Abdomen 3 Flashcards
the small and large intestine are supplied by what
the superior and inferior mesenteric aa.
the superior mesenteric a. supplies what region
mid duodenum through to the mid-transverse colon
the superior mesenteric arises at what vertebral level
L1
the superior mesenteric a. emerges from behind what organ?
from behind the head of the pancreas at the uncinate process and horizontal (3rd part) of the duodenum
The superior mesenteric a. extends down where
extends in the root of the mesentery toward the terminal portion of the ileum
first branch of the superior mesenteric a.
inferior pancreatico-duodenal a.
what does the inferior pancreatic-duodenal a. anastomose with
the superior pancreatic-duodenal a. off the common hepatic branch of the celiac trunk
Off to the left side of the superior mesenteric artery arise what branches
jejunal and ileal branches (intestinal arteries)
what is the second major branch of the superior mesentaric a. and what does it supply
middle colic a. that supplies the midtransverse colon
what is the 3rd branch off the superior mesenteric a.
right colic a. that passes towards the ascending colon
what is the 4th branch off the superior mesenteric a.
ileocolic a. that extends toward the cecum
which artery ends up anastomosing with the terminal portion of the superior mesenteric?
ileocolic a., together they form an anastomotic loop
the anastomotic loop of the superior mesenteric terminal branch and the ileocolic a. gives off what
anterior and posterior cecal aa.
the posterior cecal aa. gives rise to what artery?
appendicular a.
the inferior mesenteric a. supplies what region
the hind gut, remainder of the transverse colon
what is the first branch off the inferior mesenteric a. and what does it supply
left colic a. that goes up to anastomose with the marginal artery to supply the last part of the transverse colon
what branches off the left colic artery?
the descending branch that supplies the descending colon
what arteries branch of the inferior mesenteric to supply the sigmoid colon?
sigmoid arteries
what is the final branch of the inferior mesenteric a. and what does it supply
superior rectal a. that supplies the upper rectal area
what arteries supply the remainder of the rectum
middle and inferior rectal arteries
where do the middle rectal arteries arise from
internal iliac artery
where do inferior rectal arteries arise from
internal pudendal arteries
what two arteries contribute to the formation of the marginal artery
sigmoid and left colic aa.
blood from the stomach and intestines is carried to where
to the liver via the hepatic portal system
after being filtered by the liver, the venous blood is then dumped into the ____ by the ____
inferior vena cava by the hepatic vein
what forms the hepatic portal vein
formed by the union of the superior mesenteric vein with the splenic vein
the splenic vein accept what vein
the inferior mesenteric vein
what is the chair of the venous drainage of the intestine
chair back: hepatic portal vein
seat: splenic v.
back chair leg: superior mesenteric v.
front chair leg: inferior mesenteric v.
the seat and the back chair left fuse to form the hepatic portal vein
what are portocaval anastomoses
a type of anastomosis that occurs between the veins of the portal circulation and those of the systemic circulation
why do we have portocaval anastomoses
utilized when return of blood through the liver becomes obstructed and that increases hydrostatic pressure in the venous portal system
how are the alternate pathways for the hepatic portal system found
found at sites where the venous drainage is shared by both hepatic portal and systemic venous systems
first portocaval anastomosis
lower end of the esophagus- where esophogeal veins drain via the left gastric vein to the portal vein or the azygous v. in the thorax (esophageal varices)
second portocaval anastomosis
at the anal canal- where rectal vv. drain via the inferior mesenteric v. to the portal vein or to the internal ilaic vv. via the middle and inferior rectal vv.
distended anal veins are called what
hemorrhoids; portal obstruction is a rare cause for these
3rd portocaval anastomosis
at the umbilicus, where the region may be drained by small veins traveling in the falciform ligament to the portal vein or by systemic veins draining the anterior abdominal wall
the pattern of distended veins radiating form the umbilicus is called
caput medusae
fourth portocaval anastomosis
at the retroperitoneal of the intestine- where veins in the wall of the intestine may drain via portal tributaries or to veins of the adjacent abdominal wall (areas of the duodenum, ascending colon/descending colon)
reminder to look at diagram on pg 203 for portal caval anastomoses
…
what are the 3 main types of of branches of the abdominal aorta
- parietal
- paired visceral
- unpaired visceral
what branches are in the unpaired visceral group of the aortic branches
- celiac trunk
- superior mesenteric a.
