Anatomy

Transumbilical plane

Goes through L3/L4

Transtubercular plane

Goes through iliac tubercle L5

Subcostal plane

L2

Transpyloric plane

About L1 through pyloris of stomach

Abdominal regions

Hypochondriac, lateral or lumbar, inguinal
epigastric, umbilical, hypogastric

Layers of Thoracic wall

external intercostal, internal intercostal, neurovascular plane innermost intercostal, endothoracic fascia, parietal pleura

Layers of Abdominal wall

external oblique, internal oblique, neurovascular plane, transverse abdominal, transversalis fascia, peritoneum

Fiber direction of muscles of thoracic and abdominal walls

same!

Sternalis

m. in thorax comparable to rectus abdominis

External Oblique

-extends anteriorly to linea alba, external surface of ribs 5-12, linea alba, pubic tubercle, iliac crest
-Intercostoabdominal nerves and subcostal nerve

Inguinal ligament (Poupart's ligament)

Inferior edge of aponeurosis of the external oblique. From Anterior superior iliac spine to pubic tubercle.

Internal Oblique

1/3 upper fibers as that of internal intercostal, 2/3 lower opposite direction. Attaches to thoracolumbar fascia, anterior 2/3 iliac crest, lateral 1/2 of inguinal ligament, inferior borders of ribs 10-12, linea alba, pecten pubis
Intercostoabdominal, subcostal, lumbar nerves

Transversus Abdominis

Horizontal fibers. Attaches to internal surfaces of costal cartilages 7-12, thoracolumbar fascia, iliac crest, lateral 1/3 of inguinal ligament, linea alba, pubic crest, pecten pubis
Intercostoabdominal, subcostal, lumbar nerves

Rectus Abdominis

Pubic symphysis, pubic crest, costal cartilages 5-7, xiphoid process
Intercostoabdominal nerves and subcostal nerve

Fibrous sheath of rectus abdominis

Aponeurosis of external, internal oblique & transversalis abdominis. It encloses rectus abdominis, superior & inferior epigastric vessels, lymphatics, nerves.

Arcuate Line

Location of sheath of rectus abdominis (RA) where pattern of aponeurotic coverings changes (may also be gradual). Superior to line: aponeurosis superficial and deep to RA (between Internal oblique aponeurosis). Inferior to line: only anterior of RA in contact with aponeurosis, posterior with transversalis fascia.

Actions of abdominal muscles -together

Together: compress, support abdominal viscera, stabilize penis, important in respiration, defecation, and parturition (straining), control volume of abdominal cavity

Actions of abdominal muscles-unilaterall or bilaterally

EO, IO (same side)-bend trunk to the same side
TA-rotates trunk to same side
RA bilaterally-flexes trunk (not hip)

Ventral and dorsal rami of spinal nerves innervate:

skin & muscles of body wall, parietal: pleura, pericardium and peritoneum.

Cutaneous nerves (from ventral rami)

1. T1-T6 - intercostal -
2. Intercostoabdominal (thoracoabdominal) nerves (T7-T11)-anterior & lateral cutaneous branches
3. Subcostal nerve-ant and lat T12
4. L1-2 branches-iliohypogastric, ilioinguinal

Transverse thoracic

-intercostal nerves (T1-T6) and intercostoabdominal nerves (T7-T11)

Parietal pleura innervated by:

phrenic nerve
intercostal nerves

Parietal pericardium innervated by:

phrenic nerve

Parietal peritoneum (anterior) innervated by:

phrenic nerve
intercostoabdominal nerves

Veins/lymphatics/transumbilical plane

Superior to transumbilical plane-drain to axillary or parasternal vessels
Inferior to transumbilical plane-drain to femoral region

Axillary vein to Femoral Vein path

Axillary, lateral thoracic, thoracoepigastric, superficial epigastric, femoral vein

Internal thoracic arterial branches

Subclavian-Internal thoracic branches into muculophrenic & superior epigastric
-Deep veins-muscolophrenic, superior epigastric, internal thoracic, brachiocephalic

Inferior epigastric artery is a branch of _________.

external iliac artery

Anastomoses

anterior and posterior intercostal
superior and inferior epigastric
inferior epigastric and lumbar

Deep lymphatics (superior and inferior)

Superior abdominal wall-parasternal lymph nodes, parasternal trunks, subclavian veins
Inferior abdominal walll-deep inguinal lymph nodes, inferior vena cava,, thoracic duct

Thoracic cavity surrounded by:

endothoracic fascia

Abdominopelvic cavity surrounded by:

transversalis fascia

Gut forms during the ______ week of development

4th week-flat to cylindrical-gut forms due to folding

During the 4th week of development why does the head and tail form?

