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Block 3: Anatomy & Embryo > Abdominal Cavity/GI Tract & Foregut > Flashcards

Abdominal Cavity/GI Tract & Foregut Flashcards

1
Q

Explain the difference between abdominal (visceral) vs. subcutaneous obesity

A

Abdominal- “Male” type, MORE COMPLICATIONS, androgens promote it. Apple-shaped obesity
Subcutaneous- “Female” type. Estrogen promotes it. Pear-shaped.

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2
Q

What are the foregut derivatives?

A

Esophagus, stomach, proximal duodenum, pancreas, liver, gall bladder, spleen.

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3
Q

What are the midgut derivatives?

A

Distal duodenum, jejun, ileum, cecum, appendix, ascending colon, most of transverse colon

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4
Q

What are the hindgut derivatives?

A

Distal transverse colon, descending colon, sigmoid colon, recutm, upper 2/3 anal canal.

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5
Q

Foregut organs of digestion+spleen have what kind of pain and where? Arterial supply?

A

Initially, pain is dull and vague in the epigastric region.

Celiac artery

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6
Q

Midgut organs of digestion have what kind of pain and where? Arterial supply?

A

Pain is initially dull and vague in the umbilical region

superior mesenteric artery

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7
Q

Hindgut organs of digestion have what kind of pain and where? Arterial supply?

A

Pain is initially dull and vague in the hypogastric region.

Inferior mesenteric artery.

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8
Q

Which part of the peritoneum is very sensitive to pain?

A

Parietal peritoneum.

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9
Q
  1. Which extends more superior, the greater or lesser peritoneal sac?
  2. What connects the greater and lesser peritoneal sacs?
  3. what is posterior to the lesser sac?
  4. what two structures are anterior to the lesser sac?
A
  1. The lesser sac (aka omental bursa)
  2. The omental foramen
  3. The pancreas, and major arteries and veins
  4. The lesser omentum and the stomach.
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10
Q

What is the greater omentum? What does it do?
What does it extend to/from?
Also important for..

A

Peritoneum with fat. Has lymphocytes that move to infection.
Extends from greater curvature of stomach to the transverse colon.
Important source of intra-abdominal fat.

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11
Q
  1. The lesser omentum is between what?
  2. What is the left part of it called? Connects what?
  3. What is the right part of it called? Connects what?
A
  1. The liver and the stomach/duodenum.
  2. Called the hepatogastric lig. Connects liver to lesser curvature of stomach.
  3. Called hepatoduodenal lig. Connects liver to duodenum.
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12
Q

What contains the portal triad?

A

The hepatoduodenal ligament.

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13
Q

What is the mesentery?
Characteristics? How many layers?
More anterior or posterior?

A

Peritoneum that isn’t parietal or visceral. Suspends organs from body wall. Has two layers.
More posterior.

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14
Q

What are the 4 mesenteries?

What do they support? Characteristics?

A

Suspends these organs from POSTERIOR abdominal wall

  1. Transverse mesocolon (for transverse colon)
  2. THE mesentery- For small intestine. Angles from upper left to lower right
  3. Mesoappendix- for appendix
  4. Sigmoid mesentery
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15
Q

What do the falciform ligaments, coronary ligaments, and triangular ligaments do?

A

Falciform ligament- Divides liver into right and left lobes. Suspends liver from anterior abdominal wall. Contains round ligament of liver (ligamentum teres hepatis).
Has two layers, which are the right and left anterior and posterior layers of the coronary ligaments. Continues superiorly to become these.

R/L Coronary ligaments- Suspend liver from diaphragm.

R/L Triangular ligaments- place where ant/post layers of coronary ligaments merge here.

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16
Q

What is on the bare area of the liver?

Other characteristics?

A

IVC is on it. Lacks peritoneum. Near diaphragm.

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17
Q
  1. What is the gastrophrenic lig?

2. Phrenicocolic lig?

A
  1. Suspends upper part of stomach from diaphragm.

2. Suspends left colic flexure (junction of transverse and descending colon) from diaphragm.

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18
Q
  1. what is the gastrosplenic lig?

