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MS2 > GI TBL 25 > Flashcards

GI TBL 25 Flashcards

1
Q

Define the location of the abdominopelvic cavity in relation to the diaphragm(s).

A

Abdominopelvic cavity is between the thoracic and pelvic diaphragms.

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2
Q

Is pelvic or abdominal cavity larger?

A

Abdominal cavity is much larger than the pelvic cavity

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3
Q

Discuss the parietal and visceral peritoneum (line/invest).

A

Parietal peritoneum lines the abdominal cavity

Visceral peritoneum (mesothelium of the serosa) invests some of the viscera (organs).

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4
Q

Define the peritoneal cavity and discuss its function.

A

Peritoneal cavity is a potential space between the parietal peritoneum and visceral peritoneum (i.e., it is enlarged for illustrative purposes).

Peritoneal cavity is normally occupied by a capillary-thin fluid film that allows friction-less movements of the GI tract.

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5
Q

Discuss all organ primordia in the embryo (location of where they form).

A

in the embryo, all organ primordia form along the posterior abdominal wall and protrude to varying degrees into the parietal peritoneum.

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6
Q

Define an intraperitoneal organ and name (2).

A

Stomach and spleen protrude completely and become invested by visceral peritoneum; thus, they are designated intraperitoneal organs.

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7
Q

Define retroperitoneal organ and name (1).

A

Kidneys did not protrude and become invested by visceral peritoneum.

Instead the parietal peritoneum overlies their anterior surfaces and they are designated retroperitoneal organs.

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8
Q

What forms the mesentery and visceral peritoneum of an intra/retro-peritoneal organ?

A

Complete protrusion into the parietal peritoneum by an intraperitoneal organ forms its mesentery and visceral peritoneum.

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9
Q

Discuss the relation of mesenteries and RETROperitoneal abdominal aorta.

A

Mesenteries allow branches from the retroperitoneal abdominal aorta to supply the intraperitoneal viscera without breeching the parietal or visceral peritonea.

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10
Q

Discuss the formation of the greater omentum and its layout.

A

Extensions of the visceral peritoneum from the anterior and posterior surfaces of the stomach form the double-layered greater omentum.

Greater omentum descends inferiorly from the greater curvature and folds back to ascend as a four-layered peritoneal fold, which joins the visceral peritoneum of the transverse colon.

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11
Q

Discuss the formation of the lesser omentum and its layout.

A

Double-layered extension of visceral peritoneum from the anterior and posterior surfaces of the proximal duodenum and lesser curvature of the stomach forms the lesser omentum that ascends superiorly to join the visceral peritoneum of the liver.

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12
Q

Surgical incision through the _________ abdominal wall enters the greater/lesser sac. Define (chosen) sac.

A

Surgical incision through the anterolateral abdominal wall enters the greater sac, the largest part of the peritoneal cavity.

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13
Q

Discuss the mental foramen function.

Define lesser sac.

A

Omental foramen connects the greater sac with the lesser sac that represents the small portion of the peritoneal cavity posterior to the lesser omentum and stomach.

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14
Q

Define transverse mesocolon.

A

transverse mesocolon (mesentery of the transverse colon)

transverse mesocolon divides the greater sac into the supracolic and infracolic compartments.

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15
Q

Define the function of the parabolic gutters.

A

Right and left paracolic gutters provide free communication between the supracolic and infracolic compartments.

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16
Q

Why can peritonitis be lethal and why is the linea alba a preferred site for ascites paracentesis?

A

Given the extent of the peritoneal surfaces and the rapid absorption of material, including bacterial toxins, from the peritoneal cavity, when a peritonitis becomes generalized (widespread in the peritoneal cavity), the condition is dangerous and perhaps lethal.

Linea alba is relatively avascular.

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17
Q

How do functions of the greater omentum relate to its common displacement in the peritoneal cavity? (3)

A

The greater omentum, large and fat laden, prevents
the visceral peritoneum from adhering to the parietal
peritoneum.

It often forms adhesions adjacent to an inflamed organ, such as the appendix, sometimes walling it off and thereby protecting other viscera from it.

The greater omentum also cushions the abdominal organs against injury and forms insulation against loss of body heat.

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18
Q

How do ascites and cancer cells spread within the peritoneal cavity?

A

The paracolic gutters provide pathways for the flow of ascitic fluid and the spread of intraperitoneal infections.

Sitting upright allows passage into pelvic cavity. Lying supine allows passage into subphrenic recess.

Paracolic gutters provide pathways for the spread of cancer cells that have sloughed from the ulcerated surface of a tumor and entered the peritoneal
cavity.

