Abdomen #1 Flashcards
0
Q
Give the structures that lie posterior to the first part (superior part) of the duodenum (4)
A
Mnemonic: BIG P
- ) Bile duct
- ) Gastroduodenal artery
- ) Portal vein
- ) Inferior vena cava (IVC)
1
Q
Give the structures that lie ANTERIOR to the first part of the duodenum (3)
A
p. 292 and p.296 Rohen
1. ) Peritoneum
2. ) Gallbladder
3. ) Quadrate lobe of the liver
2
Q
The superior duodenum is connected to the liver by the ________ (part of the _____).
A
Hepatoduodenal ligament (part of the LESSER OMENTUM).
3
Q
Which structures lie superior to the first part (superior part) of the duodenum (2)?
A
- ) Neck of the gallbladder
2. ) Hepatoduodenal ligament (lesser omentum)
4
Q
Which structures lie inferior to the first part (superior part) of the duodenum (2)?
A
- ) Neck of pancreas
2. ) Greater omentum
5
Q
What artery perforates the first part of the duodenum?
A
Gastroduodenal artery
High yield, per Dr. Rich
6
Q
At what vertebral levels does the descending part (second part) of the duodenum lie?
A
Descends along the right of L1-L3
7
Q
What structure(s) lie within the hepatoduodenal ligament?
A
*Mnemonic: HH CLB* Hepatic artery proper Hepatic portal vein Common bile duct Lymphatic vessels Branches of the vagus nerve
8
Q
What supplies blood to the duodenum?
A
Celiac (foregut) and superior mesenteric (midgut) arteries
9
Q
The head of the pancreas is cradled by the _________
A
See p.296 Rohen
C-shaped portion of the descending (2nd part) part of the duodenum.
10
Q
Which structures are found near the 2nd part (descending part) of the duodenum –> medially, laterally, posteriorly, and anteriorly?
A
Medially: Head of pancreas
Laterally: Kidney and suprarenal gland
Posteriorly: Psoas major and IVC
Anteriorly: Transverse colon, border of liver
11
Q
What structure(s) lie posterior to the horizontal (third) part of the duodenum (5)?
A
IVC, abdominal aorta, L3 vertebra, psoas major, and right ureter.
12
Q
Which structures lie anterior to the third part (horizontal part) of the duodenum (3)?
A
p.296 Rohen
Superior mesenteric artery (SMA), SMV, root of mesentery, and parts of the jejunum.
13
Q
Which structures lie superior to the third part (horizontal part) of the duodenum (3)?
A
Head of the pancreas (on the right), SMA, SMV
14
Q
Which two veins unite to form the hepatic portal vein?
A
Splenic, superior mesenteric
15
Q
Parasympathetic innervation to the duodenum comes from where?
A
The vagus nerve via celiac and superior mesenteric plexuses
16
Q
What does peptic ulcer disease consists of?
A
Ulcers of the stomach and duodenum (23:24 Lecture 29a)
17
Q
Define SMA syndrome
A
Compression of the third part of the duodenum by the SMA and AA
18
Q
Define Nutcracker syndrome. Symptoms?
A
SMA compressing left renal vein against the aorta.
Symptoms: Hematuria, anemia, abdominal pain, left testicular pain (due to back up of venous flow into gonadal veins), vericocele (enlargement of veins in the scrotum), LLQ pain in women
19
Q
What is the name of the ligament where the jejunum begins?
A
Ligament of Treitz
20
Q
What quadrant does the jejunum mostly occupy?
A
LUQ
21
Q
What are the circular folds of muscle within the jejunum called?
A
Plicae circularis
22
Q
What quadrant does the ileum mainly occupy?
A
RLQ
23
Q
Where does the ileum terminate?
A
ileocecal junction
24
Compare the relative thickness and vascularity of the ileum to the jejunum
Ileum is thin-walled and less vascular than the jejunum
25
Where are Peyers patches present?
Duodenum and ileum...NOT JEJUNUM
26
1. ) What is the name for the specialized lymphatic vessels that absorb fat?
2. ) What is the absorbed fat called?
3. ) Where does the lymph ultimately drain?
1. ) Lacteals
2. ) Absorbed fat called "chyle"
3. ) Cisterna chyli
27
What supplies...
1. ) Parasympathetic innervation to the jejunum and ileum?
2. ) Sympathetic innervation to the jejunum and ileum?
1. ) Parasympathetic = VAGUS
| 2. ) Greater and lesser splanchnic nerves (T5-T9 spinal cord segments)
28
What are the boundaries of the anterior (anterolateral) abdominal wall?
