Test 2 - Hutch - GI Flashcards
Name the diff layers of pericardium
Serous visceral
Serous parietal
Fibrous parietal
What is the greater omentum like?
ZZ Top’s beard. Just covers everything
Where is lesser omentum found?
It connects liver to stomach
The greater omentum separates what?
The greater and lesser sacs
What connects SI to body wall?
Mesentery
Which organs are intraperitoneal? What does intraperitoneal mean?
Stomach 1st and 4th parts of duodenum SI Spleen Liver Gallbladder Appendix Transverse colon and sigmoid colon
The organ is covered in peritoneum, associated with mesentery
Which organs are primary retroperitoneal and what does retroperitoneal mean?
Kidneys
Suprarenal glands
Abdominal aorta
IVC
Which organs are secondary retroperitoneal and what does that mean?
2nd and 3rd parts of duodenum
Pancreas
Colon - ascending and descending
Rectum
Name the parts of the stomach that you need to know.
Cardia - where esophagus comes in
Fundus - sup part
Body - with longitudinal rugal folds
Pylorus
Pyloric antrum
Pyloric canal
Lesser curvature
Greater curvatureName the parts of the lesser omentum.
Hepatogastric ligament
Hepatoduodental ligament
Epiploic foramen - connects the greater and lesser sacs
Name the parts of the portal triad and what does it cover?
Bile duct
Portal vein
Proper hepatic a.
This triad covers the epiploic foramen
Name the parts of the duodenum and what does it do?
Superior
Descending
Minor duodenal papilla (maybe)
Ampulla of vater (major duodenal papilla)
Horizontal
Ascending
Releases bile (lipid digestion), bicarb (acid neut.), and pancreatic enzymes (digestion)
There are also circular folds and Brunner’s glands found in the duodenum
What comes after duodenum and what comes after what comes after duodenum? What are their differences?
DJI
Jejunum
Ileum
Jejunum - Large circular folds
Ileum - Peyer’s patches, small circular folds
Name as many parts of the colon as possible.
Cecum Appendix Ascending Right colic (hepatic) flexure Transverse Left colic (splenic) flexure Descending Sigmoid Rectum
Other features Ileocecal valve Tenia coli (strip of muscle) Haustra (segments) Semilunar folds (inside the colon, helps to move poop) Epiploic appendices/appendages
What is the function of the colon?
Water absorption
What does the liver do?
Produces bile (where is it stored?) - gallbladder
Produces: hormones and enzymes
Filtering of blood
Parts of the liver.
Right, left, caudate, quadrate lobes. Right GQ.
Round ligament (umbilical vein)
Falciform ligament
Sup surface has a bare area
Surrounding this: R, L, and coronary ligaments
Where is the gall bladder?
Tucked under right inferior lobe of liver
What are the parts of the gall bladder?
Body, fundus, cystic duct
Name the bile duct system.
Right and left hepatic ducts>Common hepatic duct>Common hepatic meets with cystic duct to form bile duct>bile duct meets pancreatic duct at ampulla>empties into major duodenal papilla in duodenum
The accessory pancreatic duct empties into minor duodenal papilla
What does the pancreas do?
Production of digestive enzymes and bicarbonate
What does the spleen do?
Removes blood cells and performs immune functions
Kidneys
What do they do and what are they covered in?
Filters blood and produces urine
Primary retroperitoneal
Adrenal glands
What do they do and what are they covered in?
Stress response, sex hormones, metabolism, immune system, etc.
Primary retroperitoneal
What are the major sites of digestion?
Stomach and duodenum
What are the major sites of absorption and absorption of what?
Jejunum and ileum - nutrients
Colon - H2O
The omentum is a bilateral of what?
Peritoneum
Where are the foregut, midgut, hindgut boundaries?
Foregut
Stomach, duodenum (parts 1&2)
Midgut Duodenum (parts 3&4), jejunum, ileum, colon (ascending, first half of transverse)
Hindgut
Colon (second half of transverse, descending, sigmoid), rectum, anus
Where is the aortic bifurcation?
L4/5
Abdominal aorta is found where?
L1-L4/5
Name the first trunk off the abdominal aorta that you need to know and what does it serve?
Celiac trunk - Foregut, liver, gall bladder, spleen
What branches off celiac trunk?
To the left: splenic a.
To the left/middle: Left gastric a.
To the right: Common hepatic a.
What branches off of splenic a.?
Left gastroomental a.
Pancreatic branches
What branches off common hepatic a.?
Right gastric a. (Anastomoses with left gastric a.)
Gastroduodenal a.
What branches off gastroduodenal a., and what does it ultimately become?
Duodenal branches
Ant/Post sup pancreaticoduodenal a.
Right gastroomental a. (Anastomoses with left gastroomental a.)
