Netter''s anatomy flash sards with over 300 multiple-choice questions presented. A perfect complement to study aid and Netter''s Concise clinical anatomy 3rd edition text and the Netter/Atlas of human anatomy 6th edition.
4 Abdomen Cards 4-1 to 4-31 Bones and Joints 4-1 Bony Framework of Abdomen Muscles 4-2 External Abdominal Oblique 4-3 Internal Oblique 4-4 Rectus Abdominis 4-5 Cremaster 4-6 Anterior Abdominal Wall: Deep Dissection 4-7 Quadratus Lumborum 4-8 Diaphragm Nerves 4-9 Autonomic Nerves and Ganglia of Abdomen 4-10 Autonomic Reflex Pathways: Schema 4-11 Nerves of Kidneys, Ureters, and Urinary Bladder 4-12 Visceral Referred Pain 4-13 Veins of Anterior Abdominal Wall 4-14 Inguinal Canal and Spermatic Cord 4-15 Arteries of Stomach, Liver, and Spleen 4-16 Arteries of Large Intestine 4-17 Arteries of Posterior Abdominal Wall 4-18 Renal Artery and Vein in Situ Vessels Netter’s Anatomy Flash Cards Abdomen Cards 4-1 to 4-31 4-19 Veins of Posterior Abdominal Wall 4-20 Hepatic Portal Vein Tributaries: Portosystemic Anastomoses Viscera 4-21 Greater Omentum and Abdominal Viscera 4-22 Omental Bursa: Stomach Reflected 4-23 Omental Bursa: Cross Section 4-24 Gallbladder and Extrahepatic Bile Ducts 4-25 Surfaces of Liver 4-26 Mucosa and Musculature of Small Intestine 4-27 Mucosa and Musculature of Large Intestine 4-28 Gross Structure of Kidney 4-29 Abdominal Wall and Viscera: Median (Sagittal) 4-30 Schematic Cross Section of Abdomen at T12 4-31 Schematic Cross Section of Abdomen at L2 Section and L3 Abdomen Table of Contents Bony Framework of Abdomen 12 11 10 Abdomen 4-1 Bony Framework of Abdomen 10 11 12 Costal cartilages Iliac crest Anterior superior iliac spine Anterior inferior iliac spine Superior pubic ramus Pubic arch Pecten pubis Greater trochanter of femur Ischial spine Iliac crest Xiphoid process Body of sternum Clinical: Imaginary lines mentally drawn on the surface of the abdominal wall assist clinicians in localizing pain and associated anatomic structures The subcostal line is an imaginary horizontal line across the lower margin of the costal cartilages; it crosses the descending duodenum The transumbilical plane is a horizontal line passing through the umbilicus and the L3-4 intervertebral disc The transtubercular plane passes through the iliac tubercles of the iliac crest and corresponds to the body of the 5th lumbar vertebra Another clinically useful way to locate painful viscera is to divide the abdomen into quadrants This is done by visualizing an imaginary vertical (median) plane from the xiphoid process to the pubic symphysis and a horizontal (transumbilical) plane The quadrants are the right upper quadrant, left upper quadrant, right lower quadrant, and left lower quadrant Abdomen Atlas Plate 243 Anterior Abdominal Wall: Superficial Dissection A B Abdomen 4-2 Anterior Abdominal Wall: Superficial Dissection External oblique muscle: muscular part (A) and aponeurotic part (B) Origin: Arises by fleshy digitations from the external surfaces and inferior borders of the lower ribs Insertion: The muscle attaches to the anterior half of the iliac crest, to the anterior superior iliac spine, and into a broad aponeurosis along a line from the 9th costal cartilage to the anterior superior iliac spine The aponeurosis inserts into the midline linea alba Action: Compresses the abdominal contents Contracting bilaterally, the muscles flex the vertebral column or trunk Acting alone, the muscle bends the vertebral column laterally and rotates it so as to bring the shoulder of the same side forward Innervation: Supplied by intercostal nerves T7-11 and the subcostal nerve (T12) Comment: This is the largest and most superficial of the flat abdominal muscles Clinical: On the left side (patient’s left), one can see the fatty Camper’s fascia and the underlying membranous (Scarpa’s) fascia of the abdominal wall These fascial planes are important in the spread of infection Fluid from the perineal region (e.g., resulting from a ruptured urethra) can spread into the abdominal wall between Scarpa’s