B4.083 - GI Anatomy Flashcards
1
Q
what is diverticulosis
A
external evagination of colon cucosa
most common in sigmoid colon
2
Q
is the large intestive intraperitoneal or retroperitoneal
A
it alternates
cecum - intra
ascending - retro
transverse - intra
descending - retro
sigmoid - intra
rectum - extra
3
Q
what are the top causes of lower GI bleeding
A
40% diverticuli
21% inflammatory bowel disease
10-15% cacer, coagulopathy, anal disease
4
Q
what is diastasis recti
A
abdominal separation between the right and left side of the rectus abdominus muscle
5
Q
mesentery
A
a double layered peritoneium connecting intraperitoneal orgnas with the abdominal wall. Neurovasculature is sandwiched between the two layers
6
Q
what might be wrong if a patient has RLQ pain
A
- appendicytis
- cholecystitis
- crohns
- kidney stones
7
Q
what organs are in RLQ
A
appendix
cecum
pelvic organs
8
Q
what are all the parts of the GI tract in order
A
mouth
pharynx
esophagus
stomach
small intestine (duodenum, jejunum, ileum)
large intestine (cecum, asc. colon, trans. colon. desc. colon, sigm. colol, rectum)
anal canal
9
Q
retroperitoneal organs
A
partially covered by peritoneum
10
Q
where is the lesser sac
A
behind the stomach
11
Q
what is pyrosis
A
heart burn
12
Q
how do the internal oblique muslce fibers run
A
superiorly they run 180 to the external obliques but inferiorly start to run more straight across
13
Q
what is derived from the midgut
A
3rd and 4th portions of duodenum to distal 1/3 or transverse colon
14
Q
what are the 2 portions of the lesser omentum
A
hepatogastric ligament - attaches from stomach to liver
hepatoduodena ligament - attaches liver to duodenum
15
Q
what is the trans-umbilical plane
A
passing through the umbilicus at the level of theintervertebral disc between L3 andL4
16
Q
what happens in testis migration
A
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
17
Q
what is the peritoneal cavity
A
an empty sac with small amount of fluid ~20 ml
18
Q
what does segemental dermatome overlap mean
A
if one is not working you may have a parasthesia, hypothesia not anasthesia
19
Q
where is surgery on the abdomen ususally done through
A
linea alba
20
Q
upper hypogastric dermatome
A
T11
21
Q
what is the transpyloric plane
A
extrapolated midway between jugular notch and pubic symphysis
commonly transects the pylorus of the stomch in supine or prone position
pass through L1
22
Q
the neuromuscular bundle that serves the abdominal region runs where
A
in between transversus abdominus and internal oblique
23
Q
umbilical dermatome
A
T10
24
Q
direct hernias are common in what group
A
older men
25
typical volume of peritoneal fluid
20 ml
26
where does the transveres abdominis run from
linea alba to pubic crest
27
where is the transverse mesocolon mesentery attached to
transverse colon
28
where does the inguinal ligament run from
the anterior superior iliac crest to the pubic tubercle
29
what is mostly in lower right quadrant or hypogastrium and inguinal region
ileum
30
what artery from the stomach is used or bypass
gastro-omental
31
milky peritoneal fluid suggests
inflammatory condition
32
good place to go through for surger
linea alba
little blood vessels. few nerves
33
what is the peritoneum
a continuous glistening and slippery transparetn serous membrane that lines th abdominopelvic cavity andivests (wraps around) the abdominopelvic viscera (organs)
34
What types of hernias are noted
35
peritonitis
inflammation and infection of peritoneum
36
compare and contrast jejunum and ileum
37
what are taeniae coli
3 longitudinal muscle bands, not present in appendix and rectum in large intestine
38
what does the lateral umbilical fold cover
bilateral inferior epigastric arteries
39
pain from appendicitis is where
periumbilically, if touches peritoneum then will be localized to mcburneys point
40
what does cloudy, turbid peritoneal fluid suggest
infection
41
small intestinal pain is referred where because its derived from where
periumbilical region
midgut
42
what is a straddle injury
Can cause blood within the superficial perineal space and scarpas fascia on anterior bdominal wall
43
what does the median umbilical fold cover
obliterated urachus
44
where is the deep ring of inguinal canal
on the lateral side of the inferior epigastric artery and vein
45
where does the rectus abdominus from from and to
from ribs 4, 5, 7 to the pubic crest
46
identify the 3 arrows
blue - retroperitoneal
black - mesentery
