ANATOMY

001 - Dermatomal landmarks

Dermatome	Region
T4	__________ Nipple
T10	__________ Umbilicus
T12	__________ Pubis

002 - The abdominal musculature has three distinct layers that take three different directions. The external oblique muscle, internal oblique muscle, and transverse abdominis muscle may be sequentially split and retracted so that extensive __________ suturing is unnecessary to provide a strong repair (McBurney's incision).

003 - Because the __________ Linea alba is relatively avascular, incisions may not heal well and predispose to epigastric herniation.

004 - Above the arcuate line, the anterior leaf of the rectus sheath is formed by fusion of the external oblique and internal oblique __________ Aponeuroses; the posterior leaf is formed by the fusion of the internal oblique and transverse abdominis __________ Aponeuroses.

005 - Below the arcuate line, the anterior leaf of the rectus sheath is formed by fusion of all __________ Three aponeuroses and there is __________ No posterior leaf.

006 - The inferior epigastric artery passes into the rectus sheath at the arcuate line. This is a potential site for __________ spigelian herniation into the rectus sheath.

007 - Hernia characteristics

Hernia	Pathway
__________ Direct Inguinal	Through the inguinal triangle bounded by inguinal ligament, inferior epigastric artery, and rectus abdominis-therefore, medial to the inferior epigastric artery. Exits through the superficial inguinal ring adjacent to the spermatic cord.Usually acquired
__________ Indirect Inguinal	Through the deep inguinal ring and along the inguinal canal-therefore, lateral to the inferior epigastric artery. Exits through the superficial ring within the spermatic cord. Usually congenital
__________ Femoral	Passes inferior to the inguinal ligament through the femoral ring into the thigh. More prevalent in women

008 - Peptic ulceration of the lower esophagus, stomach, or superior duodenum is referred along the greater __________ splanchnic nerve to the fifth and sixth dermatomes which include the epigastric region.

009 - The hepatic triangle, bounded by the cystic duct, gallbladder, and common hepatic duct, contains the cystic arteries, and right __________ hepatic artery with potential for extensive variation.

010 - The duodenal papilla usually contains the hepatopancreatic ampulla, formed by the joining of the common bile duct and the pancreatic duct. If blocked by a stone, __________ pancreatitis may develop.

011 - The tail of the pancreas contains the majority of the pancreatic islets (of Langerhans), a consideration in pancreatic __________ resection.

012 - Ileal (Meckel's) diverticulum is found in about __________ 3 percent of the population, located within 3 feet of the ileocecal junction (on the antimesenteric side of the ileum), and usually less than 3 inches long. Peptic ulceration of adjacent ileal mucosa and volvulus are complications.

013 - The hepatic portal vein directs venous return from the gastrointestinal tract to the __________ liver.

014 - Because the hepatic portal system has no valves, blood need not flow toward the liver. Liver disease (such as __________ Cirrhosis) or compression of a vein (as in pregnancy or __________ Constipation) results in blood shunting through the anastomotic connections to the systemic venous system.

015 - Portal-systemic anastomoses occur in several areas:

Location	Anastomotic Connections	Signs & Symptoms
Esophagus	Azygos veins with left gastric and short gastric veins	__________ Esophageal varices, intractable hematemesis
Umbilicus	Paraumbilical veins with superior and inferior epigastric veins	__________ Caput medusa
Rectum	Superior rectal vein with middle and inferior rectal veins	__________ Internal and external hemorrhoids

016 - The renal fascia (the false capsule or Gerota's fascia) is a discrete fascial layer that surrounds each kidney. Paranephric fat outside this capsule and perinephric fat inside this fascial layer support the __________ Kidney.

017 - Minor calyces receive one or two pyramids before fusing into major calyces. Two to four minor calyces join to form major calyces that coalesce to form the __________ Renal pelvis.

018 - The ureters narrow at three points-at the renal pelvis, at the pelvin brim, and the __________ Bladder. Kidney stones may lodge at these locations with pain referred respectively to the __________ Subcostal, inguinal, and perineal regions.

019 - Adrenal arteries arise from the inferior phrenic arteries, the aorta, and the renal arteries. The right adrenal vein usually drains __________ Medially into the inferior vena cava; the left adrenal vein usually drains __________ Inferiorly into the left renal vein.

020 - The superior lumbar trigone (a posterior approach to the kidneys, suprarenal glands, and the upper ureters) is bounded by the quadratus lumborum muscle, superior border of the internal oblique muscle, and the __________ Twelfth rib.

021 - Pain referral from abdominal viscera:

Organ	Referral area	Pathway
Diaphragm   Central   Marginal	C3-C5: Neck and shoulder T5-T10: Thorax	__________ Phrenic nerve Intercostal nerves
Stomach, gallbladder, liver, bile duct, superior duodenum	__________ T5-T9: Lower thorax Epigastric region	Celiac plexus to greater splanchnic nerve
Inferior duodenum, jejunum, ileum, appendix, ascending colon, transverse colon	T10-T11: Umbilical region	__________ Superior mesenteric plexus to lesser splanchnic nerve

022 -

Organ	Referral area	Pathway
Kidneys, upper ureters, gonads	T12-L1: Lumbar and ipsilateral inguinal regions	__________ Aorticorenal plexus to lumbar splanchnic nerves
Descending colon, sigmoid colon, mid ureters	L1-L2: Pubic andinguinal regions, anterior scrotum or labia, anterior thigh	__________ Aortic plexus to lumbar splanchnic nerves