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Gastroenterology > Anatomy > Flashcards

Anatomy Flashcards

Peritoneum, Abdominal Viscera

1
Q

What is the peritoneum?

A

continuous transparent serous membrane

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2
Q

What is the parietal peritoneum and what is it sensitive to?

A

lines abdominal cavity wall; sensitive to pressure, pain, heat, cold, and laceration

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3
Q

What is the visceral peritoneum?

A

covers abdominal viscera; insensitive to touch, heat, cold, and laceration; sensitive to stretch & chemical irritation; pain referred to the region the organ belongs to (foregut, midgut, hindgut)

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4
Q

What does the peritoneal cavity develop from and what does it do?

How much peritoneal fluid does it contain?

A

develops from visceral mesoderm and folds over gut tube as it develops

wraps around & suspends portions of gut from dorsal wall and ventral wall

there are no organs within the cavity

contains ~50mL

Notes: very complex shape; surface area is larger than skin

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5
Q

What is the mesentery?

A

double layer of peritoneum that connects intraperitoneal organ to abdominal wall

other mesenteries: transverse & sigmoid mesocolons; mesogastrium, mesoappendix

Notes: small intestine mesentery commonly called “the mesentery”

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6
Q

What is the omentum?

A

double layered extension or fold of peritoneum that passes from stomach & proximal duodenum to adjacent organs

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7
Q

Where is the greater omentum?

A

4 layers; from greater curve of stomach to proximal duodenum & folds back to attach to anterior surface of transverse colon

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8
Q

Where is the lesser omentum located?

A

smaller, 2 layers; connects lesser curve of stomach to liver

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9
Q

What is the peritoneal ligament?

A

double layer peritoneum that connects an organ to another organ or the abdominal wall

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10
Q

The liver connects to the anterior abdominal wall via what ligament?

A

falciform ligament

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11
Q

The liver connects to the stomach via what ligament?

A

hepatogastric ligament

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12
Q

The liver connects to the duodenum via what ligament?

A

hepatoduodenal ligament

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13
Q

What does the transverse mesocolon divide the peritoneal cavity into and what does it contain?

A

divides cavity into supracolic compartment

contains: stomach, liver, spleen, AND an infracolic compartent containing small intestine, ascending & descending colon

infracolic compartment is posterior to greater omentum and is divided into L and R infracolic spaces (by mesentery of small intestine)

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14
Q

What are paracolic gutters?

A

communicating passages between the infra & supracolic compartments

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15
Q

What does the digestive tract consist of?

A

esophagus, stomach, small intestines, large intestines

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16
Q

What are the accessory organs of digestion?

A

liver, gallbladder, pancreas

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17
Q

What is the foregut comprised of and where is pain referred?

A

esophagus, stomach, duodenum (proximal to bile duct), liver, & biliary ducts

pain referred to epigastrium

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18
Q

What organs comprise the midgut & where is pain referred?

A

small intestine (distal to bile duct), cecum, appendix, ascending colon & most of transverse colon

pain referred to periumbilical area

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19
Q

What organs comprise the hindgut and where is the pain referred?

A

distal transverse colon, descending colon, sigmoid colon, & rectum

pain is reffered to the hypogastrum

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20
Q

What is the purpose of the esophagus and where are the constriction points located?

A

conveys food bolus from pharynx to stomach

1) pharyngoesophageal junction
2) bronchoaortic
3) diaphragmatic constriction

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21
Q

What are the two muscles layers of the esophagus for peristalsis and where does it pass through the diaphragm?

A

internal circular layer & external longitudinal layer (proximal 1/3 of external muscle is under voluntary striated muscle control, inferior 1/3 is smooth muscles, middle 1/3 is mix)

Passes through elliptically shaped esophageal hiatus of diaphragm just L of midline of T10

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22
Q

Where is the stomach related to the peritoneal cavity and what are the 4 parts?

A

intraperitoneal

cardia, fundus, body, pyloric

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23
Q

Where is the cardia located?

A

surrounds the opening into the superior stomach; ~6th L costal cartilage; T11 level

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24
Q

Where is the fundus of the stomach located?

A

superior segment- lies against L diaphragm (when supine: pos to L 6th rib at MCL)

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25
Q

Where is the pyloric portion of the stomach located and what is it’s function?

A

funnel-shaped outflow region w/widest intake area called pyloric antrum –> pyloric canal –> pyloris/pyloric sphincter which controls the flow of chyme into SI

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26
Q

What are rugae and what is their purpose?

A

internal gastic folds

allow for expansion of stomach and increase surface area for digestion

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27
Q

What is the vasculature of the stomach and what is the drainage of the veins?

A

all arterial supply comes from branches off the celiac trunk (a branch of the abdominal aorta)

all veins drain into hepatic portal system for blood to be cleaned by liver

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28
Q

What lymphnodes drain the superior 2/3rds of stomach?

