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MD3002 > embryology of the abdomen > Flashcards

embryology of the abdomen Flashcards

1
Q

what does the diaphragm develop from

A 
the septum transversum in the neck close to the thoracic inlet
also contributed to from:
pleuroperitoneal membranes
dorsal mesentary of the oesophagus
ingrowth from the body wall
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2
Q

where do diaphragmatic muscles originate from

A

the xiphoid process

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3
Q

where does the left crus arise from

A

L1 and 2

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4
Q

where does the right crus originate from

A

L1,2 and 3

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5
Q

where is the median arcuate ligament found

A

in the midline at t12

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6
Q

describe the course of the right crus

A

fibres travel up and insert on the central tendon of the diaphragm
some cross the midline to form a loop around the oesophagus

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7
Q

where is the bare area of the diaphragm

A

posterior to the liver

is it not covered by peritoneum

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8
Q

what passes through the diaphragm at T8, through the central tendon

A

inferior vena cava

right phrenic nerve

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9
Q

what passes out of the diaphragm at T10 through the right crus

A

left gastric artery from the coeliac artery

oesophagus, ant and post vagal trunks, left gastric vein

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10
Q

what passes out of the diaphragm at T12 behind the median arcuate ligament

A

thoracic duct, azygous vein and hemiazygous vein

descending thoracic aorta

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11
Q

what passes through the crura

A

greater and lesser splanchnic nerves

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12
Q

what passes behind the median arcuate ligament

A

left and right sympathetic trunks

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13
Q

what is the most common type of hiatus hernia

A

sliding - 90% of cases

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14
Q

what happens in a sliding hernia

A

the intra abdominal part of the gastro-oesophageal junction rises above the oesophageal hiatus. This means some of the acid secreting parts of the stomach are above the diaphragm. leads to heart burn and dysphagia. may be asymptomatic

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15
Q

what is a rolling hernia

A

the fundus herniates but the gastro oesophageal junction is intact. May cause dysphagia, early satiety or inability to hold down food.

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16
Q

where are diarphragmatic hernias usually found

A

in neonates

presents with resp distress and cyanosis. Look for asymmetry on clinical examination

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17
Q

what is the purpose of the peritoneum

A

allows movement and distension of the GI tract

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18
Q

what is the difference in peritoneum between males and females

A

males- closed cavity

females- communication with the exterior through uterine tubes, the uterus and vagina

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19
Q

what is the consequence of female peritoneal arrangement

A

possible spread of infection from exterior to interior of peritoneal cavity

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20
Q

where is the extraperitoneal fascia

A

between the parietal peritoneum and the fascial lining of the abdominal wall (transversalis fascia)

it helps to support the kidneys

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21
Q

where is the lesser peritoneal sack

A

lies behind the stomach and lesser omentum. extends slightly into the greater omentum

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22
Q

what is the epiploic foramen (of Winslow)

A

allows communication between the greater and lesser sacs

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23
Q

what structures does the peritoneum form

A

omenta
mesenteries
ligaments

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24
Q

what is the greater omentum derived from

A

the dorsal mesentery
hangs from the greater curvature of the stomach and first part of the duodenum
overlies the transverse colon and small intestine

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25
Q

where is the lesser omentum

A

passes from the lesser curvature of the stomach and first part of duodenum to the inferior border of the liver

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26
Q

what is the hepatoduodenal ligament

A

the free edge of the lesser omentum containing the portal vein, hepatic artery and bile duct

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27
Q

what does epiploic mean

A

used to describe something associated with the omentum

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28
Q

what are mesenteries

A

double layered peritoneal folds that attach viscera to the posterior abdo wall
conduits for vessels, nerves and lymphatics

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29
Q

what are the different mesenteries

A

small intestine mesentery
transverse mesocolon
sigmoid mesocolon

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30
Q

what is the Mesentary

A

double layered fold of peritoneum that connects the jejunum and ileum to the posterior abdom wall

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31
Q

describe the course of the Mesentary

A

base starts left of L2 and passes obliquely downwards to the right, ending just above the sacro iliac joint,

it crosses the 3rd part of the duodenum, aorta and IVC, right gonadal vessels and right ureter

it contains branches of SMA and SMV, with nerves and lymphatics

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32
Q

describe the vasa recta of the jejunum

A

few arcades with long vasa recta to the intestine

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33
Q

describe the vasa recta of the ileum

A

many arcades with short vasa recta. This helps surgeons to identify it

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34
Q

what is the sigmoid mesocolon

A

the double layered fold of peritoneum that connects the sigmoid colon to the posterior abdom wall

