B5-011 Posterior Abdominal Wall and Nerves Flashcards
1
Q
the foregut and midgut are innervated by parasympathetics from the
A
vagus nerve
2
Q
the hindgut is innervated by parasympathetics from the
A
pelvic spanchic nerves
3
Q
the foregut is sympathetically inervated via
A
thoracic splanchic nerves T5-T9
(greater splanchnic)
4
Q
the midgut is sympathetically innervated via
A
thoracic splanchic nerves T8-T12
5
Q
the hindgut is sympathetically innervated by
A
lumbar splanchic nerves L1-L2
6
Q
pain from the foregut refers to
A
epigastrium
7
Q
pain from the midgut refers to
A
umbilical region
8
Q
pain from the hindgut refers to
A
hypogastrium
9
Q
foregut derivatives
5
A
- esophagus
- stomach
- liver and pancreas
- billiary apparatus
- proximal duodenum
10
Q
midgut derivatives
4
A
- small intestine
- cecum and vermiform appendix
- ascending colon
- right half of transverse colon
11
Q
hindgut derivatives
5
A
- left half of transverse colon
- descending colon
- sigmoid colon
- rectum
- superior anal canal
12
Q
sympathetic or parasympathetic function?
contrict blood vessels of skin and GI tract
A
sympathetic
13
Q
sympathetic or parasympathetic function?
decreases peristalsis of gut, constricts spinchters
A
sympathetic
14
Q
sympathetic or parasympathetic function?
stimulates suprarenal glands to release adrenaline
A
sympathetic
15
Q
sympathetic or parasympathetic function?
stimulates peristalsis
A
parasympathetic
16
Q
sympathetic or parasympathetic function?
inhibits sphincters, stimulates contraction of bladder and rectum
A
parasympathetic
17
Q
nerve
T5-T9
A
greater splanchnic
18
Q
nerve
T10-T11
A
lesser splanchnic
19
Q
nerve
L1-L2
A
lumbar splanchnic
20
Q
parasympathetic nerves of the abdomen
2
A
vagus
pelvic splanchnic
21
Q
nerve
S2-S4
A
pelvic splanchnic
22
Q
nerve
T12
A
least splanchic
23
Q
- located near celiac trunk
- many fibers of the greater splanchic synapse here
A
celiac ganglia
24
Q
- located near superior mesenteric artery
- fibers from greater and lesser splanchnic synapse here
A
superior mesenteric ganglion
25
* located along renal arteries
* fibers from the greater splanchnic, least, and lumbar synapse here
aorticorenal ganglia
26
* located near inferior mesenteric artery
* fibers from the least and lumbar splanchnics will synapse here
inferior mesenteric ganglia
27
only fibers that actually synapse in the prevertebral ganglia
sympathetic
28
gives rise to renal, testicular/ovarian, and ureteric plexuses
intermesenteric plexus
29
gives rise to hypogastric nerves, which form the inferior hypogastric plexus
superior hypogastric
30
situated on the sides of the rectum, cervix of uterus, and bladder
inferior hypogastric plexus
31
provide sympathetic innervation to rectum
lumbar splanchic L1-L2
32
provide parasympathetic innervation to rectum
pelvic splanchnic
33
somatic nerve that innervates the rectum below the pectinate line
pudendal nerve
| cause pain from external hemmorhoids
34
for the rectum, pain travels with [...] nerves
| para or sympathetic
parasympathetic
| pelvic splanchnic
35
generally, pain travels with
| sympathetic or parasympathetic
sympathetics
| except below pelvic line
36
below the pelvic line, pain travels with
| para or sympathetics
parasympathetics
37
where is the pelvic pain line?
* inferior limit of peritoneum
* GI tract: middle of sigmoid colon
38
visceral reflexes that maintain homestasis travel with the
| para or sympathetic
parasympathetics
| vagus/pelvic splanchnic
39
visceral afferents with input for pain travel with
| sympathetic or para
sympathetics
| above pelvic pain line
40
visceral afferents with input for pain travel with the [...] distal to the middle of the sigmoid colon
| sympathetic or para
parasympathetic
41
back/flank pain
fever
inguinal mass
limp
anorexia
weight loss
psoas abscess
| associated with Tb
42
positive poas sign
lower abdominal pain ellicited by extending limb
43
the lumbar part of the diaphragm attaches to the medial and lateral [...] ligament
arcuate
44
# which crus of the diaphragm?
* larger and longer
* attaches to L3-L4
| in 80% of people, wraps to esophageal hiatus
right
45
# which crus of the diaphragm?
* attaches to L2-L3
* shorter
left
46
# what diaphragmatic hiatus?
* located at T8
* IVC and rt. phrenic n. pass through
caval hiatus
47
# what diaphragmatic hiatus?
* located at T10
* esophagus and vagal trunks pass through
esophageal hiatus
48
# what diaphragmatic hiatus?
* located at T12
* aorta, thoracic duct, and sometimes azygous pass through
aortic hiatus
49
# vascular structure
T12-L4
aorta
50
# vascular structure
T12
celiac
51
# vessel
L1
superior mesenteric a.
