D1 Anatomy chapter 4 test 3 Flashcards
What level is the Transpyloric plane?
lower aspect of L1
Name some landmarks of the Transpyloric sphincter
Passes sternum at 9th costal cartilage, Crosses C shaped duodenum, through body of pancreas, passes through parts of hila of kidneys
name the 3 main arteries of gastrointestinal system
celiac trunk, superior mesenteric a. , inferior mesenteric a.
celiac trunk branch level and what it supplies
upper border of L1, supplies the foregut
superior mesenteric a. level and what it supplies
lower border L1, supplies the midgut
inferior mesenteric a. level and what it supplies
L3, supplies the hindgut
what does the left renal vein drain?
kidney, suprarenal gland, gonad on same side
left common iliac vein
crosses L5 to join right common iliac vein to form inferior vena cava
what does the inferior vena cava drain?
lower limbs, pelvis, perineum, and some abdominal wall
describe the venous drain system of the gastrointestinal system
blood from abdominal parts of the gastro intestinal system and spleen have to pass a second vascular bed in the liver before returning to the heart
pathway GI tract, pancreas, Gallbladder and spleen into liver
enter via hepatic portal vein which distributes blood to small endothelieal-lined sinusoids which form a vascular exchange in the liver
pathway out of the liver
blood collects in hepatic veins that drain into inferior vena cava just before it enters the diaphragm
Innervation of skin, muscles, parietal peritoneum and anterolateral abdominal wall
T7-L1
describe these nerves branching?
a lateral cutaneous branch and end as a anterior cutaneous branch
T7-T11 pathway spinal nerves
leave intercostal spaces passing deep to costal cartilages and continue onto the anterolateral abdominal wall between internal oblique and transversus abdominis muscles
T7-T11 pathway continued
They pass deep to lateral edge of rectus sheath. Near midline they pass through the abdominus and sheath to supply the skin.
T12 pathway
“subcostal nerve” follows same pathway as intercostals
L1 pathway
” Iliohypogastric, ilio-inguinal nerve”. Originates from lumbar plexus
what does T7-T9 supply
skin from xiphoid process to just above umbilicus
what does T10 supply?
skin around umbilicus
T11, T12, L1 supplies?
skin just below umbilicus to pubic region
Ilio-inguinal nerve supplies?
anterior surface of scrotum or labia majora and small cutaneous regions of thigh
what does musculophrenic artery supply(superficially)?
superior part of abdominal wall ( remember its a branch of the internal thoracic artery)
what does the superficial epigastric artery supply? (superficially)
medially inferior part of abdominal wall
what does the superficial circumflex iliac artery supply(superficially)?
lateral inferior part of abdominal wall
what do the superficial epigastric and superficial circumflex iliac arteries branch from??
femoral artery
branches of 10th, 11th intercostal aa. and subcoastal artery (deep)
lateral part of wall
inferior epigastric artery( deep)?
inferior medial part of wall
deep circumflex iliac artery (deep)
lateral, deep wall
which vessel does the inferior epigastric and deep circumflex arteries branch from?
external iliac artery
where do the superior and inferior epigastric arteries anastamose?
posterior to rectus abdominis muscle
superficial lymphatics above umbilicus go where?
superior direction to axillary nodes
superficial lymphatics below umbilicus go where?
inferior to superficial inguinal nodes
deep lymphatics go where
follow deep arteries back to parasternal nodes along internal thoracic artery, lumbar nodes along aorta, and external iliac nodes along external iliac artery
where do the omenta develop from?
original dorsal and ventral mesenteries which suspend the GI tract
Omenta consists of what?
2 layers of peritoneum which pass from stomach and first part of duodenum to other viscera
Greater omentum is derived from
dorsal mesentery
lesser omentum is derived from
ventral mesentery
what does greater omentum attach to?
greater curvature of stomach, first part of duodenum
where else does it attach?
to peritoneum of superior surface of transverse colon, then posterior abdominal wall
what is between the 2 folds of the omentum?
right and left gastro-omental vessels ( veins and arteries)
where does lesser omentum attach?
lesser curvature of stomach to inferior surface of liver
name the two parts of lesser omentum
medial hepatogastric ligament, lateral hepatoduodenal ligament
hepatogastric ligament attaches what to what
liver to stomach
hepatoduodenal attaches what to what?
liver to duodenum
what is enclosed in the free edge by liver of hepatoduodenal lig.?
hepatic artery proper, bile duct, portal vein
what are mesenteries defined as?
peritoneal folds that attach viscera to posterior abdominal wall
name the 3 mesenteries
mesentery, transverse mesocolon, sigmoid mesocolon
what are mesenteries derived from?
the dorsal mesentary
Mesentary attaches what to what
jejunum and ilieum to posterior abdominal wall
superior/inferior attachement of mesentary
sup. - duodenojejunal junction
inf. -ileocecal junction
what is between the two peritoneal layers of mesentery?
veins, nerves, arteries, lymphatics that supply the Jejunum and ileum
what does transverse mesocolon attach?
transverse colon to posterior abdominal wall
where does the T mesocolon come out ?
above head and body of pancreas
the anterior layer of Transverse colon is adherent to what?
greater omentum
Sigmoid mesocolon resembles what letter and attaches what to what?
inverted V shape. attaches sigmoid colon to posterior abdominal wall
about where is the apex of the V?
near division of left common iliac artery
Left leg of V follows by what?
medial border of psoas major muscle
right leg of V follows by what?
descends into pelvis and ends near S3
what are peritoneal ligaments?
