Lecture Exam 3 Flashcards
How many regions is the abdomen divided into topographically?
9 regions by two vertical and two horizontal planes
Which plane extends inferiorly from the midpoints of the clavicles to the midpoints of lines joining the anterior superior iliac spine to the pubic symphysis?
Midclavicular plane
Which plane is a horizontal plane joining the lowest point of the costal margin on each side. It lies at the inferior margin of rib 10 (L. V. 3 level)
Subcostal plane
Which plane lies at the inferior margin of rib 10 (L.V. 3 level)?
Subcostal plane
Which plane is a horizontal plane which joins the tubercles of the iliac crests (L.V. 5 level)
Trans tubercular plane
What are the nine regions of the abdomen?
- Right hypochondrium
- Epigastric
- Left hypochondrium
- Umbilical
- Left flank (lateral)
- Right flank (lateral)
- Right groin (inguinal)
- Left groin (inguinal)
- Pubic
The liver lies in mostly which regions of the abdomen?
Right hypochondrium and epigastric region
The spleen and the fundus and body of the stomach are found in which region of the abdomen?
Left hypochondrium region
The simple version of dividing up the abdomen is called what?
Quadrants, involving diving the abdomen up into four parts
Using the quadrant system, how are the regions divided up? (Which planes are used?)
Median plane (vertical plane through midline) Transumbilical plane (horizontal plane through the umbilicus)
What are the names of the quadrants?
Right upper quadrant
Left upper quadrant
Right lower quadrant
Left lower quadrant
What is a variable landmark which lies between L.V. 2 and L.V. 5?
The umbilicus
Name the layers of the anterior abdominal wall from superficial to deep
Skin Superficial layer of superficial fascia (Camper’s Fascia) Deep layer of the superficial Fascia (Scarpa’s fascia) Deep (investing) Fascia External Oblique muscle Internal Oblique muscle Transversus Abdominis Muscle Transversalis Fascia Extraperitoneal Fascia Parietal peritoneum Peritoneal Cavity Visceral Peritoneum Abdominal Organs
The fascia of the anterior abdominal wall consists of how many major layers? Names of those layers?
2 layers
Superficial fascia
Deep (investing) Fascia
The superficial fascia is further subdivided into how many layers?
Subdivided into two layers
What are the two subdivisions of the superficial fascia?
superficial layer (Camper’s Fascia) Deep Layer (Scarpa’s Fascia)
Which layer is a thin fatty layer of fascia which is continuous with the superficial fascia of the perineum and thigh?
Superficial layer (Camper’s Fascia)
Which layer is a membranous layer of fascia which is firmly fastened to the fascia Alta of the thigh, just below the inguinal ligament?
Deep layer (Scarpa’s Fascia)
Which layer covers each of the anterior abdominal wall muscles on its anterior and posterior surface?
Deep (investing) fascia
Extravasation of Urine refers to a potential space between two layers of fascia, what two layers are they?
Scarpa’s Fascia and deep (investing) fascia
In Extravasation of Urine, this structure when ruptured allows accumulation of urine within this space?
Rupture of the Spongy Urethra
Is extravasation more common in males or females and why?
More common to males (exclusively) due to urethra being longer, more superficial, and more horizontally oriented than in females
This structure is a median tendinitis raphe which extends from the xiphoid process to the pubic symphysis. Anterior abdominal wall muscles insert into this raphe via their aponeurosis.
Linea Alba
The fibers of the external oblique run….?
Run downward and forward
The fibers of the internal oblique run….?
Run downward and backward
This muscle acts as an internal back brace
Transversus Abdominis muscle
The fibers of the transversus Abdominis muscle run…?
Run horizontally across the abdomen
What lies in between the left and right rectus abdominis muscles
Linea Alba
This structure is a curved line along the lateral border of the rectus abdominis muscle
Linea semilunaris
This structure is 3 bundles of connective tissue which run transversely across the rectus abdominis muscle and which fuse with the rectus sheath
Tendinous intersections
This muscle is a small and often absent slip of muscle which lies anterior to the rectus abdominis within its sheath
Pyramidalis muscle
Low back pain is often due to….
Weak abdominal muscles
Anterior abdominal wall muscles are active in the following 6 actions
- Coughing
- Sneezing (1 and 2 are forced expiration)
- Vomiting
- Micturition
- Defecation
- Parturition
This structure is formed by the aponeurosis of the external oblique, internal oblique, and transversus abdominis muscles
Rectus sheath
The rectus sheath encloses these 5 structures
- Rectus abdominis muscle
- Pyramidalis muscle (when present)
- Superior epigastric artery and vein
- Inferior epigastric artery and vein
- Anterior primary rami of lower 6 thoracic nerves
The rectus sheath consists of a ______ and _____ layer. The composition of those layers changes when one passes above or below the ______
Anterior
Posterior
Arcuate line
This structure is a crescent shaped line in the posterior layer of the rectus sheath located midway between the umbilicus and pubic crest
Arcuate Line
When above the arcuate line, the anterior layer of the rectus sheath is composed of…..
Composed of the aponeuroses of the external and internal oblique muscles
When above the arcuate line, the posterior layer of the rectus sheath is composed of….
Composed of the aponeuroses of the internal oblique and transversus Abdominis muscles
Above the arcuate line, the aponeurosis of the _____ ______ muscle splits to enclose the rectus abdominis
Internal oblique muscle
When below the arcuate line, the anterior layer of the rectus sheath is composed of…..
Composed of the aponeuroses of the external oblique, internal oblique, and transversus abdominis muscles
When below the arcuate line, the posterior layer of the rectus sheath is formed by….
Formed by the transversalis fascia
How many folds are present on the posterior surface of the anterior abdominal wall, below the umbilicus?
5 folds are present
Each of these folds on the posterior surface of the anterior abdominal wall are formed by _____ _____ overlying a structure
Parietal peritoneum
This structure extends from the apex of the bladder to the umbilicus. It contains the urachus
Median umbilical fold
The median umbilical fold contains the….
The urachus
This structure extends from the side of the bladder to the umbilicus. It contains the obliterated umbilical artery.
Medial umbilical fold
The medial umbilical fold contains the…
The obliterated umbilical artery
This structure extends from the deep inguinal ring to the arcuate line. It contains the inferior epigastric vessels.
Lateral umbilical fold
The lateral umbilical fold contains the…..
The inferior epigastric umbilical artery
The median umbilical, medial umbilical, and lateral umbilical folds form the boundaries between these three paired fossae
Supravesical fossa
Medial inguinal fossa
Lateral inguinal fossa
The supravesical fossa is between…
Between the median and medial umbilical folds
The medial inguinal fossa is between….
Between medial and lateral umbilical folds
The lateral inguinal fossa is between….
Between lateral to the lateral umbilical fold
This structure lies above the umbilicus and contains the obliterated umbilical vein.
Ligamentum teres
The ligamentum teres is the ____ ____ of the falciform ligament, which is attached to the liver.
Free edge of the falciform ligament
What arteries supply blood to the anterior abdominal wall?
- Superior epigastric artery (from internal thoracic artery)
- Inferior epigastric artery (from the external iliac artery)
- Lumbar arteries (from the abdominal aorta)
- Deep circumflex iliac artery (from the external iliac artery)
What nerves supply the anterior abdominal wall?
Lower 6 thoracic nerves
Run between the internal oblique and transversus abdominis muscles
This structure is formed by the lower edge of the external oblique aponeurosis. It extends from the anterior superior iliac spine to the pubic tubercle
Inguinal ligament
The inguinal ligament extends from the ________ to the _________
Anterior superior iliac spine
Pubic tubercle
This structure is the most medial fibers of the inguinal ligament which are inserted into the superior pubic ramus
Lacunar ligament
This structure is a lateral extension of the lacunar ligament along the pecten pubis (pectinal line)
Pectinal ligament
What is another name for the pecten pubis?
Pectinal line
This structure is an oblique passage 3 to 5 cm in length through the anterior abdominal wall
Inguinal canal
How long is the inguinal canal through the anterior abdominal wall?
