliac Vessels branch from the Abdominal Aorta?

    • Left Common Iliac

    • Right Common Iliac

  • The Right Common Iliac further branches into two. What are these two branches?

    • External Iliac

    • Internal Iliac

  • The External Iliac gives off two branches before becoming the Femoral Artery. What are these two branches?

    • Deep Circumflex

    • Inferior Epigastric

  • What landmark causes the External Iliac to turn into the Femoral?

    • Inguinal Ligament

  • What does the Deep Circumflex Artery supply?

    • Iliac Crest

  • What is special about the Inferior Epigastric Artery?

  • The Internal Iliac further divides into two more branches. What are these?

    • Anterior Division

    • Posterior Division

  • What are the three branches of the Posterior Division?

    • Iliolumbar

    • Lateral Sacral

    • Superior Gluteal

  • The Iliolumbar further divides into two branches. What are these branches, and what do they supply?

    • Iliac Branch  Iliacus Muscle

    • Lumbar Branch  Psoas Major and Quadratus Lumborum Muscles

  • What does the Lateral Sacral branch supply?

    • Piriformis Muscle

    • Sacral Canal

  • What does the Superior Gluteal Branch supply?

    • Gluteus Maximus

  • The Anterior Division of the Internal Iliac gives off two branches before the special branch that is different between males and females. What are these two branches? Where do they supply?

    • Umbilical  Becomes Medial Fold (not functioning)

    • Obturator  Medial Thigh

  • The Anterior Division of the Internal Iliac has a special branch that is different in males and females. What is the name of this branch in both sexes?

    • Males – Inferior Vesical

    • Females – Utero/Vaginal Trunk

  • What three (or possibly 4) branches does the Superior Vesical give off? Where does the Superior Vesical Artery go?

    • Artery to the Seminal Vesicles

    • Artery to the Ductus Deferens

    • Artery to the Prostate

    • Superior Vesical Artery  Bladder

  • In females, the Utero/Vaginal Artery splits into two. What are these branches? What is unique about them?

    • Uterine

    • Vaginal

    • THEY ANASTOMOSE

  • The Vaginal Artery splits into two (or three) branches. What are these? What do they supply?

    • Vaginal  Vagina

    • Interior Vesical  Bladder

    • Middle Rectal  Rectal Canal

  • After the special M/F Artery is given off of the Anterior Division of the Internal Iliac, the Anterior Division splits and turns into two new arteries. What are these? Where do they go?

    • Internal Pudendal  Inferior Rectal, Sex Organs

    • Inferior Gluteal  Gluteus Minimus, Gluteus Medius




Spermatic Cord


  • What is included in the Spermatic Cord?

    • FANS+1

      • F: Fascial Layers

        • External Spermatic

        • Cremasteric

        • Internal Spermatic

      • A: Arteries

        • Cremasteric Artery

        • Artery to Vas Deferens

        • Testicular Artery

      • N: Nerves

        • Genital Branch of Geniofemoral Nerve

        • Sympathetics

        • Ilioinguinal Nerve

      • S: Structures

        • Pampiniform Plexus

        • Vas Deferens

        • Lymphatics

      • +1

        • Processus Vaginalis



Osteology


  • What three bones form the Acetabulum?

    • Ilium

    • Pubis

    • Ischium

  • Which is the largest bone of the hip?

    • Ilium

  • What are the wings of the Ilium called?

    • Ala

  • What muscle attaches to the iliac fossa of the ilium?

    • Iliacus

  • What is the name of the joint that connects the two pubic bones?

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The Liver


  • What is the portal hepatitis?

    • The entry point of the portal triad into the liver

  • What is the portal triad?

    • The Hepatic Proper Artery

    • The Hepatic Portal Vein

    • The Bile Duct

  • What are the FUNCTIONAL lobes of the liver divided by?

    • The IVC (posteriorly)

    • The Gall Bladder (inferiorly)

  • The functional lobes can actually be further broke down, so that one branch of the Portal Triad goes to each. How many lobes are there?

    • 8

  • There are two further lobes, which exist just to the left of the Right Lobe. What are these lobes, and what main lobe do they belong to (functionally)?

    • Caudate Lobe (posterior) and is functionally independent

    • Quadrate Lobe (anterior) and is functionally part of the left lobe.

  • What are the STRUCTURAL lobes of the liver divided by?

    • The Falciform Ligament

  • Where is the Bare Area?

    • The area where the liver is continuous with the diaphragm. It has not peritoneum.

  • Because the peritoneum does not unite at the bare area, two recesses are formed. What are they?

