ABDOMEN
ANTERIOR ABDOMINAL WALL
I.
II.
Abdomen
1. What are the 9 regions of the abdomen?
-right and left hypochondriac, epigastric, right and left lumbar, umbilical, right
and left inguinal (iliac), and hypogastric (pubic).
2. At what level does the umbilicus lie?
-at the level of the intervertebral disk between the L3-L4
3. What nerve innervates the umbilical region?
-10th thoracic nerve
4. What are the names of the horizontal and vertical plane lines of the abdomen?
-vertical- midclavicular
-horizontal- transpyloric and intertubercular
Muscles of the anterior abdominal wall
1. What are the main muscles of the anterior abdominal wall?
-external and internal oblique, transverse, rectus abdominis, pyramidal, cremaster
2. What is the origin of the external oblique muscle?
- External surface of lower eight ribs (5–12)
3. What is the insertion of the external oblique muscle?
-Anterior half of iliac crest; anterior–superior iliac spine; pubic tubercle; linea
alba
4. What nerves innervate the external oblique muscle?
- Intercostal (T7–T11); subcostal (T12)
5. What is the function of the external oblique muscle?
- Compresses abdomen; flexes trunk; active in forced expiration
6. What is the origin of the internal oblique muscle?
- Lateral two-thirds of inguinal ligament; iliac crest; thoracolumbar fascia
7. What is the insertion of the internal oblique muscle?
- Lower four costal cartilages; linea alba; pubic crest; pectineal line
8. What nerves innervate the internal oblique muscle?
- Intercostal (T7–T11); subcostal (T12); iliohypogastric and ilioinguinal (L1)
9. What is the function of the internal oblique muscle?
- Compresses abdomen; flexes trunk; active in forced expiration
10. What is the origin of the transverse muscle?
- Lateral one-third of inguinal ligament; iliac crest; thoracolumbar fascia; lower
six costal cartilages
11. What is the insertion of the transverse muscle?
- Linea alba; pubic crest; pectineal line
12. What nerves innervate the transverse muscle?
- Intercostal (T7–T12); subcostal (T12); iliohypogastric and ilioinguinal (L1)
13. What is the function of the transverse muscle?
- Compresses abdomen; depresses ribs
III.
14. What is the origin of the rectus abdominis muscle?
- Pubic crest and pubic symphysis
15. What is the insertion of the rectus abdominis muscle?
- Xiphoid process and costal cartilages fifth to seventh
16. What nerves innervate the rectus abdominis muscle?
- Intercostal (T7–T11); subcostal (T12)
17. What is the function of the rectus abdominis muscle?
- Depresses ribs; flexes trunk
18. What is the origin of the pyramidal muscle?
-pubic body
19. What is the insertion of the pyramidal muscle?
-linea alba
20. What nerves innervate the pyramidal muscle?
- Subcostal (T12)
21. What is the function of the pyramidal muscle?
- Tenses linea alba
22. What is the origin of the cremaster muscle?
- Middle of inguinal ligament; lower margin of internal oblique muscle
23. What is the insertion of the cremaster muscle?
- Pubic tubercle and crest
24. What nerves innervate the cremaster muscle?
- Genitofemoral
25. What is the function of the cremaster muscle?
- Retracts testis
Fasciae and ligaments of the anterior abdominal wall
1. What is the organization of fascia?
-superficial layer (tela subcutanea)
-deep layer
2. What are the two layers of the superficial fascia?
-superficial fatty layer (Camper’s fascia)
-deep membranous layer (Scarpa’s fascia)
3. Where is the Camper’s fascia located?
- Continues over the inguinal ligament to merge with the superficial fascia of the
thigh.
-Continues over the pubis and perineum as the superficial layer of the superficial
perineal fascia.
4. What is the Scarpa’s fascia attached to?
- to the fascia lata just below the inguinal ligament
5. Where is the Scarpa’s fascia located?
- Continues over the pubis and perineum as the membranous layer (Colles’s
fascia) of the superficial perineal fascia.
-Continues over the penis as the superficial fascia of the penis and over the
scrotum as the tunica dartos, which contains smooth muscle
6. Where is the deep fascia located?
- Covers the muscles and continues over the spermatic cord at the superfi cial
inguinal ring as the external spermatic fascia.
-Continues over the penis as the deep fascia of the penis (Buck’s fascia) and over
the pubis and perineum as the deep perineal fascia.
7. What is the linea alba?
- tendinous median raphe between the two rectus abdominis muscles
8. How is the linea alba formed?
- by the fusion of the aponeuroses of the external oblique, internal oblique, and
transverse abdominal muscles.
9. Where does the linea alba extend to and from?
- Extends from the xiphoid process to the pubic symphysis
10. What happens to linea alba in pregnancy?
- it becomes a pigmented vertical line (linea nigra), probably due to hormone
stimulation to produce more melanin.
11. What is the linea semilunaris?
- curved line along the lateral border of the rectus abdominis
12. What is the linea semicircularis (arcuate line)?
- crescent-shaped line marking the inferior limit of the posterior layer of the rectus
sheath just below the level of the iliac crest
13. What is the lacunar ligament (Gimbernat’s ligament)?
- medial triangular expansion of the inguinal ligament to the pectineal line of the
pubis.
14. What does the lacunar ligament form?
- medial border of the femoral ring and the floor of the inguinal canal.
15. What is the pectineal (Cooper’s ligament)?
- a strong fibrous band that extends laterally from the lacunar ligament along the
pectineal line of the pubis
16. What is the inguinal ligament (Poupart’s ligament)?
- the folded lower border of the aponeurosis of the external oblique muscle,
extending between the anterior superior iliac spine and the pubic tubercle.
17. What does the inguinal ligament form?
- the floor (inferior wall) of the inguinal canal
18. What is the iliopectineal arcus or ligament?
- fascial partition that separates the muscular (lateral) and vascular (medial)
lacunae deep to the inguinal ligament.
19. What does the muscular lacuna transmit?
- the iliopsoas muscle.
20. What does the vascular lacuna transmit?
- the femoral sheath and its contents, including the femoral vessels, a femoral
branch of the genitofemoral nerve, and the femoral canal.
21. What is the reflected inguinal ligament formed by?
IV.
-by fibers derived from the medial portion of the inguinal ligament and lacunar
ligament and runs upward over the superficial tendon to end at the linea alba
22. What is the falx inguinalis (conjoint tendon) formed by?
- the aponeuroses of the internal oblique and transverse muscles of the abdomen
and is inserted into the pubic tubercle and crest
23. What is the function of the falx inguinalis?
- Strengthens the posterior wall of the medial half of the inguinal canal.
24. What is the rectus sheath formed by?
- fusion of the aponeuroses of the external oblique, internal oblique, and
transverse muscles of the abdomen
25. Which structures are enclosed by the rectus sheath?
-rectus abdominis and sometimes pyramidal muscle
- superior and inferior epigastric vessels
-ventral primary rami of thoracic nerves 7 to 12.
26. Anterior Layer of the Rectus Sheath
- Above the arcuate line: aponeuroses of the external and internal oblique
muscles.
-Below the arcuate line: aponeuroses of the external oblique, internal oblique, and
transverse muscles.
27. Posterior Layer of the Rectus Sheath
-Above the arcuate line: aponeuroses of the internal oblique and transverse
muscles.
- Below the arcuate line: rectus abdominis is in contact with the transversalis
fascia.
Inguinal region
1. What are the boundaries of the inguinal (Hesselbachs) triangle?
-medially by the linea semilunaris (lateral edge of the rectus abdominis),
-laterally by the inferior epigastric vessels,
-interiorly by the inguinal ligament.
2. Why is the inguinal triangle important clinically?
-it is a common site of a direct inguinal hernia.
3. What are the two inguinal rings?
-superficial and deep
4. Where is the superficial inguinal ring located?
-triangular opening in the aponeurosis of the external oblique muscle that lies
just lateral to the pubic tubercle.
5. Where is the deep inguinal ring located?
-in the transversalis fascia, just lateral to the inferior epigastric vessels.
6. Where is the inguinal canal located?
-Begins at the deep inguinal ring and terminates at the superficial ring.
7. What structures pass through the inguinal canal?
-spermatic cord or the round ligament of the uterus
- genital branch of the genitofemoral nerve
V.
-ilioinguinal nerve (partially)
-indirect inguinal hernia (if present)
8. What structures run through the deep inguinal ring?
-spermatic cord or the round ligament of the uterus
- genital branch of the genitofemoral nerve
-indirect inguinal hernia (if present)
9. What structure runs through the superficial inguinal ring?
-ilioinguinal nerve
10. What are the boundaries of the inguinal canal?
-Anterior wall: aponeuroses of the external oblique and internal oblique muscles.