3 to 5 cm in length
The inguinal canal begins at the ______ and ends at the _______
Deep inguinal ring
Superficial inguinal ring
The deep inguinal ring within the anterior abdominal wall lies…..
Lies lateral and internal
The superficial inguinal ring within the anterior abdominal wall lies…..
Medial and external
Is the inguinal canal larger in males or females?
Larger in males
These three things are transmitted in the inguinal canal
Spermatic cord (males) Round ligament of the uterus (females) Ilioinguinal nerve (both)
This structure is formed by the fusion of the aponeuroses of the internal oblique and transversus abdominis muscles as they insert into the pubic crest and pecten pubis deep to the inguinal ligament.
Conjoint tendon (inguinal Falx)
The conjoint tendon (inguinal Falx) helps by….
Strengthens the posterior wall of the medial half of the inguinal canal
What is another name for the conjoint tendon?
Inguinal Falx
What are the boundaries of the inguinal canal?
- Anterior wall
- Posterior wall
- Roof
- Floor
The anterior wall boundary of the inguinal canal is formed by….
Formed by the aponeurosis of the external oblique muscle
The posterior wall boundary of the inguinal canal is formed by…
Formed by the conjoint tendon and transversalis fascia
The roof boundary of the inguinal canal is formed by…
Formed by the arching fibers of the internal oblique and transversus abdominis muscles
The floor boundary of the inguinal canal is formed by…
Formed by the inguinal and lacunar ligaments
This structure is a triangular opening in the external oblique aponeurosis. It lies immediately lateral to the pubic tubercle.
Superficial inguinal ring
The superficial inguinal ring lies immediately lateral to the….
Pubic tubercle
The superficial inguinal ring transmits this structure in males, this structure in females and this structure in both sexes
Spermatic cord in males
Round ligament of the uterus in females
Ilioinguinal nerve in both sexes
The structures that exit the inguinal canal become ______ at the superficial ring
Become subcutaneous at the superficial ring
The superficial inguinal ring is formed by the splitting of this muscle aponeurosis
Splitting of the external oblique aponeurosis
The splitting of the external oblique aponeurosis for the formation of the superficial inguinal ring is split up into how many crura? Names for those crura
Two crura
Lateral crus
Medial crus
The lateral crus of the superficial inguinal ring inserts into the ____. Some of its fibers reflect to the ______ as the lacunar ligament.
Pubic tubercle
Superior pubic ramus
The medial crus of the superficial inguinal ring inserts into the _______.
Pubic crest
This structure strengthens the apex of the superficial inguinal ring
Intercrural fibers
This structure is an opening within the transversalis fascia. It is located above the inguinal ligament midway between the anterior superior iliac spine and the pubic symphysis. It lies just lateral to the inferior epigastric vessels
Deep inguinal ring
The deep inguinal ring lies just lateral to the…..
Inferior epigastric vessels
The deep inguinal ring is located above the _____ between the anterior superior iliac spine and the pubic symphysis.
Inguinal ligament
This structure is an area of potential weakness in the anterior abdominal wall. Direct inguinal hernias occur here
Inguinal triangle
The inguinal triangle is bounded by these structures
Medially: by the lateral edge of the rectus abdominis muscle
Laterally: by the inferior epigastric vessels
Inferiorly: by the inguinal ligament
Is the inguinal canal present before birth?
Yes, but is shorter and much less oblique than in the adult
During development of the inguinal canal, lets say before/ around the time of birth, the superficial inguinal ring lies almost directly _____ to the deep inguinal ring
Directly anterior
During childhood development, this structure lengthens and assumes it characteristically oblique position
The inguinal canal
Contraction of the muscles of the anterior abdominal wall during coughing and straining elevates what in the abdomen, potentially forcing abdominal contents into the canal.
Elevates intra-abdominal pressure
What two anatomical adaptations function to strengthen the inguinal canal?
- Inguinal canal is oblique in adults, allows canal to be compressed by muscles of anterior abdominal wall when they contract
- Paradoxically, the same muscles which increases intra-abdominal pressure (promoting hernia) also narrow the inguinal canal (preventing hernia)
This structure reinforces the posterior wall of the inguinal canal
Conjoint tendon
This is an abnormal protrusion of tissue through an opening
A hernia
In inguinal hernias, what protrudes through the inguinal region
Abdominal viscera (usually the small intestine)
Are inguinal hernias more common in males or females
Males
What are two reasons why inguinal hernias are more common in males
- Large diameter of the inguinal canal in males, for passage of spermatic cord
- The fact the scrotum is an outpouching of the anterior abdominal wall. It creates a large potential space for the abdominal viscera to fill
What structure is homologous to the males scrotum in females?
The labia majora, but it is mostly filled with fat
What are two kinds of inguinal hernias (general)
Indirect hernias
Direct hernias
In indirect inguinal hernias, describe the passageway before descending into the scrotum (or labia majora)
Passes through the deep inguinal ring, inguinal canal, and superficial inguinal ring before descending into the scrotum
In indirect inguinal hernias, the abdominal viscera passes _____ to the inferior epigastric vessels
Lateral to the inferior epigastric vessels
Can indirect hernias be congenital, acquired, or both?
Can be both
- Congenital (associated with a patent processus vaginalis)
- Acquired (through forced opening of the passage)
What percentage of inguinal hernias are indirect?
75%
This structure is an embryological outpouching of peritoneum which forms the inguinal canal and the tunica vaginalis of the scrotum. It normally obliterates. When it does not, it leaves a sizeable passageway for intestines to pass into the scrotum.
Processus Vaginalis
Does the processus vaginalis stay intact or obliterate?
Eventually obliterates
What happens if the processus vaginalis does not obliterate?
It leaves a sizeable passageway for intestines to pass into the scrotum
In direct inguinal hernias, what is the passageway for the visceral abdominal organs?
Punches directly through the posterior wall of the inguinal canal, bypassing the deep inguinal ring
In direct inguinal hernias, the visceral abdominal organs pass ____ to the inferior epigastric vessels, through the inguinal triangle
Pass medial to the inferior epigastric vessels
In direct inguinal hernias, there is usually a general bulging of the anterior abdominal wall, but does not decent into what structure?
The scrotum
Are direct inguinal hernias congenital or acquired?
Always acquired - due to weakness in the conjoint tendon or transversalis fascia
What is the percentage of getting direct inguinal hernias? Who does it occur mostly in?
25% of inguinal hernias
Mostly in men over 40 years old
What kind of subluxations may affect the functioning of the anterior abdominal wall muscles, increasing the risk of inguinal hernias?
Lower thoracic and lumbar subluxations may affect
This type of hernia passes through the femoral canal
Femoral hernia
Femoral hernias occur inferior to the ______, while inguinal hernias occur superior to the ______
Inguinal ligament for both fill ins
Does femoral hernias occur more in males or females?
Females
This type of hernia usually results from incomplete closure of the anterior abdominal wall after ligation of the umbilicus at birth
Umbilical hernia
Umbilical hernias can also occur due to defects in the _____
Linea alba
This structure begins at the deep inguinal ring and ends at the testis
The spermatic cord
The spermatic cord is covered by how many concentric layers of fascia derived from the anterior abdominal wall
Three concentric layers of fascia derived from the anterior abdominal wall
Name the three concentric layers of the fascia covering the spermatic cord
External spermatic fascia
Cremasteric fascia
Internal spermatic fascia
The external spermatic fascia is derived from the…..
Derived from the external oblique aponeurosis
The cremastic fascia is derived from the….
Derived from the internal oblique aponeurosis
The cremastic fascia layer can be recognized by the presence of many bundles of muscle fibers, collectively referred to as the _____. This muscle is derived from the ______
Cremaster muscle
Internal oblique muscle
This muscle functions in temperature regulation of sperm
Cremaster muscle
The internal spermatic fascia is derived from the…
Derived from the transversalis fascia
Subluxations of ____,____ may affect male fertility (hypothesis)
L1, L2
The spermatic cord contains these structures
Ductus deferens Testicular artery Pampiniform plexus of veins Artery to the ductus deferens Cremastic artery Genital branch of genitofemoral nerve Remnant of processus vaginalis Autonomic nerves Lymphatics
This structure is a muscular duct which transports sperm from the epididymis to the ejaculatory duct
Ductus deferens
The testicular artery is a branch of the….
