Lab 10: Abdomen Flashcards

1
Q

abdominal skeleton

A
  • bounded superiorly by the abdominal diaphragm and inferiorly by the upper margin of the bony pelvis
  • consists of a large cavity that is walled by muscle and serous membrane
  • abdominal cavity is continuous inferiorly with the pelvic cavity which is enveloped by the bony pelvis
  • structure of rib cage and tilt of pelvis cause the thoracopelvic gap between them to be higher in front than behind
  • dome of abdominal diaphragm is very high -> from margins of 12th ribs up to the level of 5th ribs
  • some abdominal organs are covered by the lower 5 or 6 ribs and their costal cartilage
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2
Q

relationship of abdominal viscera to the rib cage

A
  • several ab organs are partially, largely, or entirely covered by the rib cage
  • liver- deep to rib cage, covered anteriorly by the bottom of the sternum and some of the inferior costal cartilage to the left, on the right -> covered by the 5th to 11th ribs and their costal cartilage, posteriorly it is deep to the 9th to 11th ribs
  • stomach- covered anteriorly on the left side by the 5th to 8th ribs
  • spleen- entirely covered by the 9th to 11th ribs
  • kidneys- deep to ribs -> both adrenal (suprarenal) glands are covered by the 12th ribs
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3
Q

roof of the abdominal cavity

A
  • abdominal diaphragm forms the roof of the abdominal cavity

- innervated by phrenic nerve (C3-C5)

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4
Q

anterolateral walls of the abdominal cavity

A
  • cover by 4 muscles on each side

- one is strap-like longitudinal muscles in the front and 3 sheet-like muscles more laterally

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5
Q

anterior abdomen muscle: rectus abdominis

A
  • rectus abdominis- strap-like muscle that arises from the xiphoid (and 5th to 7th costal cartilage)
  • runs from superior (xiphoid process), 5th-7th costal cartilages -> to the pubis
  • 2 sheets
  • inserts on the superior edge of the pubis
  • flexes the trunk
  • in between each muscle belly there is a tendinous intersections muscle section
  • 3 (sometimes 4) connective tissue tendinous intersections that interrupts the muscle belly
  • recuts sheath- encloses the rectus abdominis
  • formed by aponeuroses of 3 lateral wall muscles
  • arcuate line (bellow belly bottom)- below this line the rectus sheath is only in the front (not behind)
  • semilunar line- where it stops
  • tendinous sheath of lateral wall muscle - make up the layers of rectus abdominis
  • innervated by spinal nerves T7-T12
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6
Q

3 layers of rectus abdominis

A

external oblique aponeuroses

  • internal oblique aponeuroses
  • transversus abdominis
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7
Q

anterolateral wall: external oblique

A
  • external oblique- most superficial layer
  • arises from the lower 8 ribs and the iliac crest
  • fibers run inferiorly and medially and become tendinous anteriorly to form the linea alba
  • inguinal ligament
  • thick inferior edge of aponeurosis -> stretches between the anterior superior iliac spine and the pubic tubercle -> inguinal ligament
  • superficial inguinal ring- hole in the aponeurosis above the pubic tubercle (testes exit here)
  • inguinal canal passes though the inguinal ligament- testes originate here and drop)
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8
Q

anterolateral wall: internal oblique

A
  • middle layer
  • arises from the front of the iliac crest and the inguinal ligament
  • fibers run superiorly and medially -> insert onto ribs 10-12
  • inferior edge form an arc above the inguinal ligament that is deep to and slightly lateral to the superficial inguinal ring
  • above the umbilicus -> aponeurosis splits into superficial and deep layers around rectus abdominis
  • below umbilicus -> aponeurosis runs superficial to rectus abdominis to mesh with the linea alba
  • runs the opposite direction of external oblique
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9
Q

anterolateral wall: transversus abdominis

A
  • running horizontally
  • deepest muscle layer
  • arises posteriorly form an aponeurosis that passes behind quadratus lumborum
  • attaches to transverse processes of L1-L5
  • also attaches to the lower 6 costal cartilages -> iliac crest and inguinal ligament
  • fibers run anteriorly to become aponeurotic and mesh with the linea alba
  • above the umbilicus -> aponeurosis passes behind rectus abdominis
  • below umbilicus -> its aponeurosis passes in front of rectus abdominis
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10
Q

transversalis fascia

A
  • fascial layer
  • below the three layers of muscle in the anterolateral wall
  • internal aspect of the abdominal wall is lined with a layer of tissue known as the transversalis fascia
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11
Q

rectus sheath

A
  • formed from the aponeuroses of the obliques and transversus abdominis
  • arcuate line- inferior margin of posterior rectus sheath
  • below arcuate line -> the rectus abdominis sits directly on transversalis fascia
  • weak spot in abdominal wall
  • aponeuroses of the left and right external oblique muscles cover the rectus abdominis muscles anteriorly and fuse to the midline to form the linea alba
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12
Q

above arcuate line: superficial to deep

A
  • external oblique aponeurosis
  • first half of internal oblique aponeurosis
  • rectus abdominis
  • second half of internal oblique
  • transversus abdominis
  • transversalis fascia
  • parietal peritoneum
  • first and second half enclose
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13
Q

below arcuate line: superficial to deep

A
  • external oblique aponeurosis
  • internal oblique aponeurosis
  • transversus abdominis
  • rectus abdominis
  • transversalis fascia
  • parietal peritoneum
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14
Q

pyramidalis

A
  • arises from the pubis and inserts into the linea alba

- 80% of people have this small muscle

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15
Q

linea alba

A
  • left and right muscles (anterior abdomen muscle) are separated by a longitudinal band of connective tissue called the linea alba
  • tendinous intersections and linea alba create the six pack
  • aponeuroses of the left and right external oblique muscles cover the rectus abdominis muscles anteriorly and fuse to the midline to form the linea alba
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16
Q

