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315 Cards in this Set
- Front
- Back
Boundaries of the abdominal cavity
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TV12 to LV5 posteriorly
Ala wings of sacrum and illeum, inferiorly and laterally (sometimes called the false pelvis) |
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Bony Boundaries of the true pelvis
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Sacrum Posteriorly
Ischiopubic rami and ischial spines laterally. |
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Soft tissue boundaries
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Diaphram superiorly, pelvic Diaphram inferiorly
Abdominal musculature between rib cage and pelvic girdle |
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skin with the ubilicus and vertebral level
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LV4 and dermatome t10
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Superficial fascia two layers
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Camper's-fatty
Scarpa's -membranous and deeper |
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External abdominal oblique att.
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attaches from lower 8 ribs, the fibers run inferiorly and anteriorly to attach to the aponeurosis forming the external lamella of the rectus sheath
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external oblique midline attachment and Inferior attachemnt-
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attach to the linea alba and to crest of the illeum
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Inferior extent of the external oblique gives rise to the
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the inguinal ligament (form anterior posterior spine to pubic tubercle
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Lacunar ligament is the
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medial end of the inguinal ligament which is rolled under the spermatic cord
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Pectineal ligament continues (cooper)
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laterally from the lacunar ligament along the pectineal line of the pubis (Strongest ligament of the body)
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The three ligamnets described are used during surgery
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for anchor points during hernia repair surgeries
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internal abdominal oblique att.
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attaches from the lateral 1/2 inguinal ligament and to the anterior 2/3 of the illiac crest. Fibers course superiorly and anteriorly. Superior attachment is the lower 3 or 4 ribs and to rectus sheath
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internal abdominal oblique abaove the arcuate line
below arcuate line |
splits into anterior and posterior lamellae
entire aponeurosis courses anterior to the rectus |
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Transversus Abdominis
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fibers begin from the lateral 1/3 of the inguinal ligament and anterior 3/4 of the of the illiac crest, from the thoracolumbar fascia, and from the lower 6 ribs.
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Transversus abdominus facia and arcuate line
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attaches to posterior lamellae of the rectus sheath above the arcuate line and to the anterior lamella of the rectus sheath below
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Rectus Abdominis muscle mm.
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a paired muscle on either side of the linea alba. Fibers run vertically, attach to the cartilages of ribs 5-7 superiorly, and the crest of the pubis inferiorly. Three horizontal tendinous intersections usually subdivide the mm. into 4 segments.
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Actions of muscles of abdominal wall
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compress the abdomen
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Blood supply to abdomen:
what courses horizontally between the internal oblique and transversus abd. and anastomose to supply abdominal wall |
the lower 5 intercostals aa., the subcostal a., and the lumbar aa. course nearly horizontal between these muslces
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superior and inferior epigastric course vertically and supply the rectus abdominis mm.
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yes they do, and also form an important anastomotic connection deep to the muscles
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Important vein of abdominal wall
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is the thoracoepigastric vein in the superficial fascia and forms important anastomosis with the lateral thoracic vv. superiorly paraumbilical, superficial epigastrics, and circumflex illiac
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It is critical to know that the rectus abdominis
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receives blood supply from the inferior and superior epigastric aa. This artery courses vertically then horizintally to supply the obligues.
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umblicus vertebral level
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L4, t10 dermatome
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suprapubic dermatome
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L1,
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LV4
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umblicus, illiac crest, and dorsal aorta bifurication
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Falciform ligament
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ventral mesentary derivaative that is continuous with the parietal periteneum and the anterior abdominal wall of the diaphram
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Umbilical ligaments
from peritoneal folds over umb. aa from peritoneal over urachus |
not true ligaments
medial umbilical- median umbilical |
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lateral umbilical ligaments
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formed by periteneum overlying the inferior epigastric vessels as they course through the deep surface of the rectus
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inferior epigastric aa.
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are branches of the external illiac aa.
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inferior epigastric vein
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terminate in the exteranl illiac vein
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Inguiunal Triangle
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medial to the inferior epigastric muscles and is the site of a direct hernia. Leads directly to the superficial ring.
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Boundaries of Hasselbach's ring
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lateral-inferior epigastric vessels
medial-lateral edge of rectus abdominis m Inferior-inguinal ligament |
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direct inguinal hernia
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it leads directly to the superficial inguinal ring
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indirect inguinal hernias
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occur lateral to the inferior epigastric vessels. This is the site of the deep inguinal ring.
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scrotum
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has kinky hairs
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Dartos tunic
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scrotal layer devoid of fat, but it is continuous with dartos fascia of the penis and the superficial fascia of the groin and the perineum, the thigh and the abdomen (scarpa's).