Abdominal aorta
This structure is an extensive network of veins which makes up the bulk of the spermatic cord. These structures join together at the deep inguinal ring to form the testicular vein
Pampiniform plexus of veins
The left testicular vein drains into the……
The right testicular vein drains into the….
Into the left renal vein
Drains directly into the inferior vena cava
Artery to the ductus deferens is a branch of the…..
Superior vesicular artery
Cremastic artery is a branch of the….
Inferior epigastric artery
This nerve supplies the cremaster muscle
Genital branch of the genitofemoral nerve
The lymphatics in the spermatic cord drain into the…..
Drain into the lumbar lymph nodes
This nerve runs through the inguinal canal and superficial inguinal ring. It accompanies the spermatic cord but is not part of it
Ilioinguinal nerve
What are the two branches of the ilioinguinal nerve
Femoral branch
Anterior scrotal or anterior labial nerve
The femoral branch of the ilioinguinal nerve supplies the…..
Supplies the upper medial part of the thigh
The anterior scrotal or anterior labial nerve branch of the ilioinguinal nerve supplies the…
Supplies the root of the penis and anterior part of the scrotum. (Anterior scrotal nerve)
Or supplies the mons pubis and anterior part of the labia majora (anterior labial nerve)
What is a varicocele
Varicose veins within pampiniform plexus
This structure is an outpouching of the anterior abdominal wall
Scrotum
Why is the skin of the scrotum thin with little to no fat?
Important for maintaining a temperature below body temperature
What are the structures the scrotum contains?
Testes
Epididymis
Lower part of the spermatic cord
The scrotum consists of a series of concentric layers which are derived from corresponding layers of the…..
The anterior abdominal wall
The homolog of skin for the anterior abdominal wall is this structure for the scrotum
Anterior abdominal wall. Scrotum
1. Skin. 1. Skin
The homolog of the subcutaneous tissue, superficial and deep fascia in the anterior abdominal wall is what structure in the scrotum
Anterior abdominal wall. Scrotum
2. Subcutaneous tissue, 2. Dartos muscle
Superficial and deep fascia
The homolog of the external oblique muscle in the anterior abdominal wall for the scrotum what
Anterior abdominal wall Scrotum
3. External oblique. 3. External spermatic fascia
The homolog of the internal oblique muscle in the anterior abdominal wall is what for the scrotum
Anterior abdominal wall Scrotum
4. Internal oblique muscle. 4. Cremastic fascia and cremaster muscle
The homolog of the transversus abdominis muscle in the anterior abdominal wall is what for the scrotum?
Anterior abdominal wall. Scrotum
5. Transversus abdominis muscle. 5. No continuations
The homolog of the transversalis fascia in the anterior abdominal wall is what for the scrotum
Anterior abdominal wall. Scrotum
6. Transversalis fascia. 6. Internal spermatic fascia
The homolog of the extraperitoneal fascia in the anterior abdominal wall is what for the scrotum
Anterior abdominal wall Scrotum
7. Extraperitoneal fascia 7. No continuation
The homolog of the peritoneum in the anterior abdominal wall is what for the scrotum?
Anterior abdominal wall. Scrotum
8. Peritoneum. 8. Tunica vaginalis
This muscle has smooth muscle fibers which are firmly adherent to the skin of the scrotum. This muscle functions in temperature regulation. (This is other one besides cremaster)
Dartos muscle
The tunica vaginalis consists of how many layers?
2 layers
What are the two layers of the tunica vaginalis?
The parietal layer
The visceral layer
The parietal layer of the tunica vaginalis has what orientation in the body?
Superficial, lies internal to the internal spermatic fascia
The visceral layer of the tunica vaginalis has what orientation in the body?
Deep, firmly adherent to the testis and epididymis
What is hydrocele?
Accumulation of fluid within the cavity of the tunica vaginalis
This structure are paired, mobile organs in the scrotum
Testis
Name the functions of the testis
Production of spermatozoa
Secretion of androgens
This structure is the fibrous covering of the testis. It lies deep to the visceral layer of the tunica vaginalis, which is the deepest layer fo the scrotum
Tunica albuginea
The testis is divided by septa into numerous wedge shaped portions called…..
Lobules
This structure is a fibrous compartment in the posterior part of the testis where the septa converge
Mediastinum testis
This structure is the functional, sperm producing portion of the testis.
Seminiferous tubules
Each lobule has how many seminiferous tubules?
2 to 3
Seminiferous tubules will eventually unite in each lobule to form ____ tubules
Straight tubules
Rete has what meaning?
Mesh like or net like
This structure is an elaborate network of canals located within the mediastinum testis into which the straight tubules empty.
Rete testis
This structure is a duct which connect the rete testis to the head of the epididymis
Efferent ductules
This structure is a C-shaped structure attached to the superior and posterior aspect of the testis
Epididymis
What is the function of the epididymis
Function is to store sperm until they mature
What are the three parts of the epididymis
Head of the epididymis
Body of the epididymis
Tail of epididymis
The head of the epididymis is connected to the ______ ______ of the testis by the ______ _____.
Superior surface of the testis
By the efferent ductules
The body of the epididymis is located along the _____ ______ of the testis
Posterior surface of the testis
The tail of the epididymis ends in the……
Ends in the ductus deferens
For lymphatic drainage, the testis drain into the…..
Lumbar nodes
For lymphatic drainage, the scrotum drawings into the…..
Superficial inguinal nodes
Where do the testes develop?
In the lumbar region inside the abdominal cavity
The testes normally descend through the ______ into the scrotum just before birth
Inguinal canal
This structure is a ligament present in the fetus which connects the testis to the scrotum. It contracts to pull the testis downward and through the inguinal canal during its descent.
Gubernaculum testis
What is cryptorchidism
Testes are undescended into proper place
What percentage of full term infants have cryptorchidism?
What percentage of premature infants?
3 % of full term infants
30 % of premature infants
In cryptorchidism, what is the most common place to find the undescended testes and is it bilateral or unilateral.
Most commonly found in the inguinal canal
Condition is usually unilateral
In what week do the testes usually descend after birth?
Most descend within the first week after birth
If the testes do not descend, is the patient still fertile or infertile? What about androgens?
Infertility, but androgens secretions not impaired
Are undescended testes at risk for cancer?
They are at greatly increased risk for cancer
This structure is a smooth membrane which lines the abdominal cavity
Peritoneum
The peritoneum is similar to the ____ and the _____ in its arrangement
Pleura and pericardium
The parietal peritoneum lines the….
Abdominal walls
The visceral peritoneum covers the….
Abdominal organs
This is a potential space between the parietal and visceral peritoneum. It is empty except for a film of serous fluid
Peritoneal cavity
Infection of the peritoneal cavity via the uterine tubes occur in these two types of conditions
- Immunocompromised women
2. Unsanitary conditions during parturition
The peritoneal cavity is what in males?
Completely closed sac in males
The peritoneal cavity in females communicates with the exterior through the ______.
Uterine tubes
If an infection of the vagina spreads, how will it spread?
It will spread via the uterine tubes
If doing the test for patency of the uterine tubes, and the dye that was introduced in the uterus does go through the uterine tubes, but then not the peritoneal cavity, what does this indicate?
This indicates an obstruction
What are the functions of the peritoneum
To minimize friction between organs
To resist infection
Fat storage
Define retroperitoneal organs
They lie posterior to the peritoneum and are covered by peritoneum only on their anterior surface (example: kidney)
Define ascites
An accumulation of fluid within the peritoneal cavity
In ascites, this represents an imbalance between what two things?
Imbalance between fluid production and absorption. Several liters of fluid may accumulate
In a healthy person, peritoneums are highly what?
Highly absorbant
The peritoneal cavity is mainly used for what?
Used for kidney dialysis
What are the causes of ascites?
Malnutrition Congestive heart failure Liver failure Kidney failure Peritonitis
What is peritonitis?
Inflammation of the peritoneum, usually from infection
What are the causes of peritonitis?