The developing nervous system grows faster than anything else.

During folding, what becomes the gut?

Yolk sac

What does the intraembryonic coelom become?

pericardial, pleural, peritoneal cavitie

Which cavity surrounds the gut?

peritoneal cavity

What are the Gut tube derivatives? (in abdomen and pelvis)

stomach, small & large intestine, appendix, liver, gallbladder, pancreas, rectum, part of anal canal. NOT SPLEEN

Mesentery

double layer of peritoneum, ligament

Intraperitoneal

suspended by a mesentery....so in the beginning GI tract was like this and projected into peritoneal cavity

The gut mesentery is first in a ______ plane and then it rotates to a ______plane.

sagittal, coronal

The cul de sac in respect to the ventral mesentery changes:

From on either side of ventral mesentery to posterior to the ventral mesentery.

Root of the lung

the location through which vessels and nerves have access to the lung

Vessels and nerves have access to GI tract and its derivatives via__________.

mesenteries

Arterial supply of abdominal gut

Foregut: Celiac trunk
Midgut: Superior mesenteric artery
Hindgut: Inferior mesenteric artery
*All these unpaired branches from the aorta

Branches of abdominal aorta: Unparied vs. Paired

Unpaired: celiac, superior mesenteric, inferior mesenteric
Paired: Inferior phrenic, suprarenal, renal, lumbar, gonadal (testicular or ovarian)
Unpaired: supply GI tract and its derivatives plus spleen
Paired: supply body wall and associated organs: kidneys

Blood to gut and its derivatives goes through _______ before returning to heart.

Two capillary beds -portal system

Retroperitoneal

Posterior to parietal peritoneum on the posterior abdominal wall.
Ex. GI tract and derivatives go from being intraperitoneal to being secondarily retroperitoneal...only anterior surface is covered with peritoneum.

Vessels and nerves supplying secondarily retroperitoneal organs are _______.

retroperitoneal

Retroperitoneal

Posterior to parietal peritoneum on posterior wall abdominal wall. Also deep to transversalis (endoabdominal fascia)
Kidneys, aorta, inferior vena cava, pancreas, small & large intestine

Extraperitoneal

space between parietal peritoneum and transversalis fascia (retroperitoneal is a subdivision). Ex. umbilical ligaments: extraperitoneal but not retroperitoneal. Ascending colon: extra peritoneal and retroperitoneal

Subdivisions of peritoneal cavity (2)

1. Greater sac: supracolic and infracolic compartments
2. Lesser sac: omental bursa

Omental bursa (AKA lesser sac)

Has an inferior and superior recess
*Superior recess posterior to liver
*Inferior recess usually obliterated due to fusion of the gastrocolic ligament and transverse mesocolon.

Abdominal viscera supplied by celiac trunk

Foregut: stomach, proximal duodenum, spleen, liver, biliary tract, pancreas

Liver and pancreas begin as diverticuli from the ______

foregut

The gallbladder is a diverticulum from the developing ______

liver

The spleen develops within the ______. Although not derived from foregut, it is supplied by the _______.

dorsal mesentery, celiac trunk

The cardia of the stomach is adjacent to the ____________.

esophagus

The fundus of the stomach is superior to the ________________.

cardial notch

The angular notch separates the ____ from the ________part of the stomach.

body, pyloric

The __________________is continous with the first (superior) part of the duodenum.

pyloric sphincter

Only structures that are _______are dependable on location.

retroperitoneal

Pylorus is _______much of duodenum is __________________stabilizing pylorus.

intraperitoneal, secondarily retroperitoneal.