1. ) Superiorly
2. ) Inferiorly
1. ) Superiorly: Cartilages of the 7th-10th ribs, and the xiphoid process of the sternum.
2. ) Inferiorly: Inguinal ligament and the superior margins of the anterolateral aspects of the pelvic girdle (iliac crests, pubic crests, and pubic symphysis).
pp. 184-186 Moore
29
Name and describe the three flat muscles of the anterolateral abdominal wall
1. ) External oblique:
2. ) Internal oblique:
3. ) Transversus abdominis:
30
Name all of the structures in the RUQ (10)
1. ) Liver: right lobe
2. ) Gallbladder
3. ) Stomach: pylorus
4. ) Duodenum: parts 1-3
5. ) Pancreas: head
6. ) Right suprarenal gland
7. ) Right kidney
8. ) Right colic (hepatic) flexure
9. ) Ascending colon: superior part
10. ) Transverse colon: right half
31
What is the name for the deep perineal fascia of the penis?
Buck's fascia
32
What is the arcuate line and where is it?
It is a crescent-shaped line marking the inferior limit of the posterior layer of the rectus sheath --> it is located just below the level of the iliac crest.
33
1. ) The superficial inguinal ring is a hole in the _________.
2. ) The deep inguinal ring is a hole in the _________.
1. ) External oblique aponeurosis
| 2. ) Transversalis Fascia
34
What early embryological structure forms the inguinal canal and scrotum? What is it called when it forms the scrotum?
Processus Vaginalis --> becomes the Tunica Vaginalis when it envelops the testis.
35
Give mnemonic and structures of RUQ (10)
RUQ = QUR = Queer --> Lesbians Get Pussy, Doubtfully Penis (head). Stop Knocking Cock And Try It.
Liver (right lobe), Gallbladder, Pylorus, Duodenum (1-3), Pancreas (head), Suprarenal gland (right), Kidney, Colic flexure (hepatic), Ascending colon (superior), Transverse colon
36
Give mnemonic and structures of LUQ (10)
Mnemonic --> Like Sloppy Seconds? Come Fuck This Dirty Sluts Puss...Just Kidding
Liver (left lobe), Spleen, Stomach, Colic Flexure (splenic), Transverse colon, Descending colon, Suprarenal gland (left), Pancreas (body and tail), Jejunum, Kidney.
37
Give mnemonic and structures of LLQ
* (For both LLQ and RLQ --> U^2 So So = Ureter, Urinary bladder, Uterus, Uterine tube -- Spermatocord, Ovary)*
- Mnemonic = Lick D's
LLQ = liq = lick --> D's (colon) --> Descending and Sigmoid Colon.
38
Give mnemonic and structures for RLQ
* (For both LLQ and RLQ --> U^2 So So = Ureter, Urinary bladder, Uterus, Uterine tube -- Spermatocord, Ovary)*
- Mnemonic = Ass CAM --> Ascending colon, Cecum, Appendix, Most of ileum
39
List the layers of the anterior abdominal wall (superficial to deep) above the arcuate line (and lateral to rectus abdominis)
Skin --> Camper's Fascia (fatty) --> Scarpa's Fascia (membranous) --> External obliques --> Internal obliques --> Transversus abdominis --> Tranversalis fascia --> Peritoneum
40
Give the analogous structures in the scrotum to each of the following structures/layers:
* Skin*
1. ) Camper's Fascia (fatty)
2. ) Scarpa's Fascia (membranous)
3. ) External oblique muscle and fascia
4. ) Internal oblique muscle
5. ) Transversus abdominis muscle and fascia
6. ) Tranversalis fascia
7. ) Peritoneum
* Skin*
1. ) Dartos fascia (and muscle)
2. ) Dartos fascia (and muscle)
3. ) External spermatic fascia
4. ) Cremasteric fascia and muscle
5. ) *NO CONTINUATION*
6. ) Internal spermatic fascia
7. ) Tunica vaginalis
p. 208 Moore
41
What is the female homologue of the male scrotum?
Labia majora
42
What is the fate of the following embryonic female structures and what do the mature structures do?
1. ) Upper gubernaculum
2. ) Lower gubernaculum
1. ) Becomes the OVARIA LIGAMENT: Connects ovaries to the uterus
2. ) Becomes the ROUND LIGAMENT: Attaches uterus to the labia majora
43
Describe the location of each of the following (in relation to umbilical folds) and what hernias are possible there:
1. ) Medial inguinal fossae
2. ) Lateral inguinal fossae
3. ) Supravesical fossae
1. ) Between the MEDIAL and LATERAL umbilical folds (area also commonly called the inguinal triangle, i.e. Hesselbach Triangles), they are potential sites for the less common DIRECT INGUINAL HERNIAS.
