Exam 3 Flashcards
The liver lies mostly in which abdominal regions?
right hypochondrium and epigastric region
The spleen, funds and body of stomach lie mostly in which abdominal region?
left hypochondrium
Between what two layers of the abdomen would a extravasation of urine happen? What gender is it more common in? What causes it?
Between Scarpa’s facia and deep fascia of abdomen, more common in men, and trauma of spongy urethra
What comprises the rectus sheath
aponeuroses of the external oblique, internal oblique, and transversus abdominis
What structures does the rectus sheath enclose?
rectus abdominis, pyramidalis muscle, superior and inferior epigastric arteries and veins, and anterior primary rami of lower 6 thoracic nerves
What 4 vessels supply blood to anterior abdominal wall?
Superior and Inferior Epigastric, lumbar arteries, and deep circumflex iliac artery
Innervation of anterior abdominal wall
Lower 6 thoracic nerves
What forms the inguinal ligament and where does it extend to?
lower edge of the external oblique aponeurosis, and extends from ASIS to pubic tubercle
Is there a difference in diameter of inguinal canal between sexes? And what travels through it?
Yes, larger in males. Spermatic cord (males) Round ligament of uterus (female) and ilioinguinal nerve (both sexes)
What forms the conjoint tendon?
aponeuroses of internal oblique and transversus abdominis
What forms the anterior and posterior walls of inguinal canal?
Anterior: aponeurosis of external oblique, Posterior: conjoint tendon and transversalis fascia
What forms roof and floor of inguinal canal
roof: arching fibers internal oblique and transversus abdominis, floor: inguinal and lacunar ligaments
True or false, the superficial inguinal ring is made of three crura
false, made of two; lateral and medial crus
What forms the inguinal triangle?
Medially: rectus abdominis, Laterally: inferior epigastric vessels, Inferiorly: inguinal ligament
What is notable clinically about the inguinal triangle?
Area of potential weakness where direct inguinal hernias occur
In a child what direction is the inguinal canal facing?
much less oblique like in adult, more vertical
Why does the inguinal canal face obliquely in adults?
It strengthens the canal by being compressed by muscles
Are inguinal hernias more common in one sex? If so, why?
Yes, males. The males canal is larger in diameter for the spermatic cord
What is a indirect inguinal hernia? Where does it pass the inferior epigastric vessels?
Hernia that passes through deep inguinal ring, through canal, through superficial inguinal ring into groin region. Passes laterally to inferior epigastric vessels
How is a indirect inguinal hernia acquired? What percentage do indirect inguinal hernia account for?
Can be congenital or acquired through forced passage, 75%
What is a direct inguinal hernia? Where does it pass the inferior epigastric arteries? What percentage do direct inguinal hernias account for?
Punches directly through posterior wall of canal, bypassing deep inguinal ring (causes abdominal bulging)
Passes medially to vessels
25%
Are femoral hernias more common in men or women?
Women
The external spermatic fascia is derived from what?
external oblique aponeurosis
The cremasteric fascia is derived from what? How is it recognized
internal oblique muscle; bundles of muscle fibers
What are the bundles of muscle fibers in the cremasteric fascia collectively known as?
Cremaster muscle
What is the function of the cremaster muscle?
Control temperature of sperm
What is the internal spermatic fascia derived from?
trasversalis fascia
What is the ductus deferens
muscular duct which transports sperm from epididymis to ejaculatory duct
What is the pampiniform plexus of veins?
extensive network of veins, bulk of spermatic cord. Join at deep inguinal ring to form testicular vein
True or false, the ilioinguinal nerve runs through inguinal canal and superficial inguinal ring, accompanying the spermatic cord which it is a part of
False, it does accompany the spermatic cord, but it is not a part of it
What are the two branches of the iliolinguinal nerve?
Femoral branch, and Anterior scrotal or anterior labial nerves
What does the femoral branch of the iliolinguinal nerve supply?
upper medial thigh
What does the anterior scrotal or anterior labial nerve supply?
root of the penis and anterior part of scrotum, or mons pubis and anterior part of labia majora
Does the scrotum contain fat? Why or why not?