-Posterior wall: aponeurosis of the transverse abdominal muscle and transversalis
fascia.
-Superior wall (roof): arching fibers of the internal oblique and transverse
muscles.
-Inferior wall (floor): inguinal and lacunar ligaments.
11. What is the path of the indirect inguinal hernia?
-through the deep inguinal ring, inguinal canal, and superficial inguinal ring and
descends into the scrotum
12. What is the location of the indirect inguinal hernia?
-lateral to the inferior epigastric vessels,
13. Is the indirect inguinal hernia congenital or acquired?
-congenital, associated with the persistence of the processus vaginalis
14. What are the coverings of the indirect inguinal hernia?
- the peritoneum and the coverings of the spermatic cord.
15. Where is the path of the direct inguinal hernia?
-directly through a weakened area of the abdominal wall muscles (posterior wall
of the inguinal canal), lateral to the edge of the conjoint tendon (falx inguinalis),
in the inguinal triangle, and rarely descends into the scrotum
16. Where is the direct inguinal hernia located?
-medial to the inferior epigastric vessels and protrudes forward to (rarely through)
the superfi cial inguinal ring
17. Is the direct inguinal hernia congenital or acquired?
-acquired
18. What are the coverings of the direct inguinal hernia?
-sac formed by the peritoneum and occasionally the transversalis fascia.
19. Which hernia is more common?
-indirect
Spermatic cord, scrotum and testis
1. What are the components of the spermatic cord?
-ductus deferens; testicular, cremasteric, and deferential arteries; pampiniform
plexus of testicular veins; genital branch of the genitofemoral and cremasteric
nerves and the testicular sympathetic plexus; and lymph vessels
2. What are the fascia covering the spermatic cord?
-external spermatic fascia
-cremasteric fascia
-internal spermatic fascia
3. Where does the external spermatic fascia derive from?
- from the aponeurosis of the external oblique muscle.
4. Where does the cremasteric fascia derive from?
- originating in the internal oblique muscle
5. Where does the internal spermatic fascia derive from?
- from the transversalis fascia.
6. What is processus vaginalis testis?
- Is a peritoneal diverticulum in the fetus that evaginates into a developing
scrotum
7. What does the processus vaginalis testis form?
- visceral and parietal layers of the tunica vaginalis testis.
8. What usually happens to the processus vaginalis testis?
- Normally closes before birth or shortly thereafter and loses its connection with
the peritoneal cavity
9. What happens if the processus vaginalis testis persists?
- congenital indirect inguinal hernia
10. What is hydrocele processus vaginalis?
-fluid accumulation when the processus vaginalis testis is occluded
11. What is tunica vaginalis?
- Is a double serous membrane, a peritoneal sac that covers the front and sides of
the testis and epididymis.
12. Where is the tunica vaginalis deriverd from and what does it form?
- derived from the abdominal peritoneum and forms the innermost layer of the
scrotum
13. What is the gubernaculum testis?
- Is the fetal ligament that connects the bottom of the fetal testis to the developing
scrotum
14. Why is the gubernaculum testis important?
- pulls the testis down as it migrates- testicular descent
15. What are the homologous structures to the gubernaculum testis in the female?
- ovarian ligament and the round ligament of the uterus.
16. What is the name of the fascia covering the scrotum?
-dartos fascia
17. What nerves innervate the scrotum?
- genital branch of the genitofemoral, anterior scrotal branch of the ilioinguinal,
posterior scrotal branch of the perineal, and perineal branch of the posterior
femoral cutaneous nerves
18. What vessels supply the scrotum?
- anterior scrotal branches of the external pudendal artery and posterior scrotal
branches of the internal pudendal artery
VI.
19. Where does the scrotum drain lymph to?
-superficial inguinal nodes
20. What is the name of the layer that covers the testes?
-tunica vaginalis
21. Where is the sperm produced?
-in the semniferous tubules
22. Where is testosterone produced?
-in the interstitial (Leydig) cells
23. What nerves innervate the testes?
-Autonomic
24. Where do the testes drain lymph into?
- deep inguinal nodes and to the lumbar and preaortic nodes
25. Which vessels supply the testes?
- testicular arteries arising from the aorta,
26. What vessels drain the testes?
-testicular veins, which empty into the inferior vena cava (IVC) on the right and
the renal vein on the left.
Inner surface of the anterior abdominal wall
1. What is supravesical fossa and where is it located?
-depression on the anterior abdominal wall between the median and medial
umbilical folds of the peritoneum.
2. Where is medial inguinal fossa located?
- on the anterior abdominal wall between the medial and lateral umbilical folds of
the peritoneum. Lateral to the supravesical fossa.
3. What is characteristic about the medial inguinal fossa?
-it is the location of most direct inguinal hernias
4. Where is the lateral inguinal fossa located?
- on the anterior abdominal wall, lateral to the lateral umbilical fold of the
peritoneum.
5. What are the umbilical folds/ligaments?
-medial umbilical ligament/fold
-median umbilical ligament/fold
-lateral umbilical fold
6. Median umbilical ligament is a remnant of which structure?
-obliterated urachus
7. Where is the median umbilical ligament located?
- between the transversalis fascia and the peritoneum and extends from the apex
of the bladder to the umbilicus.
8. Medial umbilical ligament is a remnant of which structure?
-obliterated umbilical artery
9. Where is the medial umbilical ligament located?
-it extends from the side of the bladder to the umbilicus.
10. What structures are covered by the lateral umbilical fold?
- inferior epigastric vessels
11. Where is the lateral umbilical fold located?
- from the medial side of the deep inguinal ring to the arcuate line.
12. What is the tranversalis fascia?
- lining fascia of the entire abdominopelvic cavity between the parietal
peritoneum and the inner surface of the abdominal muscles
13. What other fasciae are continuous with the transversalis fascia?
- diaphragmatic, psoas, iliac, pelvic, and quadratus lumborum fasciae.
14. What structure is formed by the transversalis fascia?
-deep inguinal ring
15. What structures does the transversalis fascia give rise to?
- femoral sheath and the internal spermatic fascia.
16. What muscle is the transversalis fascia in direct contact with below the arcuate
line?
-rectus abdominis
VII. Nerves of the anterior abdominal wall
1. What are the main nerves of the anterior abdominal wall?
-subcostal, iliohypogastric and ilioinguinal nerve
2. Which nerve is the ventral ramus of the 12th thoracic nerve?
-subcostal nerve
3. What does the lateral cutaneous branch of the subcostal nerve innervate?
-skin of the side of the hip
4. Where does the iliohypogastric nerve arise from?
-first lumbar nerve
5. What does the iliohypogastric nerve innervate?
- the internal oblique and transverse muscles of the abdomen.
6. What does the iliohypogastric nerve divide into?
- lateral cutaneous branch to supply the skin of the lateral side of the buttocks and
an anterior cutaneous branch to supply the skin above the pubis
7. Where does the ilioinguinal nerve arise from?
-the first lumbar nerve
8. What is the path of the ilioinguinal nerve?
- Arises from the first lumbar nerve, pierces the internal oblique muscle near the
deep inguinal ring, and accompanies the spermatic cord through the inguinal canal
and then through the superficial inguinal ring.
9. What does the ilioinguinal nerve innervate?
- the internal oblique and transverse muscles.
10. What branches does the ilioinguinal nerve give rise to?
- Gives rise to a femoral branch, which innervates the upper and medial parts of
the anterior thigh, and the anterior scrotal nerve, which innervates the skin of the
root of the penis (or the skin of the mons pubis) and the anterior part of the
scrotum (or the labium majus)
VIII. Lymphatic drainage of the anterior abdominal wall
IX.
1. Where do the lymphatics in the region above the umbilicus drain into?
- into the axillary lymph nodes
2. Where do the lymphatics in the region below the umbilicus drain into?
- into the conjoint
nodes
3. Where do the superficial inguinal lymph nodes receive lymph from?
- the lower abdominal wall, buttocks, penis, scrotum, labium majus, and the lower
parts of the vagina and anal canal
4. Where do the efferent vessels of the superficial inguinal lymph nodes enter?
- Their efferent vessels primarily enter the external iliac nodes and, ultimately, the
lumbar (aortic) nodes.