posterior wall of abdomen: quadratus lumborum

A
  • forms most posterior wall
  • laterally flexes trunk
  • forms the bulk of the posterior abdominal wall
  • originates on the iliolumbar ligament and iliac crest
  • inserts onto the transverse process of L1-L4 and the lowermost rib
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17
Q

posterior wall of abdomen: psoas major

A
  • originates on vertebral column from T12-L5
  • runs down to iliacus and merges -> forms iliopsoas m.
  • hip flexor, laterally flexes trunk
  • forms the medial part of the posterior abdominal wall adjacent to the vertebral column
  • arises from the bodies and intervertebral discs of T12-L5
  • fibers merge with those of iliacus to form a conjoint iliopsoas tendon that inserts onto the lesser trochanter of the femur
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18
Q

posterior wall of abdomen: psoas minor

A
  • only present in 50-60% of people
  • runs along the front of psoas major
  • very small
  • arises from the bodies and disc of T12-L1 and runs along the front of psoas major
  • inserts onto the iliopubic eminence of the pelvis
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19
Q

posterior wall of abdomen: abdominal diaphragm

A
  • forms the superoposterior wall of the abdominal cavity

- where all the posterior abdominal wall muscles end

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20
Q

peritoneum

A
  • serious membrane, like pleura and pericardium
  • parietal peritoneum- outer layer
  • visceral peritoneum- inner layer, lies against walls of organs
  • retroperitoneal organs- not enclosed by peritoneal cavity
  • mesentery- reflected peritoneum that folds around an organ
  • greater omentum- fat flap, double layer of visceral peritoneum (specialized mesentery)
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21
Q

retroperitoneal organs

A
  • suprarenal glands
  • aorta/inferior vena cava
  • duodenum (2nd and 3rd parts)
  • pancreas
  • ureter
  • colon (ascending and descending)
  • kidneys
  • esophagus
  • rectum
  • SAD PUCKER
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22
Q

mesenteries

A
  • small intestine is suspended by the mesentery (proper)
  • transverse colon suspended by the transverse mesocolon
  • omentum- lesser and greater
  • connects to transverse colon and hangs of the greater portion of stomach -> greater omentum
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23
Q

digestive canal organs

A
  • esophagus
  • stomach
  • small intestine
  • large intestine
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24
Q

accessory organs

A
  • liver
  • gallbladder
  • pancreas
  • spleen
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25
Q

biliary tree

A

-carries bile and digestive enzymes from these organs to the small intestine

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26
Q

stomach

A
  • made up of walls of muscle layers: circular, longitudinal, oblique
  • mixes food with acids to make chyme
  • rugae- rough ridges for mechanical digestions
  • 3 parts: fundus, body, pylorus
  • 2 sphincters: cardiac and pyloric
  • cardiac sphincter- between esophagus and stomach (prevents regurgitation of acid)
  • pyloric sphincter- between stomach and duodenum
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27
Q

stomach

A
  • made up of walls of muscle layers: circular, longitudinal, oblique
  • mixes food with acids to make chyme
  • rugae- rough ridges for mechanical digestions
  • 3 parts: fundus, body, pylorus
  • 2 sphincters: cardiac and pyloric
  • cardiac sphincter- between esophagus and stomach (prevents regurgitation of acid)
  • pyloric sphincter- between stomach and duodenum (discharge chyme)
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28
Q

stomach: mesenteries

A
  • intraperitoneal
  • attached to posterior
  • lesser omentum- connects stomach and liver, runs in lesser curvature
  • greater omentum- hangs down from the stomach, connects with transverse colon -> runs along greater curvature
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29
Q

small intestine

A
  • responsible for digesting food and absorbing nutrients
  • 3 regions: duodenum (mainly retroperitoneal), jejunum (freely mobile, suspended by mesentery), ileum (suspended by mesentery)
  • ileum opens into the cecum of the large intestine
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30
Q

duodenum

A
  • most proximal part of small intestine
  • c-shaped
  • curves around head of pancreas
  • pierced by: main pancreatic duct + bile duct through major duodenal papilla
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31
Q

jejunum

A
  • wide lumen
  • thick walls
  • numerous circular folds
  • superior mesenteric artery supply
  • few arcades, long vasa recta
  • shorter
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32
Q

ileum

A
  • narrower lumen
  • thin walls
  • fewer circular folds
  • superior mesenteric artery supply
  • many arcades, short vasa recta
  • longer
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33
Q

small intestine: mesenteries

A
  • jejunum and ileum are intraperitoneal
  • attached to posterior abdominal wall by mesentery
  • mesentery- surrounding the blood vessels that go to the organs
  • mesentery proper
  • encroaches on intestinal walls in the ileum, not in the jejunum
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34
Q

large intestine

A
  • responsible for water absorption
  • storing undigested material
  • 8 regions:
  • cecum
  • vermiform appendix
  • ascending colon
  • transverse colon
  • descending colon
  • sigmoid colon
  • rectum
  • anal canal
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35
Q

haustra and taeniae coli

A
  • differentiates large intestine
  • haustra- pouches of the large intestine
  • taeniae coli- longitudinal thin muscle that goes throughout the entire large intestine
  • omental (epiploic) appendages- fat blobs that hang
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36
Q

large intestine: mesenteries

A
  • partly intraperitoneal
  • ascending and descending colon, rectum etc. are retroperitoneal
  • transverse colon is intraperitoneal
  • greater omentum- attaches the transverse colon to the stomach
  • transverse mesocolon- attaches transverse colon to posterior abdominal wall
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37
Q

