Anatomy Flashcards by Hunter Garrett

What specifically are the retroperitoneal structures?

Suprarenal (adrenal) gland
Aorta and IVC
Duodenum (2nd and 3rd parts)
Pancreas (except tail)
Ureters
Colon (descending and ascending
Kidneys
Esophagus (lower 2/3)
Rectum (lower 2/3)

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Injuries to retroperitoneal structures cause what?

blood or gas accumulation in retroperitoneal space

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Direct injury to the kidney has caused a laceration to it. Where will the blood drain?

retroperitoneum

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generally, what are included as retroperitoneal structures?

GI structures lacking a mesentery and non-GI structures

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What is found in the ligament that connects liver to anterior abdominal wall? what is it a derivative of?

Falciform ligament contains ligamentum teres hepatis;

Falciform ligament is derivative of ventral mesentery

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What is contained in the ligament that connects liver to duodenum? what what else does it connect?

Hepatoduodenal ligament contains portal triad

Hepatoduodenal ligament connects greater and lesser sacs

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What is found in the portal triad?

hepatic artery,
portal vein,
common bile duct

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How will a surgeon control bleeding from the structures w/in the hepatoduodenal ligament?

Pringle maneuver=> ligament compressed bw thumb and index finger placed in omental foramen to control bleeding

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what is contained in the ligament connecting the liver to the lesser curvature of the stomach?

gastrohepatic ligament contains the gastric arteries

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What does the gastrohepatic ligament separate? when might it be cut?

separates greater and lesser sacs ON RIGHT;

cut during surgery to access lesser sac

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What does ligament connecting the greater curvature of the stomach to the transverse colon contain?

gastrocolic ligament contains gastroepiploic arteries

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What is gastrocolic ligament apart of?

greater omentum

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What ligament does the greater curvature of stomach and spleen contain?

gastrosplenic ligament contains short gastrics, left gastroepiploic vessels

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What does gastrosplenic ligament separate?

separates greater and lesser sacs on LEFT

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What does the ligament connecting the spleen to posterior abdominal wall contain?

splenorenal ligament contains splenic artery and vein along w/ tail of pancreas

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What are the layers of the gut wall from inside to outside?

MSMS;
Mucosa
Submucosa
Muscularis externa
Serosa

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What is found in the mucosa in the gut wall? give function for each

epithelium => absorption;
lamina propria => support;
muscularis mucosa => motility

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What is found in the submucosa of the gut wall?

submucosal nerve plexus (meissner’s plexus)

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What is found in the muscularis externa of the gut wall?

myenteric nerve plexus (Auerbach’s plexus)

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What part of the gut wall is variable depending on location w/in the body?

serosa => intraperitoneal

adventitia => retroperitoneal

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Differentiate ulcers from erosions

ulcers extend into submucosa, inner or outer muscular layer;

Erosions are in mucosa only

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What are the frequencies of basal electric rhythm throughout the GI tract?

Stomach: 3 waves/min

duodenum: 12 waves/min
ileum: 8-9 waves/min

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What type of cells characterize normal esophagus?

nonkeratinized stratified squamous epithelium

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what cells, structures characterize stomach?

gastric glands

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what cells, structures characterize duodenum?

villi and microvilli increases absorptive surface; Brunner's glands (submucosa); crypts of Liekberkuhn

what cells, structures characterize jejunum?

Plicae circulares; | crypts of Lieberkuhn

what cells, structures characterize ileum?

Peyer's patches (lamina propria, submucosa); plicae circulares (proximal ileum); cyrpts of Lieberkuhn

Where are the largest number of goblet cells in small intestine?

ileum

what cells, structures characterize colon?

crypts but no villi, numerous goblet cells

differentiate artery supplying GI vs non-GI structures

supplying GI branch ANTERIORLY non-GI branch LATERALLY

Describe SMA syndrome

transverse portion (3rd segment) of duodenum entrapped bw SMA and aorta => intestinal obstruction

where does the celiac trunk branch?

branches anteriorly from T12

What branches from L1?