Blood vessels of the anterior abdominal wall
1. What are the main blood vessels of the anterior abdominal wall?
-superior and inferior epigastric artery
-deep circumflex iliac artery
-superficial epigastric artery
-superficial circumflex iliac artery
-superficial (external)pudendal arteries
-thoracoepigastric veins
2. Which vessel does the superior epigastric artery arise from?
-internal thoracic artery
3. What is the path of the superior epigastric artery?
- Arises from the internal thoracic artery, enters the rectus sheath, and descends
on the posterior surface of the rectus abdominis
4. Which vessel does the superior epigastric artery anastomose with?
- with the inferior epigastric artery within the rectus abdominis
5. Which vessel does the inferior epigastric artery arise from?
- external iliac artery above the inguinal ligament
6. What is the path of the inferior epigastric artery?
- Arises from the external iliac artery above the inguinal ligament, enters the
rectus sheath, and ascends between the rectus abdominis and the posterior layer of
the rectus sheath
7. Which vessel does the inferior epigastric artery anastomose with?
- with the superior epigastric artery, providing collateral circulation between
the subclavian and external iliac arteries.
8. Which vessel does the inferior epigastric artery give rise to?
- the cremasteric artery, which accompanies the spermatic cord.
9. Which vessel does the deep circumflex iliac artery arise from?
-external iliac artery
10. What is the path of the deep circumflex iliac artery?
- Arises from the external iliac artery and runs laterally along the inguinal
ligament and the iliac crest between the transverse and internal oblique muscles
11. What vessel does a branch of the deep circmflex iliac artery anastomose with?
-musculophrenic artery
12. Which vessel do the superficial epigastric arteries arise from?
-femoral artery
13. What is the path of the superficial epigastric arteries?
-Arise from the femoral artery and run superiorly toward the umbilicus over the
inguinal ligament.
14. Which vessel do the superficial epigastric arteries anastomose with?
- with branches of the inferior epigastric artery.
15. Which vessel does the superficial circumflex iliac artery arise from?
-femoral artery
16. What is the path of the superficial circumflex iliac artery?
- Arises from the femoral artery and runs laterally upward, parallel to the inguinal
ligament.
17. Which vessels does the superficial circumflex iliac artery anastomose with?
- with the deep circumflex iliac and lateral femoral circumflex arteries.
18. Which vessel do the superficial external pudendal arteries arise from?
-femoral artery
19. What is the path of the superficial external pudendal arteries?
- Arise from the femoral artery, pierce the cribriform fascia, and run medially to
supply the skin above the pubis.
20. What do the thoracoepigastric veins connect?
-the lateral thoracic vein and the superfi cial epigastric vein.
21. Why are the thoracoepigastrci veins important?
- Provide a collateral route for venous return if a caval or portal obstruction
occurs.
PERITONEUM AND THE PERITONEAL CAVITY
I.
Peritoneum
1. What is peritoneum and what is it made of?
- serous membrane lined by mesothelial cells.
2. What are the two layers of the peritoneum?
-parietal and visceral peritoneum
3. What does the parietal peritoneum line?
- abdominal and pelvic walls and the inferior surface of the diaphragm
4. What nerves innervate the parietal peritoneum?
-somatic nerves such as the phrenic, lower intercostal, subcostal, iliohypogastric,
and ilioinguinal nerves.
5. What does the visceral peritoneum cover?
-the viscera
6. What nerves innervate the visceral peritoneum?
-visceral nerves
7. Is the visceral peritoneum sensitive to pain?
-no
II.
Peritoneal reflections
1. What is an omentum?
- fold of peritoneum extending from the stomach to adjacent abdominal organs.
2. What is the lesser omentum and where is it located?
- double layer of peritoneum extending from the porta hepatis of the liver to the
lesser curvature of the stomach and the beginning of the duodenum.
3. What ligaments does the lesser omentum consist of?
-hepatogastric and hepatoduodenal ligaments
4. What vessels run between the layers of the lesser omentum?
-left and right gastric vessels run between the two layers along the lesser
curvature of the stomach
5. What is characteristic about the right margin of the lesser omentum and what
structures does it contain?
-the right margin is free and contains the proper hepatic artery, bile duct, and
portal vein.
6. What is the greater omentum derived from?
-embryonic dorsal mesentery
7. Where is the greater omentum located?
- Hangs down like an apron from the greater curvature of the stomach, covering
the transverse colon and other abdominal viscera.
8. What vessels does the greater omentum transmit along the greater curvature of the
stomach?
-right and left gastroepiploic
9. How does the greater omentum prevent inflammation?
- Adheres to areas of inflammation and wraps itself around the inflamed organs,
thus preventing serious diffuse peritonitis
10. What are the ligaments in the greater omentum?
- gastrolienal, lienorenal, gastrophrenic, and gastrocolic
11. What is the path of the gastrolienal (gastrosplenic) ligament?
- Extends from the left portion of the greater curvature of the stomach to the hilus
of the spleen
12. What vessels does the gastrolienal ligament contain?
- short gastric and left gastroepiploic vessels.
13. What is the path of the lienorenal (splenorenal) ligament?
- Runs from the hilus of the spleen to the left kidney
14. What structures does the lienorenal ligament contain?
-splenic vessels and the tail of the pancreas.
15. What is the path of the gastrophrenic ligament?
- Runs from the upper part of the greater curvature of the stomach to the
diaphragm
16. What is the path of the gastrocolic ligament?
- Runs from the greater curvature of the stomach to the transverse colon.
17. What are the mesenteries in the abdomen?
-mesentery proper/mesentery of the small intestine
-transverse mesocolon
-sigmoid mesocolon
-mesoappendix
18. What is the mesentery proper and where is it located?
- Is a fan-shaped double fold of peritoneum that suspends the jejunum and the
ileum from the posterior abdominal wall
19. Where is the root of the mesentery located and how long is it
- extends from the duodenojejunal flexure to the right iliac fossa and is
approximately 15 cm (6 in.) long
20. What does the mesentery proper contain?
- superior mesenteric and intestinal (jejunal and ileal) vessels, nerves, and
lymphatics
21. What structures does the transverse mesocolon connect?
- posterior surface of the transverse colon to the posterior abdominal wall
22. What is the gastrocolic ligament?
-place where the transverse mesocolon fuses with the greater omentum
23. What structures does the transverse mesocolon contain?
- middle colic vessels, nerves, and lymphatics.
24. What structures does the sigmoid mesocolon connect?
- the sigmoid colon to the pelvic wall
25. What structures does the sigmoid mesocolon contain?
-sigmoid vessels
26. What structures does the mesoappendix connect?
- appendix to the mesentery of the ileum
27. What structures does the mesoappendix contain?
-appendicular vessels
28. Where is the phrenicocolic ligament located?
- Runs from the left colic flexure to the diaphragm
29. What does the falciform ligament connect?
- a sickle-shaped peritoneal fold connecting the liver to the diaphragm and the
anterior abdominal wall.
30. What structures does the falciform ligament contain?
- ligamentum teres hepatis and the paraumbilical vein, which connects the left
branch of the portal vein with the subcutaneous veins in the region of the
umbilicus
31. Where is the ligamentum teres hepatis (round ligament of the liver) located?
- Lies in the free margin of the falciform ligament and ascends from the umbilicus
to the inferior (visceral) surface of the liver, lying in the fissure that forms the left
boundary of the quadrate lobe of the liver.
32. How is the ligamentum teres hepatis formed?
III.
- Is formed after birth from the remnant of the left umbilical vein, which carries
oxygenated blood from the placenta to the left branch of the portal vein in the
fetus. (The right umbilical vein is obliterated during the embryonic period.)
33. What is the coronary ligament?
- a peritoneal reflection from the diaphragmatic surface of the liver onto the
diaphragm
34. What structure of the liver does the coronary ligament enclose?
- triangular area of the right lobe, called the bare area of the liver.
35. The ligamentum venosum is a remnant of which structure?
-ductus venosus
36. Where is the ligamentum venosum located?
- Lies in the fissure on the inferior surface of the liver, forming the left boundary
of the caudate lobe of the liver.
37. What are some peritoneal folds?
- five folds of peritoneum below the umbilicus, including the median, medial, and
lateral umbilical folds
38. Where is the rectouterine fold located?
- Extends from the cervix of the uterus, along the side of the rectum, to the
posterior pelvic wall
39. What structure does the rectouterine fold form?
-rectouterine pouch of Douglas
40. Where is the ileocecal fold located?
- Extends from the terminal ileum to the cecum.
Peritoneal cavity
1. What is the peritoneal cavity?
- a potential space between the parietal and visceral peritoneum and contains a
film of fluid that lubricates the surface of the peritoneum and facilitates free
movements of the viscera.
2. How does the peritoneal cavity differ in males and females?
- a completely closed sac in the male but is open in the female through the uterine
tubes, uterus, and vagina.
3. How is the peritoneal cavity divided?
-into lesser and greater sac
4. Where is the lesser sac (omental bursa) located?
- behind the liver, lesser omentum, stomach, and upper anterior part of the greater
omentum
5. What is the name of the place where the lesser sac communicates with the greater
sac?