2. ) Lateral to the LATERAL umbilical folds, it includes the DEEP INGUINAL RINGS and are the potential sites for the MOST COMMON type of lower abdominal wall hernia...the INDIRECT INGUINAL HERNIA.
3. ) Located between the MEDIAN and MEDIAL umbilical folds *NO HERNIA*
p. 293 Rohen, p.202 Moore
44
List the contents of each of the umbilical folds
1. ) Median umbilical folds: Covers the MEDIAN UMBILICAL LIGAMENT (fibrous remnants of the URACHUS).
2. ) Medial umbilical folds: Cover the MEDIAL UMBILICAL LIGAMENTS (formed by occluded parts of the umbilical arteries).
3. ) Lateral umbilical folds: Cover the INFERIOR EPIGASTRIC VESSELS (thus, bleed if cut).
pp. 201-202 Moore
45
In the term supravesical fossa, what does VESICAL refer to?
Bladder
46
Where is the Hasselbachs Triangle located? Borders?
- Located in the medial inguinal fossa.
| - Borders --> Lacunar ligament, inferior epigastric vessels, rectus abdominus
47
Where does the rectus sheath begin and end (lateral to medial)?
Starts at the midclavicular line (MCL) and ends at the midline where it merges with the opposite side and forms the linea alba.
p.188 Moore
48
1. ) What are the afferent and efferent limbs of the cremasteric reflex?
2. ) What does the absence of a cremasteric reflex imply?
1.) Afferent: FEMORAL BRANCH of the genitofemoral nerve and ilioinguinal nerve.
Efferent: Motor fibers of the genital branch of the genitofemoral nerve (which causes the cremaster muscle to contract and elevate the testis
2.) Absence of the cremasteric reflex can suggest TESTICULAR TORSION
49
1. ) What is cryptorchidism?
2. ) Monorchidism?
3. ) What is the name of the condition where a testis can be readily moved between the scrotum and canal?
1. ) The absence of one or both testes (undescended) from the scrotum at birth.
2. ) Having only ONE testicle.
3. ) Retractile testis
- p.210 Moore
50
Where do most of (60%) undescended testes end up?
High up in the scrotum
51
What are the contents the inguinal canal?
1. ) Spermatic Cord (males) or Round Ligament of the Uterus (females)
2. ) Genital branch of the genitofemoral nerve
52
Where does the RECTUS SHEATH begin and end (lateral to medial)?
Starts at midclavicular line (MCL) and ends at the midline where it merges with the opposite site and forms the linea alba.
p.188 Moore
53
What is the most dense, inferior-most portion of the external oblique aponeurosis called?
Inguinal ligament
54
What is the site and cause of indirect inguinal hernias?
Site/cause: Occurs at a PATENT PROCESSUS VAGINALIS, and internal viscera can enter the scrotum.
55
What are the fascial coverings that surround the spermatic cord (3) and what abdominal fascial layers are they derived form?
1. ) Internal spermatic fascia: Derived from transversalis fascia.
2. ) Cremasteric fascia: Derived from investing fascia of the internal oblique muscle.
3. ) External spermatic fascia: Derived from external oblique aponeurosis and its investing fascia.
56
If the inguinal swelling of a hernia is LATERAL to the inferior epigastric artery, what type of hernia is it? Why?
Indirect inguinal hernia, because it must travel through the DEEP INGUINAL RING.
57
What supplies cutaneous sensation to the abdomen and abdominal wall?
Thoracoabdominal nerves (T7-T11) --> with anterior cutaneous and lateral cutaneous branches.
58
1. ) Superficial lymphatic vessels of the anterior abdominal wall accompany the ________.
2. ) Superficial lymphatic vessels superior to the transumbilical plane drain into the ________.
3. ) Superficial lymphatic vessels inferior to the transumbilical plane drain into the ________.
1. ) Subcutaneous veins
2. ) Axillary lymph nodes
3. ) Superficial inguinal lymph nodes
- p.195 Moore
59
1. ) Deep lymphatic vessels of the anterior abdominal wall accompany _______.
2. ) Deep lymphatic vessels of the anterior abdominal wall drain into ______ (4 places)
1. ) Deep veins of the abdominal wall
2. ) External iliac, common iliac, right and left lumbar (caval and aortic) lymph nodes.
- Moore p.195
61
What are the covering layers of the spermatic cord (3)?
