Abdominal Viscera/Vasculature Flashcards
What is the free edge of the falciform ligament called?
Ligamentum teres hepatis (round ligament of liver)
The alimentary canal is composed of what structures/organs?
Mouth, pharynx, esophagus, stomach, duodenum, ileum, jejunum, large intestines, rectum, anus
What is the relationship of the rectum to the peritoneum?
The rectum is below the peritoneum
From external to internal what are the layers of the alimentary tract components?
Serosa (visceral peritoneum), outer muscularis (longitudinal muscle fibers), inner muscularis(circular muscle fibers), submucosa, mucosa
From which embryological layer is the mucosa of the alimentary tract derived? The muscles?
Endoderm; splanchnic mesoderm
What are the two intrinsic nerve plexes of the GI tract? Where are they?
Myenteric- between the muscle layers
Submucosal- within the submucosa
Where in the mediastinum is the esophagus located?
posterior mediastinum
At what vertebral level is the esophageal hiatus of the diaphragm? What passes through it along with the esophagus?
T10; Vagus nn.
At what vertebral level is the aortic hiatus of the diaphragm? What structures create this hiatus? What structures accompany the aorta through the hiatus?
T12; Right and left crus of the diaphragm; Thoracic duct and azygous v.
Through what does the inferior vena cava pass in the diaphragm? At what vertebral level?
Through the central tendon at T8
Where does all lymph from the abdomen pool?
Cisterna chyli
What are the five anatomic subdivisions of the stomach? Which of these acts as a sphincter?
Fundus, cardia, body, antrum, pylorus; pylorus is sphincter
What is the name of the internal folds of the stomach?
Rugae
What is the anatomical basis of GERD? Why can it be so dangerous?
The gastroesophageal junction isn’t a true sphincter, there if the left and right crus of diaphragm loosen, gastric acid can wash back up into the esophagus and can lead to adenocarcinoma in the distal esophagus
What are the two types of hiatal hernias? Which is more likely to lead to gastric inversion?
Sliding and paraesophageal; paraesophageal
What is the term for the first part of the duodenum?
The bulb
What is the direction of the 2nd part of the duodenum?
Descending?
Where does the common bile duct empty? Through what structure?
Distal end of 2nd part of the duodenum through the major duodenal papilla?
Through what does the pancreas empty into the duodenum?
The main pancreatic duct empties via the major duodenal papilla, the accessory pancreatic duct empties via the minor duodenal papilla
What structure marks the end of the 2nd part of the duodenum
The major duodenal papilla
What is the direction of the 3rd part of the duodenum?
Transverse
What demarcates the boundary between the 3rd and 4th parts of the duodenum?
Superior mesenteric a and v crossing anterior
What is the direction of the 4th part of the duodenum?
Ascending
Which parts of the duodenum are secondary retroperitoneal?
2-4
Of the small bowel, what portion is jejunum?
Proximal 2/3
Which portion of the small bowel has a single arcade with long vasa recta?
Jejunum
What is the difference in the plicae of the jejunum and ileum?
Jejunum has high plicae, ileum has low plicae
From what layer of the GI tract are plicae projections?
Submucosa
What is the lymphatic structure within the villi on plicae circularis?
Lacteal
What are the specialized longitudinal muscular bands of the large bowel? How many are there?
Tenia Coli- 3
What are the individual sacs on the colon? What is there function?
Haustra- helps with propulsion and allows maximal water absorption
What are the fat lobules hanging from the large bowel?
Epiploic appendages
What is the first part of the colon? What does it contain?
Cecum; has the ileocecal valve and appendiceal orifice
What marks the turn from ascending to transverse colon?
The hepatic flexure
What marks the turn from transverse to descending colon?
Splenic flexure
At what point do tenia coli end?
The rectosigmoid junction
What is the mesentery of the appendix? What does it contain?
Mesoappendix; appendiceal a.
What is the most common position of the appendix?
Retrocecal ~64%
What also happens at approximately the level of the rectosigmoid junction?
Peritoneal reflection
True or false: the rectum is covered in serosa?
False- outside peritoneum
Where does the rectum become the anus?
The pelvic diaphragm
What provides sacculation of the rectum?
Rectal valves of Houston
The pelvic diaphragm muscles contribute to what sphincter of the anus? The longitudinal mm?
Voluntary; involuntary
What are the three components of the external sphincter?
Subcutaneous, superficial, deep
What line divides the anal canal? What is the embryologic basic of this line?
Dentate/pectinate line- endoderm transitions to ectoderm
What type of sensory fibers supply the anal canal above the dentate line? Below?
GVA above; GSA below
What is the venous plexus above the dentate line? below?
Internal hemorrhoidal; external hemorrhoidal
What are the accessory organs of the digestive system?
Sublingual, submandibular, and parotid salivary glands; liver, gallbladder, pancreas
Blood enters the liver through what structures?
Hepatic artery; portal vein
Through what does the gallbladder connect with the biliary system? What does it join with and what does that structure then become
Gallbladder connects to the common hepatic duct via the cystic duct, which then becomes the common bile duct
What structures are included in the portal triad? In what structure are is the portal triad housed?
The proper hepatic artery, common bile duct, portal vein; all within the hepatoduodenal ligament of lesser omentum
As the falciform ligament continues on the superior surface of the liver, what is the name of the ligament? What does that ligament then become?
Continues as coronary ligament with continues as left and right triangular ligaments
What is the ligamentum teres hepatis a remnant of?
Umbilical vein
What is the bare area of the liver?
Area of the liver with no visceral peritoneum
What liver lobe sits posteriorly and inferiorly adjacent to the IVC?
Caudate lobe
What lobe sits between the falciform/round ligament and the gallbladder?
