Abdominal viscera Flashcards
1
Q
What is the funciton of the esophagus
A
msucular tube to move food from pharynx to stomach
2
Q
Where does the esophagus enter the abdomen
A
TV10
3
Q
where does the esophagus enter stomach
A
TV11
4
Q
What does the phrenicoesophageal ligament do
A
attach esophagus to diaphragm to allow for independent movement
5
Q
what structure helps prevent herniation of esophagus into the thorax
A
the phrenicoesophageal ligament
6
Q
What are the constrictions of the esophagus
A
cervical- cricopharyngeus muscles
thoracic- arch of aorta and left primary bronchus
diaphragmatic- diaphragm forms physiological ingerior esophageal sphincter
7
Q
what does the diaphragmatic constriction of the esophagus prevent against
A
reflux of food and acid into the esophagus
8
Q
What aa supply the esophagus
A
left gastric a
9
Q
where does the left gastric vein drain into
A
hepatic portal vein
10
Q
wehre do the esophagela veins drain into
A
SVC
11
Q
where do esophageal lymph drain to
A
left gastric lymph nodes–> celiac lymph nodes
12
Q
where are hiatal hernias
A
herniation of esophagus and or stomach through esophageal hiatus of diaphragm
13
Q
what is a paraesophageal hiatal hernia
A
fundus of stomach herniates thorugh esophageal hiatus anterior to esophagus
14
Q
what is caused by a weakening of the phrenicoesophageal ligaments
A
sliding of the cardia and fundus of stomach to herniate into thorax
15
Q
what is the function of the stomach
A
accumulates and digests food materials
16
Q
what quadrant is the stomach found int
A
left upper
17
Q
what factors influence position of stomach
A
fullness, body type and gender
18
Q
what is superior to stomach
A
diaphragm
19
Q
what is anteiror to stomach
A
ventral body wall, diaphragm and left lobe of the liver
20
Q
what is posterior and inferior to the stomach
A
omental bursa and stomach bed
21
Q
what structure make up the stomach bed
A
diaphragm, spleen, left kidney and suprarenal gland, pancreas and transverse colon with its mesocolon
22
Q
What are the curvatures of the stomach
A
greater curvature (left border of stomach) lesser curvature (right border of stomach)
23
Q
what are the regions of the stomach
A
cardia, fundus, body and pyloric region
24
Q
where is the cardia region of the stomach located
A
anterior to TV11
25
where is the fundus of the stomach
separated from esophagus by cardiac notch
26
where is the body of the stomach
between fundus and pyloric antrum
27
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
28
What is the structure of the stomach wall
serosa, msucular layer and mucosa
29
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
30
how is the mucosa aranged in stomach
gastric folds called rugae
| most prevalent along greater curvature and form gastric canal along lesser curvature
31
What are the associated mesenteries with the stomach
lesser and greater omentum
32
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
33
what aa supply the fundus region of stomach
short gastric branches of splenic a
34
where do vv drain from stomach
portal vein
35
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
36
What is the function of the duodenum
absoprtion of nutrients
37
what are the general features of the duodenum
first portion of small intestine (12 in long)
| c shaped to course around head of pancreas
38
what are the divisions of the duodenum
4 parts
| superior descending, horizontal and ascending
39
which part of teh duodenum is known as duodenal bulb
first superior part
40
which part of the duodenum is peritonealized
the first superior part
41
at what level is the superior part of the duodenum
LV1
42
at what level is the second or descending part of the duodenum
LV1 to LV3 and is retroperitoneal
43
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
44
at what level is the third or horizontal part of duodenum
right to left at LV3
45
at what level is the fourth or ascending part of duodenum
LV3 to LV2
46
where is the duodenojejunal flexure
where duodenum is continuous with jejunum
47
what ligament supports the duodenojejunal flexure
suspensory ligament of Treitz
48
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
49
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
50
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
51
what lays anterior and posterior to the ascending part of the duodenum
anterior- root of mesentery and SI
| posterior- aorta, left psoas major
52
What are the internal strcutures of duodenum
villi- folds of mucosa which increase SA
| plica circularis- folds of mucosa and submucosa
53
What is a paraduodenal hernia
inconstant folds of peritoneum that surround the third and fourth parts of duodenum
small intestin can herniate into folds
54
Why is surgery to repair paraduodenal hernias dangerous
careful not to injure the inferior mesenteric vessels
55
what structures anastomose around the duodenum
celiac trunk and SMA
56
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
57
where do the veins around duodenum drain to
portal vein
58
where to lymph from duodenum drain
anterior to pancreaticoduodenal nodes to pyloric to celiac lymph nodes
posterior to the superior mesenteric nodes
59
What are peptic ulcers
lesions of mucosa of stomach of duodenum
| gastric is stomach, duodenal is in duodenum
60
What are the most common peptic ulcers
duodenal ulvers
61
What occurs with perforatin ulcers
stomach contents and gas escape into peritoneal sac causing diffuse peritonitis
62
posterior perforating ulcers of stomach can involce what other structures
pancreas or splenic aa
63
perforating duodenal ulcers erode what
gastroduodenal a
64