-epiploic (omental) foramen
6. What are the recesses of the lesser omentum and where are they located?
-superior recess, which lies behind the stomach, lesser omentum, and left lobe of
the liver;
-inferior recess, which lies behind the stomach, extending into the layers of the
greater omentum;
-splenic recess, which extends to the left at the hilus of the spleen.
7. Where is the greater sac located?
-extends across the entire breadth of the abdomen and from the diaphragm to the
pelvic floor
8. What are the recesses of the greater sac?
-subphrenic (suprahepatic) recess
-subhepatic recess or hepatorenal recess (Morrison’s pouch)
-paracolic recess (gutters)
9. Where is the subphrenic (suprahepatic) recess located?
- Is a peritoneal pocket between the diaphragm and the anterior and superior part
of the liver
10. What separates the subphrenic (suprahepatic) recess into right ad left recesses?
-falciform ligament
11. Where is the subhepatic recess located?
- between the liver anteriorly and the kidney and suprarenal gland posteriorly
12. What recesses does the subhepatic recess communicate with?
- lesser sac via the epiploic foramen and the right paracolic gutter, thus the pelvic
cavity.
13. Where are the paracolic recesses located?
- lateral to the ascending colon (right paracolic gutter) and lateral to the
descending colon (left paracolic gutter).
14. What is the epiploic or omental (Winslow’s) foramen?
- natural opening between the lesser and greater sacs.
15. What are the boundaries of the omental foramen?
-superiorly by peritoneum on the caudate lobe of the liver
-inferiorly by peritoneum on the first part of the duodenum
-anteriorly by the free edge of the lesser omentum
-posteriorly by peritoneum covering the IVC.
GI VISCERA
I.
Esophagus (abdominal portion)
1. How long is the esophagus?
-25 cm
2. How much of the esophagus is in the abdomen?
-0.5 inch
3. What is the path of the abdominal part of the esophagus?
-from the diaphragm to the cardiac orifice of the stomach, entering the abdomen
through an opening in the right crus of the diaphragm.
4. What kind of contraction is present in the physiologic esophageal sphincter?
-tonic
5. What is hiatal/esophageal hernia?
II.
III.
- herniation of a part of the stomach through the esophageal hiatus of the
diaphragm into the thoracic cavity
Stomach
1. What forms the stomach bed?
- pancreas, spleen, left kidney, left suprarenal gland, transverse colon and its
mesocolon, and diaphragm.
2. Where is the stomach located?
- in the left hypochondriac and epigastric regions of the abdomen
3. What are the four regions of the stomach?
-cardia, fundus, body, pylorus
4. Where does the fundus lie?
- inferior to the apex of the heart at the level of the fifth rib.
5. What is the pylorus divided into?
-antrum and pyloric canal
6. Which vessels supply blood to the stomach?
- right and left gastric, right and left gastroepiploic, and short gastric arteries.
7. What are rugae?
- longitudinal folds of mucous membrane,
8. Which part of the stomach produces HCl?
-fundus and body
9. Which part of the stomach produces gastrin?
-antrum
Small intestine
1. Where does the small intestine start and end?
-starts at the pyloric opening and ends at the ileocecal junction
2. What is the function of the small intestine?
- complete digestion and absorption of most of the products of digestion and
water, electrolytes, and minerals such as calcium and iron
3. What are the main parts of the small intestine?
-duodenum, jejunum, ileum
4. What is the shape of duodenum?
-letter C
5. What is the length of the duodenum?
-25 cm
6. What is the location of the duodenum? Retro or intraperitoneal?
- retroperitoneal except for the beginning of the first part
7. What connects the first part of the duodenum to the liver?
- hepatoduodenal ligament of the lesser omentum.
8. What vessels supply the duodenum?
- celiac (foregut) and superior mesenteric (midgut) artery.
9. What are the parts of the duodenum?
-superior, descending, inferior/transverse, ascending
10. What is the duodenal cap?
IV.
-mobile section of the superior part of the duodenum
11. What important structures are located in the descending part of the duodenum?
-greater papilla- bile and main pancreatic ducts enter through it
-lesser papilla- accessory pancreatic duct enters here
12. Which part of the duodenum is the longest?
-transverse
13. At what level does the ascending part of the duodenum end?
-at L-2, at the duodenojejunal junction
14. What fixes in position the ascending part of the duodenum?
-suspensory ligament of Treitz
15. How long is the jejunum?
-2/5 of the small intestine length
16. Compare jejunum with ileum?
- emptier, larger in diameter, and thicker walled
-has the plicae circulares (circular folds), which are tall and closely packed.
-contains no Peyer’s patches (aggregations of lymphoid tissue).
- Has translucent areas called windows between the blood vessels of its
mesentery.
- Has less prominent arterial arcades (anastomotic loops) in its mesentery
- Has longer vasa recta (straight arteries, or arteriae rectae)
17. How long is the ileum?
-3/5 of the small intestine length
18. Where is the ileum located?
-false pelvis in the right lower quadrant of the abdomen.
19. What is the characteristic of ileum?
-Peyer’s patches (lower portion)
20. Compare ileum with jejunum.
- presence of Peyer’s patches (lower portion)
-shorter plicae circulares
-shorter vasa recta
-more mesenteric fat and arterial arcades
Large intestine
1. Where does the large intestine begin and end?
- from the ileocecal junction to the anus
2. How long is the large intestine?
-1.5m
3. What are the parts of the large intestine?
- cecum, appendix, colon, rectum, and anal canal.
4. What are the functions of the large intestine?
- convert the liquid contents of the ileum into semisolid feces by absorbing water,
salts, and electrolytes. It also stores and lubricates feces with mucus.
5. Colon-retro or intraperitoneal?
-retro: ascending and descending colon
V.
-intra: transverse and sigmoid
6. Which parts of the colon have their own mesentery?
-sigmoid and transverse (mesocolons)
7. What vessels supply the colon parts?
-ascending and transverse: superior mesenteric artery
-descending and sigmoid: inferior mesenteric artery
8. What nerves supply the colon parts?
-ascending and transverse: vagus nerve
-descending and sigmoid: pelvic splanchnic nerves
9. What are the characteristics of the colon?
- Teniae coli: three narrow bands of the outer longitudinal muscular coat.
- Sacculations or haustra: produced by the teniae, which are slightly shorter than
the gut.
-Epiploic appendages: peritoneum-covered sacs of fat, attached in rows along the
teniae.
10. What is the cecum?
-blind pouch of the large intestine
11. Does cecum have a mesentery?
-no
12. Where is cecum located?
-in the right iliac fossa
13. Cecum-retro or intra?
-intra
14. Does appendix have a mesentery?
-yes, mesoappendix
15. Where is the pain located during appendicitis?
-periumbilical region first, then RLQ
16. Where is McBurney’s point located?
- at the junction of the lateral one-third of the line between the right anterior
superior iliac spine and the umbilicus
17. Where do the rectum and anal canal extend?
-from the sigmoid colon to the anus
Accessory organs
1. What is the largest visceral organ and the largest gland in the human body?
-liver
2. What is the function of the liver?
-production and secretion of bile
-detoxification
-storage of carbohydrates as glycogen
-production and storage of lipids as triglycerides;
-plasma protein synthesis (albumin and globulin)
-production of blood coagulants (fibrinogen and prothrombin),
-production of anticoagulants (heparin)
-production of bile pigments (bilirubin and biliverdin) from the breakdown of
hemoglobin;
-reservoir for blood and platelets
-storage of certain vitamins, iron, and copper.
-In the fetus, the liver is important in the manufacture of red blood cells.
3. Liver- intra or retroperitoneal?
-intra
4. What ligaments attach the liver to the diaphragm?
- coronary and falciform ligaments and the right and left triangular ligaments
5. What is the bare area?
-area on the diaphragmatic surface of the liver that has no peritoneum and is
limited by layers of the coronary ligament
6. Which vessels deliver blood to the liver?
-hepatic artery: oxygenated blood
-portal vein: deoxygenated, nutrient rich, sometimes toxic blood
7. Which vessels drain the liver?
-hepatic vein into the IVC
8. What does the portal triad consist of?
-branches of portal vein, hepatic artery, bile duct
9. What structures separate the liver into right and left lobes?
-fossae for gallbladder and the IVC
10. What are the subdivisions of the right lobe of the liver?
-anterior (superior and inferior) and posterior (superior and inferior) segments
11. What are the subdivisions of the left lobe of the liver?
-medial (superior and inferior) and lateral (superior and inferior)
12. Where does the quadrate lobe (medial inferior) receive blood from?
-left hepatic artery
13. Where does the quadrate lobe (medial inferior) drain bile into?
-left hepatic duct
14. Where does the cuadate lobe (medial inferior) receive blood from?
-right and left hepatic arteries
15. Where does the caudate lobe (medial inferior) drain bile into?
-right and left hepatic ducts
16. What are the fissures of the liver?
-fissure for the round ligament (ligamentum teres hepatis)
-fissure for the ligamentum venosum
-fissure for the IVC
-fossa for the gallbladder
-porta hepatis (transverse fissure on the visceral surface of the liver)
17. Where is the gallbladder located?
- at the junction of the right ninth costal cartilage and lateral border of the rectus
abdominis,
- on the inferior surface of the liver in a fossa between the right and quadrate
lobes
18. What is the shape of the gallbladder?
-pear like
19. What is the capacity of the gallbladder?
-approx 30-50 ml
20. What are the parts of the gallbladder?
-fundus, body, neck, head
21. Which organs does the gallbladder touch?
-duodenum, liver and transverse colon
22. Does the cystic duct have valves?
-yes, Heister’s valves
23. Which vessel supplies the gallbladder?
-cystic artery, which arises from the right hepatic artery within the cystohepatic
triangle (of Calot)
24. What structures form the cystohepatic triangle of Calot?
-superiorly: visceral surface of the liver
-inferiorly: cystic duct
-medially: common hepatic duct
25. What is Hartmann’s pouch?
- abnormal conical pouch in gallbladder’s neck, also called the ampulla of the
gallbladder.