liver

A
  • produces bile
  • filters blood from GI trace
  • produces bile
  • metabolizes carbs, fats, and proteins
  • lobes (4)- right lobe, left lobe, quadrate lobe (next to gallbladder!), caudate lobe (next to IVC)
  • round ligament of the liver (ligamentum teres)- used to be umbilical vein
  • falciform ligament- separates the right and left lobe
  • falciform ligament splits into 2- top portion (posterior) of the liver is bare (no peritoneum)
  • hepatic portal vein, hepatic artery proper, and common bile duct (portal triad) going into the liver -> porta hepatis
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38
Q

porta hepatis

A
  • where blood vessels enter and exit the liver
  • hepatic artery- carries oxygenated blood to tliver
  • portal vein- drains blood from GI tract to liver
  • common bile duct- drains bile from the liver (joins cystic duct from gallbladder to form common bile duct
  • deoxygenated blood drains from the liver into the inferior vena cava
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39
Q

biliary tree

A
  • right + left hepatic ducts -> common hepatic ducts
  • cystic duct + common hepatic duct -> common bile duct
  • bile ducts and the main pancreatic duct both drain into the duodenum, via the major duodenal papilla
  • bile helps break down lipids
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40
Q

kidneys

A
  • excrete metabolic waste
  • maintain water and electrolyte balance
  • blood vessels: renal arteries, renal veins
  • hilum of kidneys transmit the renal artery, renal vein, and ureter
  • regions: pelvis (collection chamber for urine) -> major and minor calyces; medulla (urine ducts) -> renal pyramids
  • renal pyramids- receive urine form collecting ducts of the nephron
  • renal papilla (opening to minor calyx)
  • renal pyramids -> renal papilla -> minor calyx -> major calyx -> renal pelvis -> ureter -> bladder
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41
Q

adrenal glands

A
  • endocrine glands, secrete hormones including adrenaline
  • blood vessels- suprarenal arteries (3) suprarenal veins
  • superior suprarenal artery branches off inferior phrenic artery (which supplies the diaphragm)
  • middle suprarenal artery off aorta
  • inferior suprarenal artery off renal artery
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42
Q

renal artery and veins relationship

A
  • renal veins are superficial to renal arteries
  • left renal vein is much longer than the right (bc it must cross over aorta)
  • inferior mesenteric artery (IMA) comes off the aorta over the left renal vein
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43
Q

nephron: tubular component

A
  • glomerular (bowmans) capsule
  • proximal convoluted tubule
  • loop of henle
  • distal convoluted tubule
  • collecting duct
  • urine leaves through collecting duct
  • things that are moved into the blood leave through efferent arteriole
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44
Q

nephron: vascular component

A
  • afferent arteriole
  • glomerulus
  • efferent arteriole
  • peritubular capillary network
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45
Q

arteries of abdomen

A
  • 3 major branches of abdominal aorta:
  • celiac trunk (T12-L1)- emerges near aortic hiatus -> supplies foregut
  • superior mesenteric artery (L1)- supplies midgut
  • inferior mesenteric artery (L3)- supplies hindgut (splenic flexure, ascending and descending colon, rectum)
  • also note that paired visceral branches from the aorta: middle suprarenal arteries, renal arteries, gonadal arteries
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46
Q

celiac trunk

A
  • main branches:
    1. left gastric artery: supplies stomach, esophagus
    2. splenic artery: supplies pancreas spleen (gives off left gastroepiploic artery)
    3. common hepatic artery: splits into gastroduodenal artery and proper hepatic artery
  • gastroduodenal artery- supplies duodenum (gives off right gastroepiploic artery)
  • proper hepatic artery- supplies liver (gives off right gastric artery to stomach and cystic artery to gallbladder)
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47
Q

anastomoses

A
  • 2 different sources of blood join and form one artery
  • lesser curvature gets blood from left gastric artery and right gastric artery -> they combine
  • left side
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48
Q

superior mesenteric artery

A

-L1
-enters mesentery of small intestine
-supplies distal 1/3 of duodenum, remaining small intestine, proximal large intestine
1. jejunal branches
2. ileal branches
3. middle colic artery: gives blood to transverse colon and some ascending colon,
4.

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49
Q

inferior mesenteric artery

A
  • supplies distal large intestine and proximal rectum
  • branches:
    1. left colic artery- supplies distal transverse colon and proximal descending colon
    2. sigmoid branches- supply descending colon, sigmoid colon
    3. superior rectal artery-
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50
Q

venous drainage

A
  • systemic venous system drains blood from the whole body (except the GI tract)
  • portal venous system drains blood from the GI tract
  • passes through liver before continuing to the heart
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51
Q

portal venous system

A
  • inferior mesenteric vein drains into splenic vein
  • splenic vein meets up with superior mesenteric vein -> forms hepatic portal vein
  • portal vein enter the liver via the porta hepatis
52
Q

gonadal vessels

A
  • gonadal arteries- testicular artery in males and ovarian artery in females
  • gonadal veins are not symmetrical
  • left gonadal vein drains into left renal vein
  • right gonadal veins drains into inferior vena cava
53
Q

peritoneum

A
  • cavity that is enclosed by the abdomen and pelvis is lined with a serous membrane -> peritoneum
  • peritoneal sac has an outer parietal and inner visceral component that lies against the walls of organs that have pushed into it
54
Q

peritoneal cavity

A

-membranous sac that some of the abdominal organs protrude

55
Q

retroperitoneal

A
  • sit between the parietal peritoneum and the posterior wall of the abdomen
  • kidneys and adrenal glands, ascending colon, descending colon, rectum, parts of the pancreas and duodenum
56
Q

mesentery

A

-push into the peritoneal sac from behind
-push into the sac so deeply that the peritoneum stretches out behind them becoming bilaminar between the organ and the posterior abdominal wall
-permits the organ a degree of movement and it is the conduit for blood vessels and nerves to the organ
-small intestine is suspended by the mesentery -> mesentery proper
-transverse colon is suspended by a mesentery -> transverse mesocolon
-

