Peritoneum, Omentum, Esophagus and Stomach Flashcards
1
Q
What supplies the abdominal wall of the hypochondriac region, anterolateral, and diaphragm?
A
- superior epigastric a
- musculophrenic a off internal thoracic
2
Q
What supplies the lateral abdominal wall?
A
10th and 11th posterior intercostal and subcostal off the abdominal aorta
3
Q
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?
A
- inferior epigastric a
- deep circumflex iliac a off of external iliac artery
4
Q
What supplies the superficial abdominal wall of inguinal region and adjacent anterior thigh and subcutaneous tissue and skin over pubic and inferior umbilical region?
A
- superficial circumflex iliac a.
- superficial epigastric a. off femoral a.
5
Q
How many sources of blood are their to the abdominal wall?
A
4
6
Q
What is the venous drainage of the abdominal wall superior to the umbilicus?
A
internal mammary, intercostal, and lateral thoracic veins
7
Q
What do the veins of the abdominal wall superior to the umbilicus drain into?
A
SVC
8
Q
What is the venous drainage of the abdominal wall inferior to the umbilicus?
A
superficial epigastric and circumflex iliac veins
9
Q
What forms the thoraco-epigastric vein?
A
venous anastomosis between the superficial epigastric vein and lateral thoracic veins
10
Q
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?
A
thoraco-epigastric vein
11
Q
Anything above T10 is going to drain into what?
A
the axillary region
12
Q
What do the superficial vessels of the abdominal wall accompany?
A
the subcutaneous veins
13
Q
Superficial lymphatic vessels superior to the umbilicus drain mainly to what?
A
axillary lymph nodes
14
Q
Superficial lymphatic vessels inferior to the umbilicus drain into what?
A
superficial inguinal lymph nodes
15
Q
The deep lymphatic vessels of the abdominal wall accompany the deep veins and drain into what?
A
external iliac, common iliac, and lumbar lymph nodes
16
Q
What does the first lumbar nerve bifurcate into?
A
- iliohypogastric nerves
- ilioinguinal nerves
17
Q
Which nerves do not enter the rectus sheath?
A
- iliohypogastric nerve
- ilioinguinal nerve
18
Q
What nerve pierces the external oblique aponeurosis superior to the superficial inguinal ring?
A
iliohypogastric nerve
19
Q
What nerve passes through the inguinal canal to emerge through the superficial inguinal ring?
A
ilioinguinal nerve
20
Q
The iliohypogastric and ilioinguinal nerves supply branches to what muscles?
A
internal oblique and transversus abdominis muscles
21
Q
What does the foregut span from?
A
pharynx to hepatopancreatic ampulla (sphincter)
22
Q
What artery supplies the foregut?
A
celiac artery
23
Q
What region is epigastric pain associated with?
A
foregut
24
Q
What does the midgut span from?
A
hepatopancreatic ampulla (sphincter) to 2/3 transverse colon
25
What is the blood supply to the midgut?
SMA
26
What region is associated with periumbilical pain
midgut
27
What does the hindgut span from?
1/3 transverse colon to the anal canal
28
What is the blood supply to the hindgut?
IMA
29
What region is hypogastric pain associated with?
hindgut
30
What develops independently to the GIT?
the spleen
31
What vertebral level spinal nerve supplies the celiac trunk?
T12
32
What vertebral level spinal nerve supplies the superior mesentaric artery?
L1
33
What vertebral level spinal nerve supplies the inferior mesenteric artery?
L3
34
What is a transparent serous membrane that consists of two continuous layers?
the peritoneum
35
What are the two layers of the peritoneum?
- parietal peritoneum
- visceral peritoneum
36
What is a double layer of parietal peritoneum that secretes serous fluid, providing lubrication and decreasing the friction between abdominal organs?
mesentery
37
What does the connective tissue of the mesentery contain?
- lymph vessels
- nerves
- arteries
- veins
38
What do the vessels in the mesentery create?
a pathway between the abdominal wall and internal organs
39
What is responsible for holding the abdominal organs in place?
mesentery
40
What is the double layer of parietal peritoneum between organs?
omentum
41
What connects the stomach to the colon and hangs from the stomach to keep the intestines warm?
greater omentum
42
What is composed of mostly fatty tissues and contains macrophages which help fight infections?
greater omentum
43
What connects the stomach and liver?
lesser omentum
44
What invests viscera organs such as the spleen and stomach?
visceral peritoneum
45
What is the anatomical space located behind the abdominal or peritoneal cavity?
retroperitoneum
46
What type of organs are not in direct continuation with the food pathway?
accessory digestive organs
47
What is a potential space of capillary thinness between the parietal and visceral layers of peritoneum?
peritoneal cavity
48
What contains a thin film of peritoneal fluid that keeps the peritoneal surfaces moist?
peritoneal cavity
49
What enables the viscera to move over each other without friction and allowing the movements of digestion?
peritoneal fluid
50
What does the peritoneal fluid contain?
leukocytes and antibodies that resist infection
51
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
52
What are other abdominal organs that develop behind the peritoneum and are not suspended in the peritoneal cavity?
retroperitoneal organs
53
What organs are considered retroperitoneal organs?
