Exam III Flashcards
These are vertical planes which extend inferiorly from the midpoints of the clavicles to the midpoints of lines joining the anterior superior iliac spine to the pubic symphysis.
Midclavicular planes
This is a horizontal plane jointing the lowest point of the costal margin on each side. It lies at the inferior margin of rib 10 (L3 level).
Subcostal plane
This is a horizontal plane which joins the tubercles of the iliac crests (L5 level).
Transtubercular plane
What are the nine regions of the abdomen?
- Right hypochondrium
- Epigastric
- Left Hypochondrium
- Right Flank (Lateral)
- Umbilical
- Left Flank (Lateral)
- Right Groin (Inguinal)
- Pubic
- Left Groin (Inguinal)
Which organ lies mostly in the right hypochondrium and epigastric region?
Liver
Which organs are found in the left hypochondrium?
Spleen and the fundus and body of the stomach
Which planes are used to create the quadrant system of the abdomen?
- Median Plane
- Transumbilical plane
The umbilicus is a variable landmark which lies between which vertebral levels?
L2-L5
-It is lower in children and the elderly than in young adults
What are the layers of the anterior abdominal wall from superficial to deep?
- Skin
- Superficial layer of superficial fascia (Camper’s fascia)
- Deep layer of superficial fascia (Scarpa’s fascia)
- Deep (investing) fascia
- External oblique muscle
- Internal oblique muscle
- Transversus abdominis muscle
- Transversalis fascia
- Extraperitoneal fascia
- Parietal Peritoneum
- Peritoneal Cavity
- Visceral Peritoneum
- Abdominal Organs
Super Silly Dogs Dance Excessively Inside To Take down Extremely Pessimistic People in VA
This subdivision of superficial fascia is a thin fatty layer which is continuous with the superficial fascia of the perineum and thigh.
Superficial layer (Camper’s Fascia)
This subdivision of superficial fascia is a membranous layer which is firmly fastened to the fascia lata of the thigh, just below the inguinal ligament.
Deep layer (Scarpa’s Fascia)
Between what two layers of fascia is there a potential space where a leakage of urine can accumulate?
Scarpa’s fascia and the deep fascia of the abdomen
This structure is a median tendinous raphe which extends from the xiphoid process to the pubic symphysis . Anterior abdominal wall muscles insert into this raphe via their aponeuroses.
Linea alba
What is the origin of the external oblique muscle?
Lower 8 ribs
What is the insertion of the external oblique muscle?
Iliac crest, anterior iliac spine, pubic tubercle, and linea alba by aponeurosis
What is the innervation of the external oblique muscle?
Anterior primary rami of the lower 6 thoracic nerves
What is the action of the external oblique muscle?
Compresses the abdomen, supports abdominal viscera, and is a lateral flexor of the trunk
In which direction do the fibers of the external oblique muscle run?
Downward and forward
What is the origin of the internal oblique muscle?
Lumbar fascia, iliac crest, lateral 2/3 of inguinal ligament
What is the insertion of the internal oblique muscle?
Lower 3 ribs, linea alba by aponeurosis
What is the innervation of the internal oblique muscle?
Anterior primary rami of the lower 6 thoracic and first lumbar nerves
What is the action of the internal oblique muscle?
Compresses the abdomen, supports abdominal visceral, and is a lateral flexor of the trunk
In which direction do the fibers of the internal oblique muscle run?
Downward and backward
What is the origin of the transversus abdominis muscle?
Lower 6 costal cartilages, lumbar fascia, iliac crest, and the lateral third of the inguinal ligament
What is the insertion of the transversus abdominis muscle?
Into the linea alba by aponeurosis
What is the innervation of the transversus abdominis muscle?
Anterior primary rami of the lower 6 thoracic and first lumbar nerves
What is the action of the transversus abdominis muscle?
Compresses the abdomen, supports abdominal viscera, and acts as an internal back brace to support the spine
In which direction do the fibers of the transversus abdominis muscle run?
Horizontally across the abdomen
What is the origin of the rectus abdominis muscle?
Pubic crest and pubic symphysis
What is the insertion of the rectus abdominis muscle?
Xiphoid process and the costal cartilages of ribs 5-7
What is the innervation of the rectus abdominis muscle?
Anterior primary rami of the lower 6 thoracic nerves
What is the action of the rectus abdominis muscle?
Compresses the abdomen, supports abdominal viscera, and is an anterior flexor of the trunk
The linea alba lies between which two muscles?
The left and right rectus abdominis muscles
This is a curved line along the lateral border of the rectus abdominis muscle.
Linea semilunaris
What is the origin of the pyrimidalis muscle when present?
Body of the pubis
What is the insertion of the pyramidalis muscle when present?
Linea alba
What is the innervation of the pyramidalis muscle when present?