The _____-& ______ are consistent in location..Inferior of stomach can vary widely.

esophageal hiatus (T10), pylorus (L1)

Name 4 parts of duodenum

Superior, descending, horizontal, ascendi

All parts of duodenum are ________ except the proximal 2 cm of the _____ because___

secondarily retroperitoneal, first superior part, it has a mesentery, the hepatoduodenal ligament

The stomach and proximal 2 cm of duodenum are ______

intraperitoneal because they have mesenteries

Greater omentum

attached along greater curvature of stomach-gastrocolic, gastrosplenic, gastrophrenic ligaments

Lesser omentum

gastrophepatic (attached along lesser curvature), and hepatoduodenal ligament

hepatoduodenal ligament contains

hepatic artery proper, portal vein, biliary ducts

Round ligament of liver

runs in free edge of the falciform ligament-it's the obliterated umbilical vein, there are also paraumbilical veins

Liver is intra, retro, extra peritoneal?

intraperitoneal

Ligamentum venosum

obliterated ductus venosus that connected the umbilical vein (now the round ligament) with the inferior vena cava

Left sagittal fissure

ligamentum venosum, round ligament

Right sagittal fissure

inferior vena cava, gallbladder

Porta Hepatis

Site of entry or exit of the portal vein, hepatic artery proper, hepatic duct, lymphatic vessels and axons. Surrounded by hepatoduodenal ligament

Gastrohepatic ligament

separates left and caudate lobes

The mesentaries are the

falciform, coronary (contacts diaphraghm), gastrohepatic, hepatoduodenal ligaments

Bile Path

Liver---L & R hepatic ducts, common hepatic duct, bile duct constricted, up cystic duct, gallbladder
*When bile duct not constricted bile goes into 2nd part-descending part-duodenum
**Pancreatic duct merges with bile duct

2 ligaments associated with spleen and contents

1. gastrosplenic-short gastric vessels (connects stomach with spleen)
2. splenorenal-splenic vessels, tail of pancreas (connects spleen to posterior abdominal wall)

Spleen is _________ and forms in ____________.

intraperitoneal, dorsal mesentery

Secondarily retroperitoneal organs

duodenum, pancreas (except tail which is within splenorenal ligament

Head of pancreas in nestled in __________________.

the curve of the duodenum

The bile duct travels posterior to both the ____ part of ________ and the _____.

1st, duodenum, pancreas

Union of the bile and pancreatic ducts

Most common-join together, hepatopancreatic sphincter of Oddi

25% of the time-remain separate

Pancreas begins as two outgrowths from the _______.

foregut

Primarily retroperitoneal

celiac trunk, aorta, kidneys, pancreas, inferior vena cava, splenic vessesls (except terminal part)

Any arteries that supply an intraperitoneal organ MUST go through a __________.

mesentery

What goes through the hepatogastric ligament?

right and left gastric arteries

What goes through the gastrocolic ligament?

The right and left gastro-omental arteries

What goes through the gastrosplenic ligament?

The short gastric arteries

What goes through the hepatoduodenal ligament?

The hepatic artery proper

What goes through the splenorenal (lienorenal) ligament?

Splenic artery

What two arteries join to form Portal vein?

The splenic and superior mesenteric
*The inferior mesenteric may either drain into splenic or at the intersection of splenic and superior mesenteric.

In which regions do foregut derivatives lie in?

R & L hypochondriac and epigastric. Protected by rib cage, liver andn spleen not normally palpable.

Spleen's location relative to stomach

lateral and posterior

Liver's relationship to gallbladder and stomach

Liver is superior and anterior to both gallbladder and stomach

Omental (epiploic) foramen

site of continuity between omental bursa (lesser sac) and greater sac

Clinical relevance of superior recess

Adjacent to inferior vena cava and distal esophagus. Place where infectious or bloody fluids can accumulate in supine patients.

Viscera supplied by the S & I Mesenteric arteries

Pancreas, distal duodenum, jejunum, ileum, cecum, ascending, transverse, descending, and sigmoid colon, and proximal rectum

Omphalocele

If midgut fails to return to the abdominal cavity. After surgery to remove omphalocele, children do not have belly button.