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19
Q

What planes denote the different abdominal quadrants?

A

transumbilical and median planes denote the right and left upper and lower quadrants of the abdominal cavity.

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20
Q

What planes and lines demarcate the epigastric, umbilical, and pubic regions of the abdominal wall.

A

Subcostal and transtubercular planes, and the midclavicular lines demarcate the epigastric, umbilical, and pubic regions of the abdominal wall.

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21
Q

Define SOMATIC AFFERENT nerve innervation in the epigastric, umbilical, and pubic regions of the abdominal wall and underlying parietal peritoneum.

A

somatic afferent fibers in the epigastric, umbilical, and pubic regions of the abdominal wall and underlying parietal peritoneum convey sensations of touch, pain, and temperature to the DRG at T5-T9, T10-T11, and T12-L1, respectively.

Epigastric- DRG @ T5-T9
Umbilical- DRG @ T10-T11
Pubic Regions- DRG @ T12-L1

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22
Q

What does sharp, localized pain result from (abdominal region).

A

sharp, localized pain results from injury to abdominal wall and from distension or inflammatory irritation of the underlying parietal peritoneum.

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23
Q

Why does the phrenic nerve deviate from the concept that sharp, localized pain results from distension or irritation of the parietal peritoneum?

A

Pain from the diaphragm radiates to two different
areas because of the difference in the sensory nerve
supply of the diaphragm.

Pain resulting from irritation of the diaphragmatic pleura or the diaphragmatic peritoneum is referred to the shoulder region, the area of skin supplied by the C3–C5 segments of the spinal cord. These segments
also contribute anterior rami to the phrenic nerves.

Irritation of peripheral regions of the diaphragm, innervated by the inferior intercostal nerves, is more localized, being referred to the skin over the costal margins of the anterolateral abdominal wall.

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24
Q

Discuss the intraperitoneal portion of the diaphragm’s parietal peritoneum.

A

Parietal peritoneum reflects from the inferior surface of the diaphragm to surround the esophagus; thus, its short abdominal portion is intraperitoneal.

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25
Q

Discuss the inferior esophageal sphincter.

A

Diaphragmatic muscle surrounding the hiatus acts as the inferior esophageal sphincter that normally prevents the reflux of gastric contents.

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26
Q

What forms the hepatic portal vein?

A

Superior mesenteric vein (SMV) unites with the splenic vein to form the hepatic portal vein

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27
Q

What supplies the ABDOMINAL ESOPHAGUS?

A

Left gastric artery from the celiac trunk supplies the abdominal esophagus.

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28
Q

Discuss how venous blood drains from the ABDOMINAL esophagus.

A

Left gastric vein drains venous blood from the abdominal esophagus into the hepatic portal vein.

29
Q

Some tributaries of (name) ANASTOMOSE with (name) tributaries of the AZYGOS VEIN.

A

Some tributaries of the left gastric vein anastomose with esophageal tributaries of the azygos vein.

30
Q

Discuss the origin/termination of Azygos vein and why is this advantageous?

A

Azygos vein originates from the IVC and terminates into the SVC

Portal-systemic anastomosis provides a collateral circulation when the liver or hepatic portal vein is obstructed.

31
Q

How is pyrosis related to GERD?

A

Pyrosis (G., burning), or “heartburn,” is the most
common type of esophageal discomfort or substernal
pain.

This burning sensation in the abdominal part of
the esophagus is usually the result of regurgitation of small amounts of food or gastric fl uid into the lower esophagus (gastroesophageal reflux disorder; GERD).

32
Q

How do esophageal varices form and when are they life-threatening?

A

Because the submucosal veins of the inferior
esophagus drain to both the portal and systemic
venous systems, they constitute a portosystemic
anastomosis.

In portal hypertension (an abnormally increased blood pressure in the portal venous system), blood is unable to pass through the liver via the hepatic portal vein, causing a reversal of flow in the esophageal
tributary.

The large volume of blood causes the submucosal
veins to enlarge markedly, forming esophageal varices. These distended collateral channels may rupture
and cause severe hemorrhage that is life-threatening
and difficult to control surgically.

Esophageal varices commonly
develop in persons who have developed alcoholic
cirrhosis (fibrous scarring) of the liver

33
Q

lesser and greater curvatures of the stomach; and distinguish the cardiac orifice, fundus, body, and pylorus.

A

Informational.

34
Q

What controls the discharge of stomach contents into the duodenum?

A

tonic contraction of the pyloric sphincter

35
Q

Discuss the origin/bifurcations of common hepatic artery.