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35
Q

where is the sigmoid mesocolon

A

root is in the left iliac fossa, crossing the birfurcation of the left common iliac vessels and the left ureter

it transmits the sigmoid branches of the inferior mesenteric vessels, plus nerves and lymphatics

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36
Q

what does the transverse mesocolon do

A

suspends the transverse colon from the posterior abdo wall

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37
Q

where is the transverse mesocolon

A

inferior to the pancreas

carries branches of the middle colic vessels

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38
Q

how does the transverse mesocolon divide the peritoneal cavity greater sac

A

divides it into supra and infra colic compartments

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39
Q

what does the supra colic compartment contain

A

liver stomach and spleen and part of the duodenum

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40
Q

what does the infra colic compartment contain

A

jejunum, ileum, ascending colon and descending colon. part of the duodenum

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41
Q

what divides the infracolic compartment

A

the Mesentary divides it into right and left halves, each has a paracolic gutter

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42
Q

what is Morison’s pouch also known as

A

right subphrenic recess or hepatorenal recess

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43
Q

where might pus collect and form abscesses when the patient is recumbent

A

Morison’s pouch

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44
Q

what seperates the rectum from the uterus in females

A

rectouterine pouch

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45
Q

what seperates the rectum from the bladder in males

A

rectovesical pouch

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46
Q

what separates the bladder and uterus in females

A

vesico uterine pouch

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47
Q

what is a peritoneal fold

A

a reflection of peritoneum with more or less sharp borders

usually covers blood vessels, ducts and obliterated foetal vessels

it connects two organs together

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48
Q

what is the importance of the lesser sack

A

allows distension of the stomach after a meal

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49
Q

what is the hepatogastric ligament

A

passes from the lesser curvature of the stomach to the liver

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50
Q

where may peritoneal folds or recesses form

A

where the intestine moves from being retro to intraperitoneal e.g. a paraduodenal recess

possible site for hernia

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51
Q

what is the significance of the peritoneal pouches, recesses, spaces and gutters

A

can house puss or blood or allow the spread of infection around the abdomen

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52
Q

where is the right hepatorenal pouch

A

behind the liver
above the kidney

puss can get into the space and form and abscess
it could overflow into the lesser sack
this is more likely if the patient is recumbent
this is due to the proximity to the epiploic foramen

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53
Q

what folds are visible on the anterior abdominal wall peritoneum

A

lateral umbilical folds, medial umbilical folds and median umbilical fold

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54
Q

what does the median umbilical fold contain

A

urachus which extends from the urinary bladder to the umbilicus

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55
Q

what do the medial umbilical folds contain

A

obliterated umbilical arteries extending from the internal iliac arteries to the umbilicus

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56
Q

what raises the lateral umbilical folds

A

inferior epigastric arteries

extending from the deep inguinal rings to the arcuate lines

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57
Q

what connects the liver to the diaphragm

A

falciform ligament, coronary ligament and the right and left triangular ligaments

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58
Q

what connects the spleen to the posterior abdominal wall and to the stomach

A

splenorenal and gastro splenic ligaments

part of the greater omentum

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59
Q

what is the allantois

A

a canal that drains the urinary bladder of the foetus and runs with the umbilical cord

it becomes the urachus

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60
Q

what does intra peritoneal mean

A

the organ is almost totally covered with visceral peritoneum and is suspended within the peritoneal cavity

61
Q

what does retroperitoneal mean

A

organs lie outside or behind the peritoneum and are only partially covered with visceral peritoneum

62
Q

is the ovary intraperitoneal?

A

yes- it has absorbed its peritoneal covering

63
Q

what does secondarily retroperitoneal mean

A

the mesentery has been resorbed and lost

it used to be intra peritoneal but then moved out

64
Q

what organs are 1o retroperitoneal

A

adrenal glands
kidneys
ureter
bladder

Aorta
IVC

oesophagus
rectum

65
Q

what organs are 2o retroperitoneal

A

head, neck and body of the pancreas
the distal part of the duodenum
ascending and descending parts of the colon

