1. Anatomy Pt. I Flashcards by J L

After passing through the esophageal hiatus of the diaphragm, the abdominal ESOPHAGUS discharges its contents into the ____

The stomach empties into the ____, comprising DUODENUM, JEJUNUM and ILEUM.

The ileum is continuous with the ____, the proximal part of the LARGE INTESTINE or COLON.

Distal to the cecum we find, in sequence, the ____, TRANSVERSE, DESCENDING and ____ parts of the colon.

Finally, the ____ and ANAL CANAL are found in the true pelvis.

stomach
small intestine
cecum
ascending
sigmoid
rectum

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GI viscera occupy both the ____ and the ____ cavities of the trunk

abdominal

pelvic

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It is important to note that diaphragmatic contraction, pelvic floor contraction and contraction of the muscles in aponeuroses of the antero-lateral abdominal wall will have a profound effect on the pressures within the cavity.

The pressures will change with certain activities such as: • ____
• ____
• ____

respiration
defecation
urination

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The ____ muscles and their ____ form a strong but flexible abdominal wall, restraining the viscera and regulating changes in intra-abdominal pressure

Violating the integrity of the abdominal wall may lead to formation of ____

anterolateral abdominal
aponeuroses
hernias

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Here are examples of hernias:
• Epigastric hernia – Just under the ____ of the sternum we see
abdominal-pelvic contents escaping
• Umbilical hernia – in region of the ____

These are hernia locations in the abdominal-pelvic cavity, we will discuss diaphragm hernia locations in a bit

xiphoid process

umbilicus

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The walls, roof and floor of the abdominopelvic cavity are lined with a serous membrane - ____ – derived from ____

parietal peritoneum

somatic mesoderm

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While most gut derivatives are ____, invested by a thin layer of ____, derived from ____, and suspended by a mesentery…

…others have lost their suspensory mesentery and assumed a
____ position

peritonealized
visceral peritoneum
splanchnic mesoderm
(secondarily) retroperitoneal position

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The potential space between the parietal and visceral layers of peritoneum is called the ____

peritoneal cavity

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With the muscles of the abdominal wall and their aponeuroses reflected, note the…

FALCIFORM LIGAMENT
Derived from the
____
of the embryonic foregut

In the free edge, the
ROUND LIGAMENT OF THE LIVER
the obliterated
____

GREATER OMENTUM
Derived from the
____
of the embryonic foregut

ventral mesentery
umbilical vein
dorsal mesentery

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So what is a mesentery anyway?

It is a double layer of ____

visceral periotneum

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The____ of the peritonealized (intraperitoneal) viscera of the developed human suspend the organs and transmit the following structures between the GI tract and the posterior abdominal wall

Arterial supply from branches of the ____
Venous drainage to the ____
____ nerves
____

dorsal mesenteries
abdominal aorta
hepatic portal system
autonomic
lymphatics

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Much of the GI tract remains attached to the posterior abdominal wall via
____

But…during development, some viscera lose their suspensory mesenteries and become ____ to the posterior abdominal wall

Such viscera are covered by peritoneum only on their ____ and lateral aspects

These are referred to as ____ VISCERA

dorsal mesentery
fixed
anterior
secondarily retroperioneal

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____ frequently persist for these (retroperitoneal) organs

mesenteric stubs

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The secondarily retroperitoneal viscera include:

____
____
____
____

distal 3/4 duodenum
ascending colon
descending colon
rectum

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Derivatives of the ____ that suspended the embryonic gut are associated in the adult with FOREGUT derivatives only

ventral mesentery

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As the liver expands dramatically into the ____ of the foregut during development, these elements of the ____ will be examined more closely in the next module

ventral mesentery

lesser omentum

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The dorsal mesenteries are conduits for three arteries arising from the anterior aspect of the ____

abdominal aorta

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These vessels, arising as ____ in the embryo, will supply organs derived from the endoderm of the three abdominal divisions of the embryonic gut

vitelline arteries

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The origins of these vessels are consistent in relation to the vertebral column

____
– L1 transpyloric plane —
____
– L3 subcostal plane —
____

celiac
superior mesenteric
inferior mesenteric

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Recall that ____ and ____ are continuous with each other in the axial plane of the inferior border
of the ____, at the ____ vertebral level

hypopharynx
esophagus
cricoid cartilage
C6

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The thoracic ESOPHAGUS courses the length of both the ____

The esophagus passes through the esophageal hiatus of the ____ at the ____ level along with:
• ____
• ____

superior and posterior mediastinum
diaphragm
T10
anterior and posterior vagal trunks
esophageal blood vessels