red - intraperitoneal
47
what does the appendix do
trap for heavy particles that are ingested
48
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
49
what art the parts of the duodenum
1st part is called **duodenal bulb (L1)**
**Descending L2**
**Horizontal L3**
**Ascending L3-L2**
50
what is the sigmoid mesentery attached to
sigmoid colon
51
how are inguinal hernias diagnosed
placing a finger into inguinal ring
tell pt to turn head and cough
52
what structure does an indirect hernia go through
deep inguinal ring
53
what is a verform appendix
a blind intestinal diverticulum off cecum, contains lymphoid tissue
position vary - mostly retrocecal
**root at McBurney point**
54
what structure does a direct inguinal hernia go through
inguinal triangle
55
what is appendicitis
acute inflammation is common in young people
surgical incision at mcburneys point
56
middle hypogastric dermatome
T12
57
what are indirect inguinal hernia
congenital
recapitulates what the testicles do and migrates down
58
where do all nerves travel to get to dermatomes
neurovascular plane
59
what is the aponeurosis
an extension of the epismysium forms the inguinal ligament
60
what spacial part of the stomach reffers pain to foregut
epigastric
61
what organs are in the RUQ
Right lobe of liver
gall bladder
parts of duodenem
62
what might be wrong if a patient has LLQ pain
1. diverticulitis
2. irritable bowel syndrome
3. lactose intolerance
4. celiac disase
5. kidney stones
6. constipation
7. crohns, ulcerative colitis
8. inguinal hernia
63
what kind of hernia is this
indirect inguinal hernia
Note: lateral to inferior epigastric vessels
64
what is teh arcuate line
all 3 aponeuroses go anteriorly to the rectus abdominis at 1/3 distance below umbilicus leaving a crescent line
65
where does the umbilicus usually site
In teh L3-L4 junction
66
where is The mesentery attached to
small intestine
67
what is the median plane
passing through the midline of the body, dividing left and right halves
68
gastric ulcer
open lesion on stomach mucosa, associated with infections of H. pylori, ulcer erodes arteries case bleeding and even wall performation
69
is the female peritoneal cavity completely sealed?
no, fallopian tube opens up
70
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
71
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.
72
what is the line on the abdomen separating right from left side
linea alba
73
what might be wrong if a patient has lower abdomen pain
1. aortic aneurysm
2. colitis
3. diverticulitis
4. intestinal obstruction
5. perforated viscus
6. pelvic inflammatory disease
7. rectal hematoma
74
components of nerves of anterior wall
motor - efferent
sensory - afferent
sympathetic - afferent
75
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
76
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
77
in what group are indirect hernias more common
congenital so babies
78
what is pylorospasm
spasmodic contraction of pylorus
food stay in stomach, resulting in stomach overfilling and vomiting
79
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
80
epigastrium dermatome
T7-9
81
what is itussuseption
telescoping of one portion of small intestine into other part or ileocecal junction
82
what is the ligament of treitz
marks end of diodenum and beginning of jejunum
83
what color is peritoneal fluid normally
clear and slightly yellowish
84
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.**
85
genital area and thigh dermatome
ilioinguinal L1
86
what is the obliterated umbilical vein embryonically
round ligament
87
how do the fibers of the external oblique run
like hands into your pockets
88
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.
89
women median age of a groin hernia
60-79
90
which ligament subdivides the liver
the falciform ligament (above umbilicus)
91
what is the greater sac
main larger part of peritoneal cavity
92
what is a diaphragmatic hernia
Bochdaleks, typiclaly posterior and left sided
93
symptoms of meckels diverticulum
bleeding
especially consider for lower GI bleeding in children \<2 yo and GI tract obstruction
when inflamed **mimics appendicitis**
94
peak age range at persentation for indirect inguinal hernia in women
40-60 yo
95
mesentery
2 layers of peritoneum adhere together connecting intraperitoneal orgnas to abdominal wall.
96
blood vessels serving stomach are all off of what
celicac trunk ~T12
97
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.