26. Where can gallstones lodge?
-fundus of the gallbladder
-bile duct
-hepatopancreatic ampulla
27. Where is the pancreas located?
- largely in the floor of the lesser sac in the epigastric and left hypochondriac
regions, where it forms a major portion of the stomach bed
28. Pancreas- retro or intraperitoneal
-retro, except for a small portion of its tail, which lies in the lienorenal
(splenorenal) ligament.
29. What is uncinate process?
- projection of the lower part of the head to the left side behind the superior
mesenteric vessels.
30. Where does the pancreas receive blood from?
- branches of the splenic artery and from the superior and inferior
pancreaticoduodenal arteries.
31. What are the ducts of pancreas?
-main and accessory
32. What is the path and function of the main pancreatic duct (Duct of Wirsung)?
- Begins in the tail, runs to the right along the entire pancreas, and carries
pancreatic juice containing enzymes
VI.
33. What structure does the duct of Wirsung join and where does it end?
- Joins the bile duct to form the hepatopancreatic ampulla (ampulla of Vater)
before entering the second part of the duodenum at the greater papilla.
34. What is the path of the accessory pancreatic duct (Santorini’s duct)?
- Begins in the lower portion of the head and drains a small portion of the head
and body. Empties at the lesser duodenal papilla approximately 2 cm above the
greater papilla.
35. What are the ducts involved in the bile passage?
-right and left hepatic ducts
-common hepatic duct
-cystic duct
-common bile duct (ductus choledochus)
-hepatopancreatic duct or ampulla (of Vater)
36. How are hepatic ducts formed and what do they drain?
- formed by union of the intrahepatic ductules from each lobe of the liver and
drain bile from the corresponding halves of the liver.
37. How is common hepatic duct formed?
- by union of the right and left hepatic ducts.
38. What vessels accompany the common hepatic duct?
- proper hepatic artery and the portal vein.
39. Why does the cystic duct have valves?
- keep the cystic duct constantly open, and thus bile can pass upward into the
gallbladder when the common bile duct is closed
40. How is the common bile duct formed?
- by union of the common hepatic duct and the cystic duct
41. Where is the common bile duct located and what is its path?
- lateral to the proper hepatic artery and anterior to the portal vein in the right free
margin of the lesser omentum. Descends behind the first part of the duodenum
and runs through the head of the pancreas. Joins the main pancreatic duct to form
the hepatopancreatic duct (hepatopancreatic ampulla), which enters the second
part of the duodenum at the greater papilla.
42. What is the name of the sphincter at the lower end of the common bile duct?
-sphincter of Boyden
43. How is hepatopancreatic duct/ampulla of Vater formed?
- by the union of the common bile duct and the main pancreatic duct
44. Where does the hepatopancreatic duct enter?
-enters the second part of the duodenum at the greater papilla.
45. What is the name of the sphincter in the hepatopancreatc duct?
-sphincter of Oddi (located in the greater duodenal papilla)
Spleen
1. Where is the spleen located?
-against the diaphragm and ribs 9 to 11 in the left hypochondriac region
2. Is the spleen covered by peritoneum?
-yes, except at the hilum
3. What ligaments support the spleen?
-lienogastric (splenogastric) and lienorenal (splenorenal) ligaments
4. What vessels supply and drain the spleen?
-by the splenic artery and drained by the splenic vein.
5. What are the two components of the spleen?
-white (immunity) and red pulp (filtration)
6. What are the functions of the spleen?
-Filters blood (removes damaged and worn-out erythrocytes and platelets by
macrophages); acts as a blood reservoir, storing blood and platelets in the red
pulp; provides the immune response (protection against infection); and produces
mature lymphocytes, macrophages, and antibodies chiefly in the white pulp.
VII. Development of the GI system
VIII. Celiac and mesenteric arteries
1. Where does the celiac trunk arise from?
- from the front of the abdominal aorta immediately below the aortic hiatus of the
diaphragm, between the right and left crura
2. What does the celiac trunk divide into?
- left gastric, splenic, and common hepatic arteries
3. Which artery is the smallest branch of the celiac trunk?
-left gastric artery
4. What vessel does the left gastric artery anastamose with?
-right gastric artery
5. What is the path of the left gastric artery?
- Runs upward and to the left toward the cardia, giving rise to esophageal and
hepatic branches and then turns to the right and runs along the lesser curvature
within the lesser omentum to anastomose with the right gastric artery.
6. What artery is the largest branch of the celiac trunk?
-splenic artery
7. What is the path of the splenic artery?
- runs a highly tortuous course along the superior border of the pancreas and
enters the lienorenal ligament.
8. What vessels does the splenic artery give rise to?
-dorsal pancreatic artery
-short gastric arteries
-left gastroepiploic (gastro-omental) artery- runs along the greater curvature of the
stomach
9. What is the path of the common hepatic artery?
- Runs to the right along the upper border of the pancreas
10. What arteries does the common hepatic artery divide into?
- proper hepatic artery
-the gastroduodenal artery
-possibly the right gastric artery.
11. What arteries does the proper hepatic artery give rise to?
-left and right hepatic arteries
-right gastric artery
12. What is the path of the proper hepatic artery?
-Ascends in the free edge of the lesser omentum and divides, near the porta
hepatis
13. What artery does the right hepatic artery give rise to?
-cystic artery in the cystohepatic triangle of Calot
14. What are the boundaries of the triangle of Calot?
-common hepatic duct, cystic duct, and inferior surface of the liver
15. Where does the right gastric artery arise from?
-Arises from the proper hepatic or common hepatic artery
16. What vessel does the right gastric artery anastamose with?
-left gastric artery
17. What is the path of the right gastric artery?
-Arises from the proper hepatic or common hepatic artery, runs to the pylorus and
then along the lesser curvature of the stomach, and anastomoses with the left
gastric artery.
18. What arteries does the gastroduodenal artery give rise to?
-supraduodenal artery to its superior aspect and a few retroduodenal arteries to its
inferior aspect.
-right gastroepiploic (gastro-omental) artery
-superior pancreaticoduodenal artery
19. What is the path of the gastroduodenal artery?
-Descends behind the first part of the duodenum, giving off the supraduodenal
artery to its superior aspect and a few retroduodenal arteries to its inferior aspect
20. What is the path of the right gastroepiploic artery?
-runs to the left along the greater curvature of the stomach, supplying the stomach
and the greater omentum.
21. What is the path of the superior pancreaticoduodenal artery?
-passes between the duodenum and the head of the pancreas
22. What does the superior pancreaticodudenal artery divide into?
-anterior and posterior superior pancreaticoduodenal artery
23. Where does the superior mesenteric artery arise from?
-Arises from the aorta behind the neck of the pancreas.
24. What is the path of the superior mesenteric artery?
-Arises from the aorta behind the neck of the pancreas.
-Descends across the uncinate process of the pancreas and the third part of the
duodenum and then enters the root of the mesentery behind the transverse colon
to run to the right iliac fossa
25. What arteries does the superior mesenteric artery give rise to?
-inferior pancreaticoduodenal artery
-middle colic artery
-right colic artery
-iliecolic artery
-intestinal arteries
26. What does the inferior pancreaticoduodenal artery divide into?
-anterior and posterior inferior pancreaticoduodenal artery
27. What is the path of the inferior pancreaticoduodenal artery?
-Passes to the right and divides into the anterior–inferior pancreaticoduodenal
artery and the posterior–inferior pancreaticoduodenal artery, which anastomose
with the corresponding branches of the superior pancreaticoduodenal artery
28. What arteries does the middle colic artery divide into?
-right and left branches
29. What do the branches of the middle colic artery anastomose with?
-right branch with right colic artery
-left branch with the ascending branch of the left colic artery
30. What is the name of the anastomosing structure formed by the branches off the
mesenteric arteries?
