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Abdomen/Pelvis Flashcards

1
Q

Abdomen

A

Abdomen is located between thoracic cavity and
pelvic cavity

Bulges into thoracic cage

Continuous with pelvic cavity

Partially covered by rib cage

Support of viscera by bony pelvis

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2
Q

Diaphragm

A

A skeletal muscle.

Attaches to inferior
borders of the rib cage, the xiphoid process, the
lumbar vertebrae, and the posterior wall of the
abdominal cavity.

Separates the thoracic and abdominal cavities
from each other.

Diaphragm limits abdomen superiorly

Three openings in the diaphragm:

  1. Caval opening (T8)
  2. Esophageal hiatus (T10) *vagus also travels with
  3. Aortic hiatus between right and left crura (T12)
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3
Q

Pelvic Floor

A

Supports the abdominal and pelvic viscera.

Has hiatuses for for rectum, urethra, and vagina, as
well as other small openings.

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4
Q

Posterior Abdominal Wall Musculature

A

Three layers of anterior abdominal wall muscles
Quadratus lumborum muscle
Psoas muscle
Iliacus muscle

Psoas muscle + iliacus muscle = iliopsoas muscle

Function: support all the organs in the abdomen cavity
and keep them in place, Also to compress the
abdomen during breathing, coughing, empty bladder and rectum and parturition. Some of them actually move the trunk.

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5
Q

Upper Right Quadrant

A 
Liver
Gall bladder with biliary tree
Duodenum
Head of pancreas
Hepatic flexure of colon
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6
Q

Upper Left Quadrant

A 
Stomach
Spleen
Left lobe of liver
Body of pancreas
Left kidney and adrenal gland
Splenic flexure of colon
Parts of transverse and descending colon
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7
Q

Greater Omentum

A

First thing when you cut open in the abdominal cavity and slice open that sac and move the peritoneal sac aside – what you are going to see is this sheet of fat called the greater omentum,

– has many functions :
collects fat
functions in immune system, so if you have an infection in the abdomen it will migrate to that area and
isolate it

Underneath is see the large intestine,
small intestine and cecum.

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8
Q

Esophagus

A

Conveys food from pharynx to stomach
Begins at the inferior pharynx, continuous with the cricopharyngeus muscle

Terminates at cardiac orifice of stomach

Esophagus enters abdomen through right crus (leg) of
diaphragm, which acts as a physiological constrictor
(T10) and a level of T11, switches from esophageal
mucosa to gastric mucosa: Zigzag (Z) line

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9
Q

Stomach

A

Primary function is enzymatic digestion

Two curvatures

  • Greater curvature
  • Lesser curvature
4 main subdivisions
  - Cardiac part 
  -  Fundus
  -  Body
  -  Pyloris
        > Antrum (the beginning of it) 
       >Pyloric canal 
       >Pyloric sphincter: that controls the passage of food out of the stomach and opens into the duodenum.

Note
Z-line = junction of gastric and esophageal mucosa
Rugae = folds in stomach wall for increase surface area
Pyloric orifice = controls passage of food

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10
Q

Small Intestine

A

Extends from pyloric orifice of stomach to the ileocecal junction (where it joins the large intestine)

mesentery which is this sheet of peritoneum that attaches the intestines to the back wall of the abdomen and allows for passage of blood vessels
and nerves and lymph to get to and from the intestines.

Three subdivisions:

1) Duodenum (primary function is digestion)
2) Jejunum (primary function is nutrient absorption)
3) Ileum (primary function is water absorption)

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11
Q

Duodenum

A

Begins at pyloric orifice ends at duodeno- jejunal junction

C-shaped path around head of pancreas

Much about digestion of ingested food

Four subdivisions

1) Superior: 1st part
2) Descending (receives bile and pancreatic ducts: 2nd part)
3) Horizontal: 3rd part
4) Ascending (joins jejunum at duodenojejunal junction): 4th part

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12
Q

Jejunum & Ileum

A

From duodenojejunal junction to ileocecal junction

Jejunum is primarily for nutrient absorption

Ileum is primarily for water absorption

 Plicae circulares (circular folds/valves of Kerking) more
frequent in jejunum

Simpler arterial arcades in jejunum

Pyers patches in ileum

More encroaching fat in ileum

End of the ileum and here is what we call the ileocecal junction (joining of the ileum to the the
cecum - the very beginning of the large intestine)

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13
Q

Large Intestine

A

The colon = large intestine

  • Cecum is a blind pouch
  • Appendix
  • Ascending colon
    ileocecal junction to hepatic flexure (right colic
    flexure)
    water absorption
  • Transverse colon
    hepatic flexure to splenic flexure (left colic flexure)
    (because they are located in close proximity to the liver and and spleen)
    water absorption (more absorption here)
- Descending colon 
      splenic flexure to left iliac fossa  fecal transport
- Sigmoid colon
       iliac fossa to S3 
       fecal storage
-  Rectum
        storage and evacuation
- Anal canal
       evacuation
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14
Q

Large vs. Small Intestine

A

Large intestine is very large (thick in diameter), it has these extra muscles called

