Anatomy Flashcards
What can injury to retroperitoneal structures cause
Blood or gas accumulation in retroperitoneal space
Retroperitoneal structures/organs
SAD PUCKER: Suprarenal (adrenal glands) Aorta and IVD Duodenum (2nd through 4th parts) Pancreas (except tail) Ureters Colon (ascending and descending) Kidneys Esophagus (thoracic portion) Rectum (partially)
Derivative of fetal umbilical vein
Falciform ligament
Connects liver to anterior abdominal wall
Falciform ligament
Structures contained in the falciform ligament
Ligamentum teres hepatis
Tissue falciform ligament derived from
Ventral mesentery
Structure ligamentum teres hepatis derived from
Fetal umbilical vein
Connects liver to duodenum
Hepatoduodenal ligament
Structures contained within the hepatoduodenal ligament
Portal triad: common Bile duct, Portal vein, proper Hepatic artery
Maneuver used to control bleeding by compressing hepatoduodenal ligament between thumb and index finger
Pringle maneuver
Cavity where fingers are placed to perform Pringle maneuver
Omental foramen
Ligament which borders omental foramen and lesser sacs
Hepatoduodenal ligament
Ligament used for Pringle maneuver
Hepatoduodenal ligament
Connects liver to lesser curvature of the stomach
Gastrohepatic ligament
Structures contained within the Gastrohepatic ligament
Gastric arteries
Ligament which separates the greater and lesser sacs on the right
Gastrohepatic ligament
Ligament which may be cut to access lesser sac during surgery
Gastrohepatic ligament
Ligaments that are part of the lesser omentum
Hepatoduodenal and Gastrohepatic ligaments
Ligament which connects the greater curvature and transverse colon
Gastrocolic ligament
Structures contained within the Gastrocolic ligament
Gastroepiploic arteries
Ligament which connects the greater curvature and spleen
Gastrosplenic ligament
Structures contained within the Gastrosplenic ligament
Short gastric and left gastroepiploic vessels
Ligament which separates the greater and lesser sacs on the left
Gastrosplenic ligament
Ligaments which are part of the greater omentum
Gastrosplenic and Gastrocolic ligaments
Ligament which connects spleen to posterior abdominal wall
Splenorenal ligament
Structures contained within the Splenorenal ligament
Splenic artery and vein and tail of pancreas
Layers of the gut wall
MSMS:
Mucosa, Submucosa, Muscularis externa, Serosa
Layers of the mucosal layer of gut wall
Epithelium, Lamina propria, Muscularis mucosa
Layers of the submucosa of gut wall
Submucosal gland and Meissner plexus
Layers of the muscularis externa
Inner circular layer, Auerbach plexus, Outer longitudinal layer
Erosions are found in which gut walls
Mucosal layer only
Ulcers are found in which gut walls
Can extend into all gut layers
Frequency of basal electric rhythm waves in stomach
3 waves/min
Frequency of basal electric rhythm waves in duodenum
12 waves/min
Frequency of basal electric rhythm waves in ileum
8-9 waves/min
Outer layer of gut wall when intraperitoneal
Serosa
Outer layer of gut wall when retroperitoneal
Adventitia
Type of tissue in the esophagus
Nonkeratinized stratified squamous epithelium
Location of gastric glands
Stomach
Location of Brunner glands
Submucosa of duodenum
Glands that secrete HCO3-
Brunner glands
Location of crypts of Lieberkuhn
Duodenum, jejunum, ileum, colon
Structure that contains stem cells that replace enterocytes and goblet cells
Crypts of Lieberkuhn
Cells that secrete defensins, lysozyme and TNF
Paneth cells
Location of stem cells and Paneth cells
Crypts of Lieberkuhn
Location of plicae circulares
Distal duodenum, jejunum, proximal ileum
Section of small intestine that contains the largest number of goblet cells
Ileum
Lymphoid aggregates in lamina propria and submucosa
Peyer patches
Location of Peyer patches
Ileum
Direction arteries supplying GI structures branch
Anteriorly
Direction arteries supplying non-GI structures branch
Laterally and posteriorly
Main artery that supplies the foregut
Celiac artery
Provides parasympathetic innervation to the foregut
Vagus nerve
Organ of mesoderm origin found in the foregut
Spleen
Vertebral level celiac artery is located
T12/L1
Nerve that supplies innervation to the pharynx
Vagus nerve
Provides blood supply to the lower esophagus
Celiac artery
Structures supplied by the celiac artery
Lower esophagus to proximal duodenum, liver, gallbladder, pancreas, and spleen
Main artery that supplies the midgut
SMA
Vertebral level SMA is located
L1
Provides parasympathetic innervation to the midgut
Vagus
Structures supplied by the SMA
Distal duodenum to proximal 2/3 of transverse colon
Main artery that supplies the hindgut
IMA
Vertebral level IMA is located
L3
Provides parasympathetic innervation to the hindgut
Pelvic splanchnic