Trauma - bad belly button piercings
Inflammation bowel disease (including ruptured appendix)
Vaginal infections
Perforated ulcers
What does peritonitis usually result in?
Usually results in adhesions between the parietal and visceral peritoneum - get stuck to body walls
The parietal peritoneum is supplied by nerves of the adjacent body wall, name them
Phrenic nerve Intercostal nerves Subcostal nerves Iliohypogastric nerve Ilioinguinal nerve
Is the parietal peritoneum sensitive to pain?
Very sensitive to pain
Visceral peritoneum is supplied by ____ nerves which travel within the organs it invests
Autonomic
Is the visceral peritoneum sensitive to pain?
Insensitive to pain
This structure is a broad, apronlike reflection of the peritoneum. There are two within the abdominal cavity
Omentum
This omentum has a large apronlike structure which hangs from the greater curvature of the stomach, coving abdominal viscera.
Greater omentum
The greater omentum reflects ____ to attach to the transverse colon and transverse mesocolon.
Posteriorly
What are the three parts of the greater omentum
Gastrophrenic ligament
Gastrosplenic ligament
Gastrocolic ligament
The gastrophrenic ligament is inbetween what two things?
Between greater curvature of stomach and diaphragm
The gastrosplenic ligament is inbetween what two things?
Between greater curvature of stomach and spleen
The gastrocolic ligament is in between what two things?
Between greater curvature of stomach and colon
Why is the greater omentum called the “abdominal policeman”
It is very mobile and often adheres to areas of inflammation, wrapping itself around inflamed organs and restricting spread of infection.
This structure is a double layer of peritoneum which extends form the porta hepatis (hilum) of the liver to the lesser curvature of the stomach and the beginning of the duodenum.
The lesser omentum
How many parts consists of the lesser omentum?
Two parts
Name the parts of the lesser omentum
Hepatogastric ligament
Hepatoduodenal ligament
The hepatogastric ligament is inbetween what two things?
Between the liver and the lesser curvature of the stomach
The hepatoduodenal ligament is inbetween what two things?
Between the liver and the duodenum
What is the general term for mesentery
Any double layer of peritoneum which connects a portion of intestine to the body wall
What is the specific term for mesentery?
The double layer of peritoneum which connects the jejunum and the ileum to the body wall. This mesentery is sometimes referred to as the “mesentery proper”
The mesentery for the jejunum and ileum suspends them to what wall and transmits what to the corresponding structures?
Suspends them to the posterior body wall and transmits nerves and vessels which supply them.
What does the transverse mesocolon connect?
Connects the transverse colon to the posterior body wall
What does the sigmoid colon connect?
Connects the sigmoid colon to the pelvic wall
What does the mesoappendix connect?
Connects the appendix to the mesentery of the ileum
What does the phrenicocolic ligament connect?
Attaches the left colic flexible to the diaphragm, below the spleen
The peritoneal cavity is divided into what two things?
The omental bursa and greater sac
This structure is an irregularly shaped space which lies posterior to the liver, lesser omentum, and stomach. It is a closed sac except for its opening into the greater sac through the omental foramen
Omental bursa (lesser sac)
This structure extends from the diaphragm to the pelvic floor and across the entire breadth of the abominal cavity
The greater sac
What are the subdivisions of the greater sac?
Right subphrenic space (recess) Left subphrenic space (recess) Subhepatic space (recess) Right paracolic gutter Left paracolic gutter
Where is the right subphrenic space located?
Located below the diaphragm and above the liver, to the right of the falciform ligament
Where is the left subphrenic space located?
Located below the diaphragm and above the liver, to the left of the falciform ligament
Where is the subheptic space located?
Between the liver and the transverse colon
What is a subdivision of the subhepatic space?
Hepatorenal recess
What is the hepatorenal recess?
Posterosuperior extension of the subhepatic space, between the liver and right kidney
What is the right paracolic gutter?
A longitudinal depression lateral to the ascending colon
What is the left paracolic gutter?
A longitudinal depression lateral to the descending colon
The spaces of the greater sac are clinically important for what reason?
They channel and compartmentalize peritoneal fluid and infectious processes
This structure is the opening between the omental bursa and greater sac
The omental foramen
What are the boundaries of the omental foramen
Liver (superiorly)
First part of the duodenum (inferiorly)
Free edge of the lesser omentum (anteriorly)
Peritoneum covering the inferior vena cava (posteriorly)
What are the structures which pass through the porta hepatis and which are surrounded by the lesser omentum?
Bile duct ( anterior and to the right) Hepatic artery (anterior and to the left) Portal vein (behind)
Early in embyrological development, the alimentary tract consists of how many parts?
Name those parts
3 parts
Foregut
Midgut
Hindgut
What does the foregut form?
Forms the distal esophagus, stomach and part of the duodenum. Foregut ends within the second part of the duodenum, at the entrance of the bile duct
What does the midgut form
Begins at the entrance of the bile duct into the second part of the duodenum, and ends with the right 2/3 of the transverse colon
What does the hindgut form?
Begins with the left 1/3 of the transverse colon, and ends in the upper part of the anal canal
The adult derivates of the foregut, midgut, and hindgut of each share what together?
Share a unified blood supply and autonomic nerve supply
What is the blood supply of what foregut, midgut, and hindgut?
Foregut - branches of the celiac trunk
Midgut - branches of the superior mesneteric artery
Hindgut - branches of the inferior mesenteric artery
What are the sympathetic nerve innervations for the foregut, midgut, and hindgut?
Foregut - greater splanchnic nerves (T5-9) and lesser splanchnic nerve (T10-11)
Midgut - greater splanchnic nerves (T5-9) and lesser splanchnic nerve (T10-11)
Hindgut - lumbar splanchnic nerve (L1-2)
What are the parasympathetic nerve innervations of the foregut, midgut, and hindgut
Foregut - vagus nerve
Midgut - vagus nerve
Hindgut - pelvic splanchnic nerve (S2-4)
What does sympathetic innervation have on the gastrointestinal tract
Decreases motility and tone and contracts sphincters
What does parasympathetic innervation have on the gastrointestinal tract
Increases motility and tone and relaxes sphincters
What are the layers of the gut wall?
Mucosa
Submucosa
Muscularis externa
Serosa or adventitia
What does the mucosa form?
Mucous membrane, which forms the innermost layer and contains the muscularis mucosa, a thin layer of smooth muscle
What does the submucosa form?
A loose connective tissue layer containing blood vessels and lymphatics
What does the muscularis externa form?
A thick layer of smooth muscle responsible for peristalsis
What are the layers of the muscularis externa
Inner circular layer
Outer longitudinal layer
What is peristalsis?
Propulsive movement of the gut. Contractile ring appears and moves distally
When does reverse peristalsis happen
Occurs in vomiting
What does the serosa or adventitia form
Visceral peritoneum is referred to as serosa. Retroperitoneal organs are covered with a connective tissue coat called adventitia
What is the enteric nervous system
Regional system of nerves specific to the gut.
Is the enteric nervous system dependent or independent of the CNS
It is semi-independent of the CNS
Where does the submucosa plexus orient?
Within the submucosa near border with muscularis externa
What does the submucosa plexus carry
Postganglionic fibers supply muscularis mucosa and mucus secreting glands
Where does the myenteric plexus orient
Between circular and longitudinal layers of the muscularis externa
What does the myenteric plexus carry
Postganglionic fibers supply these smooth muscle layers and stimulate peristalsis
What shape is the stomach when empty
J shaped
This structure is a distensible organ which lies in the left hypochondrium, epigastric, and umbilical regions of the abdomen.
Stomach
What is the function of the stomach
Primarily digestive rather than absorptive, stores and mixes food with gastric secretions, converting it to chyme
What are the parts of the stomach
Cardia
Fundus
Body
Pyloric part
What is the cardia of the stomach
Where esophagus joins the stomach (surrounds the cardia orifice)
What is the fundus of the stomach
Above the cardia
What is the body of the stomach
Between the fundus and pyloric part
What is the pyloric part of the stomach
The most distal portion, adjacent to the duodenum
What are the curvatures and notches of the stomach
Greater curvature
Lesser curvature
Cardial notch - between esophagus and fundus
Angular incisure - between body and pyloric part
What are the openings of the stomach
Cardial openings - between the esophagus and stomach
Pyloric orifice - between the stomach and duodenum
What are the subdivisions of the pyloric part of the stomach and what they are (definition or term)
Pyloric antrum - wide proximal part
Pyloric canal - narrow distal part
Pylorus distal - termination of the pyloric part which contains:
-pyloric orifice - into duodenum
-pyloric sphincter - a circular muscle layer which surrounds the pyloric orifice
The pylorus is marked externally by the…..
