Abdominal viscera Flashcards
What are the sympathetic innervation nerves?
abdominopelvic splanchnic nerves: greater, lesser, least, and lumbar
What does the greater nerve supply?
T5-T9 liver, gallbladder, pancreas
What does the lesser nerve supply?
T11-T12, adrenal, kidneys, gonads, ascending colon, some small intestine
What does the least nerve supply?
T12, directly to adrenal gland
What does the lumbar nerve supply?
L1-L3, descending colon
What are the parasympathetic innervations?
CN X- vagus nerve, sacral nerves
reminder: parasympathetic = long pre-ganglion
What’s the blood supply for the abdomen?
aorta and 3 large branches: 1) celiac 2) superior mesenteric 3) inferior mesenteric
What is splanchnic circulation?
blood flow to abdominal gastrointestinal organs including stomach, liver, spleen, pancreas, small intestine, large intestine
What are the three main branches of the celiac trunk?
common hepatic artery, splenic artery, and left gastric artery
review this slide and the anatomy of the vessels in the body
What are the four major branches of the superior mesenteric artery?
1) inferior pancreaticoduodenal artery
2) middle colic arteries (intestines!)
3) right colic artery
4) ileocolic artery
What are the three main branches of the inferior mesenteric artery?
1) left colic artery
2) sigmoid branches
3) superior rectal artery
how does the inferior mesenteric artery function?
branches at L3 between renal arteries and iliac bifurcation and forms a watershed to the final 1/3 of transverse colon, descending colon, and upper rectum
What are the layers of the digestive tract?
peritoneum –> 2 layers of smooth muscle (circular and longitudinal) –> submucosa (blood, nerves, lymphatics) –> mucosa
What are characteristics of the abdominal esophagus?
2.5cm in length, entering stomach at cardiac hiatus and measured from incisors 23cm from aortic arch 25cm from left bronchus
What is the Z line?
junction between squamous epithelium and gastric columnar epithelium (1cm below sphincter proximal border)
What are the sphincters of the stomach?
upper esophageal sphincter located at lower end of pharynx and guards the entrance into esophagous;
lower esophageal sphincter preventing reflux but can cause GERD
What’s the most common spot for ulcers?
lesser curvature due to much less rugae
What does it mean when there are ulcers in the greater curvature?
malignant most likely
What’s the function of the stomach?
acidic and mechanical digestion
What are the different parts of the stomach?
fundus, cardia, body, curvatures, pyloric region
What’s the rugae’s job?
permit distention after food is ingested
What does pylorus do?
control discharge of stomach contents through the pyloric orifice into duodenum
What’s the gastric canal?
passageway when stomach is relaxed
Where does most gastric content travel?
lesser curvature
What’s special about the stomach and its blood supply?
IT’s supplied by all THREE main branches of the celiac trunk - splenic, common hepatic, and left gastric
What does the small intestine consist of?
duodenum -> jejunum -> ileum
d- 25cm
j&i together about 6-7m
Where is the duodenum?
retroperitoneal except the 1st 2.5 cm connecting to stomach
What are the four parts of the duodenum?
superior (5cm), descending (7-10cm), inferior (6-8cm) and ascending (5cm)
note that this goes around the pancreas and has a lot of vessels, thus introducing how pancreatic cancer can have a big role in a lot of abdominal parts
What’s the duodenum arterial supply?
celiac trunk: gastroduodenal artery and branch superior pancreaticoduodenal artery,
superior mesenteric artery: inferior pancreaticoduodenal artery branch
What’s the venous drainage of the duodenum?
duodenal veins that drain into the hepatic portal vein
What are the differences between the jejunum and ileum?
j - thicker walled, mesentery (less fat) and arcade formation of artery branches. Pilcae circulares more prominent
i - patches of lymphoid tissue called Peyer’s patches and more arcade forming blood supply
What’s the blood supply/drainage of jejunum/ileum?
superior mesenteric artery with arterial arcades and vasa recta
and
superior mesenteric vein which meets splenic vein = hepatic portal vein
What does the large intestine consist of?
appendix, cecum, colon, rectum, anal canal
What are distinguishing features of the large intestine?
tineae coli (muscle bands), haustra (pouches), omental appendices (fat hanging off the intestine), size
What is the cecum/appendix?
blind sac at lower end of ascending colon and joins ileum at ileocecal valve and prevents reflux
How is the appendix positioned?
usually retrocecal
What’s the supply of the ileum/cecum?
ileocolic artery, drained by ileocolic vein
REFRESH FROM CLIN SKILLS! What are clinical signs of appendicitis?