-marginal artery
31. What arteries does the right colic artery arise from?
-Arises from the superior mesenteric artery or the ileocolic artery
32. What is the path of the right colic artery?
-Runs to the right behind the peritoneum and divides into ascending and
descending branches, distributing to the ascending colon
33. What does the ileocolic artery divide into?
-ascending colic artery
-anterior and posterior cecal arteries
-appendicular artery
-ileal branches
34. What is the path of the ileocolic artery?
-Descends behind the peritoneum toward the right iliac fossa and then divides
35. How many intestinal arteries are there?
-12-15
36. What organs do the intestinal arteries supply?
-jejunum and ileum
37. What organs are supplied by the inferior mesenteric artery?
-descending and sigmoid colons and the upper portion of the rectum.
38. What arteries does the inferior mesenteric artery give rise to?
-left colic artery
-sigmoid arteries
-superior rectal artery
39. What is the path of the left colic artery?
-Runs to the left behind the peritoneum toward the descending colon and divides
into ascending and descending branches
40. How many sigmoid arteries are there and where are they located?
-2-3 arteries that run toward the sigmoid colon in its mesentery
41. Which vessels is the termination of the inferior mesenteric artery?
-superior rectal artery
42. What is the path of the superior rectal artery?
-descends into the pelvis, divides into two branches that follow the sides of the
rectum, and anastomoses with the middle and inferior rectal arteries
43. Where do the middle rectal arteries arise from?
-internal iliac arteries
44. Where do the inferior rectal arteries arise from?
-inferior rectal arteries
Celiac trunk
1. Left gastric
1. Esophageal branch
2. Hepatic branch
2. Splenic
1. Dorsal pancreatic
2. Short gastric
3. Left gastroepiploic
3. Common hepatic
1. Proper hepatic
i. Left hepatic
ii. Right hepatic
1. Cystic
iii. Right gastric
2. Gastroduodenal
i. Supraduodenal
ii. Retroduodenal
iii. Right gastroepiploic
iv. Superior pancreaticoduodenal
1. Anterior
2. Posterior
3. Possibly right gastric artery
Superior mesenteric artery
1. inferior pancreaticoduodenal artery
a. anterior
b. posterior
2. middle colic artery
a. right branch
b. left branch
3. right colic artery
a. ascending branch
b. descending branch
4. iliecolic artery
a. ascending colic artery
b. anterior and posterior cecal arteries
c. appendicular artery
d. ileal branches
5. intestinal arteries
IX.
Hepatic portal venous system
1. What is the hepatic portal system?
-Is a system of vessels in which blood collected from one capillary bed (of
intestine) passes through the portal vein and then through a second capillary
network (liver sinusoids) before reaching the IVC (systemic circulation).
2. How long in the portal vein?
-8 cm
3. What structures does the portal vein drain?
-the abdominal part of the gut, spleen, pancreas, and gallbladder
4. The union of which vessels forms the portal vein?
-splenic vein and the superior mesenteric vein posterior to the neck of the
pancreas.
5. Which vessels does the inferior mesenteric vein join?
-either the splenic or the superior mesenteric vein or the junction of these two
veins.
6. What vein does the portal vein receive?
-left gastric (or coronary) vein
7. Does the portal vein carry oxy or deoxygenated blood? Rich or poor in nutrients?
-deoxygenated blood, rich in nutrients
8. The pressure in the portal vein is higher or lower than in the IVC?
-higher
9. What is the path of the portal vein?
-Ascends behind the bile duct and hepatic artery within the free margin of the
lesser omentum.
10. What are the consequences of portal hypertension?
-esophageal varices
-caput medusae
-hemorrhoids
11. What vessel does the superior mesenteric vein accompany?
-the superior mesenteric artery on its right side in the root of the mesentery.
12. What is the path of the superior mesenteric vein?
-Crosses the third part of the duodenum and the uncinate process of the pancreas
and terminates posterior to the neck of the pancreas by joining the splenic vein,
thereby forming the portal vein.
13. How is the splenic vein formed?
-by the union of tributaries from the spleen
14. Which veins does the splenic vein receive?
-short gastric, left gastroepiploic, and pancreatic veins.
15. How is the inferior mesenteric vein formed?
-by the union of the superior rectal and sigmoid veins.
16. Which vein does the inferior mesenteric vein receive?
-left colic vein
17. Where does the inferior mesenteric vein drian into?
-usually drains into the splenic vein, but it may drain into the superior mesenteric
vein or the junction of the superior mesenteric and splenic veins.
18. Where does the left gastric (coronary) vein drain into?
-portal vein
19. What vessels do the esophageal tributaries d the left gastric vein anastomose
with?
-the esophageal veins of the azygos system at the lower part of the esophagus and
thereby enter the systemic venous system.
20. Where are the paraumbilical veins located?
-in the falciform ligament
21. What vessels do the paraumbilical veins connect?
-left branch of the portal vein with the small subcutaneous veins in the region of
the umbilicus,
22. What are some important portal-caval (systemic) anastomoses?
-The left gastric vein and the esophageal vein of the azygos system.
-The superior rectal vein and the middle and inferior rectal veins.
-The paraumbilical veins and radicles of the epigastric (superfi cial and inferior)
veins.
-The retroperitoneal veins draining the colon and twigs of the renal, suprarenal,
and gonadal veins.
23. What vessels do the hepatic veins consist of?
-right, middle and left hepatic veins
24. Where do the hepatic veins converge on?
-on the IVC
25. Do the hepatic veins have valves?
-no
RETROPERITONEAL VISCERA, DIAPHRAGM, AND POSTERIOR ABDOMINAL WALL
I.
Kidney, ureter and suprarenal gland
1. Is the kidney retro or intraperitoneal?
-retro
2. From which vertebra to which vertebra do the kidneys extend?
-from T12 to L3
3. Which kidney lies a little lower and why?
- The right kidney lies a little lower than the left because of the large size of the
right lobe of the liver.
4. Which ribs do the right and left kidney relate to?
-right to rib 12
-left to ribs 11 and 12
5. What is the name of the structure that surrounds the kidney?
-renal capsule
6. What are the names of the fat that the renal fascia divides?
-perirenal (perinephric) fat
-pararenal (paranephric) fat
7. What is the name of the structure through which the ureter, renal vessels, and
nerves enter or leave the organ?
-renal hilum
8. What are the parts of the kidney?
-medulla and cortex
9. What are the parts of the nephron?
- renal corpuscle (found only in the cortex), a proximal convoluted tubule,
Henle’s loop, and a distal convoluted tubule.
10. What are the functions of the kidney?
- Filters blood to produce urine; reabsorbs nutrients, essential ions, and water;
excretes urine (by which metabolic [toxic] waste products are eliminated) and
foreign substances; regulates the salt, ion (electrolyte), and water balance; and
produces erythropoietin and renin.
11. What are renal columns?
-projections of the cortex into the medulla
12. What parts of the nephron are in the cortex?
- renal corpuscles and proximal and distal convoluted tubules.
13. What does the renal corpuscle consist of?
- glomerulus (a tuft of capillaries) surrounded by a glomerular (Bowman’s)
capsule
14. What does the medulla consist of?
-8-12 renal pyramids of Malpighi
15. What parts of the nephron are in the medulla?
-loop of Henle, collecting tubules
16. What is the function of minor and major calyces?
-minor calyces Receive urine from the collecting tubules and empty into two or
three major calyces, which in turn empty into an upper dilated portion of the
ureter, the renal pelvis
17. Where does the ureter begin and end?
-begins with the renal pelvis and ends in the urinary bladder
18. Is the ureter retro or intraperitoneal?
-retro
19. What is the path of the ureter?
II.
III.
- descends on the transverse processes of the lumbar vertebrae and the psoas
muscle, is crossed anteriorly by the gonadal vessels, and crosses the bifurcation of
the common iliac artery.
20. What is the name of the junction of the ureter and kidney?
-ureteropelvic junction
21. What is the name of the junction of the ureter and urinary bladder?
-ureterovesicular junction
22. Which vessels supply the ureters?
- aorta and from the renal, gonadal, common and internal iliac, umbilical, superior
and inferior vesical, and middle rectal arteries
23. Which nerves innervate the ureters?
- lumbar (sympathetic) and pelvic (parasympathetic) splanchnic nerves.
24. Are the adrenal gland retro or intraperitoneal?
-retro
25. Where are the adrenal glands located?
- on the superomedial aspect of the kidney.
