Chapter 4: The Abdomen pt 2 Flashcards
- the largest visceral organ in the body
- in the right hypochondrium and epigastric regions
- has diaphragmatic and visceral surfaces
the liver
- smooth and domed
- Associated with it are the subphrenic and hepatorenal recesses
diaphragmatic surface
part of the peritoneal cavity
hepatorenal recess
are continuous anteriorly
The subphrenic and hepatorenal recesses
divided into to right and left areas by the falciform ligament
subphrenic recess
covered by visceral peritoneum, except in the fossa for the gallbladder and the porta hepatis (gateway to the liver)
visceral surface of liver
serves as the point of entry for the portal vein, exit point for the hepatic ducts
porta hepatis
attaches the liver to the abdominal wall
The falciform ligament
covered in visceral peritoneum except for the bare area
liver
connect the liver to the stomach (hepatogastric ligament), duodenum (hepatoduodenal ligament), the diaphragm (left and right triangular ligament and anterior and posterior coronary ligaments)
Additional folds of the peritoneum
divided into right and left lobes by the fossa for the gallbladder and the inferior vena cava
liver
arise from the right lobe but are functionally distinct
quadrate and caudate lobes
made up of the neck, body, and fundus
gallbladder
what is the liver supplied by?
the right and left hepatic arteries, both of which arise from the hepatic artery proper
what is the gallbladder supplied by?
supplied by the cystic artery from the right hepatic artery
secondarily retroperitoneal (except for a small part of the tail)
pancreas
lies in the C-shaped concavity of the duodenum
head of pancreas
project off the head of the pancreas
uncinate process and neck
distal from the head of the pancreas
body and tail
- begins in the tail and passes through the body into the head
- joins the bile duct and forms the hepatopancreatic ampulla which enters the duodenum at the major duodenal papilla
pancreatic duct
empties into the duodenum via the minor duodenal papilla
accessory pancreatic duct
what is the arterial supply to the pancreas?
***ultimately arises from the celiac trunk
-common hepatic and
splenic branches which
feed the pancreas
- drain respective lobes of the liver
- combine to form the common hepatic duct
right and left hepatic ducts
joins the cystic duct and forms the bile duct
common hepatic duct
drains into the duodenum
bile duct
produced in the liver and stored in the gallbladder until it is needed in the duodenum
bile
- develops as part of the vascular system in the dorsal mesentery
- lies against the diaphragm and stomach and is therefore found in the upper left quadrant
spleen
- attached to the greater curvature of the stomach by the gastrosplenic ligament and to the left kidney by the splenorenal ligament
- covered in visceral peritoneum except for the hilum
spleen
- the entry point for the splenic vessels
- Occasionally the tail of the pancreas reaches this area
hilum of the spleen
what is the arterial supply of the spleen?
comes from the splenic artery which comes off the celiac trunk
extends from the aortic hiatus to the branch of the common iliac arteries
abdominal aorta
what are the anterior branches of the abdominal aorta that go to the GI tract?
- celiac trunk
- superior mesenteric
- inferior mesenteric
begins with the abdominal esophagus and ends at the major duodenal papilla and is supplied by the celiac trunk
foregut
begins just inferior to the major duodenal papilla and ends 2/3 of the way along the transvers colon and is supplied by the superior mesenteric
midgut
begins 2/3 of the way along the transverse colon and ends at the upper part of the anal canal and is supplied by the inferior mesenteric
hindgut
- arises immediately inferior to the aortic hiatus
- divides into left gastric, splenic, and common hepatic arteries
celiac trunk
- extends superiorly and curves back down the surface of the lesser curvature of the stomach
- anastomoses with the right gastric
left gastric artery
the largest branch off the celiac trunk
splenic artery
- passes along the superior margin of the pancreas and gives off numerous branches to the neck, body, and tail
- Approaching the spleen it gives off the short gastric and left gastro-omental artery
splenic artery
runs to the right and divides into the hepatic artery proper and the gastroduodenal artery
common hepatic trunk
proper ascends toward the liver and divides into left and right hepatic arteries
hepatic artery
divides into supraduodenal, right gastro-omental, and the anterior superior pancreaticoduodenal arteries
gastroduodenal artery
The 1st branch off the superior mesenteric (SM)
the inferior pancreaticoduodenal artery
what does the superior mesenteric give off after the inferior pancreaticoduodenal artery?
jejunal and ileal branches to the left and middle and right colic and ileocolic arteries
supple the jejunum and most of the ileum
jejunal and ileal arteries
supplies the transverse colon
Middle colic artery
supplies part of the ascending colon
right colic artery
supplies part of the ascending colon, cecum, and appendix
ileocolic artery
branches into left colic, several sigmoid, and superior rectal arteries
inferior mesenteric artery
splits into ascending and descending branches which supply the distal end of the transverse colon and the upper and lower descending colon
left colic artery
supply the lowest part of the descending colon and the sigmoid colon
sigmoid arteries (2-4 branches)
supply the rectum
superior rectal arteries
where is the Venous drainage of the spleen, pancreas, gallbladder, and abdominal GI tract (except for inferior part of rectum) through?
the portal system
formed by the union of the splenic and superior mesenteric vein
portal vein
receives gastric veins, cystic veins, and para-umbilical veins
the portal vein as it ascends toward the liver
what are the tributaries to the splenic vein?
