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ACE: Unit 3 > TBL 16 > Flashcards

TBL 16 Flashcards

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1
Q

What is the peritoneal cavity? What is the function of peritoneal fluid?

A

•peritoneal cavity: space between parietal peritoneum and visceral peritoneum present within the abdominal cavity
•contains peritoneal fluid: composed of water, electrolytes, and other substances derived from interstitial fluid in adjacent tissues
•function of peritoneal fluid:
-lubricates the peritoneal surfaces so viscera can move over each other without friction → allowing movements for digestion
-contains leukocytes and antibodies: resists infection
•lymphatic vessels below the diaphragm: absorb the peritoneal fluid

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2
Q

What is the difference in the structure of peritoneal cavity between males and females?

A

•peritoneal cavity is completely closed in males but in females there is communication from exterior of the body through the uterine tubes, uterine cavity, and vagina; potential pathway for infection

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3
Q

Why can peritonitis be lethal and why is the linea alba a preferred site for ascites paracentesis?

A

Peritonitis:
•due to gas, fecal matter, and bacteria entering peritoneal cavity which results in infection and inflammation of the peritoneum
•it can become lethal because high amounts of peritoneal surfaces and rapid absorption of material including bacterial toxins from the peritoneal cavity
•symptoms: severe abdominal pain, tenderness, naseau, vomiting, fever, constipation

Paracentesis:
•Surgical puncture of peritoneal cavity for aspiration and drainage of the fluid at the linea alba (bloodless and avoids major nerves)
•Needle is inserted superior to the empty urinary bladder in a location that avoids the inferior epigastric artery

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4
Q

How can peritoneal adhesions cause emergency complications?

A
  • When peritoneum becomes damaged, the peritoneal surfaces become inflamed making them sticky with fibrin → fibrin becomes fibrous tissue which forms abnormal attachments between adjacent visceral peritoneum or between visceral peritoneum and parietal peritoneum → this limits the normal movement of the viscera
  • Symptoms: may cause chronic pain or intestinal obstruction when intestine becomes twisted around an adhesion
  • Adhesiotomy: surgical separation of adhesions
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5
Q

what are example of organs that are intraperitoneal and retroperitoneal?

A

intraperitoneal organs: stomach, spleen, intestines: completely protrude into the parietal peritoneum and are surrounded by visceral peritoneum
retroperitoneal organ: kidneys: do not protrude into the peritoneum and parietal peritoneum cover the anterior surfaces

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6
Q

How are mesenteries formed and what is its function?

A
  • mesenteries: continuity of visceral and parietal peritonea that extend from the intraperitoneal organs into the parietal peritoneum
  • mesenteries enclose branches of abdominal aorta (retroperitoneal) and IVC
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7
Q

Distention/irritation of parietal peritoneum causes what type of pain…

A

•distention/irritation of parietal peritoneum activates sensory fibers causing sharp, localized pain

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8
Q

Describe the greater ommentum.

A

•greater omentum: four-layered peritoneal fold that hangs from the greater curvature of the stomach and proximal part of duodenum and then folds back and attaches to the anterior surface of the transverse colon and its mesentery

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9
Q

How do functions of the greater omentum relate to its common displacement in the peritoneal cavity?

A

-greater omentum prevents the visceral peritoneum from adhering to parietal peritoneum → has considerable mobility and moves around the peritoneal cavity with peristaltic movements; it also cushions the abdominal organs against injury and forms insulation against heat loss

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10
Q

Describe the lesser momentum.

A

•lesser omentum: double layered peritoneal fold that connects the lesser curvature of stomach and proximal part of duodenum to the liver

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11
Q

How does the phrenic nerve provide an exception to the concept that pressure applied to the parietal peritoneum results in sharp, localized pain?

A

o Pain from the parietal peritoneum is well localized except on the inferior surface of the central part of diaphragm where it is innervated by the phrenic nerve; irritation here is referred to C3-C5 dermatomes over the shoulder

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12
Q

Describe the greater sac and its compartments.