1. ) Internal spermatic fascia
2. ) Cremasteric fascia
3. ) External spermatic fascia
- p.206 Moore
62
What are the contents of the spermatic cord (9)?
| *mnemonic*
* Mnemonic: C STAPLD VG --> "see stapled vag"*
1. ) Ductus deferens (vas deferens)
2. ) Testicular artery
3. ) Artery of ductus deferens --derived from--> Inferior Vesical Artery
4. ) Cremasteric artery --derived from--> Inferior Epigastric Artery
5. ) Pampiniform venous plexus (become the testicular veins)
6. ) Sympathetic nerve fibers on arteries, and sympathetic and parasympathetic nerve fibers on the ductus deferens.
7. ) Genital branch of the genitofemoral nerve
8. ) Lymphatic vessels
9. ) Vestige of processus vaginalis
- p.207 Moore
63
What are the contents of the scrotum (3)?
1. ) Epididymis
2. ) Testes
3. ) Distal portion of spermaticord
64
What supplies blood to the scrotum (3; and what they are branches of)?
Veins?
1. ) Posterior scrotal branches of the PERINEAL ARTERY (a branch of the internal pudendal artery)
2. ) Anterior scrotal branches of the DEEP EXTERNAL PUDENDAL ARTERY (a branch of the femoral artery)
3. ) Cremasteric artery (a branch of the inferior epigastric artery)
* Scrotal veins accompany the artery*
65
1. ) Where do the lymphatic vessels of the scrotum drain?
| 2. ) Where do the lymphatic vessels of the testes drain?
1. ) Into the SUPERFICIAL INGUINAL LYMPH NODES
| 2. ) Into the AORTIC LYMPH NODES (because they are deeper)
66
What nerves supply the following portions of the scrotum (4; give the source and nerve roots):
1. ) Anterior
2. ) Posterior
3. ) Anterolateral
4. ) Posteroinferior
1. ) Anterior scrotal nerves: Branches of the ilio-inguinal nerve (L1)
2. ) Posterior scrotal nerves: Branches of the PERINEAL branch of the PUDENDAL NERVE (S2-S4)
3. ) Genital branch of the genitofemoral nerve (L1, L2)
4. ) Perineal branches of the posterior cutaneous nerve of thigh (S2, S3)
- p.209 Moore
67
What is outermost covering of the testes? What lies beneath that layer?
```
Tunica vaginalis (outermost) --> Tunica albuginea
-p.209 Moore
```
68
1. ) What structure(s) produce sperm in the testes?
2. ) Where do the above structures immediately drain?
3. ) Where does the sperm go after that?
1. ) Seminiferous tubules (highly coiled tubules that lie between the testicular septi)
2. ) Rete testis (in the mediastinum of the testis)
3. ) Efferent ductules ---> Epididymis
69
What are the constituents of the epididymis? What does it become?
- Head, body, and tail.
| - The tail of the epididymis becomes the DUCTUS DEFERENS
70
What is the function of the epididymis?
Store sperm for maturation
71
What is the blood supply for the testes (3; and their origins)?
1. ) Long testicular arteries: Arise from the anterolateral aspect of the abdominal aorta, just inferior to the renal arteries.
2. ) Cremasteric artery: A branch of the inferior epigastric artery, which itself is a branch of the external iliac artery.
3. ) Artery to the ductus deferens: A branch of the inferior vesical artery, which itself is a branch of the internal iliac artery.
72
Describe the venous drainage of the testicles (2)
| *exam question b/c of exceptions*
1. ) The RIGHT TESTICULAR VEIN drains into the IVC
2. ) The LEFT TESTICULAR VEIN drains into the LEFT RENAL VEIN
- p.210 Moore
73
Describe the lymphatic drainage of the testes
It follows the testicular artery and vein to the right and left LUMBAR (caval/aortic), and the PRE-AORTIC lymph nodes.
74
Describe the nerve supply to the testes, i.e. SNS, PSN, afferent, efferent, etc.
Autonomic nerves of the testes arise as the TESTICULAR PLEXUS of nerves on the testicular artery, which contains VAGAL PARASYMPATHETIC and VISCERAL AFFERENT FIBERS and SYMPATHETIC FIBERS from the T10-T11 segment of the spinal cord.
-Parasympathetic fibers arise from PELVIC SPLANCHNICS.
75
Describe the formation/composition of the ejaculatory duct
Ductus deferens (i.e. vas deferens) + Duct of seminal vesicle = Ejaculatory duct
76
1. ) What is the bloody supply for the Vas Deferens?
| 2. ) Venous drainage?
1. ) Deferential artery (a branch of the inferior vesical artery)
2. ) Deferential vein(s) to prostatic venous plexus to internal iliac veins
77
What is a varicocele? Describe
Dilated, engorged testicular veins (feels like a bag of worms):
- More common on left, very RARE on RIGHT
* Observe on ultrasound as in lecture*
- p.215 Moore
78
What is a testicular hydrocele? hydrocele of cord?
