Peritoneum, Omentum, Esophagus and Stomach Flashcards
What supplies the abdominal wall of the hypochondriac region, anterolateral, and diaphragm?
- superior epigastric a
- musculophrenic a off internal thoracic
What supplies the lateral abdominal wall?
10th and 11th posterior intercostal and subcostal off the abdominal aorta
What supplies the inferior rectus abdominis and medial part of the anterolateral abdominal wall and iliacus muscle and inferior part of the anterolateral part of the abdominal wall?
- inferior epigastric a
- deep circumflex iliac a off of external iliac artery
What supplies the superficial abdominal wall of inguinal region and adjacent anterior thigh and subcutaneous tissue and skin over pubic and inferior umbilical region?
- superficial circumflex iliac a.
- superficial epigastric a. off femoral a.
How many sources of blood are their to the abdominal wall?
4
What is the venous drainage of the abdominal wall superior to the umbilicus?
internal mammary, intercostal, and lateral thoracic veins
What do the veins of the abdominal wall superior to the umbilicus drain into?
SVC
What is the venous drainage of the abdominal wall inferior to the umbilicus?
superficial epigastric and circumflex iliac veins
What forms the thoraco-epigastric vein?
venous anastomosis between the superficial epigastric vein and lateral thoracic veins
What provides a potential collateral pathway for blood normally draining via the IVC to return to the heart via the SVC when the IVC is blocked?
thoraco-epigastric vein
Anything above T10 is going to drain into what?
the axillary region
What do the superficial vessels of the abdominal wall accompany?
the subcutaneous veins
Superficial lymphatic vessels superior to the umbilicus drain mainly to what?
axillary lymph nodes
Superficial lymphatic vessels inferior to the umbilicus drain into what?
superficial inguinal lymph nodes
The deep lymphatic vessels of the abdominal wall accompany the deep veins and drain into what?
external iliac, common iliac, and lumbar lymph nodes
What does the first lumbar nerve bifurcate into?
- iliohypogastric nerves
- ilioinguinal nerves
Which nerves do not enter the rectus sheath?
- iliohypogastric nerve
- ilioinguinal nerve
What nerve pierces the external oblique aponeurosis superior to the superficial inguinal ring?
iliohypogastric nerve
What nerve passes through the inguinal canal to emerge through the superficial inguinal ring?
ilioinguinal nerve
The iliohypogastric and ilioinguinal nerves supply branches to what muscles?
internal oblique and transversus abdominis muscles
What does the foregut span from?
pharynx to hepatopancreatic ampulla (sphincter)
What artery supplies the foregut?
celiac artery
What region is epigastric pain associated with?
foregut
What does the midgut span from?
hepatopancreatic ampulla (sphincter) to 2/3 transverse colon
What is the blood supply to the midgut?
SMA
What region is associated with periumbilical pain
midgut
What does the hindgut span from?
1/3 transverse colon to the anal canal
What is the blood supply to the hindgut?
IMA
What region is hypogastric pain associated with?
hindgut
What develops independently to the GIT?
the spleen
What vertebral level spinal nerve supplies the celiac trunk?
T12
What vertebral level spinal nerve supplies the superior mesentaric artery?
L1
What vertebral level spinal nerve supplies the inferior mesenteric artery?
L3
What is a transparent serous membrane that consists of two continuous layers?
the peritoneum
What are the two layers of the peritoneum?
- parietal peritoneum
- visceral peritoneum
What is a double layer of parietal peritoneum that secretes serous fluid, providing lubrication and decreasing the friction between abdominal organs?
mesentery
What does the connective tissue of the mesentery contain?
