Blackcloud Body Wall and Thorax p.40-65 Flashcards
connects to posterior abdominal wall, fan-shaped, attachment called “root”
“the mesentery” of jejunum and ileum
jejunum, ileum, transverse and sigmoid colon, first and fourth part of duodenum, cecum, appendix
intraperitoneal segments, covered in visceral peritoneum
middle duodenum, ascending and descending colon
secondarily retroperitoneal segments (developed in a reabsorbed mesentery, stuck to posterior abdominal wall)
has a thick wall and mucosa with circular folds, proximal 2/5
jejunum
thin walls, few if any circular folds, numerous lymphoid nodules, distal 3/5
ileum
1/3 of the way between anterior superior iliac spine and umbilicus
Mc Burney’s point, most common location of appendix
Does the cecum have a mesentery? Does the appendix?
No, yes.
peritoneal gap at the duodenojejunal junction, potential space for fluid or hernia
duodenal recess
Which part of colon has mesentery?
tranverse (fusese with greater omentum during development), sigmoid
colic flexure attached to diaphragm by phrenicocolic ligament, usually superior to other
left colic flexure
approximate location of rectosigmoid junction
S3
large size, omental fat tags, tenaie coli muscles, haustra saccules
large intestine, not small!
small outpocketing from colon, develop with age, may become inflamed
diverticuli
celiac trunk originates near
T12
inferior pancreaticoduodenal, middle colic, intestinal, ileocolic and right colic are branches of
superior mesenteric artery
supplies duodenum distal to bile duct, head of pancreas
inferior pancreaticoduodenal artery
supplies proximal 2/3 of transverse colon, runs in transverse mesocolon
middle colic artery
supply jejunum, ileum, “the” mesentery, end in straight terminal branches called vasa recta
intestinal arteries
supply distal ileum, appendix, cecum and proximal ascending colon
ileocolic artery
supplies ascending colon, is entirely retroperitoneal
right colic artery
branches include left colic, sigmoidal, superior rectal
inferior mesenteric
supplies descending colon, distal transverse colon
left colic artery
supplies sigmoid colon
sigmoidal branches
supplies superior part of the rectum
superior rectal artery
continuous artery running along entire large intestine
marginal artery
celiac trunk branches anastomose with branches of
superior mesenteric artery
superior mesenteric artery anastomoses with
celiac trunk and inferior mesenteric artery
left colic artery (IMA) anastomoses with
middle colic branch (SMA)
why is reverse blood flow possible in GI tract?
No valves in GI veins
anastomoses between esophageal branch of left gastric (portal) and esophageal tributaries of azygous (caval) result in
potentially fatal esophageal varices
anastomoses between superior rectal vein (portal) and mid and inferior rectal veins (caval) can result in
hemorrhoids
anastomoses between paraumbilical veins (portal) and superficial epigastric veins of anterior abdominal wall (caval) can result in
caput medusa
all of the duodenum, except proximal 2cm, which has mesentery, ligament, portal vein and bile duct
retroperitoneal
part of duodenum that is most intraperitoneal
superior part (first)
part of duodenum right of midline, anterior to kidney, retroperitoneal, where bile and pancreatic ducts drain
descending part (second)
part of duodenum anterior to IVC and aorta, retroperitoneal, crossed anteriorly by superior mesenteric vessels
horizontal part (third)
part of duodenum that ascends to join jejunum
ascending part (fourth)
supplies majority of superior duodenum
superior pancreaticoduodenal artery
supplies descending, horizantal and ascending duodenum
inferior pancreaticoduodenal artery
inferior mesenteric vein ____ accompany artery, passes ____ of the duodenojejunal junction
does not, to the left of
explains the prevalence of liver metastases in colon cancer
colon drains to portal vein, blood goes to liver
where bile duct and main pancreatic duct enter the duodenum
major duodenal papilla (internal surface)
accessory pancreatic duct enters duodenum as ____, which is ____ to major papilla
minor duodenal papilla, superior to
expanded part of pancreas, embraced by C-curve of duodenum
head
short part of pancreas, overlies superior mesenteric vessels
neck
continuation from the neck of the pancreas
body
part of pancreas closely related to the hilum pf spleen and left colic flexure
tail
tributaries of splenic and superior mesenteric parts of hepatic portal vein, empty into splenic vein
pancreatic veins
which kidney is higher?
