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GI exam 1 > organization of the abdomen II > Flashcards

organization of the abdomen II Flashcards

1
Q

what is the abdominopelvic cavity bounded by?

A

musculoskeleltal components of the abdominal wall
thoracoabdominal diaphragm
pelvic diaphragm

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2
Q

what is the peritoneum

A

it is serous membranes which lines the internal surface of the abdominopelvic cavity (parietal layer) and covers the viscera (visceral layer)

secretes serous fluid

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3
Q

what does the paretal layer line

what is it deep to

A

lines the body wall

found deep to the subserous fascia

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4
Q

what are peritonealized (intraperiotneal) organs

A
  1. Completely covered with visceral peritoneum; associated with a mesentery.
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5
Q

what are examples of peritonealized organs

A 
stomach
spleen 
parts 1 and 4 of duodenum
jejunum
ileum
transverse and sigmoid colon
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6
Q

what is a primary retroperitoneal organ

A

posterior to the peritoneum

no mesentary

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7
Q

what are examples of primary retroperitoneal organs

A

(non-gut tube organs usually)
kidneys
ureters
suprarenal glands

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8
Q

what is a secondary retroperitoneal organ

A
  1. During early development, the organ was peritonealized and associated with a mesentery; later in development, the mesentery is pushed against the posterior body wall and fuses with surrounding parietal peritoneum.
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9
Q

examples of secondary retroperitoneal organs

A

most of duodenum
ascending colon
descending colon
pancreas

gut tube organs not associated with mesentary

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10
Q

what is peritonitis

A

inflammation of the peritoneum

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11
Q

what is the difference b/w visceral and parietal peritonitis and its presentation and the cause of the differing presentations

A

c. Parietal peritoneum is richly innervated by the same somatic nerves which innervate the body wall; sensitive to heat, cold, pressure, laceration.
Peritonitis is thus very painful and pain is well-localized.

e. Innervation to the visceral peritoneum is autonomic (thus pain is not well-localized; mostly registers information about stretch, chemical irritation).

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12
Q

what occurs with paritoneal adhesions

A

a. Peritoneal adhesions = fusion of various parts of peritoneal membranes.
b. Causes: inflammation of organs, surgery, trauma, ulcers.
c. Can limit normal movement of viscera and cause chronic pain.

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13
Q

what is a mesentery

A

double layer of peritoneum

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14
Q

what is the function of mesentery

A

provide a pathway for blood vessels, lymphatics, and nerves to organs

attachment

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15
Q

what are the 8 dorsal mesenteries

A 
mesoesophagus
greater omentum 
splenorenal 
phrenicocolic 
mesentery proper
mesoappendix
transverse mesocolon 
sigmoid colon
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16
Q

where is the mesoesophagus

A

final inch of esophagus

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17
Q

what are the three parts of the greater omentum

A

gastrocolic ligament
gastrosplenic ligament
gastrophrenic ligament

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18
Q

where is the gastrocolic ligament

A

from stomach to transverse colon

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19
Q

where is the gastrosplenic ligament

A

from stomach to spleen

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20
Q

where is the gastrophrenic ligament

A

from fundus of stomach to diaphragm

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21
Q

splenorenal ligament?

A

from spleen to posterior body wall (near kidney)

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22
Q

phrenicocolic ligament (sustentaculum lienis)

A

diaphragm to left colic flexure

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23
Q

what is the mesentary proper associated with

A

small intestine

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24
Q

mesoappendix?

A

dorsal mesentary to appendix

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25
Q

transverse mesocolon?

A

dorsal mesentary to transverse colon

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26
Q

sigmoid mesocolon?

A

dorsal mesentery to sigmoid colon

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27
Q

what are the 4 ventral mesenteries

A

lesser omentum
falciform ligament
coronary ligaments
triangular ligaments

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28
Q

what are the 2 parts of the lesser omentum

A

hepatogastric ligament

hepatoduodenal ligament

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29
Q

what is the falciform ligament and what does it contain

A
  1. Peritoneal attachment of liver to anterior body wall.

