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Medicine Sem 4 > Case 2 Anatomy > Flashcards

Case 2 Anatomy Flashcards

1
Q

what is the peritoneum?

A

double layered, serous membrane, which lines the walls of the abdominal and pelvic cavities and invests the viscera

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2
Q

what is an intraperitoneal organ?

A

an organ that is suspended from the body wall by a mesentery

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3
Q

what is the lesser omentum?

A

a double layer of peritoneum that connects the liver with the lesser curvature of the stomach

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4
Q

what is the greater omentum?

A

a double layer of peritoneum that connects the greater curvature of the stomach with the transverse colon

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5
Q

what is the mesentery?

A

a double layer of peritoneum that connects an intraperitoneal organ with the body wall (e.g. The mesentery, transverse mesocolon, mesoappendix)

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6
Q

what is the parietal peritoneum?

A

the serous membrane that lines the inner surface of the body wall

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7
Q

what is the visceral peritoneum?

A

the serous membrane that covers the external surfaces of the abdominal organs

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8
Q

what is the peritoneal cavity?

A

the fluid-filled potential space between the parietal and visceral peritoneums

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9
Q

what is a retroperitoneal organ?

A

an organ that is pushed up against the body wall and is only partially covered by peritoneum

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10
Q

what does the peritoneal cavity contain?

A
  • Contains a small amount of peritoneal fluid that enables the organs of the abdomen to slide smoothly over each other
  • A number of spaces/subsections exist within the cavity
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11
Q

what are the spaces/subsections of the peritoneal cavity?

A
  • greater sac
  • lesser sac
  • supracolic compartment
  • infracolic compartment
  • right paracolic gutter
  • left paracolic gutter
  • hepatorenal recess
  • subphrenic space
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12
Q

what is the greater sac?

A

the largest portion of the peritoneal cavity

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13
Q

what is the lesser sac?

A

the smallest portion of the peritoneal cavity which lies posterior to the lesser omentum and stomach

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14
Q

what is the supracolic compartment?

A

the part of the peritoneal cavity which lies above the transverse mesocolon

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15
Q

what is the infracolic compartment?

A

the part of the peritoneal cavity inferior to the transverse mesocolon

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16
Q

what is the right paracolic gutter?

A

the depression/recess lateral to the ascending colon

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17
Q

what is the left paracolic gutter?

A

the depression/recess lateral to the descending colon

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18
Q

what is the hepatorenal recess?

A

the part of the peritoneal cavity which lies inferior to the liver and anterior to the kidney suprarenal gland

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19
Q

what is the subphrenic space?

A

the part of the peritoneal cavity which lies between the diaphragm and liver

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20
Q

what is the epiploic foramen?

A

a small opening where the lesser sac communicates with the greater sac (omental foramen)

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21
Q

what are the boundaries of the epiploic foramen?

A
  • Anterior boundary = hepatoduodenal ligament
  • Superior boundary = liver
  • Inferior boundary = superior part of duodenum
  • Posterior boundary = inferior vena cava
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22
Q

what is the hepatoduodenal ligament formed from?

A

the free border of the lesser omentum

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23
Q

which structures pass through the hepatoduodenal ligament on route to the liver?

A
  • Hepatic artery
  • Bile duct
  • Portal vein
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24
Q

what can be seen on the anterior wall of the abdomen?

A

a number of mucosal folds

= umbilical folds (and ligaments)

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25
Q

what are these umbilical folds?

A
  • A single median umbilical fold extends from the apex of the bladder to the umbilicus; it overlies the median umbilical ligament
  • There are two medial umbilical folds which lie lateral to the median fold; they overlie the medial umbilical ligaments
  • Two lateral umbilical folds lie lateral to the medial fold

(median umbilical fold is a raised ridge of parietal peritoneum in the deep aspect of the anterior abdominal wall overlying the median umbilical ligament)

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26
Q

what is the median umbilical ligament?

A

is a remnant of the urachus (allows communication between developing urinary bladder and the placenta)

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27
Q

what are the medial umbilical ligaments?

A

remnants of the umbilical arteries

28
Q

what do the lateral umbilical ligaments overlie?

A

inferior epigastric arteries

Unlike the median and medial umbilical folds, the contents of the lateral umbilical fold remain functional after birth.

29
Q

what is the innervation of the peritoneum? what does this mean for pain?

A
  • The parietal peritoneum receives somatic innervation from the nerves that supply the abdominal wall
  • It is therefore sensitive to pain which can clearly be localised
  • The visceral peritoneum receives autonomic innervation
30
Q

what is the gastrointestinal tract divided up into sections based on?