fascia and the underlying investing (deep) fascia of the external abdominal oblique muscle and aponeurosis Abdomen Atlas Plate 245 Anterior Abdominal Wall Abdomen 4-3 Anterior Abdominal Wall Internal oblique muscle Origin: Arises from the lateral half of the inguinal ligament, the iliac crest, and the thoracolumbar fascia Insertion: Attaches to the inferior borders of the cartilages of the last or ribs, the linea alba, the pubic crest, and the pectineal line Action: Compresses the abdominal contents Contraction of both internal oblique muscles flexes the vertebral column Contraction on one side only bends the vertebral column laterally and rotates it, moving the shoulder of the opposite side anteriorly Innervation: By the intercostal nerves T7-11, subcostal nerve (T12), and iliohypogastric and ilio-inguinal nerves (L1) Comment: In the inguinal region, the aponeuroses of the internal oblique and transverse abdominal muscles fuse to form the conjoint tendon Clinical: A weakness in the anterior abdominal wall can lead to hernias, where underlying viscera and fat may protrude anteriorly and cause a bulge or rupture of the anterior muscle layers The most common types of abdominal wall hernias are inguinal hernias, umbilical hernias, linea alba hernias (usually occurring in the epigastric region), and incisional hernias (occurring at the site of a previous surgical scar) Abdomen Atlas Plate 246 Anterior Abdominal Wall Abdomen 4-4 Anterior Abdominal Wall Rectus abdominis muscle Origin: Arises inferiorly by tendons The lateral tendon is attached to the pubic crest, and the medial tendon interlaces with the tendon of the opposite side to arise from the pubic symphysis Insertion: Attaches into the cartilages of the 5th, 6th, and 7th ribs and the xiphoid process Action: Flexes the vertebral column or trunk, tenses the anterior abdominal wall, and depresses the ribs Innervation: Intercostal nerves (T7-11) and the subcostal nerve (T12) Comment: The rectus abdominis muscle is contained in the rectus sheath and is separated from the rectus abdominis on the other side by the linea alba The muscle is crossed by fibrous bands, which are the tendinous intersections; this gives the appearance of “6-pack abs.” Clinical: If abdominal pain is present, especially if the affected visceral structure (e.g., bowel, appendix) comes in contact with the inner aspect of the peritoneal wall, the patient may present with a guarding reflex The patient will contract the abdominal wall muscles when palpated (rebound tenderness) because of the abdominal pain, and the abdomen will become rigid Abdomen Atlas Plate 246 Superficial Nerves and Veins of Lower Limb: Anterior View 11 10 Lower Limb 7-66 Superficial Nerves and Veins of Lower Limb: Anterior View Lateral femoral cutaneous nerve Saphenous opening (fossa ovalis) Anterior femoral cutaneous nerves of thigh (from femoral nerve) Branches of lateral sural cutaneous nerve (from common fibular [peroneal] nerve) Dorsal metatarsal veins Dorsal venous arch Great saphenous vein Saphenous nerve (terminal branch of femoral nerve) Cutaneous branches of obturator nerve 10 Great saphenous vein 11 Femoral vein Comment: The cutaneous nerves of the thigh and leg are branches of the femoral, obturator, and sciatic nerves The lateral cutaneous nerve of the thigh arises directly from the lumbar plexus The great saphenous vein arises from a plexus of dorsal veins over the foot It ascends along the medial aspect of the leg, knee, and thigh to drain into the femoral vein Numerous superficial tributaries drain into the great saphenous vein Perforating branches from the saphenous vein and its tributaries communicate with deep veins accompanying the femoral and tibial arteries The superficial and deep veins of the lower limb, similar to the veins of the upper limb, possess venous valves to aid in venous return to the heart against gravity Clinical: The great saphenous vein may be harvested and used as a vessel graft (e.g., in coronary bypass) The superficial veins of the lower limb may become