Part 9 Flashcards
Celiac trunk artery (derived from, pahtway, empties into)
Derived from: abdominal aorta
Travels anteriorally with 3 branches coming off,
Empties into left gastric artery, common hepatic artery, and splenic artery
Splenic artery (derived from, travels to)
Derived from: celiac trunk artery
Empties into spleen after giving off branches of dorsal and transverse pancreatic arteries
Hepatic artery (derived from, travels to)
Derived from: celiac trunk artery
Empties into liver giving rise to anterior, posteior and superior pancreaticduodenal arteries along the way
Arteries that supply the pancreas (5)
Dorsal pancreatic, transverse pancreatic, anterior postioer and superior pancreaticduodenal arteries
Sphincter of Oddi
Opening of pancreatic duct into duodenum
Pancreatic delta and F cells
Delta - release somatostatin antagonistic to GH and inhibit insulin release
F - Inhibit somatostatin function (indirectly increasing insulin)
FSH and LH function in testes
FSH go to sertoli and promote spermatogenesis
LH go to ledyig cells that synthesize testosterone
FSH and LH function in ovaries
LH goes to theca cells to promote testosterone secretion (to be converted to estrogen by granulosa cells)
FSH stimulates maturation of granulosa cells
Renal artery derived from, course, empties into
Derived from: abdominal aorta
Travel after branching off below superior mesenteric artery
Empties into interlobular arteries
Interlobular arteries, derived from, course, empty into
Derived from: renal artery
Travel to form the filtration system of the kidneys, emptying into arcuate arteries
Arcuate arteries derived from and course
Derived from: interlobular arteries
Travel in arc shape around the adrenal medulla forming the filtration system of the kidneys
Adventitia, muscularis, and mucosa of ureters characteristics
Adventitia - fibrous
Muscularis - peristaltic smooth muscle contraction
Mucosa - transitional epithelium, very susceptible to stretch
ureters, like veins, have….
valves
Trigone definition
Triangle formed between the ureters and urethra in the bladder
Detrusor muscle definition
3 layers of smooth muscle in one of the layers in the urinary bladder
Glomerulus
Small capillary bed from afferent arteriole entering kidney from renal artery surrounded by bowman’s capusle, fenestrated capillaries allow for leaking, thick basement podocyte membrane work to keep certain things in the blood and other smaller ions and glucose get filtered into the proximal convoluted tubule
Proximal convoluted tubule
Region of nephron that receives filtered blood from glomerulus and ACTIVELY reabsorbs 65% of nutrients, ions, amino acids, glucose, and water back out and back into the blood peritubular capillaries
Peritubular capillaries
tiny blood vessels, supplied by the efferent arteriole, that travel alongside nephrons allowing reabsorption and secretion between blood and the inner lumen of the nephron.
SGLT 2 Inhibitor mechanism
Because sodium glucose cotransporters account for 90% of glucose reabsorption in kidney, can increase excretion of gluocse via this system thus decreasing blood glucose for diabetic patients (they pee it all out)
3 imiportant SGLT 2 inhibitors to know
Dapagliflozin farxiga
Canagliflozin Ivokana
Empagliflozin Jardiance
Descending loop of henle definition
Follows proximal convoluted tubule, passively absorbs water due to high osmolarity of medulla (created by ascending limb)
Ascending loop of henle definition
Actively pumps Na+, Cl-and K+ out of the loop and into the medulla to make it very salty, impermeable to water
Distal convoluted tubule definition
Last region of ion absorption before entering the collecting duct
Renin secretion is controlled by what structure of the kidney? Where is this structure located?
