Gross III Exam 2 Pages 88-94 Flashcards
what is diverticulosis
a disorder where multiple false diverticula develop along the intestine
where is diverticulosis most commonl found
in elderly and middle aged persons in the Sigmoid colon
how do colonic diverticula differ from true diverticula
Colonic diverticula are formed as prtrusions through the mucous membrane between weak points in the muscle fibers whereas true divertucula involve the whole intestinal wall
What is diverticulitis
The infection and rupture of colonic diverticula
what are the main effects of diverticulitis
distortion and erosion of the nutrient aa, hemorrhage, severe abdominal pain in the LLQ, and blood in the stool
what is the main sign of diverticulosis
pellet like, slimy stool
what is the main artery to the midgut
superior mesenteric a,
what are the seven midgut derivative aa.
anterior/posterior inferior pancreaticoduodenal a, jejunal/ileal aa, middle colic a, right colic a, ileocolic a
what organ does the middle colic a. supply
transverse colon
What anastomoses with the left colic a. from IMA
Marginal a.
what does the ileocolic a supply
the distal ileum and cecum
what does the appendicular atery supply
the appendix
which artery supplies the hindgut
Inferior mesenteric a.
what artery supplies the descending colon
the Left colic a.
What do the sigmoidal arteries supply
the sigmoid colon
What is the superior rectal a.
the terminal branch to the superior portion of the rectum
Which abdominal parts of the GI tract does the Hepatic Portal vein receive nutrient rich bood from
Esophagus, stomach, small/large intestines, pancreas, gallbladder, spleen
The union of which veins form the HPV
The splenic v. unites with the superior mesenteric v. to form the HPV
Where does the blood in the splenic v. originate from
There are 2 main sources: bilirubin rich blood from the spleen drains to the splenic vein, and the inferior mesenteirc v. drains to the splenic from the distal large intestine.
What does the superior mesenteric v. drain
the superior mesenteric v. drains the small intestine and proximal large intestine
What are the 3 main hepatic portal venous return anastamoses with systemic (caval) venuos return
- esophageal vv and azygos v
- rectal vv via either inferior mesenteric v or IVC
- Paraumbilical vv. via superficial epigastric vv.
What causes portal hypertension
Obstruction of blood flow through the liver (usually HPV) by cirrhosis
What does portal hypertension lead to
The large volume of blood between portal and systemic system causes varicose veins to arise at portal-systemic anastomoses
Where do the varicose veins caused by portal hypertension normally arise
dilated vv in lower esophagus become esophageal varices, and dilated and prolapsed rectal vv.
Which veins becomes varicose in severe cases
vein in the abdominal wall that anastomoses with the paraumbilical vv become varicose
what is “caput Medusae”
“Head of Medusa” is the appearance of snake like varices radiating around the umbilicus in severe cases of portal hypertension
What are the main risks associated with portal hypertension
extreme dilation of the vessels puts them at risk for hemorrhage, and bleeding from esophageal varices is often severe, potentially fatal
What is the current treatment for portal hypertension
Pressure is reduced by surgically creating a communication between the HPV and IVC posteior to the liver, where the vessels are clostest to each other. This bypasses the liver.
Where are the Kidneys located
Retroperitoneal on posterior abdominal wall at T12-L3
Which Kidney is lower than the other and why
The right kidney is lower than the left because of the liver.
What is the right kidney associated with
The liver, duodenum, and the ascending colon
What is the left kidney associated with
The pancreas, stomach, spleen, and descending colon
Which nerves pass posterior to the kidneys
Subcostal, iliohypogastic, and ilioinguinal nn.
What are the 3 main functions of the kidneys
- Remove salts and wastes from the blood while preserving nutrients
- Maintain appropraite water balance
- secrete substances that regulate blood pressure and erythropoiesis
What is the function of the ureter
The ureter is the tube that connects the kidney to the urinary bladder for the passage of urine.
Where is the suprarenal gland located
It is located supermedially to each kidney in the perirenal fat which in turn is inside the renal fascia
What is the function of the suprarenal gland
The suprarenal gland produces corticosteroids, androgens, epinephrine, and norepinephrine
Where is the pararenal fat located
The pararenal fat is located outside the renal fascia and is most obvious posterior to the kidney
Do the kidneys move
While large amounts of fat and connective tissue hold the kidneys relatively in place, normal vertical range of motion for kidneys is 3 cm
In a kidney transplant, what happens to the donor’s suprarenal gland
The donor suprarenal gland is undamaged because it and the kidney are in separate fascial compartments
How is a transplanted kidney connected to the recipient
The donor kidney is placed in the recipient iliac fossa. The renal a. and v. are sutured to the iliac a. and v., and the ureter is sutured to the urinary bladder.