52
# vessel
L1/L2
renals
53
# vessel
L2
gonadal
54
# vessel
L3
inferior mesenteric artery
55
# vessel
bifurcation
L4
| biFOURcation
56
the body of the pancreas and splenic v. are located at what vertebral level?
L1/L2
57
the left renal v. is located at what vertebral level?
L2
58
the horizontal part of the duodenum is located at what vertebral level?
L3
59
innervated by preganglionic sympathetics from T6-L2
adrenal glands
60
which kidney is in contact with the liver, duodenum, and ascending colon?
right
61
which kidney is in contact with the stomach, spleen, pancrease, jejunum, and descending colon?
left
62
renal papilla empty into the
minor calyx
63
2-3 minor calices come together to form a
major calyx
64
major calyx dump into the
renal pelvis
65
posterior to the ductus deferens in males or uterine artery in females
ureter
66
3 constriction points of ureter
* ureteropelvic junction
* crossing illiac artery/pelvic brim
* ureter enters bladders
| places where kidney stones can become lodged
67
subcostal nerve is located at
T12
68
iliohypogastric and ilioinguinal nerves are found at what vertebral level?
| if its a common nerve it's called anterior ramus
L1
| iliohypogastric is always superior
69
exits L2-L3 deep to inguinal ligament and ASIS
lateral cutaneous nerve of the thigh
70
provides sensory to skin over mons pubis and hypogastric region
iliohypogastric
71
supplies sensory over inguinal ligament, medial thigh, and anterior labia or scrotum
ilioninguinal nerve
72
nerve that follows the psoas major muscle posteriorly
femoral
73
* innervates anterior muscles of thigh
* helps with hip flexion, knee extension
* sensory to anterior thigh and medial surface of leg
femoral nerve
74
nerve that follows psoas major anteriorly
genitofemoral
75
* innervates cremaster muscles
* sensory to skin of upper thigh
* innervates anterior scrotum
genitofemoral
76
nerve lies medial to psoas major
obturator nerve
77
* innervates adductor compartment of thigh
* helps with adduction
* sensory to medial aspect of thigh
obturator nerve
78
muscles of the muscular floor
| 4
* psoas major/minor
* illiacus
* quadratus lumborum
* diaphragm
79
tendonous arch of the crura of diaphragm
median arcuate ligament
80
* fascial thickening of the psoas fascia
* lateral to median arcuate ligament
medial arcuate ligament
81
thickening of fascia lining the quadratus lumborum
lateral arcuate ligament
82
colicky pain without jaundice
gallstones blocking cystic duct
83
what structures are endangered during a cholecystectomy?
portal triad
liver
common hepatic duct
proper hepatic artery
right and left hepatic arteries
84
what artery is ligated during a cholecystectomy?
cystic artery
85
what landmarks are used to identify the cystic artery?
cystohepatic triangle (of Calot)
| bile duct, common hepatic duct, surface of liver
86
what two organs are most likely to be affected by cholecysto-enteric fistulas?
duodenum: cause small bowel obstruction
transverse colon
| gas can enter the gallbladder
87
what causes the intial pain with kidney stones?
stone stuck in pelvico-ureter junction
88
3 constriction sites for kidney stones
* pelvico-ureter junction
* external iliac artery / pelvic brim
* bladder wall
89
why is pain from kidney stones intermittent?
when it gets stuck at constriction points, it causes stretching which causes pain
90
does the pain travel with the sympathetics or parasympathetics in the ureter?
sympathetics
91
what nerve fibers pick up pain in the ureter?
lesser and least splanchnic
92
when does pain start to travel with the parasympathetics?
below the pelvic line
| middle of sigmoid colon and below
93
what ligaments/vessels would be cut in a splenectomy?
splenic artery/vein close to spleen
gastrosplenic ligament
94
what ligament contains the short gastrics?
gastrosplenic
95
what structures should be avoided during splenectomy?
short gastrics
cutting splenic artery close to pancreas
tail of pancreas
left gastro-omental artery
96
what ligament contains the splenic artery?
splenorenal
97
what ligament contains the tail of the pancreas?
splenorenal
98
what vessels supply the fundus of the stomach?
short gastrics
99
what ligaments contain the gastro omentals?
gastrocolic
100
starts in the gastrosplenic ligament and continues in the gastrocolic ligament
left gastro-omental
101
what artery is contained in the splenorenal ligament?
splenic a.