Initially hindgut is a _______.

single tube

During development hindgut subdivides into:

1. anterior-urogenital tube -future bladder and urethra
2. posterior-gastrointestinal tube-transverse colon through superior anal canal

The jejunum is tethered to the body wall at the _____junction by a band of skeletal tissue from the ______, the ________ (of Treitz)

duodenojejunal, right crus of the diaphragm, suspensory ligament

Duodenal recess

Peritoneal gap aat the duodenojejunal junction. Potential space for accumulation of fluid and herniation.

Hernia

protrusion of a part of the GI tract through a weakness in the body wall such as in the inguinal, umbilical, and femoral regions.

Duodenal recess may be site of ____________________.

paraduodenal hernia

Ileum and jejunum are _____ to ____ feet long.

15, 20

The ileum is ______ than the jejunum.

longer (ileum has the letter l for longer)

Proximal jejunum characteristics

many circular folds, thick wall
-1 layer of arcades, vasa recta long

Distal ileum characteristics

few, if any circular folds, thin wall, numerous lymphoid nodules
-arcades many layers, vasa recta short

Root of the mesentery

6 inches long, begins at duodenojejunal junction and ends at the ileocecal junction. Contains superior artery and vein since they provide blood supply to the jejunum and ileum.

What vessels are within the root of the mesentery?

Superior mesenteric artery and vein

Does cecum have mesentery?

No, but it is mobile so considered intraperitoneal.

What prevents reflex from the cecum into the ileum?

a sphincter

Appendix is a diverticulum from the_________.

cecum

Does appendix have mesentery?

Yes, the mesoappendix

Why does clinical presentation of appendicities vary greatly?

Due to varying position of appendix.....sometimes in pelvis, inferior to liver, or on the contralateral side (situs inversus)

McBurney's point

1/3 of the way from the anterior superior iliac spine to the umbilicus

Volvulus

twisting that can cause internal blockage as well as compromised blood supply resulting in ischemia and subsequent necrosis. Can occur during development and throughout life.

Left colic (splenic) flexure vs. Right colic (hepatic) flexure

Left colic flexure is attached to the diaphragm by the phrenicocolic ligament, usuall superior to the right colic flexure.

Characteristics of colon

semilunar folds of mucosa
omental tags of fat
teniae coli (3 strips of longitudinal muscle along its length)
Haustra-sacculations due to teniae coli being shorter than colon

Mesenteries of large intestine

transverse mesocolon and sigmoid

Why is there so much variation in length and location of the sigmoidi sinus?

It's an intraperitoneal part of GI tract. MUCH variation.

Name vertebral levels of : celia trunk, superior mesenteric, inferior mesenteric,

celiac trunk T12
superior mesenteric artery L1
Inferior mesenteric artery L3

A primarily peritoneal structure is ALWAYS _____ to a secondarily retroperitoneal structure.

posterior

Intraperitoneal structures

ileum, jejunum,

Branches of the Superior mesenteric

1. inferior pancreaticoduodenal artery
2. middle colic artery
3. intestinal arteries
A. ileocolic artery
B. right colic artery

Inferior pancreaticoduodenal artery

Branch remains retroperitoneal.
Supplies duodenum distal to entrance to bile duct, head of pancreas, (secondarily retroperitoneal). Bifurcates into anterior and posterior branches and anastomoses with the superior pancreaticoduodenal branches.

Middle colic artery

Supplies proximal 2/3 of transverse colon (intraperitoneal), runs in the transverse mesocolon

Ileocolic artery

distal ileum, appendix, cecum, proximal ascending colon. Branches supplying ileum and appendix are within "the" mesentery or the mesoappendix respectively while branches to the ascending colon are retroperitoneal.

Right colic artery

ascending colon (secondarily retroperitoneal), retroperitoneal.

Ileocolic and right colic arteries often arise:

from a common stem off the superior mesenteric artery.

Derivatives of the hindgut are supplied by the _______ ______ artery.

inferior mesenteric

Branches of the inferior mesenteric artery

left colic artery
four branches that supply sigmoid colon
superior rectal artery

Left colic artery

descending colon (secondaritly retroperitoneal) and distal part of the transverse colon. Therefore the initial part of the artery is retroperitoneal but the branches to the transverse colon run in the transverse mesocolon

4 branches to the sigmoid colon

sigmoid colon is intraperitoneal so sigmoidal branches run in the transverse mesocolon.

superior rectal artery

superior part of rectum (secondarily retroperitoneal), branch remains retroperitoneal.