A

based on the embryonic development from the primitive gut tube

31
Q

explain the sections that the GI tract is divided up into

A
  • Structures derived from the primitive foregut are referred to as foregut structures, those derived from the midgut as midgut structures and from the hindgut as hindgut structures
  • The structures within each of these sections receive a common blood and nerve supply
  • They also share a common route of lymphatic drainage
  • Therefore, if you know from which part of the gut a structure is derived you can work out its neurovascular supply
32
Q

what does the foregut consist of?

A

extends from the lower part of oesophagus to the second part of the duodenum and also includes the liver, spleen and part of the pancreas (pancreas is bit behind and below the stomach)

  • Stomach
  • Duodenum proximal to major papilla (major duodenal papilla is an opening of the common bile duct and pancreatic duct into the duodenum)
  • Liver
  • Spleen
  • Pancreas
  • Gallbladder
33
Q

what does the midgut consist of?

A

extends from the second part of the duodenum to the distal third of the transverse colon, it also includes part of the pancreas

  • Duodenum distal to major papilla
  • Jejunum
  • Ileum
  • Caecum
  • Appendix
  • Ascending colon
  • Hepatic flexure
  • Proximal 2/3 of transverse colon
34
Q

what does the hindgut consist of?

A

extends from the distal third of transverse colon to the proximal part of the anus

  • Distal 1/3 of transverse colon
  • Splenic flexure
  • Descending colon
  • Sigmoid colon
  • Rectum
  • Proximal part of anus
35
Q

what is the blood supply to the GI tract?

A
  • Foregut = coeliac trunk
  • Midgut = superior mesenteric artery
  • Hindgut = inferior mesenteric artery
36
Q

what is the lymphatic drainage of the GI tract?

A
  • Lymph from the gut drains first into regional lymph nodes that tend to be associated with the organ
  • For example, lymph from the liver drains into the hepatic nodes and lymph from the stomach drains into gastric nodes
  • Efferent vessels from these regional nodes drain into nodes located around the major vessels
  • Therefore, lymph from foregut structures drains into the coeliac nodes, that from midgut structures to the superior mesenteric nodes and that from the hindgut structures into the inferior mesenteric nodes
  • Efferent vessels from the coeliac, superior mesenteric and inferior mesenteric nodes drain into intestinal trunk
  • Intestinal trunk empties into the cisterna chyli which is located at the inferior end of the thoracic duct
  • Thoracic duct drains into the left subclavian vein
37
Q

describe the autonomic innervation of the GI tract

A
  • Preganglionic sympathetic fibres arise in the lateral horn of grey matter of the thoracolumbar regions of the spinal cord
  • Their axons pass in the ventral horn, spinal nerve, ventral ramus and white ramus communicantes to enter the sympathetic chain
  • They pass through the chain without synapsing and continue on to the prevertebral ganglia (not paravertebral ganglia) as splanchnic nerves
  • They terminate in prevertebral ganglia by synapsing with the postsynaptic fibres that pass to the effector organ
  • Vagus nerve provides parasympathetic innervation to the gut
38
Q

what are the splanchnic nerves?

A

splanchnic nerves are paired visceral nerves, carrying fibres of the ANS (visceral efferent fibres) as well as sensory fibres from the organs (visceral afferent fibres)

39
Q

are the splanchnic nerves sympathetic or parasympathetic?

A

the thoracic, lumbar and sacral splanchnic nerves are sympathetic in function while the pelvic splanchnic nerves are parasympathetic

40
Q

foregut structures

  • where preganglionic fibres originate
  • which ganglion
  • which nerve
A
  • Preganglionic fibres originate T5-9
  • Coeliac ganglion
  • Greater splanchnic nerve
41
Q

midgut structures

  • where preganglionic fibres originate
  • which ganglion
  • which nerve
A
  • Preganglionic fibres arise T10-T11
  • Superior mesenteric ganglion
  • Lesser splanchnic nerve
42
Q

hindgut structures

  • where preganglionic fibres originate
  • which ganglion
  • which nerve
A
  • Preganglionic fibres arise T12, L1
  • Inferior mesenteric ganglion
  • Lumbar splanchnic nerve
43
Q

describe the sensory innervation of the GI tract

  • what information conveyed with what
  • what enters spinal cord where
A
  • Visceral afferent information for reflexes (such as stretch to the intestinal wall) is conveyed with parasympathetic fibres
  • Visceral afferent pain fibres are conveyed with sympathetic fibres (got to be sympathetic because they’re in pain)
  • Therefore, pain afferents from the foregut enter the spinal cord at levels T5-9, those from the midgut at T10-11 and from the hindgut at T12-L1
  • This accounts for why referred pain from the abdominal viscera is perceived on specific regions of the abdominal wall
44
Q

where pain from the abdominal viscera referred to on the abdominal wall?

