B4.083 - GI Anatomy Flashcards
what is diverticulosis
external evagination of colon cucosa
most common in sigmoid colon
is the large intestive intraperitoneal or retroperitoneal
it alternates
cecum - intra
ascending - retro
transverse - intra
descending - retro
sigmoid - intra
rectum - extra
what are the top causes of lower GI bleeding
40% diverticuli
21% inflammatory bowel disease
10-15% cacer, coagulopathy, anal disease
what is diastasis recti
abdominal separation between the right and left side of the rectus abdominus muscle
mesentery
a double layered peritoneium connecting intraperitoneal orgnas with the abdominal wall. Neurovasculature is sandwiched between the two layers
what might be wrong if a patient has RLQ pain
- appendicytis
- cholecystitis
- crohns
- kidney stones
what organs are in RLQ
appendix
cecum
pelvic organs
what are all the parts of the GI tract in order
mouth
pharynx
esophagus
stomach
small intestine (duodenum, jejunum, ileum)
large intestine (cecum, asc. colon, trans. colon. desc. colon, sigm. colol, rectum)
anal canal
retroperitoneal organs
partially covered by peritoneum
where is the lesser sac
behind the stomach
what is pyrosis
heart burn
how do the internal oblique muslce fibers run
superiorly they run 180 to the external obliques but inferiorly start to run more straight across
what is derived from the midgut
3rd and 4th portions of duodenum to distal 1/3 or transverse colon
what are the 2 portions of the lesser omentum
hepatogastric ligament - attaches from stomach to liver
hepatoduodena ligament - attaches liver to duodenum
what is the trans-umbilical plane
passing through the umbilicus at the level of theintervertebral disc between L3 andL4
what happens in testis migration
the testis was located inside the abdominal cavity between parietal peritoneum and transversalis fascia (outside peritoneal cavity; testicles are retroperitoneal) they pass through ingunal canal
what is the peritoneal cavity
an empty sac with small amount of fluid ~20 ml
what does segemental dermatome overlap mean
if one is not working you may have a parasthesia, hypothesia not anasthesia
where is surgery on the abdomen ususally done through
linea alba
upper hypogastric dermatome
T11
what is the transpyloric plane
extrapolated midway between jugular notch and pubic symphysis
commonly transects the pylorus of the stomch in supine or prone position
pass through L1
the neuromuscular bundle that serves the abdominal region runs where
in between transversus abdominus and internal oblique
umbilical dermatome
T10
direct hernias are common in what group
older men
typical volume of peritoneal fluid
20 ml
where does the transveres abdominis run from
linea alba to pubic crest
where is the transverse mesocolon mesentery attached to
transverse colon
where does the inguinal ligament run from
the anterior superior iliac crest to the pubic tubercle
what is mostly in lower right quadrant or hypogastrium and inguinal region
ileum
what artery from the stomach is used or bypass
gastro-omental
milky peritoneal fluid suggests
inflammatory condition
good place to go through for surger
linea alba
little blood vessels. few nerves
what is the peritoneum
a continuous glistening and slippery transparetn serous membrane that lines th abdominopelvic cavity andivests (wraps around) the abdominopelvic viscera (organs)
What types of hernias are noted
peritonitis
inflammation and infection of peritoneum
compare and contrast jejunum and ileum
what are taeniae coli
3 longitudinal muscle bands, not present in appendix and rectum in large intestine
what does the lateral umbilical fold cover
bilateral inferior epigastric arteries
pain from appendicitis is where
periumbilically, if touches peritoneum then will be localized to mcburneys point
what does cloudy, turbid peritoneal fluid suggest
infection
small intestinal pain is referred where because its derived from where
periumbilical region
midgut
what is a straddle injury
Can cause blood within the superficial perineal space and scarpas fascia on anterior bdominal wall
what does the median umbilical fold cover
obliterated urachus
where is the deep ring of inguinal canal
on the lateral side of the inferior epigastric artery and vein
where does the rectus abdominus from from and to
from ribs 4, 5, 7 to the pubic crest
identify the 3 arrows
blue - retroperitoneal
black - mesentery
red - intraperitoneal
