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GIR Test 1 > B5.011 GI Organs and the Retroperitoneum > Flashcards

B5.011 GI Organs and the Retroperitoneum Flashcards

1
Q

GI tract

A

mouth > pharynx > esophagus > stomach > duodenum > jejunum > ileum > large intestine (cecum) > ascending colon > transverse colon > descending colon > sigmoid colon > rectum > anal canal

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2
Q

GI associated organs

A 
liver
gallbladder
pancreas
spleen
kidneys
adrenal glands
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3
Q

foregut

A

proximal to 2nd half of duodenum
celiac axis blood supply
epigastric innervation

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4
Q

midgut

A

distal half of duodenum to proximal 2/3 of transverse colon
superior mesenteric artery blood supply
paraumbilical innervation

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5
Q

hindgut

A

distal 1/3 of transverse colon to rectum
inferior mesenteric artery blood supply
suprapubic innervation

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6
Q

vessels off of celiac trunk

A

left gastric artery
splenic artery
common hepatic artery

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7
Q

vessels off of SMA

A

ileocolic artery
right colic artery
middle colic artery

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8
Q

vessels off of IMA

A

left colic artery
sigmoidal arteries
superior rectal artery

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9
Q

spleen overview

A

oval shaped, fist sized, but variable
protected by lower left thoracic cage, normally not palpable
largest lymphatic organ
removes old RBCs

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10
Q

splenic anatomy

A

4 borders (anterior, superior, posterior, inferior)
4 surfaces (diaphragmatic, gastric, colic, renal)
intraperitoneal, expandable, mobile
one hilum
one fibrous capsule

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11
Q

splenic hilum

A

includes gastrosplenic ligament (contain short gastric vessels)
splenorenal ligament

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12
Q

relationship of spleen to other organs

A

anterior- stomach
posterior, superior, lateral- diaphragm
inferior- left colic flexure and left kidney
medial- left kidney, left adrenal gland, tail of the pancreas

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13
Q

splenic vessels

A

splenic artery- from celiac trunk artery, highly coiled, superior and posterior to pancreas body
splenic vein- drains to hepatic portal vein

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14
Q

splenic rupture

A

most frequent injured organ in the abdomen
caused by sudden deceleration
can lead to hypovolemic shock if massive
hard to repair, usually splenectomy is performed

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15
Q

Kehrs sign

A

pain from splenic rupture irritating the undersurface of the diaphragm on the left side
sharp pain in the left shoulder

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16
Q

splenomegaly

A

abnormally enlarged, palpable under left costal arch

common causes include congestion due to portal hypertension, infiltration by leukemias and lymphomas, mono (EBV)

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17
Q

“local” spleen pain

A

blood leaks and irritates parietal peritoneal wall adjacent to spleen

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18
Q

what is the pancreas

A

an enlongated digestive and endocrine gland, located retroperitoneal wrapped by the duodenum and extending towards the spleen

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19
Q

5 parts of the pancreas

A

head- within C shaped duodenum (to the right of SMA and SMV)
uncinated- process posterior to SMA and SMV
neck- short region anterior/ overlies SMA and SMV
body- left of neck @ L1/L2
tail- touches splenic hilum

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20
Q

pancreatic duct

A

runs along the body, joins common bile duct to form hepatopancreatic ampulla (space that allows the mixing of bile and pancreatic secretions)
opens into duodenum at major duodenal papilla, projects into the lumen of the 2nd portion of the duodenum

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21
Q

sphincters of hepatopancreatic ampulla

A

sphincter of common bile duct
sphincter of pancreatic duct
sphincter of hepatopancreatic ampulla (Oddi)

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22
Q

pancreatic arteries

A
  1. splenic
  2. gastroduodenal
  3. SMA
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23
Q

pancreatic veins

A
  1. splenic

2. SMV

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24
Q

blockage of sphincter of oddi

A

can cause pancreatitis
gallstone blocks the ampulla, causes bile flow into the pancreas
incompetent sphincter of Oddi
spasm of sphincter of Oddi

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25
Q

pancreatic cancer

A

cancers in the head region may cause jaundice
neck and body cancers may cause obstruction of portal vein or IVC
typically present as epigastric pain or severe back pain
typically metastasizes to liver