- short gastric
- left gastro-omental
- pancreatic
- inferior mesenteric veins
begins in the right iliac fossa as veins drain the terminal ileum, cecum, and appendix
superior mesenteric vein
- drains the rectum, sigmoid and descending colon, and splenic flexure
- begins as the superior rectal vein
inferior mesenteric vein
drain into pre-aortic lymph nodes
Lymph from the rectum, spleen, pancreas, gallbladder, and liver
divided into: celiac, superior mesenteric, and inferior mesenteric groups
Pre-aortic lymph nodes
innervated by both intrinsic and extrinsic components of the nervous system
abdominal viscera
involve sending and receiving impulses from the CNS
Extrinsic components
involve the enteric system
intrinsic components
travel between the viscera and CNS via the spinal nerves, sympathetic trunks, splanchnic nerves, prevertebral plexus , and the vagus nerve
Afferent sensory fibers, sympathetic, and parasympathetic fibers
- carry sympathetic fibers
- travel from sympathetic ganglia to the prevertebral plexus
Thoracic, lumbar, and sacral splanchnic nerves
- carries parasympathetic fibers
- originate directly from anterior rami and travel to the hypogastric plexus
pelvic splanchnic nerve
what are the 3 major divisions of the prevertebral plexus?
- celiac plexus
- aortic plexus
- superior hypogastric plexus
provides parasympathetic innervation to the foregut and midgut
vagus nerve
provides parasympathetic innervation to the hindgut
pelvic splanchnic nerve
- A local neural network of the GI tract
- Controls many intestinal functions including peristalsis
enteric system
what are the 2 interconnecting networks of the enteric system?
- myenteric plexus
- submucosal plexus
- posterior to the abdominal GI tract
- contains the abdominal aorta and associated nerve plexuses, inferior vena cava, sympathetic trunks, lymphatics, kidneys, and adrenal glands
posterior abdominal region
what are the bones of the posterior abdominal region?
- The 5 lumbar vertebrae and intervertebral discs project into this region
- ribs, sacrum, and ilia form components of the bony make up of this posterior region
what are the muscles of the posterior abdominal region?
- Superiorly- the diaphragm
- Medially- psoas major and minor
- Laterally- quadratus lumborum
- Inferiorly- iliacus
arise from bodies of the vertebrae TXII and all 5 lumbar (minor- TXII and L1) and passes inferiorly along the pelvic brim onto the lesser trochanter of the femur
Psoas major and minor
fills the space between the pelvis and rib XII
quadratus lumborum
fills the iliac fossa and joins the psoas major to become the iliopsoas
iliacus
ORIGIN: lateral surface of bodies of TXII and LI to LV vertebrae; transverse processes of the lumbar vertebrae, and intervertebral discs between TXII and LI to LV vertebrae
psoas major
insertion: lesser trochanter of the femur
psoas major
innervation: anterior rami of L1 to L3
psoas major
function: flexion of thigh at hip
psoas major
ORIGIN: lateral surface of bodies of TXII and LI vertebrae and intervening intervertebral disc
psoas minor
INSERTION: pectineal line of the pelvic brim and iliopubic eminence
psoas minor
innervation: anterior rami of L1
psoas minor
FUNCTION: weak flexion of lumbar veterbral column
psoas minor
ORIGIN: transverse process of LV vetebrae; iliolumbar ligament and iliac crest
quadratus lumborum
INSERTION: transverse processes of LI to LIV vertebrae and inferior border of ribs XII
quadratus lumborum
INNERVATION: anterior rami of T12 and L1 to L4
quadratus lumborum
FUNCTION: depress and stabilize rib XII and some lateral bending of the trunk
quadratus lumborum
ORIGIN: upper 2/3 of iliac fossa; anterior sacro-iliac and iliolumbar ligaments, and upper lateral surface of sacrum
iliacus
INSERTION: lesser trochanter of femur
iliacus
INNERVATION: femoral nerves (L2 to L4)
iliacus
function: flexion of thigh at hip joint
iliacus
- consists of the central tendon surrounded by muscle
- anchored to the lumbar vertebrae via the left and right crura which blend with the longitudinal ligament of the vertebral column
diaphragm
are connected across the midline by the median arcuate ligament
crura
attach medially to the transverse process of LI and laterally to rib XII
lateral acruate ligaments
innervated by the phrenic nerve
diaphragm
***these structures pass throug the:……..
-Aorta
-Thoracic duct
-Azygous and
hemiazygous vein
-Esophagus
-Vagal trunks
-Left gastric artery and
vein
-Inferior vena cava
-Right and left phrenic
nerve
-Splanchnic nerves
-Sympathetic trunks
-Epigastric vessels
diaphragm
retroperitoneal in the posterior abdominal region
kidneys
are located superiorly to the kidneys
suprarenal glands
associated with the diaphragm, psoas major, quadratus lumborum, and transversalis abdominis
posterior side of the kidneys
Immediately outside the renal capsule
perinephric fat which completely surrounds the kidney
encloses the perinephric fat, kidney, and suprarenal gland
renal fascia
surrounds the renal fascial compartment
paranephric fat
has a smooth anterior and posterior surface covered in a fibrous renal capsule
each kidney
what structures are found in the kidney?
