organization of the abdomen II Flashcards
what is the abdominopelvic cavity bounded by?
musculoskeleltal components of the abdominal wall
thoracoabdominal diaphragm
pelvic diaphragm
what is the peritoneum
it is serous membranes which lines the internal surface of the abdominopelvic cavity (parietal layer) and covers the viscera (visceral layer)
secretes serous fluid
what does the paretal layer line
what is it deep to
lines the body wall
found deep to the subserous fascia
what are peritonealized (intraperiotneal) organs
- Completely covered with visceral peritoneum; associated with a mesentery.
what are examples of peritonealized organs
stomach spleen parts 1 and 4 of duodenum jejunum ileum transverse and sigmoid colon
what is a primary retroperitoneal organ
posterior to the peritoneum
no mesentary
what are examples of primary retroperitoneal organs
(non-gut tube organs usually)
kidneys
ureters
suprarenal glands
what is a secondary retroperitoneal organ
- 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.
examples of secondary retroperitoneal organs
most of duodenum
ascending colon
descending colon
pancreas
gut tube organs not associated with mesentary
what is peritonitis
inflammation of the peritoneum
what is the difference b/w visceral and parietal peritonitis and its presentation and the cause of the differing presentations
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).
what occurs with paritoneal adhesions
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.
what is a mesentery
double layer of peritoneum
what is the function of mesentery
provide a pathway for blood vessels, lymphatics, and nerves to organs
attachment
what are the 8 dorsal mesenteries
mesoesophagus greater omentum splenorenal phrenicocolic mesentery proper mesoappendix transverse mesocolon sigmoid colon
where is the mesoesophagus
final inch of esophagus
what are the three parts of the greater omentum
gastrocolic ligament
gastrosplenic ligament
gastrophrenic ligament
where is the gastrocolic ligament
from stomach to transverse colon
where is the gastrosplenic ligament
from stomach to spleen
where is the gastrophrenic ligament
from fundus of stomach to diaphragm
splenorenal ligament?
from spleen to posterior body wall (near kidney)
phrenicocolic ligament (sustentaculum lienis)
diaphragm to left colic flexure
what is the mesentary proper associated with
small intestine
mesoappendix?
dorsal mesentary to appendix
transverse mesocolon?
dorsal mesentary to transverse colon
sigmoid mesocolon?
dorsal mesentery to sigmoid colon
what are the 4 ventral mesenteries
lesser omentum
falciform ligament
coronary ligaments
triangular ligaments
what are the 2 parts of the lesser omentum
hepatogastric ligament
hepatoduodenal ligament
what is the falciform ligament and what does it contain
- Peritoneal attachment of liver to anterior body wall.
2. Contains the ligamentum teres hepatis (obliterated umbilical vein).
what is the coronary ligament
- Peritoneal attachment of liver to inferior surface of diaphragm.
- Left and right; anterior and posterior portions.
what are the triangular ligaments (right and left
where anterior and posterior coronary ligaments meet
what is the peritoneal cavity
what is it filled with
- Space between visceral and parietal peritoneal layers; filled with serous fluid allowing organs to move freely
where is the location of the lesser sac
aka the omental bursa
posterior to the stomach and lesser omentum
what is the superior recess of the lesser sac bounded by?
inferior recess?
b. Superior recess – bounded superiorly by the diaphragm.
c. Inferior recess – between the two layers of greater omentum.
what are the three parts of the greater sac (peritoneal cavity)
supracolic
infracolic
paracolic gutters
where is the supracolic compartment?
what does it contain?
- Superior to transverse mesocolon.
2. Contains the stomach, liver, spleen, gall bladder.
where is the infracolic compartment?
what does it contain?
what separates this compartment into left and right?
- Inferior to transverse mesocolon.
- Contains small intestine, ascending colon, descending colon.
- Separated into right and left compartments by mesentery proper.
where are the paracolic gutters
between the posterolateral body walls and ascending/descending colon
what is the epiploic foramen
what are the anterior, posterior, superior, inferior borders
communication between greater and lesser sacs
Boundaries
- Anterior: hepatoduodenal ligament
- Posterior: IVC
- Superior: liver
- Inferior: first part of the duodenum
what is ascites?
what are some causes
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.
where does peritoneal fluid from the left infracolic compartment flow?
right infracolic compartment?
- Fluid in the left infracolic compartment freely communicates with the pelvic peritoneal cavity.