A hydrocele is the presence of excess fluid in a PERSISTENT PROCESSUS VAGINALIS (can be associated with an indirect inguinal hernia).
- Hydrocele of testis: Confined to the scrotum and distends the tunica vaginalis.
- Hydrocele of the spermatic cord: Confined to the spermatic cord and distends the persistent part of the stalk of the processus vaginalis.
* p.212 Moore*
79
What are the three different type of hydrocele? Describe
1. ) Communicating (congenital) hydrocele: A patent processus vaginalis permits flow of peritoneal fluid into the scrotum. *Indirect hernias are associated with this type*
2. ) Non-communicating: A patent processus vaginalis is present, but there is no communication with the peritoneal cavity.
3. ) Hydrocele of cord: Defective closure of tunica vaginalis, i.e. the distal end of the processus vaginalis closes correctly, but the mid-portion of the processus remain patent. *The proximal end may be open or closed in this type of hydrocele*
- p.212 Moore
80
What is a spermatocele?
A retention cyst (collection of fluid) in the epididymis, usually NEAR ITS HEAD (i.e. closer to the teste). *Spermatoceles usually contain a MILKY FLUID and are generally asymptomatic*
-p.215 Moore
81
What is an epididymal cyst?
A collection of fluid anywhere in the epididymis.
| -p.215 Moore
82
Name and describe the two abdominal peritoneum layers. How are they similar & different?
1. ) Parietal peritoneum: Lines the internal surface of the abdominopelvic wall.
2. ) Visceral peritoneum: Invests viscera such as the stomach and intestines.
* Both layers of peritoneum consist of mesothelium, a layer of simple squamous epithelial cells*
- p.217 Moore
83
What is the blood, nerve, and lymph supply for the parietal peritoneum? Visceral peritoneum?
- The parietal peritoneum is served by the same blood vessels, lymphatic vasculature, and somatic nerve supply as the region of the wall it lines.
- Same for the visceral, except the visceral peritoneum shares all with the ORGANS IT COVERS.
- p.217 Moore
84
Are either of the layers of peritoneum sensitive to touch, heat, etc.? Elaborate.
Parietal peritoneum: Like the overlying skin, it is sensitive to pressure, pain, heat, cold, and laceration. Pain is well localized.
Visceral peritoneum: Insensitive to touch, heat, cold, and laceration. Responds primarily to stretching and chemical irritation. Pain is poorly localized, being referred to the dermatomes of the spinal ganglia providing sensory fibers.
-p.217 Moore
85
What is the opening that connects the greater sac of the peritoneal cavity to the lesser sac of the peritoneal cavity called?
The omental/epiploic foramen
| -p.217 Moore
86
What does it mean for an organ to be retroperitoneal? Subperitoneal?
- Retroperitoneal means that the organ lie behind the peritoneum and is covered by peritoneum only on its ANTERIOR SURFACE.
- Subperitoneal means that the organ lies inferior to the peritoneum and is covered by peritoneum only on its SUPERIOR SURFACE.
87
What is the part of the greater peritoneal cavity that encloses the small intestine called? Encloses transverse colon? Stomach?
```
Small Intestine = Mesentery
Transverse colon = Mesocolon
Stomach = Omentum (greater and lesser)
*A mesentery connects an intraperitoneal organ to the body wall – usually the posterior body wall*
-p.219 Moore
```
88
What embryonic tissue/structure is the greater omentum derived from?
Embryonic dorsal mesentery
89
What are the four parts of the greater omentum that serve as attachments for the stomach to three different structures called and what do they attach?
1. ) Gastrophrenic ligament: Stomach to inferior surface of diaphragm.
2. ) Gastrosplenic ligament: Stomach to hilum of the spleen.
3. ) Gastrocolic ligament: Stomach to transverse colon.
4. ) Splenorenal (or lienorenal) ligament: Connects the spleen to the kidney.
- p.219 Moore
90
Describe the pathway of the gastrocolic ligament
An apron-like portion of the greater omentum, it descends from the greater curvature of the stomach, turns under, then ascends to the transverse colon.
-p.219 Moore
91
What are the two parts of the lesser omentum that serve as attachments for one organ to another called and what do they attach?
1. ) Hepatogastric ligament (or gastrohepatic): Connects the liver to the stomach.
2. ) Hepatoduodenal ligament: Connects the liver to the duodenum.
- p.219 Moore
92
1. ) What does the "free border" of the lesser omentum contain?
