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LSS Anatomy of the Abdomen, Pelvis and Perineum > lecture 2 > Flashcards

lecture 2 Flashcards

1
Q

what is the peritoneum

A

lining of abdominal cavity; single continous membrane made of simple squamous epithelium (mesothelium)

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2
Q

what is in between the abdominal wall and peritoneum

A

abdominal cavity

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3
Q

what is the peritoneal cavity

A

potential space within layer of peritoneum (between parietal peritoneum surrounding the abdominal wall, and visceral peritoneum, surrounding the internal organs), containing small amount of peritoneal fluid to allow organs to slide

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4
Q

what are the peritoneal reflections which suspend components of GI tract called

A

mesentries

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5
Q

components of GI tract in order

A

mouth and pharynx, oesophagus, (below diaphragm) stomach, duodenum, jejenum and ileum, caccum and large intestine, (within pelvic cavity just above pelvic floor) sigmoid colon, rectum and anus

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6
Q

early development of gut tube

A

originates from endoderm and splanchnic (from visceral - not part of body wall) mesoderm at 4 weeks - separates from yolk sac; suspended from posterior abdominal wall by peritoneal fold (dorsal mesentery - may be absorbed in adult life)

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7
Q

mesentries

A

peritoneal folds attaches to viscera, attaching viscera to abdominal walls; act as conduit for vessels, nerves and lymphatics supplying viscera

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8
Q

visceral peritoneum

A

covers suspended organs

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9
Q

parietal peritoneum

A

lines abdominal wall

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10
Q

intraperitoneal structures

A

within peritoneal cavity; most of small intestine, suspended from abdominal wall by mesentries

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11
Q

retroperitoneal structures

A

behind or outside parietal peritoneum: kidneys and great vessels that lie between parietal peritoneum and abdominal wall

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12
Q

retroperitoneal organs on posterior abdominal wall: SADPUCKER

A

kidneys and ureters, suprarenal glands, aorta/inferior vena cava, nerves (lumbar plexus, sympathetic trunk), oesophagus and rectum

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13
Q

secondarily retroperitoneal organs on posterior abdominal wall that originally had a mesentry but which fused with body wall

A

duodenum (except first part), pancreas (tail is intraperitoneal), colon (ascending and descending only)

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14
Q

3 divisions of GI tract (different blood and nerve supplies)

A

foregut (distal 3rd of oesophagus to 2nd part of duodenum at entrance of bile duct - major duodenal papilla), midgut (2nd part of duodenum to 2/3rds along transverse colon), hindgut (distal third of transverse colon to rectum)

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15
Q

dorsal and ventral mesenteries

A

entire gut tube suspended from dorsal mesentery (posterior); foregut also has a ventral mesentery (anterior) - contains liver, which splits ventral mesentery into falciform ligament and lesser omentum

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16
Q

formation of omental bursa (lesser sac) of peritoneal cavity

A

only in foregut region - rest of gut in greater sac region; communication between each other through narrow foramen; as liver grows, moves to right while dorsal mesentery and spleen move left; original right side of peritoneal cavity is now posterior - lesser sac of peritoneal cavity (omental bursa)

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17
Q

where is omental bursa

A

epiploic foramen is entrance to lesser sac between liver and lesser curvature of stomach; part of ventral foregut mesentery

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18
Q

what is greater omentum

A

lower part of dorsal foregut mesentery extending down as a double fold anterior to intestine

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19
Q

why is rotation of foregut important

A

only then can formation of sacs occur

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20
Q

lesser omentum on right free edge

A

portal vein, hepatic artery and bile duct run between abdominal wall and liver

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21
Q

why is lesser omentum free edge present

A

ventral mesentery ends at start of midgut

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22
Q

greater and lesser sacs in sagittal view

A

lesser sac: mainly behind stomach and posterior aspect of liver; greater sac anterior

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23
Q

clinical importance of peritoneal compartments

A

if infection occurs in a compartment can have abscess formation - virulent material can flow into different parts of cavity

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24
Q

what is present either side of ascending and descending colon

A

paracolic gutter - abscess material can flow down these into other compartments

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25
Q

compartments above mesentery of transverse colon

A

supracolic compartment

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26
Q

compartments below mesentery of transverse colon

A

infracolic compartment

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27
Q

falciform ligament

A

attaches liver to underside of diaphragm; prevents abscess material flowing from left to right paracolic gutters

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28
Q

where do all infections from abscess come to

A

pelvic area - most dependent part

29
Q

directions of peritoneal fluid movement in peritoneal cavity

A

moves upwards (e.g. through paracolic gutters) to underside of diaphragm to be reabsorbed

30
Q

where does inflammatory exudate from abscess move

A

downwards towards pelvis

31
Q

general plan of GI tract: inner to outer layers

A

mucosa (epithelium, mucous membranes, muscularis mucosa which produces movement to move mucosal surface) - submucosa (MALT, glands, endocrine cells, Meissner’s plexus) - muscularis (inner circular and outer longitudinal - peristaltic movement, Auerbach’s plexus) - serosa (connective tissue) - mesentery peritoneum (autonomic nerves and arteries)

