Abdomen I: Abdominal Viscera Flashcards
What is apart of the Abdominal Viscera
- Stomach/Esophagus
- Liver
- Gallbladder
- Spleen
- Duodenum
- Pancreas
- Intestines
What is the location of the Foregut?
Esophagus to Mid Duodenum
What is the location of the Midgut?
Mid Duodenum to Left Colic Flexure
What is the location of the Hindgut?
Left Colic Flexure to Anus
What is the Arterial Supply of the Foregut?
Celiac Trunk
What is the Arterial Supply of the Midgut?
Superior Mesenteric
What is the Arterial Supply of the Hindgut?
Inferior Mesenteric
What is apart of the Celiac Trunk?
- Left Gastric artery
- Splenic artery
- Common Hepatic a.
Extras
4. Inferior phrenic a. (aorta)
5. Esophageal branch (Left gastric a.)
What is the Esophagus?
Muscular tube conveying food to stomach
What are the 3 constrictions of the Esophagus?
- Upper
- Middle
- Lower
What are the arteries to the Esophagus?
- Aorta
- Esophageal branches from the Aorta
- Esophageal branch of left gastric artery
- Left gastric artery
ANASTOMOSES from above below the diaphragm
VEINS follow the same path as the arteries
What is the Vagus Nerve (CN X)?
Parasympathetic innervaton to MOST of the abdominal
What is the stomach?
Acidic and mechanical breakdown of food (doesn’t absorb, just holds)
What is the Fundus’ function?
no food in here
- just an air bubble (helps with moving food around & mechanical digestion)
What is the purpose of the Rugae in the stomach?
for expansion & allows us to breakdown food better
What are the 2 types of Hiatal Hernias?
- Sliding Hernia
- Para-esophageal Hernia
What is a Sliding Hernia?
- CARDIA PROTRUDES into mediastinum
- SOME REGURGITATION of stomach contents
some sort of acid reflux will result
What is a Para-esophageal Hernia?
- FUNDUS PROTRUDES into mediastinum
- NO REGURGITATION of stomach contents (b/c fundus is filled with air)
What are the causes of Hiatal Hernias?
Weakening of muscular diagram and widening of hiatus (elderly)
What is the treatment of Hiatal Hernias?
Stomach acid suppressant (Antacids); surgical hernia repair (not often)
What is the vasculature of the stomach?
- Left Gastrica. (Celiac trunk)
- Right Gastric a. (Proper hepatic a.)
- Gastroduodenal a. (Common Hepatic a.)
- Right Gastro-omental a. (Gastroduodeanl a.)
- Left Gastro-omental a. (Splenic a.)
- Short Gastric a. (Splenic a.)
What is the Bariatric Surgery?
Surgical intervention to achieve weight-loss
*makes stomach smaller (affects blood supply as well)
What is the Duodenum?
BEGINNING OF ABSORPTION of vitamins, mineral and other nutrients
Superior Mesenteric artery
Superior Mesenteric vein
Suspensory Ligament of the Duodenum (Ligament of Treitz)
Where is Bile from?
BILE from liver and pancrea.c enzymes are released via the MAJOR DUODENAL PAPILLA to aid in chemical breakdown of food
(some have a Minor Duodenal Papilla from accessory duct)
What is the Pancreas?
- Aids in digestion by secreting enzymes
- exocrine function
- Produces INSULIN and GLUCAGON to control blood sugar
- endocrine function
What is unique about the Pancreas?
*the tail is intraparientanial (only portion that is)
What is apart of the Pancreas?
- Major Duodenal Papilla
- Hepatopancreatic Ampulla (of Vater)
- Common Bile Duct
- Accessory Pancreatic duct (of Santorini)
- Main Pancreatic duct (of Wirsung)
- Hepatopancreatic Sphinter (of Oddi)
What is Pancreatic Cancer?
