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Y1 - Anatomy of the Abdomen, Peritoneum and Pelvis > Lecture 2 - The gut and the peritoneal cavity > Flashcards

Lecture 2 - The gut and the peritoneal cavity Flashcards

1
Q

What cell type is the peritoneum made up of?

A

Simple squamous epithelium called mesothelium. It is then supported by a thin layer of areolar connective tissue.

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2
Q

What does the peritoneum do?

A

Lines the abdominal cavity and encloses the peritoneal cavity.

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3
Q

What is found in the peritoneal cavity?

A

It is a potential space so there is a small amount of fluid and nothing else.

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4
Q

Which abdominal organs lie above the abdominal cavity in the thoracic cage?

A
  • Liver
  • Gall bladder
  • Transverse colon
  • Spleen
  • Stomach
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5
Q

Which abdominal organs lie just below the abdominal cavity in the pelvic cavity?

A
  • Sigmoid colon

- Rectum

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6
Q

What tissue does the gut arise from?

A

Endoderm and splanchnic mesoderm.

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7
Q

How are intra-abdominal organs arranged in the abdominal cavity?

A

They are suspended form the posterior abdominal wall in peritoneal reflections called mesenteries (dorsal mesentery).

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8
Q

What do the mesenteries do?

A

They are peritoneal folds that attach the viscera to the abdominal wall and contain blood vessels, nerves and lymphatics that supply the viscera.

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9
Q

What lines the peritoneal cavity?

A

Parietal peritoneum lines the abdominal wall whilst the visceral peritoneum lines the suspended organs/viscera.

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10
Q

What does retroperitoneal mean?

A

Refers to the structures such as the kidneys and the great vessels that lie between the parietal peritoneum and the abdominal wall.

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11
Q

What structures are retroperitoneal (originally)?

A
  • Kidneys and ureters
  • Suprarenal glands
  • Aorta and IVC
  • Nerves (lumbar plexus and sympathetic trunk)
  • Oesophagus
  • Rectum
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12
Q

Which structures were originally intra-peritoneal but became secondarily retroperitoneal?

A
  • Duodenum (apart from first part)
  • Pancreas (except tail)
  • Colon (ascending and descending only)
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13
Q

How can the GI tract be divided?

A

Can be divided into three different regions:

  • Foregut
  • Midgut
  • Hindgut
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14
Q

What makes up the foregut?

A

Distal third of the oesophagus to the second part of the duodenum at the entrance of the bile duct (major duodenal papilla).

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15
Q

Describe the structure of mesenteries for the foregut?

A

Has a dorsal mesentery as well as a ventral mesentery.

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16
Q

What is the blood supply for the foregut?

A

Coeliac trunk, which also supplies the liver, lower oesophagus, stomach, pancreas and spleen.

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17
Q

What makes up the midgut?

A

Second part of the duodenum to two-thirds along the transverse colon.

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18
Q

What is the blood supply for the midgut?

A

Superior mesenteric artery

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19
Q

What makes up the hindgut?

A

Distal third of the transverse colon to the rectum.

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20
Q

What is the blood supply for the hindgut?

A

Inferior mesenteric artery.

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21
Q

Where do the coeliac trunk, SMA and IMA branch off from?

A

Abdominal aorta

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22
Q

What does the ventral mesentery split into?

A

The falciform ligament and the less momentum.

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23
Q

What happens to the ventral mesentery as it develops?

A

The ventral mesentery contains the liver however as the liver grows, it moves to the right and separates from the ventral mesentery and spleen which move to the left side of the body. The lesser omentum then moves posteriorly.

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24
Q

What is the epiploic foramen?

A

The entrance to the lesser sac/omentum.

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25
Q

What is the greater omentum?

A

It is the lower part of the dorsal foregut mesentery that extends down as a double fold anterior to the intestine.

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26
Q

Describe the movement of peritoneal fluid.

A

Moves upwards towards the diaphragm whereas the inflammatory exudate moves downwards towards the pelvis.

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27
Q

What is the pyloric sphincter?

A

A ring of smooth muscle at the distal end of the pyloric canal in the stomach prevents the movement of chyme into the duodenum.

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28
Q

Where is the most common area for duodenal ulcers?

A

Near the duodenal cap which is the first part of the duodenum.

