Mid/hind gut and posterior abdominal wall

Question 1

What supplies blood to the muscular part of the diaphragm?

Answer 1

musculophrenic a

Question 2

What supplies blood to the under surface of the diaphragm?

Answer 2

inf. phrenic a.

Question 3

What are the paired arteries that branch from the abdominal aorta?

Answer 3

inf. phrenic; renal; gonadal; common iliacs

Question 4

The gonadal, either ovarian or testicular a., which side is higher up?

Answer 4

the left is slightly higher than the right

Question 5

what are the branches of common iliac a. ?

Answer 5

external iliac - becomes femoral to supply lower extremities

internal iliac - supplies pelvic organs

Question 6

What a. comes off the bifurcation of the abdominal aorta to supply the ventral surface of the sacrum?

Answer 6

median sacral

Question 7

What are the branches of the SMA that supply the intestines?

Answer 7

middle colic: transverse colon
right colic: ascending colon
iliocolic: juction of ileum and cecum
intestinal branches: all of small bowel

Question 8

What branches off the SMA to supply the entire small bowel?

Answer 8

intestinal branches

Question 9

What are the branches of IMA that supply the intestines?

Answer 9

left colic: descending colon
sigmoidal branches: sigmoid colon
superior rectal (hemorrhoidal): last part of colon

Question 10

What artery do the SMA and IMA use to anastomose around the colon?

Answer 10

marginal a.

Question 11

In what three areas is the anastomoses of the colon weak?

Answer 11

near the splenic flexure, near the jxn of the ileum and cecum, and at the sigmoid colon

Question 12

Ligament of Treitz

Answer 12

part of the right crus that passes down to connect to the duodenojejunal flexure

Question 13

Jejunum blood supply

Answer 13

short arcades, long vasa recti

Question 14

ileum blood supply

Answer 14

long arcades, short vasa recti

Question 15

what are the branches of the iliocolic a. ?

Answer 15

posterior and anterior cecal; ileal; appendicular

Question 16

mesenteric ischemia

Answer 16

embolus to intestines; pain out of proportion to physical findings (no fever, normal white ct); gangrenous bowel - short window to fix will often lose part of bowl

Question 17

What is a common cause of mesenteric ischemia?

Answer 17

a fib in elderly; clot originates from left atrium/auricle

Question 18

Why would mesenteric ischemia not be due to an embolus from a clot in a leg vein?

Answer 18

from the leg viens travel into IVC, to the right atrium, r. ventricle, then to lung. would get PE from DVT

Question 19

In Afib, if you throw a clot from the left side/auricle, what would occur?

Answer 19

stroke or mesenteric ischemia

Question 20

In afib, if you throw a clot from the right side, what would occur?

Answer 20

PE

Question 21

What exception would allow for a clot in the right auricle to cause mesenteric ischemia?

Answer 21

ASD or VSD - would pass from right to left side

Question 22

a vein w/ a capillary bed on each end = ?

Answer 22

portal vein

Question 23

What is the biggest portal vein in the body and what is it made up of?

Answer 23

hepatic portal vein; sup. mes, inf. mes and splenic v.

Question 24

Where do the veins come togehter to drain into the hepatic portal v?

Answer 24

portal triad in the free margin of the lesser omentum

Question 25

What is the make up of the hepatic portal vein?

Answer 25

post capillary - went from arteries to capillaries then veins so it's deoxygenated blood but high in nutrients

Question 26

What supplies oxygen to the liver?

Answer 26

hepatic arteries off celiac trunk - not veins

Question 27

Where do caval blood and portal blood anastomse?

Answer 27

belly button; anus; esophagus; = portal blood intermixing w/ caval blood

Question 28

What are the characteristics of portal veins?

Answer 28

no valves - blood can go either way;

Question 29

What happens to the portal veins with cirrhosis?

Answer 29

portal blood can travel smoothly so it backs up in the vein = portal hypertension. = varicosities in the 3 anastomoses. esophageal, hemorrhoids and caput medusa

Question 30

What are the other effects of cirrhosis?

Answer 30

large liver, poor clotting, low albumin = acites

Question 31

porto-caval shunt

Answer 31

reduces portal hypertension via anastomsing the splenic vein w/ the left renal vein which diverts portal blood into the caval system

Question 32

internal hemorrhoids

Answer 32

hemorrhoids above the pectinate line; autonomics so painless

Question 33

external hemorrhoids

Answer 33

below pectinate line; somatic so painfull

Question 34

esophageal varicies

Answer 34

can rupture and bleed and since pts clot poorly keep bleeding into stomach and will vomit bright red blood

Question 35

What are the fatty lobes coming off the colon?

Answer 35

epiploic appendices

Question 36

tenia coli

Answer 36

3 bands of longitudinally arranged muscles that all meet at appendix

Question 37

Why does the colon appear wrinkled/draped?

Answer 37

haustra

Question 38

How to find appendix

Answer 38

follow the tenia coli inferiorly through the cecum

Question 39

Where is the appendix most often found?

Answer 39

64% of the time is folded under the cecum

Question 40

Where do the vagus n. and S2-4 find their post ganglionics?

Answer 40

within the organ

Question 41

Hirschsprung's disease

Answer 41

aka aganglionic megacolon; normally there are postganglionic parasympathetic cell bodies w/i the muscle laters of the colon, in the disease the neurons fail to migrage (mostly related to S2-4) so no defication = stool and air in colon

Question 42

What are the primary retroperitoneal structures?

Answer 42

(behind parietal peritoneum) kidneys, ureters adrenal glands

Question 43

secondary retroperitoneal structures

Answer 43

part of duodenum; pancreas; ascending colon; descending colon

Question 44

Descrbe the aseymmetiry of the vessels in the abdomen

Answer 44

aorta is to the left of IVC, IVC is always on the right

Question 45

Why do you never put a pregnant woman on her right side?

Answer 45

would compress the IVC

Question 46

What is the greatest flexor of the hip?

Answer 46

iliopsoas (tendons of psoas and ilacus)

Question 47

Triple A

Answer 47

abdominal aortic aneurysm; once aorta is greater than 4cm in diameter it's an aneursym; above 6cm need intervention