A

Common hepatic artery arises from the celiac trunk and bifurcates into the proper hepatic and gastroduodenal arteries.

36
Q

Discuss the right and left gastric artery in relation to each other. Discuss the origin of the right gastric artery.

A

Right gastric artery branches from the proper hepatic artery and anastomoses with the left gastric artery on the lesser curvature of the stomach.

37
Q

Discuss origin of right gastroepiploic artery and where it anastomoses onto (discuss said origin)

A

Right gastroepiploic artery branches from the gastroduodenal artery and anastomoses on the greater curvature of the stomach with the left gastroepiploic artery, a branch of the splenic artery.

38
Q

How do paraesophageal and sliding hiatal hernias differ?

Note: A hiatal (hiatus) hernia is a protrusion of part of the
stomach into the mediastinum through the eso phageal
hiatus of the diaphragm.

A

In the less common para-esophageal hiatal hernia, the cardia remains in its normal position. However, a pouch of peritoneum, often containing part of the fundus of the stomach, extends through the esophageal hiatus anterior to the esophagus. In these cases, usually no regurgitation of gastric contents occurs because the cardial orifice is in its normal position.

In the common sliding hiatal hernia, the abdominal part
of the esophagus, the cardia, and parts of the fundus of the stomach slide superiorly through the esophageal hiatus into the thorax, especially when the person lies down or bends over. Some regurgitation of stomach contents into the esophagus is possible because the clamping action of the right crus of the diaphragm on the inferior end of the esophagus is weak.

39
Q

How is Helicobacter pylori infection related to gastric ulcers, and why are ulcers that perforate the posterior wall of the stomach life-threatening?

Note: Gastric ulcers are open lesions of the mucosa of the stomach, whereas peptic ulcers are lesions of the
mucosa of the pyloric canal or, more often, the duodenum.

A

The bacteria erode the protective mucous lining of the stomach, inflaming the mucosa and making it vulnerable to the effects of the gastric acid and digestive enzymes (pepsin) produced by the stomach.

A posterior gastric ulcer may erode through the stomach
wall into the pancreas, resulting in referred pain to the
back. In such cases, erosion of the splenic artery results in severe hemorrhage into the peritoneal cavity.

40
Q

C-shaped duodenum courses around (location).

A

C-shaped duodenum courses around the head of the pancreas.

41
Q

What parts of the duodenum are intraperitoneal foregut derivates?

A

1st part and proximal half of the 2nd part are intraperitoneal foregut derivatives.

42
Q

What parts of the duodenum are retroperitoneal midgut derivates?

A

Distal half of the 2nd part, and the 3rd and 4th parts of the duodenum are retroperitoneal midgut derivatives.

43
Q

Spatial relations with structures

1st part of duodenum: anterior(2)/posterior(1)

A

anterior- liver and gallbladder

posterior- gastroduodenal artery

44
Q

Spatial relations with structures

2nd part of duodenum: anterior(1)/posterior(1)

A

anterior- transverse colon

posterior- right kidney

45
Q

Spatial relations with structures

3rd part of duodenum: anterior(1)/posterior(1)

A

anterior- SMA

posterior- aorta

46
Q

Discuss the organs supplied by the superior/inferior pancreaticoduodenal artery and origin?

A

superior pancreaticoduodenal artery branches from the gastroduodenal artery and supplies the duodenum and head of the pancreas that also receive blood from the inferior pancreaticoduodenal artery, a branch of the SMA.

47
Q

Discuss the lymph drainage form foregut-derived viscera.

A

lymph drains from the foregut-derived viscera into the celiac lymph nodes surrounding the celiac trunk.

48
Q

When do duodenal ulcers cause peritonitis, which organs can become inflamed, and why can life-threatening hemorrhage occur?

A

Occasionally, an ulcer perforates the duodenal wall, permitting the contents to enter the peritoneal cavity and
causing peritonitis.

Erosion of the gastroduodenal artery (a posterior
relation of the superior part of the duodenum) by a duodenal ulcer results in severe hemorrhage into the peritoneal cavity and subsequent peritonitis.

49
Q

Presynaptic greater splanchnic nerves originate from?

A

presynaptic greater splanchnic nerves originate in spinal cord segments T5-T9.

50
Q

Discuss the neuronal anatomical path taken by the sympathetic (visceral) motor fibers of the greater splanchnic nerves.

A

sympathetic (visceral) motor fibers join the anterior rami of spinal nerves T5-T9, enter the corresponding segmental paravertebral ganglia via the white communicating rami, and without synapsing directly enter the thoracic cavity.

