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Anatomy Flashcards

1
Q

At what level does the celiac trunk appear? What does it supply?

A

T12/upper L1; supplies the foregut (ABD esophagus -> superior to major duodenal papilla)

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2
Q

At what level does the SMA appear? What does it supply?

A

Lower L1; supplies the midgut (inferior to major duodenal papilla -> proximal 2/3 transverse colon)

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3
Q

At what level does the IMA appear? What does it supply?

A

L3; supplies the hindgut (distal 1/3 transverse colon -> midway through anal canal)

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4
Q

At what level does the aorta bifurcate?

A

L4

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5
Q

What 3 branches come off the celiac trunk?

A

Left gastric A.; splenic A.; common hepatic A.

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6
Q

In what L. does the left gastric A. lie? What branches come off it?

A

hepatogastric L.; gives off esophageal As.

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7
Q

Name the 4 branches of the splenic A. Is the splenic A. intraperitoneal or retroperitoneal?

A
  • pancreatic branches; splenic branches; short gastric As.; left gastro-omental A.
  • retroperitoneal until it enters the splenorenal L. (along w/ tail of pancreas)
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8
Q

Name the 3 branches off of the common hepatic A.

A

right gastric A., proper hepatic A., and gastroduodenal A.

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9
Q

In what L. is the proper hepatic A.? Name 3 branches off of it

A
  • hepatoduodenal L.

- left hepatic A., right hepatic A., cystic A. (can come off proper hepatic or right hepatic A.)

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10
Q

Name the 3 branches of the gastroduodenal A.

A

supraduodenal A.; right gastro-omental A.; superior pancreaticoduodenal A. (anterior and posterior branches)

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11
Q

What is Pringle’s maneuver?

A

surgical maneuver to control hemorrhaging of the cystic A. by clamping the hepatoduodenal L. (can be used during cholecystectomy)

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12
Q

Name the 6 branches of the SMA

A

inferior pancreaticoduodenal As (anterior and posterior branches); jejunal As.; ileal As.; middle colic A.; right colic A.; ileocolic A.

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13
Q

How do you distinguish between jejunum and ileum?

A

jejunal As. have large arcades and long vasa recta; ileal As. have small arcades and short vasa recta

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14
Q

Name the 2 branches of the ileocecal A.

A

cecal branch and appendicular A.

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15
Q

Name the 3 branches off of the IMA

A

left colic A., superior rectal A., and sigmoid As.

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16
Q

Name 3 upper GI anastamoses

A
  • left gastric A. and right gastric A. (lesser curvature of stomach)
  • left gastro-omental A. and right gastro-omental A. (greater curvature of stomach)
  • superior and inferior pancreaticoduodenal As. (anterior and posterior branches)
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17
Q

What is Nutcracker syndrome? What are some sxs?

A
  • compression of the left renal vein between the SMA (anterior) and the ABD aorta (posterior)
  • sxs include hematuria, left flank pain, N/V, left testicular pain in men
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18
Q

Where do the left and right gonadal Vs. drain?

A

left gonadal V. drains into left renal V.

right gonadal V. drains into IVC

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19
Q

What forms the hepatic portal vein?

A

merging of the splenic V. and superior mesenteric V.

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20
Q

What are 3 locations that the inferior mesenteric V. can drain?

A
  • directly into hepatic portal vein (1/3)

- into splenic vein or superior mesenteric vein (2/3)

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21
Q

What porto-caval anastomosis would cause esophageal varies?

A

esophageal V. (from L. gastric V.) with esophageal V. (from Azygos V.)

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22
Q

What porto-caval anastomosis would cause hemorrhoids?

A

superior rectal V. (continues as IMV) with inferior rectal V. and middle rectal V.

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23
Q

What porto-caval anastomosis would cause caput medusae? What is caput medusae?

A
  • para-umbilical Vs (dump directly into hepatic portal V.). w/ epigastric Vs.
  • veiny webbing of dilated vessels around umbilicus (seen in very severe liver cirrhosis)
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24
Q

What is the 4th porto-caval anastomosis?

A

visceral Vs. with retroperitoneal Vs of posterior ABD wall and diaphragm

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25
Q

What divides the rectum into 2 regions? What is each region derived from?

A

pectinate line; above the line is made of endoderm; below the line is made of ectoderm

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26
Q

What is the artery and vein from the superior part of the rectum? What supplies the artery and where does the vein drain?

A

superior rectal A. (from IMA)

superior rectal V. (IMV -> portal system)

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27
Q

What is the artery and vein from the inferior part of the rectum? What supplies the artery and where does the vein drain?

A

inferior rectal A. (from internal pudendal A.)

inferior rectal V. (internal pudendal V. -> internal iliac V. -> common iliac V. -> IVC)

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28
Q

Internal vs External Hemorrhoids?