Structures supplied by the IMA
Distal 1/3 transverse colon to upper portion of rectum
Branches of the celiac trunk
Splenic artery, Left gastric artery, Common hepatic artery
Constitute the main blood supply to the stomach
Splenic artery, Left gastric artery, Common hepatic artery
Anastomoses with the left gastroepiploic artery
Right gastroepiploic artery
Anastomoses with the left gastric artery
Right gastric artery
Ulcer that can damage gastroduodenal artery causing hemorrhage
Posterior duodenal ulcer
Ulcer that can cause pneumoperitoneum
Anterior duodenal ulcer
Artery that may be damaged in a posterior duodenal ulcer
Gastroduodenal artery
Condition that may be caused by an anterior duodenal ulcer
Pneumoperitoneum
Supply blood to lesser curvature of the stomach
Left and Right gastric arteries
Supply blood to the greater curvature of the stomach
Right and Left gastroepiploic arteries
Branches off the splenic artery to supply the fundus of the stomach
Short gastric
Branches off the splenic artery to supply the left side of the greater curvature of the stomach
Left gastroepiploic artery
Branches of the splenic artery
Short gastric and left gastroepiploic arteries
Branches off the left gastric artery to supply the esophagus
Esophageal branches
Branches of the common hepatic artery
Gastroduodenal and Proper hepatic artery
Branches of the Proper hepatic artery
Left and Right hepatic arteries and right gastric artery
Branches off the Right hepatic artery to supply the gallbladder
Cystic artery
Branches off the Proper hepatic artery to supply the right lesser curve of the stomach
Right gastric artery
Branch off the Gastroduodenal artery to supply the proximal duodenum
Anterior and Posterior superior pancreaticoduodenal arteries
Branches of the Gastroduodenal artery
Anterior and Posterior superior pancreaticoduodenal arteries and the right Gastroepiploic artery
Clinical sign between superior rectal and middle/inferior rectal veins in portal HTN
Anorectal varices
Clinical sign between paraumbilical veins and small epigastric veins of the anterior abdominal wall in portal HTN
Caput medusae
Clinical sign between left gastric and azygous veins in portal HTN
Esophageal varices
Treatment which places a device between the portal vein and hepatic vein to relieve portal HTN by shunting blood to the systemic circulation, bypassing liver
TIPS (transjugular intrahepatic portosystemic shunt)
TIPS device is placed between what two veins to reliever portal HTN
Portal vein and hepatic vein
Anatomic structure in anal canal formed by union between endoderm and ectoderm
Pectinate line (dentate)
Pathologies that form above pectinate line
Internal hemorrhoids and adenocarcinoma
Blood supply to the anal canal above the pectinate line
Superior rectal artery
Superior rectal artery branches off what main artery
IMA
Venous drainage above the pectinate line
Superior rectal vein - inferior mesenteric vein - splenic vein - portal vein
The superior rectal vein drains into what vein
Inferior mesenteric vein
The inferior mesenteric vein drains into what vein
Splenic vein
The splenic vein drains into what vein
Portal vein
Lymphatic drainage from the anal canal above the pectinate
Internal iliac lymph nodes
Pathologies that form below pectinate line
External hemorrhoids, anal fissures, squamous cell carcinoma
Blood supply to the anal canal below the pectinate line
Inferior rectal artery
Inferior rectal artery branches off what main artery
Internal pudendal artery
Venous drainage below the pectinate line
Inferior rectal vein - internal pudendal vein- internal iliac vein - common iliac vein - IVC
The inferior rectal vein drains into what vein
Internal pudendal vein
The internal pudendal vein drains into what vein
Internal iliac vein
The internal iliac vein drains into what vein
Common iliac vein
The common iliac vein drains into what vein
IVC
Tear in the anal mucosa below the pectinate line
Anal fissure
Anal fissures are associated with what type of diets
Low fiber diets
Symptoms of anal fissures
Pain while Pooping, blood on toilet Paper
Common location of anal fissures in anal canal
Posteriorly because Poorly Perfused
Lymphatic drainage from anal canal below pectinate line
Superficial inguinal nodes
Innervation to anal canal below pectinate line
Inferior rectal branch of pudendal nerve
Innervation to anal canal above pectinate line
Visceral innervation
Surface of hepatocytes that faces bile canaliculi
Apical side
Surface of hepatocytes that faces sinusoids
Basolateral
Specialized macrophages that form lining of sinusoids
Kupffer cells
Cells in the space of Disse that store vitamin A and produce extracellular matrix
Hepatic stellate (Ito) cells
Function of stellate cells when quiescent
Store vitamin A
Function of stellate cells when active