A

gastric nodes & pancreatosplenic nodes

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29
Q

What lymphnodes drain the right 2/3rds or inferior 1/3rd of the stomach?

A

the pyloric nodes

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30
Q

What lymphnodes drain the left 1/3 or inferior 1/3 of stomach?

A

pancreaticoduodenal nodes

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31
Q

What are the parasympathetic nerves supplying the stomach?

A

anterior vagal trunk and posterior vagal trunk

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32
Q

What is the anterior vagal trunk dervied from and what nerve branches does it give off?

A

from L vagus nerve; gives off hepatic, duodenal, & anterior gastric nerve branches

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33
Q

What is the posterior vagal trunk derived from, what does it supply, & what branches does it give off?

A

from R vagus nerve; supplies anterior & posterior stomach; gives off celiac plexus & anterior gastric branch

34
Q

Where are the sympathetic nerves of the stomach located?

A

from T6-T9 & pass through greater splanchic nerve to celiac plexus around gastric & gastro-omental arteries

35
Q

Where is the duodenum located and what are the segments?

A

most is fixed to abdominal wall by peritoneum (partially retroperitoneal)

superior, descending, inferior (horizontal), ascending

36
Q

What is the hepatopancreatic ampulla?

A

where common bile duct and pancreatic duct joins to enter the posteriomedial portion of the descending duodenum

37
Q

What is the vascular supply hepatopancreatic ampulla supplied by?

A

celiac trunk branches- gastroduodenal & superior pancreaticoduodenal arteries

38
Q

What is the vascular supply distal to hepatopancreatic ampulla supplied by?

A

from superior mesenteric artery branch- inferior pancreaticoduodenal artery

39
Q

What do the anteror lymphatic vessels of the duodenum drain into?

A

into pancreaticoduodenal nodes then into pyloric nodes

40
Q

What do the posterior vessels of the duodenal lymphactics drain into?

A

superior mesenteric nodes

41
Q

Where is the nerve supply from to the duodenum?

A

from vagus and greater and lesser splanchnic nerves via celiac & superior mesenteric plexuses

42
Q

Where is the jejunum & ileum located?

A

intraperitoneal; attached to posterior abdominal wall by “the mesentery”

43
Q

What is the vascular supply to the jejunum & ileum?

A

superior mesentery artery branches –> jejunal arteries, ileal arteries

44
Q

What are the lymphatic vessels in the intestinal villi called, what do they do, and where do they drain?

A

called lacteals; absorb fat from gut & drain via intramesenteric vessles into 3 sets of nodes: juxta-intestinal, mesenteric, and superior central

45
Q

Where do the sympathetic and parasympathetic fibers of the jejunum and ileum originate from?

A

Sympathetic: from T8-T10 SC levels

Parasympathetic: from posterior vagal trunk

46
Q

What are the 3 controls of motility and secretion?

A

What are the 3 controls of motility and secretion?

enteric NS, autonomic, intrinsic

47
Q

What are the plexuses of the enteric NS and what does it control?

A

auerbach & meissner plexus (both internal)

auerbach: b/t smooth muscle; controls and coordinates motility along entire gut
meissner: in submucosal layer; controls local motility & secretion and blood flow

48
Q

Intrinsic intenstinal motility has what type of character and how long does it take?

A

smooth muscle cells have intrinsic slow-wave activity; 12/min in duodenum, 8-9/min in ileum

49
Q

What organs are in the foregut and what is it supplied by?

A

esophagus, stomach, duodenum (proximal to bile duct), liver, biliary ducts

supplied by branches from the celiac trunk

50
Q

What organs are in the midgut and what is it supplied by?

A

duodenum [distal to bile gut], jejunum, ileum, cecum, ascending colon, most of transverse colon

supplied by branches from the superior mesenteric artery

51
Q

What is in the hindgut and what is it supplied by?

A

distal transverse colon, descending colon, sigmoid colon, rectum

supplied by branches from the inferior mesenteric artery

52
Q

What comprises the large intestines?

A

cecum (w/appendix), ascending colon, transverse colon, descending colon, sigmoid colon, rectum, anal canal

53
Q

What is the cecum and where does it attach?

A

first part of large intestine & continuous w/ascending colon

commonly attached to lateral abdominal wall by one or more peritoneal folds (cecal folds)

Notes: blind pouch, ~7.5cm; enveloped in peritoneum; can be lifted freely from R iliac fossa

54
Q

What is the ileal orfice and ileocecal valve?

A

ileal orifice: distal opening of ileum to cecum

ileocecal valve: not true sphincter muscle (a “flap”)

55
Q

What is the appendix and where does it attach?

