Week 1/Lab 1 Flashcards
Why is it important to know the quadrants?
-so you know where to ausculate, percuss, and palpate them and to record locations of findings during a physical exam
important notes about quads
- extends up under the rib cage
- belly button separates all quads
- extends down into the pelvis
Right Upper quadrant includes:
- liver:right lobe
- gallbladder
- pylorous of stomach
- Duodenum(1-3)
- pancreas: head
- right suprarenal gland
- right kidney
- ascending colon
- transverse colon
Left Upper quadrant includes:
- liver:left lobe
- spleen
- stomach
- pancreas:body and tail
- jejunum and proximal ileum
- left kidney
- left suprarenal gland
- transverse colon:left half
- descending colon
Right lower quadrant includes…
- cecum
- appendix
- most of ileum
- ascending colon
- right ovary
- right uterine tube
- right ureter:abdominal part
- right spermatic cord:abdominal part
- uterus if enlarged
- bladder if enlarged
Left lower quadrant includes…
- sigmoid colon
- descending colon
- left ovary
- left uterine tube
- left ureter:abdominal part
- left spermatic cord
- uterus if enlarged
- bladder if enlarged
Epigastric region
- the upper central region of the abdomen.
- located between the costal margins and the subcostal plane
Hypogastric region
- region of the abdomen located below the umbilical region
- pubis bone is lower limit
Umbilical region
area centralized on umbilicus
Right and left iliac regions
-region of the abdomen, on either side of the hypogastric regions, below the lumbar regions
Skin of the abdomen
- loosely attached except at the umbilicus where scar tissue makes strong attachment
- collagen runs in natural lines of cleavage that mimic dermatome patterns
Cutaneous nerve supply
-anterior rami of spinal nerves of lowest 5 intercostal nerves, the subcostal nerve, and the 1st lumbar
1st lumbar nerve
-iliohypogastric and ilioinguinal nerve
Dermatome of T7
-in epigastric area near xiphoid process
Dermatome T10
-near umbilicus
Dermatome L1
near area of inguinal canal
Skin blood supply at midline
- superior and inferior epigastric artery
- superior from INTERNAL THORACIC ARTERY
- inferior from EXTERNAL ILIAC ARTERY
lateral flanks
-branches of intercostal arteries, lumbar, and deep circumflex iliac arteries
blood supply at inguinal region
- superficial epigastric
- superficial circumflex iliac
- superficial external pedundle arteries
Skin venous drainage
superiorly: via lateral thoracic vein into the axillary vein
Inferiorly: via superficial epigastric and great saphenous veins into femoral vein
skin lymph drainage
- drainage of anterior abdominal wall above the level of the umbilicus is upward to the anterior axillary(pectoral) group of nodes
- below the umbilicus, drains downward and laterally to the superficial inguinal node
Fascia
-thin sheath of fibrous tissue enclosing a muscle or organ
Superficial fascia
- loose fatty layer named campers fascia found just below the skin
- tough membraneous layer (scarpa’s fascia) that lies beneath the fatty layer and right before the muscle layer
Deep fascia
thin layer of fascia that envelopes the muscles of the abdominal wall
External oblique
most external abdominal muscle found laterally
-runs anterio-inferiorly
Internal oblique
Lies below external oblique
- muscle fibers run anterior-superiorly
- fibers run at 90 degrees from external oblique
Transversus
lies below the internal oblique
-deepest abdominal wall muscle
Rectus abdominus
- long strap muscle that extends whole length of anterior abdominal wall
- it is broader above and lies close to the midline
- separated by its fellow by linea alba
Rectus sheath
- long fibrous sheath that encloses rectus abdominal muscle and contains ANTERIOR RAMI OF LOWER 6 THORACIC NERVES
- formed by aponeuroses of three lateral abdominal muscles
aponeurosis
sheet of white fibrous tissue that takes the place of a tendon in sheet like muscles having a wide area of attachment
Thickness of muscles
-no matter where you slice it, you will get different thicknessess
fascia transversalis
- thin layer of fascia that lines transversus abdominis and is continuous with a similar layer lining the diaphragm and iliacus muscle
- forms femoral sheath for femoral vessels
Inguinal canal
- oblique passage through the lower part of the anterior abdominal wall
- in males, structures can pass from testis to the abdomen(via spermatic cord)
- in females, allows round ligament of the uterus to pass from the uterus to the labium majus
-allows structures to go from deep to superficial
Inguinal canal composition
anterior wall- external oblique aponeurosis
posterior wall-conjoint tendon medially, fascia transversalis laterally
Roof/superior wall: arching lowest fibers of the internal oblique and transversus abdominis
floor/inferior wall: upturned lower edge of the inguinal ligament and lacunar ligament
Spermatic cord
- collection of structures that pass through the iguinal canal and form the testis
- begins at the deep iguinal ring lateral to the inferior epigastric artery and ends at testis
- round ligament of the uterus
Spermatic cord contents
- vas deferens
- testicular artery
- testicular veins
- testicular lymph
- autonomic vessels
- processus vaginalis
- genital branch of genitofemoral nerve (supplies the cremaster muscle of the scrotum)
Liver
- located in upper part of abdominal cavity
- inferior to the diaphragm
- divided into two unequal lobes by falciform ligament
Liver function
- PRODUCE bile
- detoxifies alcohol,drugs, ammonia
- phagocytizes bacteria and blood cells
- Stores vitamins, iron, and glucose
- synthesize proteins and AA
Glucose/glycogen
glucose-in use in the blood
glycogen-stored form
Gallbladder
- 3-4 inches
- tucked into a depression along the anteroinferior margin of the liver’s RIGHT lobe
- STORES bile
Esophagus
-pierce diaphragm to the left of the midline at the ESOPHAGEAL HIATUS(T10)
-becomes continuous with stomach at the cardiac orifice.