A
  • Foregut structures = epigastric region
  • Midgut structures = umbilical region
  • Hindgut structures = hypogastric region
45
Q

ENS

  • what considered as
  • what consist of
A
  • Often considered to be third part of the autonomic nervous system
  • Consists of two nerve plexuses:
  • one plexus is located between the inner circular and outer longitudinal layers of muscle in the muscularis externa = myenteric plexus
  • the other is located within the submucosa = submucosal plexus = Meissner’s plexus
46
Q

what is the myenteric plexus responsible for?

A

gastrointestinal motility

47
Q

what does the submucosal plexus do?

A

senses environmental changes in the lumen and regulates gastrointestinal blood flow and epithelial cell function

48
Q

what is the link between the ENS and CNS?

A
  • The enteric nervous system can function autonomously

- But it communicates with CNS and is regulated by the sympathetic and parasympathetic parts of ANS

49
Q

what are the functions of the stomach?

A
  • Storage of ingested food
  • Control of chyme entering the duodenum
  • Protection against invading pathogens
  • Expands to store food = rugae
  • Controls amount of food released into duodenum = pyloric sphincter
  • Mechanical digestion = extra smooth muscle layer
  • Chemical digestion = chief cells produce pepsinogen
50
Q

what are the anterior relations of the stomach?

A
  • Liver
  • Diaphragm
  • Abdominal wall
51
Q

what are the posterior relations of the stomach?

A
  • Left kidney (surprisingly near the abdominal aorta)
  • Transverse colon
  • Spleen (looks kind of like kidney on left side of stomach)
  • Splenic artery (on the way to spleen)
  • Transverse mesocolon
  • Left suprarenal gland
  • Lesser sac
  • Pancreas
52
Q

describe what the stomach consists of

A
  • Cardia (where the oesophagus connects to the stomach and through which food passes into the stomach)
  • Fundus
  • Body
  • Lesser curvature
  • Greater curvature
  • Pyloric antrum
  • Pyloric canal (opening to the duodenum)
  • Pyloric sphincter
53
Q

describe the pylorus

A

the funnel-shaped pylorus connects the stomach to the duodenum – the wider end of the funnel, the pyloric antrum, connects to the body of the stomach – the narrower end is called the pyloric canal, which connects to the duodenum

54
Q

what can be seen on the inside of the stomach?

A

inside numerous longitudinal (go from cardia to pylorus) folds can be seen on the mucosal surface = rugae

55
Q

what is the lesser omentum?

A

double fold of peritoneum that extends from the liver to the lesser curvature of the stomach and proximal part of the duodenum

56
Q

what is the greater omentum?

A

double fold of peritoneum that extends from the greater curvature of the stomach to the transverse colon

57
Q

what is the hepatoduodenal ligament?

A

free edge of the peritoneal fold that extends between the liver and lesser curvature of the stomach

58
Q

what is the arterial supply of the stomach?

A
  • As it’s a foregut structure, it receives blood supply form the coeliac trunk
  • Branches of the coeliac trunk that supply the stomach:
    • Common hepatic
    • Left gastric
    • Splenic
  • Smaller branches arise from these main vessels to supply different regions of the stomach:
    • Fundus = short gastric
    • Lesser curvature (upper) = left gastric
    • Lesser curvature (lower) = right gastric
    • Greater curvature (upper) = left gastroepiploic
    • Greater curvature (lower) = right gastroepiploic
59
Q

what do the short gastric arteries arise from?

A

splenic artery

60
Q

what does the right gastric artery arise from?

A

common hepatic artery

61
Q

what does the right gastroepiploic artery arise from?

A

gastroduodenal artery

62
Q

what does the gastroduodenal artery arise from?

A

common hepatic artery

63
Q

what does the left gastroepiploic artery arise from?

A

splenic artery

64
Q

what is the venous drainage of the stomach?

A
  • Initially the venous drainage of the stomach parallels the arterial supply with the short gastric, right and left gastric, and right and left gastroepiploic, draining the regions supplied by the arteries of the same name
  • Right and left gastric veins drain into portal vein
  • Short gastric and left gastroepiploic veins drain into splenic vein
  • Right gastroepiploic vein drains into superior mesenteric vein
  • Hepatic portal vein is formed by the union of the splenic and superior mesenteric veins
  • The portal vein is formed behind the pancreas
65
Q

what is the lymphatic drainage of the stomach?

A
  • Short gastric
  • Left gastric
  • Right gastric
  • Left gastroepiploic
  • Right gastroepiploic
  • Coeliac
  • Coeliac lymph nodes receive lymph from the regional nodes of the stomach
66
Q

what is the innervation of the stomach?

A
  • Preganglionic sympathetic fibres to the stomach arise from T5-T9
  • Greater splanchnic nerve conveys preganglionic sympathetic fibres for the stomach
  • Postganglionic sympathetic fibres for the stomach arise from the coeliac prevertebral ganglion
  • The vagus nerve transmits parasympathetic fibres to the stomach
  • Visceral pain from the stomach is perceived in the epigastric region

Medicine Sem 4 (23 decks)

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