  • TENIAE COLI = look like stripes along the surface of the colon.
  • It has these things that hang of that are like little droplets of fatty tissue they are call EPIPOLIC (mental) appendages
  • It has these HAUSTRA which are just these balloon shaped structures
  • the caliber of the lumen is much thicker than that of the small intestine.
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15
Q

Accessory Organs of the GI Tract

A

Liver
Gall Bladder
Pancreas

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16
Q

Liver

A 
Metabolism
Processing of drugs and hormones
Storage of glycogen, vitamins and minerals
Excretion of bilirubin
Synthesis of bile salts (made in the liver and
stored in the gall bladder)
Phagocytosis
Activation of vitamin D

Falciform ligament: peritoneum coming out of the liver to the front wall of the abdomen)

Ligamentum teres
(remnant of umbilical vein)

 Porta hepatis
(passageway into liver)

1) Portal vein
2) Hepatic ducts
3) Hepatic artery

Note that Inferior vena cava run posterior to liver,
partly surrounded by it.

Four lobes

1) Left
2) Caudate
3) Right
4) Quadrate

17
Q

Portal Triad

A

Found in the hepatoduodenal ligament (free margin of lesser omentum)

Structures:

1) Proper hepatic artery -supplying the liver with oxygenated blood
2) Portal vein
3) Bile duct - which is bringing bile out of the liver

18
Q

Biliary Ducts

A

Right and left hepatic ducts join to form the
COMMON HEPACTIC duct

The cystic duct joins the common hepatic duct to
form the BILE DUCT (common bile duct)

The bile duct joins pancreatic duct and enters duodenum at the major duodenal papilla

19
Q

Pancreas

A

Runs transversely between duodenum and spleen.

Accessory digestive gland:

 - Endocrine secretion into vascular system (e.g. insulin).
- Exocrine secretion via main pancreatic duct and accessory pancreatic duct (pancreatic juices).

Main pancreatic duct joins the common bile
duct.

The head of the pancreas is tucked in between the C of the duodenum and the tail of the pancreas is at the spleen.

20
Q

Spleen

A

Largest lymphatic organ in the body

“Rests” on left colic flexure (also called
the splenic flexure), under the diaphragm

21
Q

Foregut

A

Stomach
1⁄2 of descending duodenum
Liver & gallbladder
Pancreas

Blood Supply: Celiac trunk to foregut derivative

Parasympathetics: Vagus X (from dorsal motor nucleus) and synapses at target structue

Sympathetics: Greater splanchnic nerve (synapses at Celiac ganglion) and post ganglionic sympathetics travel along branches of Celiac artery

22
Q

Midgut

A 
From lower 1⁄2 of descending duodenum onwards
 Jejunum & ileum
 Cecum & appendix
 Ascending colon
 2/3 of transverse colon

Blood Supply: Superior mesenteric

Parasympathetics: Vagus (X) nerve (from dorsal motor nucleus) and synapses at target structue

Sympathetics: Lesser splanchnic nerve (synapsed at Superior mesenteric ganglion) and post ganglionics travel along branches of superior mesenteric a.

23
Q

Hindgut

A 
1/3 of transverse colon
 Descending colon
 Sigmoid colon
 Rectum
 Anal canal (part of)

Blood Supply:
Inferior mesenteric

Parasympathetics: Spinal cords S2-S4 - Pelvic Splanchnic nerves synapsing at target organ

Sympathetics: Lumbar splanchnic nerve (synapsed at Inferior mesenteric ganglion) and post ganglionics travel along branches of inferior mesenteric a.