    • Subphrenic Recess

    • Hepatorenal Recess (right kidney)

  • What part of the liver has the most Islets of Langerhans?

    • The tail.

  • There is an important pouch located around the liver. What is this pouch and what is the significance?

    • The Hepatorenal Pouch (Morrison’s Pouch)

    • Located between the liver and the kidneys.

    • Abdominal infection can gather here when the person is lying down.



The Pelvic Diaphragm


  • What are the three Levator Ani muscles?

    • Puborectalis

    • Pubococcygeus

    • Iliococcygeous

  • What is the additional muscle of the Pelvic Diaphragm that is NOT a Levator Ani muscle?

    • Coccygeus

The Bladder/Urethra


  • There are 4 sections to the male urethra. What are they?

    • Prostatic Urethra

    • Membranous Urethra

    • Bulbous Urethra

    • Spongy Urethra

  • Who has the loner urethra? Males or females?

    • Males

  • How many sphincters do both males and females have?

    • Both have 2

  • What is a Trigone?

    • A small, triangular region of the internal bladder formed by the ureteral orifices. It senses the expansion of the bladder and sends the signal to the brain so you know when you have to empty it.

  • What is the muscle of the bladder?

    • Detrusor



Male Reproductive System


  • What is the sperms path from the testes?

    • Semiiniferious Tubules  Epididymis  Vas Deferens  Ejaculatory Duct  Prostatic Urethra  Glans Penis  Exit

  • What is the order of nerves, arteries, and veins in the penis?

    • Nerve Artery Vein Artery Nerve

  • How do Sympathetics and Parasympathetics work together in the penis?

    • Point and Shoot

      • Parasympathetics cause erection

      • Sympathetics cause ejaculation

  • What muscle keeps the penis erect?

    • Ischiocavernous Muscle

  • What muscle causes ejaculation?

    • Bulbospongiosus Muscle

  • What are Hypospadia and Epispadia? What is the difference?

    • Hypospadia – condition where the Urethra opens on the ventral side of the penis, instead of in the glans like normal.

    • Epispadia – condition where the Urethra opens on the dorsal side of the penis, instead of in the glans like normal.

  • What is the Perineal Body in the male?

    • The location between the Bulb of the Penis and the Anus

  • If the Perineal Body is damaged, what can occur?

    • Prolapse of the Rectum or the Bladder

  • What are the serous glands in the Male called? What Perineal Pouch are they located in?

    • Bulbourethal Glands (Cowper’s Glands)

    • Deep Perineal Pouch

  • What is Cryptochidism?

    • Failure of the testes to descend

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Female Reproductive System


  • What is the Perineal Body in the female?

    • The location between the Vagina and the Anus

  • If the Perineal Body is damaged, what can occur?

    • Prolapse of the Rectum, Uterus, or Bladder

  • What are the serous glands in the Female called? What Perineal Pouch are they located in?

    • Bartholin’s Glands

    • Superficial Perineal Pouch

  • What pouch is located between the Rectum and the Uterus?

    • Rectouterine Pouch – Pouch of Douglass

  • What is the pouch located between the Uterus and the Bladder?

    • Vesicouterine Pouch – Pouch of Dunn

  • How do you drain the Pouch of Douglass?

    • Through the Posterior Fornix of the Vagina

  • What is the procedure called when you go through the Posterior Fornix of the Vagina?

    • Culdocentesis

  • What are the four parts of the Fallopian Tube?

    • Infundibulum

    • Ampulla

    • Isthmus

    • Uterine Part

  • What parts of the Fallopian Tube do most ectopic pregnancies occur?

    • Ampulla

  • When doing a Hysterectomy, there are two arteries that you must be aware of. What are they, and where do they come from?

    • Uterine Artery from Internal Iliac Artery

    • Ovarian Artery from the Aorta

    • BOTH have to be clamped to prevent bleeding.

  • What do we call the normal position of the Uterus?

    • Anteverted and Anteflexed

  • What are the three structures that come off of the Fundus of the Uterus?

    • Fallopian Tube

    • Round Ligament of Uterus

    • Ovarian Ligament

  • What is the “water under the bridge” in females?

    • The Ureter runs under the Uterine Artery

  • What is a Bicornuate Uterus? What ducts are involved?

    • A V-Shaped Uterus (usually no pathology)

    • Mullerian ducts fuse completely

_________________________________________________________________________________________________
Clinical Correlates:


  • Nutcracker Syndrome

    • What is compressed? What is it compressed between?