102
bloody vomit associated with portal hypertension can be an indication of
rupture of esophageal varices
103
what causes caput medusae
paraumbilical veins anastomosing with epigastrics
104
results from anastamosis of superior and middle rectal vein
hemorrhoids
105
which nerve is responsible for sensation over the root of the penis and anterior scrotum or the mons pubis and labium majora?
ilioinguinal
106
which nerve is responsible for sensation over the lateral thigh "pocket area"?
lateral femoral cutaneous
107
which nerve will provide motor to the anterior compartment of the thigh?
femoral nerve
108
3 anatomic constrictions along the ureter
* renal pelvis/ureter
* ureter/pelvic brim
* ureter/urinary bladder
| points where kidney stones get stuck
109
receive lymphatic drainage from the descending colon, sigmoid colon, and superior aspect of the rectum
inferior mesenteric nodes
110
cancer cells from adenocarcinomia within the superior aspect of the rectum may metastasize to the inferior mesenteric nodes after reaching the [...] nodes
pararectal
111
receive lymph from the gluteal region, inferior rectum, and pelvic viscera
internal iliac nodes
112
receive lymphatic drainage from the pelvic organs in direct contact with peritoneum
external iliac lymph nodes
113
receive lymphatic drainage from posterior abdominal wall, gonads, testies, kidney, ureters, uterus, and uterine tubes
lumbar nodes
114
receive lymphatic drainage from midgut
superior mesenteric nodes
115
emerges from medial border of psoas at the pelvic brim
obturator nerve
116
most inferior nerve emerging from lateral border of psoas major
femoral nerve
117
lumbar plexus is formed within the [...] muscle
psoas major
118
emerges on anterior surface of psoas major and passes downward on the face of the muscle
genitofemoral
119
emerge from lateral border of psoas major
| 4
iliohypogastric
ilioinguinal
lateral cutaneous
femoral
120
if the IVC is obstructed, how can bloodflow bypass it?
ascending lumbar veins to azygous and hemiazygous
| caval-caval anastomosis
121
[...] nerves are wrapped around the esophagus and onto the stomach
| must be given close attention during repairs of esophageal hiatus
vagus
122
the inferior hypogastric (pelvic) plexus contains preganglionic parasympathetic fibers from the [...] nerves
pelvic splanchnic
123
the lumbar and sacral splanchnic nerves and the sacral sympathetic chain ganglia contrain preganglionic [...] fibers
sympathetic
124
pain from the stomach with travel with what nerve?
greater splanchnic
125
pain from the distal small intestin, cecum, ascending colon, transverse colon, and kidneys would be carried by what nerve?
lesser splanchnic
126
pain from the descending colon and kidneys would be carried by what nerve?
least splanchnic
127
parasympathetic nerve fibers found in the inferior hypogastric plexus come from which nerve?
pelvic splanchnic
128
pain from the distal sigmoid colon would travel with what nerve?
pelvic splanchnic
129
what two structures pass through the caval hiatus at T8?
IVC and right phrenic
130
what structures pass through the esophageal hiatus at T10?
esophagus, anterior and posterior vagal trunks
131
what structures pass through the aortic hiatus at T12?
aortic, thoracic duct, sometimes azygous
132
the left phrenic and sympathetic chain travel through which diaphragmatic hiatus?
none, directly pierce diaphragm
| sorry it was tricky
133
celiac trunk is located at
T12
134
SMA is located at
L1
135
renal arteries are located at
L1/L2
136
gonadal arteries are located at
L2
137
the IMA is located at
L3
138
the bifurcation of the aorta is located at
L4
139
what two veins drain into the left renal vein?
left adrenal
left phrenic
140
the right adrenal vein drains into
into the IVC
141
what two veins join to form the portal vein?
superior mesenteric and splenic
142
the inferior mesenteric vein will usually drain into the [...] but sometimes [...]
splenic vein
sometimes contributes to formation of portal vein
143
the subcostal nerve and anterior ramus of L1 are located posterior to the
kidney
144
located posterior to psoas major and enters the thigh deep to the inguinal ligament
femoral nerve
145
located anterior to psoas major
genitofemoral
146
located medial to psoas major
obturator n.
147
located on the lateral side of the vertebrae
sympathetic chain
148
structures anterior to right kidney
| 3
liver
duodenum
ascending colon
149
structures anterior to left kidney
| 5
stomach
spleen
pancreas
jejunum
descending colon
150
located posterior to kidneys
| 3
posterior abdominal wall
subcostal nerve
anterior ramus of L1 and its branches