2. ) What lies underneath the free edge of the lesser omentum?
1. ) The portal triad (HH CLB)
| 2. ) Epiploic foramen
93
Describe the Mesentery of the Small Intestine (Mesentery Proper) *Three things* i.e. 1.) structure, 2.) placement/where it lies, and 3.) what it contains/transmits.
1. ) It is a double fold of peritoneum that suspends the jejunum and the ileum from the posterior abdominal wall.
2. ) Its root extends diagonally from the duodenojejunal flexure to the right iliac fossa.
3. ) It transmits nerves and blood vessels to and from the small intestine, and its FREE BORDER encloses the small intestine.
94
How do arteries get to the transverse colon?
Via the transverse mesocolon (mesentery of the transverse colon) *Belongs to the greater peritoneal cavity*
-p.211 Moore
95
What structure connects the sigmoid colon to the pelvic wall? What does it contain?
The sigmoid mesocolon. It contains the sigmoid vessels.
96
What does the mesoappendix do?
It connects the appendix to the mesentery of the ileum and contains the appendicular vessels.
97
What is distinct about the posterior aspect of the liver?
It is called the bare area, which means that it is not covered by peritoneum
98
What attaches the superior border of the liver to the diaphragm?
The CORONARY LIGAMENT.
| -plate 277 Netter
99
What structure anatomically divides the liver into a larger right lobe, and a smaller left lobe? What else does this structure connect?
The FALCIFORM LIGAMENT. It also attaches the anterior surface of the liver to the anterior abdominal wall.
100
1. ) What is the round ligament?
| 2. ) What does it do?
1. ) It is the free edge of the inferior falciform ligament that is derived from the OBLITERATED LEFT UMBILICAL VEIN.
2. ) ??????
101
What are the free borders/edges (on left and right) of the coronary ligament called?
Triangular ligaments (right and left)
102
1.) What are the medial umbilical ligaments (right and left) derived from? 2.) What are they covered by?
1. ) Umbilical artery --> They are the obliterated umbilical arteries.
2. ) Covered by the medial umbilical folds
- p.202 Moore
103
What is the subphrenic/suprahepatic recess?
A peritoneal pocket between the diaphragm and the anterior and superior part of the liver and is separated into right and left recesses by the falciform ligament. *Can be the site of subphrenic abscess*
104
Describe the greater sac, i.e. location, borders, etc.
It is a portion of the peritoneal cavity that extends the entire breadth of the abdomen and from the diaphragm to the pelvic floor. It presents numerous recesses into which pus from an abscess may be drained.
- Bottom of p.217 Moore
- p.193 BRS
105
Describe the subhepatic/hepatorenal recess (aka _______). Clinical?
aka Morrison's Pouch: It is a deep peritoneal pocket between the liver (anteriorly) and the kidney and suprarenal gland (posteriorly) that communicates with the lesser sac via the epiploic foramen and the right paracolic gutter, thus the pelvic cavity.
*Clinically, if there is an infection in this area, it can spread to the lesser sac (through the epiploic foramen) or the pelvic cavity*
106
Describe the paracolic recesses; two (aka ______)
Paracolic recesses (aka Gutters):
1. ) Right paracolic gutter: Lies lateral to the ASCENDING colon (p.273 Netter)
2. ) Left paracolic gutter: Lies lateral to the descending colon.
107
1. ) If a person is standing and there is a fluid collection in the abdomen, where will it end up?
2. ) If the person is lying down?
1. ) It will settle in the most dependent (?) part --> Rectouterine pouch (females), or retovesicle pouch (males).
2. ) Hepatorenal pouch (Morrison's pouch), from there it can go through the epiploic foramen and into the lesser peritoneal cavity.
108
Describe the location of the three recesses of the lesser sac (omental bursa)
1. ) Superior recess: Lies behind the stomach, lesser omentum, and left lobe of the liver.
2. ) Inferior recess: Lies behind the stomach, extending into the layers of the greater omentum.
3. ) Splenic recess: Extends to the left at the hilus of the spleen.
- 40:21 lecture 27
109
What blood vessel is at risk when performing surgical procedures on the lesser peritoneal sac, e.g. draining something through the epiploic foramen?
IVC
110
What are the boundaries of the epiploic/omental/Winslow's foramen? Superior, inferior, anterior, and posterior.
Superior: Peritoneum on the caudate lobe of the liver.
Inferior: Peritoneum on the first part of the duodenum.
Anterior: Free edge of the lesser omentum.