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Esophageal arteries (4-5)
arise from the \_\_\_\_

Esophageal veins participate in an ____ between the ____ circulations

descending (thoracic) aorta
anastomosis
portal and caval (systemic)

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The esophageal plexus is formed with contributions from:

____ nerves
Direct visceral branches from ____ ganglia

Inferiorly, the vagus nerves reconstitute as ____

left and right vagal

upper thoracic sympathetic

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The esophagus is vulnerable to inflammation and carcinogenesis at three points of constriction

1 – ____
2 – ____
3 – ____

cervical constriction
broncho-aortic constriction
draphragmatic constriction

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Esophageal diverticulum Some 70% of these are ____ occurring at the junction of the pharynx and the ____ ____ diverticulum ____ (parahiatal) diverticulum

hypopharyngeal diverticulum esophagus parabronchial epiphrenic

Retention of food and secretions within the lesion’s pouch leads to: * ____ * ____ * ____ * ____

halitosis regurgitation aspiration dysphagia

Foregut derivatives Distal____, stomach, liver, gall bladder, ____, proximal duodenum Receive blood supply from the ____ and its branches Receive preganglionic sympathetic innervation from ____ Receive preganglionic parasympathetic innervation from the ____

``` esophagus pancreas celiac artery thoracic splanchnic nerves vagus nerves ```

A physiological ____ is found at the gastroesophageal junction ____– incomplete IES relaxation ____ Junction of esophageal and gastric mucosae GERD – excessive relaxation of IES leading to ____ and ____

inferior esophageal sphincter achalasia Z-line esophagitis barrett's esophagus

An acute angle between the ____ and the ____ of the stomach - the ANGLE OF HIS - also functions as a ____, limiting potential reflux of gastric contents

esophagus cardia valve

- CARDIA - FUNDUS - BODY - PYLORUS - lesser and greater curvatures hese curvatures are formed by the rotations of the ____

embryonic foregut

This 1st rotation explains the ____ The AP rotation also explains the size and relations of the ____derived from the ____

vagal trunks greater omentum dorsal mesogastrium

Note that the GREATER OMENTUM features ____ layers of peritoneum and fuses with the ____

four | transverse mesocolon

The stomach consists of ____ muscular layers which churn food, liquid and saliva into ____

three | chyme

- PYLORIC SPHINCTER - PYLORIC CANAL - gastric folds (rugae) Peptic ulcer disease (PUD) – lesions extending thru either the ____ or ____ mucosa

gastric | duodenal

An essential component of surgical management of peptic ulcer disease, ____ was once commonly performed to treat and prevent PUD - NO LONGER

vagotomy

DIAPHRAGMATIC HERNIAS result from loss of muscle tonus and widening of the ____ PARAESOPHAGEAL HIATAL HERNIA usually involves the ____ SLIDING HIATAL HERNIA a ____-shaped protrusion usually involving the ____

esophageal hiatus fundus bell cardia

Lesser omentum A remnant of ____ mesentery connecting the ____ to the lesser curvature of the ____ and the ____

ventral liver stomach first part of the duodenum

The LESSER OMENTUM is comprised of two distinct portions - ____ ligament - ____ ligament contains the ____

hepatogastric hepatoduodenal hepatic triad

Hepatic (portal) triad - ____ - ____ - ____

proper hepatic artery common bile duct hepatic portal vein

Vascular and biliary elements pass through a ____ fissure in the visceral surface of the liver known as the ____ Proper Hepatic Artery a branch of the ____ (is a direct branch of ____)

transverse porta hepatis common hepatic artery celiac artery

Main branches of the CELIAC TRUNK: - ____ - ____ - ____

left gastric common hepatic splenic

Proper hepatic Esophageal Left & right gastrics ____ is ligated in cholecystectomy (gallbladder removal) ____ may bleed profusely as a result of peptic ulcer disease LOOK AT THIS SLIDE BROTHER

cystic | gastroduodenal

Branches of ____ and | ____ anastomose around pancreas and duodenum

celiac | superior mesenteric