57
Q

omentum or ligament

A
  • some organs push into the peritoneal sac even more deeply
  • one organ may push into the sac in front of another, so the first becomes suspended by a bilaminar sheet of peritoneum that is reflected off of the second
  • suspensory fold such as this is referred to as either a ligament or omentum
58
Q

lesser omentum

A

-stomach is suspended from the liver

59
Q

greater omentum

A
  • stomach and transverse colon are connected by a large flap of peritoneum known as greater omenutm
  • hangs down like an apron to cover the front of most of the intestinal tract
  • it will adhere to the surface of the gut around a site of infection or perforation which helps seal off and localize such conditions
60
Q

digestive system

A
  • consists of alimentary canal and the abdominal organs of digestion that are associated with it
  • alimentary canal begins with the oral cavity and includes the oropharynx and pharynx in the head and beck and the esophagus through the neck and thorax
  • esophagus passes through the abdominal diaphragm to enter the gut
  • gut is contained with the abdominopelvic cavity
  • about 1/2 inch below the diaphragm the esophagus opens into the stomach
  • stomach leads to small intestine (21 ft)
  • small intestine opens into the large intestine (4ft)
  • digestive organs associated with alimentary -> liver, gall bladder, pancreas
61
Q

small intestine

A
  • duodenum
  • jejunum
  • ileum
  • most of the digestion of food and the absorption of nutrients
  • 2 layers of smooth muscle: longitudinal and circular (superficial to deep)
  • longitudinal- peristaltic
  • circular- segmenting contractions
62
Q

large intestine

A
  • cecum
  • vermiform appendix
  • ascending colon
  • transverse colon
  • descending colon
  • sigmoid colon
  • rectum
  • anal canal[
  • absorption of water and storage of undigested material until it can be expelled as feces
  • 4 ft
  • shorter but larger diameter than small intestine
  • forms frame around small intestine
63
Q

spleen

A
  • lymphatic organ primarily

- produces a substance used by the liver to make bile which is digestive

64
Q

bile

A
  • liver produces and gallbladder stores bile
  • delivered into the small intestine by a network of tubes -> biliary tree
  • biliary tree opens into the duodenum
  • liver also filters blood from the intestines and metabolizes the carbohydrates, fats, and proteins that are carried to it by that blood
65
Q

pancreas

A
  • produces the hormone insulin -> key role in carbohydrate metabolism
  • most of substance manufactures digestive enzymes
  • delivered to the small intestine by tubes that are linked to the biliary tree
66
Q

gut

A
  • foregut
  • midgut
  • hindgut
  • receive blood from separate vessels form the abdominal aorta -> celiac, superior mesenteric, inferior mesenteric
67
Q

portal venous system

A
  • blood from the GI has to be filtered by the liver before it reaches the heart
  • carries blood from the gut to the liver
68
Q

stomach

A
  • large, dilated portion of the alimentary canal
  • stores food for processing and mixes the foot with acidic secretion from glands in its walls to form semifluid -> chyme
  • delivers chyme to the small intestine
  • esophagus is continuous with the stomach just below the abdominal diaphragm
  • opening into the stomach is known as the cardiac orifice
  • greater curvature- longer left margin
  • lesser curvature- shorter right margin
  • 3 parts: fundus, body pylorus
  • fundus- dome-shaped region that extends upward from the cardiac orifice
  • body- extends from the level of the cardiac orifice to the end of the lesser curvature
  • pylorus- extends to the point at which the stomach becomes continuous with the small intestine
69
Q

cardiac sphincter

A

-circular band of smooth muscle that surrounds the cardiac orifice prevents the regurgitation of food and drink

70
Q

pyloric orifice

A
  • stomach opens into the small intestine at the pyloric orifice
  • walls of this orifice are thickly muscles forming the pyloric sphincter -> regulates the discharge of chyme into the small intestine
71
Q

stomach wall

A
  • mucous membrane that lines the inside of the stomach wall is thick
  • numerous folds -> rugae
  • rugae- mainly longitudinal oriented, flatten out as the stomach become distended with food
  • stomach can expand to accommodate a bit more than a quart of ingested material
  • walls of stomach comprise of three layers of smooth muscle: longitudinal, circular, oblique (superficial to deep)
72
Q

duodenum

A
  • retroperitoneal- fixed in place
  • C-shaped
  • curves around the head of the pancreas
  • continuous with the second part of the small intestine -> jejunum
  • vertical portion is pierced by the conjoined main pancreatic duct and bile duct -> forms the major duodenal (hepatopancreatic) papilla
  • the orifice of this small projection on the inner surface is guarded by a smooth muscle sphincter -> sphincter of oddi
  • accessory pancreatic duct- opens a little proximal sphincter of oddi it through minor duodenal (hepatopancreatic) papilla
  • muscous membrane lining the inside has numerous transverse permanents fold -> plicae circulares -> serve to increase SA for absorption
73
Q

jejunum

A
  • long coils- freely movable
  • attached to the posterior abdominal wall by a fold of the peritoneum -> mesentery
  • lies primarily in the upper left of the peritoneal cavity
  • wide lumen and thick wall
  • supplied by the superior mesenteric artery -> branches of which form anastomosing arcades
  • branches form only one or two arcades and heir terminal portions are long
  • numerous closely set plicae circulares
  • shorter than ileum -> 7 1/2 ft
74
Q

ileum

A
  • lies mostly in the lower right part of abdomen
  • opens into the cecum of the large intestine
  • long coils- freely movable
  • attached to the posterior abdominal wall by a fold of the peritoneum -> mesentery
  • narrow lumen and thin wall
  • supplied by the superior mesenteric artery -> branches of which form anastomosing arcades
  • branches form several arcades and their terminal portions are short
  • plicae are set farther apart in the proximal part and are absent from its distal part
  • 11 ft
75
Q