24
Q

Vascular Supply of GI Tract

A

Three large unpaired branches from the aorta:
1) Celiac trunk/artery

2) Superior mesenteric artery
3) Inferior mesenteric artery

**Note that the aorta splits into common iliac arteries

25
Celiac Trunk
Splenic artery (spleen) ``` Common hepatic artery - Right gastric -Proper hepatic right hepatic left hepatic -Gastroduodenal right gastroepiploic (gastroomental) superior pancreaticoduodenal -Left gastric artery esophageal ``` ``` Celiac (via its branches) supplies: • Pancreas • Abdominal part of esophagus • Stomach • Liver & gallbladder • Duodenum (part of) • Spleen (while not derived from the foregut, it develops in association with it) ```
26
Superior Mesenteric
``` Superior mesenteric artery branches • Inferior pancreaticoduodenal • Jejunal and ileal branches • Ileocolic • Right colic • Middle colic ``` ``` Supplies • Duodenum (part of) • Jejunum & ileum • Cecum & appendix • Ascending colon • 2/3 transverse colon ```
27
Inferior Mesenteric
* Left colic artery * Sigmoid arteries * Superior rectal artery ``` supplies • 1/3 transverse colon • Descending colon • Sigmoid colon • Rectum • Anal canal (part of) ```
28
Portal and Caval Venous Systems
Portal system drains the abdominal viscera and involves two capillary beds (one in the wall of the viscera and the other within the liver) It does NOT drain directly to the heart. In the liver the portal blood gets filtered and then drains into the caval system and then goes up to you heart. ``` The caval (systemic) system drains the head and neck, body wall and extremities. It involves a single capillary bed and does drain to the heart. ``` Receives blood from the portal system that has been processed in the liver via hepatic veins (not to be confused with hepatic portal veins) ** Formed by junction of right & left common iliac veins**
29
Portal System
Hepatic portal vein (= portal vein) formed by junction of superior mesenteric vein and splenic vein Inferior mesenteric vein usually joins splenic vein Includes the veins collecting blood from the abdominal part of the digestive tube, along with the spleen, pancreas and gallbladder. Absence of valves which allows for reverse flow All drain into hepatic portal vein, which drains into liver at porta hepatis.
30
Portacaval Anastomoses
Anastomoses between portal and caval (systemic) veins allowing for collateral circulation. 1-Esophagus: Left gastric vein (P) with esophageal veins (C) -Can get esophageal varices 2-Anal canal: Superior rectal vein (P) with middle and inferior rectal veins (C) - Can get hemorrhoids 3-Umbilicus: Para-umbilical (and/or left umbilical) veins (P) with superficial veins (C) around umbilicus - Can get caput medusa 4-Retroperitoneal
31
Parasympathetics
Promote peristalsis and glandular secretions While passing through the preaortic ganglia they do not synapse there, but rather within the wall of the target organ (travel with arteries) ***Vagus nerve (CN-X) supplies foregut and midgut derivatives Vagus travels to the gut along the esophagus, passing through the diaphragm at T10 Right and left vagus become the posterior and anterior vagal trunks respectively Pelvic splanchnic nerves (S2-S4) supply hindgut derivatives Erection is parasympathetically controlled, ejaculation is sympathetically controlled.
32
Sympathetics
``` Greater splanchnic (T5-T9) to: Foregut derivatives (Celiac ganglion) ``` ``` Lesser splanchnic (T10-T11) to: Midgut derivatives (Superior mesenteric ganglion) ``` ``` Lumbar splanchnics to: Hindgut derivatives (inferior mesenteric ganglion) ```
33
Posterior Abdominal Wall Structures
Structures - Suprarenal (adrenal) glands - Kidneys - Inferior vena cava - Aorta - Renal arteries and veins (branches of the aorta and IVC respectively) - Gonadal arteries and veins - Ureters - Bladder - Cisterna chyli (a very big pocket of lymph collection that then leads to the thoracic duct)
34
Gonadal Vessels
Gonadal arteries are branches of aorta Left gonadal vein is branch of left renal vein Right gonadal vein is branch of IVC
35
Kidney
Renal Artery and Vein which will go to the aorta and IVC Renal cortex Renal pyramids each one ending in whats called a papilla. The nephrons are filtering here - Urine which collects in these calyces (you have 3 minors ones which collect into a major one). This is the renal pelvis where the urine collects and from here it drains down to the ureter and then to the bladder.
36
Blood supply of pelvic viscera
R. and L. internal iliac arteries R. and L. internal iliac veins **Note that the external iliac vessels enter the thigh and are continuous with the femoral vessels
37
ANS in Pelvis
Sympathetics - Lumbar and sacral splanchnics Parasympathetics - Pelvic splanchnics Both sympathetics and parasympathetics travel with arteries to reach the target organs. **note** False pelvis is above the pelvic brim (this is where the guts are) and the true pelvis is below the pelvic brim, that is where most of the reproductive organs reside except during pregnancy
38
Peritoneum and Peritoneal Cavity
Abdominal cavity contains the peritoneal sac: the largest serous sac of the body Peritoneum is composed of mesothelium, a layer of simple squamous epithelial cells. Extends from abdominal cavity into pelvic cavity and subdivides into a greater and lesser sacs (bursa) (lesser sac is continuous with greater sac) Lesser sac located posterior to stomach, greater omentum and liver. All organs in the abdominal cavity are surrounded or covered by peritoneum (like the pleura around the lungs), with serous fluid between the two layers: - Parietal layers line abdominal cavity walls. - Visceral layers surround organs. Mesentery is a double layer of peritoneum that connects between an organ and the abdominal wall attaching the organ to the wall. And vessels and nerve that supply the organ travel within the mesentery. Omentum is also a double layer that attaches one organ to another they are called peritoneal ligaments or omenta.
39
Retroperitoneal
Gut organs in the adult are either intraperitoneal or secondarily retroperitoneal Structures that do not develop between peritoneal folds are primarily retroperitoneal (e.g. kidneys) Intraperitoneal: stomach, liver, spleen, 1⁄4 of duodenum, jejunum, ileum, cecum, appendix, transverse colon, sigmoid colon Secondarily retroperitoneal structures: Result from loss of mesentery during development Include: pancreas, 3/4 duodenum, ascending & descending colon, rectum Primarily retroperitoneal structures are not derived from the gut. (Were always retroperitoneal) Include: kidneys & ureters, suprarenal glands, abdominal portion of aorta, inferior vena cava, sympathetic trunks

Anatomy (14 decks)

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