Block 2: Abdomen, Gray's Review Flashcards
1
Q
Omental Bursa
- alternate name
- location
A
aka lesser sac
space posterior to the stomach and the liver
2
Q
What connects the omental bursa to the rest of the greater sac?
A
omental foramen
3
Q
Hepatorenal Space
- alternate name
- location
A
space/pouch of Morrison
separates the liver from the R kidney
4
Q
Subphrenic Recess
A
separates the diaphragmatic surface of the liver from the diaphragm
5
Q
Falciform Ligament
A
separates the subphrenic region into R and L components
6
Q
What is directly posterior to the omental foramen?
A
Inferior vena cava
7
Q
What are the borders of the omental foramen?
A
- visceral peritoneum of the liver.
- inferior: peritoneum covering the IVC
- anteriorly: hepatoduodenal ligament
- inferiorly: duodenum peritoneum
8
Q
Fundic Region of the Stomach
A
area above the cardial orifice
9
Q
What arteries lie on the fundus?
A
short gastric arteries
10
Q
Ileum
- location
- what is it?
A
location: in the RLQ
what: distal 3/5 of the small intestines
11
Q
Transverse Mesocolon
A
fold of the peritoneum that connects the transverse colon to the posterior abdominal wall
12
Q
Gastrosplenic Ligament
A
connects the stomach to the spleen
13
Q
Rectouterine Pouch
- location
- alternate name
A
location: space between the uterus and the rectum
alternate name: Pouch of Douglas
14
Q
Paracolic Gutter
A
space b/w the colon and the abdominal wall
15
Q
Retroperitoneal meaning
A
between the abdominal wall and the peritoneal cavity, embedded in mesentery
16
Q
Which of the following organs is retroperitoneal?
jejunum stomach descending colon transverse colon appendix
A
descending colon
17
Q
Processus Vaginalis
A
a tubular extension of the peritoneal cavity
18
Q
Darto’s Fascia
A
a layer of camper’s fascia that continues into the scrotum and forms specialized fascial layer containing smooth munscle fibers
19
Q
Hypospadias
- what is it?
- what’s the cause?
A
what: urethra opens on the ventral side of the penis
cause: DHT deficiency
20
Q
Epispadias
- what is it?
- what’s the cause
A
what: urethra opens on the dorsal side of the penis
cause: genital tubercle developing more dorsally
21
Q
Hydrocele
A
peritoneal fluid passing through the patent processus vaginalis into the tunica vaginalis
22
Q
Descending colon innervation
A
innervated by the parasympathetic nerves from S2-S4 and visceral afferents
23
Q
Duodenum Innervation
A
duodenum innervated by the vagus nerve, which innervates the GI tract up to the L colic flexure
24
Q
Liver innervation
A
sympathetic innervation:
celiac ganglion
parasympathetic: vagus nerve
25
What does hematuria or hematemesis indicate?
it indicates bleeding within the gastrointestinal tract
26
SMA location in respect to the L renal vein
SMA lies superior and anteriorly to the L renal vein
27
What are the differences between the L and R renal veins, L and R testicular veins, & L and R suprarenal veins
IVC leads to the L renal vein, then L testicular vein, then L suprarenal vein
IVC leads directly to the R testicular vein, then the R suprarenal vein
28
List the normal points of ureteric constriction (3)
1. close to the divergence of the common iliac vessels
2. where the ureters enter the bladder
3. pelvic-ureteric junction (where the renal pelvis meets the ureter)
29
paraesophageal hernia
characterized by herniation of the stomach into the mediastinum
30
sliding hernia
the gastroesophageal junction is displaced
31
By which rib does the kidney lie?
the 12th rib
32
Spleen Location (rib wise)
rib 9-11, under the liver
33
Liver Location (side of the body & ribs)
R side of the body, ribs 5-10
34
Pancreas Location (adjacent organs & ribs)
located in the middle of the body, medial to the kidneys at rib 11-12
35
What artery crosses the ureter?
uterine artery
36
Gallstone Ileus
a rare small bowel obstruction caused by a gallstone being lodged within the ileum of the small intestine
37
Psoas Sign
what is it?
alternative name?
indicates?
what: sign that indicates the irritation to the iliopsoas group of hip flexors in the abdomen
alternative name: Cope's Psoas Test
Indicates: the inflamed appendix is retrocecal in position
38
List the layers of fat/tissue surrounding the kidney
(in order): Renal capsule, perinephric fat, renal fascia, perinephric fat
39
Varices
large, dilated veins
40
What is the result of portal venous pressure increase?
varices can occur at the sites of portosystemic anastomoses, pooling usually accumulates there
41
What are the sites of portosystemic anastomoses?