A
  • internal occur above the pectinate line (visceral innervation - not painful)
  • external occur below the pectinate line (somatic innervation - painful)
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29
Q

What is the most common portosystemic shunt?

A

central splenorenal shunt - between splenic V. and left renal V.

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30
Q

What is the major differences between CT and MRI?

A

CT - fast, all data collected at once, involves radiation (Xray)
MRI - slow, no radiation (not Xray), have to set parameters for proper info

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31
Q

What is the modality of choice for viewing the biliary tree?

A

endoscopic retrograde cholangiopancreatography (ERCP)

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32
Q

What is the modality of choice for viewing ABD aortic vasculature?

A

digital subtraction arteriography

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33
Q

What is ascites and the most common causes (5)?

A
  • accumulation of fluid in the ABD

- portal HTN, liver cirrhosis, salt and water retention, heart failure, cancer

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34
Q

Why don’t you see ascites around the kidneys?

A

kidneys are retroperitoneal

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35
Q

What is a mid-sagittal view useful for assessing?

A

SMA syndrome and Nutcracker syndrome

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36
Q

What is Superior Mesenteric Artery Syndrome? When is it mostly seen and what are the sxs?

A

compression of the 3rd part of the duodenum between the ABD aorta and SMA; usually seen in people after large amounts of weight loss; sx include ABD pain, fullness, N/V, and weight loss

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37
Q

sliding hiatal hernia vs paraesophageal hiatal hernia

A
  • sliding hiatal hernia: bulging of stomach through LES (reflux)
  • paraesphageal hiatal hernia: bulging of fundus up next to esophagus (no reflux)
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38
Q

What is zenker’s diverticulum? Sxs?

A

diverticular formation in esophageal wall next to inferior pharyngeal constrictor; sxs include severe halitosis, dysphagia, feeling of food stuck in throat, regurgitation hours after eating

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39
Q

What is ulcerative colitis? What is the hallmark of it?

A

spasm of the longitudinal muscle and/or irreversible fibrosis; hallmark is the “lead pipe” appearance of colon due to loss of haustral markings

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40
Q

What is the test of choice for dx cholelithiasis?

A

Gallbladder US

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41
Q

What is a shatzki ring?

A

narrowing of the esophagus caused by a ring of mucosal tissue or muscular tissue

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42
Q

What is the cause of Hischprung’s disease? What is the tx?

A

absence of parasympathetic post-ganglionic plexus due to absence of NCC migration; causes megacolon and lack of peristalsis; tx is surgical resection of affected area

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43
Q

What is the origin, insertion, and innervation of the psoas major and minor Ms.?

A

O: transverse process and bodies of T12-L5
I: tendon of lesser trochanter or femur
N: L1-L3

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44
Q

What is the origin, insertion, and innervation of the iliacus M.?

A

O: superior 2/3 of iliac fossa and iliac ala
I: lesser trochanter of femur; travels w/ psoas major M. at level of inguinal L. and unite and insert together
N: femoral N. (L2-L4)

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45
Q

What is the origin, insertion, and innervation of the quadratus lumborum M.?

A

O: inferior 12th rib, tp of lumbar transverse processes
I: iliolumbar L., lip of iliac crest
N: T12-L4

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46
Q

What is the median arcuate L. of the posterior ABD wall?

A

tendinous arch crossing aorta; unites left and right crura of diaphragm

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47
Q

What is the medial arcuate L. of the posterior ABD wall?

A

lateral to median arcuate L. on each side; fascial thickening of psoas M. from lumbar body to TP

48
Q

What is the lateral arcuate L. of the posterior ABD wall?

A

fascial thickening of quadratus lumborum M. that spans from L2 TP to tip of 12th rib

49
Q

What are the 3 muscular parts of the diaphragm?

A
  • sternal: attaches to xiphoid process
  • costal: attaches to inferior 6 costal cartilages
  • central tendon: central part of diaphragm
50
Q

What are the crura of the diaphragm? Which is longer?

A
  • tendons that extend below the diaphragm on the vertebral column to help muscle contraction
  • right crus extends further (L3-L4) than the left crus (L2-L3)
51
Q

What are the 3 diaphragmatic openings and at what level are they?

A
  • caval (T8)
  • esophageal (T10)
  • aortic hiatus (T12)
52
Q

What runs through each of the 3 diaphragmatic openings? Mnemonic?

A

I 8 10 Eggs At 12

  • T8: IVC and right phrenic N.
  • T10: esophagus, anterior and posterior vagal trunks
  • T12: aortal and thoracic duct
53
Q

What are the 6 arteries that supply the diaphragm?