- inferior mesenteric a.
study abdominal aorta diagram on pg 204 (no associated text to explain)
…
where are abdominal prevertebral autonomic plexuses located
on the anterior surface of the abdominal aorta, around the branches of vessels originating there
celiac plexus is found surrounding what
celiac trunk
there is a ___ ___ on either side of celiac trunk
celiac ganglion
what brings pre-ganglionic sympathetic innervation into the celiac plexus
greater splanchnic n.
what brings pre-ganglionic parasympathetic innervation into the celiac plexus
anterior and posterior vagus nn.
only the sympathetic preganglionic fibers that have not already synapsed where will synapse in the prevertebral ganglia
in the paravertebral ganglia of the sympathetic trunk
do parasympathetic vagal fibers synapse in the prevertebral ganglia?
no, they pass through it and then synapse in the wall of the organs they innervate
what are the main subsidiary plexuses that extend out along the various vessels in and around the celiac trunk
hepatic, gastric, splenic, suprarenal, renal, gonadal
where is the superior mesenteric plexus found
at the base of the superior mesenteric a.
the superior mesenteric plexus also receives sympathetic and parasympathetic innervation from where
sympathetic from sympathetic trunk via greater splanchnic n. and parasympathetic via anterior/posterior vagus nn.
where is the intermesenteric plexus
lies between the two mesenteric plexuses
where does the intermesenteric plexus receive its innervation from
receives sympathetic input via the lumbar splanchnic n.
the inferior mesenteric plexus receives its parasympathetic input from where
from the pelvic parasympathetic outflow via the pelvic splanchnic nn.
where does the pelvic parasympathetic outflow come from
S2, S3, S4
where do you have white rami communicans vs grey
white only T1-L2, grey C1-Co4
What two plexuses are found continuing down into the pelvis
superior and inferior hypogastric plexuses
which nerves carry afferent (sensory) fibers back to the CNS
pelvic splanchnic and sympathetic nerves
The sensory fibers coming from the abdomen synapse where and do what
do NOT synapse in the various autonomic ganglia, synapse in CNS and are responsible for sensation of pain from abdominal viscera
the kidneys are part of the posterior abdominal wall and are considered
retroperitoneal
at birth the kidneys exhibit what
fetal lobulation which is normally lost at age 5-6
kidneys location
on the posterior abdominal wall in the paravertebral gutter around the level of the upper 3 lumbar vertebra
Which kidney is higher
the left, with its upper pole overlapping the diaphragm
what is the renal sinus
space around the renal pelvis
Each kidney is covered by a what
fibrous capsule
cortex of kidney
lies immediately under the capsule and extends inward as renal columns between the renal pyramids
renal pyramids
comprise the medulla
renal papilla
the apex of each pyramid
the renal papilla is surround by a funnel shaped ____
minor calyx
Minor calyces are branches of larger ___
major calyces
Major calyces are branches of ___
the renal pelvis
The renal pelvis narrows into ___
ureter
what is a ureter
a muscular tube traversing the posterior abdominal wall into the pelvis and penetrating the walls of the urinary bladder
what lies on top of the kidneys
adrenal glands or suprarenal glands
the stomach has an association with which kidney
left kidney
the liver has an association with which kidney
right kidney
the duodenum has an association with which kidney
right kidney
the colon has an association with which kidney
both kidneys
the small intestine has an association with which kidney
both kidneys
the pancreas has an association with which kidney
left kidney
the spleen has an association with which kidney
left kidney
each kidney and surparenal gland is surround by what
perirenal fat which is in turn enclosed by anterior and posterior layers of renal fascia
the perirenal fat and renal fascia fuse where
fuse above and lateral to the kidney but remain as separate layers around the ureter, blending with the adjacent retro-peritoneal tissue
renal arteries carry about ___% of cardiac output
20%
about 90% of the 20% CO delivered to kidneys is specifically delivered to
the cortex for filtration
at the ___ of the kidney, the renal artery dives into ____ to supply ___
hilus of the kidney, the renal artery dives into a number of branches to supply the five segments of each kidney
five segments of the kidney
apical, upper, middle, lower, posterior
the lower lobes may also receive arterial branches directly from the ___
aorta
each of the segmental arteries going to the kidney can be considered an ____
end artery
if the renal arteries are ligated, what happens
the development of an obvious ischemic area within the kidney parenchyma
each segmental artery of the kidney divides into what
a number of interlobar arteries
interlobar arteries ascend where
ascend in the renal columns to the corticomedullary junction
the interlobar arteries branch into what
arcuate arteries that run parallel to this interface
what arteries arise from the arcuate arteries
interlobular arteries that ascend into the overlying cortex
Interlobular arteries provide ____ ____ that supply each glomerulus
afferent arterioles
what is a glomerulus
filtration capillary of the kidney
What are the 3 points of constriction of the ureter where a kidney stone may be lodged
- narrowing of the renal pelvis to the ureter
- where ureter crosses the common iliac artery bifurcation before bending down into pelvis
- penetration of bladder wall
ureters are retroperitoneal and cross ____ to the bifurcation of the ___ ____ ___ into the external and internal iliac aa.