What does common hepatic become after the branches?
Proper hepatic a.
What branches off proper hepatic a.?
Right and left hepatic aa.
What is the next branch off the abdominal aorta and what does it serve?
Sup. Mesenteric a. (SMA) - midgut, duodenum, transverse colon
What are the branches off the SMA?
Inferior pancreaticoduodenal a., middle colic a., jejunum aa., ileal aa., ileocolic a., right colic a. (For the ascending colon)
What is the next branch off the abdominal aorta and what does it serve?
Inferior mesenteric a. (IMA) - Hindgut, descending colon, rectum
What branches off of IMA?
Marginal a. of Drummond
Left colic a.
Sigmoid a.
Sup rectal a.
Where do the gonadal aa. come off of?
Abdominal aorta
What are the two venous drainage systems of the GI tract?
Caval (systemic)
Portal
If it is not the GI tract, it is drained by the systemic system (IVC)
How are the gonads drained?
Left gonadal drains into left renal v.
Right gonadal drains into IVC
If an organ is primary retro, it is drained by what?
IVC
If the organ is in the GI tract and not primary retro, it is drained by what?
Portal system
What is the main vein on the right side of the GI tract?
What is the main vein on the left side of the GI tract?
Sup mesenteric v.
Inf mesenteric v.
What drains into the sup mesenteric vein?
Jejunal vv. Ileal vv. Appendicular v. Ileocolic v. Right colic v. Middle colic v. Inf pancreaticoduodenal v. Right gastroomental v.
What drains into inf mesenteric v.?
Sup rectal v.
Sigmoid vv.
Left colic v.
The sup mesenteric vein meet with what to form what?
Inf mesenteric v.>portal v.
The inf mesenteric v. Jjoins with what to be called inf mesenteric yet again?
Splenic v.
What drains into the splenic v.?
Pancreatic vv.
Short gastric vv.
What drains into the portal v.?
Post sup pancreaticoduodenal v.
Right gastric v.
Left gastric v.
Which vein is associated with esophageal vv.?
Left gastric v.
What small vein drains into the portal vein?
Cystic v.
What are the portal-caval anastomoses?
Esophagus (Gut)
Rectum (Butt)
Superficial abdomen (Caput)
For the esophageal anastomosis, what makes up the portal and what makes up the caval?
Portal: gastric vv. to (hepatic) portal vein
Caval: esophageal vv. to azygos vv.
What innervates parietal peritoneum?
Phrenic nerve - It refers pain to c3-c5 dermatomes
There is a blockage in the liver and blood cannot drain, how does the body deal with this?
Blood goes from portal vein to gastric vein to esophageal veins to azygos v.
This makes up the esophageal portal-caval anastomosis. This is indicated by the presence of esophageal varices.
What are the parts of the rectal portal-caval anastomosis?
Portal: sup rectal vv. to (hepatic) portal v. (It will actual connect with IMV, then splenic is added, and then the portal vein)
Caval: mid and inf rectal vv. to internal iliac v.
When the rectal portal-caval anastomosis occurs, what is happening?
Blood will flow from sup rectal v to mid and inf rectal vv.
It will then enter the internal iliac vein>common iliac vein>IVC
This is the rectal portal-caval anastomosis. This is indicated but the presence of internal hemorrhoids.
What are the parts of the gut portal-caval anastomosis?
Portal: paraumbilical vv. to (hepatic) portal v.
Caval: epigastric vv. to femoral v.
When the gut anastomosis occurs, what is taking place?
Instead of the paraumbilical vv. draining into the (hepatic) portal vein, they drain into superficial vv. of abdominal wall>superficial epigastric vv.>femoral v.>ext iliac v.>common iliac v.>IVC
This is indicated by the presence of a caput medusa (bulges on a patient’s stomach)
Why does a distal splenorenal shunt (procedure that connects splenic vein and left renal vein) relieve portal hypertension?
It reroutes that splenic vein blood from joining with the IMV and into the portal vein to instead drain into the left renal vein which drains direct into IVC.
What is the GI tract innervated by?
Sym and parasym only. No somatic innervation in GI tract
Sympathetics come from where and synapse where? Parasympathetics come from where and synapse where?
T1-L2 - Synapse on paravertebral or preaortic ganglia
CN X (Vagus) & S2-S4 - Synapse close to targets
GI Sympathetics
T5-T12?
L1-L2?
T5-T12
Greater, lesser, and least splanchnic nn. - innervate foregut and midgut
These synapse in pre-aortic ganglia
L1-L2
Lumbar splanchnic nn. - innervate hindgut
These synapse in pre-aortic ganglia
GI Parasympathetics
Vagus nerve?
S2-S4?
Vagus
Innervates Foregut and midgut
S2-S4
Innervates hindgut
All parasympathetics synapse close to targets
