Abdomen: Viscera Overview/Foregut Flashcards

1
Q

Right costal margin

A
  • Liver

- Gallbladder

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2
Q

Left costal margin

A
  • Stomach
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3
Q

Ribs protect

A
  • Spleen
  • Part of the liver
  • Kidneys
  • Rib frx puts certain viscera at risk (liver, spleen, kidneys)
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4
Q

Foregut extends from

A
  • Esophagus > 2nd part of duodenum
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5
Q

Foregut arterial supply

A
  • Branches from the celiac trunk
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6
Q

Midgut extends from

A
  • 2nd part of duodenum > distal 1/3 of transverse colon
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7
Q

Midgut blood supply

A
  • Branches from superior mesenteric artery
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8
Q

Hindgut extends from

A
  • Distal 1/3 transverse colon > upper anal canal
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9
Q

Hindgut blood supply

A
  • Branches from the inferior mesenteric artery
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10
Q

The GI tract is largely drained by

A
  • The hepatic portal venous system
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11
Q

Foregut innervation (sympathetic)

A
  • Greater splanchnic nerve (T5-T9) > celiac ganglia
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12
Q

Midgut innervation (sympathetic)

A
  • Lesser splanchnic nerve (T10-T11) > superior mesenteric ganglion, aorticorenal ganglia
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13
Q

Hindgut innervation (sympathetic)

A
  • Lumbar splanchnic nerve (L1,L2) > inferior mesenteric ganglion
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14
Q

Least splanchnic nerve (T12) innervates

A
  • Aorticorenal and renal plexus
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15
Q

Postsynaptic sympathetic fibers travel in _____ to destination

A
  • Periarterial plexuses
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16
Q

Postsynaptic sympathetic fibers traveling in periarterial plexuses go to

A
  • Renal plexus, hepatic plexus, etc.
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17
Q

Adrenal gland (medulla) receives

A
  • Direct innervation from presynaptic fibers

- Exception of postsynaptic sympathetics destination pathway

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18
Q

Sympathetic primary functions in abdomen

A
  • Altering vasomotor tone

- Slowing peristalsis

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19
Q

Presynaptics travel in (parasympathetic innervation of abdomina viscera)

A
  • Vagus nerve (A/P vagal trunks)

- Pelvic splanchnic nerves

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20
Q

Vagus nerve innervation (presynaptic parasympathetic)

A
  • Innervates lower esophagus to left colic flexure

- Foregut and midgut

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21
Q

Pelvic splanchnic nerves have nothing to do with

A
  • Sympathetics
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22
Q

Pelvic splanchnic nerves are derived from

A
  • Spinal segments S2-4
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23
Q

Pelvic splanchnic nerves travel through

A
  • Inferior hypogastric plexus
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24
Q

Pelvic splanchnic nerves innervate (presynaptic parasympathetic)

A
  • Descending colon to rectum (hindgut)

- Pelvic organs

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25
Q

Vagus and pelvic splanchnic (pre/para) synapse on

A
  • Postsynaptic neuron on/in wall of viscera
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26
Q

Parasympathetic primary functions in abdomen

A
  • Promote peristalsis and secretion
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27
Q

Visceral Afferents (Sensory)

A
  • Unconscious reflexes

- Nociception

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28
Q

Visceral afferents (sensory) of foregut and midgut travel in

A
  • Vagus nerve
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29
Q

Visceral afferents (sensory) of hindgut travel in

A
  • Pelvic splanchnic nerves
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30
Q

Visceral afferent fibers conveying nociception follow

A
  • Follow sympathetic fibers

- Travel in a reverse course to spinal cord

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31
Q

Visceral afferent fibers conveying nociception from foregut follow

A
  • Foregut > greater splanchnic nerve
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32
Q

Visceral afferent fibers conveying nociception from midgut follow

A
  • Midgut > lesser splanchnic nerve
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33
Q

Visceral afferent fibers conveying nociception from hindgut follow

A
  • Hindgut > lumbar splanchnic nerves
  • Descending colon
  • Proximal ½ sigmoid colon
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34
Q

Exception to visceral pain afferents

A
  • Midpoint of sigmoid colon to rectum
  • Pain afferents follow parasympathetic fibers
  • Pelvic splanchnic to cord levels S2-4
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35
Q