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Dartos muscle
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under sympathetic controlo regulates temperature of the testes.
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Covering's of spermatic cord and testis
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kwas 3:
exernal spermatic fascia-EAO cremaster muscle and fascia = IAO Internal Spermatic Fascia= transversalis fascia=deep ring |
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3 arteries
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cremasteric a. - off inf. epigastric
testicular a. - off aorta artery to vas deferens -off inf. vesicular |
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3 nerves
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ilioinguinal-L1, cutaneous to skin of anterior scrotum as anterior scrotal nn.
genital br. of genitofemoral n. (l1, l2) to cremaster muscle for cremaster reflex, uses l1 for distribution to the medial thigh as afferent limb of the reflex. autonomics to testes, dartos and to the blood vessels |
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3 other structures
1) |
pampiniform plexus of veins which drain the testis and give rise to the testicular v., which terminates in the left renal vein on the left or in the inferior vena cava on the right
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2) ductus deferens
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which is continuous with the epidymis, courses as the most posterior strucutre in the spermatic cord and joins seminal vescile
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3) lymphatics
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paralles venous drainage. This is why tumor metastasis from the testis is clinically very important, since it goes to the posterior abdominal wall
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Testis:
a-H |
next cards
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A
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retroperitoneal-develops along the urogenital ridge between layers which become transversalis fascia and parietal peritoneum
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B
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processus vaginalis-is an outpocketing of peritoneum into scrotum which proceeds the descent of the testis
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C
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Descent into scrotum goes along the course of the process vaginalis through superficial and deep ingiunal rings, gaining all coverings of the cord
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D
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Descent into scrotum
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D. hydrocele
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is a fluid filled sac as a remnant of the lumen of the processus vaginalis
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E. coverings
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the testes are covered by visceral and parietal layers of tunica vaginalis
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F. Efferent ducutules
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15 to 20, which are continuous with the seminferous tubules at the superior pole of the testis and drain into the epidymis
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G. the convulted epidymis
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used for sperm storage, drains into the vas deferens, goes to ejaculatory duct through the prostrate
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H. Tunica Albuginea
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dense white covering which forms the capsule of the testis
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Hernia follows
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cards
hernia is a protrusion into no no land |
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Hernia contains
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periteneum enclosing a lopp of intestines
10% of population |
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Inguinal hernia
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7:1 to male prevalence
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indirect:
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75% of male hernias, congenital, in young males at deep ring, lateral to inferior epigastric
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direct:
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25% aquired in older males at superficial ring. Through inguinal canal at superficial ring. Through inguinal triangle medial to inferior epigastric
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umbilical
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About 14% of hernias, and more common in females at region of umbilicus
1.7 to 1 |
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femoral
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5% of total hernias
more common in females than males 1.8 to 1 |
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obturator
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at obturator foramen
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epigastric
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at linea alba
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spigelian
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in posterior rectus sheath below arcuate line
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Lumbar
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On back of lumbar traingle
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Perineal
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through or between muscles of pelvic diaphram
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Diagphragmatic
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at a hiatus in diaphragm
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Repair of Hernia's
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necessary to prevent strangulation
Retract abdominal contents and strengthen wall suture to pectineal or inguinal ligament |
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pareintal peritoneum and pain
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receives same innervation as the overlying musculature; thus somatic peritoneal pain will be well localized and defined (referred c3-c5)
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visceral periteneum
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same innervation, vasc, and lymph as the organ it invests: relatively insensitive; vague visceral pain referred to epigastric, preumbilical, falnk, and pelvic domains derms
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peritoneal formations
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following cards
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mesentary
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double layer of peritoneum reflected off dorsal abdominal wall to viscera containg neurovasc, and lymph, fat
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mesentary proper
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is a braod fan like mesentary suspending the small bowel to the posterior abdominal wall, obliquely from the duodenojejunal fold to the right of the illiac fossa
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transverse mesocolon
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dorsal mesentary to the transverse colon
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sigmoid mesocolon
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attaches to the sigmoid colon to the posterolateral abdomino pelvic wall
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OMENTUM:
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double layer extension or fold of periteneum
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lesser ommentum
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ventral mesenteric derivative from the lesser curvature of the stomach and duodenum to the liver
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greater omentum
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dorsal mesenteric, from greater curvature of the stomach, draping over abdominl viscera, and back to transverse colon mesentary
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Ligament of tritz
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suspends the duodenal fold from the diaphram
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omental bursa
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refer to picture but space behind stomach and bounded by the liver
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subphrenic space
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above liver and but below diaphram
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paraduodenal recesses
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lateral to ascending duodenum
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Hepatorenal
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sub hepatic space above the right kidney; frequent abcess
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Esophagus
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right border continuous with the lesser curvature, and left border with greater curvature. Phrenico-eso. ligs attach. crura function as lower esophageal sphincter . terminates in cardiac sphincter of the stomach
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Stomach:
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intra-peritoneal, cardia surrounds the cardiac orfice. refer to feits for pic:
cards below |
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lesser curvature:
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concave, facing liver, lesser omentum associated: to porta hepatis forms ventral wall
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Ligaments of the greater omentum
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flaciform, coronary, triangular ligaments, -Hepatic:
Splenic: Lieno renal, gastro-splenic to right kidney and stomach Duodenum; ligament of treitz suspending duodenal fold Colon: phrenico colic ligment |
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subphrenic space
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above liver below diaphram
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hepatorenal
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subhepatic space above the right kidney, frequent abcess formation
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paracolic gutters
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lateral spaces along the asc. dsc colon
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paraduodenal recess
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lateral to ascending duodenum, duodenjejual fold; frequent abcess formation
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lower esophageal sphincter
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the crus of the diaphram
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duodenum
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from pylorus to dudodejunal fold, c shaped loop around of pancreas; lv1-lv3,4. mostly fixed, retroperitoneal location.