1. varices @ anorectal junction
| 2. esophageal varices @ gastroesophageal junction
42
IMA supplies the
hindgut (distal 1/3 of the TC, descending colon, sigmoid colon, and rectum)
43
What is the connection b/w the SMA and the IMA?
anastamoses b/w middle colic (derived from the SMA) & L colic artery (derived from the IMA)
44
What system of veins do the esophageal veins arise from?
caval, particularly from the azygous system of veins
45
What is the consequence of cirrhosis of the liver on the portal venous system?
cirrhosis means the portal system doesn't properly do its job; the portal venous flow will back up to the systemic flow, and will pool at areas of the portal-caval anastamoses
46
Where do aortic aneurysms usually occur?
below the bifurcation of the abdominal aorta
47
What do aortic aneurysms lead to?
increases in pressure, marked pulsation
48
Caput Medusae
systemic vessels that radiate from paraumbilical veins enlarge and become visible on the abdominal wall
49
What is the cause of caput medusae?
caused by severely elevated portal venous pressure
50
Paralytic Ileus
obstruction of the intestines due to the paralysis of he intestinal muscles
51
Borborygmi
Bowel Sounds
52
Borborygmi and Bowel Obstruction
bowel obstructions initially characterized by increased Borborygmi, usually immediately follows mechanical obstruction.
As the muscle tires, bowel sounds become reduced or absent
53
Nutcracker Syndrome
the duodenum lies between the aorta and the SMA with a normal 45 degree angle. when that angle diminishes to less than 20 degrees, the transverse colon can get entrapped, leading to partial SBO symptoms
54
SMA main branches (3)
middle colic
r colic
ileocolic
55
Ileocolic branches to
ileal branch
| cecal branch
56
What arteries supply the head of the pancreas?
the pancreaticoduodenal arteries
57
How does the portal vein arise?
from the junction of the splenic and the superior mesenteric veins
58
posthepatic jaundice
obstruction of the biliary tree that causes jaundice
59
What causes yellow eyes and jaundice?
reversal of flow of the bile into the blood stream
60
The tail of the pancreas is supplied by
the splenic artery (anteriorly ad posteriorly)
61
Duodenum is supplied by
superior and inferior anterior & posterior pancreaticdoduodenal arteries
62
Gallbladder is supplied by
the cystic artery
63
Kidney is supplied by
the R and L renal arteries
64
Gastroduodenal artery branches from the
common hepatic artery
65
Transverse Mesocolon
fold of the peritoneum that connects the transverse colon to the posterior abdominal wall
66
What ligament connects the stomach to the spleen?
gastrosplenic
67
What is the omental foramen bound by?
the portal triad and the IVC
68
Processus Vaginalis
parietal peritoneum that precedes the testes in men, labia majora in women, as it "migrates" from upper lumbar wall to abdomen
69
Patent Processus Vaginalis
processus vaginalis fails to obliterate like it should
70
Cryptorchism
undescended testicles
71
Chordee
head of the penis turns downward
72
Direct Inguinal Hernia
herniated sac enters the ingunial canal through the posterior wall of the inguinal canal
73
Indirect Inguinal Hernia
herniated sac enters through the deep inguinal ring
74
Inguinal canal contents
Both: genital branch of genitofemoral nerve
Women: round ligament of the uterus
Men: Spermatic Cord
75
What are the contents of the spermatic cord?
1. testicular, cremasteric & deferential arteries
2. pampiniform plexus of testicular nerve
3. genital branch of genitofemoral nerve
4. cremasteric nerve
5. testicular sympathetic plexus
76
Chromaffin cells
modified postganglionic sympathetic neurons that release norepinephrine & epinephrine that passes into the adrenal glands
77
What are chromaffin cells derivedfrom?
neural crest cells
78
What are the walls of the spermatic cord?
internal spermatic fascia
cremasteric fascia
external spermatic fascia
79
Internal spermatic fascia
deepest layer of spermatic cord
arises from the transveraslis fascia
80
Cremasteric Fascia
associated w/ the cremaster muscle
middle layer, originating from internal oblique muscle and its fascial coverings
81
External spermatic fascia
derived from the external oblique aponeurosis
82
Canalization failure leads to
atresia
83
What happens if the inferior end of the vaginal plate fails to canalize?
results in an imperforate hymen
84
Vaginal Plates are formed by
fusion of sinovaginal bulbs
85
What does the vaginal plate give rise to?
lumen of the vagina
86
What happens if the sinovaginal bulbs don't develop?
absence of Vagina
87
Persistent urachus
results from an abnormal fistula between the bladder and the umbilicus, leading to urine leaking from the external abdominal wall
88
Ureteric Bud
responsible for development of the ureter
89
What happens if the ureteric bud fails to branch?
results in 1 ureter being attached to 2 kidneys
90
What happens if there's incomplete division of the ureteric bud?
double ureter and supernumerary kidney
91
Supernumerary Kidney
additional/accessory kidney
92
What happens if the ureteric buds fail to form?
no ureters will be present
93
What is the fate of the processus vaginalis?