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29
Q

Where do the main bile duct and the accessory pancreatic duct enter the duodenum?

A

The major duodenal and minor duodenal papilla respectively.

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30
Q

What are the four parts of the duodenum and what is their location in relation to other structures?

A
  • Anterior - to bile duct, gasproduodenal artery, portal vein and IVC
  • Descending - pancreatic bile duct enters here
  • Inferior - crosses the IVC and is posterior to SMA
  • Ascending - terminates at the duodenojejunal flexure
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31
Q

What are the differences between the jejunum and the ileum?

A

Jejunum

  • Proximal two-fifths
  • Larger in diameter than ileum
  • Upper L quadrant
  • Longer vasa recta
  • Less prominent arterial arcades
  • Supplied by the jejunal arteries (branch of SMA)

Ileum

  • Distal three-fifths
  • Small in diameter than jejunum
  • Lower R quadrant
  • Shorter vasa recta
  • Prominent arterial arcades
  • Supplied by the ileal arteries (branch of the SMA)
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32
Q

What distinguishes the small intestine from the large intestine?

A

The large intestine has fatty tags known as appendices epiploicae, ribbons of longitudinal muscles (taeniae coli) and segmented/pocketed walls. Using the diameter to differentiate is not always reliable.

33
Q

What are some of the branches of the superior mesenteric artery?

A
  • Middle colic artery
  • Right colic artery
  • Ileocolic artery
  • Jejunal arteries
  • Ileal arteries
34
Q

What are some of the branches of the inferior mesenteric artery?

A
  • Left colic artery
  • Superior rectal artery
  • Sigmoid arteries
35
Q

Which arteries supply the large intestine?

A

Ascending colon - right colic artery
Tranverse colon - middle colic artery
Descending colon - left colic artery
Sigmoid colon - sigmoid arteries

36
Q

Where does the switch from the SMA to the IMA take place?

A

At the junction between the midgut and the hindgut near the left flexure of the colon (splenic flexure).

37
Q

Where does the hepatic portal vein arise from?

A

SMA and splenic veins posterior to the first part of the duodenum/pylorus of the stomach.

38
Q

Describe the pathway of the hepatic portal vein.

A

Runs along the free edge of the lesser omentum to the lover, draining the blood from all of the abdominal viscera and liver.

39
Q

What can liver obstructions cause?

A

Liver or portal obstructions can cause these veins to dilate, possibly leading to severe venous haemorrhage from the oesophagus or the rectum.

40
Q

What is the cisterna chyli?

A

An elongate lymphatic sac that is located in front of the L1 and L2 bodies. The thoracic duct originates from the cisterna chyli, moving superiorly into the thoracic cavity.

41
Q

What does the cisterna chyli drain?

A

Lymph from the bowel.

42
Q

How is the abdominal viscera innervated?

A

By the autonomic nervous system.

43
Q

How is pain mediated from abdominal viscera?

A

The sympathetic sensory fibres are important in mediating pain, using the thoracic splanchnic (T5-12) and lumbar splanchnic (L1-2)

44
Q

How is parasympathetic innervation of the abdomen achieved?

A

Via the vagus nerve and pelvic splanchnic nerves (S2-4)

45
Q

What the superior and inferior boundaries of the abdomen?

A

Superiorly - inferior thoracic aperture

Inferiorly - pelvic inlet

46
Q

What does the ectoderm produce?

A
  • Nervous system and skin
  • Oral epithelia
  • Distal anal epithelia
47
Q

What does the mesoderm produce?

A
  • Muscle and bones
  • Vasculature and heart
  • Connective tissue/smooth muscle
  • Kidney, spleen and urogenital tract
48
Q

What does the endoderm produce?

A
  • Gut epithelium (most of it)
  • Liver
  • Pancreas
  • Lungs
49
Q

What does the coelomic cavity separate into?

A

A pleural and peritoneal cavity.

50
Q

What does the lesser omentum do?

A

It is a double layer of peritoneum that connects the liver to lesser curvature of the stomach (hepatogastric ligament) and the first part of the duodenum (hepatoduodenal ligament).

51
Q

What is the greater omentum?

A

Visceral peritoneum that hangs down from the stomach.

52
Q

What are the lesser and greater peritoneal sacs?