No, because fat is an insulator and would make controlling temp of sperm difficult
The dartos muscle is a continuation of what structures of abdominal cavity, and how does it differ from the cremaster muscle?
subcutaneous tissue, superficial and deep fascia, and it is smooth muscle not skeletal like cremaster
What is the tunica vaginalis? What are it’s layers
Serous covering of testes; Parietal layer (superficial) Visceral layer (deep, firmly adhered to testes and epididymis)
What is hydrocele
Accumulation of fluid with cavity of tunica vaginalis
What are the two functions of testes
production of spermatozoa and secretion of androgens
What is the Tunica Albuginea
fibrous outer covering of testes, deep to visceral layer of tunica vaginalis
Inside each lobule of the testes the seminiferous tubules have what function?
Produce sperm
Describe the path of sperm from production in the seminiferous tubules to the ductus deferens
Sperm enter a net like structure called the rete testis via the straight tubules; then enter the head of the epididymis via the efferent ductules, then travel down the body of the epididymis to the tail finally to the ductus deferens
What is the function of the epididymis
Store sperm until they are mature
Lymphatically, where do the testes drain into? Does it differ from where the scrotum drains?
Testes drain into lumbar nodes, and yes the scrotum drains into superficial inguinal nodes
What causes decent of the testes
Release of testosterone
Where do the testes develop before decent
lumbar region of abdomen
Where and when do the testes usually descend?
Through the inguinal canal, and usually just before birth
What is the gubernaculum testis and what is it’s function
Ligament present in fetus, connects the testis to scrotum. Contracts to pull testis down though inguinal canal
What is cryptorchidism? How is it treated? Unilateral or bilateral?
Undescended testes at birth, treated with testosterone. Usually unilateral
What is the peritoneum?
Smooth membrane which lines abdominal cavity
What are the two layers of peritoneum?
Parietal (covering abdominal walls) and Visceral (covering abdominal organs)
What are two common types of individuals who would be susceptible to infection of the peritoneal cavity?
Immunocompromised women, and women who gave birth in unsanitary conditions
Is the peritoneal cavity closed in both sexes?
No, in males it is but in females the uterine tubes travel through it (infections of vagina can enter peritoneal cavity this way)
What are retroperitoneal organs and what is one example of one
organs lying posterior to the peritoneum (covered only on anterior side of organ; example: kidneys
What is Ascites
Accumulation of fluid in the peritoneal cavity
Is the peritoneum absorbent? How can this play a role clinically?
Yes, highly absorbent.
Because of absorbency, rabies vaccine is given here, and kidney dialysis performed here
What causes ascites
malnutrition, congestive heart failure, liver failure, kidney failure, peritonitis
What is peritonitis
Inflammation of the peritoneum
What causes peritonitis
Trauma, inflammation bowl diseases (ruptured appendix), vaginal infections, perforated ulcers
Can adhesions occur in peritonitis?
Yes and often do
The parietal peritoneum is supplied by nerves of adjacent body such as:
Phrenic nerve, intercostal nerves, subcostal nerves, iliohypogastric nerve, ilioinguinal nerve
Is the parietal peritoneum sensitive to pain?
Yes, extremely
The visceral peritoneum is supplied by what nerves?
The autonomic nerves that travel with organs it invests
Is the visceral peritoneum sensitive to pain?
No
What is the Omentum?
Broad apron like reflection of peritoneum
The greater omentum has three parts which are:
Gastrophrenic ligament, Gastrosplenic ligament, and Gastrocolic ligament.
Why is the greater omentum often referred to as the “Abdominal Policeman”
Because it is very mobile and often attaches itself to areas of infection on nearby organs
What are the two parts of the lesser omentum
hepatogastric ligament and hepaoduodenal ligament
What does the general term of mesentery mean?
any double layer of peritoneum that connects portion of intestine to the body wall
What does the specific term of mesentery mean?
double layer of peritoneum that connects jejunum and ileum to body wall
What is the specific term of mesentery often referred to as?
mesentery proper
The omental bursa (lesser sac) is a closed sac except for where?
Where it connects to the greater sac through the omental foramen
How many divisions are in the greater sac? Are the spaces clinically significant?