- lymph vessels
- nerves
- arteries
- veins
What do the vessels in the mesentery create?
a pathway between the abdominal wall and internal organs
What is responsible for holding the abdominal organs in place?
mesentery
What is the double layer of parietal peritoneum between organs?
omentum
What connects the stomach to the colon and hangs from the stomach to keep the intestines warm?
greater omentum
What is composed of mostly fatty tissues and contains macrophages which help fight infections?
greater omentum
What connects the stomach and liver?
lesser omentum
What invests viscera organs such as the spleen and stomach?
visceral peritoneum
What is the anatomical space located behind the abdominal or peritoneal cavity?
retroperitoneum
What type of organs are not in direct continuation with the food pathway?
accessory digestive organs
What is a potential space of capillary thinness between the parietal and visceral layers of peritoneum?
peritoneal cavity
What contains a thin film of peritoneal fluid that keeps the peritoneal surfaces moist?
peritoneal cavity
What enables the viscera to move over each other without friction and allowing the movements of digestion?
peritoneal fluid
What does the peritoneal fluid contain?
leukocytes and antibodies that resist infection
What organs are considered intraperitoneal organs?
- stomach
- first part of duodenum
- jejunum
- ileum
- cecum and appendix
- transverse colon
- sigmoid colon
- upper third of rectum
- liver
- tail of pancreas
- spleen
What are other abdominal organs that develop behind the peritoneum and are not suspended in the peritoneal cavity?
retroperitoneal organs
What organs are considered retroperitoneal organs?
- kidneys
- ureters
- suprarenal glands
- inferior 2/3rds of the rectum
What is completely closed in males?
the peritoneal cavity
What has a communication pathway in females to the exterior of the body through the uterine tubes, uterine cavity, and vagina?
the peritoneal cavity
Because there is communication to the exterior of the female body in the peritoneal cavity, this creates a potential pathway of what?
infection from the exterior
In women, the uterus, fallopian tubes, ovaries, and gonadal blood vessels are located where?
in the intraperitoneum
What is the mnemonic for retroperitoneal organs?
SAD PUCKER (suprarenal glands, aorta and IVC, duodenum, pancreas, ureters, ascending/descending colon, kidneys, esophagus, rectum)
What suspends much of the small intestines from the posterior abdominal wall?
mesentery
What consists of a double layer of peritoneum that connects an organ with another organ or the abdominal wall?
peritoneal ligament
What connects the liver to the anterior abdominal wall?
falciform ligament
What is the double layered extension of peritoneum passing from the stomach and proximal part of the duodenum to the adjacent organs?
omentum
What extends superiorly, laterally to the left, and inferiorly from the greater curvature of the stomach and the proximal part of the duodenum?
greater omentum
What are the 3 parts of the greater omentum?
- gastrophrenic ligament
- gastrosplenic ligament
- gastrocolic ligament
What is found between the greater curvature of the stomach and the diaphragm?
gastrophrenic ligament
What is found between the greater curvature of the stomach and the spleen?
gastrosplenic ligament
What is the largest part of the greater omentum, descending anteriorly and inferiorly beyond the transverse colon and the superior layer of its mesentery?
gastrocolic ligament
What attaches at the inferior portion of the greater curvature of the stomach?
gastrocolic ligament
The descending and ascending portions of the gastrocolic part of the greater omentum usually fuse together, forming a four-layered fatty what?
“omental apron”
Where can you find the hepatobiliary area?
lesser omentum
What connects the lesser curvature of the stomach and the proximal part of the duodenum to the liver?
lesser omentum
What ligament connects the stomach to the liver and is the membranous portion of the lesser omentum?
hepatogastric ligament
What is the thickest free edge of the lesser omentum and conducts the portal triad?
hepatoduodenal ligament
What structures are included in the portal triad?
- hepatic portal vein
- proper hepatic artery
- bile duct
What runs from the ligamentum venosum to the lesser curvature of the stomach?
hepatogastric ligament
What runs from the liver to the first part of the duodenum?
hepatoduodenal ligament
What is the passage of communication between the general cavity and the omental bursa?
omental foramen
Pain from the esophagus, stomach, pancreas, duodenum, liver, and biliary ducts cause pain in what region?
epigastric region
Pain from the small intestine distal to the bile duct, cecum, appendix, ascending colon, and most of the transverse colon cause pain in what region?
periumbilical region
Pain from the distal part of the transverse colon, descending colon, sigmoid colon and rectum cause pain in what region?
hypogastric region
What supplies blood to the GI tract, spleen, pancreas, gallbladder, and liver?
abdominal aorta
What are the 3 major branches of the abdominal aorta?
