GA

Question 1

what is the anterior portion of the abdominal wall made up of?

Answer 1

aponeuroses and muscles

Question 2

layers of the anterior and antero-lateral abdominal walls:

Answer 2

skin, superficial fascia, deep fascia/epimysium, muscles, fascia transversalis, extraperitoneal fat, peritoneum

Question 3

roles of the abdominal wall:

Answer 3

• protects viscera of the abdomen
• flexes and laterally rotates the spine
• depresses the ribs
• increases intra-abdominal P by contracting muscles
• assists in forced expiration, coughing, sneezing, peeing, pooping

Question 4

tension lines

Answer 4

direction of collagen fibers on the skin which result in a practically invisible scar if an incision is made in the direction in which they run

Question 5

4 abdomen shapes and what could cause it:

Answer 5

shapes: flat, rounded, scaphoid, protrubent
causes: feces, fetus, food, flatus, fluid, fat

Question 6

superficial fascia

Answer 6

divided into two layers separated by the neurovascular bundle: Camper’s fatty layer (superficial fatty layer) and Scarpa’s membranous layer (superficial vessels) which becomes continuous with the fascia of the back and thorax

Question 7

deep fascia/epimysium

Answer 7

thin connective tissue sheath that covers individual abdominal muscles anteriorly and posteriorly

Question 8

muscles of the abdomen

Answer 8

3 lateral: external oblique (most superficial), internal oblique (perpendicular to external) and transversus abdominis

2 medial: rectus abdominis and pyramidalis (strengthens linea alba but may not be present or paired in some people)

Question 9

fascia transversalis

Answer 9

thin layer of fascia lining transversus abdominis muscle continuous with another layer lining the diaphragm and iliacus muscle

Question 10

rectus sheath

Answer 10

formed from aponeuroses of the three anter-lateral muscles to encapsulate the rectus abdominis muscles

*internal oblique aponeurosis will split and half follows the external oblique muscle anteriorly and the other half follows the tranversus aponeurosis posteriorly (wraps n the rectus muscle)

Question 11

extraperitoneal fat

Answer 11

thin layer of CT with fat that lies between fascia transversalis and peritoneum

Question 12

peritoneum

Answer 12

large serous membrane containing a single layer of epithelial cells lying on a layer of loose CT serving to minimize friction, resist infection and store fat

*parietal when lining the abdominal wall and then reflexed to become visceral when surrounding organs–> peritoneal fluid exists in the peritoneal cavity formed between the parietal and visceral peritoneum

Question 13

foramen epiplocium/of Winslow

Answer 13

the way by which the greater and lesser sac communicate with one another

Question 14

intraperitoneal vs. retroperitoneal organs

Answer 14

intraperitoneal: surrounded by peritoneal cavity (ex: liver, spleen)
retroperitoneal: only one part is dressed (ex: kidneys)

Question 15

greater omentum vs. lesser omentum

Answer 15

greater: hangs from transverse colon and has 4 layers of peritoneum (2 anterior and 2 posterior)–> usually perforated (from the dorsal mesentery)
lesser: from the inferior part of the liver to other organs and consists of the hepatogastric ligament (liver to stomach) and the hepatoduodenal (porta hepatis to duodenum containing portal triad) ligament (from the ventral mesentery)

Question 16

what connects the liver to the diaphragm?

Answer 16

visceral ligaments made of double layers of peritoneum and the lesser omentum:

1 falciform
2 coronary
2 triangular

Question 17

what makes up the portal triad?

Answer 17

bile duct, hepatic vein and hepatic artery

Question 18

mesentery

Answer 18

folds of peritoneum connecting intestines to posterior abdominal wall and contains vessels and nerves

(if organ presents it, it will be intraperitoneal)

Question 19

9 regions of the abdomen

Answer 19

left to right:
R hypochondriac, epigastric, L hypochondriac
R lumbar, umbilical, L lumbar
R iliac, hypogastrin, L iliac

Question 20

what exists in each quadrant?

Answer 20

upper right: liver, gallbladder, stomach antrum, duodenum, right kidney, right adrenal (suprarenal), pancreas (head), colon (hepatic flexure), IVC

upper left: abdominal esophagus, stomach fundus, spleen, left kidney, left adrenal, abdominal aorta, pancreas (body, tail), part of jejunum, colon (spenic flexure)

lower right: ileum, ascending colon, cecum, appendix, right ureter

lower left: part of jejunum, part of ileum, descending colon, sigmoid colon, left ureter

Question 21

where does the esophagus pierce the diaphragm and then where does it enter the stomach?