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Superior portion of duodenum
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related to gall bladder and liver (LV1) ventrally, heptaduodenal ligament, gastrodudenal artery. common bile duct portal vein and pancreas dorsally
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descending
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lv1 to lv4, covered ventrally by peritenuem. relationship with right kidney, IVC and psoasm. dorsally. Transverse colon. liver and jejunal loops are ventral. Common bile and pancreatic duct enter this portion about 7cm dorsal to the pyloric at the hepatopancreatic duct. and dudodenal papilla.
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Horizontal
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crosses lv3 lv4 area. head of pancrea superiorly.
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Ascending
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ascends to the duodenodal flecure left of LV2 and aorta. Transverse mesocolon and lig of trietz superiorly. Sup. mesenteric passes over top.
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duodenal ulcers
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occur close to pylorus most in posterior wall. massive hemorhage may result by eating through wall to the pancreas, gall bladder, or pancreaduodenal arteries.
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Lymphatics of duodenal region
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follow the arterial circulation and drain in to the pancreatic duodenal, superior mesenteric and celiac lymph nodes.
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Jejunum
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locted in the upper right and. has larger diameter, thicker wall and more vasculature. more mucosal folds.
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Illeum
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terminates at the illeocecal valve in cecal wall.
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small bowel mesentary
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contains the superior mesenteric artery and vein. visceral periteneum in this.
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lymphatics
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lacteal in mucosa drain to the mesenteric lymphs and. Abundant nea r antimesenteric border of illeum are called peyer' patches
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appendix
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also called the veriform appendage and contains lymphatics. Variable location in relation to the cecum
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ascending colon
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extends to the right colic flexure. just ventral to the kidney
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transverse colon
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from right hepatic flexure to splenci flexure
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liver
visceral surfaces saggital fossae |
porta hepatis-fissure for the portal vsin hepatic artery and hepatic bile duct ad lymphatics. attachemnt of heptaduodenal ligament and gastro hepatic ligament
relief for the ligamentum venosus, and the round ligament (ligamnetum teres). Boundaries of the caudate and quadrate hepatic |
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lobes of the liver seperated by
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falciform ligamament
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caudate lobe
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where vena cava and and liver asscoaite
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spleen impressions
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gastric, splenic flexure, pancreatic and renal impressions
has a central hilum |
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Sympathetics
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T5-9-greater splanchnic
lesser-t9-t12 least t12 lumbar l1-l3 |
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Celiac arteries
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arises at t12 just caudal to the aortic hiatus, has three main forgut branches
Below |
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Left Gastric artery
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supplies blood to 3 organs, esophagus (via esophageal branches), stomach ( along the lesser curvature via dorsal and ventral branches which anastomese with the branches of the right gastric a.) and liver via an accesory or abberant hepatic
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Splenic artery
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will explain in next few what it supplies
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Pancreas
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via twig branches caterogized into dorsal pancreatic, pancreatic magna, and caudal pancreatic
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Stomach
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via the left gastroepiploic usually the largest branch off the splenic. It courses through the pancreaticlieinal and gastrolienial ligamnets to reach the greater curvature of the stomach via the anterior aspect of the greater omentum. The short gastric aa. are 5-7 in number.-they reach the left side of the greater curvature of the stomach via the gastrolienal ligament. Here the anastomese with the left gastric and gastroepiploic.
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Spleen
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main branch to spllen via the superior and inferior branches at the hilum.