Abdominal esophagus

A
  • Begins at T10 at the esophageal hiatus

- Joins stomach at cardiac region

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36
Q

Parts of the stomach

A
  • Cardia
  • Fundus
  • Body
  • Pylorus
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37
Q

Fundus of the stomach is positioned

A
  • Against left dome of diaphragm
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38
Q

Parts of the pylorus

A
  • Outflow region
  • Pyloric antrum
  • Pyloric canal
  • Pyloric sphincter
  • Pyloric orifice
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39
Q

Pyloric sphincter

A
  • Thickened layer of smooth muscle

- Regulates release of chyme into duodenum

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40
Q

Interior of the stomach contains

A
  • Gastric folds (rugae)
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41
Q

Stomach position and supine surface projection depends on

A
  • Position
  • Body type
  • Fed-state
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42
Q

Intraperitoneal organ

A
  • Covered by peritoneum (except at the “bare area”)

- Location of gastrophrenic ligament

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43
Q

Organs located anterior to the stomach

A
  • Left lobe of liver
  • Diaphragm
  • Anterior abdominal wall
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44
Q

Organs located posterior (posterolateral) to the stomach

A
  • Lesser sac
  • Pancreas
  • Left kidney
  • Adrenal gland
  • Spleen
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45
Q

Organs located superior to stomach

A
  • Diaphragm
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46
Q

Organs located inferior to stomach

A
  • Transverse colon

- Transverse mesocolon

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47
Q

Arterial bloody supply to stomach is from the

A
  • Celiac trunk
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48
Q

Arteries supplying the stomach

A
  • Rt. Gastric (RG)
  • Lt. Gastric (LG)
  • Rt. Gastroepiploic (Rt. GEP)
  • Lt. Gastroepiploic (Lt. GEP)
  • Short Gastric (SG)
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49
Q

Veins (same names as the arteries) drain into

A
  • Portal venous system
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50
Q

Other branches supplying trunk

A
  • Common hepatic artery (CHA)
  • Hepatic artery proper (HAP)
  • Gastroduodenal (GD)
  • Splenic (Spl)
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51
Q

Spleen (lien) function

A
  • Prenatal hmatopoiesis
  • Storage and destruction of RBC and platelets
  • Iron and globin recycling
  • Immune function
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52
Q

Spleen (lien) location

A
  • Left upper quadrant
  • Lies on diaphragm (ribs 9-11)
  • Recumbent position
  • Long axis parallels rib 10
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53
Q

Spleen (lien) can be injured by

A
  • Rib fracture (lies on diaphragm/ribs 9-11)
54
Q

Two surfaces of the spleen

A
  • Diaphragmatic

- Visceral

55
Q

Diaphragmatic surface of spleen (posterior, superior)

A
  • Against diaphragm
56
Q

Visceral surface of spleen

A
  • Abuts organs (stomach, left kidney, left colic flexure)
  • Left colic flexure is inferior
  • Left kidney, stomach are medial
  • Stomach is anteromedial
57
Q

Spleen is considered

A
  • Intraperitoneal
58
Q

Ligaments of the spleen

A
  • Gastrosplenic ligament

- Splenorenal ligament

59
Q

Gastrosplenic ligament

A
  • Ggreater curvature to spleen

- Contains short gastric vessels

60
Q

Splenorenal ligament

A
  • Spleen to kidney
  • Contains splenic vessels and tail of pancreas
  • Splenic artery
61
Q

Splenic artery

A
  • Runs along upper border of pancreas
  • Very tortuous
  • Multiple branches enter spleen
62
Q

Liver is considered

A
  • Intraperitoneal
63
Q

Liver function

A
  • Exocrine secretion (bile production)
  • Endocrine secretion (IGF-1)
  • Receives blood from GI tract via portal vein (nutrient rich, except for fat)
  • Synthesis of proteins (clotting factors, albumin, etc)
  • Stores glycogen
  • Modifies toxic compounds (drug metabolism)
64
Q

Two surfaces of liver

A
  • Diaphragmatic

- Visceral

65
Q

Diaphragmatic surface (anterior, superior, posterior) of liver

A
  • Against diaphragm
  • Separates it from pericardial and pleural cavities
  • Subphrenic recesses
66
Q

