Abdominal Contents: Foregut Flashcards by Kaelyn Garner

Abdominal cavity

What separates abdominal cavity from thoracic cavity?

Peritoneum

What are the two types?
Describe the innervation to each one

Abdominal cavity

Separated from the thoracic cavity by the diaphragm

Parietal peritoneum

Lines the abdominopelvic wall
Somatic sensory innervation via abdominal wall nerves (pain, temperature, touch)
Pain tends to be acute and localized

Visceral peritoneum

Lines the organs
Visceral innervation (stretch ischemia)
NO somactic sensory (pain, temperature, touch)

(Similar to the visceral / parietal pleura)

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Peritoneal cavity

Location?
What does it contain? What does it not contain?
Why do you consider the cavity open in females?
What is ascites?

Peritoneal cavity

Potential space between the parietal and visceral peritoneum
Contains a thin layer of fluid that keeps surfaces moist and lubricated
Does NOT contain organs
Females
- Cavity is open since there is communication to outside world via vagina, uterus, and uterine tubes
Males
- Cavity is closed

Ascites

Excess fluid in the peritonal cavity
Caused by infections, metastasis of cancer, perforatins of GI tract, etc

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Retroperitoneal space

Location?
What does it contain?
What are the three types of organs based on the ontogeny of the gut tube?

Retroperitoneal space

Located between the parietal peritoneum and muscles of the posterior abdominal wall
Contains fat, vessels (e.g. IVC, abdominal aorta), and some organs (e.g. kidneys)

Primary retroperitoneal organs

Organs occupying the retroperitoneal space

Intraperitoneal organs

Organs completely covered by the visceral peritoneum
These ograns are mobile (e.g. stomach)

Secondary retroperitoneal organs

Organs that were completely covered by the visceral peritoneum early in development, but came to be pushed up against the posterior abdominal wall, losing their ability (e.g. ascending colon
However, visceral peritoneum is still attached so you can still remobilize these organs during surgery

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Mesentery

What is it?
Where to the nerves and vessels travel?
What is a mesentary associated with stomach called?
What are the names of the two types?

Mesentery

Two layers of peritoneum that attach organ to the body wall or another organ
Nerves and vessels travel between the two layers to reach the organs
Mesentaries associated with the stomach are called omenta
There is the greater omentum and lesser omentum

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Greater omentum

Location?
How does it provide protection?

Greater omentum

Extends from the greater curvature of the stomach to transverse colon
Forms adhesions to wall off inflamed organs, protecting adjacent viscera

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Lesser omentum

Location?
What two peritoneal ligaments is it composed of?
Which ligament contains the portal triad?
What comprises the portal triad?

Lesser omentum

Extends from the lesser curvature of the stomach to the liver
Composed of the:
- Heptaogastric ligament - between stomach and liver
- Hepatoduodenal ligament - between duodenum and liver
  - Hepatoduodenal ligament contains the portal triad
    - Portal vein
    - Proper hepatic artery
    - Bile duct

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Greater and lesser sacs

What are they?
Location of each?
What structure allows for communication between the two?

Greater and lesser sacs - peritoneal cavity is divided into two sacs (potential spaces)

Greater sac - larger sac that extends from the diaphragm to the pelvic region

Lesser sac - smaller sac that is posterior to the stomach and lesser omentum

Omental (epiploic) foramen - opening deep to the heptoduodenal ligament that allows for communication between the greater and lesser sacs

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Divisions in the gut tube

What are the three divisions?
What do organs in each division share?

Divisions in the gut tube

Embyonic gut tube can be divided into three divisions:
- Foregut
- Midgut
- Hindgut
Organs in same division share:
- Common blood supply
- Route of venous drainage
- Route of lymphatic drainage
- Innervation

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Esophagus

What vertebral level does it pass through diaphragm?
What functions as a sphincter to the esophagus?
Where do hiatal hernias take place?

Esophagus

Passes through esophageal hiatus of diaphragm at T10
Abdominal portion of esophagus is intraperitoneal
The contraction of the diaphragm functions as a sphincter, helping to prevent acid reflux (regurgitation of stomach contents into the thoracic esophagus)
Hiatal hernia - abdominal esophagus and proximal stomach can herniate through the esophageal hiatus and into the thoracic cavity

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Stomach

Location?
List the structures of the stomach

Stomach

Intraperitoneal
Left upper quadrant
Transpyloric plane
However, stomach is highly variable in shape and quadrants occupied

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Lesser and greater curvature of the stomach

Location?
Associated with with omentum?