26. What are the adrenal glands coated by?
-capsule and fascia
27. What are the shapes of the right and left adrenal glands?
- pyramidal on the right and semilunar on the left.
28. What hormones are produces by the adrena cortex and in which part?
-outer zona glomerulosa: mineralocorticoids (aldosterones)
-middle zona fasciculata: glucocorticoids (cortisol and corticosterone)
-inner zona: androgens
29. What hormones does the medulla od the adrenal gland secrete?
-epinephrine and norepinephrine
30. Where do the adrenals receive arteries from?
- the superior suprarenal artery from the inferior phrenic artery
-the middle suprarenal artery from the abdominal aorta
-the inferior suprarenal artery from the renal artery.
31. Which vessel drains the adrenals?
- suprarenal vein, which empties into the IVC on the right and the renal vein on
the left.
Development of kidney, urinary bladder and suprarenal
Posterior abdominal blood vessels and lymphatics
1. What is the hole called that the aorta passes through when entering the abdomen?
-aortic hiatus
2. A what vertebral level is the aortic hiatus?
-T12
3. What vessels does the aorta bifurcate into and at what vertebral level?
-right and left common iliac arteries, at L4
4. What vessels does the aorta give rise to?
-inferior phrenic arteries
-middle suprarenal arteries
-renal arteries
-testicular or ovarian arteries
-lumbar arteries
-middle sacral artery
5. Where do the inferior phrenic arteries arise from?
- Arise from the aorta immediately below the aortic hiatus
6. What do the inferior hrenic arteries supply?
-the diaphragm
7. What vessels do the inferior phrenic arteris give rise to?
- superior suprarenal arteries.
8. What is the path of the inferior phrenic arteries?
- Diverge across the crura of the diaphragm, with the left artery passing posterior
to the esophagus and the right artery passing posterior to the IVC.
9. What is the path of the middle suprarenal arteries?
- Arise from the aorta and run laterally on the crura of the diaphragm just superior
to the renal arteries.
10. Where do the renal arteries arise from?
- Arise from the aorta inferior to the origin of the superior mesenteric artery.
11. What is the difference between right and left renal artery?
- The right artery is longer and a little lower than the left and passes posterior to
the IVC; the left artery passes posterior to the left renal vein.
12. What vessels do the renal arteirs give rise to?
- inferior suprarenal and ureteric arteries.
13. What branches do the renal arteris divide into?
- superior, anterosuperior, anteroinferior, inferior, and posterior segmental
branches.
14. Are the testicular/ovarian arteries retro or intraperitoneal?
-retro
15. What is the path of the testicular or ovarian arteries?
- Descend retroperitoneally and run laterally on the psoas major muscle and
across the ureter.
16. Which structures does the testicular artery accompany?
- ductus deferens into the scrotum
17. What structures does the testicular artery supply?
- spermatic cord, epididymis, and testis.
18. What structure does the ovarian artery supply?
- enters the suspensory ligament of the ovary, supplies the ovary,
19. What vessel does the ovarian artery anastomose with?
- supplies the ovary, and anastomoses with the
20. How many lumbar arteires are there and where do they arise from?
- Consist of four or fi ve pairs that arise from the back of the aorta
21. What is the path of the lumbar arteries?
- Run posterior to the sympathetic trunk, the IVC (on the right side), the psoas
major muscle, the lumbar plexus, and the quadratus lumborum
22. Where does the middle sacral artery arise from?
- Arises from the back of the aorta, just above its bifurcation
23. On the front of which structure does the middle sacral artery descend?
-sacrum
24. Where does the middle sacral end?
- the coccygeal body.
25. What does the middle sacral artery supply?
- Supplies the rectum and anal canal,
26. What vessels does the middle sacral artery anastomose with?
- the lateral sacral and superior and inferior rectal arteries.
27. The union of which vessels forms the IVC?
- two common iliac veins,
28. Where does the IVC start?
- formed on the right side of L5 by the union of the two common iliac veins,
below the bifurcation of the aorta.
29. Which vessel is longer? IVC or abdominal aorta?
-IVC
30. Which chamber of the heart does the IVC enter?
-right atrium
31. At what level and where does the IVC enter the thorax?
- Passes through the opening for the IVC in the central tendon of the diaphragm
at the level of T8
32. Which vessel does the IVC receive?
- right gonadal, suprarenal, and inferior phrenic veins
- three (left, middle, and right) hepatic veins
-right and left renal veins
33. What is cisterna chyli?
- Is the lower dilated end of the thoracic duct
34. Where is cisterna chyli located?
- lies just to the right and posterior to the aorta, usually between two crura of the
diaphragm
35. What structures form the cysterna chyli?
- formed by the intestinal and lumbar lymph trunks.
36. What are the lymph nodes related to the aorta?
-preaortic
-paraaortic, lumbar and lateral aortic
37. What are some preaortic lymph nodes?
- celiac, superior mesenteric, and inferior mesenteric nodes
38. Where do the preaortic lymph nodes drain lymph from?
- drain the lymph from the GI tract, spleen, pancreas, gallbladder, and liver
39. What structure do the efferent vessels of the preaortic nodes form?
IV.
-intestinal trunk
40. What organs do the paraaortic, lumbar and lateral aortic lymph nodes drain lymph
from?
- kidneys, suprarenal glands, testes or ovaries, uterus, and uterine tubes;
41. What vessels supply lymph to the paraaortic, lumbar and lateral aortic nodes?
- common, internal, or external iliac;
42. What structure do the efferent vessels of the paraaortic, lumbar and lateral aortic
nodes form?
- right and left lumbar trunks
Nerves of the posterior abdominal wall
1. By the union of which nerves is the lumbar plexus formed?
-union of the ventral rami of the fi rst three lumbar nerves and a part of the fourth
lumbar nerve.
2. Where is the lumbar plexus located?
-anterior to the transverse processes of the lumbar vertebrae within the substance
of the psoas muscle.
3. What is the path of the subcostal nerve (T12)?
- Runs behind the lateral lumbocostal arch and in front of the quadratus
lumborum.
-Penetrates the transverse abdominal muscle to run between it and the internal
oblique muscle
4. What muscles does the subcostal nerve innervate?
- external oblique, internal oblique, transverse, rectus abdominis, and pyramidalis
muscles.
5. What is the path of iliohypogastric nerve (L1)?
-Emerges from the lateral border of the psoas muscle and runs in front of the
quadratus lumborum.
-Pierces the transverse abdominal muscle near the iliac crest to run between the
muscle and the internal oblique muscle.
-Pierces the internal oblique muscle and then continues medially deep to the
external oblique muscle.
6. What muscles does the iliohypogastric nerve innervate?
- internal oblique and transverse muscles of the abdomen
7. What branches does the iliohypogastric nerve divide into and what do they
innervate?
- anterior cutaneous branch, which innervates the skin above the pubis,
-lateral cutaneous branch, which innervates the skin of the gluteal region.
8. What is the path of the ilioinguinal nerve (L1)?
- Runs in front of the quadratus lumborum, piercing the transverse and then the
internal oblique muscle to run between the internal and external oblique
aponeuroses.
-Accompanies the spermatic cord (or the round ligament of the uterus), continues
through the inguinal canal, and emerges through the superfi cial inguinal ring
9. What structures does the ilioinguinal nerve accompany?
- spermatic cord (or the round ligament of the uterus
10. What muscles does the ilioinguinal nerve innervate?
- internal oblique and transverse muscles
11. What branches does the ilioinguinal nerve divide into?
- femoral cutaneous branches to the upper medial part of the thigh and anterior
scrotal or labial branches.
12. What is the path of the genitofemoral nerve (L1-L2)?
- Emerges on the front of the psoas muscle and descends on its anterior surface.
13. What branches does the genitofemoral nerve divide into and what do they
innervate?
- Divides into a genital branch, which enters the inguinal canal through the deep
inguinal ring to reach the spermatic cord and supply the cremaster muscle and the
scrotum (or labium majus), and a femoral branch, which supplies the skin of the
femoral triangle.
14. What is the path of the lateral femoral cutaneous nerve (L2-L3)?
- Emerges from the lateral side of the psoas muscle and runs in front of the iliacus
and behind the inguinal ligament.
15. What structures does the lateral femoral nerve innervate?
- the skin of the anterior and lateral thigh.
16. What is the path of the femoral nerve (L2-L4)?
- Emerges from the lateral border of the psoas major and descends in the groove
between the psoas and iliacus.
-Enters the femoral triangle deep to the inguinal ligament and lateral to the
femoral vessels, outside the femoral sheath, and divides into numerous branches.
17. What structures does the femoral nerve innervate?
- skin of the thigh and leg, the muscles of the front of the thigh, and the hip and
knee joints.