51
Q

After traversing tiny apertures in the diaphragm, the greater splanchnic nerves synapse in the (location).

A

Celiac ganglion residing adjacent to the celiac trunk.

52
Q

(Fibers) form periarterial plexuses on the aforementioned branches (2) of the celiac trunk.

(Nerves) contribute to the periarterial plexuses.

A

Postsynaptic sympathetic fibers form periarterial plexuses on the aforementioned branches, left gastric artery and common hepatic artery, of the celiac trunk.

Vagus nerves contribute to the periarterial plexuses.

53
Q

Discuss how rates of PERISTALTIC contraction and/or _____ secretion increase with the contribution of the vagus nerve.

A

presynaptic fibers of the vagus nerve synapse with the visceral motor neurons of the ENS and thereby increase the rates of peristaltic contraction and/or glandular cell secretion.

54
Q

Discuss how rates of ENS-mediated contractile and/or secretion decrease.

A

Postsynaptic sympathetic fibers from the celiac ganglion decrease the ENS-mediated contractile and/or secretory rates.

55
Q

Discuss the anatomical route taken by the Visceral afferent fibers from the DRG at T5-T9 to the periarterial plexuses.

A

Visceral afferent fibers from the DRG at T5-T9 enter the white communicating rami, traverse the celiac ganglion, and accompany the postsynaptic sympathetic fibers in the periarterial plexuses.

56
Q

Visceral pain from the foregut derivatives and somatic pain from the abdominal wall or parietal peritoneum enter where?

Visceral pain is perceived how?

A

Visceral pain from the foregut derivatives and somatic pain from the abdominal wall or parietal peritoneum both enter the CNS via the DRG at T5-T9.

Visceral pain is consciously perceived as dull, diffuse pain in the epigastric region of the abdominal wall.

57
Q

When do duodenal and/or gastric ulcers create dull, diffuse pain in the epigastric region or sharp, localized pain in the abdominal wall?

A

Upon irritation of the viscera the pain is dull and diffuse. Upon reaching the parietal peritoneum the pain will be sharp, localized in the abdominal wall.

58
Q

Embryologically where does the primordial of the spleen form?

A

Primordium of the spleen forms in the dorsal mesogastrium (embryonic mesentery of the stomach).

59
Q

Discuss the relation of stomach rotation and orientation of spleen and dorsal mesogastrium.

A

Rotations of the stomach pull the spleen and dorsal mesogastrium to the left

60
Q

Discuss what the dorsal mesogastrium forms (3). Discuss a fusion that occurs.

A

Dorsal mesogastrium forms the visceral peritoneum of the spleen and creates the gastrosplenic ligament that extends from the stomach to the spleen.

Portion of the dorsal mesogastrium fuses with the parietal peritoneum and its non-fused portion forms the splenorenal ligament that extends from the spleen to the abdominal wall in the region of the retroperitoneal left kidney.

61
Q

Discuss the splenic artery and its branches.

A

splenic artery is a tortuous branch of the celiac trunk and near the hilum of the spleen the left gastroepiploic artery and short gastric arteries branch from the splenic artery.

62
Q

Locate gastrosplenic and splenorenal ligaments.

A

Informational

63
Q

Discuss the anatomical course of the splenic artery.

A

splenic artery courses in the splenorenal ligament from its retroperitoneal position into the hilum of the spleen.

64
Q

Gastrosplenic ligament conveys the ________ arteries to the (structure).

A

gastrosplenic ligament conveys the short gastric arteries to the fundus of the stomach.

65
Q

Discuss the formation of the hepatic portal vein and what it drains.

A

Inferior mesenteric vein (IMV) typically joins the splenic vein prior to its union with the SMV to form the hepatic portal vein

Venous blood from the entire GI tract and spleen drains into the hepatic portal vein

66
Q

Define spleen and its location (post. and ant.). Is it protected, discuss.

A

Spleen, which is the largest lymphatic organ, resides posteriorly in the left upper quadrant of the abdomen

Spleen is protected by the left 9th to 12th ribs.

Anteriorly, the spleen does not extend below the left costal margin.

67
Q

Do side effects usually result from a total splenectomy in adults?

A

Even total splenectomy usually does not
produce serious effects, especially in adults, because most of its functions are assumed by other reticuloendothelial organs (e.g., liver and bone marrow)

But there is a greater susceptibility to
certain bacterial infections.

68
Q

When can the spleen be palpated?

A

The spleen is not usually palpable in the adult. Generally,
if its lower edge can be detected when palpating below the left costal margin at the end of inspiration, it is
enlarged about three times its “normal” size.

MS2 (6 decks)

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