anterior; common iliac artery
blood supply of the ureters
derived segmentally from the renal and vesical aa.
what are the suprarenal glands
essential endocrine glands capping the apical lobe of each kidney and are separated from it by peritoneal fat
the left suprarenal gland has what shape
semilunar
the right suprarenal gland has what shape
pyramidal
blood supply of the of the suprarenal glands
branches from the inferior phrenic, renal aa., and the aorta for endocrine function
the left suprarenal gland drains to the ___ ___
renal vein
the right suprarenal gland drains to the ____
inferior vena cava
what kind of fibers penetrate the suprarenal glands and synapse in the medulla
pre-ganglionic sympathetic fibers
-NO synapsing at paravertebral or prevertebral ganglion
what do the sympathetic fibers do in the suprarenal glands
stimulate release of epinephrine and norepinephrine; allows us to respond to scary situations very quickly
muscles of the posterior abdominal wall
psoas major, iliacus, quadratus lumborum
location of psoas major
in the paravertebral gutter adjacent to the lumbar vertebral bodies
the psoas major passes under the ___ ___ with the ___ muscle to a common tendinous attachment on the _____
inguinal ligament; iliacus; lesser trochanter of the femur
psoas major innervation
ventral rami of L1, L2, L3
iliacus muscle location
arises from internal aspect of the ala of the iliac bone
the illiacus muscle and psoas major are covered by what
illiac fascia
iliacus muscle innervation
innervated by the femoral nerve
the combined iliopsoas muscle has what action
powerful flexor of the hip
what is the psoas minor
a muscle that may occur on the anterior surface of the major
where does the psoas minor distally attach
the pectineal line
quadratus lumborum location
flat muscle immediately lateral to the upper part of psoas
quadratus lumborum attachment
extends from R12 and the tips of the lumbar transverse processes to the iliolumbar ligament
where is the iliolumbar ligament located
between L5 and the iliac crest
action of the quadratus lumborum
stabilizes R12 in inspiration as well as laterally flexing the trunk
innervation of quadratus lumborum
ventral rami of T12, L1, L2, L3
a thickening of the fascia over the surface of the psoas major forms ___
the medial arcuate ligament of the diaphragm
thickening of fascia over the quadratus lumborum forms the
lateral arcuate ligament of the diaphragm
the majority of the muscle fibers of the diaphragm arise from the inner aspect of the thoracic outlet and arise to insert into a
central tendon (central tendon of the diaphragm)
muscular part of the diaphragm arises from what sources
- sternal part
- costal part
- lumbar part
- fibrous arches
- crura
sternal part
two slips from the deep surface of the xiphoid process
-descends to the central tendon
the sternal part has a small gap on each lateral aspect called
the sternocostal triangle
the sternocostal triangle transmits what through it
superior episgastric a. and lymphatics
potential site for diaphragmatic hernia
sternocostal triangle
costal part
inner aspect of lower 6 ribs and costal cartilages
-form left and right domes of the diaphragm
the costal parts insert into what
into the anterolateral aspects of the central tendon
what are lumbocostal triangles
they may exist between the costal muscular and the lateral arcuate ligament; have a relationship with the posterosuperior aspects of the kidneys and are separated from them only by pleura
lumbar part
vertebral part; from the lateral, medial, and median arcuate ligaments and as crura from the upper lumbar vertebrae
fibrous arches
medial arcuate ligament and lateral arcuate ligament
medial arcuate ligament
a thickening of the fascia over the upper psoas major spanning the body of L1 to its transverse process
lateral arcuate ligament
a thickening of the fascia over the upper quadratus lumborum spanning the transverse process of
L1 to R12
muscles fibers from both the medial and lateral arcuate ligaments extend up where
to the central tendon of the diaphragm
crura
arise from the lumbar vertebrae in the form of two muscular crura that ascend to the central tendon
right crus location
from L1 to L3/L4
left crus location
arises from L1-L2 only
the crura unite in front of the ___ in a fibrous arch, the ____. the crura uniting forms the ____
aorta; median arcuate ligament; aortic hiatus of the diaphragm
the right crus splits to do what
surround the esophagus in a sling-like loop
the left crus goes to the left of the ____, but may assist in formation of the ____ ____
esophagus; esophageal hiatus
openings of the diaphragm
- aortic
- esophageal
- caval
aortic hiatus
anterior to T12, between crura and transmits the aorta, thoracic duct and azygous vein and greater splanchnic nerve
esophageal hiatus
art level of T10 and transmits the esophagus and right and left vagus nn.