Quadrate lobe
What drains the liver of blood? Into what do they empty?
The right, middle, and left hepatic vein. Empty to IVC
Approximately what percentage of bile produced does the gallbladder store?
10%
What stimulates contraction of the gallbladder?
Cholecystokinin
What is the medical term for gallstones? What can they be composed of?
Cholelithiasis; cholesterol or bile
What structure sits in the C loop of the duodenum?
Pancreas
Is the pancreas a peritoneal, true retroperitoneal, or secondary retroperitoneal structure?
2ndary retroperitoneal
What are the three subdivisions of the pancreas? What part is most closely associated with the C loop of the duodenum?
Head, body, tail; head is within C loop
What is the spatial relationship of the pancreas to the Superior Mesenteric a and v?
Pancreas lies anterior to SMA/V- a and v come out from underneath the pancreas and run over the duodenum
What condition could result from significant weight loss and compression of the duodenum by the SMA/V? What symptoms would be associated with it?
Nutcracker syndrome; associated with postprandial pain and vomiting
What is the Duct of Santorini?
The accessory pancreatic duct
What is the Duct of Wirsung?
Main pancreatic duct
What attaches the spleen to the bottom side of the diaphragm?
Splenophrenic and lienocolic ligaments
What is the function of the spleen?
Serves as lymphoid organ and blood filter- helps fight certain kinds of bacteria and encapsulated microorganisms; breaks down partially degraded blood cells
Where do the ureters run?
Retroperitoneum
What kind of organ is the bladder (in what cavity does it sit)?
True pelvic organ- below peritoneal reflection
What paired structures sit on either side of the aortic hiatus
Adrenal glands
From anterior to posterior what tissue layers surround the kidney?
Parietal peritoneum, pararenal fat, renal/Gerota’s fascia, perirenal fat,kidney, perirenal, transversalis fascia
What attaches the spleen to the bottom side of the diaphragm?
Splenophrenic and lienocolic ligaments
What is the pathway of the left renal vein?
Runs to the right crossing over the aorta immediately inferior to the point at which the superior mesenteric a. comes off the aorta
Where do the ureters run?
Retroperitoneum
What kind of organ is the bladder (in what cavity does it sit)?
True pelvic organ- below peritoneal reflection
What paired structures sit on either side of the aortic hiatus
Adrenal glands
From anterior to posterior what tissue layers surround the kidney?
Parietal peritoneum, pararenal fat, renal/Gerota’s fascia, perirenal fat, kidney, perirenal fat, transversalis fascia
What vertebral levels are the kidneys?
T12-L5
What major artery supplies the foregut, midgut, and hindgut?
Celiac trunk, Superior mesenteric, inferior mesenteric a, respectively.
What condition can result from significant weight loss and the compression of the left renal v by the superior mesenteric a.? What symptoms will present?
Nutcracker syndrome; left flank pain
What is the spatial relationship of renal artery to renal vein entering the kidney hilum
Renal arteries are inferior to renal veins
What is the path of the ureters?
Ureters cross under the gonadal vessels at the mid psoas, cross over the iliac vessels just below the pelvic brim, and cross under the uterine artery/ artery to vas deferens. In males the ureter runs postero-lateral to vas deferens
What arteries supply the adrenal glands? From what arteries do each branch?
Superior Suprarenal aa. off inferior phrenic aa.; middle suprarenal aa off the aorta; inferior suprarenal aa. off the renal aa.
What is the venous drainage of the adrenal glands?
Right suprarenal v into the IVC, left suprarenal v. into the left renal v.
What major artery supplies the foregut, midgut, and hindgut?
Celiac trunk, Superior mesenteric, inferior mesenteric a, respectively.
What supplies blood to the pancreas?
Celiac and Superior Mesenteric
What branches come off the gastroduodenal a? What happens to the continuation of the a.?
Gives off anterior- and posterior- superior pancreaticoduodenal aa., continues onto greater curve of stomach as right gastroepiploic?
The celiac trunk splits into what three arteries?
The common hepatic a., let gastric a., and the splenic a.
What does the left gastric artery supply? What artery branches off of it?
Lesser curve of the stomach; esoophageal a.
What arteries cross between the spleen and greater curve of the stomach?
Short gastric aa.
What artery branches from the splenic a.? What does it supply?
L. gastroepiploic; greater curve of the stomach
What is the first branch of the common hepatic a.? What is the c hepatic then called?
Gastroduodenal a.; proper hepatic a.
What branches come off the gastroduodenal a? What happens to the continuation of the a.?
Gives off anterior- and posterior- superior pancreaticoduodenal aa., continues onto greater curve of stomach as right gastroepiploic?
What are the branches of the superior mesenteric a.?
Inferior pancreaticoduodenal, middle colic, branches to small bowel, right colic, ileocolic aa
What are the branches of the inferior mesenteric aa?
MArginal a of Drummond, Left colic a., sigmoid aa., superior rectal a.
What connects SMA flow to IMA flow?
The marginal artery of Drummond
What are the first branches off of the abdominal aorta?
Inferior phrenic arteries
How many pairs of lumbar arteries branch off the aorta?
4
What is the difference in the course of the gonadal arteries in men and women?
Ovarian arteries head straight off the aorta down onto ovaries; testicular arteries run through retroperitoneum and head anterior to deep inguinal ring and into the spermatic cord and out to the testicle
At what vertebral level is the bifurcation of the aorta? What are the branches of the bifurcation?
L4; Common iliac arteries; usually a median sacral artery in the middle
What are the branches of the common iliac arteries’ birfurcation?
external and internal iliac aa.
What are the two venous systems of the abdomen?
The systemic/ caval venous system and the portal venous system