A
  • superior phrenic A.
  • inferior phrenic A.
  • pericardiocophrenic A.
  • musculocophrenic A.
  • superior suprarenal A.
  • intercostal As.
54
Q

From what levels does the ABD aorta run? Where does it bifurcate?

A

runs from T12-L4 then bifurcates

55
Q

Name 4 unpaired As. of the posterior ABD wall. What do they all come from?

A

all come from ABD aorta

  • celiac trunk (T12)
  • SMA (L1)
  • IMA (L3)
  • median sacral A. (L4 at bifurcation)
56
Q

Name the 7 pairs of arteries of the posterior ABD wall.

A
  • inferior phrenic As.
  • subcostal As.
  • lumbar As.
  • suprarenal As.
  • Renal As.
  • deep circumflex As.
  • gonadal As.
57
Q

At what level do both renal As. and gonadal As. come off ABD aorta?

58
Q

Name 3 visceral veins of the posterior ABD wall

A

drain organs

  • suprarenal V.
  • renal V.
  • gonadal V.
59
Q

Name 3 parietal veins of the posterior ABD wall

A

drains body cavity

  • inferior phrenic V.
  • lumbar V.
  • common iliac V. (where ABD aorta and IVC bifurcate)
60
Q

At what level does the IVC begin and where does it run?

A

L5; runs slightly to the right of the ABD aorta

61
Q

What drains into the common iliac lymph nodes?

A

internal and external iliac lymph nodes (pelvic region)

62
Q

What does the common iliac lymph nodes drain into? Where do these lymph nodes receive lymph and where do they run?

A
  • lumbar lymph nodes (posterior ABD wall, pelvic wall, and organs in region)
  • run along side the IVC and aorta
63
Q

Where do they pre-aortic lymph nodes lie and what do they drain?

A

lie in front of the aorta and drain the GI tract, liver, spleen, and pancreas

64
Q

Where does all lymph of the lower body collect?

A

cysterna chyli

65
Q

What 6 nerves of the posterior ABD wall are part of the lumbar plexus?

A
  • iliohypogastric N.
  • ilioinguinal N.
  • lateral femoral cutaneous N.
  • femoral N.
  • obturator N.
  • lumbosacral trunk
66
Q

What makes up the subcostal N. and where does it run?

A

T12; runs underneath 12th rib (protected)

67
Q

What makes up the iliohypogastric N. and ilioinguial N.? When are they likely to be damaged?

A

L1; likely to be damaged if kidney is damaged (run over kidneys on posterior side)

68
Q

What makes up the genitofemoral N. and where does it run?

A

L1-L2; runs on top of psoas major M.

69
Q

What makes up the lateral femoral cutaneous N.?

70
Q

What makes up the femoral N. and obturator N.?

71
Q

What makes up the lumbosacral trunk?

72
Q

What 3 nerves of the posterior ABD wall run lateral to the psoas major M.?

A
  • ilioinguinal N.
  • lateral femoral cutaneous N.
  • femoral N.
73
Q

What nerve of the posterior ABD wall runs medial to the psoas major M.?

A

obturator N.

74
Q

At what level are the kidneys? Which one is lower and why?

A

T12-L3; right kidney is lower due to the liver

75
Q

What lies over the inferior pole of each kidney?

A

quadratus lumborum M.

76
Q

What is the innervation of the kidneys?

A

renal plexus as well as least pelvic splanchnic Ns. (aorticorenal ganglion); also innervated by vagal trunk

77
Q

What are the 3 layers of renal fascia?

A
  • perinephric fat (surrounds kidney directly)
  • renal fascia: covers perinephric fat and suprarenal gland
  • paranephric fat: outside renal fascia
78
Q

What does the renal A. split into?

A

segmental As going to each segment of the kidneys

79
Q

Where do the ureters run in males and females?

A

posterior to ductus deferens in males; posterior to uterine A. in females

80
Q

What are 3 constriction points for the ureters?

A
  • ureterophelvic junction (UPJ) -> junction of ureter w/ renal pelvis
  • pelvic brim
  • where it enters bladder wall
81
Q

Name 6 arteries that supply the ureters?

A
  • renal A.
  • gonadal A.
  • ABD arota
  • common iliac A.
  • superior vesicular A.
  • pelvic branches
82
Q

What is the innervation of the ureters (4)?

A
  • renal plexus
  • ABD aortic plexus
  • superior hypogastric plexus
  • sympathetics: T11-L2
83
Q

What sits next to the right adrenal gland?

A

right crus of the diaphragm and IVC

84
Q

What sits next to the left adrenal gland?

A

left crus of diaphragm, spleen, stomach, and pancreas

85
Q

Where do each of the 3 suprarenal As. come off?