***Posterior: Peritoneum covering the IVC***
111
Name and describe the subdivisions of the peritoneal cavity
The TRANSVERSE MESOCOLON divides the abdominal cavity into:
1. ) Supracolic compartment: Contains the stomach, liver and spleen.
2. ) Infracolic compartment: Divided by mesentery into...
a. ) Right infracolic space
b. ) Left infracolic space
c. ) Paracolic gutters
- p.221 Moore
112
1. ) Where do the three parts of the esophagus lie?
| 2. ) Where does it start and terminate?
1. ) Neck (cervical), Thorax (thoracic), and Abdomen (abdominal)
2. ) Begins at the end of the pharynx (lower border of cricoid cartilage opposite C6), ends in the stomach (at cardiac orifice, opposite T11)
- p.168 Moore
113
Where does the esophagus cross the midline AFTER its commencement?
At T5, then goes left.
114
Where is the esophagus at its most narrow? (two places)
At its commencement (beginning; at the end of the pharynx), and at the point when it pierces/passes through the diaphragm.
115
Concerning the CERVICAL ESOPHAGUS, what structure(s) lie:
1. ) Anterior
2. ) Posterior
3. ) Laterally
4. ) Where do recurrent nerves lie in relation?
1. ) Trachea
2. ) Vertebral column and Longus Colli muscles
3. ) Common carotid artery and parts of the lobes of the thyroid gland.
4. ) Recurrent nerves ascend between it and the trachea
* To the left of it is the THORACIC DUCT*
116
Where does the esophagus lies in its thoracic portion?
In the superior mediastinum between the trachea and the vertebral column, A LITTLE TO THE LEFT OF THE MEDIAN LINE.
*Runs along the RIGHT SIDE OF THE DESCENDING AORTA*
117
At what vertebral level does the esophagus pierce the diaphragm?
T10
118
Concerning the THORACIC ESOPHAGUS, what structure(s) lie:
1. ) Anterior (6)
2. ) Posterior (5)
3. ) Inferior (2)
1. ) Trachea, aortic arch, R pulmonary artery, left bronchus, pericardium, diaphragm.
2. ) Vertebral column, longus colli muscles, R aortic intercostal arteries, thoracic duct, hemiazygous veins.
3. ) Diaphragm, front of aorta
119
What is the upper esophageal constrictor (UES)?
Cricopharyngeus muscle (skeletal muscle): Just inferior to the first part of the esophagus.
120
Concerning the ABDOMINAL ESOPHAGUS:
1. ) Where does it lie?
2. ) Does it have a covering?
3. ) Shape?
1. ) Lies in the esophageal groove on the posterior surface of the left lobe of the liver
2. ) Its FRONT and LEFT ASPECT are covered by peritoneum.
3. ) Somewhat conical in shape with its base applied to the upper orifice of the stomach, and is known as the ANTRUM CARDIACUM.
121
1. ) What structure allows food to enter the stomach?
| 2. ) A failure of this structure to close causes what disorder?
1. ) Lower esophageal sphincter (LES) --> SMOOTH MUSCLE (unlike crycopharyngeus muscle)
2. ) GERD
122
What are the four layers/coats of the esophagus from outer to inner?
1. ) External/fibrous coat
2. ) Muscular coat
3. ) Submucous/areolar coat
4. ) Internal/mucous coat
123
How many constrictions are there in the esophagus? Where are they?
Three:
1. ) Cervical constriction: At the pharyngoesophogeal junction by the crycopharyngeus muscle.
2. ) Thoracic constriction: Where it is first crossed by the arch of the aorta.
3. ) Diaphragmatic constriction: Where it passes through the esophageal hiatus of the diaphragm at T10.
* Know how these appear on a barium swallow!* <--14:30 lecture 28a
124
Describe the blood supply to the esophagus
1. ) Cervical esophagus: Inferior thyroid branch of the thyrocervical trunk
2. ) Thoracic esophagus: Descending thoracic aorta
3. ) Abdominal esophagus: Left gastric branch of the celiac artery, and from the left inferior phrenic branch of the abdominal aorta
125
What is the nerve supply for the esophagus?
Derived from the:
1. ) Vagi (Right vagus posterior to the esophagus, Left vagus goes anterior to the esophagus)
2. ) and the Sympathetic trunks
126
What are the three muscular layers of the stomach?
1. ) Outer longitudinal
2. ) Inner circular
3. ) Innermost oblique
127
Where does the lesser curvature of the stomach lie? What is the angular incisure (an associated structure/landmark)?
Lesser curvature: Forms the shorter concave right border of the stomach. Lies just left of the midline. *The angular incisure (notch), the most inferior part of the curvature, indicates the junction of the body and pyloric parts of the stomach*
-p.232 Moore
128
What is the stomach bed? Describe the structures of the stomach bed, superior to inferior (6).