      • Compressed: Left Renal Vein (turns into Testicular Vein)

      • Between the Aorta and Superior Mesenteric Artery (SMA)

    • What are the symptoms?

      • Varicocele in the scrotal sac

      • Looks like “bag of worms”




Clinical Presentation

Portal

Caval

Esophageal Varices

Esophageal Branch of Left Gastric Vein

Esophageal Branch of Azygous Vein

Caput Medusa

Paraumbilical Veins

Superficial Epigastric Veins

Internal Hemorrhoids (painless)

External Hemorrhoids (painful)

Superior Rectal Vein (IMV)

Middle Rectal Vein

Inferior Rectal Vein



--

Right, Left, Middle Colic

Renal, Suprarenal, Gonadal Veins



  • Horseshoe Kidney

    • What stops the kidneys from ascending and separating, causing horseshoe kidney?

      • Inferior Mesenteric Artery

  • Meckel’s Diverticulum

    • What is another name for it?

      • Littre’s Hernia

    • What is the “Rule” you use to identify this?

      • Rule of 2’s

    • How far from the ileocecal valve?

      • 2 feet

    • How much of the population has it?

      • 2%

    • What is the length of the protrusion?

      • 2 inches

    • What is the common age of presentation?

      • 2 years old

    • What is the ratio of males to females?

      • 2:1

  • Pringle Maneuver

    • What is the Pringle Maneuver?

      • During Liver Surgery, you compress structures to stop the bleeding if the liver is hemorrhaging.

    • What structures are compressed?

      • Bile Duct

      • Hepatic Proper Artery

      • Hepatic Portal Vein

    • What ligament do these structures lie in?

      • Hepatoduodenal Ligament

    • If you perform the Pringle Maneuver and there is still bleeding, what does this mean?

      • That there is an aberrant or an accessory artery that is still bleeding, which you must find.

    • What are the possibilities for aberrant or accessory arteries?

      • Aberrant Left Hepatic Artery arising from Left Gastric Artery

      • Aberrant Right Hepatic Artery arising from Superior Mesenteric Artery

      • Accessory – If these are in addition (and not replacing) the normal ones

    • What foramen does this lie in (there are three names for it)?

      • Epiploic Foramen

      • Foramen of Winslow

      • Omental Foramen

    • The Epiploic Foramen allows for communication between two areas. What are these areas?

      • Greater Omentum

      • Lesser Omentum

  • Hesselbach’s Triangle

    • What are the borders?

      • Inferior Epigastric Vessels

      • Linea Semilunaris

      • Inguinal Ligament

    • What type of hernia goes through the triangle?

      • Direct Hernia

    • Are Direct Hernias congenital or acquired?

      • Acquired

    • Are Indirect Hernias congenital or acquired?

      • Congenital

    • Are Direct Hernia’s medial or lateral to Epigastric Vessels?

      • Medial

    • Are Indirect Hernias medial or lateral to Epigastric Vessels?

      • Lateral

    • Where does an Indirect Hernia protrude?

      • Through the deep inguinal canal

  • Congenital Diaphragmatic Hernia

    • What is another name for it?

      • Bochdalek Hernia

    • Where does it occur?

      • The intestines herniate through the left side of the diaphragm (because liver protects the right side)

    • Why is this a medical emergency?

      • The hernia impinges on the lungs, and the baby cannot breathe.

  • McBurney’s Point

    • What is McBurney’s Point used for?

      • To locate the approximate location of the appendix so an incision can be made.

    • How do you find this point?

      • Find Umbilicus

      • Find Anterior Superior Iliac Spine

      • Draw a line between them

      • Point is 2/3 from umbilicus

  • Prostate Cancer

    • How many lobes are there?

      • Anterior

      • Middle

      • Posterior

    • Which lobe has generally benign tumors? What does this cause?

      • The Middle Lobe has benign tumors. However, the tumor can press on the ureter or the seminal vesicle and block the flow.

    • Which lobe has metastatic tumors? (Prostate cancer)

      • Posterior Lobe

    • What is ascities?

      • The accumulation of fluid in the peritoneal cavity (between the visceral and parietal layers), which causes abdominal distention

  • Peptic Ulcers

    • Where do Peptic Ulcers occur most often?

      • The first part of the Duodenum (closest to the stomach)

  • Compare and Contrast Hydrocele and Varicocele by answering the following questions:

    • What causes Hydrocele?

      • The Processus Vaginalis does not close like it should, and continues to produce fluid, which fills the scrotal sac.

    • What causes Varicocele?

      • The Left Renal Vein is compressed between the SMA and the Aorta.