- celiac trunk
- superior mesenteric arteries
- inferior mesenteric arteries
What is formed by the union of the superior mesenteric and splenic veins?
hepatic portal vein
What is the main channel of the portal venous system?
hepatic portal vein
What does the portal venous system collect blood from?
- abdominal part of the GI tract
- pancreas
- spleen
- most of the gallbladder and carries it to the liver
What allows nutrients to get into the liver?
hepatic portal vein
What runs slightly to the left of the vertebral bodies and posterior to the trachea?
esophagus
What level does the esophagus enter into the abdomen by way of the diaphragm?
T10
The abdominal esophagus joins the stomach at what sphincter?
esophagogastric sphincter
At what level does the esophagus start and end?
C6 (cricoid cartilage)
T11 (cardial orifice)
What are the two muscle layers of the esophagus?
longitudinal and circular
The superior third of the esophagus is made up of what type of muscle?
skeletal
The middle third of the esophagus is made up of what type of muscle?
skeletal and smooth
The inferior third of the esophagus is made up of what type of muscle?
smooth muscle
What marks the transition of the columnar gastric epithelium to the squamous esophageal epithelium?
Z-line
What is a common spot of esophageal cancer due to prolonged GERD symptoms creating ulcers and metaplasia?
lower esophageal sphincter
What level is the squamous columnar junction (Z-line) found?
T10
Areas of constriction of the esophagus where swallowed foreign objects are most likely to lodge and where stricture may develop occur at levels of which structures?
- arch of aorta
- left main bronchus
In the superior third of the esophagus, the external layers of the muscle consists of what?
voluntary striated muscle
The inferior third of the esophagus of the external longitudinal muscle is composed of what?
smooth muscle
The middle third of the esophagus of the external longitudinal muscle is composed of what?
both voluntary striated and smooth muscle
Voluntary control of the esophagus are what type of fibers?
GVE fibers
Cervical esophageal constrictions (junction of pharynx and esophagus) occur at what vertebral level?
C6
What are the associated structures with an esophageal constriction?
- cricopharyngeus m
- upper esophageal sphincter
Aortic arch esophageal constrictions occur at what level?
T4/T5
What are the associated structures with an aortic arch esophageal constriction?
sternal angle
Left main bronchus esophageal constrictions occur at what level?
T5-T6
What are the associated structures with a left main bronchus esophageal constriction?
tracheal bifurcation
Left atrium esophageal constrictions occur at what levels?
T6-T7
What are the associated structures with a left atrium esophageal constrinction?
heart
Diaphragmatic (esophageal hiatus) constrictions occur at what level?
T10
What are the associated structures with diaphragmatic constrictions?
- diaphragm
- lower esophageal sphincter (esophagus to esophageal hiatus)
- z-line
What allows gastric contents to enter the lower esophagus resulting resulting in GERD?
an ineffective lower esophageal sphincter
What can cause deleterious changes to the epithelium of the esophagus?
GERD
What is dysphasia?
difficulty swallowing
What is odynophagia?
painful swallowing
What artery supplies the upper esophagus?
inferior thyroid a
What artery supplies the middle esophagus?
descending aorta
What artery supplies the lower esophagus?
left gastric and left inferior phrenic aa
What vein drains the upper esophagus?
inferior thyroid v
What vein drains the middle esophagus?
azygos system (systemic system)
What vein drains the lower esophagus?
left gastric v (portal system)
Where does esophageal lymphatics and lymph drain into?
subclavian at the junction with jugular veins
What lymph nodes drain the foregut?
celiac nodes
Most of the esophagus (except for the proximal part) is under autonomic control mediated by what?
esophageal plecxus
Innervation of the esophagus includes what nerves?
- vagal trunks (becoming anterior and posterior gastric nerves)
- thoracic sympathetic trunks via the greater splanchnic nerves
- peri-arterial plexus around the left gastric a and left inferior phrenic a
What is the sympathetic nerve supply of the esophagus?