Subcostal nerve
What is the action of the pyramidalis muscle when present?
Tenses the linea alba
Anterior abdominal wall muscles are active in which functions?
- Coughing
- Sneezing
- Vomiting
- Defecation
- Micturation
- Parturition
This structure is formed by the aponeuroses of the external oblique, internal oblique, and transversus abdominis muscles.
Rectus sheath
What does the rectus sheath enclose?
- Rectus abdominis muscle
- Pyramidalis muscle (when present)
- Superior epigastric artery and vein
- Inferior epigastric artery and vein
- Anterior primary rami of lower 6 thoracic nerves
This is a crescent shaped line in the posterior layer of the rectus sheath located midway between the umbilicus and pubic crest.
Arcuate line
What lies above the arcuate line?
- Anterior layer of the rectus sheath composed of the aponeuroses of the external and internal oblique muscles
- Posterior layer of the rectus sheath composed of the aponeuroses of the internal oblique and transversus abdominis muscle
What lies below the arcuate line?
- Anterior layer of the rectus sheath composed of the aponeuroses of the external oblique, internal oblique, and transversus abdominis muscles
- Posterior layer of the rectus sheath formed by the transversalis fascia
Five folds are present on the posterior surface of the anterior abdominal wall, below the umbilicus. What are they?
- Median umbilical fold
- Medial umbilical fold (left and right)
- Lateral umbilical fold (left and right)
This umbilical fold extends from the apex of the bladder to the umbilicus. It contains the urachus.
Median umbilical fold
This umbilical fold extends from the side of the bladder to the umbilicus. It contains the obliterated umbilical artery.
Medial umbilical fold
This umbilical fold extends from the deep inguinal ring to the arcuate line. It contains the inferior epigastric vessels.
Lateral umbilical fold
What is each umbilical fold on the posterior surface of the anterior abdominal wall formed from?
Parietal peritoneum overlying a structure
The umbilical folds form the boundaries between three paired fossae. What are they and where are they located?
- Supravesical fossa: between the median and medial umbilical folds
- Medial inguinal fossa: between the medial and lateral umbilical folds
- Lateral inguinal fossa: lateral to the lateral umbilical fold
This structure lies above the umbilicus and contains the obliterated umbilical vein. It is the free edge of the falciform ligament, which is attached to the liver.
Ligamentum teres
What is the blood supply of the anterior abdominal wall?
- Superior epigastric artery (from the internal thoracic artery)
- Inferior epigastric artery (from the external iliac artery)
- Lumbar arteries (from the abdominal aorta)
- Deep circumflex iliac artery (from the external iliac artery)
What is the innervation of the anterior abdominal wall?
Lower 6 thoracic nerves
Which nerves run between the internal oblique and transversus abdominus muscles?
7th to 12th thoracic nerves
This structure is formed by the lower edge of the external oblique aponeurosis. It extends from the anterior superior iliac spine to the pubic tubercle.
Inguinal ligament
These are the most medial fibers of the inguinal ligament which are inserted into the superior pubic ramus.
Lacunar ligament
This is a lateral extension of the lacunar ligament along the pecten pubis (pectineal line).
Pectineal ligament
This structure is an oblique passage 3-5 cm in length through the anterior abdominal wall. It begins at the deep inguinal ring and ends at the superficial inguinal ring.
Inguinal canal
The inguinal canal is much larger in the male than the female. What does it transmit?
- Spermatic cord (in the male)
- Round ligament of the uterus (in the female)
- Ilioinguinal nerve (in both sexes)
This is formed by the fusion of the aponeuroses of the internal oblique and transversus abdominis muscles as they insert into the pubic crest and pecten pubis deep to the inguinal ligament. This structure strengthens the posterior wall of the medial half of the inguinal canal.
Conjoint tendon (inguinal falx)
What are the boundaries of the inguinal canal?
- Anterior wall: formed by the aponeurosis of the external oblique muscle
- Posterior wall: formed by the conjoint tendon and transversalis fascia
- Roof: formed by the arching fibers of the internal oblique and transversus abdominis muscles
- Floor: formed by the inguinal and lacunar ligaments
This is a triangular opening in the external oblique aponeurosis. It lies immediately lateral to the pubic tubercle.
Superficial inguinal ring
The superficial inguinal ring is formed by the splitting of the external oblique aponeurosis into two crura. What are they?
- Lateral crus: inserts into the pubic tubercle
- Medial crus: inserts into the pubic crest
These fibers strengthen the apex of the superficial inguinal ring.
Intercrural fibers
This is an opening within the transversalis fascia. It is located above the inguinal ligament midway between the anterior superior iliac spine and the pubic symphysis. It lies just lateral to the inferior epigastric vessesls.
Deep inguinal ring
This is an area of potential weakness in the anterior abdominal wall. Direct inguinal hernias occur here.