Anastomosis between SM and IM

Middle colic artery and left colic artery.

What is unique about the lymphatic drainage of the abdominal viscera

The lymphatic vessels follow ARTERIES (celiac, SM, IM branches) and NOT VEINS.

Chyle cistern

lymphatic vessels form an intestinal trunk, empties into chyle cystern (adjacent to celiac trunk), drains into thoracic duct, empties into venous system at or near junction of internal jugular and subclavian veins

Hematogenous metastasis

malignant cells carried in the veins of the abdominal viscera to the portal vein and liver, liver metastases in colon cancer.

The IM vein is usually a tributary of the ____ vein.

splenic

Veins of the body wall are called:

caval veins

Portocaval anastomoses

1. esophageal branch of left gastric and esophageal tributaries of the azygos
Result: esophageal varices
2. superior rectal vein and middle/inferior rectal veins
hemorrhoids
3. paraumbilical veins and superficial epigastric veins of anterior abdominal wall
caput medusai (dilated veins on anterior abdominal wall)
4. veins of secondarily retroperitoneal organs and veins of posterior abdominal wall

T or F. The abdominal viscera are composed of smooth muscle and glands and are therefore innervated by the autonomic nervous system.

null

Splanchnic nerves

The splanchnic nerves are paired nerves that contribute to the innervation of the viscera, carrying fibers of the autonomic nervous system (visceral efferent fibers) as well as sensory fibers from the organs (visceral afferent fibers). All carry sympathetic fibers except for the pelvic splanchnic nerves, which carry parasympathetic fibers.

Greater, lesser, and least splanchnic nerves pierce the _______.

crura of the diaphraghm

Vagal trunks go through______.

esophageal hiatus.

Significance of medial arcuate ligament

fascia covering the psoas major. The sympathetic chain enters the abdominal cavity by going under it.

Where do the axons within the greater, lesser, least, and lumbar splanchnic nerves synapse?

In prevertebral (preaortic) ganglia within the abdomen.

Which is the largest of the pretervebral ganglia?

Celiac ganglia, can be seen macroscopally

Where do axons on vagal trunks synapse?

Axons in vagal trunks synapse in, on , or near their targets.

Pelvic nerves

provide parasympathetic innervation to abdominal viscera. They pass through hypogastric nerves and superior hypogastric plexus to reach their targets.

Name layers of gut

mucosa, submucosa, inner circular layer, outer longitudinal layer (smooth muscle), visceral peritoneum

Names of ganglia within submucosa and layers of smooth muscle.

submucosal and myenteric ganglia

Peristalsis-related innervation

1. enteric nervous system-initiates it and coordinates
2. Sympathetic-decreases rate, constricts sphincters
3. Parasympathetic-increases rate, relaxes sphincters

Hirschsprung disease

Aganglionic segment of gut, no peristalsis, prevents normal passage of feces, enlargement of gut proximal to aganglionic segment.

Quadratus Lumborum

Attaches to Rib 12, lumbar transverse processes, iliac crest
Actions: unilaterally-flexes vertebral column, ipsilateral
-extends, contralateral
bilaterally-stabilizes and lowers rib 12 during inspiration
Innervation: T12 and lumbar ventral rami

Psoas Major

Proximal attachment: Lumbar vertebrae, intervertebral discs
Innervation-Lumbar ventral rami

Iliacus

Proximal attachment: iliac fossa
Innervation: Femoral nerve (L2-L4)
Iliopsoas Distal Attachment: Lesser attachment of the femur
Actions: flexion at hip joint
unilaterally-flexion of vertebral column, ipsilateral
extension-contralateral

Medial arcuate ligament overlies:

psoas major

Lateral arcuate ligament overlies:

quadratus lumborum

Openings of diaphragm

-caval, esophageal hiatus, aortic

Caval opening

opening in the diaphragm, transmits IVC, within central tendon

Esophageal hiatus

opening in diaphragm, transmits esophagus, anterior and posterior vagal trunks, esophageal branches of the left gastric vessels.