it is supposed to terminate, giving rise to the tunica vaginalis
94
True Hermaphroditism
presence of testicular and ovarian tissue
95
Pseudohermaphroditism
errors in sexual differentiation lead to contrasting phenotypes
96
Atresia
a blind ending pouch
97
Subhepatic Cecum
failure of cecal buds to descend
98
Consequence of sub-hepatic cecum
absence of an ascending colon
99
Midgut Volvulus
improperly positioned and incompletely fixed intestines that leads to twisting of the midgut
100
Why is midgut volvulus an issue?
the intestines rotate around the vasculature that supplies them
101
Hirchsprung Disease
lack of autonomic ganglion cells in the myenteric plexus distal to the colon leads to an enlarged colon (megacolon)
102
What causes megacolon?
failure of neural crest cells to migrate to the walls of the colon
103
Anal Agenesis
incomplete separation of the cloaca
104
Rectal Atresia
rectal and anal canals are not connected due to incomplete or absence of canalization
105
What is the most common site of Meckel's Diverticulum?
ileum
106
Meckel's Diverticulum
alternate name
clinical correlate
remnant of
aka: congenital ileum diverticulum
may become enflamed and mimic appendicitis symptoms
remnant of omphaloenteric duct (yolk sac)
107
How does Meckel's Diverticulum look?
a fingerlike projection of ileum
108
Umbilical Hernia
intestines return to abdominal cavity and later herniate through an imperfect umbilicus
109
What protrudes in an umbilical hernia?
greater omentum & small intesitnes
110
Rule of 2's
common for Meckel's Diverticulum
```
2% of popualtion
2 ft proximal from ileocecal jx
2 inches long
2x as often in males
may contain 2 types of ectopic tissue
may be associated with 2 clinical conditions
```
111
Types of ectopic tissue associated w/ Meckel's Diverticulum
gastric mucosa
| pancreatic tissue
112
Hypertrophied Pyloric Sphinter is the result of
thickened pyloric sphincter muscle that narrows the sphincter, blocking material from leaving the stomach
113
Duodenal stenois vomitus
has bile
114
Duodenal atresia vomitus
usually immediately after birth
115
Incomplete Recanalization is most likely to occur in which part of the duodenum?
distal 3rd portion
116
Incomplete recanalization of the duodenum is caused by
duodenal stenosis
| partial occlusion of the lumen of the duodenum
117
Duodenal Atresia
complete occlusion of the duodenal lumen that is the result of a failed reformation of the lumen fo the duodenum
118
Double Bubble
distended, air filled stomach usually associated w/ duodenal atresia
119
Meckel's Diverticulum is a remnant of
omphaloenteric duct
120
Malrotation of the Midgut
the intestine doesn't rotate as it re-enters the abdomen, so the small intestine lies on the R side and the large intestine lies on the L side
121
Gastrochisis
extension of abdominal contents that is the result of incomplete lateral fold closure
122
Gastrochisis results in
epigastric hernia with viscera that protrude into the amniotic cavity & are covered with amniotic fludi
123
Imperforate Anus
anal canal ends blindly or there may be an ectopic anus or anoperineal fistula
124
Anoperineal Fistula
abnormal passage of anus into pernieum
125
Anal Stenosis
anus is in normal position but the anus and the canal are narrow
126
Anal stenosis is the result of
dorsal deviation of the urorectal septum as it grows caudally
127
What happens if the anal membrane does not perforate?
develop imperforate anus
128
What causes anal agenesis?
incomplete separation of the cloaca by the urorectal septum
129
McBurney's Point
most common location of the appedix at the cecum
130
What are the fascial layers of McBurney's point
aponeurosis of external abdominal oblique muscle
internal oblique muscle
transversus abdominis muscle
transversalis fascia
parietal peritoneum
131
achalasia
failure of the smooth muscle of the esophagus to relax, leading to lower esophageal sphincter remaining closed
132
The veriform appendix is best located by tracing and following what?
taeniae coli of ascending colon
133
In adults, the urachus is represented as
median umbilical ligament
134
Urachus
a thick cord remnant of allantois that extends from urinary bladder to umbilicus
135
Why is Meckel's Diverticulum prone to infection?
b/c the diverticulum may contain fecal material that can become infected
136
Duodenal Atresia presents w/:
distended epigastrium biliius vomiting
| double bubble sign
137
Omphaloenteric Fistula
abnormal connection between umbilical surface and terminal ileal lumen
138
Down syndrome is associated with what issue?
increased instance of duodenal atresia
139
What is the most superior portion where ureters can be contstricted?
ureteropelvic junction
140
Pancreas Innervation
vagus, celiac ganglion and pancreatic plexus
141
List the dermatome levels of the abdomen and what they effect
T7-T9: skin from xiphoid process to above umbilicus
T10: skin around the umbilicus
T11-L1: supply the skin below the umbilicus to and including the pubic region
L1: anterior surface of scrotum or labia majora, small cutaneous branch to the thigh
142
How would metastatic cells anywhere in the GI tract be spread? Where would they go first?
how: through the portal venous system
where 1st: to the liver
the liver (portal vein) receives all blood from the gastrointestinal system.
143
Anorectal Agenesis
rectum ends blindly