```
The stomach lies on it in the SUPINE POSITION.
Superior to inferior:
1.) Left dome of the diaphragm
2.) Spleen
3.) Left kidney and suprarenal gland
4.) Splenic artery
5.) Pancreas
6.) Transverse mesocolon
-p.232 Moore
```
129
What is the most common location of ulcers in the stomach? What artery is at risk because of this...why?
On the POSTERIOR WALL. The posterior wall can be perforated, allowing acid into the omental bursa --> WHERE THE SPLENIC ARTERY LIES.
131
Where do veins of the anterior abdominal wall drain if they are:
1. ) Superior to the transumbilical plane
2. ) Inferior to the transumbilical plane
1. ) Superior = Axillary vein
| 2. ) Inferior = Femoral vein
132
After given off by the common hepatic artery, the gastroduodenal artery lies _________ to the _______.
* **POSTERIOR TO THE FIRST PART OF THE DUODENUM***
| - Dr. Rich says this is very important = test question --> PEPTIC ULCER DISEASE CAUSES THIS ARTERY TO BLEED!
133
Where do the right and left gastric arteries drain into?
The portal vein
134
The short gastrics and left gastroepiploic veins drain into where?
The splenic vein
135
The superior mesenteric vein (SMV) drains into where?
Portal vein
136
The right gastroepiploic vein drains into what?
Superior mesenteric vein (SMV)
137
Which two veins unite to form the portal vein?
| *EXAM QUESTION*
Splenic vein and superior mesenteric vein (SMV)
138
What supplies parasympathetic innervation to the stomach and what are the effects?
Sympathetic?
Parasympathetic: Anterior and posterior vagal trunks --> Increase peristalsis and relax pyloric sphincter.
Sympathetic: From T6-T9 spinal cord segments via great splanchnic nerve to celiac plexus --> Inhibits peristalsis and contracts pyloric sphincter.
139
Relate the 4 parts of the duodenum to the peritoneum, i.e. retro-, intra-, etc.
```
First part (superior part) = INTRAperitoneal
Parts 2-4 = RETROperitoneal
```
140
What connects the first part of the duodenum to the liver?
Hepatoduodenal ligament
141
What structures are related to the following aspects of the first part of the duodenum:
1. ) Anterior
2. ) Posterior
1. ) Anterior: Peritoneum, Gallbladder, Quadrate lobe of the liver (A-PGQ)
2. ) Posterior: Bile duct, Gastroduodenal artery, Portal vein, IVC (BIG-P)
142
Name the four parts of the duodenum
1. ) Superior
2. ) Descending
3. ) Horizontal
4. ) Ascending
143
What are the most important structures associated with the descending part of the duodenum?
On the medial aspect of the duodenum, the common bile duct and pancreatic duct join together and pierce the medial aspect of the duodenum and drain into the duodenum --> That is how bile and pancreatic secretions get into the duodenum and start digestion that happens in the small intestine.
144
What is the spatial relationship between the gastroduodenal artery, duodenum, and pancreas?
It passes posterior to the first part of the duodenum (in between the duodenum and the pancreas).
145
What two veins unite to form the portal vein?
SMV and Splenic vein.
146
As the SMV ascends, how does it relate to the pancreas?
It passes POSTERIOR to the NECK OF THE PANCREAS.
147
Where does sympathetic innervation to the duodenum come from?
Celiac and superior mesentery plexuses, traveling on pancreaticoduodenal arteries.
148
What is the function of the ligament of Treitz?
It connects the junction between the duodenum, jejunum, and deuodenojejunal flexure to connective tissue surrounding the superior mesenteric artery and coeliac junction. ***OR*** it attaches the duodenum to the diaphragm (according to Dr. Rich).
-Wiki
149
What marks the end of the small intestine?
The ileocecal junction (ileocecal valve is the opening into the cecum)
150
What quadrant does the jejunum occupy?
LUQ
151
What is the most important outward difference between the jejunum ileum?
Plicae circularis (circular muscle layer) within the jejunum
152
What quadrant does the ileum mostly occupy?
RLQ
153
What are the straight arteries called that connect the anastomotic loops (arcades) of ileal arteries to the ileum?
Vasa recta
154
What artery supplies the terminal branches of the ileum, cecum, and appendix?
*EXAM QUESTION*
***Ileocolic artery***
155
Define and describe the two types of IBD
1. ) Crohn's disease: Skip lesions (one part affected, next part ok, one part affected, next part ok).
2. ) Ulcerative colitis: Sigmoid colon and rectum.
