Abdominal viscera Flashcards
What is the funciton of the esophagus
msucular tube to move food from pharynx to stomach
Where does the esophagus enter the abdomen
TV10
where does the esophagus enter stomach
TV11
What does the phrenicoesophageal ligament do
attach esophagus to diaphragm to allow for independent movement
what structure helps prevent herniation of esophagus into the thorax
the phrenicoesophageal ligament
What are the constrictions of the esophagus
cervical- cricopharyngeus muscles
thoracic- arch of aorta and left primary bronchus
diaphragmatic- diaphragm forms physiological ingerior esophageal sphincter
what does the diaphragmatic constriction of the esophagus prevent against
reflux of food and acid into the esophagus
What aa supply the esophagus
left gastric a
where does the left gastric vein drain into
hepatic portal vein
wehre do the esophagela veins drain into
SVC
where do esophageal lymph drain to
left gastric lymph nodes–> celiac lymph nodes
where are hiatal hernias
herniation of esophagus and or stomach through esophageal hiatus of diaphragm
what is a paraesophageal hiatal hernia
fundus of stomach herniates thorugh esophageal hiatus anterior to esophagus
what is caused by a weakening of the phrenicoesophageal ligaments
sliding of the cardia and fundus of stomach to herniate into thorax
what is the function of the stomach
accumulates and digests food materials
what quadrant is the stomach found int
left upper
what factors influence position of stomach
fullness, body type and gender
what is superior to stomach
diaphragm
what is anteiror to stomach
ventral body wall, diaphragm and left lobe of the liver
what is posterior and inferior to the stomach
omental bursa and stomach bed
what structure make up the stomach bed
diaphragm, spleen, left kidney and suprarenal gland, pancreas and transverse colon with its mesocolon
What are the curvatures of the stomach
greater curvature (left border of stomach) lesser curvature (right border of stomach)
what are the regions of the stomach
cardia, fundus, body and pyloric region
where is the cardia region of the stomach located
anterior to TV11
where is the fundus of the stomach
separated from esophagus by cardiac notch
where is the body of the stomach
between fundus and pyloric antrum
where is the pyloric antrum, canal and pylorus
antrum is the funnel shaped outflow where the canal is the narrow inferior part and the pylorus is the part with pyloric sphincter
LV1/LV2
What is the structure of the stomach wall
serosa, msucular layer and mucosa
describe the layers of the muscular layer of the stomach
outer longitudinal layer of smooth m
inner circular layer of smooth m (pyloric sphincter
innermost oblique layer of smooth muscle
how is the mucosa aranged in stomach
gastric folds called rugae
most prevalent along greater curvature and form gastric canal along lesser curvature
What are the associated mesenteries with the stomach
lesser and greater omentum
what arterieis supply stomach
2 arches Gastric arterial arch with right gastric a and left gastric a
gatroepiploic arch with right gastroepiploic a and left gastroepiploic a
what aa supply the fundus region of stomach
short gastric branches of splenic a
where do vv drain from stomach
portal vein
where is the lymphatic drainage from stomach
gastric lymph nodes along lesser curvature go to celiac lymph
gastroepiploic nodes along greater curvature go to celiac lymph
What is the function of the duodenum
absoprtion of nutrients
what are the general features of the duodenum
first portion of small intestine (12 in long)
c shaped to course around head of pancreas
what are the divisions of the duodenum
4 parts
superior descending, horizontal and ascending
which part of teh duodenum is known as duodenal bulb
first superior part
which part of the duodenum is peritonealized
the first superior part
at what level is the superior part of the duodenum
LV1
at what level is the second or descending part of the duodenum
LV1 to LV3 and is retroperitoneal
In the second part of duodenum there are two papillae, what are they and funtion
major duodenal papilla opens to hepatopancreatic ampulla
minor duodenal papilla opens for accessory pancreatic duct
at what level is the third or horizontal part of duodenum
right to left at LV3
at what level is the fourth or ascending part of duodenum
LV3 to LV2
where is the duodenojejunal flexure
where duodenum is continuous with jejunum
what ligament supports the duodenojejunal flexure
suspensory ligament of Treitz