Pyloric constriction
This structure are longitudinal folds of mucous membrane, located within the cavity of the stomach.
Gastric folds (rugae)
Definition of congenital hypertrophic pyloric stenosis
A tumor like increase in the size of the pyloric sphincter, which reduces size of the pyloric canal
What does congenital hypertrophic pyloric stenosis result in?
Results in projectile vomiting - may be present at birth
With congenital hypertrophic pyloric stenosis, what is the drug in a study done that showed increase risk postnatally?
The antibiotic crythromycin
What is the proper treatment for congenital hypertrophic stenosis?
Surgical intervention early in infancy
Definition of plyorospasm
Spasmodic contraction of the pyloric sphincter - sometimes present in infants
What happens to food in people with plyorospasm?
Food does not pass easily from the stomach to the duodenum
This causes the stomach to become overly full, which results in vomiting, sometimes projectile
Subluxations of what vertebral levels may play a role in pylorospasms?
Subluxations of T5-9
Definition of a gastric ulcer
A crater like depression in the mucosa of the stomach
In gastric ulcers what happens to the lining of the alkaline mucus
The alkaline mucus can sometimes be not adequate enough, and begins to erode away from the gastric acid. This forms a gastric ulcer
Causal factors for gastric ulcers
Excess acid secretion: often related to stress
Inadequate mucus barrier: usually related to the presence of bacteria (hello after pylori), which erode the mucus barrier
Secretion of gastric acid (by parietal cells) is controlled by the vagus nerve subluxations of T5-9 may play a role
Where does the stomach lie in comparison to the lesser sac and pancreas
Lies anterior
Where does the stomach lie in comparison to the diagphragm, left lobe of the liver, and anterior abdominal wall
It lies posterior to all of them
Blood supply of the stomach
Branches from the celiac trunk
What is the innervation of the stomach
Nerve supply is from the celiac plexus.
Sympathetic: greater splanchnic nerve (T5-9)
Parasympathetic: vagus nerve
The celiac trunk is the first what from the abdominal aorta. It arises where from the aortic hiatus of the diaphragm
First unpaired branch from the abdominal aorta
Arises immediately below aortic hiatus of the diaphragm
What are the branches of the celiac trunk
Left gastric artery
Splenic artery
Common hepatic artery
What structure is the smallest branch of the celiac trunk and runs along the lesser curvature writhing the lesser omentum to anastomose with the right gastric artery
Left gastric artery
What are the branches of the left gastric artery
Esophageal branches
Gastric branches
This structure is the largest branch of the celiac trunk, it runs posterior to the stomach, along the superior border of the pancreas to terminate in the spleen
Splenic artery
Branches of the splenic artery and where they go
Pancreatic branches: multiple branches to the pancreas
Short gastric arteries: to the fundus of the stomach
Left gastro-omental (gastroepiploic) artery: runs to the right along the greater curvature of the stomach within the greater omentum
This structure runs to the right along the superior border of the pancreas. It becomes the haptic artery proper after giving off the gastroduodenal artery
Common hepatic artery
Branches of the common hepatic artery and where they go
Gastroduodenal artery: descends behind the first part of the duodenum and gives off three branches
Supraduodenal artery: to the superior aspect of the duodenum
Right gastro-omental (gastroepiploic) artery: runs to the left along the greater curvature of stomach within the greater omentum. It anastomoses with the left gastro-omental artery
Superior pancreaticoduodenal artery: passes between the duodenum and head of the pancreas
Hepatic artery proper: participates in the formation of the anterior border of the omental foramen. The bile duct is to its right and the portal vein lies behind it.
What are subdivisions of the hepatic artery proper and where do they go
Right gastric artery: runs along the lesser curvature of the stomach within the lesser omentum to anastomose with the left gastric artery
Right hepatic artery: to the right lobe of the liver
-cystic artery: to the gall bladder
Left hepatic artery: to the left lobe of the liver
Where does the small intestine extend from and to and how long?
Extends from the pyloric orifice to the ileocecal junction and is about 7m in length
What is the functional differences between the small intestine and large intestine
Small intestine almost entirely does absorption of nutrients and the large intestine mostly absorbs water
Small intestine consists of what three parts
Duodenum
Jejunum
Ileum
Duodenum contains Brunner (duodenal) glands, what is their function
Secrete a dilute alkaline mucus. -neutralize stomach acid
What is the shape of the duodenum
C-shaped tube which surrounds the head of pancreas
How long is the duodenum
Shortest (25 cm) and widest part of the small intestine
What are the four parts of the duodenum and their corresponding orientations and parts
Superior (first) part - runs to the right. The beginning of the superior part is called the duodenal Cap (Ampulla)
Descending (second) part - contains the junction of the foregut and midgut, where the bile duct and pancreatic duct empty
Inferior or horizontal (third) part - the longest part. It runs to the left, anterior to the inferior vena cava, aorta, and vertebral column
Ascending (fourth) part - ascends to the left of the aorta and terminates at the duodenojejunal flexure
This structure is a fibromuscular band which extends from the diaphragm to the duodenojejunal flexure
Suspensory muscle (ligament) of the duodenum
The duodenum is entirely retroperitoneal except for the….. which is free (mobile)
Duodenal cap
Which artery and vein pass anterior to the third part of the duodenum
Superior mesenteric artery
Superior mesenteric vein
What is the blood supply to the duodenum
Superior pancreaticoduodenal artery (from gastroduodenal artery)
Supraduodenal artery (from gastroduodenal artery)
Inferior pancreaticoduodenal artery (from superior mesenteric artery)
The inferior pancreaticoduodenal artery supplies what parts of the duodenum
The third and fourth parts of the duodenum
What is the innervation of the duodenum
Autonomic fibers form the celiac and superior mesenteric plexuses
Definition of a duodenal ulcer
Mucosa in the duodenum is eroded to form a crater-like depression
Where is the duodenal ulcer most commonly located
Within the duodenal cap
Ulcers may perforate, allowing contents to escape into the peritoneal cavity, causing peritonitis. Explain the route for perforation in duodenal ulcers
Fluid travels from the A) subhepatic recess to the B) right paracolic gutter to the C) right iliac fossa
What organs are often damage due to proximity by perforated duodenal ulcers
Liver, pancreas, and gall bladder
Erosion of the gastroduodenal artery by a perforated duodenal ulcer can result in..
Severe hemorrhage
Both gastric and duodenal ulcers have been found to be associated with what kind of subluxations
Midthoracic subluxations
The jejunum makes up what part of the small intestine
Proximal 2/5ths of the small intestine
Where does the jejunum start and orients where
Begins at duodenojejunal flexure and lies mostly in the left upper quadrant of the abdomen, also joins the cecum at the ileocecal junction
How are the jejunum and ileum suspended?
Suspended from the posterior abdominal wall by the mesentery, which carries blood vessels, nerves, and lymphatics to them.