Inguinal triangle
What are the boundaries of the inguinal triangle?
- Medially by the lateral edge of the rectus abdominis muscle
- Laterally by the inferior epigastric vessels
- Inferiorly by the inguinal ligament
What is the orientation of the inguinal canal before birth? Adulthood?
The inguinal canal is much shorter and less oblique before birth. The superficial ring lies almost directly anterior to the deep inguinal ring. In the adult the canal lengthens and assumes its characteristically oblique position
What two anatomical adaptations function to strengthen the inguinal canal?
- Its oblique nature allows it to be compressed by the muscles of the anterior abdominal wall when they contract
- Conjoint tendon reinforces the posterior wall of the inguinal canal
This condition is an abnormal protrusion of tissue through an opening.
Hernia
Inguinal hernias are more common in males than females. Why?
- The large diameter of the inguinal canals in males
- The scrotum is an outpouching of the anterior wall. It creates a large potential space for abdominal viscera to fill.
What are the two types of inguinal hernias?
- Indirect inguinal hernia
- Direct inguinal hernia
This type of inguinal hernia passes through the deep inguinal ring, inguinal canal, and superficial inguinal ring before descending into the scrotum (or labia majora), it passes lateral to the inferior epigastric vessels, and accounts for 75% of inguinal hernias.
Indirect inguinal hernia
This type of inguinal hernia passes directly through the posterior wall of the inguinal canal, bypassing the deep inguinal ring. It passes medial to the inferior epigastric vessels, through the inguinal triangle, causes a general bulging of the anterior abdominal wall, but does not descend into the scrotum, and is always acquired.
Direct inguinal hernia
This is an embryological outpouching of peritoneum which forms the inguinal canal and the tunica vaginalis of the scrotum. It normally obliterates. When it does not, it leaves a sizable passageway for intestines to pass into the scrotum.
Processus vaginalis
This other kind of hernia passes through the femoral canal, occurs inferior to the inguinal ligament, and is more common in females than men.
Femoral hernia
This other kind of hernia usually results from incomplete closure of the anterior abdominal wall after ligation of the umbilicus at birth. It can also occur due to defects in the linea alba.
Umbilical hernia
What are the three concentric layers of fascia derived from the anterior abdominal wall that cover the spermatic cord?
- External spermatic fascia
- Cremasteric fascia
- Internal spermatic fascia
What is the origin of the cremaster muscle?
Internal oblique muscle, inguinal ligament, pubic tubercle, pubic crest
What is the insertion of the cremaster muscle?
Spermatic cord
What is the innervation of the cremaster muscle?
Genital branch of the genitofemoral nerve (L1, L2)
What is the action of the cremaster muscle?
To retract the testis
A subluxation of what vertebral levels can decrease sperm levels?
L1 and L2
What structures does the spermatic cord contain?
- Ductus deferens
- Testicular artery
- Pampiniform plexus of veins
- Artery to the ductus deferens
- Cremasteric artery
- Genital brach of genitofemoral nerve
- Remnant of processus vaginalis
- Autonomic nerves
- Lymphatics
This is a muscular duct which transports sperm from the epididymis to the ejaculatory duct.
Ductus deferens
This is an extensive network of veins which makes up the bulk of the spermatic cord. These veins join together at the deep inguinal ring to form the testicular vein.
Pampiniform plexus of veins
This term is used to describe varicose veins in the pampiniform plexus.
Varicocele
The ilioinguinal nerve runs through the inguinal canal and superficial inguinal ring. It accompanies the spermatic cord but is not part of it. What are its two branches?
- Femoral branch: supplies the upper medial part of the thigh
- Anterior scrotal or anterior labial nerve: anterior scrotal nerve supplies the root of the penis and anterior part of the scrotum. Anterior labial nerve supplies the mons pubis and anterior part of the labia majora
This is an outpouching of the anterior abdominal wall. Its skin is thin with little or not fat and it is important for maintaining a temperature below body temperature.
Scrotum
What structures does the scrotum contain?
- Testes
- Epididymis
- Lower part of the spermatic cord
These are smooth muscle fibers which are firmly adherent to the skin of the scrotum. It functions in temperature regulation.
Dartos muscle
This layer of the scrotum is the continuation of peritoneum and contains both a parietal (superficial, lies internal spermatic fascia) and visceral layer (deep, firmly adherent to the testis and epididymis).
Tunica Vaginalis
What are the functions of the testes?
- Production of spermatozoa
- Secretion of androgens
This is the fibrous outer covering of the testis. It lies deep to the visceral layer of the tunica vaginalis, which is the deepest layer of the stcrotum.
Tunica Albuginea
This is a fibrous compartment in the posterior part of the testis where the septa converge.
Mediastinum testis
This is the functional, sperm producing portion of the testis. Each lobule contains 2 to 3 of these and they unite to form straight tubules.