What is anterior, superior, posterior and inferior to the first part of duodenum
anterior superior is the gallbladder and liver
posterior is the common bile duct and gastroduodenal a, portal vein
inferior is the head of pancrea
what lays anterior, posterior and medial to the descending part of the duodenum
anterior- liver gallbladder, transverse colon and SI
posterior, R kidney, renal vessesl and IVC
medial- pancreas, gastroduodenal a, bile and pancreatic ducts
what lays anteiror, posterior and superior to the third or horizontal part of duodenum
anterior- superior mesenteric vessels and root of mesentery
posterior- right psoas major, IVC, aorta, right gonadal vessels
superior- head and uncinate process of pancreas
what lays anterior and posterior to the ascending part of the duodenum
anterior- root of mesentery and SI
posterior- aorta, left psoas major
What are the internal strcutures of duodenum
villi- folds of mucosa which increase SA
plica circularis- folds of mucosa and submucosa
What is a paraduodenal hernia
inconstant folds of peritoneum that surround the third and fourth parts of duodenum
small intestin can herniate into folds
Why is surgery to repair paraduodenal hernias dangerous
careful not to injure the inferior mesenteric vessels
what structures anastomose around the duodenum
celiac trunk and SMA
What aa supply duodenum
celiac trunk via gastroduodenal a that branch into
supraduodenal (duodenal bulb)
retroduodenal (1st part)
superior pancreaticoduodenal aa (ant and post)
SMA via inferior pancreaticoduodenal aa
where do the veins around duodenum drain to
portal vein
where to lymph from duodenum drain
anterior to pancreaticoduodenal nodes to pyloric to celiac lymph nodes
posterior to the superior mesenteric nodes
What are peptic ulcers
lesions of mucosa of stomach of duodenum
gastric is stomach, duodenal is in duodenum
What are the most common peptic ulcers
duodenal ulvers
What occurs with perforatin ulcers
stomach contents and gas escape into peritoneal sac causing diffuse peritonitis
posterior perforating ulcers of stomach can involce what other structures
pancreas or splenic aa
perforating duodenal ulcers erode what
gastroduodenal a
is the jejunoileum peritonealized or retroperitoneal
peritronealized
What portion of the jejunoileum is jejunum and what part ileum
jejunum is 2/5 in LUQ and ileum is 3/5 in RLQ
What is the mesentery proper
the root of the mesentery where it attaches to the posterior body wall
where does mesentery proper extend from and to
from left side of LV2 to the right sacroiliac joint
What structures does the mesentery proper cross over
duodenum, aorta, IVC, ureter, psoas major, right gonadal vv
describe ways the jejunum is different than the ileum
thicker wall of muscles and wider diameter
more plica circulares
increased vascularity and deeper red coloration
less mesenteric fat
few peyers patches (lymph)
What a supplies the jejunoileum and name branches as well
Superior mesenteric a, jejunal ileal and ileocolic branches that form arterial arcades and vasa recta
Where do the veins of jejuneileum drain to
the hepatic portal v
What could result from a loss of blood supply to part of the bowel
paralytic ileus(obstructed intestine)
describe the path of lymphatic drainage of the jejune ileum
juxta-intestinal nodes–>mesenteric nodes–>superior mesenteric nodes
What is the function of the large intestine
absorption of water and formation of storage of fecal material
what are the separate structures that make up the large intestine
cecum, appendix, ascending colon, transverse colon, descending colon, sigmoid colon, rectum and anal canal
what are the external features of the large intestine
larger diameter
tenia coli
haustra
omental appendages
what are the internal features of the cecum through rectosigmoidal junction
plica semilunares
the mucosa is devoid of villi
are the cecum and appendix peritonealized or retroperitoneal
peritonealized
What prevents reflux from cecum to ileum
there is no sphincter but contraction of terminal ileum prevents reflux
what is the most common position of the appendix
retrocecum
what dermatome is the reffered pain for apendicitis
T10
Infection of appendix will cause pain to radiate where on the body
sharp pain in RLQ
What a supplies the cecum
Ileocolic branch of superior mesenteric artery
anterior and posterior cecal branches and the appendicular branch
where does the vein drain to from the cecum
the hepatic portal vein
describe path of lymph from cecum
ileocolic lymph nodes–> superior mesenteric lymph
what is the hepatic flexure? splenic flexure?