Main functional differences between jejunum and ileum
Jejunum - most involved with nutrient uptake
Ileum - absorbs fat soluble vitamins B12, bile salts
This structure in the small intestine are straight terminal branches of the arteries which travel through the mesentery to supply the small intestine
Vasa Recta
This structure in the small intestine are circular folds found within the small intestine
Plicae Circulares
This structure in the small intestine are aggregations of lymphoid tissue found within the walls of the small intestine
Peyer’s patches
Organize the contrast between the jejunum and ileum for: Color Vascularity Diameter Walls Vasa recta Mesenteric fat Plicae circulares Peyer’s patches
Jejunum first, ileum second Color - dark red, Pale pink Vascularity - greater , Lesser Diameter - larger , Smaller Walls - Thicker, Thinner Vasa recta - longer, Shorter Mesenteric fat - Less, More Plicae circulares - tall many , short few Peyer’s patches - absent , Present
What is the blood supply of the jejunum and ileum
Jejunal and Ileal branches of the superior mesenteric artery
Innervation of the jejunum and ileum
Autonomic fibers from the superior mesenteric plexus
Definition of ileal (Meckel’s) diverticulum
A common malformation of the digestive tract
In legal (meckel’s) diverticulum, what exactly happens with tissue malformation
Remnant portion of the embryonic vitelline duct,
Finger like pouch which projects from the distal ileum
Contains all layers of the ileum and may contain gastric or pancreatic tissue, gastric tissue may secrete acid
Diverticulum often becomes inflamed, mimicking appendicitis
Definition of crohn’s disease
Inflammatory bowel disease which most commonly effects the distal ileum and adjacent colon, but can affect any part of the digestive tract.
Affects all layers of the intestine and results in thickening and ulceration of the affected segment
Results in pain, diarrhea, and malabsorption
Etiology - unknown, produces “cobblestone” radiographic appearance
Since motility of the small intestine is controlled ,in part, by the autonomic nervous system (vagus, greater and lesser splanchnic nerve) what can we say about chiropractics and motility?
Subluxations of the lower thoracic may affect motility, contributing to conditions such as crohn’s disease
The large intestine does synthesis of which kind of vitamins?
Vitamins that required bacterial action (vitamin K)
Where does the large intestine extend to and how long is it?
Extends from the ileocecal junction to the anus and is about 1.5 m in length
The primary function of the large intestine?
Function is to convert the liquid contents of the ileum into semisolid feces by absorbing water
What is the cecum of the large intestine
A blind pouch found below the ileocecal junction. It lies within the right iliac fossa.
What is the ileal fold?
Consists of two flaps which surround the ileal orifice (opening of terminal ileum into the cecum) the flaps fuse laterally to form the frenula
What is the appendix?
A narrow muscular tube which contains lymphoid tissue in its wall. It arises from the psoteromedial aspect of the cecum, and is attached to the mesentery of the ileum by the mesoappendix
What is the position of the appendix (is it always in the same place?)
It’s variable, but most common position is retrocecal. Second most common position is pelvic
What is appendicitis
Inflammation of the appendix
Most common intra-abdominal inflammatory condition
Symptoms usually begin as umbilical pain which then localizes to the right lower quadrant
Position of the appendix is variable and can affect where pain is felt
If untreated, the appendix may rupture, leading to peritonitis
Caused by obstruction of the lumen due to) lymphoid hyperplasia 2.) fecal impaction
The colon consists of four parts
Ascending colon
Transverse colon
Descending colon
Sigmoid colon
Give the orientations of the parts of the colon
Ascending - from ileocecal junction to the right colic (hepatic) flexure
Transverse - from the right colic flexure to the left colic (splenic) flexure
Descending - from the left colic flexure to the pelvic brim
Sigmoid - from the pelvic brim to the front of the sacrum, where it becomes the rectum
What are the orientations of the appendix and cecum
They are intraperitoneal
What are the orientation of the ascending and descending colon
Retroperitoneal
Where do the transverse and sigmoid colon lie
Lie within the peritoneal cavity and are attached to the posterior body wall by the transverse and sigmoid mesocolon
This structure of the colon has three narrow longitudinal bands o muscle seen most prominently in the cecum and ascending colon
Taeniae coli
This structure of the colon has sacculations or outpouchings of the colon
Haustra of colon
This structure of the colon has small masses of fat which are covered with visceral peritoneum, and which extend from the colon
Omental appendices
This structure has terminal portions of the large intestine. They will be described with the pelvis
Rectum and anal canal
What is diverticulosis
Herniation of the mucosa of the colon through the muscular layer, without inflammation most common in individuals over 40 years of age
Occurs most commonly in the sigmoid colon
If the diverticuli becomes inflammed, the condition is called diverticulitis
It results in abdominal pain, diarrhea, and in some cases, abcess
Related to a lower fiber diet - may be treated with laser endoscopy
Radiographically, it is characterized by numerous outpouchings along the colon
What is ulcerative colitis
Severe inflammation and ulceration of the rectum and lower colon
Usually restricted to the mucosa
Abdominal pain and diarrhea are symptoms
Bowel perforation may occur
Radiographically, the bowel appears constricted
What is irritable bowel syndrome
A common condition recurrent abdominal pain and diarrhea with no inflammation or deterioration in health
Symptoms are caused by abnormal muscular contractions of the colon
The cause is unknown, but the symptoms are often brought on by stress and anxiety
Blood supply to the small and large intestine
Superior mesenteric artery
Inferior mesenteric artery
Marginal artery
Vasa Recta
The superior mesenteric artery arises from the ____ below the celiac trunk. It’s branches supply the intestine from the ____ part of the duodenum (where the bile duct joins) through the _____ of the ____ colon
Abominal aorta below the celiac trunk
Second part of the duodenum
Through the right 2/3 of the transverse colon
Branches of the superior mesenteric artery and what they supply
Inferior pancreaticoduodenal artery - supplies the pancreas and distal part of the duodenum
Jejunal and ileal arteries - 12 to 15 arteries which branch and anastomose within the mesentery to form a series of arcades. They supply the jejunum and ileum
Ileocolic artery - descends to the ileocecal junction. It supplies the ascending colon, cecum, and appendix
Right colic artery - supplies the ascending colon
Middle colic artery - supplies the transverse colon
Inferior mesenteric artery arises from the lower part of the ______. It’s branches supply the ____ from the left ____ of the _____ colon to the upper part of the anal canal
Lower part of the abdominal aorta
Supply the large intestine
From the left 1/3 of the transverse colon
What does anastomosis do?
Allows collateral circulation
What is a bowel infarction
Complete occlusion of intestinal vessels
What is a trans mural bowel infarction
Extreme bowel infarction usually resulting in a 95% fatality rate
Branches of the inferior mesenteric artery and what they supply
Left colic artery - supplies the descending colon
Sigmoid arteries - supply the sigmoid colon
Superior rectal artery - supplies the rectum and upper part of the anal canal. This is the terminal ranch of the inferior mesenteric artery
What is the marginal artery and what empties into it
An anastomotic channel which runs from the cecum to the sigmoid colon. All of the branches of the superior and inferior mesenteric arteries empty into it
The vasa recta has straight terminal branches from the _____ artery to the large intestine (also found in the small intestine)
From the marginal artery to the large intestine
The innervation for the cecum through the right 2/3 of transverse colon is supplied by what
Autonomic fibers from superior mesenteric plexus
The innervation of the left 1/3 of transverse colon to upper part of anal canal
Autonomic fibers from inferior mesenteric plexus and hypogastric plexus (lowest part)
Diarrhea, constipation, and other colon problems may be related to what kind of subluxations?
Lower thoracic, upper lumbar, or sacral subluxations
Chronic constipation is associated with increased risk of what conditions?
Hiatal hernia, inguinal hernia, diverticulosis, and colon cancer
What are the two linked venous systems within the trunk?
Portal venous system
Canal (systemic) venous system
What does the portal venous system drain
Drains the gastrointestinal tract, spleen, pancreas, and gallbladder
What nutrient does not pass through the portal system to the liver
Fats, those are picked up by lymphatic vessels of the small intestine called lacteals and bypass the liver
Blood flow of the portal venous system
From the abdominal organs named above
To tributaries of the portal vein
Then to the portal vein, which divides into left and right branches
Then to the liver sinusoids
Then to the inferior vena cava (caval system) via the hepatic veins
Blood flow of the caval (systemic) venous system
From the body wall and organs
To tributaries of the superior and inferior vena cava
Then to the superior and inferior vena cava
The portal vein is formed ____ the head of the pancreas by the union of the ____ vein and ____ vein
Portal vein is formed behind head of pancreas
Splenic and superior mesenteric vein
What are the tributaries of the portal vein
Splenic vein
Superior mesenteric vein
Left gastric vein
Paraumbilical vein
What are the subdivisions of the splenic vein
Short gastric vein
Left gastro-omental vein
Pancreatic veins
Inferior mesenteric vein
-left colic vein
-sigmoid veins
-superior rectal vein: unites with sigmoid vein to form inferior mesenteric veinWhat are the subdivisions of the superior mesenteric vein
Jejunal and ileal veins Ileocolic vein Right colic vein Middle colic vein Right gastro-omental vein Pancreaticoduodenal vein
What do the paraumbilical veins accompany?