Juxtaglomerular apparatus cells in afferent arteriole
Collecting duct
Function to receive fluid from distal convoluted tubule, can reabsorb water, empties into renal calyx
Loop diuretics - lasix mech of action
Decreases active absorption in ascending loop of henle blocking Na+, cl-m ad K+ co transporters resulting in a loss of potassium and water following
Thiazide diuretics - hydrochlorothiazide mech of action
Blocks sodium chloride co transportsers in dital convoluted tubule resulting in increased urination
Aldosterone antagonist - spironolactone mech of action
Inhibits aldosterone’s action on receptors in the collecting duct decreasing sodium reabosrption and potassium secretion (increases K+ levels in blood)
3 categories of acute renal failure
Prerenal - decrease blood supply to kidneys (think cardiac failure, stenosis)
Intrarenal - within kidneys (think glomerular injury, tubular necrosis)
Postrenal - obstruction of urniary collecting system (think stones)
Skene’s glands definition
Paraurethral glands, branched tubular glands adjacent to the distal urethra, homologous to prostate in fluid secretion
Bartholin’s glands definition
Vulvovaginal glands that open into a groove between hymen and labia minora
Levator ani muscle function, insertion, innervation
Function: Composed of 3 smaller muscles to, alongside the coccygeus muscle, form the pelvic floor and support the pelvic viscera
Insertion: inner surface of lesser pelvis to coccyx and opposite levator ani
Innervation: S3 and S4
Rectouterine pouch/cul de sac/pouch of douglas
Piece of deep peritoenum that is bound anteriorally by the fornix of the vagina and posteriorally by the rectum
Transition zone of pap smear
Where cells change from simple sqmaous to simple columnar epithelium, often a site for early detection of cervical cancer
3 parts of fallopian tubes
1) Infundibulum - reception region of ovary with fibriae attached, most distal
2) ampulla - Long, tortuous portion where fertilization occurs and ectopic implantation
3) isthmus - short segment that enters the uterine part
Suspensory ligament of ovary
Attaches tubal end of ovary to lateral wall of pelvis, contains ovarian vessels and nerves
Ligament of the ovary
Connects the inferior end of the ovary to the lateral angle of the uterus
Broad ligament of the uterus
Sheet like fold of peritoneum covering the uterus like a sheet to keep structures in place
Round ligament of the uterus
Travels from uterine horn thru the deep inguinal ring to the labia majora and mons pubis
In cancer of the vulva, lymph drainage may occur to either side of the pelvis. Because of this, what is important?
Bilateral node dissection
Uterine artery derived from, course, empties into
Derived from: internal iliac artery
Travels deep and medial, giving rise to vaginal artery branch before changing names
Empties into spiral arteries
Spiral arteries derived from and course
Derived from: uterine artery
Travels alongside the wall of the uterus, constricting hormonally during menstruation to allow for death of endometrial lining
Ovarian artery derived from and course
Derived from: abdominal aorta
Travels from division just below renal arteries into suspensory ligament to supply the ovary
How does the liver allow for living donor transplants?
Because it is divided into 8 functionally independent segments each with own vascular in and outflow
Falciform ligament definition
Infolding of mesentary that separtes right and left lobes of livers suspending it from the diaphragm and anterior abdominal wall
Round ligament of the liver
Fibrous remains of fetal umbilical vein, travels inferiorally from in between the right and left lobes to the umbilicus
Bare area of the liver
Superior diaphragmatic triangular portion of the liver containing portacaval anastamoses where infection can spread to the thoracic cavity
Hepatic portal vein derived from, course, emptie sinto
Derived from: merging of splenic and superior mesenteric veins
Travels to the liver receiving branches from gastric and cystic veins before bifurcating and entering
Empties into: hepatic veins
Hepatic veins derived from, course, empties into
Derived from: hepatic portal vein
Travels throughout the liver to filter and remove toxins
Empties into the inferior vena cava
Splenic vein derived from, cpurse, drains into
Derived from: the spleen
Travels toward the liver, receiving blood supply from inferior mesenteric vein
Drains into: hepatic portal vein
Gastric vein derived from, course, empties into
Derived from: stomach
Travels toward the liver
Empties into the hepatic portal vein shortly before it bifurcates
Cystic vein deriedfrom, course, empties into