5 (6 including hepatorneal recess which is an extension of sub hepatic) and yes, they channel and compartmentalize peritoneal fluid and infectious processes
What makes up the foregut (embryological)
distal esophagus, stomach and part of duodenum
What makes up the midgut (embryological)
entrance of bild duct and second part duodenum, ends with right 2/3 transverse colon
What makes up the hind gut (embryological)
Left 1/3 transverse colon, and upper part anal canal
Why are the three embryological divisions of the gastrointestinal tract important (foregut, midgut, and hind gut)
The adult derivatives share a unified blood supply and autonomic nerve supply
What is the blood supply of the foregut
branches of the celiac trunk
What is the blood supply of the midgut
branches of the superior mesenteric artery
What is the blood supply of the hind gut
branches of the inferior mesenteric artery
What is the sympathetic innervation of the foregut?
greater splanchnic nerves (T5-T9) and lesser splanchnic nerves (T10-T11)
What is the sympathetic innervation of the midgut
greater splanchnic nerves (T5-T9) and lesser splanchnic nerves (T10-T11)
What is the sympathetic innervation of the hind gut?
Lumbar splanchnic nerves (L1-L2)
What is the parasympathetic innervation of the foregut and midgut?
Vagus nerve
What is the parasympathetic innervation of the hind gut?
Pelvic splanchnic nerves (S2-S4)
What does sympathetic activation do to your gastrointestinal tract?
decreases motility and tone/contracts sphincters
What does parasympathetic activation do to your gastrointestinal tract?
Increases motility and tone/relaxes sphincters
What are the four major layers of the gut wall?
Mucosa, Submucosa, Muscularis Externa, and Serosa
Which layer of the gut wall is responsible for peristalsis?
Muscularis Externa
What are the two subunits of the Muscularis Externa?
Inner Circular Layer of muscle and Outer Longitudinal Layer of muscle
The Visceral peritoneum of the gut wall is referred to as what?
Serosa (One of the four major layers of gut)
True or false, the enteric nervous system is dependent on the CNS?
False, it is semi-independent
What are the two plexus’ of the enteric nervous system
Submucosal plexus and Myenteric plexus
What does the submucosal plexus of the enteric nervous system control?
muscularis mucosae, and mucus secreting glands
What does the myenteric plexus of the enteric nervous system control?
smooth muscle that causes peristalsis
What are the only two things the stomach can absorb?
alcohol and drugs
The cardinal orifice of the stomach is the opening between what two structures?
esophagus and stomach
The Pyloric orifice of the stomach is the opening between what two structures
stomach and duodenum
What is congenital hypertrophic pyloric stenosis
A tumor like increase in size of the pyloric sphincter which reduces the pyloric canal
Is congenital hypertrophic pyloric stenosis more common in one sex? And what does it cause?
Yes in males, and projectile vomiting
What is pylorospasm
Spasmodic contraction of pyloric sphincter causing difficulty of food passing from stomach to duodenum
What is a gastric ulcer
Crater like depression in mucosa of stomach
Explain how a healthy stomach avoids gastric ulcers from the presence of stomach acid?
Healthy stomach secretes viscous alkaline mucus which protects the stomach
What causes gastric ulcers
Excessive acid secretion (stress related) or Inadequate mucus barrier (usually related to presence of bacteria
Blood supply of the stomach comes from what artery’s branches
Celiac trunk
The C shape of the duodenum surrounds what structure?
Head of the pancreas
Name four parts of duodenum
Superior part, descending part, Horizontal part, Ascending part
What is Crohn’s disease?
An inflammatory disease which commonly affects distal ileum and adjacent colon but can affect part of digestive tract
Does Crohn’s disease affect all parts of the intestine? If so, how
Yes, causes thickening and ulcerations
What are some symptomatic results in a patient with Crohn’s
pain, diarrhea, and malabsorption
What is the etiology of Crohn’s
unknown, believed to be auto-immune
Adjustments of lower thoracics may relieve some symptoms in a patient with Crohn’s disease, why?
Innervation of small intestine is autonomic (Vagus, and greater and lesser splanchnic nerves)
What is the cecum
blind pouch found below ileocecal junction
What is the appendix?
Narrow muscular tube which contains lymphoid tissue
Is the position of the appendix variable? If so, where most common
Yes, retrocecal
The large intestine outside of absorbing water has what secondary function
involved in synthesis of some vitamins requiring bacterial action like Vitamin K
What is the ileal fold?
Two flaps that surround the junction of ileum and cecum.
When the ileal fold closes what structure is formed?
frenula
What is appendicitis
Inflammation of appendix (most common intra-abdominal inflammatory condition)
If appendicitis is left untreated and the appendix ruptures, what could result?