-Innervates the quadriceps femoris, pectineus, and sartorius muscles
18. What nerves does the femoral nerve give rise to?
- anterior femoral cutaneous nerve and the saphenous nerve.
19. What is the path of the obturator nerve (L2-L4)?
- Arises from the second, third, and fourth lumbar nerves and descends along the
medial border of the psoas muscle. It runs forward on the lateral wall of the pelvis
and enters the thigh through the obturator foramen
20. What branches does the obturator nerve divide into?
- anterior and posterior branches
21. What structures does the obturator nerve innervate?
- the adductor group of muscles, the pectineus, the hip and knee joints, and the
skin of the medial side of the thigh
22. What nerve is present in only 9% of the population?
-accessory obturator nerve
23. What is the path of the accessory obturator nerve (L3-L4)?
- Descends medial to the psoas muscle, passes over the superior pubic ramus,
24. What structures does the accessory obturator nerve innervate?
- supplies the hip joint and the pectineus muscle
25. Which nerves form the lumbosacral trunk (L4-L5)?
- the lower part of the fourth lumbar nerve and all of the fi fth lumbar nerve,
which enters into the formation of the sacral plexus.
26. What structures belong to the autonomic ganglia?
-sympathetic chain (paravertebral) ganglia
-collateral (prevertebral) ganglia
-paraaortic bodies
27. What are the sympathetic chain ganglia composed of?
-Are composed primarily of ascending and descending preganglionic sympathetic
general visceral efferent (GVE) fi bers and general visceral afferent (GVA) fi bers
28. Where are the cell bodies of the general visceral afferent fibers located?
-in the dorsal root ganglia
29. What are the additional cell bodies that the sympathetic chain ganglia have?
-cell bodies of the postganglionic sympathetic fi bers.
30. What ganglia do the collateral ganglia have?
-celiac, superior mesenteric, aorticorenal, and inferior mesenteric ganglia
31. Which cell bodies form the collateral ganglia?
-cell bodies of the postganglionic sympathetic fi bers.
32. Which nerves supply the collateral ganglia with preganglionic sympathetic fibers?
-greater, lesser, and least splanchnic nerves.
33. What are the other names of the paraaortic bodies?
-aortic bodies, Zuckerkandl’s bodies, organs of Zuckerkandl, or aortic glomera.
34. What is the role of aortic bodies?
-chemoreceptors responsive to lack of oxygen, excess of carbon dioxide, and
increased hydrogen ion concentration that help to control respiration.
35. What cells make aortic bodies and where are they located?
-Are small masses of chromaffi n cells found near the sympathetic chain ganglia
along the abdominal aorta
36. What are the splanchinic nerves?
-thoracic and lumbar
37. What fibers do the thoracic splanchnic nerves have?
- preganglionic sympathetic (GVE) fi bers and GVE fibers
38. Where are the cell bodies of the preganglionic sympathetic (GVE) fibers located?
- in the lateral horn (intermediolateral cell column) of the spinal cord
39. Where are the cell bodies of the GVA fibers located?
- in the dorsal root ganglia.
40. What ganglion does the greater splanchnic nerve enter?
- the celiac ganglion
41. What ganglion does the lesser splanchnic nerve enter?
- aorticorenal ganglion,
V.
42. What structure does the least splanchnic nerve join?
- renal plexus.
43. Where do the lumbar splanchnic nerves arise from?
- from the lumbar sympathetic trunk
44. What structures do the lumbar splanchnic nerves join?
- the celiac, mesenteric, aortic, and superior hypogastric plexuses
45. What fibers do the lumbar splanchnic nerves have?
- preganglionic sympathetic and GVA fi bers.
46. What are the autonomic plexuses?
-celiac and aortic
47. What nerves form the celiac plexus?
- splanchnic nerves and branches from the vagus nerves
48. What ganglia does the celiac plexus have and what nerves do they receive?
- celiac ganglia, which receive the greater splanchnic nerves.
49. Where is the celiac plexus located?
- Lies on the front of the crura of the diaphragm and on the abdominal aorta at the
origins of the celiac trunk and the superior mesenteric and renal arteries.
50. What is the other name for the celiac plexus?
-solar plexus
51. What plexuses constitute the solar plexus?
- combined nerve plexus of the celiac and superior mesenteric plexuses.
52. Where is the aortic plexus located?
- Extends from the celiac plexus along the front of the aorta
53. What other plexuses does the aortic plexus form?
- mesenteric, testicular (or ovarian), and inferior mesenteric
-superior hypogastric plexus
54. What plexuses does the enteric division consist of?
-myenteric (Auerbach’s) plexus
- submucosal (Meisner’s) plexus
55. Where is the myenteric (Auerbach’s) plexs located?
- between the longitudinal and circular muscle layers,
56. Where is the submucosal (Meisner’s) plexus located?
-in the submucosa
57. What fibers does the enteric division consist of?
- preganglionic and postganglionic parasympathetic fi bers, postganglionic
sympathetic fi bers, GVA fibers, and cell bodies of postganglionic
parasympathetic fi bers.
58. What is the role of the enteric division?
-Have sympathetic nerves that inhibit GI motility and secretion and constrict GI
sphincters; parasympathetic nerves stimulate GI motility and secretion and relax
GI sphincters.
The diaphragm and its openings
1. What muscle is the principal muscle of inspiration?
-diaphragm
2. Where does the diaphragm arise from?
- Arises from the xiphoid process (sternal part), lower six costal cartilages (costal
part), medial and lateral lumbocostal arches (lumbar part), vertebrae L1 to L3 for
the right crus, and vertebrae L1 to L2 for the left crus.
3. Where does the diaphragm receive somatic motor fibers?
-phrenic nerve
4. Which nerve supplies sensory fibers to the central part of the diaphragm?
-Phrenic nerve
5. Which nerve supplies sensory fibers to the peripheral part of the diaphragm?
-intercostal nerves
6. Which arteries supply the diaphragm?
- musculophrenic, pericardiophrenic, superior phrenic, and inferior phrenic
arteries
7. Compare diaphragm in inspiration vs expiration.
-Descends when it contracts, causing an increase in thoracic volume by increasing
the vertical diameter of the thoracic cavity and thus decreasing intrathoracic
pressure.
- Ascends when it relaxes, causing a decrease in thoracic volume with an
increased thoracic pressure.
8. Which crus of the diaphragm is larger and loner right or left?
-right
9. Where do the right and left crura originate from?
-right from vertebrae L1 to L3 and the left crus originates from L1 to L2).
10. What is the path of the medial arcuate ligament (medial lumbocostal arch)
-Extends from the body of L1 to the transverse process of L1 and passes over the
psoas muscle and the sympathetic trunk.
11. What is the path of the lateral arcuate ligament (lateral lumbocostal arch)
-Extends from the transverse process of L1 to rib 12 and passes over the quadratus
lumborum.
12. What are the apertures through the diaphragm?
-vena cava hiatus (vena caval foramen)
-esophageal hiatus
-aortic hiatus
13. Where is the vena caval foramen located?
-Lies in the central tendon of the diaphragm at the level of T8
14. What structured does the ven caval foramen transmit?
-IVC and occasionally the right phrenic nerve.
15. Where is the esophageal hiatus located?
-Lies in the muscular part of the diaphragm (right crus) at the level of T10
16. What structures does the esophageal hiatus transmit?
-esophagus and anterior and posterior trunks of the vagus nerves.
17. Where is the aortoc hiatus located?
VI.
-Lies behind or between two crura at the level of T12
18. What structures does the aortic hiatus transmit?
-the aorta, thoracic duct, azygos vein, and occasionally greater splanchnic nerve.
Muscles of the posterior abdominal wall
1. What are the muscles of the posterior abdominal wall?
-quadratus lumborum
-psoas major
-psoas minor
2. What is the origin of quadratus lumborum?
- Transverse processes of L3–L5; iliolumbar ligament; iliac crest
3. What is the insertion of quadratus lumborum?
- Lower border of last rib; transverse processes of L1–L3
4. What nerves innervate quadratus lumborum?
- Subcostal; L1–L3
5. What is the action of quadratus lumborum?
- Depresses rib 12; fl exes trunk laterally
6. What is the origin of psoas major?
- Transverse processes, intervertebral disks and bodies of T12–L5
7. What is the insertion of psoas major?
- Lesser trochanter
8. What nerves innervate psoas major?
-L2-L3
9. What is the action of psoas major?
- Flexes thigh and trunk
10. What is the origin of psoas minor?
- Bodies and intervertebral disks of T12–L1
11. What is the insertion of psoas minor?
- Pectineal line; iliopectineal eminence
12. What nerves innervate psoas minor?
-L1
13. What is the action of psoas minor?
- Aids in flexing of trunk