lower abdomen

Question 1

names of flexures of large intestines

Answer 1

R - hepatic

L - splenic

Question 2

what are the openings to the stomach and what’s it lined with

Answer 2

cardiac orifice - entrance from esophagus
pyloric sphincter - exit to duodenum
lined w/ rugae

Question 3

what are plicae circularis

Answer 3

permaent folds w/in the sm intestines that become more and more diffused distally

Question 4

what are the 4 parts of the duodenum and what vertebral levels are the first 2 at?

Answer 4

1st = superior ( no plique circularis) - L1 
2nd = descending - L2, L3
3rd = inferior
4th = ascending

Question 5

how can you distinguish jejunum from ileum?

Answer 5

jejunum has lots of plique circularis, is more proximal and has long narrow arcades (arterial loops in the mesentary) supplying it
ileum is more distal has less plique circularis, and has broad, flat arcades

Question 6

what and where is Mackel’s diverticulum and what complications can it cause

Answer 6

it’s a finger-like pouch that’s the remnant of the embryonic yolk sac
it’s on the ileum ~ 1 m proximal to the ileocecal valve
it can become inflamed and mimic appendicitis

Question 7

how is visceral abdominal pain different from parietal abdominal pain?

Answer 7

visceral pain is referred to other areas of the abdomen, and parietal pain corresponds to the actual area that’s in pain

Question 8

where is the vermiform appendix found and how is it connected

Answer 8

it’s often found retrocecal opening into the cecum inferior to the ileocecal orifice
it’s connected to the cecum and ileum by a triangular peice of mesentary called the mesoappendix

Question 9

how does pain present itself with appendicitis

Answer 9

vague pain starts in periumbilical region along dermatome T10
severe pain is in the lower R quadrant between the umbilicus and ASIS

Question 10

what are the 3 special features of the colon

Answer 10

tenia coli - 3 smooth bands running down length of the colon
haustra coli - pouches produced by tenia coli
epiploic appendages - little fat globules handging from the colon

Question 11

3 major unpaired aa off aorta are

Answer 11

celiac, superior and inferior mesenteric aa

Question 12

celiac trunk supplies

Answer 12

liver gallbladder, esophagus, stomach, spleen and pancreas

Question 13

3 branches of the celiac

Answer 13

splenic, common hepatic, left gastric

Question 14

branches off superior mesenteric

Answer 14

15-17 small intestinal aa (arcades), ileocolic, middle colic, R colic

Question 15

branches off inferior mesenteric

Answer 15

left colic, sigmoid (4), sup. rectal

Question 16

function of marginal a of drummond

Answer 16

anastomose of colic aa that forms consistent vascular arc around colon

Question 17

what aa supply the pancreas?

Answer 17

sup and inf pancreaticoduodenal supply the head of the pancreas and duodenum and the splenic supplies the rest

Question 18

what are the sup and inf pancreaticoduodenal aa branches of?

Answer 18

sup is of the gastroduodenal which is off the common hepatic (of the celiac)
inf is off the sup mesenteric

Question 19

where do aa supplying the adrenal glands branch off of?

Answer 19

renal a, inf phrenic, and aorta

Question 20

path of the renal aa

Answer 20

branches off abdominal aorta lateral to SMA sends off branches to the adrenal glands and ureters and terminates in the hilum of the kidney

Question 21

which are the gonadal aa

Answer 21

ovarian and testicular

Question 22

what are the paths of the ovarian and testicular aa?

Answer 22

ovarian crosses over the ureter and iliac vessels and descends to the ovaries
testicular crosses over the ureter and eners the inguinal canal then descends into the scrotum to supply the testes
note the left gonadal a is usually sup to the R and sometimes branches off the L renal a

Question 23

what are the spinal levels of bifurcation of the inf vena cava and abdominal aorta?

Answer 23

IVC - L5

aorta - L4

Question 24

IVC returns blood from _____ to _____

Answer 24

back, abdominal wall, and abdominopelvic viscera

to the R atrium

Question 25

what are the 4 portal caval anastomoses and where do they occur

Answer 25

portal caval place
gastric esophageal sup. stomach
paraumbelical epigastric umbilicus
colic retroperitoneal colon
sup rectal mid.+ inf rectal rectum

Question 26

how do portal vv cause caval vv to dilate

Answer 26

they have no valves so if they’re hypertensive blood goes into caval vv

Question 27

what are clinical results of dilated caval vv?

Answer 27

dilated esophageal vv = esophageal varices
dilated epigastric =caput medusae
dilated inf + middle rectal = hemorrhoids
nicking them is easy and causes hemorrhages

Question 28

what type of nn supply abdomen

Answer 28

parasymp (craniosacral) and symp (thoracolumbar) autonomic

Question 29

what are the lower thoracec splanchnic nn

Answer 29

greater lesser and least splanchnic nn which originate in T levelsand descend (T5 and down)

Question 30

what is pre and post ganglionic organization of parasymp nn?

Answer 30

pre = CNX travelling on celiac, SMA, or renal aa
or S2-S4 travelling on IMA
post = w/in effector organ

Question 31

what is pre and post gang organization of symp nn?

Answer 31

pregang SPLANCHNIC n synapse in COLLATERAL ganglia that travel on celiac, SMA renal and IMA aa to organs

Question 32

what’re the 4 major autonomic ganglia in abs

Answer 32

celiac ganglia, sup mesenteric ganglion aorticorenal ganglia (plexus on renal brs.) inf mesenteric ganglia (nn from symp lumbar splanchnic nn)