Subphrenic recesses (diaphragmatic surface of liver)

A
  • Between liver and diaphragm
67
Q

Visceral surface (posterior, inferior) of liver contains

A
  • Right colic flexure
  • Right kidney
  • Stomach
  • Duodenum
  • IVC
68
Q

Recesses of the visceral surface of liver

A
  • Subhepatic recess

- Hepatoreneal recess

69
Q

Diaphragmatic surface of liver is covered in

A
  • Peritoneum (except for bare area)
  • Peritoneum reflects off as the coronary & triangular ligaments
  • Groove for IVC
70
Q

Coronary & triangular ligaments

A
  • Attaches liver to diaphragm
71
Q

Falciform ligament

A
  • Attaches to diaphragm and anterior ab wall

- Separates subphrenic spaces into left and right

72
Q

Ligamentum teres hepatis (round ligament of the liver)

A
  • Inferior edge of the falciform ligament
  • Obliterated umbilical vein (nutrient rich blood in fetus)
  • Paraumbilical veins pass through
73
Q

Paraumbilical veins

A
  • Pass through falciform ligament

- Connect superficial veins to portal venous system

74
Q

Visceral surface of liver is covered in

A
  • Covered in peritoneum

- Peritoneum covers gallbladder

75
Q

Porta hepatis (transverse fissure of liver) contains

A
  • Hepatic portal vein (posterior)
  • Hepatic artery (left)
  • Hepatic ducts (right)
  • Hepatic nerve plexus
  • Lymphatics
76
Q

Visceral surface of the liver contains

A
  • Porta hepatis
  • Fissures
  • Impressions from neighboring viscera
77
Q

Fissures of the visceral surface of liver

A
  • For round ligament of liver

- Ligamentum venosum

78
Q

Ligamentum venosum

A
  • Remnant of ductus venosus

- Shunts blood from umbilical vein to IVC

79
Q

Anatomical lobes of the liver

A
  • Left and right lobes

- Divided by falciform ligament

80
Q

Functional subdivision of the liver is based on

A
  • Branching of portal vein, hepatic artery and vein, and hepatic duct
81
Q

Gall bladder function

A
  • Stores and concentrates, and releases bile

- Covered by peritoneum

82
Q

Gall bladder location

A
  • Located in fossa on visceral surface of liver
  • Anterior/superior to duodenum
  • Level of costal margin of rib 9
  • Transpyloric plane
83
Q

Biliary ducts function

A
  • Convey bile from liver/gallbladder to 2nd part of duodenum
84
Q

Biliary ducts (names)

A
  • Left and right hepatic ducts
  • Common hepatic duct
  • Cystic duct
  • Common bile duct
85
Q

Biliary duct pathways

A
  • Common bile duct passes posterior to duodenum
  • Joins main pancreatic duct (hepatopancreatic ampulla)
  • Open on the greater duodenal papilla (2nd part of duodenum)
86
Q

Common bile duct passes

A
  • Posterior to duodenum
87
Q

Common bile duct joins with

A
  • Main pancreatic duct

- Forms hepatopancreatic ampulla

88
Q

Main pancreatic duct opens on the

A
  • Greater duodenal papilla

- Located in 2nd part of duodenum

89
Q

Spiral valve (fold)

A
  • Keeps cystic duct open to allow bile flow

- Prevents excessive release

90
Q

Sphincter of Boyden

A
  • Sphincter of the common bile duct
91
Q

Sphincter of Oddi

A
  • Sphincter of ampulla
92
Q

Blood supply to liver

A
  • Dual blood supply
  • Portal vein
  • Hepatic arteries
93
Q

Portal vein conducts

A
  • 75-80% of blood to liver

- All nutrients absorbed from GI tract, except lipids

94
Q

Hepatic arteries conduct

A
  • 20-25% of blood to liver
95
Q

Venous drainage of liver

A
  • Left, right, and middle hepatic veins drain into IVC
96
Q

Blood supply to gallbladder

A
  • Cystic artery
97
Q

Cystic artery

A
  • Commonly branches from right hepatic (variation)
  • Post. to common hepatic duct (most common), can pass anterior
  • Cystohepatic triangle (of Calot)
98
Q