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New-Common Hepatic Artery
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it courses horizontally from left to right along the superior edge of the head of the pancrea to the first part of the duodenam. It gives three branches to be discussed in next 3.
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Gastro duodenal a.
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branches to stomach,
duodenam via supraduodenal, alonf the superior surface of the duodenam and the superior pncreatic duodenal artery which forms a ring of anast. around the head of the pancreas and duodenum. |
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proper hepatic
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has the right, left, and cystic branches
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right hepatic-
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functional right lobe of the liver,
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Left hepatic
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to both lobes, sometimes originates from the left gastric a
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cystic
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usually a branch of the righ hepatic and course through the cystic triangle either anterior or posterior(%75.
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triangles of Calot
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right-cystic duct, left-common hepatic duct, superior-liver
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rt. gastric.
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supplies the lesser curvature of the stomach and comes from the proper hepatic or common
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Superior mesenteric at lv1 courses _______ to the left renal vein, the uncinate process, and _____ part of the duodenum.
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Anterior to all that
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inferior pancreaticoduodenal a.
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anterio and posterio branches anastomose with the anterior and posterior branches of the posterior superior pancreaticoduodenal aa. around the head of the pancreas and 2nd part of duodenum.
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ileocolic
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most causal branch to the terminal illeum and cecum,
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right colic
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to the ascending colon.
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middle colic a
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first branches of the superior mesenteric.
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Inferior mesenteric
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left colic, sigmoid colic, and superior rectal.
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left colic
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descending colon
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sigmoid branches
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2 or 3 that supply the terminal part of descending colon and sigmoid pelvic colon
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superior rectal
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terminal ima that gives rise to the the anterior and posterior branches which anastomose with the middle rectal(from internal illiac) and the inferior rectal from the internal pudendal.
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colic aa. and connections with clinically important ________ a. are all interconnected by
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marginal artery is seen coursing near the colon.
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arc of Rhiolin
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interconnects the s middle collic and the left colic aa. This vessel becomes visible when the sma or ima becomes blocked. It is more proximal than the marginal artery.
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common hepatic
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formed by the union of the right and left hepatic ducts which drain the functional right and left lobes of the liver. Common hepatic joins with ___
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the cystic duct which
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supplies or drains the gall bladder and forms the _____________
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common bile duct which
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passes posterio to the 1st part of the duodenum and drains into the 2nd part of the duodenam in conjuction with the main pancreatic duct.
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liver lies in the
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right hypochondrium and superior part of the epigastrium.
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right lobe of liver is divided into
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anterio and posterior portions by segmental vesels and ducts. Each segment is then divided into anterior and superior
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left lobe is divided
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by medial and lateral segments which have superior and inferior segemnts.
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caudat lobe
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has left and right divisions.
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portal vein formation and path
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is formed by the union of the splenic and superior mesenteric veins and divides into right and left for lobes
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liver innervation
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liver and bile tract from sympathetic splanchnics from t7-t9. and paras from the left and right vagal truncks. Symps synapse in the celiac ganglion and innervate hepatic and portal vessels.
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symps of liver are __________ to the gall blader and bile ducts
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inhibitory while vagus is stimulatory
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hepatoduodenal ligament
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is free edge of the lesser omentum. Attaches to the hilum of the liver and contains the triad components (common bile duct, proper hepatic, portal vein,autonomics, and lymphatics. This lig. forms ant. boundary of the epiploic foramen (winslow). Inderior cava is posterior to foramen.
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portal system
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all major veins of the digestive tract are part of the portal system except the hepatic vein.
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portal vein
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breaks into radicles that end in the liver sinusoids
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superior mesenteric v. drains
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recieves drainage from the stomach via right gastroepiploic v.. pancreas and duodenum. all of jej. and ill., the cecum and appendix, the ascending colon. all or most of the transverse colon. Parralels the artery. End behind pancreas with splenic to form portal vein
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Inferior Mesenteric
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receieves the left colic, sigmoid, and superior rectal tributaries, and tus drains non sma transverse, the descending colon, sigmoid colon, and much of the rectum, plus the left part of the transverse colon.
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Splenic vein
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is formed by radicles from the spleen, recieves short gastric vv. and the left gastroepiploic v as it runs behind the pancreas vv. ALso recieves the inferior mesenteric vv. and ends by joining the superior mesenteric v. to form the portal vein.
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Esophageal varix
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blockage of blood flow through portal v. forces bloo back up into the veins around the esophagus causing them to enlarge as it flows from portal system to the azygos system. Veins involved are the eso. tribs of th eleft gastric vein.
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Hemorroids
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sup rectal of inf. mesenteric -portal system, communicates with the mid and inf. rectal vv. of int. illiac and int. pudendal respectively. These enlarge.