Peritonitis
What can cause appendicitis
Obstruction of lumen (lymphoid hyperplasia or fecal impaction)
What are the four parts of the colon
Ascending, transverse, descending and sigmoid
Describe Pyloric antrum
wide proximal part
Describe pyloric canal
narrow distal part
True or False the celiac trunk is the first unpaired branch of abdominal aorta
True
The left gastric artery is a branch of what?
Celiac trunk
Name the two branches off the left gastric artery
Esophageal and gastric
What is the largest branch of the celiac trunk
Splenic artery
The splenic artery gives off what branches/arteries
Pancreatic branches, short gastric arteries, and left gastro-omental artery
The common hepatic artery is a branch of what?
Celiac trunk
The gastroduodenal, surpaduodenal, right gastro-omental, and superior pancreaticodeodenal artery are all branches of what?
Common Hepatic artery
What are the four branches of the Hepatic artery proper
Right and Left Hepatic arteries, Right gastric artery, and the cystic artery (‘cyst’ mean bladder)
The absorption of nutrients happens almost exclusively in what organ?
Small intestine
Specifically what part of the small intestine is responsible for most nutrient uptake?
Jejunum
What is the ileum’s responsibility
absorb fat soluble vitamins, B12, and bile salts
What happens in the plicae circulares (circular folds in small intestine)
Area of lots of absorption, slow passage of materials
What is the function of peyers patches in the small intestine
immune defense
What is the innervation of the jejunum and ileum
superior mesenteric plexus
What is ileal (Meckel’s) diverticulum
Common malformation of digestive tract, has finger like pouch project from distal ileum
What other condition’s symptoms does ileal (Meckel’s) diverticulum often mimic
appendicitis
What parts of the large intestine are retroperitoneal and which are intraperitoneal
Retroperitoneal: Ascending and Descending colon.
Intraperitoneal: Transverse and Sigmoid colon.
What are the taeniae coli?
Narrow bands of muscle seen in cecum and ascending colon
What are haustra of colon
sacculations or outpouchings
What are omental appendices
small masses of fat covered with visceral peritoneum extending from colon
What is diverticulosis? Who is it common in? Is it more common in one area of colon?
Heriniations of mucosa of colon through muscular layer (without inflammation).
Common people over 40.
Yes, Sigmoid
If diverticulosis becomes inflamed what is it called? What are the symptoms? What is it related to and are there dietary restrictions?
Diverticulitis
Diarrhea, abdominal pain
Related to a low fiber diet, and yes; cannot eat food with little seeds (can get caught in out pouches)
What is ulcerative colitis? What are some symptoms?
Severe inflammation/ulceration of rectum and lower colon
Abdominal pain and diarrhea
What is irritable bowel syndrome? Etiology?
“Spasmodic Colon” causes pain and diarrhea with no inflammation
Etiology is unknown though believed to be stressed related
Where does the marginal artery run and what empties into it?
Runs from cecum to sigmoid colon
All branches of superior and inferior mesenteric arteries empty into it
What is the innervation of colon from cecum to right 2/3 of transverse colon
superior mesenteric plexus
What is the innervation of left 1/3 transverse colon to anal canal?
inferior mesenteric plexus and hypogastric plexus
What are the two venous systems within the trunk?
Portal and Caval
What does the portal venous system drain?
Drains gastrointestinal tract, spleen, pancreas, and gallbladder
What is the portal vein formed of and where does the union happen?
Union of splenic vein and superior mesenteric vein
Happens behind head of pancreas
Name the four tributaries of the portal vein
Splenic vein, superior mesenteric vein, left gastric vein, and paraumbilical veins
What is true for all of the tributaries of the portal vein except the paraumbilical vein
All of them accompany arteries of the same name
What is cirrhosis of the liver? As a result what happens to the liver?
Destruction of hepatic cells which are replaced by fibrous tissue or fat
Liver becomes hard
What happens to the portal vein in cirrhosis of liver
tends to become constricted at porta hepatis
What are the causes of cirrhosis of liver
Alcoholism, hepatitis, chronic obstruction of bile duct, and congestive heart failure
What is portal hypertension? What often causes it?
Abnormal elevation of pressure within the portal system
Often due to constriction of the portal vein at the porta hepatis due to cirrhosis of the liver
Does the portal system have valves? Does this cause complications?