Seminiferous tubules
This is an elaborate network of canals located within the mediastinum testis into which the straight tubules empty.
Rete testis
These are ducts which connect the rete testis to the head of the epididymis.
Efferent ductules
This is a C-shaped structure attached to the superior and posterior aspect of the testis. It functions to store sperm until they mature.
Epididymis
What are the three parts of the epididymis?
- Head: connected to the superior surface of the testis by the efferent ductules
- Body: located along the posterior surface of the testis
- Tail: ends in the ductus deferens
What is the lymphatic drainage of the testis? Scrotum?
- Testis drain into the lumbar nodes
- Scrotum drains into the superficial inguinal nodes
This is a ligament present in the fetus which connects the testis to the scrotum. It contracts to pull the testis downward and through the inguinal canal during its descent.
Gubernaculum testis
This condition is characterized by undescended testes, which are found in the inguinal canal and usually unilateral. It causes a decrease in fertility and if not corrected infertility. Androgen secretions are unimpaired.
Cryptorchidism
This is the smooth membrane which lines the abdominal cavity.
Peritoneum
This is a potential space between the parietal and visceral peritoneum. It is empty except for a film of serous fluid.
Peritoneal cavity
How is a test for patency of the uterine tubes conducted?
A dye is introduced into the uterus and normally enters the uterine tubes and then into the peritoneal cavity. If it does not, there is an obstruction
What are the functions of the peritoneum?
- To minimize friction between organs
- To resist infection
- Fat storage
These types of organs lie posterior to the peritoneum and are covered by peritoneum only on their anterior surface. An example is the kidney.
Retroperitoneal organs
This condition is characterized by an accumulation of fluid within the peritoneal cavity. Causes include malnutrition, congenital heart failure, liver and kidney failure, and peritonitis. It represents an imbalance between fluid production and absorption.
Ascites
What is the peritoneal cavity used for due to its highly absorbent nature?
- Rabies vaccine
- Kidney dialysis
This condition is characterized by an inflammation of the peritoneum, which usually results from an infection. Causes include trauma, inflammatory bowel disease, vaginal infections, and perforated ulcers. It often results in adhesions between parietal and visceral peritoneum.
Peritonitis
What is the innervation of the parietal peritoneum?
- Phrenic nerve
- Intercostal nerves
- Subcostal nerve
- Iliohypogastric nerve
- Ilioinguinal nerve
It is very sensitive to pain
What is the innervation of the visceral peritoneum?
Autonomic nerves which travel within the organs it invests. It is insensitive to pain
This is a broad, apronlike reflection of peritoneum.
Omentum
This is a large apronlike structure which hangs from the greater curvature of the stomach, covering abdominal viscera. It reflects posteriorly to attach to the transverse colon and transverse mesocolon. It is often referred to as the “abdominal policeman”.
Greater omentum
What are the three parts of the greater omentum?
- Gastrophrenic ligament: between the greater curvature of the stomach and diaphragm
- Gastrosplenic ligament: between the greater curvature of the stomach and spleen
- Gastrocolic ligament: between the greater curvature of the stomach and transverse colon.
This is a double layer of peritoneum which extends from the porta hepatis (hilum) of the liver to the lesser curvature of the stomach and the beginning of the duodenum.
Lesser omentum
What are the two parts of the lesser omentum?
- Hepatogastric ligament: between the liver and the lesser curvature of the stomach
- Hepatoduodenal ligament: between the liver and the duodenum
What is the general definition of mesentery?
Any double layer of peritoneum which connects a portion of intestine to the body wall.
What is the specific definition of mesentery?
The double layer of peritoneum which connects the jejunum and ileum to the body wall.
This connects the transverse colon to the posterior body wall.
Transverse mesocolon
This connects the sigmoid colon to the pelvic wall.
Sigmoid mesocolon
This connects the appendix to the mesentery of the ileum.
Mesoappendix
This attaches the left colic flexure to the diaphragm, below the spleen.
Phrenicocolic ligament
This is an irregularly shaped space which lies posterior to the liver, lesser omentum, and stomach. It is a closed sac except for its opening into the greater sac through the omental foramen.
Omental bursa (lesser sac)
This structure extend from the diaphragm to the pelvic floor and across the entire breadth of the abdominal cavity.
Greater sac
What are the subdivisions of the greater sac of the peritoneal cavity?
- Right subphrenic space (recess)
- Left subphrenic space (recess)
- Subhepatic space (recess): also contains the hepatorenal recess
- Right paracolic gutter
- Left paracolic gutter
What subdivisions of the greater sac of the peritoneal cavity make up Morrison’s pouch?
Subhepatic space and hepatorenal recess
What are the boundaries of the omental (epiploic) foramen?