A
  • Greater peritoneal sac is found anteriorly and to the left

- Lesser peritoneal sac (a.k.a omental bursa) is found posteriorly and more to the right behind the stomach and liver

53
Q

What happens with organs that do have a mesentery?

A

All organs must be attached to the body wall so if they do not have a mesentery they are attached to the body wall directly.

54
Q

Where are the dorsal and ventral mesenteries found?

A
  • Whole gut has a dorsal mesentery

- Only foregut has a ventral mesentery

55
Q

What is a mesentery?

A

A fold in the peritoneum that allows communication of an intraperitoneal organ with the abdominal wall.

56
Q

What happens to the orientation of the liver and spleen as they grow?

A

The abdomen is wider than it is deep so the liver rotates clockwise to the right as it grows, fusing with the body wall and obliterating the peritoneum. The spleen rotates clockwise to the left.

57
Q

What does the ventral mesentery split into?

A
  • Falciform ligamnet

- Lesser omentum

58
Q

How does the dorsal mesentery split?

A

The spleen splits the dorsal foregut mesentery into:

  • Gastrosplenic ligament
  • Splenorenal ligament
59
Q

How are the greater and less sacs connected?

A

Only connection is via the omental foramen (a.k.a epiploic foramen/foramen of Winslow) which is located under the lesser omentum.

60
Q

What makes up the portal triad?

A
  • Common bile duct
  • Portal vein
  • Hepatic artery
61
Q

How can organs become secondary retroperitoneal?

A

The duodenum, ascending and descending colon more posteriorly, causing their mesentery to fuse with the posterior abdominal wall. Only the anterior surface is covered in peritoneum.

62
Q

How can the greater sac be divided?

A

Into two by the mesentery of the transverse colon, forming supracolic or infracolic regions.

63
Q

How can the infracolic region be divided further?

A

Can be further divided by dorsal mesentery of the small intestine into the right and left infracolic regions.

64
Q

At what level does the gastro-oesophageal junction take place?

A

T11

65
Q

How is the lower oesophageal sphincter formed?

A
  • Oesophagus enters the stomach at an acute angle
  • Walls of the intra-abdominal section of oesophagus are compressed when there is positive pressure
  • Folds of mucosa aid in occluding the lumen
  • Right crus of diaphragm has a pinch-cock effect
66
Q

What are the arteries forming the coeliac trunk?

A
  • Left gastric artery (goes left)
  • Splenic artery (goes left)
  • Common hepatic artery (goes right)
67
Q

What does the common hepatic artery split into?

A
  • Gastroduodenal artery

- Proper hepatic artery

68
Q

What does the splenic artery split into?

A
  • Left gastro-omental (gastroepiploic) artery

- Pancreatic artery

69
Q

What does the gastroduodenal artery branch into?

A
  • Right gastro-omental artery

- Superior pancreatic-duodenal artery

70
Q

What does the proper hepatic artery branch into?

A
  • Right gastric artery
  • L and R hepatic arteries
  • Cystic artery
71
Q

What is the blood supply to the duodenum?

A 
1st half (foregut) - gasproduodenal artery (CT) 
2nd half (midgut) - inferior pancreaticduodenal artery (SMA)
72
Q

Which parts of the small intestine have a mesentery?

A

First and last part (out of four)

73
Q

How is each part of the gut drained?

A

Foregut - portal vein and splenic vein
Midgut - SMV
Hindgut - IMV

74
Q

Where are the portosystemic anastomosis?

A
  • Oesophageal and left gastric veins
  • Superior and inferior rectal veins
  • Paraumbilical and epigastric viens
  • Colic and abdominal wall veins
75
Q

Where is a common site for oesophageal varices?

A

Anastomosis of oesophageal and left gastric veins.

76
Q

Where is a common site for haemorrhoids?

A

Anastomosis of superior and inferior rectal veins.

77
Q

Where do the lumbar and pelvic splanchnic nerves arise from?

A

Lumbar - L1-2

Pelvic - S2-4

78
Q

Describe the function of sensory nerves that run alongside autonomic nerves?

A

Adjacent to sympathetic - mediate pain

Adjacent to parasympathetic - involved in reflex regulation and gut function

79
Q

Perforation of a gastric ulcer will cause which artery to erode?

A

Splenic artery

Y1 - Anatomy of the Abdomen, Peritoneum and Pelvis (10 decks)

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