A
  • superior suprarenal As. -> inferior phrenic A.
  • middle suprarenal As. -> ABD aorta
  • inferior suprarenal As. -> renal A.
86
Q

What innervates the adrenal glands (2)? What do they receive parasympathetic and sympathetic innervation?

A
  • celiac plexus
  • ABD pelvic splanchnic Ns.
  • parasympathetics: vagal trunks
  • Autonomics: T10-T11 that synapse on chromatin cells inside medulla
87
Q

Where do both sympathetic and parasympathetic nerve fibers leave the spinal cord?

A
  • Sympathetic: thoracolumbar

- Parasympathetic: craniosacral

88
Q

Preganglionic neuron vs postganglionic neuron

A
  • preganglionic neuron - originated in CNS (brain stem or spinal cord) and synapses on a ganglion in the PNS
  • postganglionic neuron - travels to the target organ
89
Q

What do sympathetic fibers look like compared to parasympathetic fibers?

A
  • sympathetic fibers: short presynaptic/long postsynaptic

- parasympathetic: long presynaptic/short postsynaptic

90
Q

What is the function of both sympathetic and parasympathetics?

A
  • sympathetics: respond to stress, vasoconstriction, and reduce bowel motility and secretions
  • parasympathetic: maintain homeostasis, increase bowel motility, secretion, and vasodilation
91
Q

What is a paravertebral ganglion?

What is a prevertebral ganglion?

A
  • paravertebral ganglion: interconnected ganglia that lie close to the vertebra and spinal cord
  • prevertebral ganglion: sympathetic ganglia that lie between the paravertebral ganglia and the target organ
92
Q

What synapses onto prevertebral sympathetic ganglia?

A

presynpatic sympathetic fiber; parasympathetic fibers do not synapse onto it -> skip it and synapse closer to the target organ

93
Q

What are the 4 choices presynaptic fibers have when they leave the spinal cord?

A
  • go up paravertebral chain and synapse on another ganglia
  • go down the chain and synapse
  • come out and synapse at that level
  • pass through ganglia w/o synapsing and synapse on prevertebral ganglia (visceral)
94
Q

Onto what ganglia do the greater, lesser, and least splanchnic Ns. synapse? What levels make them up?

A
  • greater (T5-T9) -> celiac ganglion
  • lesser (T10-T11) -> superior mesenteric ganglion
  • least (T12) -> aroticorenal ganglion
95
Q

Name 2 more splanchnic nerves and their levels

A
  • lumbar splanchnic (L1-L3)

- sacral splanchnic (S1-S5) -> not anterior rami (sympathetic)

96
Q

What splanchnic nerve is actually parasympathetic rather than sympathetic? What are its levels and what does it innervate?

A

pelvic splanchnic Ns. (anterior rami S2-S4) -> splenic flexure to above pectinate line in anal canal

97
Q

Describe sympathetic innervation for the foregut and midgut

A
  • foregut: presynaptic: thoracic splanchnic Ns. (T5-T9); postsynaptic: celiac ganglion
  • midgut: presynaptic: thoracic splanchnic Ns. (T5-T9); postsynaptic: superior mesenteric ganglion
98
Q

Describe sympathetic innervation of the hindgut

A

presynaptic: lumbar splanchnic Ns. (L1-L2); postsynaptic: inferior mesenteric ganglion

99
Q

Describe parasympathetic innervation of the foregut, midgut, and hindgut

A
  • foregut = vagus N.
  • midgut = vagus N.
  • hindgut = pelvic splanchnic Ns.
100
Q

Where would referred pain be located in the foregut, midgut, and hindgut?

A
  • foregut = epigastrium
  • midgut = umbilicus
  • hindgut = hypogastrium
101
Q

What is located at the T4, L10, and L1 levels?

A 
T4 = nipples
T10 = umbilicus
L1 = inguinal fold
102
Q

Visceral afferents of liver

103
Q

visceral afferents of stomach

104
Q

visceral afferents of spleen

105
Q

visceral afferents of pancreas

106
Q

visceral afferents of adrenal glands

107
Q

visceral afferents of kidneys

108
Q

visceral afferents of small intestine

109
Q

visceral afferents of appendix

110
Q

visceral afferents of the colon

111
Q

visceral afferents below the pelvic pain line (midpoint of sigmoid colon)

A

parasympathetics (S2-S4)

112
Q

reflex afferents below and above pelvic pain line

A

above = vagus N.
below = S2-S4
- parasympathetics only

113
Q

Describe visceral pain

A

diffuse, dull, can cause referred pain

114
Q

describe somatic pain

A

localized, acute or severe, supplied by somatic sensory fibers via thoracic nerves (T7-T12); extremely sensitive to stretching -> rebound tenderness

115
Q

What usually causes referred shoulder pain?

A

irritation of the diaphragm

GI Final Exam (6 decks)

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