Anatomy- Abdominal Pain Flashcards
what are the parts of the small intestine
duodenum (short)
jejunum (about 3m)
ileum (about 4m)
what are the parts of the large intestine
colon, rectum, anal canal and anus
what are the parts of the colon
caecum, appendix, ascending colon, transverse colon, descending colon, sigmoid colon
what organs are in the foregut
oesophagus to mid-duodenum,
liver and gall bladder,
spleen,
1/2 of pancreas
what organs are in the midgut
mid-duodenum to proximal 2/3rds of transverse colon,
1/2 of pancreas
what organs are in the hindgut
distal 1/3rd of transverse colon to proximal 1/2 of anal canal
what are the four quadrants of the abdominal organs
right and left upper and lower
divided at the level of the umbilicus and down the midline
what are the nine quadrants of the abdomen
from top to bottom left to right
right hypochondrium, epigastric, left hypochondrium
right lumbar, umbilical, left lumbar
right inguinal, pubic, left inguinal
divided by the mid clavicular lines and subcostal and transtubecular
which of the four quadrants in the pancreas in
left and right upper
what are the layers of the abdominal wall
external oblique, internal oblique, transverse abdominus, parietal peritonium
rectus abdominus in the middle of stomach (abs)
which way do the fibres do in the muscles of the abdominal wall
external wall hands in pockets
internal hands on chest
transverse
abdmoninis transverse
describe the paradoxical movement of stomach guarding
when injury threatens or in peritonitis muscles contract to guard abdominal organs
abdomen descends when you breath in and ascends when you breath out
what is the peritoneum
a thin, transparent, semi permeable, serous membrane that is continuous and lines the walls of the abdominopelvic cavity and organs
what is the parietal peritoneal
in contact with (parietal on) the body wall
what is the visceral peritoneal
in contact with (engulfing) the organs
what is the peritoneal cavity
gap between visceral and parietal layers
what is in the peritoneal cavity
lubricating fluid
what is peritonitis
inflammation of the peritoneum
what can cause peritonitis
blood, pus or faeces in the peritoneal cavity
what is the difference between male and female peritoneal cavities
females have holes in due to preproductive organs
describe intraperitoneal organs
almost completely covered in visceral peritoneum- minimally mobile
what is a mesentary
when the visceral peritoneum wraps behind the organ and forms a double layer- lollipop wrapper
describe organs with a mesentery
(still intaperitoneal organs) covered with a visceral peritoneum, mesentery suspends the organ from the posterior abdominal wall, very mobile
describe retroperitoneal organs
only has visceral peritoneum on its anterior surface, locates behind the peritoneum, stuck to the back
where does the mesentery attach
connects organs to posterior body wall
what are the intraperitoneal organs
liver and gall bladder, stomach, spleen, parts of the small intestine, transverse colom
what are the retroperitoneal organs
kidneys, adrenal gland, pancreas, ascending and descending colon
what is the greater and lesser curvature of the stomach
outside and inside edge
what is the omentum
Double layer of peritoneum that passes from stomach to adjacent organs
describe the greater omentum and how it moves
like an apron- Greater overlays the other organs, moved by the movement of peristalsis towards areas of inflammation to contain it
describe the lesser omentum
attaches stomach and duodenum to the liver
what are the peritoneal ligaments
Double layer of peritoneum connect organs to one another or body wall
what is in the core of the mesentery
blood and lymph vessels, nerve, lymph nodes and fat
what is the mesentery proper
the mesentery of the small intestine
what attaches the colon to the posterior body wall
transverse and sigmoid mesocolon
what attaches the appendix to the posterior body wall
mesoappendix
how much motility does the mesentery provide
high level of motility
how many layers does the greater omentum have
four
where does the greater omentum attach to
attaches the greater curvature of the stomach to the transverse colon
how many layers days the lesser omentum have
two
where does the lesser ometum connect between
lesser curvature of the stomach and duodenum to the livr
which omentum has a free edge
lesser omentum
how are the greater and lesser sacs of the omentum created
greater sac folds over on itself
what is at the free edge of the lesser omentum
portal triad
what is in the portal triad
a branch of the hepatic portal vein, a branch of the hepatic artery, and a bile duct
how do the lesser and greater omentum sacs communicate
omental foramen (foramen of winslow)
what two ligament make up the lesser omentum
hepatogastric ligament
hepatoduodenal ligament
which ligament of the lesser omentum is the free edge
the heptoduodenal ligament
how do you block the blood supply to the liver
the pringle manoeuvre at the omental foramen
what ligament connects the left kidney to the spleen
splenorenal ligament
what ligament connects the spleen to the stomach
gastrosplenic ligament
what ligament connects the stomach to the liver
hepatogastric ligament
describe the inferior aspect of the peritoneum
drapes over the superior aspect of the pelvic organs
what is the difference between peritoneum pouches in males and females
one pouch in the males; rectovesical
two pouches in females; vesico-uterine, recto-uterine pouch
what is the pouch of douglas
recto-uterine pouch
what does vesico mean
chamber