What is the hilum
The hilum is a vertical concave cleft on the medial surface of the kidney
What passes through the hilum
In anterior to posterior order: Renal v., Renal a., Renal pelvis (ureter)
Small nerves and lymphatics also pass through the hilun
What is in the renal sinus
A fat filled space, the renal sinus houses the renal pelvis and calyces.
What is the renal pelvis
The renal pelvis is the flattened, funnel shaped origin of the ureter.
What is the function of the renal pelvis
The renal pelvis collecys urine directly from the major calyces and indirectly from the minor calyces.
Where does the renal a. branch from
The renal a. braches from the abdominal aorta at the L1-L2 IVD
Which side of the renal a. is longer
The right side is longer and it passes posterior to IVC
What happens to the renal a at the hilum
It divides into 5 segmental aa
What forms the renal v.
The renal v. is formed by the union of several non-segmented intrarenal vv.
Which side of the renal v. is longer
The left side is longer and passes anterior to the abdominal aorta and posterior to SMA
Which vv. does the left renal v. receive
The left renal v. receives the left inferior phrenic v., left suprarenal v., and left gonadal v.
Which vv. does the IVC receive?
The right inferior phrenic v., the right suprarenal v., and right gonadal v.
What are the primary nodes for the kidneys and where do they drain
The lumbar nodes are the primary nodes for the kidneys and they drain to the thoracic duct.
what is the sympathetic innervation of the kidney
sympathetic innervation is supplies by lesser and least splanchnic nn., which synapse in the aorticorenal ganglion. It causes vasoconstriction.
What is the parasympathetic innervation of the kidney
The parasympathetic innervation of the kidney is supplied by the renal plexus from posterior vagal trunk. causes vasodilation (increased urine output).
Pain in the kidneys is referred to which dermatomes
sympathetics to T10-T12 core segments and is normally referred as back pain.
what is the fascial plane of the ureter
retroperitoneal
what are the three points of constriction in the ureter
- junction between renal pelvis and ureter
- point where ureter crosses brim of pelvic inlet
- point where ureter crosses through the wall of the urinary bladder.
which aa. supply the ureter
renal a, gonadal a, abdominal aorta
Which veins drain the ureter
renal v. and gonadal v.
what are the lymph nodes for the ureter
lumbar or common iliac lymph nodes
what is the sympathetic innervation for the abdominal part of the ureter
T11-L2 via renal aortic and hypogastric plexuses
what is hydronephrosis
fluid backup in renal pelvis and calyces
What are the symptoms of renal and ureteric calculi
ureteric pain is rhythmic, sharp, stabbing, and follows course of ureter
what is renal and uteric calculi
stones found in calyces, renal pelvis, ureteres, and urinary bladder
where is pain referred from renal and ureteric calculi
T11-L2 dermatome
what is lithotripsy
procedure that uses shockwaves to break stones into small pieces for easier passage
what is horseshoe kidney
inferior poles of the kidney fuse resulting in one, U-shaped kidney
what is ectopic pelvic kidney
kidney fails to send out a pelvis
what are the differences in shape between the suprarenal glands
right suprarenal gland is triangular in shape, left suprarenal gland in cresent in shape
what does the right suprarenal gland contact in the abdomen
thoracic diaphram, IVC, and Liver
what does the left suprarenal gland contact in the abdomen
thoracic diaphram, spleen, stomach, and pancreas
what does the suprarenal cortex secrete
corticosteroids and androgens
what does the suprarenal medulla secrete
epinephrine and norepinephrine
what sympathetic response do epinephrine and norepinephrine elicit
fight or flight! increased heart rate and blood pressure, dilated bronchioles, and increased blood flow to brain and skeletal muscles.
which arteries supply the suprarenal glands
superior suprarenal artery - branches from inferior phrenic artery
middle suprarenal aretery - branches from abdominal aorta
inferior suprarenal artery - branches from renal artery
what veins drain the suprarenal glands
right suprarenal vein - drains directly to IVC
left suprarenal vein - drains directly to left renal vein
Where do the lymphatics for the suprarenal glands drain
lumbar nodes and thoracic duct
what is the sympathetic innervation for the suprarenal glands
lesser and least splanchnic nn. and celiac plexus
what part of the suprarenal gland do the sympathetic nerves supply
neurons synapse directly on suprarenal medullary cells. cortex has no nerve supply
What is parasympathetic innervation for the suprarenal glands
posterior vagal trunk and celiac plexus