A
  • greater sac: largest part of peritoneal cavity
  • transverse mesocolon: mesentery of the transverse colon divides the greater sac into supra colic compartment and infra colic compartment
  • there are right and left parabolic gutters which provides free communication between the compartments
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13
Q

How do ascites and cancer cells spread within the peritoneal cavity?

A

-paracolic gutters: clinically important because it provides pathways for the flow of ascitic fluid and spread of intraperitoneal infections; also provide pathways for the spread of cancer cells that have sloughed off from ulcerated surface of tumor and enter peritoneal cavity

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14
Q

Describe the lesser sac.

A

Lesser sac (omental bursa): lies posterior to the stomach and lesser omentum

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15
Q

What does the omental foramen do?

A

-it connects the greater and lesser sac

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16
Q

Connective tissue and smooth muscle of gut tube are derivatives of…

A

-connective tissue and smooth muscle of tubular wall are derivatives of visceral mesoderm

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17
Q

What are the foregut derivatives and what arteries supply them?

A 
foregut derivatives:
•esophagus, stomach, proximal duodenum
•endoderm buds from proximal duodenum and gives rise to gallbladder, liver, pancreas
•supplied by the celiac artery
•drained by celiac lymph nodes
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18
Q

What are the midgut derivatives?

A
  • lower duodenum, jejunum, ileum, cecum, appendix, ascending colon, proximal 2/3 transverse colon
  • supplied by the superior mesenteric artery
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19
Q

What are the hind gut derivatives?

A

hindgut:
•distal 1/3 of transverse colon, descending colon, sigmoid colon, rectum, upper anal canal, urogenital sinus
•supplied by the inferior mesenteric artery

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20
Q

What are the vascular derivatives of the right and left vitelline veins?

A
  • the left and right vitelline veins enter the septum transversum to form hepatic sinusoids and hepatic veins
  • after formation of the left-to-right venous shunt, distal portion of the left vitelline vein disappears and right vitelline vein becomes portal vein and superior mesenteric vein
21
Q

Define the drainage field of the hepatic portal vein.

A

-Venous blood from the entire GI tract and spleen drains into hepatic portal vein and provides 80% of blood flow to the liver

22
Q

Describe the course of esophagus into the abdominal cavity.

A

Esophagus courses within the posterior mediastinum to enter abdominal cavity via esophageal hiatus (T10); esophageal hiatus functions as inferior esophageal sphincter that contracts and relaxes –> prevents reflex of gastric contents into the esophagus

23
Q

Where does the esophagogastric junction lie and what is the Z-line?

A
  • esophagogastric junction: lies to the left of T11 vertebrae
  • Z-line: jagged line where the mucosa abruptly changes from esophageal to the gastric mucosa
24
Q

What is a hiatal hernia? What are the two types of hiatal hernia?

A

•hiatal hernia: protrusion of part of the stomach into the mediastinum through esophageal hiatus of the diaphragm

-may occur due to weakening of muscular part of the diaphragm and widening of esophageal hiatus (inferior esophageal sphincter)
o 2 types of hiatal hernia:

  1. Paraesophageal hiatal hernia: cardia remains in normal position but pouch of peritoneum including the fundus of the stomach extends through esophageal hiatus anterior to the esophagus ; there is no regurgitation of gastric contents because cardiac orifice is in normal position
  2. Sliding hiatal hernia: abdominal part of esophagus, the cardia, and parts of the fundus of the stomach slide superiorly through the esophageal hiatus into the thorax especially when the person lies down or bend over; there is some regurgitation of the stomach contents into the esophagus
25
Q

What is a congenital hiatal hernia?

A

-when esophagus fails to lengthen so stomach gets pulled up through esophageal hiatus through the diaphragm

26
Q

What is pyrosis?

