GI and Abdomen Flashcards
- Camper’s fascia
superficial, fatty layer, absent in perineum
- Scarpa’s fascia
deep, membranous layer, continues to the perineum but changes names to Colles’ fascia, continues to reproductive organs and becomes penile or clitoral fascia
action of abdominal wall muscles
support the abdominal contents and compress the abdominal contents as for maximal expiration and coughing
arcuate line
(lower limit of posterior layer of the rectus sheath)
• Anterior - external oblique, ½ of the internal oblique
• Below – all three layers (ExtO, IntO, InnO)
• This boundary is a site of weakness where hernias can occur (also in linea alba and umbilicus)
Nerves down posterior wall, superior to inferior
- Subcostal nerve (T12)
- Iliohypogastric nerve (L1)
- Ilioinguinal nerve (L1)
- Lateral femoral cutaneous nerves (L2, 3)
superior epigastric artery
from the internal thoracic, enters rectus sheath, goes deep to rectus abdominis, anastomoses with inferior epigastric artery here
inferior epigastric artery
from the external iliac artery, enter rectus sheath at arcuate line
- Deep circumflex iliac artery: branches from the external iliac artery
lymph above umbilicus
drain to axillary nodes
lymph below umbilicus
drain to inguinal nodes
Gubernaculum
– attaches scrotum and labia major to abdominal wall
- In males the testes descend down the canal called spermatic cord, has same layers as abdominal wall
direct inguinal hernia
- Abdominal contents protrude directly (through the inguinal triangle) medial to the inferior epigastric vessels, and pass through the superficial inguinal ring into the scrotum/labium majus.
indirect inguinal hernia
- Abdominal contents protrude indirectly (lateral to the inguinal triangle) through the deep inguinal ring (lateral to the inferior epigastric vessels), traverses the inguinal canal, and emerges through the superficial inguinal ring into the scrotum/labium majus.
superficial inguinal ring
opening in the aponeurosis of the external abdominal oblique
direct unguinal hernia here
deep inguinal ring
formed by opening in transversalis fascia, superior to inguinal ligament
Deep inguinal ring is located about midway between the anterior superior iliac spine and pubic symphysis, about one-centimeter superior to the inguinal ligament; lies just lateral to the inferior epigastric vessels
indirect inguinal hernia here
Falciform ligament
separates the left and right lobes of the liver
Round ligament of the liver
ligamentum teres hepatis, remnant of left umbilical vein
Omental foramen
Epioloic foramen or Winslow – great clinical value to for surgeries to access the left kidney, adrenal gland, pancreas and posterior stomach
lesser omentum
Hepatogastric ligament – from liver to stomach, smaller area than greater omentum
o Hepatoduodenal ligament – part of lesser omentum that contains:
• Hepatic triad
Common bile duct – formed by junction of common hepatic and cystic ducts
Proper hepatic artery – arises from common hepatic artery from celiac trunk of aorta, goes into liver
Portal vein – carries blood from GI tract and accessory organs to liver
• Autonomic nerve fibers and lymphatics
greater omentum
Extends from the greater curvature of the stomach to the posterior abdominal wall; composed of the following ligaments:
o Gastrocolic
o Gastrosplenic
o Splenorenal
Referred pain in the peritoneal cavity
- Shoulder and neck via phrenic nerve can indicate blood or irritants in peritoneal cavity that collects near the diaphragm
- Pain to left shoulder can indicate splenic rupture and blood accumulation near left hemidiaphragm – Kehr’s sing
abdominal aorta vessels and nerves of foregut
celiac trunk
greater splanchnic n.
abdominal aorta vessels and nerves of midgut
superior mesenteric a.
less splanchnic v.
abdominal aorta vessels and nerves of hindgut
inferior mesenteric a.
sacral splanchnic .
regions of stomach
o Cardia – right after esophagus, contains cardial notch
o Fundus – top of stomach
o Body – main large segment
o Pylorus
• Pyloric antrum – after angular incisure
• Pyloric canal – between stomach and duodenum
main pancreatic duct
joins the common bile duct to form the hepatopancreatic ampulla, which opens onto the major duodenal papilla
accessory pancreatic duct
from jejunum into pancreas and connects main pancreatic duct
blood supply of pancreas
both the celiac trunk and superior mesenteric artery
lobes of the liver
- Right lobe – largest
- Left lobe – smaller
- Quadrate lobe – between gallbladder and ligamentum teres on visceral surface
- Caudate lobe – little section between inferior vena cava and ligamentum venosum on visceral surface
common hepatic duct
from the liver, convergence of right and left hepatic ducts
cystic duct
comes from the gallbladder
merges with common hepatic duct to make common bile duct
common bile duct
convergence of common hepatic and cystic, merges with pancreatic duct to make ampulla of Vater into the duodenum; penetrates the head of the pancreas and unites with the main pancreatic duct within the wall of the duodenum to form the hepatopancreatic ampulla
cystohepatic triangle of Calot
contains cystic artery, must be ligated during surgery
branches of celiac trunk
1. Common hepatic artery – branch of celiac trunk; splits into: o Proper hepatic artery • Left hepatic artery • Right hepatic artery Cystic artery o Gastroduodenal artery • Right gastroepiploic artery Superior pancreaticoduodenal artery 2. Splenic artery – branch of celiac trunk; splits into: • Short gastric arteries • Left gastroepiploic artery • Splenic branches 3. Left gastric artery – branch of celiac trunk
Superior mesenteric vein receives blood from ____
jejunal, ileal and colic veins
is there a celiac vein?