Accompany the ligamentum teres to the umbilicus
All of the tributaries of the portal vein accompany arteries of what?, except for the paraumbilical vein
Tributaries of portal vein accompany arteries of the same name
What is cirrhosis of the liver
A condition characterized by destruction of hepatic cells and their replacements by fibrous tissue and fat
Liver becomes nodular and hard, and tends to constrict the portal vein at the porta hepatis, causing portal hypertension
Causes:
Alcoholism, chronic obstruction of bile duct, congestive heart failure
What is portal hypertension
Abnormal deviation of pressure within the portal system, often due to cirrhosis of the liver
Portal vein is constricted within the porta hepatis
Portal system has no valves-flow is reversed, by passing the liver
Blood backs up into the caval system in the regions where portal-caval anastomoses occurs
The veins in these areas become varicose (dilated, tortuous, and then walled), and may rupture
Given the site, name the caval vein, portal vein, and obstruction sign for portal-caval anastomoses
Distal esophagus, esophageal, left gastric, esophageal varices
Around umbilicus, superficial veins of ant. Abdominal wall, paraumbilical, caput medusae
Rectum and anal canal, middle and inferior rectal, superior rectal, hemorrhoids
What is esophageal varices
Can hemorrhage, with severe and often fatal bleeding
What is caput medusae
Pronounced snake-like veins radiating around umbilicus
Usually present only in severe cases
What are hemorrhoids
Not diagnostic for portal hypertension alone
This structure is the largest visceral organ and the largest gland in the body
The liver
Functions of the liver
Bile secretion - emulsifies fat
Metabolism of proteins, fats, and carbohydrates
Storage of glycogen, vitamins, and iron
Detoxification
Name two surfaces of the liver
The diaphragmatic surface
Visceral surface
What does the diaphragmatic surface cover?
Superior and convex. It is separated from the visceral surface by a sharp, inferior border
What does the visceral surface cover
Inferior and concave
What is the porta hepatis
It is the hilum of the liver.
What does the porta hepatis contain?
Common hepatic duct (to the right) Hepatic artery (to the left) Portal vein (behind)
What helps to form the anterior border of the omental foramen. It becomes the common hepatic duct prior to passing through the porta hepatis
The bile duct
What are the anatomical lobes of the liver
Right lobe
Quadrate lobe
Caudate lobe
Left lobe of the liver
Orientation of the gall bladder and inferior vena cava on the right lobe of liver
Gall bladder lies in a fossa on its visceral surface (anteriorly).
The inferior vena cava lies posterior to the gall bladder
Orientation of the quadrate lobe
Lies between the right and left lobes, anterior to the porta hepatis. The gall bladder is immediately to the right of it.
Orientation of the caudate lobe of the liver
Lies between the right and left lobes, posterior to the porta hepatis
Orientation of the left lobe of the liver
To the left of the falciform ligament. It is smaller than the right lobe
Are anatomical lobes used for functional purposes?
No, only used for descriptive purposes.
What would be the functional division through the liver.
Functional division of the live would be made to the right of the falciform ligament. The division would be made forward fro the inferior vena cava through the gall bladder
The division using the falciform ligament splits the left and right half’s into what?
Into nearly equal weight
The left and right functional half’s are further subdivided into what?
8 hepatic segments Hepatic segments (1-4 in the left functional) Hepatic segments (5-8 in the right functional)
What structures distribute to the right and left functional halves of the liver
Hepatic arteries (left and right branches) Portal vein (left and right branches) Common hepatic duct (left and right hepatic ducts) Hepatic veins (left and right tributaries
What is the bare area of the liver
Liver is covered with visceral peritoneum except at the bare area, located on the posterior aspect of the diaphragmatic surface. The liver maintains contact with the diaphragm at the bare area.
What lies within the bare area?
The inferior vena cava
What are the ligaments of the liver
Falciform ligament Coronary ligament Right and left triangular ligament Ligamentum teres Ligamentum venosum Ligament of the inferior vena cava
What does the falciform ligament connect
Connects the liver to the diaphragm and anterior abdominal wall
What does the coronary ligament do
As the falciform ligament passes posteriorly along the diaphragmatic surface of the liver, its two layers split to become the coronary ligament.
What does the coronary ligament form borders for?
Forms the borders of the bare area, and reflects onto the diaphragm. It consists of a superior (anterior) and inferior (posterior) layer.
How are the right and left triangular ligaments formed?
Formed at the junction of the superior and inferior layers of the coronary ligament on each side
What does the ligamentum teres form
Forms the free edge of the falciform ligament and is the remnant of the obliterated umbilical vein
Where is the location of the ligamentum venosum
Located between the left and caudate lobes. It is the remnant of the ductus venosus
What does the ligament of the inferior vena cava cover?
Covers the inferior vena cava within the bare area of the liver.
What letter do the fissures of the liver form on its visceral surface
The letter H
Where is the fissure for the ligamentum teres
Between the left lobe and the quadrate lobe
Where is the fissure for the ligamentum venosum
Between the left lobe and the caudate lobe
Where is the fossa for the gallbladder
Between the right and the quadrate lobe
Where is the fissure for the inferior vena cava
Between the right lobe and the caudate lobe
What forms the crossbar of the H on the liver
The porta hepatis
The portal vein has what percentage of blood supply to the liver
75-80% of deoxygenated blood
The hepatic artery has what percentage of blood supply to the liver
20-25% of oxygenated blood
What is the blood supply to the liver
Dual blood supply from portal vein and hepatic artery
What is the innervation for the liver
Autonomic and pain fibers are from the hepatic plexus which is an extension of the celiac plexus
What is the shape of the gallbladder and its location
Pear-shaped and located in a fossa on the visceral surface of the liver
What are the three parts of the gallbladder
Fundus
Body
Neck
Where does the gallbladder drain into?
Drains into the cystic duct
What is the function of the gallbladder and how does this process work
The gallbladder stores bile and concentrates it by absorbing water. It contracts to expel the bile into the duodenum when food arrives there. Contraction is initiated by the hormone cholecystokinin (CCK)
Blood supply to the gallbladder
Cystic artery from right hepatic artery
Innervation of the gallbladder
Autonomic and pain fibers from the celiac plexus
What are the ducts of the biliary duct system
Right and left hepatic ducts Common hepatic ducts Cystic duct Bile duct Hepatopancreatic ampulla (ampulla of Vater)
What do the right and left hepatic ducts drain
Drain the corresponding functional halves of the liver
What forms the common hepatic duct
Formed by the union of the right and left hepatic duct
What does the cystic duct drain
Drains the gallbladder
What forms the bile duct
Formed by the union of the common hepatic duct and cystic duct
What forms the hepatopancreatic ampulla (ampulla of Vater)
Formed by the union of the bile duct and pancreatic duct. It empties into the second part of the duodenum at the major duodenal papilla
The sphincter of the ampulla surrounds what
Surrounds the hepatopancreatic ampulla
What does the sphincter of the bile duct surround
Surrounds the inferior terminus of the bile duct
What does the sphincter of the pancreatic duct surround
Surrounds the terminal part of the pancreatic duct
Where are the spiral folds (valves) located? Function?
Located within the cystic duct.
They function to keep the cystic duct open
What are gallstones?
Hard masses formed by the solidification of bile constituents
Mainly composed of cholesterol crystals
Most commonly become compacted at the distal end of the hepatopancreatic ampulla (at the sphincter of ampulla), as this is the narrowest point in the biliary passages
Blockage at this location causes backup of bile through the pancreatic duct. Acute pancreatitis results
Risk factors for gallstones
Being female
Obesity
Pregnancy
High fat diet
Upper abdominal disease involving the liver, gallbladder, or stomach may refer pain to what spinal cord segments?
