Abdominal contents Flashcards
what makes up the anterior abdominal contents?
digestive tract and related organs (foregut, midgut, hindgut)
what makes up the posterior abdominal contents?
kidneys, suprarenal glands, neurovascular system
what makes up the foregut and what is its blood supply?
abdominal esophagus, stomach, liver, 1/2 duodenum, pancreas, spleen
celiac artery/trunk
what makes up the midgut and what is its blood supply?
1/2 duodenum, jejunum, ileum, proximal 1/2 colon
superior mesenteric artery
what makes up the hindgut and what is its blood supply?
distal 1/2 colon
inferior mesenteric artery
what happens to the foregut in the 3rd month of development?
rotates 90 degrees clockwise
- left vagus plexus rotates anterior
- right vagus plexus rotates posterior
- formation of lesser peritoneal sac happens
what happens to the midgut as it starts to rotate and elongate?
turns around the superior mesenteric artery 270 degrees counterclockwise
what happens if the midgut doesn’t rotate all the way?
abnormal alignment of the contents at only 180 degrees: - appendix under liver - pain around McBurney's point - splanchnic nerves mixed
does the hindgut have rotation?
no & elongates slowly
what makes up the abdominal cavity?
all contents inn the abdominal wall/diaphragm and pelvic inlet
what makes up the peritoneal cavity?
contents in peritoneum
- visceral peritoneum
- parietal peritoneum
what is the folding of the visceral peritoneum?
greater and lesser omentum (ligament)
where is the greater omentum?
from the greater curvature of stomach to transverse colon
where is the lesser omentum?
from lesser curvature of stomach to liver
what is the folding of the parietal peritoneum made of?
mesentery, mesocolon, falciform ligament
- attaches organs to abdominal wall
- provide neurovascular bundle
what are the intraperitoneal organs referring to?
structures within the peritoneum / covered by visceral peritoneum
what organs are intraperitoneal organs? Are they fixed or mobile?
esophagus, stomach, jejunum, ileum, caecum, appendix, transverse colon, sigmoid colon, spleen
organs are mobile
what organs are primary retroperitoneal organs? are they fixed or mobile?
distal rectum, kidneys, ureters, adrenal glands, IVC & AA, testes before descending to scrotum in males
organs are fixed
what organs are secondary retroperitoneal? are they fixed or mobile?
what makes them secondary organs?
they are spun out of the visceral peritoneum
- 3/4 duodenum
- pancreas (tail in hilum of spleen)
- ascending colon
- descending colon
where is the greater peritoneal sac located?
with intraperitoneal organs
where is the lesser peritoneal sac located?
recess bounded by greater and lesser omentum
empty
what is the omental foramen?
connecting the greater sac and lesser sac hepatoduodenal ligament is located here - made of: 1. hepatic artery proper 2. hepatic portal vein 3. common bile duct
why is the squamocolumnar junction significant?
transition from squamous (ectoderm) to columnar (endoderm)
what causes GERD (heart burn)?
malfunction of the squamocolumnar junction
what is a partial splenectomy?
reserves partial functions and supports the stomach
what are the functions of the stomach?
digestion
limited absorption (meds, alcohol, nicotine)
intrinsic factor for B12 absorption - makes more red blood cells
- lipid and fat soluble vitamins are absorbed here too
what is anemia common in vegetarians?
they have limited vitamin B12 from their food which limits the amount of red blood cells created
what 2 additional lobes are found on the posterior side of the liver?
caudate and quadrate (medial to IVA and gallbladder)
what are the 4 ligaments of the liver that divide it into right and left lobes?
falciform ligament
coronary/left triangular ligaments
ligament teres
ligamentum venosum
what are the functions of the liver?
nutrient storage
detoxification (filter out nutrients)
secret bile –> drain to gallbladder
what is the difference between the portal vein and the hepatic vein?
portal vein drains into the liver
- nutrient enriched and deoxygenated
hepatic vein drains into IVC
what are the two blood vessels that flow into the liver? lungs?
liver: portal vein (deoxygenated) - acts like artery hepatic artery (oxygenated)
lungs: pulmonary artery (deoxygenated) bronchial artery (oxygenated)
what is the venous drain out of the liver? lungs?
liver: hepatic vein (deoxygenated)
lungs: pulmonary vein (oxygenated) - oxygenated like artery
what does the gallbladder store?