IML T1-T10 -> sympathetic trunk
What is the parasympathetic nerve supply of the esophagus?
- left vagus nerve to esophageal plexus to anterior vagal trunk
- right vagus nerve to esophageal plexus to posterior vagus trunk
Parasympathetic innervation of the esophagus allows for what?
- peristalsis
- arterial vasoconstriction
- glandular secretion
What are the 4 parts of the stomach?
- cardia
- fundus
- body
- pylorus
What are the 2 curvatures of the stomach?
- lesser curvature
- greater curvature
What part of the stomach surrounds the cardial orifice?
cardia
What is the dilated superior part of the stomach that is related to the left dome of the diaphragm and is limited inferiorly by the horizontal plane of the cardial orifice and may be dilated by gas, fluid, or food?
fundus
What is the major part of the stomach?
body
What is the distal funnel-shaped region of the stomach?
pylorus
What forms the shorter concave border of the stomach?
lesser curvature
What forms the longer convex border of the stomach?
greater curvature
What levels can you find the esophagogastric junction/Z-line?
T10-T11
What allows for expansion of the stomach?
rugae
Acid damage can be found where?
esophagus and duodenum (duodenum ulcers are very common)
What arteries can be found in the greater omentum?
- gastro-omental a (left and right)
- short gastric aa
What forms the cardial notch?
esophagus and fundus
Most of the blood of the stomach is supplied by the anastomoses along the lesser curvature by which two arteries and along the greater curvature by which two arteries?
- lesser curvature:
** left and right gastric aa - greater curvature:
** right and left gastro-omental aa
The fundus and upper body of the stomach receive blood supply from what?
short and posterior gastric aa (branches of the splenic artery)
What are the levels of the celiac trunk, SMA, and IMA, respectively?
- T12
- L1
- L3
What is the blood supply to the liver to help it survive?
hepatic artery proper
What lies behind the stomach, runs on the top of the pancreas, and supplies blood to the spleen?
splenic artery
What supplies the lesser curvature of the stomach?
- left and right gastric aa
What are the three branches of the celiac trunk?
- common hepatic a
- left gastric a
- splenic a
What does the common hepatic a give off?
- gastroduodenal a
- proper hepatic a
What does the gastroduodenal a give off?
right gastro-omental a
What does the proper hepatic a give off?
- right gastric a
- right and left hepatic a
What does the left gastric a give off?
esophageal a
What does the splenic a give off?
- short gastric a
- left gastro-omental a
What supplies the greater curvature of the stomach?
left and right gastro-omental aa
What forms the portal vein?
union of the splenic vein and superior mesenteric vein
Venous drainage primarily to the portal venous system is through what?
left gastric vein
The proximal thoracic part of the esophagus drains primarily into the systemic venous system through what veins?
esophageal veins entering the azygos vein
What drains into the hepatic portal vein?
- right and left gastric veins
- splenic v
- superior mesenteric v
What do the short gastric v and left gastro-omental v drain into?
splenic v
What does the right gastro-omental v drain into?
superior mesenteric v
What is the autonomic innervation of the stomach?
- parasympathetic nerve supply from:
**anterior vagal trunk (L. vagus n)
**posterior vagal trunk (R. vagus n) - sympathetic nerve supply:
**T6-T9 segments of spinal cord that pass to celiac plexus via greater splanchnic nerves
The anterior and posterior vagal trunk enter the abdomen through what?
esophageal hiatus
The thoracolumbar region has what type of inputs?
sympathetic
The craniosacral region has what type of inputs?
parasympathetic
Abdominal viscera are supplied by what?
a large prevertebral plexus
The prevertebral plexus contains what?
sympathetic, parasympathetic, and visceral sensory components
The sympathetic components of the prevertebral plexus originate from what spinal cord levels?
T5 to L2
The parasympathetic components of the prevertebral plexus are from what?
the vagus nerve (X) and spinal cord levels S2-S4