A

blind intestinal diverticulum (pouch) w/masses of lymphoid tissue

attaches to cecum via mesoappendix mesentery; most common location is retrocecal BUT may be found in any position

56
Q

What is the blood supply to the cecum and appendix?

A

cecum: ileocecal artery (branch of SMA)
appendix: appendicular artery (branch of ileocecal)

venous return via ileocecal vein to SMV

57
Q

What are the lymphatics to the cecum and appendix?

A

ileocecal nodes to superior mesenteric nodes

58
Q

What are the nerves of the cecum and appendix?

A

superior mesenteric plexus (both sympathetic [lower T SC] and parasympathetic [vagus nerve])

59
Q

What are the 4 parts of the colon?

A

ascending, transverse, descending, and sigmoid

60
Q

Where is the ascending colon located?

A

from cecum –> R lobe of liver (hepatic flexure) becoming the transverse; retroperitoneal

61
Q

Where is the transverse colon located?

A

from hepatic flexure horizontally ascross abdomen to spleen (splenic flexure) becoming the descending; intraperitoneal

62
Q

Where is the descending colon located?

A

from splenic flexure to L iliac fossa & sigmoid colon; retroperitoneal

63
Q

Where is the sigmoid colon located?

A

s-shaped- from L ilac fossa to rectum in midline (~S3); intraperitoneal

64
Q

Where is the rectum located?

A

terminal colon; retro & subperitoneal

65
Q

What is the function of the liver, where is it located, and how does it move?

A

produces bile continuously

located in RUQ

moves with respiration

66
Q

What are the lobes of the liver and which have hepatic ducts?

A

right (largest) and left (both have hepatic ducts)

right lobe has 2 accessory lobes called caudate & quadrate

67
Q

What is the blood supply to the liver?

A

dual afferent supply from hepatic artery and hepatic portal system

hepatic artery is a branch off celiac trunk & supplies mostly to hepatic ducts (non-parenchymal)

hepatic portal system delivers blood from GI tract to liver & provides nutrition & oxygen

68
Q

How does the lymphatic system drain through the liver?

A

drains to hepatic nodes and phrenic nodes then to celiac nodes to cisterna chyli (distal end of thoracic duct)

69
Q

Where is the innervation of the liver derived from?

A

derived from hepatic plexus (from celiac plexus) and travel w/hepatic arteries & portal veins

sympathetic fibers from celiac plexus

parasympathetic fibers from anterior & posterior vagus trunks

70
Q

What comprises the common hepatic duct and how does it travel?

A

R & L hepatic ducts (one from each lobe) converge to form common hepatic duct which converges with the cystic duct (from GB) to form bile duct (formerly common bile duct)

75% of population bile duct & pancreatic duct join to form short hepatopancreatic duct; hepatopancreatic duct enters posteromedial descending duodenum at the ampulla of vader

each duct (bile & pancreatic) has a sphincter muscle at terminal end BEFORE forming the hepatopancreatic duct

71
Q

Where is the sphincter of oddi located & what does it control?

A

It is located in the ampulla of vader & controls flow of juices from liver/GB and pancreas

72
Q

Where is the liver located and how much bile can it hold?

A

located in GB fossa of liver along superior portion of duodenum & can hold up to 50mL of bile

73
Q

What is the function of the pancreas and where is it located?

A

exocrine and endocrine functions

in “C” of duodenum projecting behind stomach toward LUQ w/tail ending at spleen

retroperitoneal

74
Q

How does pancreatic juice travel?

A

exocrine secretions (pancreatic juice) flows to duodenum via pancreatic duct AND accessory pancreatic duct

75
Q

Where does the pancreas attach and where is the bile duct located?

A

head is attached via peritoneal ligaments to duodenum

bile duct lies in groove on pos side of pancreas OR embedded within the substance of the head

76
Q

How does the main pancreatic duct travel?

A

runs from tail through parenchyma of pancreas to head where it joins w/bile duct to enter the duodenum at ampulla of vater

77
Q

How do the lymphatics of the pancreas travel?

A

follow blood vessels to pancreaticosplenic nodes along splenic artery OR to pyloric nodes

78
Q

What are the nerves that supply the pancreas?

A

nerve branches from vagus and splanchinic nerves

79
Q

What is the function of the spleen and how far does it extend?

A

most delicate & vulnerable organ

largest lymohatic organ; proliferation of lymphocytes

NML sized doesn’t extend lower than L costal margin

80
Q

What is the blood supply to the spleen?

A

supplied from splenic artery and is returned via splenic vein to SMV to hepatic portal vein

81
Q

What are the lymphatics of the spleen?

A

nodes in hilum to pancreaticosplenic nodes along superior pancreas to celiac nodes

82
Q

What is the innervation of the spleen?

A

from celiac plexus following branches of splenic artery

Gastroenterology (5 decks)

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