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Caput medusae
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vv in the falciform and the ligamentum teres connect to the epigastric vv. on the anterior body wall and drain toward the inguinal region or the axilla.
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Kidney and adrenal vertebral level
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tv12-lv3
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renal arteries and veins are at level
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lv2
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renal artery divides in kidaney to;;;;
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the 5 different segmental supplying the five different lobes of the arteries
no anastomotic connections between these arteries. |
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segemntals of kidneys branch at the
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junction of the cortex and the medulla (the arcuates) that then supply the functional unit the nephron
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right gonadal v. empties
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into the inferior vena cavs
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left gonadal vein
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empties directly into the left renal vein
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psoas major muscle att.
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transverse process of lumbar vertebrae, bodies and discs of t12-l5 and to the lesser trochanter of the femur
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psoas inn.
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ventral braches of l2, l3, l4
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psoas actions
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with the iliacus flexes the thigh superiorly
also w/ illacus flexes the trunk inferiorly |
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illacus att.
inn. act. |
attached to illiac fossa and alla of sacrum to the lesser trochanter and shaft of femur (l2-4)
flexes the thigh and stabililzes the hip. |
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Quadrutus lumborum
inn. act. |
attached superiorly to the medial 1/2 of the inferior border of rib 12 and tip of lumbar transverse process.
Attached inferiorly to the iliolumbar ligament and illiac crest. t12-lv4. Extends and leterally flexes the vertebral column; important inspiration. |
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Diaphram
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attached to lumbar vertebrae via the musculotendinous crura which define the aortic hiatus with the median arcuate ligament
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lateral to the crura
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are the thoracolumbar fascia
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medial arcuate ligaments-
lateral arcuate ligamnets |
over the psoas muscle
over the q. lumborum m. |
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openings in the diaphram from anterior to posterior
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8 10 12
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Lumbar Plexus
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l1-l4
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l1 superior branch are
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iliohypogastric, ilioinguinal
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inferior branches of l1 are
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genitofemoral with superior branch of l2
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ilioinguinal path
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transverses the inguinal canal; supplies medial upper thigh and anterior part of the scrotum
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genitofemoral emerges on psoas at
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passes through psoas muscle, emerging on its ventral surface at the level of LV4;
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genitofemoral then
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descends under the psoas fasia
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Genitofemoral -genital
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enters the inguinal canal; supplies the cremaster
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genitofemoral -femoral
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goes under the inguinal ligamnent supplies skin of medial thigh
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lateral femoral cutaneous
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l2,l3
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obturaotor
femoral lumbrosacral trunk |
l2, l3, l4
l2-l4 l4, l5 contributes to saccral plexus |
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referred pain below cards
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fuckin a hairy pussy while she takes a shit is an east tennessee spahetti with meatballs
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heart
aff. spinal nerves referred to |
=middle inf. cradiac n. and thoracic splanchnic
=t1-t4 and cervical ganglia =arm, high/mid thorax, neck, jaw |
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diaphragm
a s r |
phrenic n.
3-5 root of neck and shoulder |
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esophagus, stomach. liver and gallbladder, bile duct, sup. duodenum
a s r |
celiac plexus, greater splanchnic
t5-59 low thorax and epigastric region |
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inf. duodenum, jejunum, trans. colon
a s r |
SM plexus, lesser splanchnic
t9-t11 umbilical region |
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kidneys, high ureter, gonads
a s r |
=aorticorenal plexus, least splanchnic, upper lumbar splanch
=t12-l1 =lumbar, inguinal regions |
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desc sigmoid colon, midureter, uterus
a s r |
aortic plexus, lumbar splanchnics
l1, l2 pubic, inguinal, ant scrotum, labia, upper thigh |
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cervix, bladder, low ureter, rectum
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pelvic plexus, pelvic splanchnics
s2-4 leg, foot, perineum |
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Bony pelvis consists of the
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right and left hip bone sacrum and coccyx. The hip bone consists of three parts; ilium, ischium and pubis.
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pelvic brim
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divides the pelvis into a greater and false pelvis.
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pelvic inlet
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defined the pelvic brim
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pelvic outlet
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is define by the boundaries of the perneum.
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perineum
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a diamond shaped area inferior to the pelvic diaphram, not as yet defined. It is defined into the three areas.
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superficial perineal pouch
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superior perineal mb., inferior-Colle's fascia (which is a continuation of Scarpa's fascia in the abdomen and Dartos fascia in the scrotum and penis).
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contents of the pouch male
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left and right crura and bulb of the penis. Muscles covering the erectile tissue. Ischiocavernous covering the crura and bulbospongious m. covering the bulb. ALso included is the superficial transverse perineal muscle.
