abdominal contents exam 3 anatomy Flashcards
what does parietal peritoneum line?
- lines internal aspect of abdominopelvic wall
somatic sensory innervation of parietal peritoneum
nerves of abdominal wall (localized pain)
what does visceral peritoneum do?
invests the organs
visceral and somatic sensory of the visceral peritoneum
- visceral- stretch, ischemia
- somatic sensory- doesnt have
what is the peritoneal cavity and what does it contain?
- potential space between parietal and visceral peritoneum
- contains thin layer of fluid NO ORGANS
What is ascites?
collection of fluid in the peritoneal cavity
in which sex is the peritoneal cavity open and which is it closed?
females-open
males-closed
what is the retroperitoneal space and what does it contain?
- space between parietal peritoneum and muscles of posterior abdominal wall
- contains= fat, vessels, some organs
what are primarily retorperitoneal organs?
organs that lie deep to the peritoneum in the retroperitoneal space
never had messentary to begin with
intraperitoneal organs
completely covered by the visceral peritoneum and are mobile (stomach)
maintain messentery
secondarily retroperitoneal organs
- organs pressed against the posterior body wall
- losing mobility
lose messentery so lose mobility
waht are messenteries?
- two layers of peritoneum
- suspend organs
- nerves/vessel travel between layers
what are two messenteries associated with the stomach?
greater and lesser omentum
function of the greater omentum
forms adhesions to wall off inflamed organs in order to protect adjacent viscera
what ligaments make up the lesser omentum?
- hepatogastric ligament
- hepatoduodenal ligament
-in the hepatoduodenal ligament is the portal triad
portal triad made up of portal vein, proper hepatic artery, bile duct
what makes up the portal triad?
- portal vein
- proper hepatic artery
- bile duct
what are the greater and lesser sacs and their function
sacs formed by the greater and lesser omentume where fluid accumulates to
what is the omental (epiploic) foramen?
opening deep to the hepatoduodenal ligament that serves as communication between the greater and lesser sac
derivates of the foregut
esophagus, stomach, proximal duodenum, liver, gallbkadder, pancreas
blood supply, venous drainage, and lymphatics of the foregut
- blood supply=celiac trunk
- venous drainage=gastric veins, splenic vein
- lymphatics=celiac lymph nodes
primarily retroperitoneal organs
esophagus, rectum, kidneys, ureters, adrenal glands
secondarily retroperitoneal organs
examples
- 2nd and 3rd part and 4th of duodenum
- ascending colon
- descending colon
- pancreas
describe the esophageal arterial supply
the top part is from the thoracic aorta but the abdominal section is supplied by the abdominal aorta
what kind of hernias can happen in the esophagus?
hiatal hernias
what abdominal plane should the pyloric sphincter be located at?
transpyloric plane (L1)
what part of the duodenum is in the foregut?
superior and descending part
what part of the duodenum is in the midgut?
horizontal and ascending part
what are the 3 parts of the pancreas?
head, body, tail
what is enlargement of the liver called?
hepatomegaly?
the liver is deep to what ribs?
ribs 7-11
what does the falciform ligament do?
divides liver into R/L
how many segments of the liver are there?
8
what do hepatic veins carry and where?
they carry detoxed blood back to IVC
what is the function of hepatocytes?
these are in the liver
produce bile and detox blood
flow of blood and bile in the liver
- deoxygenated, toxic rich blood from GI tract enters liver into the interlobular portal triad
- blood leaves triad to go to central vein which transports clean blood to hepatic vein
- now discussing bile: bile flowing from hepatocytes goes to bile canaliculi, to interlobular biliary ducts, and then to the bile portal triad in the extrahepatic portal triad
what happens when galstones get stuck in the pancreatic ducts?
pancreatitis
when the pancreatic and bile ducts come together where do they dump their contents into?
2nd part of the duodenum
what drains the segments of the right liver lobe?
right hepatic duct; into bile duct
what is the hepatopancreatic ampulla?
a small reservoir where your common bile duct and pancreatic duct meet. It collects bile and pancreatic juices; this drains through the major duodenal papilla opening
*in descending 2nd part of duodenum
what is the accesory pancreatic duct and minor duodenal papilla?
the main drainage duct of the dorsal pancreatic bud in the embryo, entering the duodenum at the minor duodenal papilla (MIP).
what organ do red blood cells go to die and what is it called when it is enlarged?
spleen; splenomegaly
where do vessels and nerves enter/exit the spleen?
hilum
not that lots of blood here so if ruptured pt can bleed out
what are the unpaired branches of the abdominal aorta?
- celiac trunk T12
- superior messenteric artery L1
- inferior messenteric artery L3
celiac trunk branches
* common hepatic artery
r/l hepatic
proper hepatic (part of portal triad too)
gastroduodenal
right gastric
right gastro-omental
* left gastric artery
esophageal
* splenic artery
left gastro-omental
short gastric
list the pancreaticoduodenal arteries
*branches of superior messenteric artery
- anterior and posterior superior pancreaticoduodenal arteries
- anterior and posterior pancreaticoduodenal arties
caval (systemic) system
- parallel to the paired aortic branches (drain contents of retroperitoneal space)
- to inferior vena cava
- to heart
what type of blood travels in the portal system?
deoxygenated, nutrient and toxin rich
describe the actions of the portal system
where blood goes and what happens to it
- blood from abdominal organs to portal vein to liver
- liver then detoxifies blood and then goes to hepatic veins to IVC to right atrium
what are the 3 main tributaries of the portal system?