Lower thoracic spinal cord segments (T8-T12)
A gallbladder attack most commonly causes pain in what region of the abdomen?
Right upper quadrant
In what percentage of patients, pain is also referred to the right subscapular region of the back
30%, also have written only 5%?
What kind of gland is the pancreas
Both an exocrine and endocrine gland
What is the exocrine and endocrine function of the pancreas
Exo = secretion of digestive enzymes Endo = secretion of hormones insulin and glucagon
What are the five parts of the pancreas
Head Neck Body Tail Uncinate process
What is the uncinate process
A projection of the head to the left behind the superior mesenteric
Where does the pancreas lie?
Lies posterior to the stomach within the epigastric and left hypochondrium regions. It is a retroperitoneal organ except for the tip of the tail, which lies within the splenorenal ligament
Where does the head of the pancreas lie?
Within the C-shaped concavity of the duodenum
The superior mesenteric artery and veins pass where to the neck and and where to the uncinate processes of the pancreas
Posterior to the neck
Anterior to the uncinate process
The splenic artery runs along the superior surface of the ______, while the splenic vein runs along its _____ surface
Surface of the pancreas
Posterior surface
What drains the pancreas
Pancreatic duct
Accessory pancreatic duct
What specific parts does the pancreatic duct drain
Drains the neck, body, and tail. It joints the common bile duct to form the hepatopancreatic ampulla, which in turn empties into the major duodenal papilla within the second part of the duodenum
What parts of the pancreas does the accessory pancreatic duct drain
Drains the head and uncinate process. It empties into the minor duodenal papilla, also located within the second part of the duodenum, 2 cm above the major duodenal papilla
What is the blood supply for the pancreas
Pancreatic branches of splenic artery
Superior pancreaticoduodenal artery (from gastroduodenal)
Inferior pancreaticoduodenal artery (from superior mesenteric)
What is the innervation of the pancreas
Autonomic and pain fibers from the celiac plexus
How does rupturing of the pancreas normally occur?
Often occurs when there is a forceful compression of the abdomen, as in an auto accident when a person is thrown against the steering column
The steering column acts as a hammer, the vertebral column acts as an anvil
Release of digestive enzymes into the body cavity causes a lot of damage to adjacent tissue
Pain from the pancreas is referred to what area of spinal segments
Lower thoracic segments
Pain from the head of the pancreas is referred to the ____ of the vertebral column, pain from the body and tail is referred to the _____
Right of vertebral column
Left of vertebral column
This is a large lymphatic organ which has several functions
Spleen
Functions of spleen?
Produces lymphocytes in the newborn
Removes worn out RBCs and other cellular debris from circulation
Stores RBCs
Where does the spleen lie?
Lies against the diaphragm and ribs 9 to 11 within the left hypochondrium region
What surface of the spleen has a convex surface which lies against the diaphragm
Diaphragmatic surface
What surface of the spleen has a concave surface which lies against abdominal viscera. It has three subdivisions, name those as well
Visceral surface
Gastric surface - lies against stomach
Colic surface - lies against colic flexure
Renal surface - lies against the left kidney
This structure of the spleen is located on the visceral surface. It transmits nerves and vessels
Splenic hilum
What are the two ligaments of the spleen and what do they attach
Gastrosplenic ligament - attaches the stomach to the spleen
Splenorenal ligament - attaches the spleen to the left kidney
Blood supply to the spleen
Splenic artery (from celiac trunk) Splenic vein (from portal vein)
Innervation of spleen
Mainly sympathetic from celiac plexus
What is splenomegaly?
Enlarged spleen
How does rupturing of the spleen normally occur, is this common?
This is the most frequently injured abdominal organ
Particularly vulnerable to blows to the left hypochondrium region
Results in severe hemorrhage and shock
May be ruptured directly by trauma
What makes the spleen more fragile to rupturing
Mononucleosis
Sickle-cell anemia
Malaria
Septicemia
What needs to be done with patients with active mononucleosis
What happens when you surgically remove the spleen
Use caution in adjusting patients with active mono
When spleen is removed, kepffer cells of the liver take over its function, phagocytize worn out RBCs
This nerve supplies preganglionic parasympathetic fibers to the esophagus, stomach, small intestine, and large intestine through the right 2/3 of the transverse colon.
Other abdominal viscera which receive their parasympathetic innervation from this include what organs?
Vagus nerve (CN X) Liver, spleen, pancreas, kidney
This nerve supplies preganglionic parasympathetic fibers to the left 1/3 of the transverse colon through the upper part of the anal canal
Pelvic splanchnic nerves (S2,3,4)
Preganglionic parasympathetic fibers carried by vagus and pelvic splanchnic nerves synapse where?
Synapse in terminal ganglia which lie within the organs they innervation
Where do preganglionic sympathetic cell bodies lies within the spinal cord segments?
Spinal cord segments T1 to L2
This trunk enters the abdomen by passing posterior to the medial arcuate ligament. It descends on the vertebral column, medial to the psoas major muscle
Sympathetic trunk
Where do the right and left trunks of the sympathetic trunk lie?
Both trunks continue to where
Right trunk lies behind the inferior vena cava
Left trunk lies lateral to the aorta
Both trunks continue into the pelvis anterior to the sacrum
The sympathetic trunk gives rise to these two nerves, which contain preganglionic sympathetic and afferent fibers. These nerves arise from sympathetic trunk ganglia.
Thoracic and lumbar splanchnic nerves
Name the following cord segments for the list of nerves below Greater splanchnic nerve Lesser splanchnic nerve Least splanchnic nerve Lumbar splanchnic nerve
Greater - T5-9
Lesser - T10-11
Least - T12
Lumbar - L1-4
Sympathetic innervation to the stomach through the right 2/3 of the transverse colon originate in what spinal cord segments?
5 through 11 thoracic spinal cord segments
Preganglionic fibers from the 5 through 11 thoracic spinal segments pass through what structure and are carried by the greater and lesser splanchnic nerves to the ____ and _____, where they synapse
Pass through the sympathetic trunk
To the celiac and superior mesenteric plexuses, where they synapse
Sympathetic innervation to the left 1/3 of the transverse colon through the upper part of the anal canal originates in what spinal cord segments
Lumbar spinal cord segments
Preganglionic fibers from the lumbar spinal cord segments pass through the sympathetic trunk and are carried by what nerves to the inferior mesenteric plexus
Lumbar splanchnic nerves to inferior mesenteric plexus
These structures contain the cell bodies of postganglionic sympathetic neurons.
Celiac, superior mesenteric, and inferior mesenteric ganglia
The preganglionic sympathetic fibers carried by the splanchnic nerves synapse in these ganglia, and postganglionic fibers travel from the ganglia to the organs they innervate via what plexus
Periarterial plexuses
From the stomach to the middle of the sigmoid colon
Fibers carrying pain sensations run with sympathetic skin of what spinal sensory ganglia
Sympathetic to thoracic and lumbar spinal sensory ganglia
From the stomach to the middle of the sigmoid colon
Visceral afferent fibers carrying reflex information run with what sensory ganglia
Run with the vagus to vagal sensory ganglia
Distal to the middle of the sigmoid
Both pain sensation and reflex information are carried to what ganglia
Carried to spinal sensory ganglia of S2,3,4
The various autonomic plexuses of the abdomen lies in front of what structure and extends along its branches
The aorta
What various autonomic plexuses of the abdomen that lies in front of the aorta carries what kind of fibers
Parasympathetic fibers
Sympathetic fibers
Afferent fibers
Autonomic ganglia
How are the autonomic plexuses of the abdomen named? What are the names of these plexuses
Named for the arteries which they lie upon and include Celiac plexus Superior mesenteric plexus Aortic plexus Inferior mesenteric plexus
What is the name of the plexus that lies between the superior and inferior mesenteric Artie’s and is a portion of the aortic plexus
Intermesenteric plexus
What is the name of the plexus where it is just below the bifurcation of the aorta and is an extension of the aortic plexus
Aortic plexus continues downward to form the superior hypogastric plexus just blow the bifurcation of the aorta
