Peritoneum and Abdominal Contents Flashcards
Boundaries of the peritoneum.
Superior: Diaphragm
Posterior: Muscles of deep back
Lateral: Abdominal muscles
Inferior: Pelvic floor muscles
Two layers of peritoneum.
Parietal - Highly sensitive peritoneal cavity, serous fluid
Visceral - insensitive to touch, temperature, pressure, pain - lacerations
Three main divisions of the peritoneum.
Greater Omentum - the thicker of the 3, significantly more so than mesenteric
Lesser Omentum
Mesenteric - cover all the blood vessels around the superior and inferior mesenteric
Intraperitoneal organs
stomach, liver, gallbladder, most of the small intestine and a portion of the colon (transverse and sigmoid colon); all inside visceral
Retroperitoneal structures.
aorta, inferior vena cava, duodenum, pancreas, adrenal glands, ascending and descending colon, kidneys, ureters, multiple sensory nerves to the abdominal walls (extending to the groin and upper legs), and nerves that regulate bowel control and sexual function
The greater omentum is primarily composed of _______ tissue.
adipose
Ligaments associated with the greater omentum.
Gastro-phrenic ligament, Gastro-splenic ligament, Gastro-colic ligament
Ligaments associated with the lesser omentum.
Hepato-gastric ligament, Hapato-duodenal ligament
Abdominal Ascites
accumulation of fluid in the peritoneal cavity
Boundaries of the omental foramen.
Anteriorly: Hp Duodenal Lig. with portal triad
Posteriorly: IVC, Rt. Crus
Superiorly: liver
Inferiorly: duodenum
Mesentery
double layer of peritoneum, holds organs in place, sites of fat storage, provides a route for circulatory vessels and nerves
Esophageal Constrictions
Cervical
Thoracic (Broncho-aortic: compound)
Diaphragmatic
Cervical constriction.
(15 cm) cricopharyngeus muscle, oblique arytenoid muscles create the first constriction towards the esophagus
Thoracic constriction.
(22cm; 27.5) aorta is deviated to the left side, with a portion that deviates to the midline, creating an aortic compression of the left side of the esophagus, right side and midline compression is from the carina or bronchi
Diaphragmatic constriction.
(40cm) widest and lowest constriction, created as the esophagus penetrates the hiatus and enters the stomach
Valsalva breathing.
allows the diaphragm to move down/inferiorly
Sthenic
average, stomach is somewhat from the epigastric region, deviated into the periumbilical regions, tends to be somewhat long
Hyperasthenic
“heavy bones,” have the shortest gut organs
Asthenic
very slender, tendency to be tall, stomach tends to be elongated
Hyposthenic
slender but not tall, stomach elongated
Four layers of the stomach.
Serosa (outer layer)
Muscularis externa
Submucosa - contains connective tissue
Rugae (ridges) - gastric secretory glands, epithelial lining
Three layers of muscularis externa.
Longitudinal Muscle Layer, Circular Muscle Layer, Oblique Muscle Layer
Stomach irrigation from the celiac trunk.
left gastric, splenic, common hepatic
Left gastric artery.
esophageal branches, branches to the left part of the lesser curvature of the stomach
Splenic artery.
pancreatic branches, short gastric, left gastroepiploic, splenic branches
Common hepatic artery.
Gastroduodenal (superior pancreatic duodenal, right gastroepiploic) Proper hepatic (right gastric, left hepatic, right hepatic - cystic)
This artery supplies the gallbladder.
cystic artery
This area of the stomach is largely responsible for size changes (larger or smaller).
fundus
Sympathetics to the stomach.
Greater Splanchnic N (T5-9) - supplies the stomach, vasoconstriction of vessels and contraction of the stomach, decreasing motility, closing pylorus
Lesser, Least Splanchnic N
Vagus nerve to the stomach.
highest percentage of sensory information of stomach (80% sensory, 20% motor), anterior (left vagus) and posterior (right vagus), vagoplexus form the net of nerves around the esophagus, motor for increasing motility, opening pylorus, initiating secretions
What type of neurons would you find in the celiac plexus ganglion?
multipolar (receives nerves from both vagus and sympathetic chain)
Venous drainage of the stomach.
splenic vein–>superior mesenteric–>portal vein–>IVC
Primary difference between a paraesophageal and mixed hernia?
paraesophageal is esophagus and part of fundus, but no merging of tissue; mixed hernia is merging of the tissue of the esophagus and part of the fundus (most difficult to treat)
What does the cardiac sphincter lack that makes it particularly susceptible to herniation?
external muscle layer (not a true physiological sphincter)
Relative lengths of the small intestine.
duodenum (25 cm), ileum and jejunum (6-7 m)
Vertebral landmarks of duodenum sections in a sthenic patient.
D1 - L1
D2 - L2, L3
D3 - L3
D4 - in between D2 and D3
Sections of the duodenum.