66
Q

where is the tail of the pancreas located

A

splenorenal ligament

67
Q

where does appendix pain refer to

A

t10- peri umbilical

68
Q

what is the parietal peritoneum sensitive to

A

pain, temperature, touch, and pressure

69
Q

what is visceral peritoneum sensitive to

A

stretch and tear e.g. in inflammation

70
Q

what is the parietal peritoneum in the pelvis supplied by

A

obturator nerve

L2,3,4

71
Q

what is the visceral peritoneum supplied by

A

autonomic afferent nerves that supply the viscera or travel in the mesentery

72
Q

where does gallbladder pain refer to

A

shoulder tip and right side

73
Q

what is a coelom

A

a cavity

74
Q

what happens to the conceptus 12 days post fertilisation

A

implants in uterine mucosa

forms bilaminar disc

75
Q

what is the neural tube and body wall derived from

A

ectoderm

76
Q

what is the cardiovascular, musculo skeletal system and coeloms derived from

A

mesoderm

77
Q

what is the gastro-intestinal, respiratory and reproductive tracts derived from

A

endoderm

78
Q

what does the notochord develop from

A

primitive node between endo and ectoderm

79
Q

what is the peritoneal cavity derived from

A

intra embryonic coelom

80
Q

what is the posterior abdo wall made from

A

mesoderm

81
Q

what is exomphalos

A

failure of intestine to return to abdomen; lies within peritoneum and amnion, in umbilical cord

82
Q

what is gastroschisis

A

failure of abdo wall, contents outside abdomen and not covered

83
Q

what does the ventral mesenterary of the stomach and duodenum become

A

lesser omentum and falciform ligament

the falciform ligament and lesser omentum have free inferior borders

84
Q

what is the foregut

A

the anterior part of the alimentary canal, from the mouth to the duodenum, just distal to the liver. The foregut develops from the folding primitive gut

85
Q

what nerve supplies the foregut

A

coeliac trunk, refers pain to epigastrium T7-9

86
Q

What does the foregut give rise to

A

oesophagus, respiratory diverticulum, stomach, proximal duodenum, liver, billary system, pancreas and spleen

87
Q

what axes does the stomach rotate about

A

longitudinal axis and AP axis

88
Q

when does the stomach appear

A

4th week of development as a dilation of the foregut

89
Q

how does the stomach rotate

A

90 degrees clockwise around the longitudinal axis so that the left side faces anteriorly and the lesser curve faces to the right and greater to the left

AP axis so the pyloric part comes to lie on the right and oesophago-gastric junction slightly left so the greater curve faces left and inferior

90
Q

how does the duodenum move during development

A

it is initially found in the midline but the rotations of the stomach cause it to rotate and swing on the right

it then falls onto the posterior abdominal wall and becomes retroperitoneal

91
Q

describe the development of the duodenal lumen

A

proliferation of cells which destroys the lumen then it is re-canalised

92
Q

when does the liver develop

A

3rd week

from and endodermal bud

93
Q

describe the development of the liver

A

it penetrates the ventral mesentery and septum transversum and gives rise to the hepatic ducts and gallbladder

the liver develops in the ventral mesentery and grows up to reach the septum transversum

94
Q

what does the pancreas form from

A

dorsal and ventral endodermal buds from the duodenum, the rotation of the latter causes the ventral bud to migrate around to lie behind and fuse with the dorsal bud so that the adult pancreas lies in the curve of the duodenum

the ducts of the dorsal and ventral buds unite to form the main pancreatic duct

the accessory duct is a remnant of the duct of the dorsal bud

95
Q

what does the visceral peritoneum of the liver develop from

A

the ventral mesentery directly in contact with the liver

96
Q

what is an annular pancreas

A

the ventral pancreas may become bifid which then form an obstructive ring around the duodenum

a bifid gallbladder is also possible

97
Q

what does the liver divide the ventral mesentery into

A

lesser omentum and falciform ligament

98
Q

how does rotation of the stomach affect the ventral mesentery

A

throws it to the right

99
Q

where is the umbilical vein

A

the free edge of the falciform ligament

100
Q

where is the bile duct

A

the free edge of the lesser omentum along with the hepatic artery and portal vein

101
Q

where is the spleen

A

dorsal mesentery

102
Q

where is the free edge of the lesser omentum

A

vertically between the liver and duodenum

103
Q

where is the lesser sac

A

posterior to the stomach and the lesser omentum

104
Q

what is the anterior boundary of the epiploic foramen

A

free border of the lesser omentum with the bile duct, hepatic artery and portal vein

105
Q

what is the posterior border of the epiploic foramen

A

IVC

106
Q

what is the superior border of the epiploic foramen

A

caudate process of the caudate lobe of the liver

107
Q

what is the inferior border of the epiploic foramen

A

first part of the duodenum

108
Q

what is Pringle’s manoevre

A

compress the hepatic artery and portal vein between the finger and thumb to control bleeding

109
Q

what is the anterior border of the lesser sac

A

caudate lobe of liver, lesser omentum and stomach

110
Q

what is the posterior border of the lesser sac

A

pancreas

111
Q

what is the lateral border of the lesser sac

A

left kidney and adrenal gland, epiploic foramen

112
Q

where is the lesser sac

A

extends upwards as far as the diaphragm and downwards a little way between the layers of the greater omentum