- splenic vein
- inferior mesenteric vein
- superior mesenteric vein
what is portal caval anastomoses and name them
- it is the the collateral communication between the portal and the systemic venous system.
- umbilicus
- distal esophagus
- colon
- rectum/anus
what veins make up the portal system in the foregut
-portal vein
~right gastric
~left gastric
~splenic
-short gastric
-left gastro-omental
~SM vein
-right gastro-omental
fetal circulation in the abdomen
- umbilical vein
- ductus venosus
- umbilical arteries
what is the adult remnant of the umbilical vein?
round ligament of the liver
located in inferior margin of falciform ligament
what is the adult remnant of the ductus venosus?
ligamentum venosum
what fetal bypass connects the pulmonary trunk to the aorta?
ductus arteriosis
1.
adult remnants of the umbilical arteries
medial umbilical ligaments
what is the chyle cistern?
the abdominal origin of the thoracic duct, and it receives the bilateral lumbar lymphatic trunks
located in FOREGUT
parasympathetic foregut innervation
- function= stimulates peristalsus, secretion
- vagus nerve
- pregang cb in brain
- pregang fibers-vagus nerve
- postgang cb and fibers= walls of foregut organs
sympathetic foregut innervation
- function= inhibits peristalsis, constricts blood vessels
- greater thoracic splanchnic nerve
- lateral horn
- ventral root > spinal nerve > ventral ramus > white ramus communicans > symp trunk > greater thoracic splanchnic nerve
3.** celiac ganglion**= post gang
foregut visceral pain
- follow sympathetic pathway back to spinal cord
- reffered pain is right under nipple area
mid gut derivatives
distal duodenum, jejunum, ileum, cecum, appendix, ascending colon, proximal 2/3 or transverse colon
blood supply, venous drainage, and lymphatics of mid gut
- superior messenteric artery
- superior messenteric vein
- superior messenteric lymph nodes
dertivatives of the hind gut
distal 1/3 of transverse colon, descending colon, sigmoid colon, rectum
blood supply, venous drainage, and lymphatics of hindgut
- inferior messenteric artery
- inferior messenteric vein
- inferior messenteric lymph nodes
what are the parts of the small intestine?
duodenum, jejunum, ileum
what emerges superior to 3rd part of duodenum?
superior messenteric vessels
what marks the duodenojejunal junction and where is it located?
it is marked by the duodenojejunal flexure and it is located in the ascending (4th) part of the duodenum
flexure supported by the suspensory muscle of the duodenum
what is the function of the suspensory ligament of the duodenum?
- also called the ligament of treitz
- it supports the duodenojejunal flexure
- surgical landmark
jejunum vs ileum
- jejunum= prominent plicae circulares
- ileum= sparse/absent plicae circulares; lymphoid nodules (peyers patches)
peyers patches
the numerous areas of lymphoid tissue in the wall of the ileum which are involved in the development of immunity to antigens present there.
ileal (Meckel’s) diverticulum
small outpouching extending from the wall of the intestine and located in the lower portion of the small intestine. The pouch is a remnant of tissue from the embryonic development of the digestive system.
what can present as appendicitis but not be related to the appendix?
inflammation of ileal (meckels) diverticulum
what part of large intestine is in mid gut and which part is in hindgut?
prox 2/3 is mid gut and distal 1/3 is hindgut
what structures are located on large intestine?
- teniae coli
- haustra
- omental appendices
what valve is on the cecum and what is the function?
ileocecal valve; Its function is to allow digested food materials to pass from the small intestine into your large intestine
where is the appendix usually located and what is it behind?
identification point
- mcburneys point
- retrocecal
where do the teniae coli converge?
at the appendix
what are the paracolic gutters?
there is a Right and Left
- areas where fluid can accumulate when laying supine
- allows fluid to move freely throughout abdomen
- The paracolic gutters are spaces between the colon and abdominal wall. They allow infectious fluid to travel out of the organs in the gut.
superior messenteric artery branches in the MIDGUT
- A/P superior and inferior pancreaticoduodenal arteries
- ileal ateries
- jejunal arteries
- colic arteries
-middle, right, ileocolic
~appendicular
compare the jejunum and ileal arterial branches of the superior messenteric artery
- jejunum-few arcade and long straight arteries
- ileal-mulitple arcades and short straight arteries
what forms the marginal artery and what is its significance?
- SMA and IMA > colic arteries > marginal artery
- this connects vasculature of the midgut and hindgut
arteries of the hindgut
IMA *arises from abdominal aorta
left colic
sigmoid
superior rectal
PS midgut innervation
- pregang cb=brainstem
- pregang fibers=vagus nerves
- postgang cb and fibers=walls of midgut organs
PS hindgut innervation
- pregang cb=s2-s4; intermediate gray matter
- pregang fibers= ventral root, spinal nerve, ventral ramus, pelvic splanchnic nerves)
- postgang cb and fibers=walls of hindgut organs
PELVIC SPLANCHNIC HERE (thoracic splanc in sympathetic)
midgut sympathetic innervation
- pregang cb= lateral horn
- pregang fibers= ventral root>spinal nerve> ventral ramus> white ramus communicans> symp trunk>thoracic splanc
- postgang cb and fibers=celiac or superior messenteric ganglion
THORACIC SPLANC NERVE
hindgut sympathetic innervation
- pregang cb=lateral horn
- pregang fibers=ventral root>spinal nerve> ventral ramus>white ramus communicans>symp trunk> lumbar splanc nerve
- postgang cb and fibers=inferior messenteric ganglion
LUMBAR SPLANC NERVE