Curves of the stomach

Lesser curve

Superior concave margin
Associated with lesser omentum

Greater curve

Inferior convex margin
Associated with greater omentum

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Structures of the stomach

Cardia
Fundus
Body
Location?
Which one is distinguishable on an x-ray and why?

Structures of the stomach

Cardia

Narrow proximal region

Fundus

Dome of the stomach
Located inferior to the left dome of the diaphragm
Distinguishable on x-rays due to presence of gas bubble

Body

Largest part of the stomach
Between fundus and pyloric antrum

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Pyloric portion of the stomach

What are the three parts?

Sphincter

What vertebral level?
What plane level?
What kind of muscle?
What does it control?

Pyloric portion of the stomach

Wide pyloric antrum
Narrow pyloric canal
Muscular pyloric sphincter
- L1 vertebral level
- Level of transpyloric plane
- Circular smooth muscle
- Controls release of stomach contents into the duodenum

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Rugae of the stomach

Location?
What happens with gastric ulcers?

Rugae of the stomach

Internal folds of the gastric mucosa
Gastic ulcers - mucosal lining of the stomach becomes eroded

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Proximal duodenum

Quadrant location?
The duodenum has four parts, but what are the first two?
Are they primary, intra, or secondary retroperitoneal?
Location of each?

Proximal duodenum

Right upper quadrant
(Duodenum has 4 parts)

Superior part

Intraperitoneal
Associated with the hepatoduodenal ligament
Lies on transpyloric plane at L1

Descending part

Secondarily retroperitoneal
Runs parallel and to the right of the IVC
Curves around head of pancreas

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Pancreas

Primary, intra, or secondary retroperitoneal?
Location?
Quandrant location?
What is the head surrounded by?
Body lies anterior to what?
Tail is in contact with what?

Pancreas

Secondarily retroperitoneal
Right upper and left upper quadrants
Posterior to stomach
Duodenom on right and spleen on left
Head is surrounded by the descending part of the duodenum and lies anterior to IVC
Body lies anterior to the aorta
Tail is in contact with the hilum of the spleen

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Liver

Primary, intra, or secondary peritoneal?
Where is it not covered with visceral peritoneum?
Location?
Quadrant location?
Deep to what ribs?
Name the two ligaments

Liver

Intraperitoneal
Covered with visceral peritoneum except at bare area, adjacent to diaphragm
Right upper quadrant, extends partially in left upper quadrant
Deep to ribs 7-11
Ligaments:
- Falciform ligament
- Hepatoduodenal ligament

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Ligaments of the liver

Name and location?
Which contains portal triad?
What is the portal triad?

Ligaments of the liver

Falciform ligament

Attaches liver to anterior abdominal wall

Hepatoduodenal ligament

Of lesser omentum
Contains portal triad
- Portal vein
- Proper hepatic artery
- Bile duct

What are the lobes of the liver?

Lobes of the liver

Right lobe
Left lobe
Caudate lobe
Quadrate lobe

Segments of the liver

How many?
What is each supplied by?
What is each drained by?
Hepatic veins like how? And drain to where?

Segments of the liver

8 segments
Each is supplied by a branch of the:
- Left or right hepatic artery
- Portal vein
Each segment is drained by a:
- Tributary of the left or right hepatic duct
- (Bile is produced by the liver)
Hepatic veins lie intersegmentally and eventually drain into the IVC

Bile ducts

What ducts form to make the common hepatic duct?
What does the common heptaic duct form with to make the bile duct?
What kind of muscle is bile duct sphincter?
What happens when it contracts?

Gallbladder

Location?
Primary, intra, or secondary peritoneal?

Bile ducts

Right and left hepatic ducts form common hepatic duct
Common hepatic duct and cystic duct form bile duct
Bile duct sphincter has smooth muscle
When sphincter contracts, it forces the bile back into the cystic duct and into the gallbaldder, where it is stored

Gallbladder

Right upper quadrant
Intraperitoneal

Main pancreatic duct

Location?
Receives what by the pancreas?
What kind of muscle is sphincter of pancreatic duct?
Merges with what to form the hepatopancreatic ampulla?