Answer 21

pierces diaphragm at: esophageal hiatus

enters stomach at: cardia

Question 22

what determines sites of organ formation?

Answer 22

interactions between the endoderm and visceral mesoderm

Question 23

divisions of the primitive gut tube

Answer 23

foregut (head to liver), midgut (liver to right 2/3 and left 1/3 of transverse colon) and hindgut (left 1/3 of transverse colon to cloacal membrane)

Question 24

development of the esophagus and clinical significance

Answer 24

development: develops from the foregut then at 4 weeks, lung buds evaginate and the tracheoesophageal septum separates the foregut into the primordium of the respiratory tract from the esophagus

clinical significance: defects leads to esophageal atresia or tracheoesophageal fistula preventing normal swallowing leading to excess fluid in the amniotic sac (polyhydramnios)

Question 25

development and rotation of the stomach

Answer 25

5th week- stomach rotates 90 degrees to the right around the craniocaudal axis--> dorsal aspect grows more rapidly forming greater curvature and ventral portion becomes lesser curvature further growth- stomach rotates around its anteroposterior axis so caudal/pyloric end moves to right and cephalic/cardiac end moves to left ballooning out and forming the omental bursa (space behind stomach)

Question 26

development of duodenum and clinical significance

Answer 26

development: retroperitoneal and forms a C-shaped loop that rotates right whose lumen is obliterated by proliferation of cells from walls but is soon recanalized clinical significance: duodenal stenosis or atresia if canalization is incomplete (leads to polyhydramnios)

Question 27

what causes the mesoduodenum to fuse with the peritoneum?

Answer 27

the duodenum and head of the pancreas pressing against the dorsal body wall

Question 28

development of liver and gallbladder; clinical significance

Answer 28

development: LIVER (week 3)- hepatic diverticulum grows from ventral side of duodenum and proliferation will result in penetration of the septum transversum and narrowing of connection to duodenum forming the bile duct GALLBLADDER- cystic diverticulum from ventral side of duodenum and formation of cystic duct clinical significance: liver= major hematopoietic organ in embryo, accessory hepatic ducts and duplication of the embryo is common, hepatic ducts recanalize if not: extrahepatic biliary atresia, and defects in duct formation in liver: intrahepatic biliary duct atresia

Question 29

development of the pancreas and clinical significance

Answer 29

development: forms from two buds that fuse when duodenum rotates forming uncinate process and main pancreatic duct and later the pancreatic islets of Langerhans clinical significance: two parts of ventral bud can migrate in different directions causing the duodenum to be surrounded by pancreatic tissue--> annular pancreas (could obstruct/constrict duodenum so needs to be bypassed)

Question 30

development of the spleen

Answer 30

mesoderm derived and develops within the dorsal mesentery located on the left after the stomach rotates and is connected to the kidney by lienorenal ligament

Question 31

Meckel's diverticulum

Answer 31

2 inch long remnant of the vitelline duct (remaining open as a fistula or forming a cyst) projecting from distal ileum that can become inflamed, can bleed or can obstruct

Question 32

herniations

Answer 32

umbilical hernia: protrusion of bowel through umbilical ring that usually closes spontaneously omphalocele: herniation of the bowel through umbilical ring covered by a thin membrane that could rupture (often patients have other issues) gastroschisis: bowel protrudes lateral to umbilical ring into amniotic cavity with no covering and can be damaged by amniotic fluid exposure

Question 33

development of the hindgut and clinical significance

Answer 33

development: results in distal 1/3 of transverse colon and beyond forming anorectal canal and urogenital sinus clinical significance: rectourethral or rectovaginal fistulas, imperforate anus or anal stenosis and congenital megacolon/Hirschprung (absence of parasympathetic ganglia)

Question 34

development of the midgut and *clinical significance

Answer 34

development: midgut communicates with yolk sac via vitelline duct and elongation of gut leads to primary intestinal loop and then physiological umbilical herniation occurs * 90 degree rotation outside of the body occurs and then after return to the abdominal cavity, a 180 degree rotation occurs and the cecal bud and appendix form clinical significance: asymmetry of midgut from errors in 180 degree rotation (non-rotation, reversed rotation, mixed rotations) causing twisting--> volvulus which will obstruct or compromise blood supply

Question 35

Ligament of Treitz

Answer 35

suspends the duodeno-jejunal flexure from the diaphragm

Question 36

what shape is the duodenum in and what are its 4 parts?