cecum

A
  • forms a pouch below its junction with the ileum at the ileocecal orifice
  • orifice is guarded by the ileocecal valve
  • hanging from the end of the cecum is the vermiform appendix -> opens into the cecum alittle below the ileocecal orifice
  • base of appendix lies directly behind a point on the anterior abdominal wall (McBurney’s point) -> 1/3rd of the way up a line drawn between the right anterior superior iliac spine and the umbilicus
76
Q

ascending colon

A
  • extends up the right side of the abdomen form the cecum to the liver
  • turns to the left at the right colic (hepatic) flexure
  • at this flexure the ascending colon becomes the transverse colon
  • transverse colon hangs down a bit as it crosses the abdomen to a point just below the spleen
  • turns downward at the left colic (splenic) flexure -> becomes the descending colon
77
Q

descending colon

A
  • runs downward along the left side of the abdomen to become the sigmoid colon at the brim of the pelvis
  • sigmoid colon leads to the rectum
78
Q

rectum

A
  • beings at the level of the 3rd sacral vertebra (S3)
  • runs downward along the sacrum to the level of the top of the coccyx
  • pierces the pelvic diaphragm to become the anal canal
79
Q

taeniae coli

A
  • longitudinal layer of muscle that completely surround the outside of the small intestine is retricted to 3 separate band in the large intestine -> taeniae coli
  • they cause regular bulges and constrictions along most of the large intestine
  • bulges-> haustra
  • haustra can be visualized by x-rays when the colon is coated internally with radiopaque material such as barium
  • taeniae coli and haustra extend the entire length of the colon up to the rectum -> rectum and anal canal lack
  • circular muscle fibers of the anal canal form an anal sphincter which is aided by a ring of skeletal muscle around it
  • anal canal opens at the anus
80
Q

liver

A
  • digestive- filters blood from the GI, metabolizes carbs, fats, and proteins carried by the blood -> produces bile
  • pyramidal shape
  • covered by rib cage
  • convex upper (diaphragmatic) surface is molded to the inferior surface of the abdominal diaphragm
  • inferior (visceral) surface is slightly concave
  • surface are separated in form by the sharp inferior border
  • 4 lobes: right (large), left (smaller), quadrate, caudate
  • quadrate and caudate lobes are central placed on the visceral surface -> left side of the liver
  • left and right lobe are separated by the mesentery that attached the liver to the middle of the anterior abdominal wall -> falciform ligament
  • falciform ligament is a thickened inferior free edge of ligamentum teres
  • ligamentum teres- extends from the liver to the umbilicus -> remnant of the fetal umbilical vein
  • peritoneum reflect off the livers visceral surface between the quadrate and caudate lobes as the lesser omentum
  • liver is covered with peritoneum except for the bare area of the diaphragmatic surface around the inferior vena cava
81
Q

gallbladder

A
  • peeks out from the visceral surface of liver under the inferior border at a point just behind the tip of the 9th costal cartilage
  • pear shaped sac
  • 3 parts: fundus, body, neck
  • fundus- rounded end that projects below the inferior margin of the liver
  • body- lies against the visceral surface of liver
  • neck- extends from the body to a tube known as the cystic duct
  • tubes that carry bile connect the liver to the gallbladder and connect the liver and gallbladder to the duodenum -> tubes comprise the biliary tree
  • left and right hepatic duct- drain bile from the left and right lobes of the liver
  • left and right hepatic duct joint -> form common hepatic duct -> exits the liver through the porta hepatis
  • common hepatic duct is joined by the cystic duct from the gallbladder -> forms bile duct
  • bile duct runs inferiorly and joins main pancreatic duct from the pancreas just before opening into the duodenum of the small intestine -> these 2 ducts enter the duodenum through hepatopancreatic orifice (ampulla) that is guarded y the sphincter of oddi
82
Q

porta hepatis

A
  • place through which the blood vessels and ducts enter and exit the liver
  • hepatic artery- supplies the liver with oxygenated blood
  • portal vein- drains blood from the entire GI tract to the liver
  • common hepatic duct- drains bile from the liver
83
Q

inferior vena cava

A

-deoxygenated filtered blood is drained from the liver into the inferior vena cava by 2 very short hepatic veins that emerge from its posterior surface

84
Q

pancreas

A
  • transverse the posterior abdominal wall behind the stomach at the level of L2-L3
  • extends from the vertical part of the duodenum to the spleen
  • retroperitoneal
  • 4 parts: heads, neck. body, tail
  • head- fits into the C shape bend of the duodenum
  • neck- connects the head to the body
  • tail- contacts the spleen
  • digestive enzymes are drained from the pancreas by the main pancreatic duct -> runs the length of the organ
  • joins with the bile duct to open into the duodenum at the hepatopancreatic orifice or major duodenal papilla
  • main pancreatic duct has a branch in the head of the pancreas known as the accessory pancreatic duct
  • opens into the duodenum a little proximal to the hepatopancreatic orifice through the minor duodenal papilla
85
Q

blood vessels of the gut

A
  • alimentary and associated digestive organs are supplied by 3 arteries that arise from the front of the abdominal aorta
  • venous blood from the gut contain products absorbed from digested food, so it must be processes by the liver before it can be added to the general circulatory system
  • blood is taken to the liver by the portal venous system -> bypasses the inferior vena cava
  • after filtering and processing it -> liver returns the blood to the inferior vena cava for general circulation
86
Q

foregut: blood supply

A
  • gives rise to the esophagus stomach and duodenum
  • also contains the liver, gallbladder, pancreas, and spleen
  • celiac artery (trunk) serves the foregut
87
Q

midgut: blood supply

A
  • gives rise to the rest of the small intestine, the cecum, and the vermiform appendix as well as the ascending colon and most of the transverse colon
  • supplied by the superior mesenteric artery
88
Q