Main pancreatic duct

Courses from tail to head of pancreas
Receives enzymes produced by pancreas
Has smooth muscle spinchter of the pancreatic duct
Merges with bile duct to form hepatopancreatic ampulla

Hepatopancreatic ampulla (AKA ampulla of Vater)

What two ducts form this?
Where does it empty?
What is the hepatopancreatic sphincter associated with?

Hepatopancreatic ampulla (AKA ampulla of Vater)

Main pancreatic duct and bile duct form the hepatopancreatic ampulla
Empties into the descending part of the duodenum at the major duodenal papilla
This entrance into the duodenum is associated with a smooth muscle hepatopancreatic sphincter (of Oddi)

Accessory pancreatic duct

Where does it empy?

Accessory pancreatic duct

Empties into the descending part of the duodenum at the minor duodenal papilla (superior to the major papilla)

Spleen * Primary, intra, or secondary? * Quadrant location? * Deep to what ribs? * What is it close to? * Size of what? * Enlargement of spleen allows what? * What is the hilum? * What is in contact with hilum?

**Spleen** * Intraperitoneal * Left upper quadrant * Deep to ribs 9-11 * Inferior to diaphragm * In close proximity to the left kidney, tail of the pancreas, and stomach * Size of a fist * Hilum * Where vessels and nerves enter / exit * Tail of pancreas is in contact with hilum

Abdominal arteries Abdominal Aorta * What vertebral level does it enter the diaphragm? * What does it bifurcate into and at what vertebral level? * What do the paired branches supply? * Unpaired branches: * Names? * What do they supply? * At what vertebral level?

**Abdominal arteries** **Abdominal Aorta** * Aortic hiatus of the diaphragm at T12 * Bifurcates into right and left common iliac arteries at L4 * Paired branches of the abdominal aorta mostly supply retroperitoneal organs (e.g. kidneys) and gonads **Unpaired branches of abdominal aorta** * Celiac trunk at T12 * Superior mesenteric artery at L1 * Inferior mesenteric artery at L3

Abdominal arteries Celiac trunk branches * Where do they supply? * What are the three branches?

**Abdominal arteries** **Celiac trunk branches** * Supply abdominal foregut derivatives and spleen * Three branches emerge immediately: * Left gastric artery * Spenic artery * Common hepatic artery

Abdominal arteries Celiac trunk branches Left gastric artery * Where does it course? * What does it branch into?

**Abdominal arteries** **Celiac trunk branches** **_Left gastric artery_** * Courses along lesser curvature in lesser omentum * Branches into esophageal arteries

Abdominal arteries Celiac trunk branches Splenic artery * Location? * What are the branches/

**Abdominal arteries** **Celiac trunk branches** **_Splenic artery_** * Courses _posterior_ to body and tail of pancreas * Branches: * **Short gastric arteries** * **Left gastro omental artery** (AKA left gastro epiploic artert) * Courses along greater curvature in greater omentum

Abdominal arteries Celiac trunk branches Common hepatic artery * What are the branches?

**Abdominal arteries** **Celiac trunk branches** **_Common hepatic artery_** * Branches * Proper hepatic artery * Gastroduodental artery

Abdominal arteries Celiac trunk branches Common hepatic artery Proper hepatic artery * Location? * What are the branches?

**Abdominal arteries** **Celiac trunk branches** **Common hepatic artery** **_Proper hepatic artery_** * Courses in the hepatoduodenal ligament * **Right gastric artery** * Courses along lesser curvature in lesser omentum * Anastomoses with left gastric artery * **Right and left hepatic arteries** * Terminal branches of proper hepatic artery that supply the liver * **Cystic artery** arises from right hepatic artery

Abdominal arteries Celiac trunk branches Common hepatic artery Gastroduodental artery * Location? * What are the branches? * What does each branch anastomose with?

**Abdominal arteries** **Celiac trunk branches** **Common hepatic artery** **_Gastroduodental artery_** * Courses posterior to the superior (1st part) of the duodenom * **Right gastro omental artery** * Courses along greater curvature in greater omenum * Anastomoses with the left gastro omental artery * **Anterior and posterior superior pancreaticoduodenal arteries** * Anastomose with the anterior and posterior inferfior pancreaticoduodenal arteries of the superior mesenteric artery

Map out the celiac trunk

Celiac trunk * Left gastric artery * Esophageal arteries * Splenic artery * Short gastric arteries * Left gastro omental artery * Common hepatic artery * Proper hepatic artery * Right gastric artery * Right and left hepatic arteries * Cystic artery * Gastroduodenal artery * Right gastro omental artery * Anterior and posterior superopr pancreaticoduodenal arteries

Abdominal veins * What are the names of the two drainage systems?