A

•pyrosis: aka heartburn: burning sensation in abdominal part of esophagus due to regurgitation of small amounts of food and gastric fluid into lower esophagus (GERD)

-pyrosis may also indicate hiatal hernia

27
Q

What’s the arterial supply of the abdominal esophagus?

A
  • left gastric artery supplies the abdominal part of esophagus
  • abdominal aorta –> celiac trunk –> left gastric artery
28
Q

What veins drains blood from the abdominal part of the esophagus?

A

-left gastric vein drains blood from the abdominal part of esophagus into hepatic portal vein
-tributaries of the left gastric vein anastomose with esophageal tributaries of the azygos vein
• azygos vein empties into SVC
• left gastric vein empties into hepatic portal vein
• anastomoses of tributaries of the left gastric vein and azygos vein create portal-systemic anastomoses

29
Q

How do esophageal varices form and why are they life-threatening?

A

esophageal varices:
• seen in portal hypertension (abnormally increased blood pressure in the portal system) and blood can’t enter liver via hepatic portal vein so causes a reversal flow into esophageal tributary due to portal-systemic anastomoses → large volume of blood cause submucosal veins to enlarge → esophageal varices
• distended collateral channels may rupture and cause severe hemorrhage that is life threatning
• seen in patients with alcoholic cirrhosis

30
Q

Describe the pylorus of the stomach.

A

•pylorus: distal part of the stomach; sphincter region of pyloric part
• has circular layer of smooth muscle that controls discharge of the stomach contents through pyloric orifice into the duodenum
• stomach emptied due to:
1. Intragastric pressure overcomes the resistance of pylorus
2. At irregular intervals, gastric peristalsis pushes chyme through pyloric canal and orifice into small intestine for further mixing, digestion, absorption

31
Q

How is Helicobacter pylori infection related to gastric ulcers and why are ulcers that perforate through the posterior wall of the stomach life-threatening?

A

-Gastric ulcers: open lesions of the mucosa of the stomach
-Peptic ulcers: lesions of the mucosa of pyloric canal and duodenum
o The high acid in stomach and duodenum overwhelms the bicarbonate produced by duodenum and reduces the effectiveness of mucous lining, leaving it vulnerable to H. pylori
o H. pylori: erodes the mucous lining of the stomach and make it vulnerable to gastric acid and enzymes and if it erodes the gastric arteries → cause life-threatning bleeding
o Posterior gastric ulcer: may erode through the stomach wall into the pancreas → causing referred pain to the back
• May cause erosion of the splecnic artery → severe hemorrhage into peritoneal cavity

32
Q

What are the intraperitoneal foregut derivatives?

A

-superior part of duodenum and proximal portion of the descending part of duodenum

33
Q

What are the retroperitoneal midgut derivatives?

A

-distal portion of descending part of duodenum, horizontal part of duodenum, ascending part of duodenum

34
Q

What is the anterior and posterior surface of the 1st, 2nd, and 3rd part of the duodenum?

A

1st part: superior part of duodenum: A: liver and gallbladder P: gastroduodenal artery
2nd part: descending part of duodenum A: transverse colon P: right kidney
3rd part: horizontal part of duodenum: A: superior mesenteric artery P: aorta

35
Q

What is the arterial supply and venous drainage of the foregut-derived duodenum?

A
  • foregut derived duodenum: superior part of duodenum and proximal portion of the descending duodenum
  • superior and inferior pancreaticoduodenal artery supplies the duodenum
  • venous blood from duodenum drains into hepatic portal vein
36
Q

When do duodenal ulcers cause peritonitis, which organs can become inflamed, and why can life-threatening hemorrhage occur?