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26
Q

pancreatic cancer epidemiology

A

median survival time 6-12 months, 5% survival rate

4th most common cancer death in US

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27
Q

pancreas referred pain

A

small tumor- jaundice, no pain
large tumor- jaundice and pain
pain comes first and then jaundice typically
innervation- great thoracic splanchnic nerve T5-9

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28
Q

liver overview

A 
largest internal organ
weighs 1500 g
accepts absorbed nutrients from GI tract via portal vein
stores glycogen
produces bile
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29
Q

liver positioning in abdomen

A

RUQ and some LUQ
R. hypochondriac and epigastric regions
R. thoracic cage
anteriorly from 5th rib (nipple) to costal arch
posteriorly from 9th to 12th ribs
should not extend below right costal margin

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30
Q

diaphragmatic surface of liver

A 
anterior, superior, posterior
dome shaped
has bare area
covered by visceral peritoneum, continues with parietal peritoneum and forms
-coronary ligament
-right triangular ligament
-left triangular ligament
-falciform ligament
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31
Q

what is the subphrenic recess of the liver

A

between diaphragm and diaphragmatic surface of the liver
fluid flow to subhepatic space
falciform ligament splits subphrenic recess into L and R

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32
Q

hepatorenal recess

A

pouch of Morison
ultrasound used in ED to detect blood accumulation when GI bleeding is suspected
most dependent spot when laying supin

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33
Q

subphrenic abscesses

A

often happen on R side from duodenal ulcers or appendicitis

can be drained below or at 12th rib or right costal margin

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34
Q

visceral surface of liver

A

2 sagittal fissures on each side of porta hepatis

  • right sagittal fissure- from fossa of gallbladder to prove of IVC
  • left sagittal fissure- from ligamentum teres to ligamentum venosum
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35
Q

porta hepatis

A

transverse fissure on visceral surface where the following structures enter or leave the liver:

  • portal vein
  • hepatic artery
  • common bile ducts
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36
Q

portal triad

A

portal vein, hepatic artery, and common bile duct travel together in the hepatoduodenal ligament

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37
Q

anatomical lobes of the liver

A

falciform ligament and left sagittal fissue divides left and right anatomical lobes
porta hepatis divides quadrate (inferior) and caudate lobes (superior)

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38
Q

causes of hepatomegaly

A

accumulation of blood- CHF
inflammation
tumor
chronic ethanol consumption

39
Q

result of hepatomegaly

A

pain in right hypochondriac region, liver can be palpated below right costal margin, jaundice, liver function abnormality

40
Q

hepatic cirrhosis

A

liver parenchyma is replaced by fat and fibrous tissue
caused by alcoholism, drug or chemical toxification, hepatitis
results in portal hypertension

41
Q

gallstones

A

composed of cholesterol crystals, may be in gallbladder, cystic duct, or common bile duct
more common in females, increase with age
can be symptom free

42
Q

biliary colic

A

stone lodged in cystic duct causing intense, spasmodic pain

43
Q

cholecystitis

A

inflammation of gallbladder due to bile accumulation
gallbladder enlargement, epigastric or right hypochondriac region pain
“murphys sign” jaundice

44
Q

murphys sign

A
  1. ask patient to exhale
  2. place hand below costal margin on right side
  3. patient inspires
    positive murphys sign = patient stops breathing in and winces
45
Q

other pain from cholecystitis

A

local pain below costal margin
referred pain to back of right scapula
referred pain to right shoulder

46
Q

overview of the diaphragm

A

double domed musculotendinous structure separating thoracic cavity from abdominal cavity
lowers during inspiration, raises during expiration to as high as 5th rib
central tendinous, peripheral muscular

47
Q

structures of diaphragm

A

3 parts: sternal, costal, lumbar
3 apertures: esophageal (T8), vena cava (T10) and aortic (T12)
2 crura: left and right next to aorta
5 arcuate ligaments: 1 median (over aorata), 2 left, 2 right (over psoas and quadratus lumborium muscles)

48
Q

diaphragmatic blood vessels

A

superior and inferior phrenic arteries and veins

49
Q

diaphragmatic nerves

A

C3-5 for motor and sensation
costal nerves for peripheral regions
thoracic splanchnic nerves
sympathetic trunks

50
Q

posterior abdominal wall muscles

A

quadratus lumborum
psoas
iliacus

51
Q

quadratus lumborum

A

from iliac crest and iliolumbar lig to 12th rib and transverse process of L1-5
fix 12th rib during respiration

