End of Exam 1 material Flashcards
Peritoneum
the membranous lining of the abdomen (heart is pericardium and lungs is pleura) have parietal peritoneum (lining body cavity), visceral peritoneum (lines organs), and mesentery
Mesentery
Greater omentum (connects inferior to stomach to transverse colon; large flap of mesentery draps over rest of GI tract [small intestine] ) and lesser omentum (connects liver to stomach; site of omental bursa or hole connecting greater and lesser sacs; has hepatogastric ligament, hepatoduodenal ligament, and epiploic foramen(connects the 2 spaces))
Greater sac
anterior to the greater and lesser omentum
Lesser sac
posterior to the greater and lesser omentum
Intraperitoneal
covered in peritoneum, associated with mesentary; ex. stomach, small intestine (jejunum, ileum, some of duodenum) spleen, liver, gallbladder, vermiform appendix, some large intestine, (transverse colon, sigmoid colon) nerves and blood vessels travel though mesentery
Primary retroperitoneal
develops and stays behind (retro) the peritoneum ex. kidney and suprarenal glands
secondary retroperitoneal
originates within but merges back into peritoneum, ex. duodenum (descending, horizontal, ascending), pancreas, colon (ascending and descending) and rectum
Stomach location
sits on the left side of abdomen, roughly 9th rib, level of pyloris ; in the right/left upper quadrant AND right/left lower quadrant (trans-pyloric plane); connects to the liver via the lesser omentum
Stomach function and anatomy
Primarily digestion (proteases), some absorption; cardia (by esophagus), fundus (top of stomach), body (has longitudinal rugal folds), lesser curvature, greater curvature, pylorus (at end; has a pyloric sphincter)
The portal triad
bile duct, portal vein, proper hepatic artery; these 3 travel together through the hepatoduodenal ligament, cover the epiploic foramen
Duodenum
First part of small intestine, runs from right upper quadrant to left upper quadrant; releases bile (lipid digestion), bicarbonate (acid neutralization) and pancreatic enzymes (digestion); 1st part- superior (posterior part of cavity) intraperitoneal; 2nd part- descending (pancreatic glands/bile excreted; has minor duodenal papilla [doesn’t connect with bile] and Ampulla of Vater or the major duodenal papilla which is the major source of where bile is secreted) secondary peritoneal; [roughly site of foregut/midgut transition] ; 3rd part -horizontal (rungs under superior mesenteric artery) secondary peritoneal [passes under the SMA]; 4th part- ascending (rises from a posterior part, forward) intraperitoneal ; has circular folds, papilla, and Brunner’s glands
Jejunum and Ileum
2nd and 3rd parts of the small intestine, site of nutrient absorption; runs left upper quadrant to right lower quadrant; no distinct line separating jejunum and ileum; jejunum connects to the duodenum (Brunner’s glands and circular folds) and has large circular folds; the ileum has peyers patches, and small circular folds and connects to the large intestine (cecum)
large intestine/colon
Absorption, especially water; on right/left upper quadrant and right/left lower quadrants; cecum (base of colon), appendix (lymphoid tissue), ascending colon, right colic flexure (hepatic), transverse colon (drapes down; intraperitoneal), left colic flexure (splenic), descending colon, sigmoid colon (bend before rectum, intraperitoneal), rectum AND ileocecal valve (entry from ileum to colon), tenia coli (longitudinal bands of smooth muscle), haustra (bulges caused by tenia coli), semilumar folds (inside, depression/internal ridge found between haustra), and epiploic appendices (fat)
Liver
Production of bile, hormones, enzymes, filtering of blood, etc. Found in the right upper quadrant , has right and left lobe in the anterior view, has caudate lobe (between IVC and fissure for teres ligament; often receives blood from both left and right hepatic arteries) and quadrate lobe (between gallbladder and teres ligament) which are much smaller lobes in the posterior view; has falciform ligament separating the 2 anterior lobes, and round ligament (ligamentum teres of liver) at the end that is a remnant of the umbilical cord vein [does nothing; going toward the fetal heart from mom]; has a superior surface bare area (where diaphragm sits; parietal and visceral peritoneum fuse into diaphragm and the bare spot is where neither parietal nor visceral pleura is present )
