the serous membrane within the abdominopelvic cavity invests the viscera has two continuous layers 1. parietal peritoneum (lines internal surfaces) 2. visceral peritoneum (invests viscera)

Additional abdomen Flashcards by Abby Davis

External oblique proximal and distal attachments`

proximal: lower ribs
distal: linea alba/pubic tubercle/iliac crest

flexion of trunk

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internal oblique

proximal: iliac crest/inguinal ligament
distal: lower ribs/ linea alba/body of pubis

flexion of trunk

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transversus abdominis

proximal: lower costal cartilages/iliac crest/ ingulinal ligament
distal: linea alba, pubic crest, pectineal line of pubis

flexion of trunk

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rectus abdominis

proximal: pubic symphysis, pubic crest
distal: Xiphoid process, lower costal cartilages

flexion of trunk

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cryptorchidism

testes undescended in 3% full term and 30% premature infants

90% occur unilaterally

increased risk of developing malignancy in the undescended testis

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hydrocele

presence of excess fluid in a persistent processus vaginalis

may be associated with indirect inguinal hernia

congenital

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torsion of the spermatic cord

surgical emergency because necrosis of the testis may occur

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what is used to detect an inguinal mass

mass would not appear with typical hydrocele, rules out possibility of testicular tuomor, hernia, varicocele

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what is a communicating hydrocele

most common in infants/children

results when proximal processus vaginalis remains open

peritoneal fluid enters scrotal sac

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non communicating hydrocele

proximal processus vaginalis is closed

distal processus vaginalis is open

fluid is trapped in the open portion of the processus vaginalis

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what is transillumination used for in hydrocele cases

bright light is applied to side of the scrotum, fluid in hydrocele is usually clear and light will outline the testes showing the presence of fluid in scrotum

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varicocele

pampiniform plexus of veins may become dilated (varicose) and tortuous producing varicocele

visible when man is standing or straining

disappears when lies down

gravity empties veins

palpation feels like bag of worms

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inguinal hernia

majority occur in the inguinal area

def: protrusion of parietal periotenum and viscera such as small intestine through a normal /abnormal opening from area they belong to area they do not belong

75% of abdominal hernias are inguinal hernias
both sexes have (86% males) because of spermatic cord passage through inguinal canal

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how to clinically examine inguinal hernia

patient standing

examiner places finger at superficial inguinal ring

patient coughs

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what is direct vs indirect with examination for inguinal hernia

direct: buldge felt against SIDE examiner finger
indirect: suspected if a buldge is felt at TIP of finger as the finger is directed toward the deep inguinal ring

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inguinal lymph nodes

12-20 superficial inguinal nodes that parallel boarder of inguinal ligament

medially placed nodes receive lymph from external genitalia (except testis, epididymis, and spermatic cord), inferior anal canal, perianal region, uterus

laterally placed nodes received lymph from lateral gluteal region and lower anterior abdominal wall

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lymphadenitis

infection (strep, staph, etc…) and subsequent enlargement of lymph nodes

swollen and painful

most common children

febrile

increased WBC

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where in the body do you find serosae (serosa)

heart

lungs

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funciton of serosae (serosa)

support organs within body cavity

mesothelial cells enrich fluid filtered from capillaries in underlying areolar connective tissue to create clear serous fluid

allow decreased friction

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what is peritoneum

the serous membrane within the abdominopelvic cavity

invests the viscera

has two continuous layers

parietal peritoneum (lines internal surfaces)
visceral peritoneum (invests viscera)

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ascites

accumulation of ascitic fluid (transudate - few nucleated cell or exudate with many nucleated cells=pus) in peritoneal cavity

peritoneal cavity= potential space between parietal and visceral peritoneal layers

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how to treat ascites

drain fluid via paracentesis - surgical puncture of the peritoneal cavity to remove ascitic fluid via aspiration or drainage

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what is done for when a pt hits renal failure and has waste products (urea) in blood/tissues accumulating to fatal levels

peritoneal dialysis

soluble substances and excess water removed from the system by transfer across peritoneum

usually employed only temporally

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what does the superior mesenteric artery supply

midgut

distal duodenum
jejunum
ileum
cecum
appendix
ascending colon
proximal 2/3 transverse colon

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what does the inferior mesenteric artery supply

hindgut ``` distal 1/3 transverse colon descending colon sigmoid colon rectum superior portion of anal canal ```

where does all venous drainage go first for alimentary canal (stomach/intestines)

hepatic portal vein to liver BEFORE returning to general circulation

what innervates the esophagus

esophageal plexus (formed by vagal trunks and splanchnic nerves)

what occurs in lower esophageal sphincter (LES) during swallowing and what is timing of events