- Liver (superiorly)
- First part of the duodenum (inferiorly)
- Free edge of the lesser omentum (anteriorly)
- Peritoneum covering the inferior vena cava (posteriorly)
What structures pass through the porta hepatis and are surrounded by the lesser omentum?
- Bile duct (to the right)
- Hepatic artery proper (to the left)
- Portal vein (behind)
Early in embryological development, the alimentary tract consists of what three independent parts?
- Foregut
- Midgut
- Hindgut
This part of the alimentary tract in embryological development will eventually develop into the distal esophagus, stomach, and part of the duodenum.
Foregut
This part of the alimentary tract in embryological development begins at the entrance of the bile duct into the second part of the duodenum, and ends with the right 2/3 of the transverse colon.
Midgut
This part of the alimentary tract in embryological development begins with the left 1/3 of the transverse colon, and ends in the upper part of the anal canal.
Hindgut
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 hindgut?
Branches of the inferior mesenteric artery
What is the sympathetic and parasympathetic innervation of the foregut?
Sympathetic: greater splanchnic nerves (T5-T9) and lesser spalnchnic nerves (T10-T11)
Parasympathetic: vagus nerve
What is the sympathetic and parasympathetic innervation of the midgut?
Sympathetic: greater splanchnic nerves (T5-T9) and lesser splanchnic nerves (T10-T11)
Parasympathetic: vagus nerve
What is the sympathetic and parasympathetic innervation of the hindgut?
Sympathetic: lumbar splanchnic nerves (L1-L2)
Parasympathetic: pelvic splanchnic nerves (S2-S4)
What are the four major layers of the gut wall?
- Mucosa
- Submucosa
- Mucularis Externa (inner circular layer and outer longitudinal layer)
- Serosa or Adventitia
This plexus of the enteric nervous system is found within the submucosa near border with muscularis externa. Postganglionic fibers supply mucularis mucosae and mucus secreting glands.
Submucosal plexus
This plexus of the enteric nervous system is found between the circular and longitudinal layer of muscularis externa. Postganglionic fibers supply these smooth muscle layers and stimulate peristalsis.
Myenteric plexus
What are the parts of the stomach?
- Cardia: where the esophagus joins the stomach
- Fundus: above the cardia
- Body: between the fundus and pyloric part
- Pyloric part: the most distal portion adjacent to the abdomen
The pyloric part of the stomach consists of what three subdivisions?
- Pyloric antrum: wide proximal part
- Pyloric canal: narrow distal part
- Pylorus: distal termination of the pyloric part which contains the pyloric orifice and pyloric sphincter
These are longitudinal folds of muscous membrane, located within the cavity of the stomach.
Gastric folds (rugae)
This condition is characterized by a tumor-like increase in size of the pyloric sphincter which reduces the size of the pyloric canal. It results in projectile vomiting when eating and requires surgical intervention early in infancy.
Congenital hypertrophic pyloric stenosis
This condition is characterized by spasmodic contractions of the pyloric sphincter. Food does not pass easily from the stomach to the duodenum and the stomach becomes “overfull” resulting in vomiting. Subluxation of T5-T9 may play a role.
Pylorospasm
This condition is characterized by crater-like depressions in the mucosa of the stomach forming. Causes include excess acid secretion as a result of stress or an inadequate mucus barrier (related to bacteria).
Gastric ulcer
Secretion of gastric acid by parietal cells is controlled by what nerve?
Vagus nerve (parasympathetic)
What layers do acute, chronic, perforating gastric ulcers penetrate?
Acute: mucosa
Chronic: submucosa
Perforating: All layers
What is the blood supply to the stomach?
Branches of the celiac trunk
What is the innervation of the stomach?
Celiac plexus. These fibers originate from the following sources:
Sympathetic from the greater splanchnic nerves (T5-T9)
Parasympathetic from the vagus nerve
What are the branches of the celiac trunk?
- Left gastric artery
- Splenic artery
- Common hepatic artery
This is the smallest branch of the celiac trunk. It runs along the lesser curvature within the lesser omentum to anastomose with the right gastric artery. It has both esophageal and gastric branches.
Left gastric artery
This is the largest branch of the celiac trunk. It runs posterior to the stomach, along the superior border of the pancreas to terminate in the spleen.
Splenic artery
What are the branches of the splenic artery?
- Pancreatic branches
- Short gastric arteries
- Left gastro-omental (gastroepiploic) artery
This branch of the celiac trunk runs to the right along the superior border of the pancreas. It becomes the hepatic artery proper after giving off the gastroduodenal artery.
Common hepatic artery
The gastroduodenal artery descends behind the first part of the duodenum off the common hepatic artery and gives off what three branches?
- Supraduodenal artery
- Right gastro-omental (gastroepiploic) artery
- Superior pancreaticduodenal artery
The hepatic artery proper participates in the formation of the anterior border of the omental foramen after branching from the common hepatic artery and gives off what three branches?
