Abdominal Contents Flashcards
What is contained in the foregut
Abdominal esophagus Stomach Liver 1/2 duodenum Pancreas Spleen Celiac artery
What is contained in the midgut
1/2 duodenum Jejunum Ileum Proximal 1/2 colon Superior mesenteric artery
What is contained in the hind gut
Distal 1/2 colon
Inferior mesenteric artery
What is contained in the posterior abdominal cavity
Kidneys
Supradrenal glands
Neurovascular bundle
When does rotation of the gut happen
3rd month gestation
What happens in the rotation of the foregut
90 degrees rotation clockwise
L vagus plexus to anterior
R vagus plexus to posterior
Formation of lesser peritoneal sac
What happens with rotation of midgut
Rotates and elongates rapidly around superior mesenteric artery
270 degrees counterclockwise
What happens if midgut rotation stops at 180 degrees
Appendix is under liver and pain is around McBurney’s point
Splanchnic nerves are mixed
Does the hindgut rotate
No, just elongates slowly
What is the omentum ligament
Folding of visceral peritoneum
Greater= from greater curvature to transverse colon
Lesser= from lesser curvature to liver
What is the mesentery, mesocolon, ligament falciform
Folding of parietal peritoneum
Attach organs to abdominal wall and provide neuromuscular bundle
What are the intraperitoneal organs
Organs that are completely surrounded by visceral peritoneum
Esophagus, stomach, jejunum, ileum, appendix, transverse colon, cecum, sigmoid colon
MOBILE
What are the retroperitoneal organs
Organs outside the parietal peritoneum
SAD PUCKER
ORGANS FIXED INTO LOCATION
What are secondary retroperitoneal organs
Some digestive organs are spinned out of visceral peritoneum
3/4 duodenum
Pancreas
Ascending and descending colon
What are the primary retroperitoneal organs
Other organs that originate outside of the peritoneal cavity
Distal rectum Kidneys, ureters Adrenal glands Great vessels, IVC, AA testes before descending
What is the one primary retroperitoneal organ that spins into intraperitoneal
Spleen
Bad temper in Chinese
What is the blueprint for the foregut
Abdominal esophagus Stomach Liver 1/2 duodenum Pancreas Spleen
What is the blood supply for the foregut
Celiac trunk
What is the blueprint for the midgut
1/2 duodenum Jejunum Ileum Appendix Cecum Ascending colon 2/3 transverse colon
What is the blood supply for midgut
Superior mesenteric artery
What is blueprint for hindgut
1/3 transverse colon Descending colon Sigmoid colon Rectum Anus
Blood supply for hindgut
Inferior mesenteric artery
What is in the greater peritoneal sac
Intraperitoneal organs
What is in the lesser peritoneal sac
Empty
Recess bounced by greater and lesser omentum
What is the omentum foramen
Connects greater and lesser sacs
Forman of Winslow
Contains hepatoduodendal ligament- hepatic artery proper, hepatic portal vein, common bile duct
What are the branches of the celiac trunk
Splenic artery, common hepatic artery, L gastric artery
What are the branches of the splenic artery
Short gastric artery
L gastroepiploic artery
What are the branches of the common hepatic artery
Gastroduodendal artery
R gastric artery, anastomosis along lesser curvature of stomach
Hepatic artery proper
What are the branches of gastroduodenal artery
Supraduodendal artery
Superior pancreaticoduodendal artery ant/post
R gastroepiploic artery
What are the branches of hepatic artery proper
R/L hepatic artery
Cystic artery from R hepatic artery
What are the sphincters in the esophagus
Gastroesophageal sphincter= internal/external sphincters
Thick circular smooth muscle
Internal esophageal sphincter
R/L crus of diaphragm
External esophageal sphincter
What is squamocolumnar junction
Transition from squamous cells (ectoderm) to columnar (endoderm)
What will the malfunction of the gastroesophageal sphincter result in
GERD
What is a fundus
Farthest part from the distal opening of a hollow organ
What is the blood supply of the lesser curvature of the stomach
Right gastric artery from common hepatic artery
Left gastric artery from celiac artery
What is the blood supply to the greater curvature of the stomach
Right gastro-omental/epiploic artery from gastroduodenal
Left gastro-omental/epiploic artery from splenic artery
What is the blood supply to the fundus of the stomach
