SSN Anatomy #2
October 9, 2002
Abdomen Schmabdomen
1 a) Abnormalities of Foregut rotation: (A: 24 II B, Moore p. 246-7)
Rotational Abnormality
Possible Sequelae
1. b) Abnormalities of Midgut Rotation (April 24II C)
Rotational Abnormality
Possible Sequelae
2. Subdivisions of GI Tract: (A:25, Moore p. 233))
Region
Foregut
Midgut
Structures
Arterial
Supply
Innervation
1)
2)
3)
4)
5)
6)
7)
1)
2)
Parasympathetic:
3)
Sympathetic:
Sympathetic:
Parasympathetic:
4)
5)
6)
1)
Hindgut
Parasympathetic:
2)
Sympathetic:
3)
Spinal
Level
Region of
Referred Pain
3. Somatic Nerves of Posterior Abdomen (A: p. 397-398)
Nerve
Motor
Sensory Functions
Spinal
Functions
Level
Iliohypogastric
Ilioinguinal
Genitofemoral
-Genital
-Femoral
Lateral
Femoral
Cutaneous
Femoral
Obturator
Lumbosacral
Trunk
Associated Reflex
4.Access to the peritoneal cavity: (A: 23 IV A-B; Moore p. 189-191)
Incision
Vertical:
Rectus sheath
Horizontal:
Rectus Sheath
Paramedian:
Rectus Sheath
Vertical:
Linea Alba
Transverse:
Ventrolateral
abdominal wall
Vertical:
Lateral Abdominal
Wall
Nerve supply cut
Arterial supply cut
Other pros & cons
5. Potential sites of herniation: (A: 23 VII D-F, Moore p. 205-207))
Weakness in
Boundaries
Hernia type
anterior wall
Triangle of
1).
Hasselbach
2)
Site of emergence
3)
1)
Deep Inguinal Ring
2)
3)
1)
Femoral Ring
2)
3)
4)
6.a) How is the arcuate line formed? (A: 28 III C, Moore p.184, Netter p. 235)
b) What is its clinical significance?
7. Primary derivatives of ventral and dorsal mesenteries. (A: 24 II A, )
Ventral Mesentery
Dorsal Mesentery
8. Peritoneal subdivisions. (A: 338 Table 24-1)
Explain what each term means and give an example of each:
Retroperitoneal
Peritoneal
Secondarily retroperitoneal
9. Peritoneal landmarks (A: 24 III B)
Peritoneal Structure
Boundaries
Clinical Significance
Foramen of Winslow
Subphrenic recess
Pouch of Morrison
Right colic gutter
10. a)Which vessels contribute to the marginal artery of the colon? (A p.377, Netter plate
287)
b) What are three clinical significance points of the marginal artery and why are they
important?
11. Liver vasculature and biliary drainage. (A: 25 II D)
Arterial Supply
Biliary Drainage
Liver lobe that is supplied
or drained
Right hepatic artery
Left hepatic duct
12. Trace the sympathetic and afferent innervation of the kidney: (A: p.388, Moore p.
290)
Sympathetic:
Afferent (Sensory):
13. Ureter innervation (A: p. 390)
Part of Ureter
Innervation
Upper abdominal
ureter
Refers pain to:
Area of narrowing
Lower abdominal
ureter
Pelvic ureter
14. From where does the adrenal vasculature supply arise and to where does the venous
drainage empty? ( A p. 392)
Arterial:
1)
2)
3)
Venous:
1)
2)
Clinical Cases
1. One day, a 48-year-old nurse practitioner comes to your office, complaining of a
“colicky” pain in the epigastric region. She notices that eating foods that are high in
fat exacerbates the pain. When you examine her, you find that she is jaundiced.
Upon taking her history, you also find that she has two children and that she had been
slightly obese until she started her “Deal-a-Meal” program a couple of months ago.
(A: p.359)
a. What do her symptoms and history indicate as a diagnosis?
b. Upon further testing, you decide that a gallbladder removal is indicated. After
entering the peritoneum, what should you locate before clamping or severing any
structures?
c. What are the boundaries of this structure?
d. What is its significance?
2. In the ER, you are presented with a 13 y/o girl who complains of diffuse, colicky pain
in the umbilical region. Her dad says she is just faking a stomachache because she
wants to avoid going to a family reunion. You feel her abdomen and it shows no
guarding (i.e. no muscle contraction to protect peritoneum upon touch). (A; p.370)
a. What is her differential diagnosis?
Due to several trauma cases that take you away, the girl and her father end up waiting for
three hours in the ER. The next time you come in, the girl is doubled over, her abdomen
displays guarding, and she shrieks when you press the lower-right quadrant.
a. Explain the guarding and the localized pain, and how this affects your diagnosis.
3. A 48 y/o male alcoholic visits his physician asking for treatment of painful
hemorrhoids. The patient’s liver is found to be enlarged, and a diagnosis of portal
hypertension is made. (A: p.379)
a. What causes portal hypertension?
b. Name three other manifestations of portal hypertension.
c. What surgical means are used to circumvent portal hypertension?
4. You’re a third-year medical student in the ER and a 50 y/o male comes in
complaining of lower back pain. You suspect kidney stones. (A: p.389)
a. Given the location of his pain, where do you think the stone has lodged?
b. What is the best way to access the kidney at the renal pelvis?
c. What complication is associated with this structure?
d. Upon surgical access to the kidney it is found that there is no stone, but rather an
acute kidney infection. How can this infection spread to other parts of the body?
“Quickies”
(April page #)
What’s the difference between the falx inguinalis and the conjoined tendon? (324)
Falx inguinalis:
Conjoined tendon:
What’s the “rule of 3’s” regarding a Meckel’s diverticulum? (365)
What are the “lineas” that surround the rectus abdominis?
Lateral:
Medial:
What three muscles comprise the posterior abdominal wall? (393)
What’s the significance of the “bloodless line” at the gastroduodenal junction? (348)
Kidney:
Which kidney lies lower in the abdominal wall and why? (385)
Is the kidney supported by mesentary? (385)
Name the three structures at the renal hilus. (386)
Where do the left and right gonadal and phrenic veins empty? (388)
Right:
Left:
Where is the kidney vascular and parenchymal pain principally referred? (388)h
The vascular supply of the ureters comes from: (390)