varicose (dilated), usually because their valves become incompetent and allow venous blood to back up and reverse flow in the veins Lower Limb Atlas Plate 470 Superficial Nerves and Veins of Lower Limb: Posterior View Lower Limb 7-67 Superficial Nerves and Veins of Lower Limb: Posterior View Middle cluneal nerves (from dorsal rami of S1, S2, S3) Branches of posterior cutaneous nerve of thigh Great saphenous vein Small saphenous vein Sural nerve Lateral sural cutaneous nerve (from common fibular [peroneal] nerve) Inferior cluneal nerves (from posterior cutaneous nerve of thigh) Superior cluneal nerves (from dorsal rami of L1, L2, L3) Comment: The sural nerve is formed by the union of cutaneous nerves from the tibial and common fibular (peroneal) nerves It courses with the small saphenous vein The small saphenous vein receives numerous superficial tributaries Perforating branches from the small saphenous vein and its tributaries communicate with deep veins accompanying the tibial artery and its branches The small saphenous vein drains into the popliteal vein behind the knee The superficial and deep veins of the lower limb, similar to the veins of the upper limb, possess venous valves to aid in venous return to the heart against gravity Clinical: Inactivity and venous stasis can have grave consequences for the veins of the lower limb Deep venous thrombosis can result and a thromboembolus can pass toward the heart and become lodged in the small capillary networks of the lung, obstructing a pulmonary artery Lower Limb Atlas Plate 471 Arteries of Thigh and Knee: Schema 10 Lower Limb 7-68 Arteries of Thigh and Knee: Schema 10 Femoral artery Deep artery of thigh Superior lateral genicular artery Anterior tibial artery Fibular (peroneal) artery (phantom) Posterior tibial artery (phantom) Inferior medial genicular artery (partially in phantom) Popliteal artery (phantom) Medial circumflex femoral artery Obturator artery Comment: The femoral artery is a continuation of the external iliac artery Its deep branch provides blood to the deep muscles of the thigh Medial and lateral circumflex femoral branches provide a rich anastomosis around the hip joint Similarly, a rich anastomosis around the knee joint is provided by medial and lateral pairs of genicular arteries When the femoral artery passes through the adductor hiatus of the adductor magnus muscle, it assumes a position behind the knee (popliteal fossa), becoming the popliteal artery Inferior to the knee, the popliteal artery divides into anterior and posterior tibial branches Clinical: Arterial pulses may be taken over the proximal femoral artery in the femoral triangle or posterior to the knee in the popliteal fossa over the popliteal artery Lower Limb Atlas Plate 499 Arteries of Leg: Anterior View Lower Limb 7-69 Arteries of Leg: Anterior View Superior lateral genicular artery Anterior tibial artery Anterior lateral malleolar artery Dorsal digital arteries Arcuate artery Medial tarsal artery Dorsalis pedis artery Inferior medial genicular artery Comment: The anterior tibial artery, a branch of the popliteal, supplies the anterior compartment of the leg and the dorsum of the foot It is accompanied by the deep fibular (peroneal) nerve, which supplies the muscles of the anterior compartment At the ankle, there is a rich anastomosis from malleolar, tarsal, and arcuate arteries Clinical: Two pulses are commonly taken on the distal lower limb The posterior tibial pulse is felt between the medial malleolus and the calcaneal tendon The dorsalis pedis artery is a continuation of the anterior tibial artery, and its pulse may be palpated on the dorsum of the foot just lateral to the tendon of the extensor hallucis longus as it emerges from the extensor retinaculum Lower Limb Atlas Plate 508 See also Plate 529 Arteries of Leg: Posterior View Lower Limb 7-70 Arteries of Leg: Posterior View Popliteal artery and tibial nerve Posterior tibial artery Medial plantar artery and nerve Lateral plantar artery and nerve Fibular (peroneal) artery (Perforating