Cystohepatic triangle (of Calot)

A
  • Liver surface

- Cystic and common hepatic ducts

99
Q

Right hepatic and superior pancreaticoduodenal supply

A
  • Hepatic duc
100
Q

Cholelithiasis

A
  • Gallstones
101
Q

Choledocholithiasis

A
  • Bile duct stones
102
Q

Cholecystitis

A
  • Inflammation of the gallbladder
103
Q

Cholecystectomy

A
  • Removal of gallbladder
104
Q

If pancreatic duct is blocked, patient will experience

A
  • Pancreatitis (inflammation of pancreas)
105
Q

Gallbladder referred pain is typically seen in

A
  • Right shoulder
  • Right upper quadrant and back
  • Upper right quadrant
106
Q

Gallbladder referred pain in the right shoulder involves

A
  • Diaphragmatic parietal peritoneum irritation, innervated by phrenic (C3-5)
  • Overlap with sensory from shoulder (supraclavicular nerves, C3,4)
107
Q

Gallbladder referred pain in the right upper quadrant and back involves

A
  • Pain sensory fibers traveling in greater splanchnic nerve (T5-9) overlap with dermatomal innervation
108
Q

Pancreas

A
  • Exocrine/endocrine organ
  • Mostly retroperitoneal
  • Head is surrounded by duodenum
  • SMA and SMV enclosed by pancreas
109
Q

The portal vein is formed

A
  • Behind the neck of the pancreas
110
Q

The neck and the uncinate process of the pancreas encolse

A
  • SMA and SMV
111
Q

Parts of the pancreas

A
  • Head
  • Uncinate process
  • Neck
  • Body
  • Tail
112
Q

Organs located anterior to the pancreas

A
  • Lesser sac

- Stomach

113
Q

Organs located posterior to the pancreas

A
  • IVC
  • Aorta
  • SMA
  • Left crus of diaphragm
  • Left kidney
  • Suprarenal gland
114
Q

Splenic artery runs along

A
  • Superior surface of pancreas
115
Q

Splenic vein runs on

A
  • Posterior surface of pancreas
116
Q

Pancreatic ducts

A
  • Main pancreatic duct

- Accessory pancreatic ducts

117
Q

Main pancreatic duct runs

A
  • From tail to head
118
Q

Blockage of the main pancreatic duct

A
  • Can cause pancreatitis
119
Q

Main pancreatic duct joins with

A
  • The common bile duct

- Forms hepatopancreatic ampulla

120
Q

Hepatopancreatic ampulla is also called

A
  • Ampulla of Vater
121
Q

Hepatopancreatic ampulla (ampulla of Vater)

A
  • Opens in the 2nd part of duodenum on greater duodenal papilla
122
Q

Smooth muscle sphincters

A
  • Sphincter of the pancreatic duct
  • Sphincter of the bile ducts
  • Hepatopancreatic sphincter
123
Q

Hepatopancreatic sphincter is also called

A
  • Sphincter of Oddi
124
Q

Sphincter of Oddi is around

A
  • Hepatopancreatic ampulla
125
Q

Accessory pancreatic duct

A
  • Not always present

- Variation in drainage

126
Q

Accessory pancreatic duct opens on

A
  • The lesser (minor) duodenal papilla

- In the 2nd part of duodenum

127
Q

Accessory pancreatic duct is located

A
  • Superior to greater (major) duodenal papilla
128
Q

The pancreas is supplied (arterial) by branches of

A
  • Gastroduodenal
  • SMA
  • Splenic
129
Q

Branches from gastroduodenal artery that supply the pancreas

A
  • Anterior Superior Pancreaticoduondenal

- Posterior Superior Pancreaticoduondenal

130
Q

Branches of the SMA that supply the pancreas

A
  • Anterior Inferior Pancreaticoduodenal

- Posterior Inferior Pancreaticoduondenal

131
Q

Branches of the splenic artery that supply the pancreas

A
  • Dorsal pancreatic
  • Greater pancreatic
  • Caudal pancreatic
  • Inferior pancreatic (continuation of dorsal pancreatic)