- 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.
where does peritoneal fluid spread from the paracolic gutters (right and left)
- 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.
- Left paracolic gutter is closed superiorly by the phrenicocolic ligament.
- Fluid within both right and left paracolic gutters can drain into the pelvic peritoneal cavity.
where does fluid from the supracolic compartment (including the hepatorenal recess) flow ?
d. Fluid from the supracolic compartment (including the hepatorenal recess) can also pass through the epiploic foramen to the lesser sac.
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?
Celiac trunk
superior mesenteric
inferior mesenteric
what vertebral level is the celiac trunk
T12
what vertebral level is the superior mesenteric artery
L1
what vertebral level is the inferior mesenteric artery
L3
what is the artery of the foregut
celiac trunk
what are the 3 arteries that branch off the celiac trunk?
left gastric artery
splenic artery
common hepatic
what are does the celiac trunk supply?
supplies distal esophagus to second portion of duodenum
what does the celiac trunk anastomoses with and where?
SMA around the duodenum and pancreas
what are the branches off the left gastric artery
esophageal branch
aberrant or accessory left hepatic a.
what are the two main branches off the common hepatic a
gastroduodenal
proper hepatic
what are the 5 branches off the gastroduodenal artery
supraduodenal retroduodenal posterior superior pancreaticoduodenal anterior superior pancreaticoduodenal right gastroepiploic
what are the 3 main branches off the proper hepatic artery
right gastric
left hepatic
right hepatic
what is the small branch off the right hepatic
cystic artery
what are the 4 branches off the splenic
pancreatic branches
short gastric
left gastroepiploic
splenic branches (4-5)
what are the 3 splenic branches
dorsal pancreatic
pancreatica manga
caudal pancreatic aa.
what is the artery of the midgut
superior mesenteric artery
where does the superior mesenteric artery run
from the 3rd part of the duodenum to the distal 2/3rd of transverse colon
what does the superior mesenteric artery anastomoses with? and where?
anastomoses with the inferior mesenteric artery around the distal 2/3rd of the transverse colon
what are the 5 branches off the superior mesenteric artery
inferior pancreaticoduodenal middle colic jejunal and ileal branches right colic ileocolic
what are the 2 branches off the inferior pancreaticoduodenal artery
anterior inferior pancreaticoduodenal a.
posterior inferior pancreaticoduodenal a
what are the 5 branches off the ileocolic
anterior cecal posterior cecal appendicular ileal ascending colon
what is included in the large marginal artery anastomoses
Anastomosis between ileocolic, right colic, middle colic, left colic, sigmoidal aa
note some people don’t have link between middle and left colic arteries
what is the artery of the hindgut
inferior mesenteric
where does the inferior mesenteric artery run
from distal 1/3rd of transverse colon to anorectal region
what does the inferior mesenteric artery anastomoses with ?
with the middle and inferior rectal arteries at the anorectal junction
what are the three branches off the inferior mesenteric artery
left colic
sigmoidal branches (usually 5)
superior rectal artery
via what does the abdominal viscera drain? and into what vein
for the most part, abdominal viscera drain via comitantes
however, instead of draining to the IVC these veins drain into the hepatic portal vein
what is a portal vein
a vein that begins and ends in a capillary bed
in the case of the hepatic portal vein where is the first capillary bed and where is the second?
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
what does the hepatic portal vein receive
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
what merges to form the portal vein
where and at what vertebral level is this occurring
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
where does the inferior mesenteric vein typically join the splenic vein
posterior to the body of the pancreas
what does the portal vein travel with to get to the liver
travels with portal triad within the hepatoduodenal ligament to the liver
what is the portal caval (portal-systemic) anastomoses
venous anastomoses between tributaries of portal vein and IVC
what is the clinical significance of the portal and IVC containing no valves
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
what region and vessels are involved with esophageal varices (dilated veins)
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
what region and vessels are involved in the formation of Caput Medusa (dilated veins)
paraumbilical region
tributaries of IVC and SVC: superior and inferior epigastric veins
tributaries of portal system: paraumbilical veins
what region and vessels are involved in hemorrhoids
submucosa of anal canal
tributaries of IVC: middle and inferior rectal veins
tributaries of portal system: superior rectal veins
what vessels are involved in the formation of dilated veins in the retroperitoneal region (no specific name)
tributaries of IVC: gonadal and renal veins
tributaries of portal system: ileocolic, right, middle, left colic veins