D1 - superior
D2 - descending
D3 - horizontal
D4 - ascending
Peyer’s patches.
lymphatic nodules in the intestines for secretion of immune functions, throughout but massively increase in the ileum and colon
Which part of the small intestine has more vasa recta?
jejunum (less arcades)
Which part of the small intestine has less vasa recta?
ileum (more arcades)
Inferior mesenteric artery.
The inferior mesenteric artery supplies the large intestine from the left colic (or splenic) flexure to the upper part of the rectum.
Superior mesenteric artery.
Inferior pancreaticoduodenal (not shown on the image)
Middle colic - to the transverse colon
Right colic - to ascending colon
Ileocecal (ileocolic) - to last part of ileum, cecum, and appendix
Above three make up Marginal aa., appendicular artery come from the colic part, which supplies the collec especially
Intestinal branches - to jejunum and ileum
Intestinal Venous Plexus.
- Esophageal plexus - Clinically important, Esophageal varices (Varicose veins), Bleeding=Death
- Rectal plexus, Hemorrhoids - major cause is obstruction (mostly caused by poor diets)
- Paraumbilical plexus, Caput medusae, abdominal obstructions that are large shunting of blood to keep pt. alive and is visible on the skin of the patient
Goblet cells.
lots of phospholipids and secretes the colon to creates less friction to help with the peristalsis in the movement of dehydrated feces, predominate in the mucosa in the colon
Pectinate or dentate line.
anatomical landmark of the transition of simple columnar epithelium (absorptive and secretory) to simple stratified epithelium (minimal absorption and skin like)
Controls motor activity of external sphincter.
Levator ani group: S2-S4, central division of nervous system (through pudendal nerve)
Controls motor activity of internal sphincter and sigmoid colon.
parasympathetic (autonomic)
Ligaments of the liver.
Falciform ligament
Round ligament/ligamentum teres
Coronary ligament
Ligamentum venosum
Falciform ligament.
“divides liver in two” but not really because tissues come together, ends on the coronary ligament, followed caudally it merges with ligamentum teres, embryologically relevant because the umbilical vein ran here in utero
Round ligament/ligamentum teres.
not to be confused with round ligament of the uterus, this is on the liver
Coronary ligament.
closest to the thoracic coronary area
Ligamentum venosum.
associated with caudate lobe of the liver and is small (but visible), named because of the proximity to the IVC
Largest lobe of the liver.
right
Gallbladder rests on this lobe of the liver.
quadrate
This lobe of the liver is anterior to the IVC.
caudate
Bile is secreted into which section of the small intestine?
D2 of the duodenum (descending)
Responsible for the segmentation of the colon.
taenia coli
This organ has both exocrine and endocrine functions.
pancreas (cannot live without_
Explain the position of the pancreas.
Head of pancreas: close to D2
Body of pancreas: crosses the midline (by IVC and Aorta) - positioned in retroperitoneum
Tail of pancreas: touches the spleen (at its hilum) - positioned in peritoneum (canted anteriorly)
This duct of the pancreas is only associated with exocrine cells.
accessory pancreatic duct of Santorini (branches off Wirsung)
Arterial supply to the pancreas.
superior pancreaticoduodenal - from the gastroduodenal
inferior pancreaticoduodenal - from the superior mesenteric
This duct courses the entire pancreas.
major pancreatic duct of Wirsung (drains into D2)
Venous drainage of the pancreas.
splenic vein–>portal vein (main); small part drains into superior mesenteric vein which then becomes the portal vein
Explain the position of the spleen (surface contacts).
Anteriorly - stomach (lateral portion of fundus), left kidney, colon
Diaphragmatic surface - diaphragm separates the spleen from the 9th, 10th and 11th ribs
Visceral surface:
Gastric - greater curvature of stomach
Renal - upper ventral surface of lt. kidney
Colic - left (splenic) flexure
Major 3 veins of the spleen.
portal, splenic, mesenteric
What function will the spleen perform in the event massive bone Fx or hemorrhage?
hemopoiesis
The 3 nerves that emerge from the lateral border of the psoas major muscle are:
iliohypogastric nerve, ilioinguinal nerve and lateral femoral cutaneous nerve
This nerve emerges between the psoas major and the iliacus muscles.
femoral nerve
This nerve emerges anterior to the psoas major muscle (or minor if present).
genitofemoral nerve
The _________ nerve and the lumbosacral trunk emerge medial to the psoas major muscle.
obturator
The posterior division of the lumbosacral trunk.
femoral nerve L2-L4
The anterior division of the lumbosacral trunk.
obturator nerve L2-L4
Celiac trunk (3 main branches)
Common hepatic artery
Splenic artery
Left gastric artery
Past this artery are the testicular or ovarian arteries, coming off a varying locations; supplies the small intestine and half of the large intestine.
superior mesenteric artery
This artery supplies only half the large intestine.
inferior mesenteric artery
How does the gonadal vein differ on each side of the body?
left drains into renal vein, but right drains right into IVC