what does the appendix do
trap for heavy particles that are ingested
during portal hypertension what happesn to venous blood flow from esophagus
most venous blood flows through lower esophageal region toward azygos veins causing esophageal varices
what art the parts of the duodenum
1st part is called duodenal bulb (L1)
Descending L2
Horizontal L3
Ascending L3-L2
what is the sigmoid mesentery attached to
sigmoid colon
how are inguinal hernias diagnosed
placing a finger into inguinal ring
tell pt to turn head and cough
what structure does an indirect hernia go through
deep inguinal ring
what is a verform appendix
a blind intestinal diverticulum off cecum, contains lymphoid tissue
position vary - mostly retrocecal
root at McBurney point
what structure does a direct inguinal hernia go through
inguinal triangle
what is appendicitis
acute inflammation is common in young people
surgical incision at mcburneys point
middle hypogastric dermatome
T12
what are indirect inguinal hernia
congenital
recapitulates what the testicles do and migrates down
where do all nerves travel to get to dermatomes
neurovascular plane
what is the aponeurosis
an extension of the epismysium forms the inguinal ligament
what spacial part of the stomach reffers pain to foregut
epigastric
what organs are in the RUQ
Right lobe of liver
gall bladder
parts of duodenem
what might be wrong if a patient has LLQ pain
- diverticulitis
- irritable bowel syndrome
- lactose intolerance
- celiac disase
- kidney stones
- constipation
- crohns, ulcerative colitis
- inguinal hernia
what kind of hernia is this
indirect inguinal hernia
Note: lateral to inferior epigastric vessels
what is teh arcuate line
all 3 aponeuroses go anteriorly to the rectus abdominis at 1/3 distance below umbilicus leaving a crescent line
where does the umbilicus usually site
In teh L3-L4 junction
where is The mesentery attached to
small intestine
what is the median plane
passing through the midline of the body, dividing left and right halves
gastric ulcer
open lesion on stomach mucosa, associated with infections of H. pylori, ulcer erodes arteries case bleeding and even wall performation
is the female peritoneal cavity completely sealed?
no, fallopian tube opens up
what is ileal (meckels) diverticulum
the most common congenital anomaly of gut due to a remnant vitelline duct.
May contain 2 ectopic tissues - stomach mucosa (ulcer) and pancreatic
rule of 2s - 2% of population, 2” long, 2ft proximal from ileocecal junction
what is an inguinal hernia
80-90% of abdominal hernias
the protrusion of parietal peritoneum and/or abdominal viscera through a normal or abmormal opening from the cavity where they dont belong.
what is the line on the abdomen separating right from left side
linea alba
what might be wrong if a patient has lower abdomen pain
- aortic aneurysm
- colitis
- diverticulitis
- intestinal obstruction
- perforated viscus
- pelvic inflammatory disease
- rectal hematoma
components of nerves of anterior wall
motor - efferent
sensory - afferent
sympathetic - afferent
describe likelihood to develop a hernia and need repair between women and men
men are 8x more likely to develp a hernia than women and 20x more likely to need a repair
what is the hepatorenal pouch of morison
next to liver and kidney only on right side and is the most dependent spot when pt is on their back
in what group are indirect hernias more common
congenital so babies
what is pylorospasm
spasmodic contraction of pylorus
food stay in stomach, resulting in stomach overfilling and vomiting
what arteries serve the following parts of the stomach:
left lesser curvature
left greater curvature
fundus
right lesser curvature
gastroduodenal
left gastric - left lesser curvature
left gastro-omental - left greater curvature
short gastric - fundus
right gastric - right lesser curvature
right gastro-omental - gastroduodenal
epigastrium dermatome
T7-9
what is itussuseption
telescoping of one portion of small intestine into other part or ileocecal junction
what is the ligament of treitz
marks end of diodenum and beginning of jejunum
what color is peritoneal fluid normally
clear and slightly yellowish
describe blood supply and innervation to visceral peritoneum
served by same blood and lymphatic vessels and nerves to organ it covers. Not sensitive to genral sensations, sensitive to stretch and chemical irritation. Can be felt as referred pain on body surface.