2. Splenorenal lig?

A
  1. Stomach to spleen. Contains aa.

2. Spleen to left kidney.

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19
Q
  1. What are umbilical folds?
  2. What makes the median, medial, and lateral umbilical folds?
  3. Umbilical folds are landmarks for what?
A
  1. ridges of peritoneum made by external structures.
  2. Median- Made by external urachus.
    medial- Made by external obliterated umbilical artery
    lateral- Made by external inferior epigastric artery/vein.
  3. Landmarks for laparoscopic hernial repair.
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20
Q

How do abdominal nn, aa, and vv get to viscera?

A

Via mesentery, since they are retroperitoneal.

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21
Q

What organs are primarily retroperitoneal?

What does secondarily retroperitoneal mean?
Which organs are they?

A

Kidneys, adrenal glands, ureters, all aa, nn, and vv

They were initially intraperitoneal but became RP at birth.
Include pancreas (except tail), last 2 parts of duodenum, ascending colon, and descending colon.
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22
Q

Explain the following pathologies:

  1. Peritoneal adhesions
  2. Ascites
  3. Intraperitoneal injection (IP)
  4. Peritoneal dialysis
A
  1. Adhesion of visceral and parietal pleura, e.g. after surgery
  2. excess serous fluid, often due to R. side heart failure, liver failure. Treatment is paracentesis.
  3. Route for drug delivery
  4. Temporary for renal failure. NOT hemodialysis.
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23
Q

What are the 4 peritoneal gutters/spaces? Why are these important?

A

R and L infracolic spaces, R and L paracolic gutters. Spread infections to/from pelvis, and spread metastases.

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24
Q
  1. When supine, where do blood/ascites collect?

2. When erect?

A
  1. supine- hepatorenal recess, right side only.
  2. erect- for males, rectovesical pouch–between rectum and bladder in pelvis
    For females, rectouterine pouch— between rectum and uterus in pelvis.
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25
Q

Which is more superior, pyloric antrum or pyloric canal?

unrelated: Most GI ulcers are what kind?

A

Pyloric antrum.

Peptic ulcers.

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26
Q

What are peptic ulcers, and where are they most likely to be found?

A

Lesions of mucosal lining, usually in stomach or 1st part of duodenum.

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27
Q
  1. Where are stress ulcers found? Are they peptic ulcers?
  2. Onset? Cause?
  3. Complications? Risk factor?
  4. Treatment?
A
  1. Stomach, duodenum, or esophagus. NOT peptic ulcers.
  2. Occur within hours of PHYSICAL STRESSORS, like trauma or burns.
  3. hemorrhaging can occur rapidly, high mortality risk. Major issue for ICU patients.
  4. HCI prophylaxis necessary for treatment.
28
Q

A gastric bypass connects stomach to what/bypasses what?

What can develop within days?

A

Skips most of stomach; attaches proximal stomach to distal jejunum. Bypasses ALL of the duodenum.
Diabetes can quickly develop.

29
Q

What does cirrhosis look like?

A

Bumpy surface w/small pale nodules.

30
Q

Most common cause of acute liver failure in the US?

A

Acetaminophen.

31
Q

What is the pathway of liver lymphatic drainage?

A

Liver to celiac nodes (near celiac a) to cisterna chyli to thoracic duct to L venous angle to left subclavian v.

32
Q

The diaphragmatic surface of the liver is separated from the diaphragm by what? exception?
What attaches it to the ant. abdominal wall?

A

By subphrenic recess, except for the bare area of the liver.
Attached to wall by falciform ligament.

33
Q

What does the visceral surface cover?

What separates it from the diaphragmatic surface?

A

Covers various organs. Separated by sharp inferior margin.

34
Q

What are the 4 anatomical lobes of the liver? Which is the biggest lobe? Where are they/what structures are they near?

A

The right anatomical lobe of liver is biggest, then left anatomical lobe.
Quadrate lobe is near gallbladder, Caudate lobe is near IVC. Both of these are seen on visceral surface.

35
Q

What are the parts of the gallbladder?
Removal of gallbladder is called?
What artery supplies gallbladder?