2. Contains the ligamentum teres hepatis (obliterated umbilical vein).

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30
Q

what is the coronary ligament

A
  1. Peritoneal attachment of liver to inferior surface of diaphragm.
  2. Left and right; anterior and posterior portions.
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31
Q

what are the triangular ligaments (right and left

A

where anterior and posterior coronary ligaments meet

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32
Q

what is the peritoneal cavity

what is it filled with

A
  1. Space between visceral and parietal peritoneal layers; filled with serous fluid allowing organs to move freely
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33
Q

where is the location of the lesser sac

A

aka the omental bursa

posterior to the stomach and lesser omentum

34
Q

what is the superior recess of the lesser sac bounded by?

inferior recess?

A

b. Superior recess – bounded superiorly by the diaphragm.

c. Inferior recess – between the two layers of greater omentum.

35
Q

what are the three parts of the greater sac (peritoneal cavity)

A

supracolic
infracolic
paracolic gutters

36
Q

where is the supracolic compartment?

what does it contain?

A
  1. Superior to transverse mesocolon.

2. Contains the stomach, liver, spleen, gall bladder.

37
Q

where is the infracolic compartment?
what does it contain?
what separates this compartment into left and right?

A
  1. Inferior to transverse mesocolon.
  2. Contains small intestine, ascending colon, descending colon.
  3. Separated into right and left compartments by mesentery proper.
38
Q

where are the paracolic gutters

A

between the posterolateral body walls and ascending/descending colon

39
Q

what is the epiploic foramen

what are the anterior, posterior, superior, inferior borders

A

communication between greater and lesser sacs

Boundaries

  1. Anterior: hepatoduodenal ligament
  2. Posterior: IVC
  3. Superior: liver
  4. Inferior: first part of the duodenum
40
Q

what is ascites?

what are some causes

A

a. Excess fluid in the peritoneal cavity (ascitic fluid).
b. Ascitic fluid can become purulent and lead to abscesses.
c. Causes: cirrhosis with portal hypertension; kidney failure; congestive heart failure; ruptured ulcer; abdominal cancers; internal bleeding.

41
Q

where does peritoneal fluid from the left infracolic compartment flow?
right infracolic compartment?

A
  1. Fluid in the left infracolic compartment freely communicates with the pelvic peritoneal cavity.
  2. Fluid in the right infracolic compartment is prevented from moving into the pelvic cavity because of the junction of the mesentery proper with the cecum and ascending colon. Thus, fluid must first pass to the left infracolic compartment before draining into the pelvic peritoneal cavity.
42
Q

where does peritoneal fluid spread from the paracolic gutters (right and left)

A
  1. Right paracolic gutter is open to the hepatorenal and subphrenic recesses superiorly. Fluid can pool in these spaces and cause abscesses which can dissect through the diaphragm into the thoracic cavity.
  2. Left paracolic gutter is closed superiorly by the phrenicocolic ligament.
  3. Fluid within both right and left paracolic gutters can drain into the pelvic peritoneal cavity.
43
Q

where does fluid from the supracolic compartment (including the hepatorenal recess) flow ?

A

d. Fluid from the supracolic compartment (including the hepatorenal recess) can also pass through the epiploic foramen to the lesser sac.

44
Q

what are the three main unpaired arteries that are branches of the aorta that provide blood to most of the GI tract from distal esophagus to proximal anal canal?

A

Celiac trunk
superior mesenteric
inferior mesenteric

45
Q

what vertebral level is the celiac trunk

A

T12

46
Q

what vertebral level is the superior mesenteric artery

A

L1

47
Q

what vertebral level is the inferior mesenteric artery

A

L3

48
Q

what is the artery of the foregut

A

celiac trunk

49
Q

what are the 3 arteries that branch off the celiac trunk?

A

left gastric artery
splenic artery
common hepatic

50
Q

what are does the celiac trunk supply?

A

supplies distal esophagus to second portion of duodenum

51
Q

what does the celiac trunk anastomoses with and where?

A

SMA around the duodenum and pancreas

52
Q

what are the branches off the left gastric artery

A

esophageal branch

aberrant or accessory left hepatic a.

53
Q

what are the two main branches off the common hepatic a

A

gastroduodenal

proper hepatic

54
Q

what are the 5 branches off the gastroduodenal artery

A 
supraduodenal
retroduodenal
posterior superior pancreaticoduodenal 
anterior superior pancreaticoduodenal 
right gastroepiploic
55
Q

what are the 3 main branches off the proper hepatic artery

A

right gastric
left hepatic
right hepatic

56
Q

what is the small branch off the right hepatic

A

cystic artery

57
Q

what are the 4 branches off the splenic

A

pancreatic branches
short gastric
left gastroepiploic
splenic branches (4-5)

58
Q

what are the 3 splenic branches

A

dorsal pancreatic
pancreatica manga
caudal pancreatic aa.