- Right gastric artery
- Right hepatic artery, which gives off the cystic artery to the gall bladder
- Left hepatic artery
The small intestine consists of what three parts?
- Duodenum
- Jejunum
- Ileum
The duodenum is a C-shaped tube which surrounds the head of the pancreas. It is the shortest and widest part of the small intestine. What are its four parts?
- Superior (first) part: the beginning of it is called the duodenal cap (ampulla)
- Descending (second) part: contains the junction of the foregut and midgut, where the bile duct and pancreatic duct empty
- Inferior or horizontal (third) part: the longest part
- Ascending (fourth) part: terminates at the duodenojejunal flexure
This is a fibromuscular band which extends from the diaphragm to the duodenojejunal flexure.
Suspensory muscle (ligament)
The duodenum is entirely _____ except for the duodenal cap, which is free (mobile).
Retroperitoneal
What is the blood supply of the duodenum?
- Superior pancreaticoduodenal artery (from the gastroduodenal artery)
- Supraduodenal artery (from gastroduodenal artery)
- Inferior pancreaticoduodenal artery (from superior mesenteric artery): supplies the third and fourth parts of the duodenum
What is the innervation of the duodenum?
Autonomic fibers from the celiac and superior mesenteric plexuses.
This condition is characterized by the mucosa in the duodenum becoming eroded. It is most common in the duodenal cap because stomach acid has not been neutralized yet. It causes the most damage to the gallbladder, liver, and pancreas and can result in severe hemorrhage due to erosion of the gastroduodenal artery.
Duodenal ulcer
This structure makes up the proximal 2/5 of the small intestine, distal to the duodenum. It begins at the duodenojejunal flexure and lies mostly in the left upper quadrant of the abdomen.
Jejunum
This structure makes up the distal 3/5 of the small intestine. It occupies the right lower quadrant of the abdomen, and joins the cecum at the ileocecal junction.
Ileum
These are the straight terminal branches of the arteries which travel through the mesentery to supply the small intestine.
Vasa recta
These are circular folds found within the small intestine.
Plicae circulares
These are aggregations of lymphoid tissue found within the walls of the small intestine.
Peyer’s patches
What is the blood supply of the jejunum and ileum?
Jejunal and ileal branches of the superior mesenteric artery
What is the innervation of the jejunum and ileum?
Autonomic fibers from the superior mesenteric plexus
This is a common malformation of the digestive tract characterized by finger like pouches projecting from the distal ileum. It is a remnant of a portion of the embryonic vitelline duct.
Ileal (Meckel’s) diverticulum
This is an inflammatory bowel disease which most commonly affects the distal ileum and colon, but can affetc any part of the GI tract. It restuls in pain, diarrhea, malabsorption, and enlargement of lymph nodes. It produces a “cobblestone” radiographic appearance
Crohn’s disease
This structure extends from the ileocecal junction to the anus and primarily functions to convert the liquid contents of the ileum into semisolid feces by absorbing water.
Large intestine
This part of the large intestine is a blind pouch found below the ileocecal junction. It lies within the right iliac fossa.
Cecum
This part of the large intestine consists of two flaps which surround the ileal orifice. The flaps fuse laterally to form the frenula, which prevents the back flow of fecal matter.
Ileal fold
This part of the large intestine is a narrow muscular tube which may contain lymphoid tissue in its walls. It arises from the posteromedial aspect of the cecum and is attached to the mesentery of the ileum by the mesoappendix.
Appendix
This condition is characterized by an inflammation of vermiform appendix and is the most common intra-abdominal inflammatory condition. It is caused by obstruction of lumen due to lymphoid hyperplasia or fecal impaction. If left untreated the appendix may rupture leading to peritonitis.
Appendicitis
What are the four parts of the colon?
- Ascending colon: from the ileocecal junction to the right colic (hepatic) flexure
- Transverse colon: from the right colic flexure to the left colic (splenic) flexure
- Descending colon: from the left colic flexure to the pelvic brim.
- Sigmoid colon: from the pelvic brim to the front of the sacrum, where it becomes the rectum
This feature of the colon contains three narrow longitudinal bands of muscle seen most prominently in the cecum and ascending colon.
Taeniae coli
These features of the colon are sacculations or outpouchings of the colon.
Haustra of colon
These features of the colon are small masses of fat which are covered with visceral peritoneum, and which extend from the colon.
Omental appendices
These are the terminal portions of the large intestine.
Rectum and anal cavity
This condition is characterized by herniations of mucosa of the colon through the muscular layer without inflammation. It is most common in the sigmoid colon and caused by a low fiber diet.
Diverticulosis
This condition is characterized by an inflammation of diverticuli and can cause abdominal pain, diarrhea, and abcess.