Rovsing sign
Psoas sign
Obturator sign
McBurney’s point tenderness
rebound tenderness
What are symptoms of appendicitis?
low grade fever, constipation or diarrhea, nausea and vomiting
What are the four parts of the colon?
ascending, transverse, descending, sigmoid
What is the blood supply of the colon?
branches of the superior mesenteric - ileocolic, middle colic, right colic
branches of inferior mesenteric - left colic, sigmoid
anastomoses throughout the colon with each other
What’s the drainage of the colon?
ileocolic and right colic veins
What arteries supply the ascending colon?
ileocolic, right colic artery, middle colic artery
What arteries supply the transverse colon?
middle colic artery, marginal artery
What arteries supply the descending colon
left colic, inferior mesenteric, superior sigmoid, sigmoid arteries
What is diverticulosis?
common in elderly where there are pockets in colon where things get stuck and often require an ostomy
What is the liver?
largest gland in the body
What does the liver do?
receives breakdown products from small intestine (portal vein), excretion of breakdown from hemoglobin in form of bile pigments, secretion of bile for digestion and absorption of fats
What are the different vessels coming out of the liver that we need to know the anatomy of (note to review the slide!!!!!)?
inferior vena cava, portal vein, proper hepatic artery (right branch),proper hepatic artery (left branch) to combine to make the proper hepatic artery and the bile duct and right hepatic duct with the gallbladder
What are the different lobes of the liver?
caudate lobe, left lobe, right lobe, quadrate lobe
What’s the liver’s supply/drainage?
hepatic portal vein (POORLY oxygenated blood from abdomen of GI tract) and hepatic artery (well-oxygenated blood)
drainage: hepatic veins
What’s the gallbladder for?
storage and concentration of bile (digesting fats!) from the liver
What does the cystic duct do?
attaches the gallbladder to the common hepatic duct
Where does the cystic duct and the common hepatic duct drain?
duodenum
What does the left and right hepatic ducts drain into?
left and right liver lobes respectively
What does the union of the left and right hepatic ducts make?
common hepatic duct
When you are in an interdigestive period, where does the bile in your liver go?
bile stored in GALLBLADDER - sphincter of Oddi contracted
When you are in a digestive period, where does the bile in your liver go?
bile released into duodenum, sphincter of Oddi RELAXED
What parts are there of the pancreas?
head, body, and tail
What’s the supply and drainage of the pancreas?
splenic artery, superior pancreaticoduodenal artery (gastroduodenal), inferior pancreaticoduodenal artery from SMA
What’s the portal venous system?
system of veins that drains body FIRST TO ORGAN then to SYSTEMIC VENOUS SYSTEM
What are veins that drain into the portal vein?
Superior mesenteric, inferior mesenteric, splenic vein
What makes up the hepatic portal vein?
superior mesenteric and splenic veins
What does portal HTN mean?
blood is forced to avoid the liver and go without filtration
What’s the sign of esophageal varices?
black and tarry stools
What is the spleen?
lymphatic organ about 12cm long, 7cm wide around 9-11th ribs, bleeds profusely
How is the spleen attached?
gastrosplenic ligament to stomach, lienorenal ligament to left kidney
What’s the blood supply and drainage of the spleen?
splenic artery, splenic vein –> portal vein
What are the two basic types of tissue in the spleen?
white pulp - immune system, WBCs, antibodies
red pulp - filtering the blood
What are the kidneys?
retroperitoneal on posterior abdominal wall separated from vertebral column by psoas muscle; keeping homeostasis, eliminating waste, producing erythropoietin
What is the kidney made up of?
cortex (outer portion) with glomeruli, convulted tubules, cortical collecting ducts, and the medulla (inner portion), with loops of Henle, medullary collecting ducts, blood vessels
How does urine flow?
minor calyces to renal pelvis to ureter to urinary bladder with active peristaltic contractions
How are the kidneys supplied?
renal artery at L1/L2 divided into 5 segmental arteries terminating at segments of each kidney
How are the ureters supplied?
renal artery, testicular/ovarian, aorta
What are the suprarenal glands?
on top of kidneys with cortex - corticosteroids, androgens and medulla - epi and nore
Where does the epigastric/hypochondriac quadrants end?
L3
Where does the umbilical/lumbar quadrants end?
L5
If you take the spleen out, what vaccines do you need to get?
meningitis, pneumonia, h flu