In right crus of the diaphragm

Aortic hiatus

opening in posterior diaphragm, between right and left crura. Transmits thoracic duct and possibly the azygos and hemiazygos veins.

The posterior of the diaphragm is almost _____ to the vertebral column.

parallel

Vertebral levels of diaphragm openings

caval-T8
esophageal hiatus-T10
aortic hiatus-T12

The right dome of the diaphragm is ____ to the left dome.

superior

The contraction of the diaphragm during full inspiration lowers the upper limit of the diaphragm by about____.

1 to 2 vertebral levels. Effect is greatest at the level of the caval opening.

If a phrenic nerve is damaged, what happens during inpiration, expiration?

expiration is normal. Inspiration, the damanged hemidiaphragm will be raised.

Lumbosacral plexus

L1 through coccygeal, ventral rami, nerves of posterior abdominal wall

Where does L1 bifurcate?

It bifurcates into iliohypogastric and ilioinguinal nerves near or far from the vertebral column.

Lateral cutaneous nerve of the thigh

L2, L3
-runs on iliacus and passes deep to the inguinal ligament to reach the thigh

Femoral nerve

L2, 3, 4 emerges lateral to the psoas major and passes deep to the inguinal ligament to reach the thigh

Genitofemoral nerve

L1, L2 runs on the anterior surface of psoas major

Obturator nerve

L2, 3, 4
medial to psoas major, passes through obturator foramen to reach the thigh

Lumbosacral nerve

L4,5
goes into pelvis

The arterial supply of the body wall is by paired arteries except the ______.

median sacral artery

How many arteries supply, how many veins drain suprarenal glands?

3 arteries (superior suprarenal from inferior phrenic, middle suprarenal from aorta, inferior suprarenal from renal), 1 vein

Right renal artery is ____ than the left.

longer

Left renal vein is ______ than the right.

longer

Right gonadal vein drains into

IVC

Left gonadal vein drains into

renal vein

Adrenal cortex

-derived from mesoderm, produces mineralcorticoids (- = Addison's dx), glucocorticoids (+ = Cushing's dx), and sex hormones
-

Adrenal medulla

-derived from neural crest, secretes epinephrine (pheochromocytoma tumor = + epinephrine)

Which kidney is slightly higher than the other?

the left kidney is usually higher than the right kidney.

Kidneys are held in place by a

fascial sheath, atrophy can lead to increase mobility of kidney, "floating kidney", may interfere with renal blood flow, and/or urinary outflow and may cause pain

Surgery of the kidneys is best done by a ____ approach.

posterior (anterior,,increase risk of peritonitis)

Kidneys are anterior to which ribs:

11 and 12, lateral to psoas major

There are _____ renal arteries because _______.

multiple, kidneys developed in pelvis and then ascended to posterior abdominal wall. As kidneys ascend new arteries form and former ones degenerate.

Horshoe kidney

inferior poles of kidneys are fused-full ascent does not occur due to prevention by IMA. Suprarenal glands and kidneys are not adjacent.

Urine journey through kidney

minor calyce, major calyce, renal pelvis, ureter,
each minor calyce is attached to a renal pyramid

Ureters are intra, retro peritoneal?

retroperitoneal

Ureters path

descend, pass anterior to psoas major, posterior to gonadal vessels,, enter pelvis by crossing anterior to bifurcation of common iliacs.

Kidney stone

not usually a problem when inside the kidney but once in ureter, there is much chain which changes over time since ureters are innervated by multiple sources as they descend. Mid-back pian and move to inguinal region with time.

Broad ligament

Mesentery of uterus, made up of 2 layers of parietal peritoneum.
Parts: mesometrium, mesosalpinx, mesovarium

Ovarian vein L/R

Right-drains into IVC
Left-drains into Renal vein

pelvic diaphraghm

muscular floor of the pelvic cavity-made up of levator ani muscle and coccygeus muscle

How does the urethra, vagina, and anal canal pass through midline openings in the pelvic diaphragm ______.

urogenital hiatus, anal hiatus

Suspensory ligament of the ovary contains

ovarian artery

T/F the vaginal artery is entirely subperitoneal

True

T/F there are end to end anastomoes of branches of the uterine, ovarian, and vaginal arteries.

null

Ureter passes _____- to the uterine artery.

inferior, bridge over water

Normal position of uterus

Anterverted and anteflexed

prolapse/complete prolapse

Uterus falls out of place.
In complete prolapse, bladder cannot completely empty so women will be prone urinary tract infections.