- kidneys
- ureters
- suprarenal glands
- inferior 2/3rds of the rectum
54
What is completely closed in males?
the peritoneal cavity
55
What has a communication pathway in females to the exterior of the body through the uterine tubes, uterine cavity, and vagina?
the peritoneal cavity
56
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
57
In women, the uterus, fallopian tubes, ovaries, and gonadal blood vessels are located where?
in the intraperitoneum
58
What is the mnemonic for retroperitoneal organs?
SAD PUCKER (suprarenal glands, aorta and IVC, duodenum, pancreas, ureters, ascending/descending colon, kidneys, esophagus, rectum)
59
What suspends much of the small intestines from the posterior abdominal wall?
mesentery
60
What consists of a double layer of peritoneum that connects an organ with another organ or the abdominal wall?
peritoneal ligament
61
What connects the liver to the anterior abdominal wall?
falciform ligament
62
What is the double layered extension of peritoneum passing from the stomach and proximal part of the duodenum to the adjacent organs?
omentum
63
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
64
What are the 3 parts of the greater omentum?
1. gastrophrenic ligament
2. gastrosplenic ligament
3. gastrocolic ligament
65
What is found between the greater curvature of the stomach and the diaphragm?
gastrophrenic ligament
66
What is found between the greater curvature of the stomach and the spleen?
gastrosplenic ligament
67
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
68
What attaches at the inferior portion of the greater curvature of the stomach?
gastrocolic ligament
69
The descending and ascending portions of the gastrocolic part of the greater omentum usually fuse together, forming a four-layered fatty what?
"omental apron"
70
Where can you find the hepatobiliary area?
lesser omentum
71
What connects the lesser curvature of the stomach and the proximal part of the duodenum to the liver?
lesser omentum
72
What ligament connects the stomach to the liver and is the membranous portion of the lesser omentum?
hepatogastric ligament
73
What is the thickest free edge of the lesser omentum and conducts the portal triad?
hepatoduodenal ligament
74
What structures are included in the portal triad?
- hepatic portal vein
- proper hepatic artery
- bile duct
75
What runs from the ligamentum venosum to the lesser curvature of the stomach?
hepatogastric ligament
76
What runs from the liver to the first part of the duodenum?
hepatoduodenal ligament
77
What is the passage of communication between the general cavity and the omental bursa?
omental foramen
78
Pain from the esophagus, stomach, pancreas, duodenum, liver, and biliary ducts cause pain in what region?
epigastric region
79
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
80
Pain from the distal part of the transverse colon, descending colon, sigmoid colon and rectum cause pain in what region?
hypogastric region
81
What supplies blood to the GI tract, spleen, pancreas, gallbladder, and liver?
abdominal aorta
82
What are the 3 major branches of the abdominal aorta?
- celiac trunk
- superior mesenteric arteries
- inferior mesenteric arteries
83
What is formed by the union of the superior mesenteric and splenic veins?
hepatic portal vein
84
What is the main channel of the portal venous system?
hepatic portal vein
85
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
86
What allows nutrients to get into the liver?
hepatic portal vein
87
What runs slightly to the left of the vertebral bodies and posterior to the trachea?
esophagus
88
What level does the esophagus enter into the abdomen by way of the diaphragm?
T10
89
The abdominal esophagus joins the stomach at what sphincter?
esophagogastric sphincter
90
At what level does the esophagus start and end?
C6 (cricoid cartilage)
T11 (cardial orifice)
91
What are the two muscle layers of the esophagus?
longitudinal and circular
92
The superior third of the esophagus is made up of what type of muscle?
skeletal
93
The middle third of the esophagus is made up of what type of muscle?
skeletal and smooth
94
The inferior third of the esophagus is made up of what type of muscle?
smooth muscle
95
What marks the transition of the columnar gastric epithelium to the squamous esophageal epithelium?
Z-line
96
What is a common spot of esophageal cancer due to prolonged GERD symptoms creating ulcers and metaplasia?
lower esophageal sphincter
97
What level is the squamous columnar junction (Z-line) found?
T10
98
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
99
In the superior third of the esophagus, the external layers of the muscle consists of what?
voluntary striated muscle
100
The inferior third of the esophagus of the external longitudinal muscle is composed of what?
smooth muscle
101
The middle third of the esophagus of the external longitudinal muscle is composed of what?
both voluntary striated and smooth muscle
102
Voluntary control of the esophagus are what type of fibers?
GVE fibers
103
Cervical esophageal constrictions (junction of pharynx and esophagus) occur at what vertebral level?
C6
104
What are the associated structures with an esophageal constriction?
- cricopharyngeus m
- upper esophageal sphincter
105
Aortic arch esophageal constrictions occur at what level?