A
  1. Fundus
  2. body
  3. neck
    - Removal is called cholecysectomy
    - Cystic artery
36
Q

How many functional lobes does the liver have? What are they/what do they include? What separates them?

A

2 functional lobes
Left functional lobe- Includes left anatomical, caudate, and most of quadrate.
Right functional lobe is the rest of it.
Divided by IVC fossa through gallbladder fossa.

37
Q
  1. The liver is divided into how many segments?
  2. What separates the segments?
  3. Each segment has its own what?
  4. How do they relate to the functional lobes?
  5. what is a segmentectomy?
A
  1. Eight segments
  2. Segments are separated by 3 hepatic vv
  3. Own br. of hepatic a, hepatic duct, and portal v
  4. Segments 1-4 are the left functional lobe, and 5-8 are the right functional lobe.
  5. Removal of segment due to disease/trauma.
38
Q

What hormone releases stored bile from gallbladder?
What does bile do besides emulsification?
What does it remove from blood?

A

CCK (cholecystokinin)
Important in fat soluble vitamin uptake.
From blood, it removes excess cholesterol and BILIRUBIN

39
Q

What is bilirubin?

Where is it formed?

A

Breakdown product of hemoglobin. Formed in spleen.

40
Q

What does the gallbladder border?

Why is this clinically significant?

A

Liver, ant. abdominal wall, diaphragm, first part of duodenum, transverse colon.
- Inflamed gallbladder can affect any of these. Especially important for referred pain.

41
Q

Explain referred viscerosensory pain.

How will pain be located/feel initially?

A

viscerosensory fiber from organ enters the same spinal cord segment as a somatosensory fiber from skin/parietal peritoneum. Brain interprets pain from skin, not organ. Makes pain DULL initially.

42
Q

All foregut derivatives, such as the gallbladder, have pain referred as coming from where?

A

Epigastric region (upper middle of tic tac toe thing)

43
Q

Gallbladder referred pain, specifically. Nerves?

What happens with pain in the advanced stages?

A

Fires viscerosensory fibers related to T6-T9 spinal nn.
Dull, vague pain in epigastric region (upper middle tic tac toe thing).
It the inflamed gallbladder touches ant body wall parietal peritoneum, SOMATOSENSORY fibers are fired related to T6-T9 DERMATOME.
Pain would be felt in R. hypochondriac region and R. inferior scapula area. SHARP, WELL LOCALIZED PAIN referred here.

44
Q

If inflamed gallbladder touches diaphragm parietal peritoneum, how and where is the pain? Nerves?

A

Pain referred to right C 3, 4, 5 DERMATOME (top of right shoulder).
- Via SOMATOSENSORY fibers traveling in phrenic nerve.

45
Q

Celiac artery comes off of what? Which number is it?

What are the branches of the celiac artery? Any further branching of those? Branches of those?

A

First branch off of abdominal aorta.
A. Common hepatic artery. Branches into:
1. Proper hepatic artery– to liver/gallbladder
- R/L hepatic arteries to liver
-Cystic artery to gallbladder (usually br of right hepatic a)

  1. Right gastric artery– to right side of lesser curvature
  2. Gastroduodenal artery. Branches into:
    • Right gastroomental artery- To right side of stomach greater curvature.
    • Superior pancreaticoduodenal artery (sometimes branches to ant/post)- To pancreas and duodenum.

B. Left gastric artery. Branches into:
1. Esophageal artery- to abdominal esophagus.

C. Splenic artery. Branches into:
1. Pancreatic branches

  1. Short gastric arteries- to fundus; in gastrosplenic ligament.
  2. Splenic branches
  3. Left gastroomental artery- to left greater curvature of stomach.
46
Q

Celiac trunk/artery is between what two organs?

A

Liver and stomach.

47
Q

What artery is at risk when part 1 of duodenum is perforated?

A

Common hepatic artery.

48
Q

What artery is at risk if stomach is perforated?

A

Splenic artery.

49
Q
  1. Where is the Portal Triad?
  2. What structures does it have in that first part?
  3. What deep structure does it have?
A
  1. In the hepatoduodenal ligament, roof of omental foramen, and part of lesser omentum.
  2. In the hepatoduodenal ligament, it has 2 anterior structures: Biliary system on right, and proper hepatic artery on left.
  3. Portal vein is deep and between.
50
Q

What is the rule and exception of the right hepatic artery?