genital area and thigh dermatome
ilioinguinal L1
what is the obliterated umbilical vein embryonically
round ligament
how do the fibers of the external oblique run
like hands into your pockets
what are peritoneal adhesions
caused by peritoneum infection, inflammation or surgery
healing of above processes cause fibrous tissue to form and scar between visceral peritoneum or between visceral and parietal peritoneum.
women median age of a groin hernia
60-79
which ligament subdivides the liver
the falciform ligament (above umbilicus)
what is the greater sac
main larger part of peritoneal cavity
what is a diaphragmatic hernia
Bochdaleks, typiclaly posterior and left sided
symptoms of meckels diverticulum
bleeding
especially consider for lower GI bleeding in children <2 yo and GI tract obstruction
when inflamed mimics appendicitis
peak age range at persentation for indirect inguinal hernia in women
40-60 yo
mesentery
2 layers of peritoneum adhere together connecting intraperitoneal orgnas to abdominal wall.
blood vessels serving stomach are all off of what
celicac trunk ~T12
whats the difference between campers and sparpas fascia
campers is more superficial and spans the whole cavity, thickness varies among individuals.
Sarpas exists only below the umbilicus as a membranous layer deep to campers.
what is a hiatal hernia
protrusion of part of the stomach into the mediastinum through esophagela hiatus
occures more often after middle age
what makes up the rectus sheath
aponeurosis of external, internal, and transverse abdominal muscles
carcinoma of stomach
happens more in body or pyloric part. associated with feeling full and vomiting
what is a direct inguinal hernia
Acquired
goes directly through anterior abdominal wall
what is the greater omentum and lesser omentum
greater attaches to greater curvature of stomach
lesser attaches to lesser curvature of stomach
stores adipose and adheres to pathology in the area
lower hypogastric dermatome
L1
what are the 2 layers of the peritoneum
Parietal - lines the intrnal surface of the walls of the abdominopelvic cavity
Visceral - invests viscera in abdominopelvic cavity
what might be wrong is a patient has LUQ pain
- Dissecting aneurysm
- esophagitis
- hiatal hernia
- esophagel rupture
- gastritis
- pancreatitis
- peptic ulcer disiease
- splenic issues
- kidney issues
what is the “watch dog” of the stomach
greater omentum
what is kwashiordor
starvation ascites, a severe form of malnutrition, cause dby deficiency ni dietary protein. Causes an osmotic imbalance in GI causing swelling of gut
what is ileus
small bowel motility disorder that mimci obstruction
paralytic ileus
paralysis of small bowel movement mostly due to surgery
stagnation - no peristalsis; fluid/gas distention
causing abnormal distention, nausea, malaise
3 major constrictions of esophagus
cervical ~15 cm from teeth
thoracic ~22.5 - 27.5 cm from incisor teeth
diaphragmatic ~ at its passing throug esophageal hiatus around T10
what are intraperitoneal organs
completely covered by peritoneum and has a mesentary
what might be wrong if a patient has RUQ pain
- Dissecting aneurism
- Gallbladder disease
* hepatitis
* hepatomegaly
*pancreatitits
*renal infarct
*appendicitis (retroperitieneal)
what part of the stomach reffers pain from hindgut
suprapubic
identify each number
1 is the right lobe of the liver,
Number 34 is the second or descending portion of the duodenum, which is the location of the entrance of the pancreatic duct and common bile duct into the small intestine.
what is the inguinal ligament
Its formed by the inferior edge of external oblique muscle aponeurosis, which thickens as an undercurving fibrous band spanning between ASIS and pubic tubercle
pain in duodenum is referred where
epigastric region
what is the duodenums major papilla function
junction of both bile and pancreatic secretions into sphincter of hepatopancrial duct
what is an umbilical hernia
around umbilicus, common in newborns
what does the medial umbilical fold cover
obliterated umbilical arteries
what are semilunar lines
lines that demarcate where the rectus abdominus muscles come into contact with the obliques
ascited
excess fluid accumulation >50 ml in peritoneal cavity
result from internal bleeding, portal hypertension, cancer metastasis, starvation etc.