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Female perineal pouch
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left and right crura covered by the ischiocaernous m. the bulbs of the vestibules are covered by the bulbospongious muslce. Puch also contains the the superficial transverese perinei muscles. ALso the great vestibular gland.
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Deep perineal pouch or urogenital diaphram
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superior- superficial fascia of the urogenital diaphragm lying just under the pelvicdiaphgram; inferior- perineal membrane or inferior fascia of the urogenital diaphgram
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contents of the male deep pouch
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membranous urethra, urethral sphincter muscle and deep transverese perinei mm. Also bulbouretral glands (cowper's glands).
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Contents of the female deep pouch
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same as male except no bulbourethral galnd and the vagina pierces this layer just posterior to the membranous urethra
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penis consists of the
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root and body
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root of the penis
crus of penis |
bulb of the penis - bulbospongius m.
ischiocavernous mm. |
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Body of the penis
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corpus spongiusom - no muslce
corpus cavernosum-no muscle |
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clitoris
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consists of a root and a body but two vestibules surrounding the vaginal opening. Body conisists of two corpora cavernosa and a glans.
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wht is different about the clitoris and penis in regards to the urethra
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the clitoris not traveresed by the urethra and therefor has no corpus spongiosum
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Erection
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vaginas cause an increase of parasympathathetic stimulatino to smooth muscle of helicine arteries. As a result these artereis straighten their lumen and enlarge allowing more blood into the cavernous spaces. These enlarge the spaces and compress the veins draining blood from the erectile tissue to the deep dorsal vein.
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after the deep dorsal vein is blocked what happens?????
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the three corpora become enlarged and penis erect. After ejaculation the symps kick in and reverse these phenomenon by diminishing blood going into the erectile tissue resulting
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ejaculation
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sympathetic stimulation of smooth muscle in the deferent ducts, seminal vesicles and prostrate makes the emmisison of sperm and semen into the urethra.
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Ejaculation after emmissio of sperm
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results from stimulation of the bulbospongius muscle by the perineal nerve
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perineum nerve supply
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from the pudendal nerve. This innervates all of the muscles of the superficial and deep pouches.
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Dorsal nerve of the penis
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carries sensory innervation to the shaft and the glans of the penis.
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internal pudendal artery and vein
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supply and drain the blood from the perineum.
exceptions on the next cards |
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deep arteries of the penis
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supply both the corpora cavernosa
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arteries to the bulb
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continue to carry the blood to the corpus spongiosum
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single deep dorsal vein of the penis
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draining to the prostatic venous plexus in the male and vesicle plexus of the female.
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obturator internus muslce
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attaches around the obturator foramen within the pelvis.Fibers converge and exit through the lesser sciatic foramen forming a tendon that attaches to the greater trochanter of the femur. Innervation- nerve to the obturator internus (l5, s1, s2.
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piriformis muscle
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attaches to the anterolateral edge of the sacrum. Its fibers converge towards the greater sciatic foramen and the tendon attaches to the greater trochanter of the femur. S1 and S2 nn.
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Levator ani muscels
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from the pelvic floor.
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pubococcygeus
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attaches to the body of the pubis and runs posterolaterally to insert into the coccyx and anococcygeal ligament.
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pubococcygeus continued (muscel fibers)
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puborectalis and levator prostate form from the medial fibers of this muslce/ In females this new subset from the medial fibers is pubocaginalis.
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illiococcygeus m.
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is a levaot ani like pubbococcygeus and attaches to the obturator fascia and the ischial spine. These muslces pass posteriorly and attach to the coccyx and annococcygeal ligament. Perineal nerve inn.
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perinneal n. branch of pudendal 2, 3, 4, innervtes illiococcygeus on the
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inferior surface ; the superior surface is innervated by twigs form the 3rd and 4th sacral ventral rami.
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coccygeus muscle
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attaches to the ischial spine and sacrospinous ligament. Its medial attachment is the coccyx and SV5. Innervation-branches of the s4 and s5 rami.
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pelvic diaphgram is made by the
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two coccygeus muscles and the levator ani muscles. muslces of the pelvic diaphragm support the pelvis.
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ishiorectal fossa
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this is a wedge shape around the base of the anal canal. Fossa is filled with loose con. tissue and fat with inferior rectal nerves, arteries, and veins crossing it in a lateral to medial direction.
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ishiorectal fossa does what
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allow the anal canal to expand unobstructed for defecation
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boundaries of the ischiorectal canal
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superior-an apex created by the attachment of the iliococcygeus ligament. to the arcus tendineous.
inferior-perinanal skin medially-anal canal, and pelvic diaphragm laterally- obturator muscle |
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two sources of NO
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helicine artery endothelial cells and postganglionic parasympathetic fibers.