Why does prolapse occur?

Women who have uterus in a retroverted position are more prone to prolapse. Also childbirth can cause weakness of the pelvic diaphragm and fascia.

Ovary releases oocyte into ____.

Peritoneal cavity

Ovulation involves breaking thorugh ___ _____ and may be painful.

parietal peritoneum

Lacunar ligament (gimbernat's ligament)

Formed by deep fibers of the inguinal ligament that attach to the pectinal line of the hip bone. Parat of it that attaches to pectineal lines is called pectineal ligament (Cooper's ligament).

Relation of deep and superficial ring of inguinal canal to inferior epigastric aretery.

Deep-lateral
Superfician-medial

inguinal canal

oblique passage through the anterior abdominal wall from the deep inguinal ring to the superficial inguinal ring

Gubernaculum becomes

ovarian ligament and round ligament

Processus vaginalis

outpocketing of the parietal peritoneum into the future scrotum that provides continuity between the abdominopelvic cavity and the scrotum.

Testis travel down into the scrotal sac through the ____.

inguinal canal. Ductus deferens, blood supply, and innvervation, descend and are contianed within the spermatic cord.

Remnant of male gubernaculum

scrotal ligament

What happens to the processus vaginalis

Largely degenerates but a remnant remains in the scrotal sac, the tuinca vaginalis

Cryptorchidism

Failure of a testis to descend down into the scrotum

Cremaster muscle

In spermatic cord, skeletal, innervated by the genital branch of genitofemoral nerve.

Sites of hernias

Inguinal canal, femoral ring, umbilicus, and linea alba

What is the most common kind of hernia

inguinal (5% of population)

Hernias can lead to

Reduction of blood supply-ischemia-necrosis
fecal obstruction

Indirect inguinal hernia

2/3 of hernias, young males, due to patent processus vaginalis, part of gut enters spermatic cord, through inguinal canal , enter scrotum, covered by parietal peritoneum

Direct Inguinal hernia

Less common than the indirect ones. Males over 40 years of age.Section of gut pushes through abdominal wall in the medial 1/3 of the inguinal canal, does NOT enter the spermatic cord. covered with parietal peritoneum...can exit superficial inguinal ring but DOES NOT enter scrotum

Differences between direct/indirect hernias

indirect-young males, into spermatic cord, scrotum
direct-old males, DOES NOT ENTER 2 structures above

Inguinal (Hesselbach's triangle)

Triangle through which direct hernias go through. Bounded by inferior epigastric vessels, rectus abdominis, and inguinal ligament

What forms the boundary between the abdomen and pelvis?

The iliac crests

What divides the false (greater) and trues (lesser) pelvis?

The pelvic brim

Perineum

area between thighs

Roof of perineum?

Pelvic diaphragm

Vasculature and nerves ______ go directly to and from the pelvis and perineum because they ____ perforate the pelvic diaphragm.

do not, do not

What structures go through the pelvic diaphraghm?

urethra, vagina, GI tract

Name hiatuses on pelvic diaphraghm

1. urogenital
2. anal

pelvic brin is AKA

pelvic inlet

Narrowest fixed distance through which a baby's head must pass during vaginal delivery?

Anteroposterior diameter between pubic symphysis and sacral promontory

Greater Sciatic foramen

Periformis goes through, connects pelvis with the gluteal region

Lesser sciatic foramen

Obturator internus goes through, covered up by LA, connects gluteal region to perineum

Tendinous arch of levator ani

Fascial attachment of the levator ani, thickening of the obturator internus fascia.

Obturator foramen

covered up by obturator membrane...lil opening is the obturatora canal

Obturator internus

superior portion in pelvic cavity
inferior portion in perineum

pericardial cavity lies in part behind sternum, between which ribs?

2-6 ribs

Anatomy

Anatomy 1 with B at Columbia University

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