hindgut: blood supply

A
  • gives rise to the terminal portion of the transverse colon together with the descending colon, sigmoid colon, rectum and anal canal
  • supplied by the inferior mesenteric artery
89
Q

abdominal aorta

A
  • aorta enters the abdominal cavity through the aortic hiatus at the back of the abdominal diaphragm
  • aorta enters the abdominal cavity at the level of T12 and runs along the front of the vertebral column -> bifurcates at the level of L4 into the left and right common iliac arteries
  • between the common iliac arteries is the thin terminal branch of the aorta known as the median sacral artery -> runs across L5 and the front of the sacrum
  • abdominal aorta gives off 3 large, unpaired median branches to abdominal (and pelvic) viscera and 3 paired lateral branches to abdominal (and pelvic) viscera
  • abdominal aorta also gives off 5 paired lateral branches to the muscles of the abdominal wall
  • uppermost of these 5 is the inferior phrenic artery -> supplies the abdominal diaphragm
  • other 4 are known as lumbar arteries -> run across the bodies of the lumbar vertebrae
90
Q

unpaired median visceral branches

A
  • celiac artery (trunk)
  • superior mesenteric artery
  • inferior mesenteric artery
91
Q

celiac artery branch

A
  • first branch to arise from the abdominal aorta, soon after it emerges through the diaphragmatic hiatus
  • comes off at the level of T12-L1
92
Q

superior mesenteric artery

A
  • arises from the abdominal aorta immediately below the celiac artery
  • comes off at the level of L1
93
Q

inferior mesenteric artery

A

-somewhat lower, arising from the front of the abdominal aorta at the level of L3

94
Q

paired lateral visceral branches

A
  • middle suprarenal arteries
  • renal arteries
  • gonadal arteries
  • gonadal arteries: ovarian arteries and testicular arteries
95
Q

middle suprarenal arteries

A
  • left and right middle suprarenal arteries arise from the sides of the abdominal aorta at about the same level as the superior mesenteric artery
  • supply the suprarenal (adrenal) glands with blood
  • each gland receives blood from 3 arteries
  • superior suprarenal arteries is a branch of the inferior phrenic artery, and the inferior suprarenal artery is a branch of the renal artery
96
Q

renal arteries

A
  • left and right renal arteries arise from the sides of the abdominal aorta just below the level of the superior mesenteric artery
  • supply the kidneys with blood
97
Q

gonadal arteries

A
  • left and right gonadal arteries arise from the sides of the abdominal aorta just below the level of the renal artery
  • supply the gonads with blood
  • depending upon the sex the gonadal arteries are properly referred to as either ovarian or testicular arteries
  • gonadal arteries arise at this level bc embryologically the gonads begin to develop high in the abdominal cavity
  • descend along the back wall of the abdominal cavity during prenatal development to reach their final positions in the 4th month (ovaries) or just before birth (testes)
98
Q

celiac artery

A
  • very short
  • arises from the aorta just below the abdominal diaphragm and behind the head of the pancreas
  • divides into 3 branches: left gastric artery, splenic artery, common hepatic artery
99
Q

celiac artery: left gastric artery

A
  • branch of celiac artery

- ascends towards the junction of the stomach and esophagus -> supplying each

100
Q

celiac artery: splenic artery

A
  • branch of celiac artery
  • runs to the left along the top of the pancreas into the spleen, supplying both
  • just before entering the spleen, it gives off the left gastroepiploic (gastro-omental) artery
  • runs back to the right along the greater curvature of the stomach
101
Q

celiac artery: common hepatic artery

A
  • branch of celiac artery
  • runs to the right toward the liver
  • divides into the hepatic artery (proper) and the gastroduodenal artery
  • after the gastroduodenal artery comes off -> there are 2 other branches from the hepatic artery -> right gastric and the cystic artery
  • gastroduodenal artery- comes off behind the duodenum and supplies it -> gives off a branch -> right gastroepiploic artery
  • gastroepiploic artery- which runs to the left along the greater curvature of the stomach to anastomose with the left gastroepiploic artery
  • right gastric artery- comes off the hepatic artery and runs to the left and upward along the lesser curvature of the stomach to anastomose with the left gastric artery
  • cystic artery- arises from the hepatic artery just before the porta hepatis of the liver to supply the gallbladder
102
Q

superior mesenteric artery

A
  • arises from the aorta just below the celiac artery
  • runs between the pancreas and the top of the horizontal part of the duodenum
  • enter the mesentery of the small intestine
  • supplies the distal third of the duodenum, the entire intestine, and the proximal part of the large intestine
  • as it runs through the mesentery it gives of 12 to 15 branches to the jejunum and ileum
  • jejunal branches form one 1 or 2 anastomosing arcades and their terminal portions are long
  • ileal branches by comparison have several arcades and their terminal portions are short
  • the superior mesenteric artery supplies the proximal half of the large intestine by 3 large branches: middle colic, right colic, and ileocolic
  • middle colic artery- first to arise and supplies the terminal portion of the ascending colon and most of the transverse colon
  • right colic artery- second to arise and supplies most of the ascending colon
  • ileocolic artery- last to arise and supplies the cecum and appendix
103
Q

inferior mesenteric artery

A
  • arises at the level of L3 (about 1 1/2 inches above the bifurcation of the aorta into the left and right common iliac arteries)
  • has a smaller diameter than diameter than either the celiac artery or the superior mesenteric artery
  • supplies the distal part of the large intestine and the proximal part of the rectum
  • gives off the left colic artery -> supplies the end of the transverse colon and beginning of the descending colon
  • gives off several sigmoid branches -> supply the descending colon and sigmoid colon
  • terminal portion of the inferior mesenteric artery changes its name to the superior rectal artery as it crosses over the left common iliac artery
  • superior rectal artery supplies the proximal third of the rectum
104
Q

venous drainage

A

-nutrient rich blood from the GI is transported to the liver for filtration and processing by a network of veins that comprise the hepatic portal venous system
-portal venous system is defined as originating in 1 capillary bed and terminating in a 2nd capillary bed
-hepatic portal system originates in the capillaries of the GI and terminates in the capillaries of the liver
-veins that drain blood from the digestive organs merge to form the short (Hepatic) portal vein -> enters the liver
-veins that drain blood from the digestive organs have the same names as the arteries they feed from (spleen is supplied by the splenic artery and drained by splenic vein)
-distal parts of the veins also follow the paths taken by the arteries of the same name
-more proximal portions of the veins have somewhat different courses
-(hepatic) portal vein is formed behind the pancreas by the union of the splenic vein and the superior mesenteric vein
-