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viagra
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stops the breakdown of cGMP in the helicine arteries.
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seminal vesicle
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60% of fluid-contains high concentrations of fructose which acts as anenergy supply to sperm
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prostate
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30% of fluid, -- has alkaline buffers to help neutralize the high acidity of the vagina
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bulbourethral glands
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contained within the deep perineal pouches and secretes a mucilagionus substance that acts a lubricant during intercourse
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male most inferior point
female |
rectovesicle pouch
vesicuterine and rectouterine pouches (recto most inferior) |
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micturition
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as bladder fills parasymp aff. with pelvic splanchnics reach a threshold level of activation thus initiating the spinal reflex. Parasymp motor carried by pelvic splanchnics complete the efferent limb of this reflex. The motor fibers stimulate detrusor to contract but also relax sphincter vesicle of bladder.
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seminal vesicle
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60% of fluid-contains high concentrations of fructose which acts as anenergy supply to sperm
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prostate
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30% of fluid, -- has alkaline buffers to help neutralize the high acidity of the vagina
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bulbourethral glands
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contained within the deep perineal pouches and secretes a mucilagionus substance that acts a lubricant during intercourse
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male most inferior point
female |
rectovesicle pouch
vesicuterine and rectouterine pouches (recto most inferior) |
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micturition
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as bladder fills parasymp aff. with pelvic splanchnics reach a threshold level of activation thus initiating the spinal reflex. Parasymp motor carried by pelvic splanchnics complete the efferent limb of this reflex. The motor fibers stimulate detrusor to contract but also relax sphincter vesicle of bladder.
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sphincter urethrae
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consists skeltal muscle innervated by s234
under voluntary control |
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defection relfex
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parasymp aff. of pel. splnchs are stretch as shit fills. this initates a reflex. para efferents then stimulate smooth muslce of the rectal wall to contract but have the opposite effect on the sphincter and internus
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somatics of defecation
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puborectalis m., as well as internal and external sphincters. these muslces are innervated by the perineal n. and inferior rectal nerves respectively, both are branches of the pudendal nerve. puborectalis relaxes rectum and anal canal made linear. Sphincter relaxes.
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pprostate shape
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somewhat conical in shape with its apex pointed inferiorly. Divided into lobes.
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lobation is created by the;
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relative posistions of the prostatic urethra and ejaculatory ducts.
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men over 45
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median lobe hypertrophies. Compromises prostatic urethra and weakens stream.
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posterior lobe
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most frequent site of prostate cancer. Easily palpated.
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umbilical artery
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remnant of the fetal umbilical artery. It retains it lumen for a short while beyond the internal illiac artery giving off the superior vesical arteries. Beyond this is the cord. or medial ligament. All below are branches of the internal illiac.
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inferior vesical artery.
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distributed to the bladder, the prostate and the seminal vesicle
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middle rectal artery
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may arise in common with the inferior vesicle artery goes to rectum and anal canal.
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rectum blood supply
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from the ima via superior rectal, inferior rectal from the pudendal,
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renal fascia is a derivative of the
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transverse alis facia
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obturator artery
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arises from the internal illiac and runs on the lateral wall of the pelvis to the obturator canal. Sometimes n accessory obturator goes through the canal.
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internal pudendal artery
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supplies the perineum. leaves through the greater sciatic foramen just superior to the ischial spine. then reneter by passing across the surface of the spine and then back thorugh the lesser sciatic foramen. goes through pudendal canal to accompany pudendl nerve.
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iliolumbar a.
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posterio to obturator nerve and the external illiac vessels to the medial border of the psoas major muscle. Divides into a lumbar and an illiac branch.
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lateral sacral arteries
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gives branches to the sacral canal and to skin and muscles on the dorsal surface of the sacrum.
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superior gluteal artery
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is the largest branch of the internal illiac. passes between the lumbosaccral trunk and the first saccral nerve out of the pelvis above the superior border of the piriformis to enter the gluteal region.
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inferior gluteal artery
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also supplies the gluteal region. It arises from the internal iliac and usuaully passes between the 1st and 2nd sacral nerves to go between the piriformis and coccygeus muscles through the lower sciatic foramen.
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illioihypogastric n.
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l1, and runs medially and inferiorly between the internal abdominal and transverse abdominal muscle
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anterior cutaneous nerves
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t7-t11, subcostal, and ilioinguinal
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caput medusae
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superficial epigastric veins with the lateral thoracic vein in the superficial fascia.