- Hilum
- Renal cortex
- Renal columns
- Renal pyramids
- Renal sinus
- Renal papilla
- Minor calyx
- Major calyx
- Renal pelvis
supply and drain the kidneys
Renal arteries and veins
divides into the anterior and posterior branches
renal artery
drain renal lymph
lateral aortic nodes
- muscular tubes that transport urine from the kidneys to the bladder
- continuous with the renal pelvis at the uteropelvic junction
ureters
at what 3 points do the ureters narrow?
- 1st at the uteropelvic junction
- 2nd at the pelvic inlet
- 3rd at the entrance to the bladder
can get lodged at the constrictions of the ureters
kidney stones
found on the superior poles of the kidneys
suprarenal glands
what is the blood supply to the suprarenal glands?
- Superior suprarenal
- Middle suprarenal
- Inferior suprarenal arteries
what is the venous drainage of the suprarenal glands?
the suprarenal veins that drain into the renal veins
- begins at the abdominal hiatus
- passes down the midline and ends as a split into right and left common iliac arteries
abdominal aorta
what do branches off the abdominal aorta supply?
- organs (visceral),
- diaphragm and body wall (posterior)
- terminal branches (common iliacs)
- Branch= anterior
- origin= Immediately inferior to the aortic hiatus of the diaphragm
- supplies= abdominal foregut
celiac trunk
- branch= anterior
- origin= Immediately inferior to the celiac trunk
- supplies= abdominal midgut
superior mesenteric
- branch= anterior
- origin= inferior to renal arteries
- supplies= abdominal hindgut
inferior mesenteric artery
- branch= lateral
- origin= Immediately superior to the renal arteries
- supplies= suprarenal glands
middle suprarenal artery
- branch= lateral
- origin= Immediately inferior to superior mesenteric
- supplies= kidneys
renal arteries
- branch= paired anterior
- origin= Inferior to renal arteries
- supplies= testes/ovaries
testicular/ovarian artery
- branch= lateral
- origin= Immediately inferior to aortic hiatus
- supplies= diaphragm
inferior phrenic artery
- branch= posterior
- origin= usually in 4 pairs
- supplies= posterior abdominal wall and spinal cord
lumbar artery
- branch= posterior
- origin= Just superior to the aortic bifurcation, passes inferiorly across lumbar vertebrae, sacrum, and coccyx
median sacral artery
- branch= terminal
- origin= bifurcation usually occurs at LIV vertebra
common iliac artery
- returns blood from all structures below the diaphragm
- formed when the 2 common iliac veins join just to the right of the midline
inferior vena cava
***receives these tributaries:
-Common iliac veins
-Lumbar veins
-Right testicular or
ovarian vein
-Renal veins
-Right supernal
-Inferior phrenic veins
-Hepatic veins
inferior vena cava
do all lumbar veins drain directly into the inferior vena cava?
no
long, anastomosing venous channels that connect the common iliac, iliolumbar, and lumbar veins with the azygous and hemiazygous
ascending lumbar vein
- generally drains into nodes associated with the major blood vessels
- then predominately drains into the thoracic duct
lymph of abdominal
anterior to the aorta
pre-aortic nodes
lateral (left and right sides) of the aorta
lateral aortic nodes
found in the posterior abdominal region
sympathetic trunks, splanchnic nerves, plexuses, and ganglia associated with the aorta
extend off ganglia on the sympathetic trunks and connect to the prevertebral plexus
Splanchnic nerves
- extends along the aorta from the diaphragm to the bifurcation into the common iliacs
- divided into the celiac plexus, aortic plexus, superior hypogastric plexus
prevertebral plexus
- found in the prevertebral plexus
- named after nearest abdominal branch
- celiac
- superior mesenteric
- aorticorenal
- inferior mesenteric
prevertebral ganglia
- formed by the anterior rami of nerves L1-L4
- forms in the substance of the psoas major muscle
lumbar plexus
what are the nerves that emerge from the lumbar plexus?
- Iliohypogastric
- Ilio-inguinal
- Genitofemoral
- Lateral cutaneous
- Iliacus
- Femoral
- Obturator
what are the nerves relative to the psoas major?
- Genitofemoral emerges anteriorly
- Obturator emerges medially
- Iliohypogastric, ilio-inguinal, femoral, and lateral cutaneous emerge laterally
have certain cutaneous and muscular distributions in the leg
nerves that emerge from the lumbar plexus