32
Q

abdominal oesophagus

A

pierces diaphragm at T10 on right crus (muscular part), contributing to lower oesophageal sphincter (prevents food going upwards or reflux)

33
Q

where does abdominal oesophagus join stomach

A

gastro-oesophageal junction

34
Q

4 sections of stomach

A

fundus, body, pyloric antrum, pyloric canal

35
Q

where does stomach join duodenum

A

gastro-duodenal junction

36
Q

what prevents food entering duodenum

A

ring of smooth muscle at distal end of pyloric canal called pyloric sphincter (can palpate)

37
Q

3 sections of small intestine

A

duodenum, jejenum, ileum

38
Q

what is first part of duodenum

A

duodenal cap

39
Q

what occurs most at duodenal cap

A

duodenal ulcers

40
Q

what does second part of duodenum contain

A

entrance for common bile duct (major duodenal papilla)

41
Q

what is most of duodenum

A

retroperitoneal

42
Q

4 sections of duodenum

A

superior, descending, inferior, ascending

43
Q

jejunum

A

proximal 2/5ths; larger in diameter; upper left quadrant of abdomen; less prominent arterial arcads; longer vasa recta

44
Q

ileum

A

distal 3/5ths; smaller in diameter; lower right quadrant of abdomen; prominent arterial arcads; shorter vasa recta

45
Q

5 sections of large intestine in order

A

caecum, ascending colon, transverse colon, descending colon, sigmoid colon

46
Q

features distinguishing large intestine from small intestine

A

fatty tags (appendices epiploicae), 3 ribbons of of longitudinal muscle (taeniae coli) which go to caecum, where appendix takes origin, segmented or pocketed walls

47
Q

3 unpaired arteries arising from anterior of aorta to supply gut

A

coeliac trunk (foregut, liver, pancreas, spleen), superior meseneric artery (SMA; midgut), inferior mesenteric artery (IMA, hindgut)

48
Q

3 coeliac trunk branches

A

common hepatic artery, left gastric artery, splenic branches

49
Q

branches of common hepatic artery

A

cystic artery (gall bladder), gastroduodenal arteries

50
Q

retroperitoneal strutures in lesser sac behind stomach and liver

A

loop of duodenum, head and body of pancreas, coeliac trunk, inferior vena cava, abdominal aorta, kindeys, adrenal glands

51
Q

branches of superior mesenteric artery

A

middle colic artery, right colic artery, ileocolic artery, ileal arteries, jejunal arteries

52
Q

branches of inferior mesenteric artery

A

left colic artery, superior rectal artery, sigmoid arteries

53
Q

where is there a change from superior to inferior mesenteric artery (with anastomoses between)

A

junction of mid- and hindgut near left splenic flexure of colon

54
Q

venous drainage

A

portal vein, splenic vein, superior mesenteric vein, inferior mesenteric vein

55
Q

what does portal vein arise from

A

splenic vein and superior mesenteric vein posterior to 1st part of duodenum and pyloris of stomach

56
Q

where does portal vein run

A

in free edge of lesser omentum to liver, draining blood from all abdominal viscera and liver

57
Q

what are portal-systemic anastomoses

A

where veins draining to portal vein and inferior vena cava communicated (only if higher pressure) e.g. if left gastric vein blocked so can’t drain to portal, goes up oesophageal vein into systemic azygos veins

58
Q

what can liver or portal obstruction cause to these veins

A

dilate widely, possibly leading to severe venous haemorrhage from oesophagus or rectum

59
Q

what does lymphatic drainage of bowel follow

A

arterial supply, not venous drainage

60
Q

where does all lymph drain

A

into cisterna chyli

61
Q

what is cisterna chyli

A

elongated sac in front of L1 and L2

62
Q

what commences from cisterna chyli

A

thoracic duct

63
Q

lymph nodes

A

coeliac, superior and inferior mesenteric

64
Q

innervation of gut

A

mainly autonomic, own nervous system (can do peristalsis on own), controlled by sympathetic sensory fibres (mediate pain and close sphincters) and parasympathetic sensory fibres (regulate reflex gut function and gland secretion)

65
Q

sympathetic sensory nerves

A

thoracic splanchnic (T5-T12; greater T5-T9, lesser T10-T11, least T12), lumbar splanchnic (L1, L2)

66
Q

parasympathetic sensory nerves

A

vagus, pelvic splanchnic (S2-S4)

67
Q

parasympathetic efferents

A

increase peristalsis, relax sphincters, increase secretion

68
Q

sympathetic efferents

A

decrease peristalsis, constrict sphincters, decrease blood flow and secretions

LSS Anatomy of the Abdomen, Pelvis and Perineum (10 decks)

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