what is the omental bursa
lesser sac (behind lesser omentum)
what is derived from foregut
from mouth until 1st and 2nd portion of duodenum
what is abdominal paracentesis
surgical puncture of peritoneal cavity for aspiration or drainage of fluid
what is zenkers diverticulum
rare phenomena where theres an invagination right at beginning of pharynx
symptoms
dysphagia
regurgitation
halitosis
men median age for inguinal hernia
50-69
what is aponeurosis
an extension of epimysium forms inguinal ligament
symptoms of hiatal hernia
heart burn
difficulty swallowing
nausea, vomiting
who typically gets a semilunar hernia
mroe in people >40, obese
what is an epigastric hernia
midline along linea alba above umbilicus
green peritoneal fluid
ruptured gall bladder, pancreatitis, intestinal perforation
red peritoneal fluid, clots and no clots
suggests a traumatic tap (clots)
malignancy (no clots)
what is mostly in the upper left quadrant or around umbilicus
jejunum
what is the gastrocolic ligament
the portion of greater omentum spanning between greater curvature of stomach and transverse colon
pain from gastric or peptic ulcer is referred where
epigastric region. Bc afferent fibers from stomach and 1st part of duodenum, via greater splanchnicn nerve to to T7-T8 level DRG, which collect dermatome sensation from there
1st part of duodenum is considered
intraperitoenial, the rest is retroperitoneal
what veins drain the lower esophagus
dual drainages
to systemic veins via azygos vein
to liver via hepatic portal vein
what is the rectouterine pouch of douglas
when pt standing up in between rectum and uterus
what is caput medusa
seen during hepatic prtal vein hypertension or obstruction causing the embyronic umbilical vein to reopen (and reverse blood flow) and carry blood away from liver onto the anterior abdominal wall veins the superior and inferior epigastric veins.
Identify each line
what folds are below umbilicus
Mediam umbilical fold
medial umbilical folds
lateral umbilical folds
what is this called
caput medusa
what organs are found in the LLQ
sigmoid colon
what is volvulus
a loop of bowel and mesentary abnormally twisted on itself
cause obstruction and vascular ischemia
sigmoid is most common - sygmoidiscope can work
cecum second most common
enema can help
sparpas fascia may retain fluid underneath during what injury
straddle injury
what are peptic ulcers
duodenal ulcers
inflammatory erosions of duodenal mucosa
erosion of gastroduodenal artery can cause severe bleeding into duodenum, retroperiteneum or lesser sac of peritoneal cavity
what is scarpas fascia
exists only below umbilicus as a membranous layer deep to campers. Superiorly int attaches to rectus/external oblique epimysium
what is campers fascia
fat layer that looks like adipocytes. May vary extensively between individuals
describe blood supply and nerve innervation to parietal peritoneum
served by same blood and lymphatic vessels and nerves in the region that it is adjacent to. Pain is well localized
what ligaments are above the umbilicus
falciform ligament
round ligament of liver or ligamentum teres
what is the lifetime risk of groin hernias in males
25% in men but less than 5% in women
what organs are in the LUQ
spleen
bulk of the stomach
parts of pancreas
left lobe of liver
jejunum and proximal ileum
left kidney
who usually gets diastasis recti
newborns and pregnant women
what is the inguinal ligament formed by
inferior edge of external oblique muscle aponeurosis
what is derived from hindgut
from distal 1/3 of transverse colon on
what are the 2 types of hiatal hernia
sliding - most, abdominal portion of esophagus + cardia + part of fundus all herniated, regurgitation possible
paraesophageal - cardia remains in normal position, part of fundus herniates, usually no regurgitation
what part of the stomach reffers pain from the midgut
paraumbilical
what is the epicloic foramen of winslow
behind portal triad theres a hole that is an opening to lesser sac
when might peritoneal fluid volume increase
in women around ovulation