1. at rest LES is contracted= no reflux 2. peristaltic waves trigger simultaneous LES relaxtion 3. pressure at LES equals atm pressure= LES opens 4. bolus into stomach 5. LES remains uopen until peristaltic wave reaches terminal end of esophagus 6. LES relaxes is mediated by inhibitory neurons of vagus nerve and release vasoactive intestinal peptide and NO

Achalasia

impaired peristalsis in lower 2/3 esophagus (involves primarily smooth muscle dysfunction) bolus not moved properly down esophagus loss of inhibitory neurons innervating LES LES fials to relax

Corkscrew esophagus

type of achalasia

what happens if parietal cells in stomach do not secrete intrinisc factor

pernicious anemia pernicious anemia= inability to utilize Vit B12, most common cause is lack of intrinsic factor intrinsic factor= essential to absorbing Vit B12. Vit B12 is essential in development of RBCs

what happens if someone takes antacids all the time

pepsinogen cannot be converted into pepsin (active proteolytic enzyme) requires HCL to be made into active form pepsinogen + HCL-> pepsin (active form)

what secretes gastrin in stomach what stimulates this what does gastrin do

G cells secrete in response to food in stomach gastrin stimulates HCL production by parietal cells

What is the stomach derived from

foregut

what is the foregut innervated by

thoracic splanchnic nerves and parasympathetic innervation (T6-T9)

what is esophagus derived from

foregut

how is pain percieved by stomach

visceral afferents (vagus and sympathetic nerves) pain receptor carried by sympathetic nerves stomach pain is referred to dermatomes T6-T9

lacteal

special lymph capillaries in small intestine transport lipids from digestive tract

where does large intestine begin and end

cecum to anal canal

tenia coli

three distinct longitudinal bands of smooth muscle on colon when they contract entire intestine gets shorter= fecal mater can move to rectum

epiploic (omental) appendices

small pouches of peritoneum filled with fat situated along colon absent in rectum

goblet cells in large intestine

mucous to protect from bacteria in feces

what does the ileocolic artery supply

branch of superior messenteric artery supplies the ileum, cecum, and part of the ascending colon

what does the appendicular branch of the ileocolic artery supply

appendix

what does the middle colic artery supply

transverse colon

what does the left colic artery supply and what artery give rise to the left colic artery

left colic artery is a branch of the inferior mesenteric artery it supplies the descending colon

what is the marginal artery

an anastomotic arches (arcades) of right and left colic arteries continues along boarder of large intestine

what is the vasa recta of large intestine

small, straight arteries that branch/radiate off the marginal artery to pentertate into the large intestine wall to supply large intestine branches of marginal artery??

which parts of the large intestine become retroperitoneal

ascending and descending colon

what ribs are associated with the spleen

ribs 9-12

what is the blood flow from the abdominal aorta to the spleen

abdominal aorta celiac trunk splenic artery

what are the different types of splenomegaly

infective congestive (portal HTN or CHF) hyperplastic (sickle cell anemia) infiltration (lymphoma)

what serum enzymes are diagnostic in pancreatitis when above the normal range

serum amylase and serum lipase approx 85% of pts with pancreatitis will have 3-fold increase in concentration of enzymes above normal range

what supplies the liver with blood

80% of blood supply to liver is via hepatic portal system (hepatic portal vein) 20% comes from arterial supply (hepatic artery proper)

what is the blood flow from abdominal aorta to liver arterial wise

abdominal aorta celiac trunk common hepatic artery

what contributes to the hepatic portal vein

1. superior mesenteric vein-> hepatic portal vein | 2. inferior mesenteric vein-> splenic vein-> hepatic portal vein

what is the route takes from liver to IVC

right, intermediate and left hepatic veins to inferior vena cava

liver cirrhosis

liver completely disrupted by bands of connective tissue chronic inflammatory cells mainly lymphocytes and other mononuclear cells in connective tissue some proliferation of bile ductules AKA fibrosis of the liver

what innervates the gall bladder

sensory through right phrenic nerve sympathetic motor: greater splanchnic nerve via celiac plexus parasympathetic right vagus nerve

what nerve roots give rise to the visceral pain sensation from the gall bladder and biliary system

T6-T9

pain impulses from the gall bladder can also be transmitted via the phrenic nerve what are the dermatomes associated with the phrenic nerve

C3-C5

what is choluria

bile in the urine

what is steatorrhea

presence of fat in stool bile is important in fat digestion of lipids because it emulsifies lipids, thus making lipids soluble in aqueous solution

what is cholelithiasis

gall stones

how is pain involving the pancreas similar / different to that of the gall bladder / biliary system

pancreas is bilateral ?????

signs and symptoms of pancreas dysfunction

signs and symptoms of gall bladder dysfunction

what does the following lab results rule out? normal serum albumin normal serum alkaline phosphatase normal serum amylase normal serum lipase

pancreatitis is rules out