Answer 36

shape: horseshoe-shaped curve known as the C-loop in which the head of the pancreas lies in it parts: superior, descending, transverse and ascending in which the last three are retroperitoneal

Question 37

jejunum vs. ileum

Answer 37

jejunum: more and thicker folds/plicae circulares ileum: more arcades and vessels

Question 38

which part of the colon is intraperitoneal?

Answer 38

the sigmoid colon which is located in the pelvis

Question 39

what forms the appendix?

Answer 39

the joining of the 3 taeniae coli (longitundinal bands) which runs through the entirety of the colon

Question 40

pancreas

Answer 40

glandular mass whose head rests in the "C" shape of the duodenum and its tail touches the spleen parts: unciate, head, neck, body, tail

Question 41

unpaired anterior visceral branches

Answer 41

celiac artery/trunk (foregut), superior mesenteric artery (midgut), inferior mesenteric artery (hindgut)

Question 42

paired lateral visceral branches

Answer 42

right and left: middle adrenal (kidneys), renal, gonadal (testes or ovaries)

Question 43

branches of celiac trunk

Answer 43

1. left gastric artery: esophageal branches and runs along lesser curvature of stomach anastomosing with right gastric artery (from proper hepatic artery) 2. splenic/lineal artery: largest and travels posterior to stomach giving branches to the pancreas and spleen and left gastroepiploic artery (which anastomoses with right gastroepiploic artery from the gastroduodenal artery along greater curvature) 3. common hepatic artery: branches into proper hepatic and gastro-duodenal arteries

Question 44

branches of superior mesenteric artery (SMA)

Answer 44

(R side:) inferior pancreaticoduodenal artery (anterior and posterior), middle coli artery (right and left), right colic artery (descending and ascending), ileocolic artery (superior and inferior) (L side:) jejunal and ileal arteries *anastomoses with secondary branches of each other

Question 45

branches of inferior mesenteric artery (IMA)

Answer 45

left colic artery (ascending, descending), sigmoid arteries (superior, inferior), superior rectal artery

Question 46

marginal artery of drummond

Answer 46

forms from anastomoses and is a continuous vessel within the inner margin of the large bowel and gives rise to the vasa recta

Question 47

what elevates the hyoid bone?

Answer 47

CN X, longitudinal pharyngeal muscle

Question 48

which nerves are responsible for the gag reflex?

Answer 48

afferent- IX | efferent- X

Question 49

top, bottom, anterior aspects of pharynx

Answer 49

top- occipital bone bottom- inferior border of the cricoid cartilage at level C6 anterior- no wall since posterior to and continuous with the nasal cavity, mouth and larynx

Question 50

purpose of pharyngeal constrictor muscles

Answer 50

to direct food to the esophagus (pushes it down)

Question 51

3 divisions of the pharynx

Answer 51

1. nasopharynx: respiratory; above soft palate and lateral walls contain Eustachian tube openings near torus tubarius, salpingopharyngeal fold, pharyngeal recess and pharyngeal tonsils (posterior and superior to Eustachian tubes) 2. oropharynx: digestive; below soft palate and anterior to C2 and C3 with palatoglossal and palatopharyngeal arches (which enclose respective muscles) and tonsillar bed in between 3. laryngopharynx: anterior to C3-C6, communicates with larynx through laryngeal inlet which has piriform recesses on either side

Question 52

what are the pharyngeal tonsils called when they are inflamed?