Gall bladder
In the right upper quadrant, Storage and concentration of bile; tucked under right inferior lobe of liver; connects to both lier and ampulla of Vater in the descending part of the duodenum
pancreas
In the left upper quadrant, production of digestive enzymes and bicarbonate, secondary retroperitoneal, surrounded by the entire duodenum
Spleen
In the left upper quadrant; Removes blood cells, immune functions
Kidneys
In the left and right upper quadrant; filters blood, produces urine, primary retroperitoneal; attached to the suprarenal glands that lay on top –> ureter–> urinary bladder
Adrenal glands
In the left and right upper quadrant; lay on top of the kidneys; stress response, sex hormones, metabolism, immune system, etc; primary retroperitoneal
Foregut
From stomach to duodenum; celiac trunk (L1)
Midgut
from 1/3 of duodenum to 2/3 of colon; Superior mesenteric artery (L1)
Hindgut
From descending colon to rectum; Inferior mesenteric artery (L3)
Celiac trunk
(L1) Serves foregut, liver, gallbladder, and spleen; has 3 branches (left gastric [DOES NOT HAVE BRANCHES], splenic, and common hepatic)
Superior mesenteric artery
(L1)Serves midgut (duodenum to transverse colon) branches into Inferior pancreatic duodenal artery, middle colic artery, jejunal and ileal arteries, ileocolic artery, and right colic artery [horizontal/ inferior duodenum travel under the SMA]
Inferior mesenteric artery
(L3) Serves hindgut (descending colon to rectum) branches into left colic artery, sigmoid arteries, and superior rectal artery
Splenic Artery
Branch of Celiac trunk; Goes into spleen and branches into Left Gastro-omental artery and pancreatic branches
Common Hepatic Artery
Branch of Celiac trunk; branches into proper hepatic artery, right gastric artery, and gastroduodenal artery
Gastroduodenal Artery
Branch of Common Hepatic Artery; branches into right gastro-omental artery, Anterior and posterior superior pancreaticoduodenal artery, and duodenal branches
Anastomes within and between foregut
superior pancreaticoduodenum A. AND SMA, or left AND right gastric A. or, left AND right gastroomental A.
Anastomes within and between midgut
marginal artery of drummond (with similar collaterals for veins) or watershed (left colic flexure- risk for ischemia[necrotic tissue, cells can die; left colic and middle colic fuse into)
Anastomes within and between hindgut
middle AND inferior rectal arteries- come from the internal iliac artery
Renal arteries
(L1/L2) supply the kidneys; between SMA and IMA
Iliac arteries
Common iliac(main one that separates into external and internal), external iliac (supplies legs) and internal iliac (supplies rectum, inguinal region); superior to them is the aortic bifurcation (L4)
Veinous drainage of the Gastrointestinal
2 separate paths- caval (systemic) and portal; if it is NOT the GI tract, it is drained by the systemic system (ex. the IVC); If it IS the GI tract, it is drained by the portal system which in turn drains into the IVC; NOTE: the left testicular/ovarian vein drains into the left renal while the right testicular/ovarian vein drains into IVC
Caval systemic system
IVC; right and left inferior phrenic V, right suprarenal V, right and left renal V. (branches into left testicular/ovarian V and left suprarenal which anastomosis with left inferior phrenic), and right testicular/ovarian veins
Caval Portal system
Foregut( the same tissues drain via similarly named veins into the portal vein vs. the celiac artery) , midgut (SMV; the same tissues drain via similarly named veins into the SMV vs the SMA), hindgut (IMV; the same tissues drain via similarly named veins into the IMV vs the IMA)
Key things to remember about the portal system
Blood flows INTO the liver via the portal vein. Blood flows out of the liver by draining into the IVC, back into the systemic circulation
The IMV drains into the splenic V, which then drains into the portal vein
The SMV drains directly into the portal V.
Portal Caval Anastomes
No valves: flow can be in any direction, depending on the pressure gradient; 1. esophagus 2. rectum (anus) 3. superficial abdomen (umbilicus)
Esophagus Portal Caval Anastomoses
Portal (gastric veins to HPV)
Caval (Esophageal veins to Azygos veins)
Ex. blockage in the liver parenchyma (ex. cirrhosis) Forms esophageal varices which are enlarged veins that develop when normal blood flow to the liver is blocked