SMA and left renal artery

What branches from L3?

IMA

where does bifurcation of abdominal aorta occur?

What artery branches inferior portion of abdominal aorta?

median sacral artery

Which testicular artery branches first from the aorta?

left testicular (ovarian) artery just above right testicular (ovarian) artery

what is the artery, parasympathetic innervation and vertebral level of the foregut region?

celiac vagus T12/L1

What are the structures supplied by the foregut artery?

stomach to proximal duodenum; | liver, gallbladder, pancreas, spleen (mesoderm)

What is the artery, parasympathetic innervations and vertebral level of midgut region?

SMA Vagus L1

What are the structures supplied by the midgut artery?

Distal duodenum to proximal 2/3 transverse colon

what is the artery, parasympathetic innervation and vertebral level of the hindgut region?

IMA Pelvic L3

What are the structures supplied by the hindgut artery?

Distal 1/3 transverse colon to upper portion of rectum;

What part of the GI is most susceptible to ischemia?

splenic flexure of the colon due to SMA and IMA anastomoses => if ischemia occurs then distal region of artery is most susceptible to damage

What are the branches of celiac trunk?

common hepatic artery; splenic artery; left gastric artery

what does the celiac trunk supply mostly?

main supply of the stomach

If the splenic artery, what is the most likely site for ischemia other than the spleen?

fundus of stomach due to poor anastomases of the short gastrics

Where do strong anastomoses of the celiac trunk occur?

Left and right gastroepiploics; | Left and right gastrics

what arteries would be subject to damage with a posterior duodenal artery?

gastroduodenal artery giving rise anterior superior pancreaticoduodenal arteries and right gastroepiploic artery

generally, what will compensate if branches of abdominal aorta are blocked?

collateral circulation w/ arterial anastomoses

Specifically, what will compensate if superior epigastric of internal thoracic/mammary artery is blocked?

inferior epigastric artery (external iliac)

Specifically, what will compensate if superior pancreaticoduodenal artery of celiac trunk is blocked?

inferior pancreaticoduodenal artery (SMA)

Specifically, what will compensate if middle colic of SMA is blocked?

left colic of IMA

Specifically, what will compensate if superior rectal of IMA is blocked?

middle and inferior rectal arteries of internal iliac

what are the sites of portosystemic anastomoses?

Esophagus; umbilicus; Rectum

What are the portal and systemic anastomoses at the esophagus?

left gastric (portal) esophageal (systemic)

What are the portal and systemic anastomoses at the umbilicus

paraumbilical (portal) superficial & inferior epigastric below umbilicus (systemic) paraumbilical (portal) superior epigastric and lateral thoracic above umbilicus

What are the portal and systemic anastomoses at the rectum?

superior rectal (portal) middle & inferior rectal (systemic)

What is the clinical sign of portal hypertension seen at the esophagus?

esophageal varices

What is the clinical sign of portal hypertension seen at the umbilicus?

caput medusae

What is the clinical sign of portal hypertension seen at the rectum?

internal hemorrhoids

Where are the varices commonly seen w/ portal HTN?

gut, butt, caput (medusae)

How is portal HTN Tx surgically?

TIPS (transjugular intrahepatic portosystemic shunt) between portal vein and hepatic vein percutaneously relieves portal HTN by shunting blood to systemic circulation

Where is the pectinate (dentate line)?

formed where endoderm (hindgut) meets ectoderm

What are common pathologies that occur above the pectinate line?

internal hemorrhoids; | adenocarcinoma

Arterial supply above pectinate line?

superior rectal artery (branch of IMA)

What is the venous drainage above pectinate line?

superior rectal vein => inferior mesenteric vein => portal system

Differentiate internal vs external hemorrhoids

IH: visceral innervation so NOT PAINFUL; lymph drainage to DEEP NODES EH: somatic innervation (inferior rectal branch of pudendal nerve) so PAINFUL; lymph drainage to SUPERFICIAL INGUINAL NODES

pathologies below the pectinate line?

external hemorrhoids, squamous cell carcinoma

Arterial supply below pectinate line?

inferior rectal artery (branch of internal pudendal artery)

venous drainage below pectinate line?

inferior rectal vein => internal pudendal vein => internal iliac vein => IVC

What do the different surfaces of the hepatocytes face?

apical surface faces bile canaliculi; | basolateral surface faces sinusoids

What are the 3 zones of the liver?