Derived from: the gall bladder
Travels toward the liver
Empties into the heppatic portal vein shortly after it bifurcates
Superior mesenteric vein derived from, course, empties into
Derived from: The small intestine
Travels toward the liver
Empties into the hepatic portal vein after merging with the splenic vein
Inferior mesenteric vein derived from, course, empties into
Derived from: Large intestine
Travels toward the liver
Empties into the splenic vein superiorally
Hepatic portal vein carries ___ of hepatic blood supply, the hepatic artery carries ___
75%, 25%
Hepatic artery derived from, course, empties into
Derived from: celiac trunk artery
Travels giving off the gastroduodenal artery before supplying the liver
Biliary canuliculi definition
Projections off hepatocytes that collect bile excreted by hepatocytes to eventually enter the common hepatic duct
Common hepatic duct
Product of bile canaliculi from hepatocytes within the liver converging, exits the inferior base of the liver before merging with the common cystic duct to form the common bile duct
Common cystic duct
Derived from the gall bladder, connects to the common hepatic duct to form the common bile duct
Gall bladder
Accessory organ used to store and concentrate bile, contracts via smooth muscle layer in response to lipid presence in intestine to promote emulsification, if removed can see difficutly digesting fatty meals
Common bile duct
Formed from the combination of the common cystic duct and common hepatic duct, receives branch from pancreatic duct before exiting at the spincter of Oddi in the duodenum
CCK mechanism of action
- Stimulated for release by chyme entering duodenum
- enters blood stream
- Induces secretion of pancreatic enzymes
- Induces gallbladder contracttion
Central vein
Drainage structure that eventually combines into the vena cava after receiving blood flow from hepatic sinusoids in a lobule as they are modified by hepatocytes
Pathway of blood flow generally to the liver
- hepatic portal vein and hepatic artery
- hepatic sinusoids
- central veins
- hepatic veins
- inferior vena cava
Kupffer cells and their 4 key functions
Liver macrophages
1) RBC destruction
2) Antibody production aid
3) phagocytosis
4) cause early ETOH induced liver injury
Excess not reasorbed conjugated bilirubin is converted by bacteria into…
…urobilinogen (if reabsorbed gives urine yellow color, most exits into colon giving feces brown color)
3 types of jaundice
Prehepatic - excessive hemolysis of RBC
Intrahepatic - affect ability of liver to remove or conjugate bilirubin
Posthepatic - obstruction between liver and intestine
Portal hypertension definition
Occurs when portal blood cannot flow thru liver increasing pressure in portal vasculature
Hepatorenal syndrome definition
Tendency for cirrhosis of the liver to cause compromising of circulation to abdominal vessels, sometimes disrupting renal blood supply leading to renal failure
4 general layers of all the GI tract and characteristics of them
1) Mucosa (innermost layer stratified squamous epithelium containing mucosal glands, lamina propria, muscularis mucosae)
2) submucosa (connective tissue housing vascular, lymphatic, and nerve supply)
3) Muscularis externa (inner circular and outer longitudinal layer of smooth muscle with peristaltic like activity)
4) serosa/adventitia (connective tissue, serosa reduces friction as a viceral peritoneum, adventitia anchors organ
Myenteric plexus
Nervous system located in the muscularis externa between layers that receives innervation from autonomic nerve fibers (such as vagus?) to activate contractile/peristaltic activity
Mesentary definition
Double layered peritoneum that attaches the intestine to the posterior abdominal wall and hold them in place like an apron, as well as provides a path for blood vessels and lymphatics and nerves
Retroperitoneal organs and what they have around them
Pancreas, portions of large itnestine, kidneys, do not have mesentary and contain peritoneum on anterior side only (high risk of trauma)
Histology of esophagus
Nonkeratnizied stratified squamous epi
Pyloric sphincter definition
A physiological sphincter between the exit of the stomach and the entrance into the duodenum
Parietal cells of stomach function
Secrete HCl and intrinsic factor into stomach, intrinsic factor rleaes not impacted by PPI’s
Chief cells of stomach function
Secrete pepsinogen into stomach
Intrinsic factor
Required for B12 absorption in small intestine, secreted by parietal cells into stomach, without it results in macrocytic anemia
Histamine function in stomach
Facilitate acid production by parietal cells