T4/T5
106
What are the associated structures with an aortic arch esophageal constriction?
sternal angle
107
Left main bronchus esophageal constrictions occur at what level?
T5-T6
108
What are the associated structures with a left main bronchus esophageal constriction?
tracheal bifurcation
109
Left atrium esophageal constrictions occur at what levels?
T6-T7
110
What are the associated structures with a left atrium esophageal constrinction?
heart
111
Diaphragmatic (esophageal hiatus) constrictions occur at what level?
T10
112
What are the associated structures with diaphragmatic constrictions?
- diaphragm
- lower esophageal sphincter (esophagus to esophageal hiatus)
- z-line
113
What allows gastric contents to enter the lower esophagus resulting resulting in GERD?
an ineffective lower esophageal sphincter
114
What can cause deleterious changes to the epithelium of the esophagus?
GERD
115
What is dysphasia?
difficulty swallowing
116
What is odynophagia?
painful swallowing
117
What artery supplies the upper esophagus?
inferior thyroid a
118
What artery supplies the middle esophagus?
descending aorta
119
What artery supplies the lower esophagus?
left gastric and left inferior phrenic aa
120
What vein drains the upper esophagus?
inferior thyroid v
121
What vein drains the middle esophagus?
azygos system (systemic system)
122
What vein drains the lower esophagus?
left gastric v (portal system)
123
Where does esophageal lymphatics and lymph drain into?
subclavian at the junction with jugular veins
124
What lymph nodes drain the foregut?
celiac nodes
125
Most of the esophagus (except for the proximal part) is under autonomic control mediated by what?
esophageal plecxus
126
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
127
What is the sympathetic nerve supply of the esophagus?
IML T1-T10 -> sympathetic trunk
128
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
129
Parasympathetic innervation of the esophagus allows for what?
- peristalsis
- arterial vasoconstriction
- glandular secretion
130
What are the 4 parts of the stomach?
1. cardia
2. fundus
3. body
4. pylorus
131
What are the 2 curvatures of the stomach?
1. lesser curvature
2. greater curvature
132
What part of the stomach surrounds the cardial orifice?
cardia
133
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
134
What is the major part of the stomach?
body
135
What is the distal funnel-shaped region of the stomach?
pylorus
136
What forms the shorter concave border of the stomach?
lesser curvature
137
What forms the longer convex border of the stomach?
greater curvature
138
What levels can you find the esophagogastric junction/Z-line?
T10-T11
139
What allows for expansion of the stomach?
rugae
140
Acid damage can be found where?
esophagus and duodenum (duodenum ulcers are very common)
141
What arteries can be found in the greater omentum?
- gastro-omental a (left and right)
- short gastric aa
142
What forms the cardial notch?
esophagus and fundus
143
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
144
The fundus and upper body of the stomach receive blood supply from what?
short and posterior gastric aa (branches of the **splenic artery**)
145
What are the levels of the celiac trunk, SMA, and IMA, respectively?
- T12
- L1
- L3
146
What is the blood supply to the liver to help it survive?
hepatic artery proper
147
What lies behind the stomach, runs on the top of the pancreas, and supplies blood to the spleen?
splenic artery
148
What supplies the lesser curvature of the stomach?
- left and right gastric aa
149
What are the three branches of the celiac trunk?
- common hepatic a
- left gastric a
- splenic a
150
What does the common hepatic a give off?
- gastroduodenal a
- proper hepatic a
151
What does the gastroduodenal a give off?
right gastro-omental a
152
What does the proper hepatic a give off?
- right gastric a
- right and left hepatic a
153
What does the left gastric a give off?
esophageal a
154
What does the splenic a give off?
- short gastric a
- left gastro-omental a
155
What supplies the greater curvature of the stomach?
left and right gastro-omental aa
156
What forms the portal vein?
union of the splenic vein and superior mesenteric vein
157
Venous drainage primarily to the portal venous system is through what?
left gastric vein
158
The proximal thoracic part of the esophagus drains primarily into the systemic venous system through what veins?
esophageal veins entering the azygos vein
159
What drains into the hepatic portal vein?
- right and left gastric veins
- splenic v
- superior mesenteric v
160
What do the short gastric v and left gastro-omental v drain into?
splenic v
161
What does the right gastro-omental v drain into?
superior mesenteric v
162
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
163
The anterior and posterior vagal trunk enter the abdomen through what?
esophageal hiatus
164
The thoracolumbar region has what type of inputs?
sympathetic
165
The craniosacral region has what type of inputs?
parasympathetic
166
Abdominal viscera are supplied by what?
a large prevertebral plexus
167
The prevertebral plexus contains what?
sympathetic, parasympathetic, and visceral sensory components
168
The sympathetic components of the prevertebral plexus originate from what spinal cord levels?
T5 to L2
169
The parasympathetic components of the prevertebral plexus are from what?
the vagus nerve (X) and spinal cord levels S2-S4