2 layers of peritoneum that connect 2 organs together or to wall
where does the esophagus enter the abdomen?
T10 , right crus of diaphragm
how do the anterior vagal trunk and posterior vagal trunk get positioned?
rotation of gut during development.
anterior vagal trunk is derived from what?
left vagus trunk
posterior vagal trunk is derived from what?
right vagus trunk
arterial supply of the abdominal esophagus
by esophageal branches from left gastric artery ( celiac trunk), and left inferior phrenic artery ( from abdominal aorta)
stomach is in what regions
epigastric, umbilical, and left hypochondrium regions
name the 4 regions of stomach
cardia, fundus, body, pyloric part
where is the pylorus?
most distal part of pyloric part
where is the transpyloric plane?
lower border of L2 , this is where you find the pyloris
gasteriosplenic ligament
attaches spleen to stomach. ( part of greater omentum)
what makes the cardiac notch?
the esophagus entering the stomach
what is the angular incisures?
bend of lesser curvature
5 arteries that supply stomach
left/ gastric artery, lef/right gastro-omental arteries, posterior gastric artery
how long is the small intestine?
6-7m long, from pyloric orfice to ileocecal fold
how long is duodenum
20-25 cm long and has largest lumen of small intestine
all of duodenum is retroperitoneal except what part
the very beginning that attaches to the hepatoduodenal ligament
superior part of duodenum extends from where to where
pyloric orfice of stomach to neck of gallbladder at L1
where do most duodenal ulcers occur?
superior part
where is descending part of duodenum
neck of gallbladder to lower border of L3
what does it touch?
transverse colon, kidney, head of pancreas
name the two papilla and where they are
major and minor duodenal papilla, major is below
inferior part of duodenum crosses what
its the longest part of duodenum , crosses inferior vena cava, aorta, and vertebral column
about how high the the ascending duodenum reach?
L2, terminates at duodenojejunal flexure
what supports the duodenojejunal flexure?
suspensory muscle (lig.) of duodenum. ( ligament of treitz)
what portion of small intestine is jejunum?
2/5
plicae circulares of jejunum
prominent mucosal folds
arterial supply of jejunum
jejunal arteries from superior mesenteric artery
ileum is what proportion of small intestine?
3/5, it has less mucosal folds than jejunum
ileocecal fold
where cecum and ileum meet, it may prevent reflux and regulate passage of contents
arterial supply of ileum
ilial arteries from superior mesenteric artery and ileal branch from ileocolic artery
how long is large intestine? what does it do
1.5m in adults, absorbs salts and fluid
name the anatomy of large intestine
ascending colon, right colic flexure, transverse colon, left colic flexure, descending colon, sigmoid colon
what are omental appendicies?
peritoneal covered accumulations of fat
what is taenieae coli?
longitudinal smooth muscle
haustra of colon
little segments of colon
which segments of colon are retroperitoneal?
ascending and descending
which parts are intraperitoneal?
transverse and sigmoid
describe right and left paracolic gutters
between colon and wall of ascending and descending segments. Material can pass from one region of cavity to another. It is blood free since vessels are on medial side of colon
where does sigmoid colon begin
above pelvic inlet and goes to S3, its supported by sigmoid mesocolon
appendix is attached to what wall of the cecum?
posterolateral wall
what holds the appendix up?
mesoappendix which also has blood vessels
name the positions the appendix can be in
pre-ileal, post-ileal, subcecal, retrocecal, pelvic
what areas of liver are not covered with visceral peritoneum ?
gallbladder fossa, porta hepatis
what enters and exits the porta hepatis?
enters- hepatic arteries, and portal vein.