A

oInflammatory erosions of duodenal mucosa
oMost occur in the posterior wall of the superior part of the duodenum
oPeritonitis: when ulcer perforates the duodenal wall permitting contents to enter peritoneal cavity
• Superior part of duodenum closely relates to liver, gallbladder, and pancreas: may adhere to the inflamed duodenum
o erosion of gastroduodenal artery: results in severe hemorrhage into peritoneal cavity → leads to peritonitis

37
Q

Describe lymph drainage from the foregut derivatives

A

-celiac lymph nodes surround the celiac trunk

38
Q

Describe the sympathetic innervation of foregut derivatives.

A

-presynaptic greater splanchnic nerves (T5-T9) pass through the paravertebral sympathetic ganglia and synapse with the pre vertebral celiac ganglion; postsynaptic sympathetic fibers form celiac ganglion form periarterial plexus on branches of celiac trunk to innervate foregut-derived viscera (esophagus, stomach, proximal duodenum, gallbladder, liver, pancreas)

39
Q

Describe the parasympathetic innvervation of foregut derivatives.

A

-vagus nerve contributes branches to the peri-arterial plexus

40
Q

Describe the route of visceral afferent fibers. Describe visceral pain.

A
  • visceral afferent fibers from DRG at T5-T9 go through the white communicating rami and join the presynaptic fibers of great splanchnic nerves enroute to celiac ganglion
  • visceral afferent fibers convey pain sensations from foregut derivatives to DRG at T5-T9 and from there both visceral pain and somatic pain fibers are relayed together by DRG at T5-T9 to CNS
  • visceral pain in CNS: from foregut-derivateivs is perceived as dull, diffuse pain sensations in the epigastric region of anterior abdominal wall
41
Q

How is somatic pain perceived?

A
  • DRG also receives pain sensations from somatic sensory fibers of spinal nerves T5-T9
  • somatic pain originates: at regional parietal peritoneum of epigastric region or from cutaneous sensory fibers of epigastric region
  • in the CNS, somatic pain is perceived as sharp, localized pain
42
Q

What constitutes the periarterial plexus?

A
  • postsynaptic sympathetic fibers from greater splanchnic nerved T5-T9
  • visceral afferent fibers
  • presynaptic vagus nerve
43
Q

Why is visceral pain from duodenal or gastric ulcers consciously perceived in the epigastric region?

A

Visceral pain from duodenal or gastric ulcers perceived in epigastric region because somatic pain from regional parietal peritoneum or cutaneous sensory fibers of epigastric region is relayed to CNS with visceral pain from the foregut derivatives

44
Q

Where is the spleen located?

A
  • spleen: largest lympathic organ
  • it is positioned posteriorly in the left upper quadrant
  • protected by the left 9th-12th ribs
  • left kidney is posteroinferior to spleen
  • spenic hilum: adjacent to tail of pancreas
45
Q

Why is the spleen the most frequently injured abdominal organ?

A
  • spleen is the most frequently injured abdominal organ in the abdomen even though its protected by the 9th-12th ribs but those ribs can be detrimental because severe blows on the left side may fracture one or more of these ribs that may lacerate the spleen
  • in addition, blunt trauma to abdomen → increases intra-abdominal pressure → can cause the thin fibrous capsule and overlying peritoneum of spleen to rupture → disturbs soft pulp
  • if spleen is ruptured → there is profuse bleeding → intraperitoneal hemorrhage and shock
46
Q

Describe the splenic artery.

A

Celiac trunk gives rise to splenic artery and near the hilum gives rise to: 1) left gastroepiloic artery 2) short gastric arteries which supplies the fundus of the stomach

47
Q

Describe the relationships of the splenic vein, IMV, SMV.

A

-inferior mesenteric vein empties into splecnic vein → courses posterior to pancreas and joins superior mesenteric vein at the origin of hepatic portal vein

48
Q

What is splenomegaly, and where is it palpated?

A
  • splenomegaly: due to diseased spleen → due to hemolytic or granulocytic anemias in which RBCs and WBCs are respectively destroyed at abnormally high rates
  • it is palpated below the left costal margin at the end of inspiration

ACE: Unit 3 (3 decks)

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