Diverticulitis
This condition is characterized by severe inflammation and ulceration of the rectum and lower colon. It can cause abdominal pain, diarrhea, and bowel perforations.
Ulcerative colitis
This condition is common and characterized by recurring abdominal pain and diarrhea with no inflammation or decrease in health. Symptoms are caused by abdnormal contractions of the colon and often brought on by stress/anxiety.
Irritable bowel syndrome
What is the blood supply to the small and large intestine?
- Superior mesenteric artery
- Inferior mesenteric artery
- Marginal artery
- Vasa recta
What are the branches of the superior mesenteric artery?
- Inferior pancreaticoduodenal artery
- Jejunal and ileal arteries
- Ileocolic artery
- Right colic artery
- Middle colic artery
What are the branches of the inferior mesenteric artery?
- Left colic artery
- Sigmoid arteries
- Superior rectal artery
This is an anastomotic channel which runs from the cecum to the sigmoid colon. All of the branches of the superior and inferior mesenteric arteries empty into it.
Marginal artery
What is the innervation of the large intestine?
- Cecum through right 2/3 of transverse colon: autonomic fibers from the superior mesenteric plexus
- Left 1/3 of the transverse colon to the upper part of the anal canal: autonomic fibers from inferior mesenteric plexus and hypogastric plexus (lowest part)
There are two interlinked venous systems within the trunk. What are they?
- Portal venous system: drains the gastrointestinal tract, spleen, pancreas, and gallbladder
- Caval (systemic) venous system: drains everything else
The portal vein is formed behind the head of the pancreas by the union of what two veins?
- Splenic vein
- Superior mesenteric vein
What are the tributaries of the portal vein?
- Splenic vein
- Superior mesenteric vein
- Left gastric vein
- Paraumbilical veins
What are the branches of the splenic vein?
- Short gastric veins
- Left gastro-omental vein
- Pancreatic veins
- Inferior mesenteric vein which branches into the left colic vein, sigmoid veins, and superior retcal vein
What are the branches of the superior mesenteric vein?
- Jejunal and ileal veins
- Ileocolic vein
- Right colic vein
- Middle colic vein
- Right gastro-omental vein
- Pancreaticoduodenal veins
This condition is characterized by a destruction of hepatic cells and their replacement by fibrous tissue and fat. The liver becomes nodular, hard, and tends to constrict the portal veins at the portal hepatis causing hypertension. It is caused by alcoholism, hepatitis, chronic obstruction of the common bile duct, or congestive heart failure.
Cirrhosis of the liver
This condition is characterized by an abnormal elevation of pressure within the portal system often due to cirrhosis of the liver. Veins become varicose and may rupture.
Portal hypertension
These are pronounced snake-like veins radiating around umbilicus. They are only present during high portal hypertension in the abdominal cavity.
Caput medusae
The liver is the largest visceral organ and is the largest gland in the body. What are some of its functions?
- Bile secretion
- Metabolism of proteins, fats, and carbohydrates
- Storage of glycogen, vitamins, and iron
- Detoxification
This condition is characterized by a yellow discoloration of the skin, sclera, and mucous membrane often due to liver damage which releases bilirubin.
Jaundice
The porta hepatis is the hilum of the liver. What does it contain?
- Common hepatic duct
- Hepatic artery proper
- Portal vein
What are the anatomical lobes of the liver?
- Right lobe
- Quadrate lobe
- Caudate lobe
- Left lobe
Where would a functional division of the liver be made?
It would be made to the right of the falciform ligament. The division would be made forward from the inferior vena cava through the gall bladder
What are the structures that distribute to the right and left functional halves of the liver?
- Hepatic artery (left and right branches)
- Portal vein (left and right branches)
- Common hepatic duct (left and right hepatic ducts)
- Hepatic veins (left and right tributaries)
The liver is covered with visceral peritoneum at the bare area, located on the posterior aspect of the diaphragmatic surface. The maintains contact with what structure at the bare area?
Diaphragm
This ligament of the liver connects the liver to the diaphragm and anterior abdominal wall.
Falciform ligament
As the falciform ligament passes posteriorly along the diaphragmatic surface of the liver, its two layers split to become what ligament of the liver?
Coronary ligament
These ligaments of the liver form at the junction of the superior and inferior layers of the coronary ligament on each side.
Right and left triangular ligaments
This ligament of the liver forms the free edge of the falciform ligament and is the remnant of the obliterated umbilical vein.
Ligamentum teres
This ligament of the liver is located between the left and caudate lobes. It is the remnant of the ductus venosus.
Ligamentum venosum
This ligament of the liver covers the inferior vena cava with the bare area of the liver.
Ligament of the inferior vena cava
What are the fissures of the liver?