    • When doing the Light Test, how do you determine if the patient has Hydrocele or Varicocele?

      • Hydrocele – the scrotal sac would illuminate red because it is filled with serous fluid

      • Varicocele – the scrotal sac would not illuminate because it is filled with blood

    • Can Hydrocele and Varicocele both occur on both sides of the body?

      • Hydrocele – yes

      • Varicocele – just on the left

    • Which one is painful?

      • Varicocele

    • Which one makes the scrotal sac look like a “bag of worms”?

      • Varicocele

  • Abscesses

    • If abscesses in the pelvic region are found, where does the incision need to be made and what are you trying to avoid?

      • As medial as possible, to avoid the Pudendal (Alcock’s) Canal, which contains the Pudendal Nerve, Vein, and Artery

    • Where is the Pudendal Canal located?

      • Between the Sacrotuberous Ligament and the Sacrospinous Ligament

________________________________________________________________________________________________


ADDITIONAL QUESTIONS FROM REVIEW


  • What is the Seat of the Devil?

    • Virchow’s Node that is located on the left side of the neck.

  • What are other names for Virchow’s Nodes?

    • Signal Nodes

    • Sentinel Nodes

  • What “sign” is used to determine that Virchow’s Nodes are swollen?

    • Troisier’s Sign

  • What does Troisier’s Sign indicate?

    • Gastric Carcinoma

    • Metastatic spread of cancer (from liver)

  • Where does the Cysterna Chyli drain?

    • Thoracic Duct

  • What is a Cholecystectomy?

    • Removal of Gall Bladder

  • Why would you remove a Gall Bladder?

    • Because gallstones can form causing pain.

  • What part of the Gall Bladder do stones accumulate?

    • Hartmann’s Pouch

  • What is Calot’s Triangle?

    • A triangle in the Gall Bladder Area

    • Contains:

      • Cystic Artery

      • Cystic Duct

      • Common Hepatic Artery

  • When a patient has Gallstones, what nerve causes the pain and where is the pain felt?

    • Inferior Phrenic Nerve

    • Sensory to Diaphragm  Pain felt in right diaphragmatic area

  • What are the three ligaments surrounding the spleen?

    • Splenophrenic

    • Splenocolic

    • Gastroplenic

  • When performing a splenectomy, what vessels do you ligate?

    • Splenic Artery

    • Splenic Vein

  • When doing a splenectomy, what vessels can be affected by ligation?

    • Short Gastric Artery  Fundus of the Stomach

    • Left Gastroepiploic Artery  Greater Curvature of the Stomach

  • When performing exploratory surgery in the abdomen, where do you make the incision and why?

    • Paramedian Incision

    • You prefer to do an incision of the Linea Alba because you have a lesser chance of hitting nerves, but that does not lead to the best healing because there are also no blood vessels.

  • If you have to do Emergency Surgery in the abdomen, where do you make an incision?

    • Linea Alba

  • What is an incisional hernia?

    • A hernia through a previous surgical incision

  • What is a Spigelian Hernia?

    • A hernia between the rectus abdominis muscle and the semilunar line.

    • Usually below the arcuate line

  • What is a Petit Hernia?

    • A hernia in the Lumbar Triangle

    • Boundaries:

      • Latissimus Dorsi

      • External Oblique

      • Iliac Crest

  • What pouch are Bartholin’s Glands located in? M/F?

    • F

    • In the Superficial Pouch

  • How do you drain blockages in the Bartholin’s Glands?

    • Posterior Fornix of Uterus  Pouch of Douglas (aka Rectouterine)

  • What two structures can be affected when you have a Sliding Hernia? What pathology does a Sliding Hernia cause?

    • Vagal Nerve

    • Esophageal Artery

    • GERD

  • What is Water Under the Bridge in M/F?

    • F: Uterine Artery above the Ureter

    • M: Vas Deferens above the Ureter

  • What nerve roots compose the Pudendal Nerve?

    • S 2-3-4

  • What two ligaments is the Pudendal Nerve between?

    • Sacrospinous Ligament

    • Sacrotuberous Ligament

  • The Pudendal does both Sensory and Motor. Which structures are Sensory and which are Motor?

    • Sensory: External Genitalia and Anal Region

    • Motor: Pelvic Muscles, External Urethral Sphincter, External Anal Sphincter

  • What is Hirchspring’s Disease?

    • Aganglionic Mesocolon in children

  • What is Potter Sequence?

    • Oligohydramnios

    • Lack of amniotic fluid in utero

    • Causes clubbed feet, compressed facial features, renal problems


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