- concentration of bile from common hepatic duct
- leaves organic components only
- digestion and absorption of lipids/lip-soluble vitamins
how does a gallstone form and what may need to happen if symptoms show?
deposits of bile (highly organic components)
cholecystectomy may happen - removal of gallbladder
what is the blood supply for the gallbladder?
cystic artery from right hepatic artery
what is the innervation of the gallbladder?
visceral motor
30-80% is innervated by the phrenic nerve - pain around shoulder and back
what are the functions of the pancreas?
endocrine: insulin and glucagon (secreted by beta and alpha cells)
exocrine: digestive enzymes
what is unique about the blood supply of the pancreas?
endocrine glands have complicated blood supply
multiple anastomoses
how is the spleen derived?
mesoderm derived
develops with endoderm-derived stomach into peritoneal organ
what is Kehr’s sign?
referred left shoulder pain - ruptured spleen
thin and easily lacerated
bleeding
what is the red pulp for in the spleen?
hematopoietic - regenerating red blood cells
what is the white pulp for in the spleen?
immunity
- follicles
- germinal centers
reproduction of WBCs
what are the functions of the spleen?
center of immune response
surveillance (24/7)
mesenteric lymph nodes come from the spleen
what is the importance of the lacteal duct?
it absorbs fat
what 2 parts of the duodenum are part of the foregut?
1 - superior
- from pyloric canal/pyloric sphincter
2 - descending
- major and minor duodenal papilla for bile and digestive enzymes
what 2 parts of the duodenum are part of the midgut?
3 - horizontal
4 - ascending (duodenojejunal junction/flexure)
what is the ligament of treitz and where is it located?
- piece of diaphragm muscle from esophageal hiatus, R crus
- suspending 3/4 duodenum and duodenojejunal flexure
what is the starting blood supply for the duodenum and where does it drain into?
blood supply: gastroduodenal branch from common hepatic artery
drains into: superior mesenteric vein
at what level is the superior mesenteric artery?
L1
at what level is the inferior mesenteric artery?
L3
which artery is embedded in the jejunum and ileum?
superior mesenteric artery
which artery is embedded in the transverse colon?
middle colic artery
which arteries are embedded in the sigmoid colon?
sigmoid and superior rectal arteries
which artery is embedded in the appendix?
appendicular artery
why can it be difficult to perform an appendectomy sometimes?
appendix can swim around the mesoappendix
in 180 degrees rotation during development it may not situate to the correct spot
how are the intraperitneal organs attached to the abdominal wall? fixed or highly mobile?
mesentery proper
highly mobile
how long is the midgut: jejunum and ileum?
5-10 m
what is the difference between the jejunum and ileum?
jejunum: less layers of arcades and longer vasa recta. mainly absorbs nutrients
ileum: less circular folds
where does the midgut stretch from?
ileocecal junction to 2/3 transverse colon
where does the hindgut extend from?
distal 1/3 transverse colon to anus
what is the total length of the colon?
2 meters
what is tenia coli?
3 separate longitudinal ribbons of smooth muscle on the outside of the colon
what is haustra?
segmentation of the wall
semilunar folds inside
what is the function of the colon?
- limited absorption: water, salt
- symbiosis
- dehydrate digested food residues to stool
what does constipation do to the colon?
compress obturator nerve and induce right inner, mid thigh numbness/tingling
which kidney is higher and why?
left kidney is higher.
right kidney is lower due to the liver
what kind of capsule does the kidneys have?
thick capsule/outer layer
what is in the hilum of the kidney?
renal artery
renal vein
renal pelvis
what are the functions of the kidneys?
urine production
electrolyte and water balance
regulate blood pressure: renin-angiotensin system
hematopoiesis: cytokine erythropoietin (EPO)
at what level is the renal artery?