caval hiatus
at level of T8 and transmits the inferior vena cava as well as the right phrenic nerve and lymphatics from the liver
splanchnic nerves pierce the ____
crura
sympathetic trunk passes where
against the vertebral bodies posterior to the medial arcuate ligament
the left phrenic n. pierces the
diaphragm to the left of the pericardial sac
the ventral rami of T1-T12 represent segmental nerves and innervate what
each ventral ramus remaining separate and is responsible for innervating an individual dermatome
the ventral ramus of T12 remains separate and is referred to as the ____ nerve
subcostal nerve
the ventral rami of L1-4 give rise to the
lumbar plexus
what is the lumbar plexus
a branching array of ventral rami that eventually anastomose to nerves responsible for an action
general action of the lumbar plexus innervation
innervation of the extensor and adductor compartments of the thigh
part of the ventral rami of L4 and L5 contribute to the ____ plexus that also supplies the _____
sacral plexus; lower limbs
location of the subcostal nerve
appears beneath the lateral arcuate ligment and crosses the quadratus lumborum below R12
subcostal nerve supplies __
lower part of rectus abdominis, the anterolateral abdominal muscles and the strip of overlying skin
the ___ and ___ nerves are dervied from L1 spinal nerve
iliohypogastric and ilioinguinal
innervation of the iliohypogastric nerve
supplies skin over the upper lateral surface of the thigh and lower abdomen above the pubis
the ilioinguinal nerves passes forward with the ___ ___
spermatic cord
ilioinguinal nerve supplies what
the skin of the external genitalia and adjacent region of the thigh
the lateral femoral cutaneous nerve arises from what
L2 and L3 spinal nerves combined
lateral femoral cutaenous nerve location
emerges from the lateral border of the psoas and passes into the thigh beneath the lateral end of the inguinal ligmant where it may become entrapped and cause pain
the lateral femoral cutaneous nerve supplies what
the skin on the lateral aspect of the thigh (said that wearing a tight pair of jeans may irritate this nerve)
largest nerve of the lumbar plexus
femoral nerve
femoral nerve is formed from what
L2, L3, L4 spinal nerves
femoral nerve location
lies in the groove between the psoas and iliacus, passes under the inguinal ligament
femoral nerve supplies what
muscles of the anterior compartment of the thigh as well as the overlying skin
genitofemoral nerve comes from where
L1 and L2 spinal nerves
location of the genitofemoral nerve and its division
on the surface of the psoas major and it divides into a genital and femoral branch
genital branch of the genitofemoral n. supplies what
supplies skin of external genitalia and cremaster m. in male
femoral branch of genitofemoral n. supplies what
a small patch of skin just below the inguinal ligament
obturator nerve root values
L2, L3, L4
obturator nerve location
appears at the medial border of the psoas and passes through the pelvis before exiting into the thigh
obturator nerve supplies what
motor innervation to the medial (adductor) compartment of the thigh and overlying skin
what is the lumbosacral trunk
a portion of L4 that joins with L5 to form a stout trunk that enters the pelvis to join in the formation of the sacral plexus
important landmark for the identification of lumbar plexus nerves
psoas major
organ located exclusively in the right hypochondriac region
liver
organ located exclusively in the epigastric region
stomach
organ located exclusively in the left hypochondriac region
spleen
organ located exclusively in the right lateral region
ascending colon
organ located exclusively in the umbilical region
small intestine
organ location exclusively in the left lateral region
descending colon
organ located exclusively in the right inguinal region
appendix
organ located exclusively in the hypogastric region
bladder
organ located exclusively in the left inguinal region
sigmoid colon