Answer 52

adenoids

Question 53

tonsillar bed

Answer 53

- between palatoglossal and palatopharyngeal arches - vessels and nerves reside deep in its mucosa (ascending pharyngeal artery, facial artery, external palatine vein, glossopharyngeal nerve)

Question 54

what happens if tonsillectomy causes damage to vessels or nerve within tonsillar bed

Answer 54

- damage to vessels (ascending pharyngeal artery, facial artery, external palatine vein)--> extensive bleeding - damage to nerve (glossopharyngeal)--> loss of taste

Question 55

palatine tonsils

Answer 55

accumulations of lymphoid tissue that sit in tonsillar beds and protect the body from entry of extraneous materials via the mucosa

Question 56

piriform recesses

Answer 56

- depressions on either side of the laryngeal inlet formed by invaginations of the larynx into the anterior wall of the laryngopharynx - recesses are separated from the laryngeal inlet by the aryepiglottic folds - lateral walls of the piriform recess are formed by the thyrohyoid membrane and the thyroid cartilage - foreign bodies can become lodged here injuring the internal and recurrent/inferior laryngeal nerves

Question 57

muscles of the pharynx

Answer 57

- external layer: 3 pairs (superior, middle and inferior constrictors) with circumferentially oriented fibers fusing at midline at median pharyngeal raphe forming 3 muscular bands; helps propel bolus * innervation fro pharyngeal plexus (sensory- IX, motor- X) -internal layer: 3 longitudinally oriented muscles--> stylopharyngeus, salpingopharingeus and palatopharyngeus which elevate the pharynx and larynx during phonation and swallowing

Question 58

soft palate

Answer 58

separates the nasopharynx from the oropharynx and is moveable (attached to hard palate) and composed of 5 muscles (levator veli palatine, tensor veli palatine, palatoglossus, palatopharyngeus and musculus uvulae) which insert into palatine aponeurosis that forms the substance of the soft palate

Question 59

innervation of the pharynx

Answer 59

- motor: CN X supplies all muscles except stylopharyngeus muscle (CN IX) and tensor veli palatine (CN V3) * external and recurrent branches of vagus also supply inferior pharyngeal constrictor muscle - sensory: CN IX to all three pharynx regions * general sensory- to pharynx, tonsils, soft palate and posterior 1/3 of tongue * special sensory- to posterior 1/3 of tongue

Question 60

tympanic plexus and lesser petrosal nerve

Answer 60

branch of CN IX that has sensory afferent fibers from mucosa of the tympanic cavity, Eustachian tube and mastoid air cells *lesser petrosal nerve--> continuation of tympanic plexus with preganglionic parasympathetic fibers that synapse in otic ganglion and postganglionic parasympathetic fibers which are secretomotor to the parotid gland

Question 61

deglutition

Answer 61

main purpose of the pharynx (swallowing) that has voluntary and involuntary components involving muscles of tongue, soft palate, pharynx and larynx *3 stages

Question 62

1st stage of deglutition

Answer 62

oral preparatory phase and oral transfer phase - voluntary cortical control - base of tongue and soft palate close oral cavity posteriorly to prevent food from spilling into the open larynx - contraction of palatoglossus and palatopharyngeal muscles lower the soft palate - suprahyoid muscles elevate and fix the hyoid bone- stabilizes the larynx

Question 63

2nd stage of deglutition

Answer 63

pharyngeal phase - involuntary rapid movement to the esophagus - swallow/pharyngeal reflex * *pharynx changes from being an air channel to a food channel - soft palate closes nasopharynx - airway sealed by glottis - suprahyoid muscles and longitudinal pharyngeal muscles pull the larynx and hyoid bone up and forward so inlet is brought under tongue to open passageway for food

Question 64

3rd stage of deglutition

Answer 64

esophageal phase - involuntary - inferior pharyngeal constrictor muscles relax allowing food to enter the esophagus - infrahyoid muscles control the descent of the larynx and stabilize the hyoid bone

Question 65

input to parotid, submandibular and sublingual glands

Answer 65

parotid gland- parasympathetic input by way of lesser petrosal nerve and otic ganglion submandibular and sublingual glands- parasympathetic input by way of chorda tympani and submandibular ganglion

Question 66

recurrent laryngeal nerve importance and what happens if damaged

Answer 66

function: adducts the vocal cords during bolus passage and allows necessary glottis closure during cough reflex damage causes: ipsilateral vocal cord paralysis, trouble swallowing liquids and poor/weak cough reflex

Question 67

hypoglossal nerve deficits (CN XII)

Answer 67

affects food bolus manipulation within the oral cavity interfering with bolus delivery to the oropharynx

Question 68

adenoids

Answer 68

enlargement of pharyngeal tonsils impeding passage of air from the nose and can block Eustachian tube opening (impairs hearing/promotes infection)

Question 69

dysphagia

Answer 69

difficulty swallowing