- 75% of cases cancer is associated with the HEAD of the pancreas
- DIFFICULT TO DIAGNOSE – NO SYMPTOMS in the early stages; Late stage
cancer associated with symptoms: lack of appetite, weight loss,
pain in middle back, jaundice (b/c bile duct is constricted) - Survival rate is only 7% survival rate aEer 5 years
What is the Spleen?
- Large lymphatic organ that helps filter blood and recycle RBCs
- Lies in the upper left abdominal quadrant (if you feel spleen then it’s too big & should get checked)
- Protected by the 9th-12th ribs
no way to control bleeding
What is included in the Spleen?
Hilum
- Splenic artery
- Splenic vein
What is a Splenic Rupture?
- Puncture from fractured ribs
- Rupture of thin capsule due to increase in intra- abdominal pressure
** Most injured organ in abdomen
- A ruptured spleen will bleed profusely and cause intraperitoneal hemorrhage and shock (b/c doesn’t have BV’s that’ll constrict)
- A splenectomy is done to prevent the pa<ent from bleeding to death
Where is the Liver?
Located immediately inferior to the diaphragm
What does the Liver do?
- Detoxifies the blood and plays a major role in the metabolism and storage of nutrients
- Creates bile which is then stored in the gallbladder and released in response to stimuli to aid in the chemical breakdown of food
What are the Liver’s attachments/ligaments?
- Coronary Ligament
- Falciform Ligament
- Round Ligament of the Liver (Ligament of Teres Hepatitis; obliterated umbilical vein) - when cut after birth
What is the Porta Hepatis of the Liver?
- Portal Vein
- Proper Hepatic Artery
- Bile duct
What is the flow of blood & bile of the liver?
Blood flows out of the liver to the IVC via 3 hepatic veins
Portal Triad
1. Proper Hepatic A.
2. Portal Vein
3. Bile Duct
- Oxygen rich blood flows into the liver through the proper hepatic artery
- Nutrient-rich blood flows into the liver from the bowel through the portal vein (slightly oxygenated)
- Bile flows out of the liver by way of the bile duct (toward gallbladder)
Where is the Gallbladder?
Lies in the gallbladder fossa on the visceral surface of the liver
What does the Gallbladder do?
Stores bile from the liver un<l it is stimulated to release it into the duodenum by CHOLECYSTOKININ (CCK)
What are the Biliary Ducts?
- Right Hepatic Duct
- LeE Hepatic Duct
- Common Hepatic Duct
- Cystic Duct
- Common Bile Duct
- Main Pancreatic Duct
What is the Arterial Supply to the Liver & Gallbladder?
Cystic triangle (of Calot)
- Liver
- Hepatic duct
- Cystic duct
What are Gallstones (Cholelithiasis) risk factors?
- Females
- Obese
- Fertile (birth control)
- Age (>40)
What are Gallstones (Cholelithiasis) symptoms?
- Cramping
- Nausea and vomi<ng
- Back and upper right
abdomen pain - Shoulder pain (b/c diaphragm sends signal & the phrenic n. hits shoulders)
What are Gallstones (Cholelithiasis) treatment?
- Low fat diet
- Cholecystectomy
What are the Small Intestine structures?
Duodenum, jejunum, and ileum
What are the Small Intestine functions?
Absorption of nutrients and minerals
What are the Small Intestine blood supply?
– Celiac Trunk
* Duodenum
– Superior Mesenteric Artery
* Duodenum, Jejunum and Ileum
What is within the Intraperitoneal?
Jejunum:
* ∼8 ft long
* absorbs nutrients from diet
Ileum:
* ∼12 ft long
* absorbs vitamin B12 and
bile salts (are recycled - reabsorbed in ileum to make more)
Jejunum vs. Ileum
Jejunum
Mesentery: Thin (relative)
Arcades: Few and large
Vasa recta: Long
Plicae circulares: Dense *(for absorption) - bc we do more
Ileum
Mesentery: Thick
Arcades: Many and small
Vasa recta: Short
Plicae circulares: Sparse
What is the Jejunum and Ileum: Blood Supply?