Exits- hepatic ducts
falciform ligament
attaches liver to anterior abdominal wall
right and left triangular ligaments
connect diaphragm to liver
anterior coronary ligament
heart to liver
where is caudate and quadrate lobes?
quadrate visible anteriorly
caudate is posterior
quadrate lobe is functionally like what lobe?
left
caudate is functionally like what lobe?
none
what supplies the liver
right and left hepatic artery proper
arterial supply for gallbladder
cystic artery from right hepatic artery
pancreas
secondarily retroperitoneal. has head, neck, body, tail, uncitate process
describe duct system for bile
R/L hepatic ducts to common hepatic duct, cystic duct combines to form bile duct which combines with pancreatic duct
development of spleen
developes as part of vascular system in part of dorsal mesentery that suspends the developing stomach in wall
where is spleen in adults?
between rib 9 and 10
what attaches spleen to greater curvature of stomach?
gastrosplenic ligament
what connects the spleen to left kidney?
splenophrenic ligament
what supplies the spleen with blood?
splenic artery
what are the terminal branches of the descending aorta?
the 2 common iliac arteries
celiac trunk supplies what
foregut
superior mesenteric artery supplies what
midgut
inferior mesenteric artery supplies what
hindgut
what is the foregut?
abdominal esophagus to major duodenal papilla. ( includes everything between stomach, duodenum, liver, pancreas, gallbladder)
midgut consists of ….
begins inferior to major duodenal papilla and ends at Junction between proximal 2/3 and distal1/3 of transverse colon ( includes duodenum, jejunum, ileum, cecum, appendix, ascending colon & right 2/3’s transverse colon)
hindgut consists of…
starts and left colic flexure and ends at mid-anal canal. ( includes left 1/3 transverse colon- upper part of anal canal
where is the celiac trunk?
immediately below aortic hiatus so L1
what does celiac trunk split into?
left gastric a., splenic a. , common hepatic arteries
left gastric artery pathway
ascends to cardioesophageal junction, sends esophageal branches upward, anastomoses with right gastric a. from common hepatic artery
splenic artery pathway ( largest)
travels through spleenorenal ligament , gives off many branches in neck, body, tail of pancreas, anastomoses with left gastro-omental a. which anastomoses with right gastro-omental a.
branches of common hepatic a
right gastric a, common hepatic artery, gastroduodenal a.
branching of hepatic artery proper
ascends in lesser omentum, branches into right/left hepatic arteries and cystic artery
Gastroduodenal artery
divides into anterior and posterior superior pancreaticoduodenal arteries
which artery gives off the right gastro-omental artery?
anterior superior gastroduodenal artery
what does the anterior/posterior superior pancreaticoduodenal arteries supply?
head of pancreas and duodenum
what does the anterior/posterior pancreaticoduodenal arteries anastamose with?
anterior/ posterior inferior pancreaticoduodenal arteries
what do the anterior/ posterior inferior pancreaticoduodenal arteries converge in to?
the inferior pancreaticoduodenal artery
where does the inferior pancreaticoduodenal artery come out from?
superior mesenteric artery
where does the superior mesenteric artery arise?
lower L1
what branches off the superior mesenteric artery
inferior pancreaticoduodental artery, jejunal and ileal arteries, right, middle, and ileocolic arteries
what does the middle, right, and ileocolic arteries supply?
terminal ileum to first 2/3rds of transverse colon
what does the inferior pancreaticoduodenal artery turn into?
anterior/ posterior inferior pancreaticoduodenal arteries
jejunal and ilial arteries come off which side of superior mesenteric a?
left
middle colic artery
enters transverse colon and branches into right and left branches
what doe the branches anastamose with?
right branch with right colic artery, left branch with colic artery
right colic artery
supplies ascending colon, divides into ascending/descending branches
where do these branches anastamose?
ascending with middle colic a. , descending with ileocolic a.
ileocolic artery
anastomoses with right colic artery
what vertebral level can you find the inferior mesenteric artery?
around L3
what does it branch into?
left colic artery, sigmoid arteries, superior rectal artery
whats special about left colic artery?
ascends retroperitonealy
whats special about superior rectal artery?
terminal branch of inf. mesenteric a. Found at S3
where do all of the abdominal lymphatics eventually end up?
pre-aortic lymph nodes
where are the pre-aortic nodes found?
by the 3 main branches of aorta
1st route lymph can take
celiac trunk drains into celiac nodes which also receive from other 2 main branches. Then it enters Cysterna chyli
2nd route of lymph
superior mesenteric artery drains in superior mesenteric nodes which also receives from inferior mesenteric a. then drains into celiac nodes
3rd route
inferior mesenteric artery drains into inferior mesenteric nodes then drains into superior mesenteric nodes
innervation of abdominal viscera is by what
extrinsic and intrinsic components
extrinsic innervation
receives motor impulses from CNS and sends sensory to CNS
Intrinsic innervation
involves regulation of digestive tract by a self sufficient network of sensory and motor neurons
some organs that receive extrinsic innervation of abdomen
spleen, GI tract, pancreas, gallbladder, liver
the 2 interconnected plexuses of the enteric system do what
coordinate contraction and relaxation of smooth muscle and regulate secretions and blood flow
what is the ganglian impar?
ganglion at bottom of coccyx
how many ganglion in cervical region?
3
thoracic region?
11/12
lumbar?
4
sacral?
4/5