branch and Communicating branch) Fibular (peroneal) artery Fibular (peroneal) artery Anterior tibial artery Comment: The posterior tibial artery is a continuation of the popliteal artery Below the knee, it gives rise to the fibular (peroneal) artery, which courses deep to the flexor hallucis longus muscle As the posterior tibial artery passes inferiorly to the medial malleolus and enters the sole of the foot, it divides into medial and lateral plantar arteries The tibial nerve accompanies the posterior tibial artery along most of its course Clinical: The tibial artery pulse can be felt midway between the medial malleolus and the calcaneal tendon This artery passes beneath the sustentaculum tali of the calcaneus with the tibial nerve and long flexor tendons Lower Limb Atlas Plate 505 See also Plate 528 Arteries of Sole of Foot Lower Limb 7-71 Arteries of Sole of Foot Plantar metatarsal arteries Deep plantar arterial arch and deep branches of lateral plantar nerve Lateral plantar artery and nerve Medial plantar artery and nerve Deep branches of medial plantar artery and nerve Superficial branches of medial plantar artery and nerve Plantar digital artery proper of superficial branch of medial plantar artery Comment: The medial and lateral plantar arteries are continuations of the posterior tibial artery The lateral plantar artery is much larger than the medial branch It forms the major portion of the plantar arch, which anastomoses with other plantar branches and the dorsalis pedis artery Plantar metatarsal arteries arise from this plantar arch and give rise to plantar digital arteries proper Clinical: Puncture wounds or lacerations to the sole of the foot may bleed profusely because of the rich vascular anastomoses of the plantar arches Moreover, because of the tight, deep compartments containing tendons, muscles, and ligaments in the sole, controlling the bleeding may be problematic Lower Limb Atlas Plate 522 Summary of Lower Limb Arteries 11 10 Lower Limb 7-72 Summary of Lower Limb Arteries 10 11 Femoral artery Deep femoral (profunda femoris) artery Superior medial and lateral genicular arteries Posterior tibial artery (phantom) Anterior tibial artery Fibular artery Dorsal digital arteries Arcuate artery Dorsalis pedis artery (dorsal artery of foot) Popliteal artery Medial circumflex femoral artery Comment: The femoral artery is a direct continuation of the external iliac artery The medial and lateral circumflex femoral arteries form an anastomosis around the hip joint, with a contribution from the obturator artery Genicular branches of the popliteal artery form a rich anastomosis around the knee The posterior tibial artery continues into the sole and divides into medial and lateral plantar arteries Clinical: The major pulse points of the lower limb include: • Femoral pulse, just inferior to the inguinal ligament • Popliteal pulse, deep behind the knee (difficult to find) • Posterior tibial pulse, on the medial aspect of the ankle posterior to the medial malleolus • Dorsalis pedis pulse, felt just lateral to the flexor hallucis longus muscle tendon Lower Limb [SRG] Instructions for online access Thank you for your purchase Please note that your purchase of this Elsevier eBook also includes access to an online version Please click here (or go to ebooks.elsevier.com) to request an activation code and registration instructions in order to gain access to the web version uploaded by [stormrg] ... Abdomen Cards 4-1 to 4-31 4-19 Veins of Posterior Abdominal Wall 4 -20 Hepatic Portal Vein Tributaries: Portosystemic Anastomoses Viscera 4 -21 Greater Omentum and Abdominal Viscera 4 -22 Omental... Bursa: Stomach Reflected 4 -23 Omental Bursa: Cross Section 4 -24 Gallbladder and Extrahepatic Bile Ducts 4 -25 Surfaces of Liver 4 -26 Mucosa and Musculature of Small Intestine 4 -27 Mucosa and Musculature... Intestine 4 -28 Gross Structure of Kidney 4 -29 Abdominal Wall and Viscera: Median (Sagittal) 4-30 Schematic Cross Section of Abdomen at T 12 4-31 Schematic Cross Section of Abdomen at L2 Section