52
Q

psoas

A

from bodies of T12-L4 to lesser trochanter of femur

chief flexor of thigh trunk

53
Q

iliacus

A

from iliac fossa/sacral ala to lateral psoas tendon
assist psoas
inserts also onto lesser trochanter of femur

54
Q

psoas abscess

A

collection of pus in the iliopsoas muscle compartment
more common in males
median age Is 44-58

55
Q

primary psoas abscess

A

occur as a result of hematogeneous or lymphatic seeding from a distant site
risk factors include diabetes, IV drug use, HIV, infection, renal failure, and other forms of immunosuppression

56
Q

secondary psoas abscess

A 
occurs as a result of direct spread of infection to the psoas muscle from an adjacent structure
vertebrae
hip arthroplasty
GI tract
aorta
GU tract
57
Q

psoas sign

A

RLQ pain produced with a patient extending the hip due to inflammation of the peritoneum overlying the psoas muscles and inflammation of the psoas muscles themselves
straightening the leg causes pain because it stretched the muscles
fetal position relieves pain

58
Q

posterior abdominal wall nerves

A
  1. subcostal nerve (T12)
  2. iliohypogastric (L1)
  3. ilioinguinal (L1)
  4. genitofemoral (L1,2)
  5. lateral femoral cutaneous (L2.3)
  6. femoral (L2-4)
  7. obturator (L2-4)
  8. lumbosacral trunk (L4.5)
59
Q

meralgia paresthetica

A

lateral femoral cutaneous nerve syndrome
caused when nerve is compressed
results in burning sensation felt in anterior, outer thigh
can be caused by sudden abdominal weight gain or too tight a belt or clothing

60
Q

cremasteric reflex

A

test both genitofemoral nerve and L1/2 spinal cord integrity
genitofemoral nerve has a genital branch and a femoral branch
genital branch- mainly motor to the cremasteric muscles which rapidly pull the testicles toward the superficial inguinal ring
femoral branch- mainly sensory to skin on the medial thigh adjacent to external genitalia
**reflex is contraction of the cremasteric muscle when the skin of the superior medial part of the thigh is touches

61
Q

sympathetic innervation to adrenal glands

A

no parasympathetics

sympathetics = preganglionic > medulla > secrete adrenalin/epi

62
Q

kidney location

A

retroperitoneal in posterior abdominal wall location from T12-L3
right side slightly lower
move a little with diaphragm
may drop lower due to peri-renal fat reduction

63
Q

internal structures of the kidneys

A 
cortex
medulla
renal pyramids
renal columns
renal papilla
renal sinus
minor calyx
major calyx
renal pelvis
ureter
64
Q

kidney vessels

A

3 pairs of suprarenal arteries and 1 pair of suprarenal veins
renal arteries arise at L1/L2 intervertebral disc
right renal artery passes posterior to IVC
left renal artery passes posterior to left renal vein
arteries divide into 5 segmental branches
left renal vein receives left testicular/ovarian vein and passes anterior to aorta

65
Q

kidney stones

A

renal and ureteric calculi
formed by inorganic salts and organic acids in kidney calices and fall into ureter
intermittent pain, ureter obstruction, infection of renal pelvis

66
Q

horseshoe kidney

A

usually at the level of the lower lumbar vertebrae
ascent in development is prevented by the root of the inferior mesenteric artery
ureters arise from the anterior surface of the kidney and pass ventral to the isthmus in a caudal direction

67
Q

horseshoe kidney epidemiology

A

1/600 people, males > females, 15% of turners syndrome females

68
Q

symptoms of horseshoe kidney

A

often asymptomatic

nausea, abdominal discomfort, kidney stones, UTIs at a greater frequency

69
Q

perinephric abscess

A

pus from an abscess may force its way into the pelvis between the loosely attached anterior and posterior layers of the pelvic fascia

70
Q

3 nonpaired arteries from abdominal aorta

A
  1. celiac trunk
  2. SMA
  3. IMA
71
Q

paired arteries from abdominal aorta from above down

A
  1. inferior phrenic > suprarenal
  2. middle suprarenal
  3. renal
  4. lumbar arerties ( 4 pairs)
  5. testicular/ovarian
  6. median sacral (single)
72
Q

projection of abdominal aorta

A 
diaphragm (T12)
celiac trunk (T12/L1)
renal (L1/L2)
SMA (L1)
IMA (L3)
aortic bifurcation (L4)
73
Q

abdominal aortic aneurysm

A

diameter >5.5 cm in males and >5 cm in females
most common site (85%) for formation below renal arteries
presents as painless, pulsatile abdominal mass
pain and tenderness often in mid to upper back