98
what is a hiatal hernia
protrusion of part of the stomach into the mediastinum through esophagela hiatus
occures more often after middle age
99
what makes up the rectus sheath
aponeurosis of external, internal, and transverse abdominal muscles
100
carcinoma of stomach
happens more in body or pyloric part. associated with feeling full and vomiting
101
what is a direct inguinal hernia
Acquired
goes directly through anterior abdominal wall
102
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
103
lower hypogastric dermatome
L1
104
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
105
what might be wrong is a patient has LUQ pain
1. Dissecting aneurysm
2. esophagitis
3. hiatal hernia
4. esophagel rupture
5. gastritis
6. pancreatitis
7. peptic ulcer disiease
8. splenic issues
9. kidney issues
106
what is the "watch dog" of the stomach
greater omentum
107
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
108
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
109
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
110
what are intraperitoneal organs
completely covered by peritoneum and has a mesentary
111
what might be wrong if a patient has RUQ pain
1. Dissecting aneurism
2. Gallbladder disease
\* hepatitis
\* hepatomegaly
\*pancreatitits
\*renal infarct
\*appendicitis (retroperitieneal)
112
what part of the stomach reffers pain from hindgut
suprapubic
113
identify each number
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.
#1 is the right lobe of the liver,
#2 is the abdominal aorta,
#5 in the inferior vena cava,
#16 is the right kidney,
#17 is the left kidney,
#19 is the left lobe of the liver,
#31 is the gallbladder,
#32 is the superior mesenteric artery,
#33 is the superior mesenteric vein anterior to the body of the pancreas
#34 is the 2nd portion of the duodenum.
114
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**
115
pain in duodenum is referred where
epigastric region
116
what is the duodenums major papilla function
junction of both bile and pancreatic secretions into sphincter of hepatopancrial duct
117
what is an umbilical hernia
around umbilicus, common in newborns
118
what does the medial umbilical fold cover
obliterated umbilical arteries
119
what are semilunar lines
lines that demarcate where the rectus abdominus muscles come into contact with the obliques
120
ascited
excess fluid accumulation \>50 ml in peritoneal cavity
result from internal bleeding, portal hypertension, cancer metastasis, starvation etc.
121
what is the omental bursa
lesser sac (behind lesser omentum)
122
what is derived from foregut
from mouth until 1st and 2nd portion of duodenum
123
what is abdominal paracentesis
surgical puncture of peritoneal cavity for aspiration or drainage of fluid
124
what is zenkers diverticulum
rare phenomena where theres an invagination right at beginning of pharynx
symptoms
dysphagia
regurgitation
halitosis
125
men median age for inguinal hernia
50-69
126
what is aponeurosis
an extension of epimysium forms inguinal ligament
127
symptoms of hiatal hernia
heart burn
difficulty swallowing
nausea, vomiting
128
who typically gets a semilunar hernia
mroe in people \>40, obese
129
what is an epigastric hernia
midline along linea alba above umbilicus
130
green peritoneal fluid
ruptured gall bladder, pancreatitis, intestinal perforation
131
red peritoneal fluid, clots and no clots
suggests a traumatic tap (clots)
malignancy (no clots)
132
what is mostly in the upper left quadrant or around umbilicus
jejunum
133
what is the gastrocolic ligament
the portion of greater omentum spanning between greater curvature of stomach and transverse colon
134
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
135
1st part of duodenum is considered
intraperitoenial, the rest is retroperitoneal
136
what veins drain the lower esophagus
dual drainages
to systemic veins via azygos vein
to liver via hepatic portal vein
137
what is the rectouterine pouch of douglas
when pt standing up in between rectum and uterus
138
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**.
139
Identify each line
140
what folds are below umbilicus
Mediam umbilical fold
medial umbilical folds
lateral umbilical folds
141
what is this called
caput medusa
142
what organs are found in the LLQ
sigmoid colon
143
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
144
sparpas fascia may retain fluid underneath during what injury
straddle injury
145
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
146
what is scarpas fascia
exists only below umbilicus as a membranous layer deep to campers. Superiorly int attaches to rectus/external oblique epimysium
147
what is campers fascia
fat layer that looks like adipocytes. May vary extensively between individuals
148
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**
149
what ligaments are above the umbilicus
falciform ligament
round ligament of liver or ligamentum teres
150
what is the lifetime risk of groin hernias in males
25% in men but less than 5% in women
151
what organs are in the LUQ
spleen
bulk of the stomach
parts of pancreas
left lobe of liver
jejunum and proximal ileum
left kidney
152
who usually gets diastasis recti
newborns and pregnant women
153
what is the inguinal ligament formed by
inferior edge of external oblique muscle aponeurosis
154
what is derived from hindgut
from distal 1/3 of transverse colon on
155
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
156
what part of the stomach reffers pain from the midgut
paraumbilical
157
what is the epicloic foramen of winslow
behind portal triad theres a hole that is an opening to lesser sac
158
when might peritoneal fluid volume increase
in women around ovulation