59
Q

what is the artery of the midgut

A

superior mesenteric artery

60
Q

where does the superior mesenteric artery run

A

from the 3rd part of the duodenum to the distal 2/3rd of transverse colon

61
Q

what does the superior mesenteric artery anastomoses with? and where?

A

anastomoses with the inferior mesenteric artery around the distal 2/3rd of the transverse colon

62
Q

what are the 5 branches off the superior mesenteric artery

A 
inferior pancreaticoduodenal 
middle colic
jejunal and ileal branches
right colic
ileocolic
63
Q

what are the 2 branches off the inferior pancreaticoduodenal artery

A

anterior inferior pancreaticoduodenal a.

posterior inferior pancreaticoduodenal a

64
Q

what are the 5 branches off the ileocolic

A 
anterior cecal 
posterior cecal 
appendicular 
ileal 
ascending colon
65
Q

what is included in the large marginal artery anastomoses

A

Anastomosis between ileocolic, right colic, middle colic, left colic, sigmoidal aa

note some people don’t have link between middle and left colic arteries

66
Q

what is the artery of the hindgut

A

inferior mesenteric

67
Q

where does the inferior mesenteric artery run

A

from distal 1/3rd of transverse colon to anorectal region

68
Q

what does the inferior mesenteric artery anastomoses with ?

A

with the middle and inferior rectal arteries at the anorectal junction

69
Q

what are the three branches off the inferior mesenteric artery

A

left colic
sigmoidal branches (usually 5)
superior rectal artery

70
Q

via what does the abdominal viscera drain? and into what vein

A

for the most part, abdominal viscera drain via comitantes

however, instead of draining to the IVC these veins drain into the hepatic portal vein

71
Q

what is a portal vein

A

a vein that begins and ends in a capillary bed

72
Q

in the case of the hepatic portal vein where is the first capillary bed and where is the second?

A

the first is in the wall of the abdominal GI tract (from distal esophagus to rectum; including all accessory glands)

second is in the liver

73
Q

what does the hepatic portal vein receive

A 
all nutrients (except some fats) from food digestion 
secretions from accessory organs of digestion (pancreas, gall bladder) 
products of RBC breakdown from the spleen and delivers these to the liver for processing
74
Q

what merges to form the portal vein

where and at what vertebral level is this occurring

A

splenic vein merges with superior mesenteric vein to form the portal vein

this forms posterior to the neck of the pancreas

anterior to IVC

LV2

75
Q

where does the inferior mesenteric vein typically join the splenic vein

A

posterior to the body of the pancreas

76
Q

what does the portal vein travel with to get to the liver

A

travels with portal triad within the hepatoduodenal ligament to the liver

77
Q

what is the portal caval (portal-systemic) anastomoses

A

venous anastomoses between tributaries of portal vein and IVC

78
Q

what is the clinical significance of the portal and IVC containing no valves

A

in cases of portal HTN (due to liver cirrhosis etc.) blood will reverse flow through portal system and return to the heart via the IVC or SVC

when this occurs the vessels involved become dilated forming varices

79
Q

what region and vessels are involved with esophageal varices (dilated veins)

A

submucosa of inferior esophagus:
vessels:
tributaries of SVC: esophageal vein
tributaries of portal system: left gastric vein

bleeding from these varicosities can sometimes be very severe and sometimes fatal

80
Q

what region and vessels are involved in the formation of Caput Medusa (dilated veins)

A

paraumbilical region

tributaries of IVC and SVC: superior and inferior epigastric veins

tributaries of portal system: paraumbilical veins

81
Q

what region and vessels are involved in hemorrhoids

A

submucosa of anal canal

tributaries of IVC: middle and inferior rectal veins

tributaries of portal system: superior rectal veins

82
Q

what vessels are involved in the formation of dilated veins in the retroperitoneal region (no specific name)

A

tributaries of IVC: gonadal and renal veins

tributaries of portal system: ileocolic, right, middle, left colic veins

GI exam 1 (11 decks)

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