No it doesn’t, and yes; in portal hypertension flow is reversed bypassing the liver into the caval system
This causes the veins in this area to varicose
In portal hypertension, if blood backs up into esophageal region what is the obstructive sign
Esophageal varices (varicose veins of esophagus) can rupture and be fatal
In portal hypertension, if blood backs up around umbilicus (superficial veins of abdominal wall) what is the obstructive sign
“medusa” pronounced snake like veins around umbilicus
In portal hypertension, if blood backs up around rectum or anal canal what is the obstructive sign?
hemorrhoids
Damage to the liver can cause what disease?
Jaundice
What causes the yellowing of skin in jaundice?
Release of bilirubin (bile pigments)
What is the largest visceral organ and largest gland of the body?
The liver
What are four main functions of the liver
Bile secretion,
metabolism of proteins, fats, and carbs,
storage of glycogen, vitamins and iron
Detoxification
What are the two surfaces of the liver
Diaphragmatic and Visceral
What are the three structures located in the porta hepatis
common hepatic duct
hepatic artery proper
portal vein
What are the four anatomical lobes of the liver
The right and left lobe of the liver, Quadrate and Caudate lobes
Do the anatomical lobes correspond to function of liver?
No, only descriptive. The functional halves correspond to function
The left and right functional halves of the liver have 8 hepatic segments how do they correspond to the left and right halves?
Hepatic segments I-IV in left functional half
Hepatic segments V-VIII in right functional half
What is the bare area of the liver? Where is it located?
only area of liver not covered with visceral peritoneum
posterior aspect of diaphragmatic surface-liver maintains contact with diaphragm in this area
What ligament forms the borders of the bare area of liver
coronary ligament
What is the blood supply of the liver?
portal vein and hepatic artery
What is the innervation of the liver?
hepatic plexus which is an extension of celiac plexus
What is the function of the gallbladder? What hormone stimulates it
Stores bile and concentrates it by absorbing water
it contracts to expel bile into duodenum when food arrives
Contraction stimulated b cholecystokinin (CCK)
What is the blood supply of the gallbladder?
right hepatic artery
What is the innervation of the gallbladder?
celiac plexus
Name the 6 ducts of the biliary duct system
right and left hepatic ducts, common hepatic duct, cystic duct, hepatopancreatic ampulla, and bile duct
What are gallstones? What are they composed of?
hard masses formed by solidification of bile constituents
mainly composed of cholesterol crystals
Where do gallstones typically get stuck?
hepatopancreatic ampulla because it is narrowest point in biliary passage
What happens if gallstone blocks biliary duct and causes back up of bile
acute pancreatitis
What area of spine will pain often be referred to in diseases involving liver, gallbladder, or stomach
T8-T12
A gallbladder attack most commonly causes pain where?
in right upper quadrant of abdomen
True or false the pancreas is both an exocrine and endocrine gland
true
What is the exocrine function of the pancreas
secretion of digestive enzymes
What is the endocrine function of the pancreas
secretion of hormones insulin and glucagon
What duct drains the neck, body and tail of the pancreas
Pancreatic duct
What duct drains the head and uncinate process of the pancreas
accessory pancreatic duct
What are the three vessels supplying the pancreas
pancreatic branches of splenic artery, superior and inferior pancreaticoduodenal artery
What is the innervation of pancreas
celiac plexus
What can cause rupture of pancreas?
Forceful compression of abdomen in auto accident
What are three main functions of spleen
Produces lymphocytes
Removes worn out RBC and other cellular debris
Stores RBC
True or false the spleen is an endocrine organ?
False, it is a lymphatic organ
What are the three surfaces on the visceral surface of the spleen
Gastric surface
Colic surface
Renal surface
What is the blood supply of the spleen?
Splenic artery and Splenic vein
What is the innervation of spleen?
celiac plexus
What is the most frequently injured abdominal organ?
Spleen
What organ is vulnerable to blows to left hyochondrium
Spleen
What happens when spleen ruptures and how does it happen?
Hemorrhage and shock
trauma
In what cases is the spleen more fragile to rupture
Mononucleosis
Malaria
Sickle cell anemia
Septicemia (blood poisoning)
When spleen is removed, what organ takes over role of destroying old RBC
Liver