SUPERIOR MESENTERIC
ARTERY: Jejunal branches Ileal branches
15-18 branches
ARTERIAL ARCADES
VASA RECTA
MESENTERY
What is the Small Intestine Development?
Yolk stalk: connects fetal small
intestine to yolk sac
Week 6: intestines herniate into umbilical cord + yolk stalk degenerates
Week 10: intestines return to abdomen, with rota<on
What is Omphalocele?
- Caused by failure of intestines to return to abdomen + weak abdominal wall
- Abdominal contents enclosed in umbilical cord
What is the Large Intestine’s function?
ABSORBS remaining liquid from undigested materials in
feces production
What is the Omental
(Epiploic) Appendages?
Fahy Projections
What is the Haustra?
Sacculations/ pouches between teniae
What is the Tenia Coli?
3 bands of longitudinal smooth muscle
What is the Cecum location & structure?
- Location: RLQ
- Structure: Blind ended
pouch
What is the Cecum’s function?
ABSORB FLUIDS AND SALTS remaining after passage through small intestine
What is the blood supply of the Cecum?
Ileocolic artery (branch of Superior Mesenteric a.)
What is the Appendix function?
houses GOOD BACTERIA for re-colonization of the gut flora aMer severe diarrhea or other causes of loss of the natural gut bacteria
What are the arteries to the colon - Superior Mesenteric Artery?
- Marginal Artery
- Middle Colic Artery
- Superior Mesenteric Artery
- Right Colic Artery
- Ileocolic Artery
What are the arteries to the Colon – Inferior Mesenteric Artery?
- Marginal Artery
- Inferior Mesenteric Artery
- Left Colic Artery
- Sigmoid Arteries
- Superior Rectal Artery
- Abdominal Aorta
What is the Venous Drainage of the Foregut?
- Portal Vein
- Splenic Vein
- Superior Mesenteric vein (SMV) - midgut
- Inferior Mesenteric vein (IMV) - hindgut
(drain through liver 1st)
What is the Portal-Caval Anastomoses?
Communications between the portal venous system and the systemic venous system
- Paraumbilical
- Esophageal
- Rectal
- Retroperitoneal
What complications could arise from this anastomosis between the two venous systems?
Portal Hypertension
INCREASE in venous pressure in the portal venous system due to DECREASE flow through the liver
What is the Sympathetic Innervation?
- Presynap<c fibers from T5-L3
- Passes through SYMPATHETIC TRUNK to Greater (T5-9), Lesser (T10-11) Least (T12) and Lumbar (L1-3) Splanchnic nerves
- Synapse at prevertebral ganglia (celiac, superior and inferior mesenteric ganglia)
- POSTSYNAPTIC FIBERS follow arteries to target ORGANS
What is the function of the Sympathetic Innervation?
- Inhibit peristalsis
- Vasoconstriction
What is the Sympathetic Innervation of the Foregut?
Greater Splanchnic
What is the Sympathetic Innervation of the Midgut?
Lesser/Least Splanchnic
What is the Sympathetic Innervation of the Hindgut?
Lumbar Splanchnic
What is the Parasympathetic Innervation?
- Anterior and posterior vagal trunks (CN X) of presynaptic fibers pass through the celiac and superior mesenteric ganglion to target organs
- Pelvic splanchnic nerves (S2-S4) presynaptic fibers pass intrinsic
ganglia at target organs - Postsynaptic fibers synapse on intrinsic ganglia on organ wall
What is the function of the Parasympathetic Innervation?
- Increase peristalsis
- Vasodilation
What is the Parasympathetic Innervation of the Foregut?
Vagus
What is the Parasympathetic Innervation of the Midgut?
Vagus
What is the Parasympathetic Innervation of the Hindgut?
Pelvic Splanchnic
What is Referred Pain?
Visceral afferent fibers convey pain sensations and accompany SYMPATHETICS retrogradely (T5-L3 and S2-S4)
Visceral pain is POORLY LOCALIZED
Referred pain is the brain misinterpre<ng visceral pain as pain corresponding to the dermatome of the
same spinal cord level