74
Q

AAA epidemiology

A

common in older adults >60

appears to be a genetic link and runs in families

75
Q

AAA outcomes

A

if untreated, mortality if ruptured is 85-90%
13th leading cause of death in US
screening with abdominal US is recommended for men 65-75 with history of smoking

76
Q

celiac trunk and branches

A 
at T12/L1, short anterior branch
gives off: 
-left gastric
-splenic
-common hepatic
below diaphragmatic hiatus
above neck of pancreas
L1+ vertebral column
retroperitoneal
provides blood to foregut
77
Q

left gastric artery

A

esophageal branch to esophagus
left side of lesser curvature of stomach
anastomoses with right gastric artery

78
Q

splenic artery

A

retroperitoneal, coiling along superior border of pancreas
travel through splenorenal ligament to hilum of spleen
branches:
-posterior gastric to stomach
-pancreatic branches to pancreas
-short gastric to fundus
-left gastro-omental artery to greater curvature of stomach

79
Q

common hepatic artery

A

retroperitoneal posterior to omental bursa

bifurcates at pylorus into: hepatic proper artery (ascending) and gastroduodenal artery (descending)

80
Q

hepatic proper artery

A 
ascends inside hepatoduodenal ligament
branches:
-right gastric
-left hepatic
-right hepatic
81
Q

gastroduodenal artery

A

descend retroperitoneally behind gastroduodenal junction
branches:
-right gastro-omental artery
-superior pancreaticduodenal arteries

82
Q

superior mesenteric artery,

A 
originates at L1 level, less than one vertebral body below celiac trunk, posterior to pancreas
branches:
-middle colic
-right colic
-ileocolic
supplies midgut organs
83
Q

inferior mesenteric artery

A 
originates at L3 level, 2 in above aortic bifurcation
descends toward rectum with 3 branches:
-left colic
-sigmoid
-superior rectal
supplies hindgut organs
84
Q

ischemic colitis

A

often occurs at junction of 2/3 transverse colon from midgut with 1/3 transverse colon from hindgut, where hindgut meets soma in rectum, or where foregut meets midgut

85
Q

hepatic portal venous system

A

portal vein- veins that have capillaries on both ends
hepatic portal vein- GI on one end, liver sinusoids on the other, no valves!
collect high nutrient blood from Gi organs and send to liver
after liver, blood returns to IVC via hepatic veins

86
Q

relationships of portal vein

A 
formed by splenic vein and SMV
behind pancreatic neck at transpyloric plane
anterior to IVC
within portal triad
anterior wall of omental foramen
enters porta hepatis
87
Q

anastomoses with systemic veins

A

following venous plexuses allow portal vein to anastomose with systemic veins:
E= esophageal plexus (esophageal varices)
P= paraumbilical plexus (caput medusa)
R= rectal plexuses (hemorrhoids)
RP= retroperitoneal plexus

88
Q

portal hypertension

A

increased pressure of hepatic portal vein due to scarring or fibrosis of the liver or obstruction of the blood flow

89
Q

splanchnic nerves

A

greater (T5-9)- celiac ganglion, foregut organs
lesser (T10,11)- superior mesenteric ganglion, midgut organs
least (T12) - inferior mesenteric ganglion, hindgut organs
lumbar and sacral- superior and inferior hypogastic plexus, pelvic organs
pelvic- parasympathetic, pelvic organs

90
Q

Hirschsprung disease

A

parasympathetic ganglion cells in the wall of large intestine do not develop before birth
without these nerves, the affected segment of the colon lacks the ability to relax and move bowel contents along

91
Q

epidemiology of HD

A

1 in 5000
M:F 4:1
associated with trisomy 21

92
Q

symptoms of HD

A

delayed passage of meconium >48 hr
abdominal distention
vomiting- may be bilious
diagnosis- rectal biopsy

93
Q

treatment of HD

A

remove aganglionic portion of rectum/sigmoid colon/large intestine and connecting the neurologically intact portion to the anus (which has somatic innervation/control)

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