``` The HEPATIC PORTAL VEIN drains the abdominal gut from the ____ to the ____... As well as the • ____ • ____ • ____ ```

``` distal esophagus superior rectum spleen pancreas gallbladder ```

The HEPATIC PORTAL VEIN is normally formed deep to the neck of the ____ by the confluence of two veins (____ and ____)

pancrease splenic superior mesenteric

The Common bile duct and the anatomy of the biliary tree will be presented in the next module

YAY

The free edge of the ____ also forms the anterior wall of the ____, providing access to the ____, a large recess of the ____ created by the rotations of the stomach during development

hepatoduodenal ligament epiploic foramen (of Winslow) lesser sac peritoneal cavity

The LESSER SAC is also known as the ____

omental bursa

The OMENTAL BURSA permits the stomach to move freely against the posterior abdominal wall during ____ ____ HERNIAS ARE POSSIBLE

peristalsis | internal

The spleen is a fully ____ organ The spleen arises as a condensation of ____ in the dorsal mesentery of the ____ rather than from ____

peritonealized mesenchyme embryonic foregut gut endoderm

The long axis of the spleen is aligned with the ____ rib, the lowest of the ____ ribs, on the left side Protected by the rib cage, the organ is NOT normally ____ on physical exam

10th false palpable

``` With the stomach removed and its dorsal mesentery opened, the splenic artery and vein are seen passing through the ____ of the organ as it lies in the ____ of the abdominal cavity ```

hilum | left upper quadrant

Why is the splenic artery, a physiologic end-artery, so tortuous? There are TWO answers The spleen may store more than ____ fluid ounces of blood This location of the spleen immediately deep to fragile ribs, coupled with the organ's vascularity and its living consistency, predisposes the organ to relatively easy rupture by ____

8 | external trauma

The duodenum has four parts 1. ____ (continuous with the pylorus) 2. ____ (a 2nd vertical or descending portion) 3. ____ (crosses midline from right left) 4. ____ (points up)

superior descending transverse ascending

The pancreas lies on the posterior abdominal wall, posterior to the ____ between the ____ on the right and the ____ on the left

stomach duodenum spleen

The duodenum wraps around the ____ The “C” shape of the duodenum embraces the pancreatic head Duodenum terminates at the ____

pancreatic head | duodenojejunal junction

Both bile and pancreatic juice drain into the second (the ____) part of the the ____ COMMON BILE DUCT The the ____ Marks the boundary between foregut and midgut derivatives

descending duodenum major duodenal papilla

Midgut derivatives Distal duodenum, jejunum, ileum, cecum, ascending colon, proximal 2/3 transverse colon 0 Receive blood supply from the ____ and its branches Receive preganglionic sympathetic innervation from ____ nerves Receive preganglionic parasympathetic innvervation from the ____

superior mesenteric artery thoracic splanchnic vagal trunks

Elevating the GREATER OMENTUM, TRANSVERSE COLON and TRANSVERSE MESOCOLON reveals the ____ and ____... Which have much in common in terms of both ____ and peritoneal ____

jejunum ileum structure relationships

``` JEJUNUM ____ quadrant ____ Many ____ folds More ____ ``` ``` ILEUM ____ quadrant ____ ____ such folds Less ____ ```

upper left wider circular vascular lower right narrower few vascular

As you look into the ileum, which has a smoother luminal wall, we might find little concentrations of tissue called ____ patches, and Peyer's patches are examples of ____. Prominent in the ____and present but not in equal abundance and not presenting as obviously in the jejunum.

peyer's gut associated lymphatic tissue (GALT) ileum

In the ____ quadrant... The ____ prevents reflux of bacteria-laden cecal contents into the small intestine ILEO- CECAL JUNCTION

right lower | ileo-cecal valve

The relatively small human cecum, lying in the ____ quadrant, is the first part of the ____.

right lower | large intestine

Diagnostic features of the colon - ____ (3) - ____ - ____ FYI - these end at the rectum

teniae coli epiploic appendages haustra

The ____ is open to the cecum inferior to the ileo-cecal valve The appendix has evolved independently ____ times in mammalian evolution...so is it really a useless vestigial structure? The appendix is suspended from the cecum by it own ____

vermiform appendix 32 mesentery

Appendicitis may be caused by ____ of lymphatic follicles or by obstruction by a ____ Thrombosis of the ____ and rupture of the appendix producing ____ are concerns

hyperplasia fecolith appendicular artery peritonitis

Ascending colon | - hepatic (right colic) flexure

Everything we have seen from the major duodenal papilla to the point 2/3 of the way along the transverse colon is midgut and is supplied by the ____ and drained by the ____. The superior mesenteric artery arising from the abdominal aorta and the superior mesenteric vein ultimately draining into the portal system, so into the hepatic portal vein.

superior mesenteric artery | superior mesenteric vein

SMA - ____(jejunal and ileal) - ____ (anatomotic loop) - ____ - ____

intestinal arcade vasa recta inferior pacreaticoduodenal

The ____ generally supply alternating sides of the intestine

vasa recta