Zone I: periportal zone; Zone II: intermediate zone Zone III: pericentral zone (centrilobular)

What zone is affected 1st by viral hepatitis?

Zone I

What is found in the zone III of the liver?

affected 1st by ischemia; contains p-450 system; most sensitive to TOXIC INJURY; Site of ALCOHOLIC HEPATITIS

What is the direction of blood and bile flow in the liver respective to the zones of the liver?

blood flow from zone I to zone III; bile flow from zone III to zone I

Describe the path of the common bile duct to its release of bile in the duodenum

Common hepatic duct joins w/ cystic duct => common bile duct => sphincter of Oddi => ampulla of vater

Where would gallstones block both bile and pancreatic ducts?

ampulla of Vater

Pancreatic tumor in the head of the pancreas may cause what?

obstruction of common bile duct

What is the organization of the femoral region?

``` Lateral to medial: Nerve Artery Vein Empty Lymphatics ```

What is found in the femoral triangle?

femoral vein, artery, nerve (venous near penis)

Define the femoral sheath

fascial tube 3-4cm below inguinal ligament

What is found in the femoral sheath?

femoral vein, artery, canal (deep inguinal lymph nodes) but not femoral nerve

What is the site of protrusion of indirect hernias?

internal inguinal ring

site of protrusion of direct hernia?

abdominal wall

What tissue makes up the external spermatic fascia?

external oblique

What tissue makes up cremasteric muscle and fascia?

internal oblique

What tissue makes up internal spermatic fascia?

transversalis fascia

Define hernia

protrusion of peritoneum through an opening, usually a site of weakness

When might a diaphragmatic hernia develop in an infant?

result of defective development of pleuroperitoneal membrane

describe the most common diaphragmatic hernia

hiatal hernia => stomach herniates upward through esophageal hiatus of diaphragm

Describe the most common hiatal hernia

sliding hiatal hernia => GEJ displaced upward and "HOURGLASS STOMACH"

What is a hiatal hernia where the GEJ is normal?

paraesophageal hernia => fundus protrudes into thorax

What is a protrusion of peritoneum going through internal (deep) inguinal ring, external (superficial) inguinal ring, and into scrotum?

indirect inguinal hernia

In an indirect inguinal hernia, where does the protrusion enter internal inguinal ring?

lateral to inferior epigastric artery

Who is at higher risk to develop indirect inguinal hernia?

males especially infants

An indirect inguinal hernia in an infant is most likely due to what?

failure of processus vaginalis to close (can form hydrocele)

An indirect inguinal hernia follows what path? what covers it?

path of descent of testes => covered by all 3 layers of spermatic fascia

Where does a direct inguinal hernia protrude?

inguinal (Hesselbach's) triangle and bulges directly through abdominal wall medial to inferior epigastric artery

What differentiates indirect from direct hernias regarding inferior epigastric artery?

MD's don't LIe Medial to inferior epigastric artery = Direct hernia Lateral to inferior epigastric artery = Indirect hernia

What covers the direct hernia?

external spermatic fascia

Who is most commonly to have a direct inguinal hernia?

older men

Define a femoral hernia

protrusion of peritoneum below inguinal ligament through femoral canal below and lateral to pubic tubercle

Who is femoral hernia most likely found in?

women

Femoral hernia will likely cause what in the bowel?

bowel incarceration

Give the borders of Hesselbach's triangle

lateral: inferior epigastric vessels Medial: lateral border of rectus abdominis Inferior: inguinal ligament