hepatic is the right colic flexure
and splenic is the left colic flexure
What ligament attaches to the splenic or left colic flexure
the phrenicocolic ligament
Where is the right paracolic gutter and where is the left?
right is between the ascending colon and body wall
left is between descending colon and body wall
Which part of the colon is the peritonealized
the transverse and sigmoid
What type of peritonealization is the ascending and descending colons
secondarily retroperitonealized
why is fusion fascia significant clinically
provides a plane of separation to remove colon from posterior body wall without damaging any vasculature
What are the borders of the ascending colon
anterior is the SI and greater omentum
posterior is the wall and kidney
medial is the SI
lateral is transversus abdominis
what are the borders of the transverse colon
anterior- anterior body wall
posterior- transverse mesocolon
superior- liver, gall bladder, stomach, spleen
inferior- SI
what are the borders of the descending colon
anterior- SI
posterior- posterior wall
medial- SI
lateral- transversus abdominis
What is the general blood supply formation of the colon
marginal a is formed from SMA and IMA
What branches come off SMA? IMA?
SMA: ileocolic, right colic and middle
IMA: left colic and sigmoidal
describe the lymph drainage of colon
right paracolic nodes-> right middle colic nodes->superior mesenterc nodes
left paracolic nodes->left colic nodes -> inferior mesenteric lymph nodes
At what level is the rectosigmoidal junction
SV3
What happens to the teniae coli at the rectum
spread out as continuous layer of longitudinal muscle
Are there epiploic fatty appendages at the rectum
no
what is the anorectal flexure and the sacral flexure
sacral- follows curve of sacrum
anorectal flexure- posteroinferior angulation as rectum passes through pelvic diaphragm
What are the chracterisitics of the internal part of the rectum
transverse rectal folds (2 left and 1 right) that are mucosa and submucosa and muscle
Ampulla which is the dilated portion of termial rectum that maintains fecal continence
what a supply rectum and what vv drain it
superior and middle rectal aa
drain via superior and middle rectal vv
describe the lymph drainage of rectum
pararectal nodes drain superior recta a to inferior mesenteric nodes
while othere pararectal nodes drain along middle rectal a to the internal iliac nodes
What innervation goes to the internal anal sphincter
SANs L1L2 to cause constriction
PANS S2-S4 for relaxation
Where does the internal anal sphincter surround? external?
internal is around superior 2/3 anal canal
external is inferior 2/3 anal canal
What innervates the external anal sphincter
voluntary inn by inferior rectal n
What are anal columns
vertical folds of mucosa containing superior rectal vessels
what are anal sinuses
small recesses at base of anal columns
what are anal valves
folds of epithelium connecting caudal ends of rectal colum
what forms the pectinate line
anal valves
what changes across the border of the pectinate line
venous drainage
lymph drainage
nerves
epithelial lining
describe the change in venous supply across the pectinate line
superior drain to superior and middle rectal vv
inferior drains to inferior rectal vv
describe the change in lymph drainage across pectinate line
superior- internal iliac lymph
inferior- superficial inguinal lymph
describe the nerve supply across pectinate line
superior is autonomic
inferior is somatic
describe the change in epithelium across pectinate line
superior is typical GI lining
inferior is stratified squamous
describe arterial supply across pectinate line
superior rectal a is superior
inferior rectal a is inferior
middle rectal a forms anastomoses between superior and inferior
where does the external rectal venous plexus drain to
inferior rectal v
what causes internal hemorrhoids
dilated vv of internal rectal venous plexus
painless
bright red bleeding
could signify portal hypertension
What are external hemorrhoids
dilated veins of external rectal venous plexus (inferior rectal vv)
what are risk factors for external hemorrhoids
pregnancy, constipation, increased intra-abdominal pressure
painful