113
Q

what is the dorsal mesentery

A

The portion of mesentery attached to the greater curvature of the stomach. it forms the greater omentum

114
Q

what is the space within the greater omentum called

A

omental bursa which is the same as the lesser sac

115
Q

where is the spleen

A

within the dorsal mesentery

116
Q

What is the lienorenal ligament

A

double layers of peritoneum between the spleen and the posterior abdominal wall close to the kidney

117
Q

what is the gastrolienal/ gastrosplenic ligament

A

the double layer between the spleen and the stomach

118
Q

where is the tail of the pancreas

A

extends into the lienorenal ligament

119
Q

where is the midgut

A

commences immediately distal to the entrance of the bile duct into the duodenum and ends 2/3rds along the transverse colon

120
Q

what is the nerve supply of the midgut

A

superior mesenteric plexus- refers pain to the peri-umbilical region -T10

121
Q

when does the midgut develop

A

week 5

122
Q

what connects the midgut to the yolk sac

A

vitelline duct

123
Q

through what angle does the midgut rotate

A

90 degrees anti clockwise in the hernia
a further 180 degrees as the loop drops back into the abdomen at 10 weeks

this leads to about 270 degrees rotation around the axis of the superior mesenteric artery

124
Q

what does the cranial limb of the midgut form

A

jejenum and ileum

125
Q

describe some congenital abnormalities related to the midgut

A 
partial or abnormal rotation 
Meckel's diverticulum 
vitilline cyst 
vitilline fistula or patent duct (faecal discharge at umbilicus)
failure of recanalization (narrowing or obstruction of the GI tract) 
gastrochisis
Omphalocele
umbilical hernia
126
Q

when is development of the hindgut

A

end of the 3rd week

127
Q

what develops from the hindgut

A

distal transverse colon
descending colon
sigmoid colon
rectum and upper anal canal

128
Q

what is the innervation of the hind gut

A

inferior mesenteric plexus

refers pain to the suprapubic region -t12

129
Q

what does the most inferior part of the hindgut develop from (anorectal canal)

A

cloaca

also develops into the urogenital system

130
Q

what is the distal third of the anal canal derived from

A

ectoderm

marked by the pectinate line

131
Q

what is the reason for imperforate anus

A

the anal membrane does not break down

132
Q

what is the reason for urogenital - anal fistulae

A

common embryological origin

133
Q

what types of anal-genital fistulae exist

A

uro-rectal fistulae
rectoperineal fistulae
rectovaginal fistulae

134
Q

what is Hirchsprung disease

A

lack of normal colonic innervation leads to a constricted, aganglionic segment of bowel, with a distended segment proximally where the innervation is normal

135
Q

describe the origins of the mesentery

A

base starts just left of L2 and passes obliquely downwards to the right ending above the sacroiliac joint
it crosses the 3rd part of the duodenum, aorta and IVC, right gonadal vessels and right ureter

136
Q

describe the root of the sigmoid mesocolon

A

root is in the left iliac fossa, crossing the birfurcation of the left common iliac vesses and left ureter
it transmits the sigmoid branches of the inferior mesenteric vessels plus nerves and lymphatics

137
Q

describe the root of the transverse mesocolon

A

fused to the inferior part of the greater omentum
root is inferior to the pancreas
transmits the middle colic vessels

138
Q

what are the paracolic gutters

A

spaces between the colon and the abdominal wall

139
Q

what is the innervation of the peritoneum lining the ant abdominal wall

A

lower six thoracic and first lumbar nerves

t7-12 and L1

140
Q

what is the nerve supply of the diaphragm

A

ventral rami of c3,4,5

141
Q

what are the components of the diaphragm

A

septum transversum
pleuroperitoneal membranes
dorsal mesentery of the oesophagus,
ingrowth from the body wall

142
Q

which part of the diaphragm contributes to the oesophageal hiatus

A

the right crus

143
Q

where does the left gastric artery pass through the diaphragm

A

t10

144
Q

where do the anterior and posterior vagal trunks pass into the abdomen

A

t10, through the right crus but left of the midline

145
Q

where does the right phrenic nerve enter the abdomen

A

t8, through the central tendon

146
Q

where does the descending thoracic aorta enter the abdomen

A

t12, behind the median arcuate ligament

147
Q

what structures pass through the crura

A

greater, lesser and least splanchnic nerves

148
Q

what do the dorsal and ventral endodermal buds go on to form

A

pancreas

MD3002 (56 decks)

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