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left ima vein to ima artery
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ascends to the left of artery
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mesoappendix
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appendicular artery
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splenic vein
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posterio to pancreas inferior to the spenic artery
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porto caval anastomosis
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left gastric vein/esophageal/ azygos
anorectal-superior rectal vein/middle and inferior rectal veins paraumbilical-paraumbilical veins/superficial epigastric retroperitoneal -colic/retroperitoneal veins |
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right and left testiculars a relationship
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inferior to the renal (just) lv2
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left renal vein
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crosses anterior to the renal arteries and aorta
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renal palvis
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most posterior in hilum
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right kidney contacts
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colic flexures, visceral liver, duodenum
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left kidney contacts
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spllen stomach, spleen, and panc
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sacroilliac articulation strenghten
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anterior and posterior sacroilliac ligaments
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membranous portion of the urethra
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in the deep pouch
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seminal vesicle to the ampulla
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lateral
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ejaculatory duct
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is formed from the seminal vesicle duct and the ductus deferens and empties into the porstatic urethra at the seminal colliculus
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ampula of the rectum
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where the puboccoccygeus surrounds
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anal columns
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contains superior rectal artery and vein
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anal valves
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forms anal sinuses
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pectinate formed
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by anal valves
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internal hems
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superior rectal and anas. with middle
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abberant obterator
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is at risk when repairing femoral hernia because of location at pelvic brim
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inferior vesicel artery
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not in female
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internal pudendal artery
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exits pelvic cavity by passing inferior to the piriformis through the greater sciatic foramen. often arises with the inferior gluteal.
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inferior gluteal artery
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usually passes between ventral rami s2 and s3. INferior to piriformis
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middle rectal
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arises in common with the inferior vesciel often. off internal illiac
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illiolumbar
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passes posteriorly then ascends between the lumbosaccral trunk and the obterator nerve. May arise with the lateral sacral.
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lateral sacral artery
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gives rise to a superior and an inferior branch. INferior branch passes anterior to the sacral ventral rami
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superior gluteal artery
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passes between the lumbosaccral trunk and the ventral ramus of s1
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prostatic, vesical and rectal drain to the internal illiac
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yes
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somatic plexus of pelvis are
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sacral and coccygeal plexus
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inferior hypogastric plexus
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primary visceral plexus of the pelvic cavity
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lumbosacral trunk l4-l5
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joins sacral plexus which is (l4 to s4)
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s2 and s3 arise
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bewtten the proxiamal attachemnt of the piriformis
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sciatic nerve
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l4 to s3, usually inferior to the piriformis
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pelvic splanchnics
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s234, carry preganglionic paras
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sacral portion of the symp trunk
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is medial to the ventral rami.
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umbilical
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at region of belly button
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femoral
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below inguinal ligament through femoral ring
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obturator
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through obturator foramen
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epigastric
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at linea alba
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spigelian
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in posterior rectus sheath below arcuat eline
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perineal
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through muscls of the pelvic diaphgram
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diapghragmatic
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hiatuses
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mesentary proper
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from the duojejunal fold to the right illiac fossa
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phrenicocolic
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diaphram to to left colic flexure
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trietz
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duodojenal flexure to the diaphram
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phrenicoesophageal ligaments
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esophagus
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crura
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lower esophageal sphincter
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lymphatics to gastric celiac nodes
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esophagus
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duodenal ulcers
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right next to the pylorus and pancreas, gall bladder and pancreaticoduodenal arteries
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lymphaticss of duo
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pancreaticoduodenal, mesenteric and celiac lymphs
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jejunum vs. illeum
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larger dia, thicker wall, longer vasa recta, more prominent plica (mucous folds) illeum has rich vascular arcade structure
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PEYERS
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ANTIMESENTERI LYMPHS
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MECKELS
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1 METER PROXIMAL TO THE ILEOCECAL VALVE ON ANTI MESENTERIC
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LYMPHATICS OF CONLN DRAIN TO SUPERIOR AND INFERIOR MESENTERIC NODES TO THE
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CISTERNA CHYLAE
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LYMPHATICS OF LIVER
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SUPERFICIAL IN GLISSON'S CAPSULE, DRAIN ALON TRIAS AND HEPATIC VEINS TO HEPATIC AND CELIAC LYMPHS, CYSTERNAE CHILI, MEDIASTINAL GO TO RETROSTERNAL VENTRALLY
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GALL BLADER
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9TH COSTAL CARTILAGE
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FUNDUS,
BODY |
ANTERIOR ABD. AND TRAN COLON
DUODENUM |
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SACRAL PARA AND PAIN
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FOR RECTAL AND ANAL
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PAIN FROM VISCERAL PERITENUEM
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EPIGASTRIC, PERI UMBLICAL, FLANK, AND PELVIC REGIONS
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