L2
what is an abdominal aorta aneurysm?
ballooning of the abdominal aorta
what is nutcracker syndrome?
left renal vein runs between superior mesenteric artery and aorta.
L renal vein impinged is nutcracker syndrome
where is the sympathetics in the kidney?
blood vessel smooth muscles
where is the parasympathetics for the kidneys?
ureter - parasympathetic for peristalsis of urine drainage into urinary bladder
where does the adrenal glands sit?
over the kidneys - no connections
what does the adrenal glands do?
regulate metabolism blood pressure immune response stress response sexual hormones
where does the right adrenal gland drain into?
IVC directly
where does the left adrenal gland drain into?
renal vein
what important structures are at the T12 level?
aortic hiatus (median arcuate ligament) celiac trunk: foregut
what important structure is at L1, transpyloric plane?
superior mesenteric artery: midgut
what important structure is at L3?
inferior mesenteric artery: hindgut
what important structure is at L2?
renal artery but can be higher too
what is the primary retroperitoneal and descends to the pelvis/scrotum?
gonadal artery
what important structure is at the division of L4?
common iliac artery
what important structures merge at L5?
inferior vena cava formed by common iliac veins
what veins drain directly to the inferior vena cava? Why?
right adrenal gland vein
right gonadal vein (left through renal vein, right directly into ivc)
IVC is on the right so many right veins drain into it
what are the celiac and mesenteric veins?
midline vessels
what percentage drains into left subclavian vein? Right?
75%
25%
what artery is the anastomosis of the foregut and midgut?
superior and inferior pancreaticoduodenal artery
what is the anastomosis between the midgut and hindgut?
middle and left colic artery
what is the anastomosis between the hindgut and pelvis?
superior rectal and middle/inferior rectal (internal iliac artery)
what is the importance of anastomosis in the abdominal aorta?
bypass of atherosclerosis (buildup of fats in arteries)
what is the water shed zone?
region that receives dual blood supply - such as splenic flexure and large intestine
- less blood supply at splenic flexure = bowel resection
where does the digestive tract drain back to?
portal vein –> goes to liver portal system
right gastric, splenic vein, superior mesenteric, inferior mesenteric
what are the functions of portal system?
storage of nutrients
detoxication
what happens to drainage during portal hypertension?
back flow of blood through anastomosis
what is the blood flow when esophageal varices are present?
gastric/splenic vein to esophageal veins
what is the blood flow during hemorrhoids?
rectal veins to internal iliac veins
what are the veins in caput medusa?
paraumbilical veins
- if IVC is impaired, drainage goes directly to subclavian veins
what is the sympathetic innervation of the foregut?
greater splanchnic nerve T5-T9
what is the sympathetic innervation of the hindgut?
lumbar splanchnic nerve L1-L2
what is the parasympathetic innervation of the foregut?
vagus nerve (cranial nerve 10)
what is the parasympathetic innervation of the midgut?
vagus nerve (cranial nerve 10) to 2/3 transverse colon
what is the parasympathetic innervation of the hindgut?
pelvic splanchnic nerve S2-S4
what are the monitoring stimuli for the visceral sensory system?
stretch, temperature, chemicals, irritation
** all are free nerve endings, not myelinated, diffuse ascending pathways
what are the reactions to stimuli as part of the visceral sensory system?
hunger, fullness, pain, nausea, etc
what is the phrenic nerve a shuttle for?
mediastinal pleura
fibrous pericardial capsule
gallbladder nociception
what is the autonomous nervous system made up of?
plexus of enteric neurons
“2nd brain”
what happens when the enteric nervous system and central nervous system (visceral motor) work together?
inhibition of sympathetic visceral motor
activation by parasympathetic visceral motor
connection by symbiotic bacteria: depression
what is referral pain?
pain commonly perceived as somatic
is the visceral membrane innervated?
no, no nociception
what is the most common referral pain in physical therapy?
- kidney problems and back pain
- severe pain around costovertebral angle
- test: percussion test (hit hand on kidney) - retroaortic left renal vein and back pain