Abdominal veins * Caval system * Portal system

Abdominal veins Caval (systemic) system * Where do the veins drain?

**Abdominal veins** **Caval (systemic) system** * These veins drain structures in the retroperitoneal space * Parallel to the paired branches of the aorta * Drain into IVC

Abdominal veins Portal system * What are the three main tributaries? * What kind of blood drains into the portal vein? * Where does the portal vein enter? * Where does the blood eventually empty to?

**Abdominal veins** **Portal system** * Three main tributaries * **Splenic vein** * **Superior mesenteric vein** * **Inferior mesenteric vein** * Oxygen poor / nutrient rich blood from the abdominal organs drains into the portal vein * Portal vein enters liver * Liver detoxifies and processes the blood * Processed blood goes to hepatic veins, then IVC

Portal caval anastomoses * Significance of not having valves? * Provides alternative route for blood if it is obstructed where? * What are the areas of portal caval anastomoses? * Esophageal varices can occur where?

**Portal caval anastomoses** * Vessels in the portal system do not have valves, so blood can flow in either direction * Anastomoses between portal and caval vessels provide alternative rotes for venous circulation if blood flow through the liver is obstructed (portal hypertension) * Areas of portal caval anastomoses: * Umbilicus * Colon * Rectum / anus * Distal esophagus * Around the distal esophagus, the esophageal veins drain into either the azygos system (caval) or left gastric vein (portal) * Dilated esophageal varices can rupture and lead to fatal bleeding

Portal system in the foregut * Veins course with arteries with one difference, which is? * The portal vein is part of? Where does this course? * What are the tributaries and the branches?

**Portal system in the foregut** * The veins course alongside and share the names of the arteries * There is no "celiac vein" though * Portal vein * Part of the portal triad that courses in the hepatoduodenal ligament * Tributaries * Cystic veins * Right and left gastric veins * Splenic vein * Short gastric veins * Left gastro omental vein * Superior mesenteric vein * Right gastro omental vein * Anterior and posterior superior pancreaticoduodenal veins

Fetal circulation in the abdomen * Where does blood enter, bypass (in the abdomen), and leave? * What kind of blood is it?

**Fetal circulation in the abdomen** * Oxygen rich blood enters the fetus via the umbilical vein * Oxygen rich blood bypasses the liver via the ductus venosus * Oxygen poor blood leaves the fetus via umbilical arteries

Fetal circulation in the abdomen * What are the adult remnants of: * Umbilical vein * Umbilical arteries * Ductus venosus

**Fetal circulation in the abdomen** * Umbilical vein - round ligament of the liver * Umbilical arteries - medial umbilical ligaments * Ductus venosus - ligamentum venosum

Foregut lymphatics * Describe pathway of lymph drainage

**Foregut lymphatics** * Lymph drains to **celiac lymph nodes** * Lymph then travels to the **chyle cistern** * Then onto the **thoracic duct**

Foregut innervation Parasympathetic * What does it do? * What is the pathway?

**Foregut innervation** **Parasympathetic** * Stimulates peristalsis and secretion * Pathway: * Preganglionic cell bodies: brain * Preganglionic fibers: vagus nerve (CN X) * Postganglionic cell bodies: wall of organ * Postganglioinc fibers: wall of organ

Foregut innervation Sympathetic * What does it do? * What is the pathway?

**Foregut innervation** **Sympathetic** * Inhibits peristalsis * Constricts blood vessels * Pathway: * Preganglionic cell bodies: lateral horn of thoracic spinal cord * Preganglionic fibers: ventral root, spinal nerve, ventral ramus, white ramus communicans, sympathetic trunk, greater thoracic splanchnic nerve (T5 - T9) * Postganglionic cell bodies: **celiac ganglion** * Postganglioinc fibers: follow arterial branches to organ targets

Foregut innervation Visceral pain * Which pathway do you follow back? * Where is foregut visceral pain typically referred to?

Foregut innervation Visceral pain * Follow the sympathetic pathways back to the spinal cord * Foregut visceral pain is typically referred to the area at and inferior to the costal margin