Short gastric arteries from splenic artery
Trabecular branches
What is partial splenectomy
Reserve partial functions and support stomach
What is the function of the stomach
Digestion
Intrinsic factor for B12 absorption
Limited absorption for meds, alcohol, nicotine
Pathway for B12
Binding B12
Transport to ileum
Crosses epithelium
Releases B12 to blood to bind with transbalamin II
What is caused by a lack of B12 and who is most susceptible
Anemia and vegetarian
What are the lobes in the anterior liver and what separates them
R and L
Falciform ligament
What are the lobes located posteriorly on the liver
Caudate and quadrate
Medially to IVC and gallbladder
What is the falciform ligament
Parietal peritoneum fold sagittal plane
Fixes liver to anterior abdominal wall
What are the coronary/L triangular ligaments
Parietal peritoneum fold coronal plane
Fix liver to inferior surface of diaphragm
What is ligament teres
Inferior fold of falciform
Remnant of umbilical vein to liver
What is ligament venosum
Posterior liver
Remnant of ductus venous, connection of umbilical vein to IVC
What divides R and L lobes of the liver posteriorly
Falciform, ligament teres, ligament venosum, L triangular ligament
Function of liver
Nutrient storage
Detoxification
Secrete bile, drains to gallbladder
What artery supplies the liver
Common hepatic from celiac trunk
Portal vein, drains into the liver
What vein drains the liver
Hepatic vein into IVC
Describe the bile storage of the gallbladder
Concentration of bile form the common hepatic duct
leave organic components
Digestion and absorption of lipids, cholesterol can form gallstones needing a cholecystectomy
What is the cystic duct
Merges with hepatic duct to continue as common bile duct
What is the blood supply to the gallbladder
Cystic artery from R hepatic artery
What is the innervation of the gallbladder
Visceral motor
30-80% of pop by R phrenic n
If pain is around shoulder and back, probably from after ent visceral sensory n
What is the location of the pancreas
Behind and inferior to stomach
Function of pancreas
Endocrine- insulin and glucagon
Exocrine- digestive enzymes
What is the blood supply of the pancreas
Abundant blood supply
Pancreatic a -> Splenic artery from celiac trunk
Sup. Pancreaticoduodendal a -> gastroduodenal a -> Common hepatic artery from celiac trunk
Inf. Pancreaticoduodendal a -> Superior mesenteric artery
Describe development of spleen (not retro/intra)
Mesoderm derived
Develops with endoderm derived stomach into peritoneal organ
Describe spleen
Intraperitoneal organ
Not related to digestion
Lateral to stomach
What is khers sign
Thin and easily lacerated, bleeding, referral pain on the L shoulder (diaphragm)
What arteries supply the spleen
Splenic artery from celiac trunk
Trabecular artery gives out short gastric arteries
What veins drain the spleen
Splenic vein to portal vein
Function for spleen
Center for immune response
Works with digestive system and bacteria
Mesenteric lymph nodes and acquired immune cells
What is interesting about the spleen in some other animals
Not a separate organ
Follows foregut longitudinally
What are the 4 parts of the duodenum
1- superior, pyloric canal to pyloric sphincter
2- descending, major and minor papilla for bile and digestive enzymes
3- horizontal
4- ascending, duodenojejunal junction
What is ligament treitz
Piece of diaphragm muscle from esophageal hiatus, R crus
Suspending 3-4 duodenum
What is the arterial supply of the duodenum
Gastroduodenal artery from common hepatic artery
Sup/inf post/ant pancreaticoduodenal arteries
Where do the veins of duodenum drain to
Superior mesenteric vein
What are the branches of the superior mesenteric artery
Middle colic Right colic Ileocolic Jejunal Ileal
What are the branches of the inferior mesenteric artery
Left colic
Sigmoid
Superior rectal artery
What might make appendectomy difficult to perform
Appendix can move around the mesoappendix
Abnormal abdominal variations with rotation in embryonic development
What is the function of Jejunum and ileum
Digestion and absorption
5-10 cm long
What is the duodenojejunal flexures and ileocecal junction
Landmark for foregut and midgut
Flexures suspended by ligament treitz
