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Anatomy Exam 1 > Abdominal Contents: Foregut > Flashcards

Abdominal Contents: Foregut Flashcards

1
Q

Abdominal cavity

  • What separates abdominal cavity from thoracic cavity?

Peritoneum

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

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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2
Q

Peritoneal cavity

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

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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3
Q

Retroperitoneal space

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

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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4
Q

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?
A

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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5
Q

Greater omentum

  • Location?
  • How does it provide protection?
A

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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6
Q

Lesser omentum

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

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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7
Q

Greater and lesser sacs

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

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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8
Q

Divisions in the gut tube

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

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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9
Q

Esophagus

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

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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10
Q

Stomach

  • Location?
  • List the structures of the stomach
A

Stomach

  • Intraperitoneal
  • Left upper quadrant
  • Transpyloric plane
  • However, stomach is highly variable in shape and quadrants occupied
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11
Q

Lesser and greater curvature of the stomach

  • Location?
  • Associated with with omentum?
A

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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12
Q

Structures of the stomach

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

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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13
Q

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?
A

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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14
Q

Rugae of the stomach

  • Location?
  • What happens with gastric ulcers?
A

Rugae of the stomach

  • Internal folds of the gastric mucosa
  • Gastic ulcers - mucosal lining of the stomach becomes eroded
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15
Q

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?
A

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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16
Q

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?
A

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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17
Q

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
A

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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18
Q

Ligaments of the liver

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

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
19
Q

What are the lobes of the liver?

A

Lobes of the liver

  • Right lobe
  • Left lobe
  • Caudate lobe
  • Quadrate lobe
20
Q

Segments of the liver

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

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
21
Q

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?
A

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
22
Q

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?
A

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
23
Q

Hepatopancreatic ampulla (AKA ampulla of Vater)

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

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)
24
Q

Accessory pancreatic duct

  • Where does it empy?
A

Accessory pancreatic duct

  • Empties into the descending part of the duodenum at the minor duodenal papilla (superior to the major papilla)
25
Q

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?
A

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
26
Q

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?
A

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
27
Q

Abdominal arteries

Celiac trunk branches

  • Where do they supply?
  • What are the three branches?
A

Abdominal arteries

Celiac trunk branches

  • Supply abdominal foregut derivatives and spleen
  • Three branches emerge immediately:
    • Left gastric artery
    • Spenic artery
    • Common hepatic artery
28
Q

Abdominal arteries

Celiac trunk branches

Left gastric artery

  • Where does it course?
  • What does it branch into?
A

Abdominal arteries

Celiac trunk branches

Left gastric artery

  • Courses along lesser curvature in lesser omentum
  • Branches into esophageal arteries
29
Q

Abdominal arteries

Celiac trunk branches

Splenic artery

  • Location?
  • What are the branches/
A

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
30
Q

Abdominal arteries

Celiac trunk branches

Common hepatic artery

  • What are the branches?
A

Abdominal arteries

Celiac trunk branches

Common hepatic artery

  • Branches
    • Proper hepatic artery
    • Gastroduodental artery
31
Q

Abdominal arteries

Celiac trunk branches

Common hepatic artery

Proper hepatic artery

  • Location?
  • What are the branches?
A

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
32
Q

Abdominal arteries

Celiac trunk branches

Common hepatic artery

Gastroduodental artery

  • Location?
  • What are the branches?
  • What does each branch anastomose with?
A

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
33
Q

Map out the celiac trunk

A

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
34
Q

Abdominal veins

  • What are the names of the two drainage systems?
A

Abdominal veins

  • Caval system
  • Portal system
35
Q

Abdominal veins

Caval (systemic) system

  • Where do the veins drain?
A

Abdominal veins

Caval (systemic) system

  • These veins drain structures in the retroperitoneal space
  • Parallel to the paired branches of the aorta
  • Drain into IVC
36
Q

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?
A

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
37
Q

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?
A

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
38
Q

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?
A

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
39
Q

Fetal circulation in the abdomen

  • Where does blood enter, bypass (in the abdomen), and leave?
  • What kind of blood is it?
A

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
40
Q

Fetal circulation in the abdomen

  • What are the adult remnants of:
    • Umbilical vein
    • Umbilical arteries
    • Ductus venosus
A

Fetal circulation in the abdomen

  • Umbilical vein - round ligament of the liver
  • Umbilical arteries - medial umbilical ligaments
  • Ductus venosus - ligamentum venosum
41
Q

Foregut lymphatics

  • Describe pathway of lymph drainage
A

Foregut lymphatics

  • Lymph drains to celiac lymph nodes
  • Lymph then travels to the chyle cistern
  • Then onto the thoracic duct
42
Q

Foregut innervation

Parasympathetic

  • What does it do?
  • What is the pathway?
A

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
43
Q

Foregut innervation

Sympathetic

  • What does it do?
  • What is the pathway?
A

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
44
Q

Foregut innervation

Visceral pain

  • Which pathway do you follow back?
  • Where is foregut visceral pain typically referred to?
A

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

Anatomy Exam 1 (8 decks)

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