is the jejunoileum peritonealized or retroperitoneal
peritronealized
65
What portion of the jejunoileum is jejunum and what part ileum
jejunum is 2/5 in LUQ and ileum is 3/5 in RLQ
66
What is the mesentery proper
the root of the mesentery where it attaches to the posterior body wall
67
where does mesentery proper extend from and to
from left side of LV2 to the right sacroiliac joint
68
What structures does the mesentery proper cross over
duodenum, aorta, IVC, ureter, psoas major, right gonadal vv
69
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)
70
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
71
Where do the veins of jejuneileum drain to
the hepatic portal v
72
What could result from a loss of blood supply to part of the bowel
paralytic ileus(obstructed intestine)
73
describe the path of lymphatic drainage of the jejune ileum
juxta-intestinal nodes-->mesenteric nodes-->superior mesenteric nodes
74
What is the function of the large intestine
absorption of water and formation of storage of fecal material
75
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
76
what are the external features of the large intestine
larger diameter
tenia coli
haustra
omental appendages
77
what are the internal features of the cecum through rectosigmoidal junction
plica semilunares
| the mucosa is devoid of villi
78
are the cecum and appendix peritonealized or retroperitoneal
peritonealized
79
What prevents reflux from cecum to ileum
there is no sphincter but contraction of terminal ileum prevents reflux
80
what is the most common position of the appendix
retrocecum
81
what dermatome is the reffered pain for apendicitis
T10
82
Infection of appendix will cause pain to radiate where on the body
sharp pain in RLQ
83
What a supplies the cecum
Ileocolic branch of superior mesenteric artery
| anterior and posterior cecal branches and the appendicular branch
84
where does the vein drain to from the cecum
the hepatic portal vein
85
describe path of lymph from cecum
ileocolic lymph nodes--> superior mesenteric lymph
86
what is the hepatic flexure? splenic flexure?
hepatic is the right colic flexure
| and splenic is the left colic flexure
87
What ligament attaches to the splenic or left colic flexure
the phrenicocolic ligament
88
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
89
Which part of the colon is the peritonealized
the transverse and sigmoid
90
What type of peritonealization is the ascending and descending colons
secondarily retroperitonealized
91
why is fusion fascia significant clinically
provides a plane of separation to remove colon from posterior body wall without damaging any vasculature
92
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
93
what are the borders of the transverse colon
anterior- anterior body wall
posterior- transverse mesocolon
superior- liver, gall bladder, stomach, spleen
inferior- SI
94
what are the borders of the descending colon
anterior- SI
posterior- posterior wall
medial- SI
lateral- transversus abdominis
95
What is the general blood supply formation of the colon
marginal a is formed from SMA and IMA
96
What branches come off SMA? IMA?
SMA: ileocolic, right colic and middle
IMA: left colic and sigmoidal
97
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
98
At what level is the rectosigmoidal junction
SV3
99
What happens to the teniae coli at the rectum
spread out as continuous layer of longitudinal muscle
100
Are there epiploic fatty appendages at the rectum
no
101
what is the anorectal flexure and the sacral flexure
sacral- follows curve of sacrum
| anorectal flexure- posteroinferior angulation as rectum passes through pelvic diaphragm
102
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
103
what a supply rectum and what vv drain it
superior and middle rectal aa
| drain via superior and middle rectal vv
104
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
105
What innervation goes to the internal anal sphincter
SANs L1L2 to cause constriction
| PANS S2-S4 for relaxation
106
Where does the internal anal sphincter surround? external?
internal is around superior 2/3 anal canal
| external is inferior 2/3 anal canal
107
What innervates the external anal sphincter
voluntary inn by inferior rectal n
108
What are anal columns
vertical folds of mucosa containing superior rectal vessels
109
what are anal sinuses
small recesses at base of anal columns
110
what are anal valves
folds of epithelium connecting caudal ends of rectal colum
111
what forms the pectinate line
anal valves
112
what changes across the border of the pectinate line
venous drainage
lymph drainage
nerves
epithelial lining
113
describe the change in venous supply across the pectinate line
superior drain to superior and middle rectal vv
| inferior drains to inferior rectal vv
114
describe the change in lymph drainage across pectinate line
superior- internal iliac lymph
| inferior- superficial inguinal lymph
115
describe the nerve supply across pectinate line
superior is autonomic
| inferior is somatic
116
describe the change in epithelium across pectinate line
superior is typical GI lining
| inferior is stratified squamous
117
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
118
where does the external rectal venous plexus drain to
inferior rectal v
119
what causes internal hemorrhoids
dilated vv of internal rectal venous plexus
painless
bright red bleeding
could signify portal hypertension
120
What are external hemorrhoids
dilated veins of external rectal venous plexus (inferior rectal vv)
121
what are risk factors for external hemorrhoids
pregnancy, constipation, increased intra-abdominal pressure
| painful