Ileocecal junction has a valve
What are the differences between Jejunum and ileum
Jejunum= more folds less arteries
Ileum= more arteries less folds
Where do the midgut and foregut lie
Midgut runs from ileocecal junction to 2/3 transverse colon
Hindgut runs from distal 1/3 of transverse colon to anus
2 m total
What is the function of the colon
Limited absorption, water and salt symbiosis
Dehydrate digested food residues to stool
What is the pathology of the colon related to constipation
Constipation enlarges the colon and can compress the obturator n and induce inner thigh tingling and numbness
What are the Tenia coli
3 separate longitudinal ribbons of smooth muscle on the outside of the colon
What is haustra
Segmentation of the colon wall, semilunar folds on the inside
What are the obstruction sites in the colon
Hepatic flexure- R side
Splenic flexure- L side
Describe the position of the kidneys
R is lower due to the liver
Concave in the center, convex on both poles
What are the contents of the renal hilium
Renal artery, renal vein, renal pelvis
What are the functions of the kidneys
Urine production
Electrolyte and water balance
Regulate BP
Hematopoiesis: cytokine erythropoietin
What artery supplies the kidneys
Renal artery
R renal artery is posterior to IVC
What is a common pathology in relation to R renal artery
R renal artery is posterior to IVC
increasing abdominal aortic aneurysm risk inferior to renal artery
What vein drains the kidneys
Renal vein to IVC
What is nutcracker syndrome
L renal vein is compressed between superior mesenteric artery and abdominal aorta
What is the nerve supply to the kidneys
Sympathetic fibers to blood vessels and smooth muscle
Parasympathetic fibers to ureter for peristalsis of urine drainage into urinary bladder
What is the function of adrenal glands
Regulate metabolism BP Immune response Stress response Sexual hormones
What is the arterial supply to adrenal glands
Superior- inferior phrenic a
Middle- aorta
Inferior- renal artery
What is the venous drainage for adrenal glands
R- to IVC
L- renal vein
What anastomosis is between foregut and midgut
Superior and inferior pancreaticoduedendal
What anastomosis is between midgut and hindgut
Middle and left colic artery
Water shed zone- less blood supply at splenic flexure
What anastomosis is between hindgut and pelvis
Superior rectal and middle/inferior rectal
What is the importance of anastomosis in abdomen
Bypass of atherosclerosis
Abdomen can still get blood even with blockage
What veins drain back to the portal vein
Right gastric vein
Splenic vein
Superior mesenteric vein
Inferior mesenteric vein
What is the importance of the digestive tract veins draining back to the liver portal system
Storage of nutrients and detoxification
What is the nerve innervation of foregut
Sympathetic- greater sphlanchnic n T5-9
Parasympathetic- vagus n
What is the innervation of midgut
Sympathetic- inconclusive
Parasympathetic- vagus n to 2/3 transverse colon
What are the functions of visceral sensory system
Monitor stimuli: stretch, temp, chemicals, irritation
Free nerve endings not myelinated
Perception: hunger, nausea, fullness, pain
Describe enteric nervous system
Autonomous nervous system= plexus of enteric neurons, outnumbers spinal cord
Like second brain, how vegetative bodies can still live and digest food
How to tell if back pain is kidney pain
Severe pain around Costovertebral angle
Positive percussion test, high sensitivity, but low specificity
What is in the hepactoduodendal ligament
Hepatic artery proper, hepatic portal vein, common bile duct
From the esophagus to the anal canal, what are the four basic layers starting from the lumen
Mucosa
Submucosa
Muscularis externalis
Serosa
Functions of lymphatic system
Transport excess tissue fluid to blood
What is the nerve innervation of the hindgut
Sympathetic- lumbar splanchnic n
Parasympathetic- pelvic splanchnic n
What structures does the superior gluteal artery run between
Lumbosacral trunk and S1
What structures does the inferior gluteal a runs between
S1 and S2
During portal hypertension, what is the back flow anastomosis?
Gastric/splenic v to esophageal v
Rectal v to internal iliac v
Epigastric v to IVC (paraumbilical can reopen with portal hypertension)