105
Q

superior mesenteric vein

A
  • drains the small intestine, cecum, ascending colon, and transverse colon
  • it is fed by about a dozen jejunal and ileal veins and by 3 large tributaries: middle colic vein, the right colic vein, and the ileocolic vein
  • superior mesenteric vein also receives blood from the pancreaticoduodenal vein and gastroepiploic vein -> drains the duodenum and greater curvature of the stomach
106
Q

splenic vein

A

-drains the spleen and has a large tributaries: inferior mesenteric vein

107
Q

inferior mesenteric vein

A
  • drains the descending colon, sigmoid colon, and the proximal third of the rectum
  • fed by 3 principal tributaries: left colic vein, sigmoid veins, and the superior rectal vein
108
Q

(hepatic) portal vein

A
  • formed by the union of the superior mesenteric and splenic veins
  • 3 veins drain into it: left gastric vein and right gastric vein, and cystic vein
  • left gastric and right gastric veins drain the lesser curvature of the stomach
  • cystic vein drains the bladder
  • portal vein enters the liver via the porta hepatis and then splits into the left and right branches that take blood to the livers lobules
  • blood that is filtered through the lobules is collected by numerous central veins that merge to form the 2 hepatic veins
  • hepatic veins drain directly into the inferior vena cava
109
Q

lymphatic draingage

A
  • abdomen, pelvis, and lower limbs are drained of lymph by 2 sets of trunks that run along the posterior abdominal wall
  • trunks merge to form the thoracic duct
  • largest lymphatic structure in the body is the spleen
  • lymph from the anterior abdominal wall and lower limbs drain into very large inguinal nodes that lie in the femoral triangle just below the inguinal ligament -> these nodes are easily palpated even in the absence of infection
  • lymph ducts from retroperitoneal abdominal organs (e.i. kidneys) drain into nodes that lie along either side of the abdominal aorta -> these lumbar nodes are connected by large ducts known as lumbar trunks
  • gut is drained by ducts that follow one of the 3 arteries that arise from the front of the abdominal aorta to supply it -> these ducts lead to preaortic nodes that lie along the front of the aorta -> connected by a large duct known as the intestinal trunk
  • lumbar and intestinal trunks merge at the level of L1-L2 to form the thoracic duct which is dilated here as the cisterna chyli
  • thoracic duct ascends through the thorax to empty into the left brachiocephalic vein
  • spleen is the principal lymphatic organ -> composed mainly of lymphatic tissue that filters blood passing through it
  • spleen also involves production of bilirubin, a constituent of bile
  • transported to the liver by the splenic and hepatic portal veins
110
Q

spleen

A
  • lies behind and to the left to the stomach between the 9th and 11th ribs
  • resides above the left colic flexure and anterior to the left kidney
  • blood and lymph vessels enter its concave visceral surface via the hilum
  • spleen receives blood from the splenic artery (primary branch of the celiac artery)
  • blood from the spleen is drained by the splenic vein
  • splenic vein is joined by the inferior mesenteric vein to drain into the hepatic portal vein
111
Q

kidney and adrenal glands

A
  • kidneys excrete most of the bodies metabolic waste product and help maintain water and electrolyte balance
  • waste and products leave the kidney as urine which passes down down a muscular tube, the ureter, to the bladder
  • lying on the superior pole of each kidney is an adrenal (suprarenal) gland
  • each gland consists of 2 separate masses of tissue: the cortex secretes over 20 steroid hormones
  • medulla secretes amine hormones
  • kidneys and adrenal glands are retroperitoneal
  • each kidney is covered with 4 protective layers of tissue: fibrous capsule, a layer of perirenal fat, renal fascia, and layer of pararenal fat (superficial to deep)
  • medial, concave aspect of the kidney has a vertical slit called the hilum
  • transmits the renal artery, the renal vein, the renal pelvis, and autonomic nerve fibers
112
Q

arteries of the kidneys

A
  • each kidney is supplied by a renal artery
  • arise from the left and right sides of the abdominal aorta a bit below the origin of the superior mesenteric artery
  • right renal artery passes behind the inferior vena cava
113
Q

arteries of the adrenal glands

A
  • adrenal glands are richly supplied with blood by 3 arteries
  • first is the superior suprarenal artery
  • its is a branch of the inferior phrenic artery, which arises from either side of the aorta immediately below the diaphragm
  • second artery is the middle suprarenal artery - arises from either side of the aorta just below the level of the celiac artery
  • third artery is the inferior suprarenal artery- runs upward to the gland from the renal artery
114
Q

veins of the kidneys

A
  • each kidney is drained by a renal vein
  • these empty into the inferior vena cava
  • left renal vein crosses anterior to the aorta just below the root of the superior mesenteric artery
  • because the left renal vein has to cross the aorta to reach the kidney, it is longer than the right renal vein
115
Q

veins of the adrenal glands

A
  • each adrenal gland is drained by the suprarenal vein
  • on the right it enters the inferior vena cava directly
  • on the left, it enters the left renal vein
116
Q