- Fissure of the ligamentum teres
- Fissure for the ligamentum venosum
- Fossa for the gallbladder
- Fissure for the inferior vena cava
- Porta hepatis
What is the blood supply of the liver?
The liver receives a dual blood supply from the portal vein and hepatic artery
What is the innervation of the liver?
Autonomic and pain fibers are from the hepatic plexus which is an extension of the celiac plexus
The gallbladder is a pear-shaped organ located in a fossa on the visceral surface of the liver. What are its parts?
- Fundus
- Body
- Neck
Contraction of the gallbladder is initiated by what hormone?
Cholecystokinin
What is the blood supply of the gallbladder?
Cystic artery from the right hepatic artery
What is the innervation of the gallbladder?
Autonomic and pain fibers from the celiac plexus
What are the ducts of the biliary duct system?
- Right and left hepatic ducts
- Common hepatic duct
- Cystic duct
- Bile duct
- Hepatopancreatic ampulla (Ampulla of Vater)
This duct of the biliary duct system is formed by the union of the bile duct and pancreatic duct. It empties into the second part of the duodenum at the major duodenal papilla.
Hepatopancreatic ampulla (Ampulla of Vater)
What are the sphincters and valves of the biliary duct system?
- Sphincter of ampulla
- Sphincter of bile duct
- Sphincter of pancreatic duct
- Spiral folds (valves)
These are hard masses formed from the solidificaction of bile (mainly cholesterol crystals). They are commonly impacted at the distal end of the hepatopancreatic ampulla (sphincter).
Gallstones
What are the risk factors for gallstones?
- Female
- Obesity
- Pregnancy
- High (animal) fat diet
Upper abdominal diseases involving the liver, gall bladder, and/or stomach may refer pain to lower thoracic cord segments such as what?
T8-T12
The pancreas is both an exocrine and endocrine gland. What does this mean?
- Exocrine function: secretion of digestive enzymes
- Endocrine function: secretion of the hormones insulin and glucagon
What are parts of the pancreas?
- Head
- Neck
- Body
- Tail
- Uncinate process
This duct drains the neck, body, and tail of the pancreas. It joins the common bile duct to form the hepatopancreatic ampulla, which in turn empties into the major duodenal papilla within the second part of the duodenum.
Pancreatic duct
This duct drains the head and uncinate process of the pancreas. It empties into the minor duodenal papilla, also located within the second part of the duodenum, 2 cm above the major duodenal papilla.
Accessory pancreatic duct
What is the blood supply of the pancreas?
- Pancreatic branches of the splenic artery
- Superior pancreaticoduodenal artery (from gastroduodenal)
- Inferior pancreaticoduodenal artery (from superior mesenteric)
What is the innervation of the pancreas?
Autonomic and pain fibers from the celiac plexus
This condition occurs during compression of the abdomen from something such as an auto accident. It can result in the release of digestive enzymes into the body cavity leading to a lot of damage to adjacent tissues.
Rupture of the pancreas
The spleen is a large lymphatic which has what functions?
- Produces lymphocytes in the newborn
- Removes worn out red blood cells and other cellular debris from circulation
- Stores red blood cells
Where does the spleen lie?
Against the diaphragm and ribs 9-11 within the left hypochondrium region
This structure is located on the visceral surface of the spleen. It transmits nerves and vessels.
Splenic hilum
What are the ligaments of the spleen?
- Gastrosplenic ligament
- Splenorenal ligament
What is the blood supply to the spleen?
- Splenic artery (from celiac trunk)
- Splenic vein (into portal vein)
What is the innervation of the spleen?
Mainly sympathetic from the celiac plexus
This is the most frequently injured abdominal organ and becomes fragile when enlarged due to mononucleosis, malaria, sickle cell anemia, and septicemia. Rupture of it can result in severe hemorrhage.
Spleen
Within 2-3 hours of spleen removal, what takes over the phagocytic function of the spleen?
Kupffer cells of the liver
This nerve supplies preganglionic parasympathetic fibers to the esophagus, stomach, small intestine, and large intestine through the right 2/3 of the transverse colon. It also supplys innervation to the liver, spleen, pancreas, and kidney.
Vagus nerve
This nerve supplies preganglionic parasympathetic fibers to the left 1/3 of the transverse colon through the upper part of the anal canal.
Pelvic splanchnic nerves (S2, S3, and S4)
Sympathetic innervation of the abdominal viscera is primarily supplied by what nerves?
- Sympathetic trunk
- Splanchnic nerves (thoracic and lumbar)
What are the autonomic plexuses of the abdomen?
- Celiac plexus
- Superior mesenteric plexus
- Aortic plexus
- Inferior mesenteric plexus
The portion of the aortic plexus between the superior and inferior mesenteric arteries is called what?
Intermesenteric plexus
The aortic plexus continues downward to form what plexus just below the bifurcation of the aorta?
Superior hypogastric plexus