left
Kidneys ____ one vertebral level during inspiration
descend
atrophy of fascial sheath results in pathological increase of mobility, which may cause pain or restrict blood flow
floating kidney
fusion of inferior poles of kidneys is called ____, full ascent is hindered by ____.
horseshoe kidney, inferior mesenteric artery
pain originating in mid-back and moving to inguinal region
kidney stones
minor calyxes at tips of renal pelvis, passed to major then pelvis to reach ureter
passage of filtrate in kidney
renal pelvis is ____ to renal artery and vein
posterior to (bridge over water)
adrenal glands are ___ to the diaphragm
anterior
derived from mesoderm, produces mineralocortocoids, glucocorticoids and sex hormones
adrenal cortex
deficiency of mineralocortocoids causes
Addison’s disease
excess of glucocortocoids causes
Cushing’s disease
derived from neural crest and secretes epinephrine
adrenal medulla
tumor resulting in excess levels of epinephrine
pheochromocytoma
supplies adrenal glands
inferior phrenic arteries, aorta and renal arteries
drains adrenal glands
left into renal vein, right into IVC
supplies kidneys
renal arteries, anterior to ureter, posterior to renal veins
which renal artery is longer, passes posterior to superior mesenteric artery
right
supplies gonads, branches from aorta between SMA and IMA
gonadal arteries
drains right gonad
IVC
drains left gonad
left renal vein
are ureters intraperitoneal?
No. Primarily retroperitoneal
ureters pass ____ to psoas major
anterior
ureters pass ____ to gonadal vessels
posterior to (bridge over water)
ureters enter the pelvis by crossing ____ to the bifurcation of common iliac into internal and external
anterior (not bridge over water!)
ureter is supplied by
renal, gonadal and vesical arteries
ureter is innervated by
renal and hypogastric plexuses
T5-T9, goes to celiac ganglia
greater splanchnic nerve
axons modulate the enteric system of the foregut, adrenal medulla
greater splanchnic nerve
T10-T11, goes to aorticorenal ganglia
lesser splanchnic nerve
axons innervate cecum, appendix, ascending colon, proximal 2/3 of transverse colon (midgut)
lesser splanchnic nerve
T12, goes to inferior mesenteric ganglia
least splanchnic nerve
all splanchnics pierce
crura of diaphragm
splanchnic chain enters abdominal cavity by passing under
medial arcuate ligament (fascia over psoas major)
Splanchnics synapse in ____, NOT sympathetic chain ganglia
prevertebral (preaortic) ganglia
passes through preaortic, superior hypogastric, and hypogastric plexuses to reach viscera
lumbar splanchnics (L1-L5)
provide parasympathetic innervation to pelvic viscera
vagus and pelvic splanchnic nerves
where do vagal trunks pass into abdomen
esophageal hiatus
pass through the hypogastric nerves and superior hypogastric plexus to reach conduit between the abdominal and pelvic cavities
pelvic nerves
sensory nerve axons in abdomen piggyback with
autonomic axons
sensory innervation in abdomen returning with vagus nerve mediates
reflexes
sensory innervation in abdomen returning with pelvic splanchnic nerves mediates
pain and reflexes
are located in the sensory ganglia of vagus nerve X and dorsal root ganglia from S2-S4
sensory neurons
only contain postsynaptic sympathetic neurons and are named according to the closest artery
prevertebral ganglia
largest of the prevertebral ganglia
celiac ganglia: look for it on the practical!