structure of the kidney

A
  • the medial, concave aspect of the kidney has a vertical slit called the hilum
  • transmits the renal artery, renal vein, and renal pelvis
  • the renal pelvis is the enlarged beginning of the ureter
  • hilum extends into the substance of the kidney for a short distance, creating the renal sinus
  • longitudinal section through the kidney reveals that it is composed of 3 distinct regions around the renal sinus
  • first region comprises the collection chambers for urine
  • renal pelvis branches into several chambers called major calyces
  • each major calyx branches into several smaller, funnel-shaped chambers known as minor calyces
  • there are about a dozen minor calyces
  • urine drains from the renal pyramids into the minor calyces
  • renal medulla is composed of about a dozen renal pyramids
  • each pyramid is cone shaped structure that contains numerous straight urine collecting ducts
  • the ducts open at the apex, or papilla, of the renal pyramid into the minor calyx
  • renal cortex contains numerous twisted (convoluted) tubes and capillaries and the renal corpuscles
  • between adjacent renal pyramids is a pillar of tissue that descends from the renal cortex
  • this pillar is called the renal column -> contains arteries and veins
  • renal pyramid together with the renal cortex capping it constitutes a renal lobe
  • nephrons are contained within the renal lobes
  • nephrons are the functional units of the kidneys
  • they are responsible for the production of urine
117
Q

nephron

A
  • functional unit of the kidney
  • each nephron lies within the renal medulla, and part lies within the adjacent renal cortex
  • most of the nephron is located within the renal cortex above a renal pyramid
  • produces urine by a 2 stage filtration process
  • blood plasma filters from a capillary bed into the end of a tube that ultimately drains into a minor calyx
  • it is desirable to conserve water, salt, and sugar -> reabsorbed back into blood vessels from the tube
  • excreted urine is hyperosmotic and largely devoid of salt and sugar
  • each nephron has a tubular component and a vascular component
118
Q

tubular component of the nephron

A
  • comprised of a renal tubule that is closed at one end and open at the other
  • closed beginning of the tubule has a cup-shaped expansion known as the glomerular (bowmans) capsule
  • surrounds a tightly twisted capillary bed, known as the glomerulus
  • together glomerular capsule constitute the renal corpuscle
  • short distance from the glomerular capsule, the renal tubule becomes twisted as the proximal convoluted tubule
  • then straightens out and loops into and out of the renal pyramid as the loop of henle
  • loop of henle is also known as the nephron loop
  • limbs of the loop of henle descend into and ascend from the renal pyramid
  • after ascending the tubule becomes twisted again as the distal convoluted tubule
  • a short distance from the glomerular capsule, the renal tubule becomes surrounded by a second capillary network
  • renal tubule opens into a collecting duct which drains several nephrons
  • collecting duct opens at the papillae of the renal pyramid into the minor calyx
119
Q

vascular component of the nephron

A
  • consists of 2 capillary networks connected by an arteriole -> portal system
  • first capillary bed is the glomerulus
  • blood reaches the glomerulus through a small vessel called an afferent arteriole
  • about 20% of the blood plasma moving through the afferent arteriole filters through the glomerulus
  • blood that passes through the glomerulus leaves it by another small vessel called an efferent arteriole
  • this leads to the 2nd capillary network, where reabsorption of water, salt, and sugar takes place
  • 2nd network is intertwined around the renal tubule -> peritubular capillary
  • small vessels lead from the peritubular capillary to the renal vein
120
Q

gonadal blood vessels

A
  • gonads are within or below the pelvis
  • their vasculature originates high up in the abdomen
  • vessels that supply and drain their blood are the same, whether the gonads are ovaries or testicles
121
Q

gonadal arteries

A
  • left and right gonadal arteries arise from the front of the abdominal aorta just below the level at which the renal arteries come off
  • gonadal arteries descend to the left and right to supply the respective gonad
122
Q

gonadal veins

A
  • right gonadal vein follows the course of the right gonadal artery for much of its length
  • enters the front of the inferior vena cava just below the level at which the renal veins come off
  • left gonadal vein follows the course of the left gonadal artery for much of its length, but as it approaches the kidney, it departs company from the artery
  • runs straight upward to drain into the left renal vein
123
Q

nerves in the abdomen

A
  • skeletal muscles of the abdomen are supplied by spinal nerves
  • spinal nerves that emanate from the spinal cord in the abdomen also innervate muscles of the lower limb
  • GI tract and organs of digestion, as well as the spleen, kidneys, and adrenal glands, are supplied by autonomic nerves
124
Q

spinal nerves in the abdomen

A
  • skeletal muscles of the abdominal wall are supplied by spinal nerves T7-L1
  • muscles of the lower limb are innervated by the ventral rami of L1-L4, which form the lumbar plexus
  • lowermost lumbar spinal nerve (L5) contributes to the sacral plexus
  • these plexuses are connected by the lumbosacral trunk between L4 and L5
125
Q

cranial nerve in the abdomen

A
  • vagus nerve (CN X) is the only cranial nerve to enter the abdominal cavity
  • recall that the left vagus nerve enters the abdomen in front of the esophagus as the anterior vagal trunk
  • it gives branches to the liver, gallbladder, stomach, and duodenum and to the kidneys and adrenal glands
  • right vagus enters the abdomen behind the esophagus as the posterior vagal trunk
  • its fibers are distributed with the branches of the celiac and superior mesenteric arteries
  • innervates the pancreas, the spleen, the stomach, the small intestine, and the large intestine as far as the left colic (splenic) flexure
126
Q

sympathetic chain in the abdomen

A
  • sympathetic chain also runs through the abdomen into the pelvis
  • only spinal nerves L1-L2 contribute preganglionic fivers to the chain
  • sympathetic ganglia below L2 have gray rami communicantes, but no white ones
  • sympathetic chain below L2 is similar to the sympathetic chain in the neck