A

Rule: Branch of proper hepatic artery.
Exception: Can be a branch of superior mesenteric artery.

51
Q

What is the rule and exception of the left hepatic artery?

A

Rule: Branch of proper hepatic artery
Exception: Can be a branch of left gastric artery.

52
Q

explain ducts from liver and gallbladder.

A

R/L hepatic ducts from liver join and become common hepatic duct. Cystic duct from gallbladder joins it, and it becomes the bile duct.

53
Q

What makes up the cystohepatic triangle?

What is inside of it?

A

Base of liver, cystic duct, and common hepatic duct.

contains right hepatic artery, cystic artery, and cystic lymph node (won’t see)

54
Q

What goes into the hepatopancreatic ampulla (of vater)?
Which part of duodenum has ampulla?
What is the major papilla?

A 
Bile duct and main pancreatic duct, which join. 
Part 2 (descending part) of duodenum. 
Major papilla is continuation of hepatopancreatic ampulla into duodenum; drainage site into duodenum.
55
Q

Liver venous flow?

A

SMV and splenic v (IMV as well, but it drains into SMV first) into portal vein.
Portal vein to lobules of liver.
R/L/Middle hepatic veins to IVC

56
Q

Portal vein is junction of?

A

Literally the fusion of SMV and splenic v.

L gastric v, paraumbilical v, and IMV all join in as well, though somewhat indirectly

57
Q

What are the 3 Portal-Caval anastomoses? Start with most important. Discuss clinical correlation of the second two.

A
  1. Thoracic esophageal vv to azygos system to SVC
    Abdominal esophageal vv to Left gastric v to portal v.
  2. Paraumbilical v to portal v
    Thoraco /superficial epigastric vv to SVC/IVC
    –relates to caput medusae
  3. Superior rectal v to inferior mesenteric v to to splenic v to portal v
    mid/inf rectal vv to common iliac v to IVC.
    – causes engorged rectal vv.
58
Q

2 Clinically significant things with portal HTN?

A
  1. Deadly esophageal variceal bleeds
    - blood intro trachea/bronchi. Drown in own blood (exsanguinate)
  2. Profound Ascites
    - Lots of fluid in peritoneum. Difficulty breathing, pain, etc.
59
Q

What is the goal of the 3 portal-caval shunts? What are they?

A

Lower venous pressure to prevent deadly esophageal varices.

  1. Portal caval shunt at omental foramen
  2. Splenorenal shunt
  3. TIPS (involves stent)
60
Q

Pancreas extends from what two organs? Head and tail?

A

From duodenum to spleen. head by duodenum, tail near spleen.

61
Q

Superior mesenteric artery bridges over what part of pancreas?
Parts of pancreas?
What artery is superior to it? Inferior? What does this do clinically?

A

Over uncinate process.
Uncinate process, head, neck, body, tail.
Celiac artery is superior to pancreas, SMA is inferior.
Makes pancreatic cancer resection dangerous.

62
Q

What are the parts of the duodenum? Which are retroperitoneal?

A
  1. Superior (cap)- Only part NOT RETROPERITONEAL.
  2. Descending
  3. Transverse
  4. Ascending
63
Q

What does the suspensory ligament of the duodenum do?

Landmark for what?

A

Anchors part 4 of duodenum to body wall. Surgical landmark for gut resection.

64
Q
  1. What does the spleen do?

2. Injury to it causes?

A
  1. Removes aged/damaged RBC via macrophages. Makes bilirubin and takes it to liver.
    Major blood reservoir.
  2. hemoperitoneum
65
Q

What is the most common abdominal organ affected by trauma?

A

Spleen.

66
Q

what arteries are clamped in splenectomy?

A

splenic artery and short gastric aa.

67
Q

Gray’s: Proper hepatic artery is in what structure?

A

In the hepatoduodenal ligament. It’s the only artery in this ligament.

Block 3: Anatomy & Embryo (8 decks)

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