no, ultimately drain into portal vein that takes all the blood from the intestinal area to liver capillary beds for detox, formed by convergence of superior mesenteric and splenic v
celiac plexus
network of nerves surrounding the celiac trunk and containing two large celiac ganglia, one on each side of the celiac trunk; its efferent contributions are:
- Preganglionic parasympathetic efferent fibers which pass through the celiac plexus are derived from the anterior and posterior vagal trunks
- Preganglionic sympathetic efferent fibers to the celiac plexus are derived from the greater splanchnic - they synapse in the celiac ganglia on postganglionic sympathetic cell bodies, which give rise to postganglionic sympathetic fibers
Mid gut extends from ____ to _____
mid gut extends from midway along the duodenum to midway along the transverse colon
Hind gut extends from ____ to _____
hind gut extends from midway along the transverse colon to the anal canal
duodenum
first part of small intestine and encloses the head of the pancreas
- Its proximal half, including the major duodenal papilla, is a foregut derivative; its distal half, although derived from the midgut, is included with the foregut for simplicity
halfway along its length, the major duodenal papilla (aka ampulla of Vater) opens into its lumen, common bile duct enters here
jejunum
2nd part of small intestine and has the most developed circular folds for absorption
- Histologically, it lacks Brunner’s glands (duodenum) and Peyer’s patches (ileum)
ileum
3rd part, contains large lymph vessels (Peyer’s patches)
- Ileocecal valve between this and cecum, prevents backflow at ileal papilla
taeniae coli
longitudinal smooth muscle bands to large intestine
haustra
small pouches that give segmented appearance to large intestine
cecum
pouch connecting large and small intestine
appendix
vermiform diverticulum of the cecum
colon
large intestine
o Ascending colon – up the right side
o Transverse colon – across horizontally
o Descending colon – down the left side
o Sigmoid colon – S shaped curve
o Anal canal – will be covered in the pelvis outline
superior mesenteric artery
the “artery of the midgut” – arises from the aorta (Level of L1)
- Inferior pancreaticoduodenal artery – splits into anterior and posterior
- Middle colic artery – supplies transverse colon
- Right colic artery – supplies ascending colon
- Ileocolic artery – supplies cecum
- Intestinal (jejunal and ileal) arteries -
inferior mesenteric artery
the artery of the hindgut – arises from the aorta (Level of L3)
- Left colic artery – supplies descending colon
- Sigmoid arteries – supplies sigmoid colon
- Superior rectal artery – supplies rectum
marginal artery
(of Drummond) – anastomosis of inferior and superior mesenteric arteries
superior mesenteric vein drains into the ____
portal v
inferior mesenteric vein drains into the ____
splenic v
posterior abdominal wall muscle innervation and blood supply
Blood supply: superior phrenic, inferior phrenic, musculophrenic, and pericardiacophrenic vessels
Innervation: phrenic nerves; derived from ventral rami C3, 4, and 5.
quadratus lumborum
action - lateral flexion of verebrae
inn. - lumbar nn
blood - lumbar branch of iliolumbar a
psoas major and minor
flexion of hip and lumbar vertebrae
inn. - lumbar nn
blood - lumbar branch of iliolumbar a
iliacus
action - flexes hip
inn - femoral n
blood supply - iliac branches of iliolumbar a
unpaired branches of abd aorta
- Unpaired branches (three)
o celiac trunk (level of T12)
o superior mesenteric artery (level of L1)
o inferior mesenteric artery (level of L3)
paired branches of abd aorta
- Paired branches (6 pairs) o Inferior phrenic arteries o Middle suprarenal arteries o Renal arteries (level of L1) o Testicular/ovarian arteries (level of L2) o Lumbar arteries (four pairs) o Common iliac arteries • External and internal iliac arteries
lumbar plexus
o iliohypogastric and ilioinguinal nerves (L1) – posterior abdominal wall
o Genitofemoral nerve (L1, 2) – pierces psoas major
o Lateral femoral cutaneous nerve (L2, 3) – posterior wall, behind psoas, down wall to leg
o Femoral nerve (L2, 3, 4) – large nerve that goes into femoral triangle, largest branch of lumbar plexus, supplies anterior thigh
o Obturator nerve (L2, 3, 4) – run next to the lumbosacral trunks, inferior, posterior, medial
o Lumbosacral trunk (L4, 5) – contributes to lumbosacral plexus (later)
- Lumbar sympathetic trunks – connects lumbar plexus with sacral plexus
cortex of kidney
outer portion between capsule and medulla, glomeruli are here
medulla of kidney
innermost part of kidney where the following are located:
• Renal pyramids – subdivisions of medulla where tubules are located
• Renal papilla – point of pyramid towards hilum
• Renal columns (extensions of the cortex) between pyramids
renal arteries
have blood from heart to kidneys to be filtered
renal veins
filtered blood from kidneys to inferior vena cava
o Drain into the inferior vena cava (note that left suprarenal vein and left testicular ovarian vein drain into the left renal vein)
adrenal glands (areas and what they do)
retroperitoneal organs on superomedial aspect of the kidney, lie at T12
o Cortex – secrete mineralocorticoids, glucocorticoids and androgens
o Medulla – secretes adrenaline
o Three arteries - Superior, middle and inferior arteries
o Single vein drainage – right gland empties into the IVC; left gland empties into left renal vein
o Innervated by sympathetic nerves – least splanchnic
