Ab 2 Flashcards
Which parts of the small intestine are intraperitoneal?
1) 1st (superior) and 5th (terminal slip) part of duodenum
2) jejunum
3) ileum
Which parts of the duodenum are secondary retroperitoneal?
2nd (descending), 3rd (horizontal), and 4th (ascending)
Where do ducts carrying excretions from the liver, gall bladder and pancreas enter?
duodenum
Where does jejunum start?
where the small intestine becomes free from secondary adhesion to the peritoneum
Which part of the small intestine run 40% of the length between the duodenum and cecum?
jejunum
Is the cecum part of the small or large intestine?
large intestine
What are three characteristics that separate small intestine from large intestine?
1) taenia coli
2) haustra
3) epiploic appendages
What is the blind intestinal pouch?
cecum
Where is vermiform appendix located?
lower pole of cecum
Is the cecum intraperitoneal, primary or secondary retroperitoneal?
intraperitoneal
Which part of the large intestine is found between cecum and right colic flexure?
ascending colon
Which part of the large intestine is found between right and left colic flexures?
transverse colon
Which part of the large intestine forms the left paracolic gutter?
descending colon
Which part of the large intestine forms the right paracolic gutter?
ascending colon
Which part of the large intestine is s-shaped?
sigmoid colon
Which part of the large intestine is fixed in position?
rectum
Which part of the large intestine is primarily retroperitoneal?
rectum and anus
Which parts of the large intestine are intraperitoneal?
cecum, transverse colon, and sigmoid colon
Which parts of the large intestine are secondarily peritoneal?
ascending colon and descending colon
Which part of the large intestine does not have taenia coli?
from rectosigmoid junction and beyond - rectum
Which part of the large intestine fuses greater omentum?
transverse colon
Which portion of the large intestine marks the division between embryonic midgut and hindgut?
midgut - duodenum to left colic flexure
hindgut - left colic flexure and beyond
Which three branches does the celiac trunk split into?
1) left gastric a
2) splenic a
3) common hepatic a
Which of the three branches of celiac trunk is the largest/
splenic a
What artery supplies the proximal portion of the lesser curvature of the stomach?
left gastric a
What artery supplies the spleen?
splenic a
What three branches does the splenic a split into?
1) pancreatic arteries
2) short gastric arteries
3) left gastro-omental (gastroepiploic) a
What does the pancreatic arteries supply?
neck, body and tail of pancreas
What does the short gastric arteries supply?
stomach (closest to the spleen)
What does the left gastro-omental (gastroepiploic) a supply?
left side of the greater curvature of the stomach
What artery supplies the liver?
R and L hepatic a. (from proper hepatic a)
what does the common hepatic a split into (3)?
1) gastroduodenal a
2) R. gastric a
3) proper hepatic a.
What does the gastroduodenal a further divides into (3)?
1) R. gastro-omental (gastroepiploic) a
2) superior pancreaticoduodenal a
3) supraduodenal a
What does the proper hepatic a further divides into (2)?
1) R. hepatic a
2) L. hepatic a
Which artery supplies the right side of the greater curvature of the stomach?
R. gastro-omental (gastroepiploic) a.
The left gastro-omental a. supplies _____ and is a branch of _______
1) left greater curvature
2) splenic a
The right gastro-omental a supplies _____ and is a branch of ______
1) right greater curvature
2) gastroduodenal a. (from common hepatic a)
What artery supplies the stomach, pancreas and head of the duodenum?
superior pancreaticoduodenal a
What artery goes to the superior duodenum, but sometimes absent?
supraduodenal a
What artery supplies the right lesser curvature?
R. gastric a.
What branch does the R. hepatic a give off?
cystic a
What artery supplies the gall bladder?
cystic a
Where does the left hepatic artery go?
liver
What are the branches of superior mesenteric artery (6)?
1) inferior pancreaticoduodenal a
2) intestinal branches
3) ileocolic a
4) R. colic a
5) middle colic a
6) marginal a
Where does the inferior pancreaticoduodenal a go?
head of the pancreas and the duodenum
Where does the intestinal branches go?
jejunum and ileum
Where does ileocolic a go?
distal ileum and cecum
Where does R. colic a go?
ascending colon
Where does middle colic a go?
transverse colon
What artery is known as the anastomotic artery that circles the colon?
marginal a
What forms the marginal a?
branches of ileocolic, R. colic, middle colic, and left colic
What does the marginal a give rise to ?
vasae rectae (straight vessels)
What are the branches of inferior mesenteric a?