presynaptic sypathetic axons in L3-L5 lumbar splanchnics must
descend in sympathetic chain from L1-2
greater splanchnics (T5-T9) piggyback
Celiac trunk and SMA
lesser splanchnics (T10-11) piggyback
SMA and renal artery
least splanchnics (T1) piggyback
IMA
lumbar splanchnics (L1-5) piggyback
IMA
presynaptic parasympathetic neurons to viscera have cell bodies in vagal nuclei in medulla or
in spinal cord from S2 to S4
parasympathetic axons from vagal trunk piggyback on
celiac trunk and SMA
parasympathetic axons from pelvic splanchnic nerves piggyback on
IMA
no peristalsis in aganglionic segment of gut leads to megacolon
Hirshprung’s disease
if it piggybacks on the branches of celiac trunk, it innervates
stomach, liver, gallbladder, bile ducts, spleen, pancreas, proximal duodenum
if it piggybacks oin the SMA, it innervates
distal duodenum, pancreas, jejunum, ileum, cecum, appendix, ascending and promximal transverse colon
if it piggybacks on the IMA, it innervates
distal transverse colon, descending and sigmoid colon, proximal rectum
all neurons mediating pain are in the ____ ganglia
dorsal root
attaches to transverse processes of lumbar vertebrae and tendon to lesser trochanter of femur
psoas major
attaches to T12 and L1 and pubic bone
psoas minor
attaches to 12th rib, tips of lumbar transverse processes and iliolumbar ligament, iliac crest
quadratus lumborum
attaches to 7th-12th costal cartilages, thoracolumbar fascia, iliac crest, CT deep to inguinal ligament, and linea alba with aponeurosis of internal oblique, pubic crest and pectin pubis
transversus abdominus
muscle innervated by lumbar plexus (anterior branches of L2-L4)
psoas major
muscle innervated by anterior ramus of L1
psoas minor
muscle innervated by anterior branches of T12 and L1-4
quadratus lumborum
muscle innervated by thoracoabdominal nerves (anterior rami of T7-T11) and first lumbar nerve
transversus abdominus
flex thigh, flex vertebral colum laterally, flexes trunk
psoas major
weak flexor of vertebrae
psoas minor
extends and laterally flexes vertebral column, fixes 12th rib during inspiration
quadratus lumborum
compresses and supports abdominal viscera
tranversus abdominis
parts of the diaphragm are named by their bony attachments, which are
sternal, lumbar, costal
all muscular parts of the diaphragm are also connected to
central tendon
blood supply to the diaphragm
superior phrenic arteries from thoracic aorta, musculophrenic and pericardiophrenic from internal thoracic arteries
diaphragm innervated by
C3,4,5
which part of diaphragm includes the crura and two free edges called ligaments
lumbar diaphragm
extend inferiorly and attach to lumbar vertebrae
right and left crura
overlies the psoas major
medial arcuate ligament
overlies the quadratus lumborum
lateral acruate ligament
opening in diaphragm within central tendon at T8
caval opening
what passes through caval opening?
IVC (vena cava=8 letters=T8)
opening in right crus of diaphragm, usually at T10
esophageal hiatus
what passes through esophageal hiatus?
esophagus, anterior and posterior vagal trunks, esophageal branches of left gastric vessels (vagal trunk = 10 letters = T10)
opening posterior to diaphragm between right and left crura, usually at T 12
aortic hiatus
what passes through the aortic hiatus?
aorta, thoracic duct, possibly azygous or hemiazygous vein. (aortic hiatus = 12 letters= T12)
follow the branches of the celiac trunk, superior and inferior mesenteric arteries, not veins, back to aorta
lymphatic vessels draining abdominal viscera
lymphatic vessels from abdominal viscera drain into ____ before thoracic duct
cisterna chyli
Thin-walled sac at inferior end of thoracic duct, anterior to the bodies of L1 and L2, between right crus and aorta
cisterna chyli
superior mesenteric artery and vein are ____ to horizontal duodenum
anterior