how is a collection off fluid in the peritoneum pouch treated
drainage- needle transrectally in males, transvaginally in females
what is ascites most commonly caused by
liver disease- cirrhosis reduces functionality of liver and causes a build up of blood in the portal system= portal hypertension
how can ascitic fluid be drained
from the peritoneal cavity by a procedure called paracentesis (abdominocentesis)
what else can cause ascites
heart failure and starvation
in a paracentesis where should the needle be placed
lateral to the rectus sheath
what must be avoided in a paracentesis
inferior epigastric artery
where does the inferior epigastric artery go
ascends in anterior abdominal wall deep to rectus abdominus
where do inguinal hernias most commonly happen
inferior to the epigastric vessels
what is visceral pain
pain from an organ, dull, achy and nauseating
what is somatic pain
from body wall, sharp and stabbing
what nerves supply the organs in the abdominal cavity and the visceral peritoneum
visceral afferents (sensory), the enteric nervous system, the autonomic nervous system
how can you remember that afferents are sensory
as they arrive at the CNS from the organs
how can you remember that para speeds up peristalsis
rest and digest
what nerves supply the abdominal wall (from skin to parietal peritoneum)
somatic sensory nerves, somatic motor nerves, sympathetic nerve fibres
where the sympathetic nerves that supply the abdominal organs leave the spinal chord
between t5 and l2
how do the sympathetic nerves reach the abdominal organs form the CNS
enter the sympathetic chains but do not synapse, leave sympathetic chains within the abdminopelvic splanchnic nerves, synapse at prevertebral ganaglia which are located anterior to the aorta at the exit points of the major branches of the abdominal aorta, then go to different organs via parietal plexus
in symp- pre ganglionic short, post ganglionic long
what are examples of prevertebral ganglia
celiac, superior mesenteric, aortico-renal, inferior mesenteric
are symp nerves alone in the parietal plexus’
no, para fibres and visceral afferents there too
what is the arteries role in the symp fibres getting to the abdominal organs
they “hitch a ride” with the arteries, and their branches, towards (or away from if sensory) the smooth muscle and glands of the organs
what abdominal organs symp innervation is unique
the adrenal gland
how do symp nerves get to the adrenal gland
leave CNS at T10-11 enter abdominopelvic splanchnic nerves DO NOT synpase ar prevertebral ganglia are carried with parietal plexus to the adrenal gland synapse directly onto cells
acts more like a para nerve
how does the vagus nerve reach the abdominal organs
leaves medulla oblongata
presynaptic para nerve fibres enter abdominal cavity on the surface of the oesophagus (vagal trunks)
travel into parietal plexus around the abdominal aorta
carried to the walls of the organs where the synapse in ganglia
what abdominal organs does the vagus nerve supply
GI tract + abdominal organs up to the distal end of the transverse colon
where do the pelvic splanchnic nerves leaves the CNS
S2,3 and 4
what are pelvic splanchnic nerve fibres and what do they innervate
pre synaptic nerve fibres, smooth muscle/ glands of the descending colon to anal canal
where does pain from organs in the foregut tend to be felt
epigastric region
where does pain from organs in the midgut tend to be felt
umbilical region
where does pain from organs in the hindgut tend to be felt
pubic region
how do visceral afferent nerve fibres get from the abdominal organs to the CNS
Pain fibres from the vast majority of the abdominal organs run alongside sympathetic fibres back to the spinal cord
where do visceral afferents from foregut structures enter the spinal chord
approx T6-T9
where do visceral afferents from the midgut structures enter the spinal chord
approx T8-T12
where do visceral afferents from the hindgut structures enter the spinal chord
T10-L2
describe reffered pain from abdominal structures
pain from these organs tends to be perceived by the patient in the dermatomes of the levels at which they enter the spinal cord (there is a little overlap)
Spinal chord doesn’t know whether it is from organ or body wall so makes pain so assumes its from body wall
the somatic motor, somatic sensory and sympathetic nerve fibres supplying the structures of the abdominal wall are conveyed within what nerves
thoracoabdominal nerves,
subcostal nerve,
iliohypogastric nerve,
ilioinguinal nerve
describe the thoracoabdominal nerves
extensions of the intercostal nerves (pass costal margin and become thorcoabdominal nerves)
7th to 11th intercostal nerves, travel anteriorly, leave intercostal spaces, travel in the plane between the internal oblique and the transverse abdominus
what is the origin of the subcostal nerve
T12 anterior ramus
what is the origin of the iliohypogastric nerve
half of L1 anterior ramus
what is the origin of the ilioinguinal nerve
other half of L1 anterior ramus
describe the pain felt during an appendicitis
initially felt as a dull, aching pain but then becomes a sharper pain in the right iliac fossa
explain the pain of an appendicitis
Pain from Midgut organs tends to be felt in the Umbilical region because the visceral afferents from these organs enter the spinal cord between levels T8-T10 (appendix is T10 – umbilicus)
As appendicitis worsens, the appendix will start to irritate the parietal peritoneum in the right iliac fossa, which lies anterior to it. The parietal peritoneum is part of the soma