1) L. colic a
2) sigmoid a
3) superior rectal a
Where does the L. colic a go?
descending colon
Where does the sigmoid a go?
sigmoid colon
Where does the superior rectal a go?
proximal recutm
The R. colic a supplies ______ and is a branch of ______
1) ascending colon
2) SMA
* *midgut
The L. colic a supplies ______ and is a branch of _____
1) descending colon
2) IMA
* *hindgut
Superior pancreaticoduodenal a supplies ____ and is a branch of _____
1) stomach, pancreas, and head of duodenum
2) gastroduodenal a (<– celiac trunk)
* *foregut
Inferior pancreaticodudodenal a supplies ____ and is a branch of _____
1) head of pancreas and duodenum
2) SMA
* *midgut
Where does deoxygenated blood from the abdomen drain to?
it goes through the hepatic portal system then to the inferior vena cava
What is a portal system?
circulatory system between two capillary beds
What are the three branches of the hepatic portal system and what part of the gut are they located?
1) splenic vein - foregut
2) superior mesenteric vein (midgut)
3) inferior mesenteric vein (hindgut)
What is the primary function of the hepatic portal system?
allows the liver to filter blood (detoxification)
Everything that goes through the gut will go through the hepatic portal system, what about suppositories?
this drug delivery system will bypass the hepatic portal system
Nitro-glycerin is administered under the tongue instead of pill form, why?
If placed underneath the tongue, the drug will be absorbed through the circulatory system without going through the hepatic portal system. If taken in pill form, the liver will turn the drug into something useless
What condition can cause this: blood pressure raised due to resistance of diseased liver? What does the body do to compensate?
Portal hypertension. alternate routes around the hepatic portal vein via portal-caval anatomoses
What condition can cause this: esophageal varices?
esophageal anatomosis (if burst, the blood can drown the individual)
What condition can cause this: hemorrhoids?
rectal anatomosis
What condition can cause this: caput medusa?
umbilical anastomosis
Secondarily retroperitoneal regions of the colon have anastomoses between portal vein and body wall veins
colonic anastomosis - generally no symptoms
Generally, ____ act to innervate blood vessels and inhibit parasympathetics
sympathetics
Visceral afferents travel with the ___ ___ fibers
sympathetic motor
____ act to promote peristalsis and some secretions
parasympathetics
What spinal nerve levels provide innervations at the foregut?
T5 - T9
Describe the pathway of spinal nerve through the foregut
presynaptics –> synaptic chain –> greater splanchnic n –> synapse in celiac ganglia –> postsynaptics follow celiac trunk –> target organs
What nerve is responsible for parasympathetics in the foregut?
vagus
Describe the journey of the parasympathetics at the foregut
from the brain –> pass through Vagus –> celiac plexus (without synapsing) –> target organ –> synapses in ganglia in gut plexuses –> postsynaptics reach targets via short postsynaptic fibers
What spinal nerve levels provide sympathetic innervations at the midgut?
T10 - T12
Describe the pathway of sympathetic fibers through the midgut
presynaptics –> synaptic chain –> lesser splanchnic and least splanchnic n –> synapse in superior mesenteric ganglion –> postsynaptics follow SMA –> target organs
Describe the pathway of parasympathetic fibers through the midgut
Same as foregut, instead of celiac plexus and celiac trunk, it passes through superior mesenteric plexus and SMA
What spinal nerve levels provide sympathetic innervations at the hindgut?
L1 - L2
Describe the pathway of sympathetic fibers through the hindgut
passes through lumbar splanchnic nerves, synapses in inferior mesenteric ganglion and follow IMA
Describe the pathway of parasympathetic fibers through the hindgut
Arise from S2-S4 (not vagus) –> pelvic splanchnic nerves –> hypogastric plexus and inferior mesenteric plexus –> IMA –> the rest is the same as foregut and midgut
celiac trunk
Vagus
T5 - T9
innervation of foregut
T10 - T12
superior mesenteric
Vagus
innervation of midgut
L1 - L2
inferior mesenteric
S2 - S4 (not Vagus)
innervation of hindgut
