Overview/Review of Abdominal Wall, GI Tract, and Peritoneum Flashcards
Abdominal aorta
Celiac plexus neurolysis
Nerves on the celiac trunk that form a plexus; goes to all the thigns the celiac artery supplies.
Visceral afferents travel with them and can be teh source of a lot of pain (e.g. pancreatic cancer.)
Thus, neurolysis ( high conc alcohol) is used as an anesthetic to offer pain relief.
Superior mesenteric artery
Inferior mesenteric artery
If a perforated ulcer reaches the posterior wall fo the duodenal bulb (1st part of duodenum), what large artery is at risk of injury/hemorrhage
Gastroduodenal
If you lose the inferior mesenteri cartery in a repair of an abdominal aneurysym, what will supply the hindgut?
Portal venous system- what veins are involved?
Venous blood from the gut goes to the liver for detoxification.
- Inferior mesenteric vein drains into splenic vein
- Splenic vein and superior mesenteric vein join to make the portal vein.
- Contributions from gastric veins and esophageal veins.
Porto-systemic anastomoses & their significance in portal hypertension
Portal hypertension from cirrhosis –> high pressure in the liver sends blood from the portal system (which is valveless) to the systemic system (going backwards).
(1) GE junction: left gastric vein (p)+ esophageal vein of azygos system (s) -> esophageal varices
(2) Anorectal junction: superior rectal vein (p) + middle&inferior rectal vein (s) ->anorectval varices
(3) Ant abd wall around umbilicus: paraumbilical veins (p) + ant abd wall veins ->caput medusae
Autonomic innervation of organs in the upper abdomen associated with the foregut - referred pain, administration of anesthesia, surgical procedures, cancer pain mgmt
Spleen position, blood supply, surface markings, relations, and peritoneal attachments.
- Position: In development, it turns to the left upper quadrant
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Blood supply: splenic artery from celiac trunk
- A CT scan will only see little pieces of it at a time because it’s torturous (distinguishes it form a splenic vein).
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Function: Spleen makes blood cells; filters blood
- Can be enlarged in blood diseases
- Protects against pneumococcus
- Embryo: Develops in teh dorsal mesoderm and dorsal mesogastrum, which evelops posteriorly and rotates to teh left and sits int eh left upper quadrant above the splenic flexure.
- Collateral blood supply: short gastric vessel from splenic artery
Collateral blood flow to the spleen
Spleen in trauma and hematopoietic disorders
What part of the pancreas is NOT retroperitoneal?
Just the tail - attached to spleen.
A patient has fever, chills, and severe abdominal pain. He has a posterior perforation of his stomach due to ulcerations. What structure is responsible for the movement of infected fluid from the perforation to the peritoneal cavity?
Omental foramen of Winslow
A surgeon opens the lesser sac of the peritoneum to access the oragn located in the posterior aspect of the lesser sac. Which of the following structures is she most likely to locate?
She’s trying to get to the pancreas. The splenic artery and splenic vein go to the pancreas.
What organ is on the anterior of the lesser sac? What organ is on the posterior?
Anterior- stomach
Posterior - Pancreas
Where is the ligament of treitz?
A peritoneal attachment where the beginning of the jejunum and the end of the duodenum is fixed to the posterior abdominal wall. So if you looked under the transverse colon, you’d see it at the beginning of the jejunum.
A surgeon had to ligate the gastroduodenal artery. How will the head of pancreas continue to receive blood?
Inferior pancreaticoduodenal artery.
The head of the pancreas has dual blood supply:
From the celiac trunk - gastrodudenal artery.
From the superior mesentery - inferior pancreaticoduodenal artery.
A surgeon uses a transverse incision just inferior to the arcuate line to acccess organs in the pelvis. All of these abdominal wall layers will be encountered during the incision except the:
- Anterior rectus sheath
- Posterior rectus sheath
- Rectus abdominis muscle
- Skin and subcutaneous tissue
- Transversalis fascia, extraperitoneal fat, and peritoneum
Posterior rectus sheath, because there is no posterior rectus sheath below the arcuate line.
What is the name of the region between the two rectus sheaths?
The linea alba.
A hernia is located with a small knuckle of intestine projected through the abdominal wall just above the inguinal ligament and lateral to the epigastric vessels. What kind of hernia is this?
Indirect inguinal hernia because lateral to the epigastric vessels.
Which of the following structures passes through the deep inguinal ring?
- Iliohypogastric nerve
- Ilioinguinal nerve
- Inferior epigastric artery
- Medial umbilical ligament
- Round ligament of the tuerus
Round ligament of the uterus is in the canal- remember that the gonads in the posterior wall get pulled down through the canal by the gubernaculum.
The ilioinguinal nerve does go to the inguinal canal and leaves through the superficial ring, but it enters through the side- not the deep ring.
The hypogastric nerve runs between the int oblique & transversus abdominus, piercing the int oblique at the anterior superior iliac spine and travelign deep to just the external oblique.
Inferior epigastric is in the lateral fold
The deep inguinal ring is an opening in which of the following structures?
- Ext abdominal oblique
- Falx inguinalis
- Internal abdominal oblique
- Scarpa’s fascia
- Transversalis fascia
Transversalis fascia.
The external abdominal oblique is responsible for the superificial ring!
Occlusion of the inferior mesenteric artery is seldom symptomatic because its territory may be supplied by the branches of the
Middle colic.
SMA > middle >marginal > left side of the colon.
The inferior mesenteric artery is often occluded without symptoms; its nromal area of distribution therefore must be mainly supplied by collateral blood flow between which arteries?
- Ileocolic & right colic
- Left & middle colic
- Left colic & sigmoidal
- Right & middle colic
- Sigmoidal & superior rectal
Left and middle colic arteries shunt blood are collaterals for the IMA.
Visceral pain is often referred to a site on the body wall that is innervated by the same spinal cord segment that innervates the visceral organ involved.
Pain of appendicitis is often first felt around the umbilicus, indicating that the appendix gets its visceral afferents from which spinal cord segment?
T10
The spleen usually doesn’t descend below the costal margin, but it will push downward and medially when pathologically enlarged. What structure limits the straight vertical downward movement of the spleen?
- Left colic flexure
- Left suprarenal gland
- Ligament of Treitz
- Pancreas
- Stomach
Left colic flexure/splenic flexure is right below the spleen; it is a continuation of the transverse and descending colon.
What keeps the splenic flexure from moving?
The colicophrenic ligament attaches the splenic flexure up to the diaphragm and to the back wall; it also prevents infection from moving up past the pelvis. The right side doesn’t have it.
The artery of the midgut
SMA
A patient is diagnosed with a bleeding ulcer of the lesser curvature of the stomach. Which artery is most likely involved?
Left gastric
Which of the following structures does not lie at least partially in the retroperitoneum?
- Adrenal gland
- Duodenum
- Kidney
- Pancreas
- Spleen
Spleen
SADPUCKER: Suprarenal(adrenal glands); Aorta; Duodenum(2-4); Pancreas; Ureters; Colon (descending and ascending); Kidney; Esophagus; Rectum
Why are varices from portal hypertension dangerous?
They are prone to bleeding -> vomiting or pooping blood