Produce extracellular matrix
Zone of liver affected first by viral hepatitis
Zone I (peripheral zone)
Zone of liver affected first by ingested toxins
Zone I (peripheral zone)
Zone of liver affected first by yellow fever
Zone II (intermediate zone)
Zone of liver affected first by ischemia
Zone III (centrilobular zone)
Zone of liver that contains cytochrome P-450 system
Zone III (centrilobular zone)
Zone of liver most sensitive to metabolic toxins
Zone III (centrilobular zone)
Zone of liver that is site of alcoholic hepatitis
Zone III (centrilobular zone)
Enlarged gallbladder with painless jaundice
Courvoisier sign
Formed by cystic duct meeting with common hepatic duct
Common bile duct
The common bile duct drains into what structure
Ampulla of Vater within pancreatic head
The ampulla of Vater drains into which section of the duodenum
First section via sphincter of Oddi
Muscular valve that controls the flow of digestive juices from the pancreas into the duodenum
Sphincter of Oddi
Structure that can be obstructed by a mass of the head of the pancreas
Common bile duct
Confluence of the pancreatic duct and common bile duct
Ampulla of Vater
Organization of structures within the femoral region from lateral to medial
Nerve, Artery, Vein, Lymphatics
you go from lateral to medial to find your NAVeL
Structures within the femoral triangle
Femoral Nerve, Artery, Vein
Structure within the femoral triangle that is nearest the penis
Femoral vein
Forms lateral border of femoral triangle
Sartorius muscle
Forms medial border of femoral triangle
Adductor longus muscle
Located 3-4 cm below inguinal ligament
Femoral sheath
Structures contained within the femoral sheath
Femoral artery, vein, inguinal canal (deep inguinal lymph nodes within canal)
Site of femoral hernia
Inguinal ring
Site of protrusion of direct hernia
Abdominal wall
Site of protrusion of indirect hernia
Deep inguinal ring
Layers that compose the spermatic cord
Internal spermatic fascia, Cremasteric muscle and fascia, and External spermatic fascia
Abdominal wall layer that gives rise to the Internal spermatic fascia
Transversalis fascia
Abdominal wall layer that gives rise to the Cremasteric muscle and fascia
Internal oblique
Abdominal wall layer that gives rise to the External spermatic fascia
External oblique
Female homolog of the spermatic cord
Round ligament of the uterus
Complication of hernias if not reducible
Incarceration and strangulation
Complication of strangulation of hernias
Ischemia and necrosis
Most common type of diaphragmatic hernia
Sliding hiatal hernia
Side diaphragmatic hernias typically occur on
Left side (right side protected by liver)
Causes of diaphragmatic hernias
Congenital defect of pleuroperitoneal membrane or trauma
Type of hernia where fundus protrudes into the thorax and normal GE junction
Paraesophageal hernia
Type of hernia in which GE junction is displaced upward giving an “hourglass stomach” appearance
Sliding hiatal hernia
Hernia that travels through internal inguinal ring
Indirect hernia
Indirect hernia terminates in what structure
Scrotum
Indirect hernia exits what structure before terminating in scrotum
External inguinal ring
Indirect hernia enters inguinal ring lateral to what structures
Inferior epigastric vessels
Type of hernia more common in males
Indirect inguinal ring
Cause of indirect inguinal hernia in infants
Processus vaginalis fails to close
In addition to an indirect inguinal hernia, what other complication can develop from failure of process vaginalis to close in infants
Hydrocele
Hernia that follows the path of descent of the testes and covered by all 3 layers of spermatic fascia
Indirect inguinal hernia
Type of hernia that is medial to inferior epigastric vessels
Direct inguinal hernia
Direct hernia protrudes through what anatomical structure
Hasselbach triangle
Structures that make up Hasselbach triangle
Inferior epigastric vessels
Lateral border of rectus abdominis muscle
Inguinal ligament
A direct inguinal hernia travels through which structure
External inguinal ring
A direct inguinal hernia is covered by which spermatic layers
External spermatic fascia
Which type of hernia is more common in older men
Direct inguinal hernia
Cause of direct inguinal hernia
Acquired weakness in the transversalis fascia
A direct hernia is medial to what structures
Inferior epigastric vessels
Which type of hernia is more likely to present with incarceration or strangulation
Femoral hernia
Type of hernia more common in females
Femoral hernia
Most common type of hernia overall
Inguinal hernias
Femoral hernia protrudes below what structure
Inguinal ligament
Femoral hernia protrudes lateral to what structure
Pubic tubercle
What structure does a femoral hernia travel through
Femoral canal