-located posterior to LEFT liver lobe
Function: transport food, liquid, saliva to stomach
Peristalsis
-wave like constriction of muscles to move food down esophagus into stomach
What are the 4 tunics composing the gastrointestinal tract
- mucosa
- submucosa
- muscularis externa
- serosa
Mucosa
- innermost tunic of GI tract
- mucosal membrane lining from mouth to anus
- 3 parts(epithelium, lamina propria, muscularis mucosae)
Epithelium layer of mucosa
- -stratified squamosal epithelial cells
- proctection(mostly in orifices)
- secretion and absorption(stomach and small intestine)
Lamina propria layer of Mucosa
- provides the epithelium with blood and lymph supply
- contains MALT
MALT
- mucosa-associated lymphoid tissue
- NODULES of lymphatic tissue containing lymphocytes and macrophages
- protect GI tract wall from bacteria and other pathogens that are mixed with food
- all along GI tract, ESPECIALLY in tonsils, small intesting, appendix, and large intestine
Muscularis mucosae layer of mucosa
-thin layer of smooth muscle responsible for local expansion
Local expansion
SMOOTH muscle that allows wrinkles which extend surface area and increase absorption
Submucosa
- highly vascular
- contains part of the submucosal nerve plexus
- Meissner’s complex: part of the autonomic nerve supply that innervates mucosa and submucosa
- vasoconstriction of vessels and innervates secretory cells for buffers and enzymes
Muscularis externa
- other than mouth and pharynx(SKELETAL MUSCLE) it is smooth muscle for peristalsis
- main nerve supply to GI
- myenteric/auerbachs plexus-controls GI tract motility (frequency/ strength of contractions)
Serosa
- covers external surfaces of most digestive organs and is continuous with serous membrane lining the abdominopelvic cavity
- watery substance with enzymes, used for lubrication
Stomach
- J shaped, sac-like dilation of the GI tract between he esophagus and small intesting
- 2 orifices (pyloric and cardial)
- function: stores, mixes, and breaks down food
Rando stomach number facts
-stomach can hold 1-2 liters of fluid
Chyme
- semi-fluid mix of gastric juice, water, food, semi-digested
- being broken down physically and chemically
Small intestine
1-2 inches in diameters and 20 inches long
- extends from pyloric sphincter to ileocecal junction of large intesting
- divided into 3 sections
Duodenum
- in RUQ
- 10 inches ish (smallest section in length)
- c-shaped and surrounds head of pancreas
- begins at pyloric sphincter and ends at duodenojejunal junction
- 4 parts: superior, descending, transverse, ascending
Jejunum and ileum
- j begins at duodenojejunal junction
- I ends at the ileocecal junction
- J is proximal 2/5 and 8 inches long
- I is distal 3/5 and 12 inches long
Small intestine function
Mechanical digestion: bile separates fat into smaller fat globules
Chemical digestion: complete digestion of carbs, proteins, fats, and nucleic acids
Absorption: 90% of NUTRIENTS absorbed
Large intestine functions
Mechanical digestion: Rhythmic contractions(hostral and mass)
Chemical digestion: fermentation due to the bacteria in large intesting
Absorption: Vitamins K and B, some electrolytes, WATER(can hold 500-1000mL and absorbs all but 200)
Defecation: whatever is not absorbed
Large intestine overview
- frames jejunum and ileum on 3 sides and extends from ileocecral valve to anus
- 5 inches
- divided into cecum, appendix, colon, rectum, anal canal, anus
Cecum
- part of the large intestine
- blind pouch at the beginning of the large intesting just below ileocecral junction
- RLQ
Appendix
- long skinny attachment to the cecum
- lined with lymphatic nodules serving immunity functions
- MALT
- RLQ
Rectum
- begins at level of S3
- when you no longer see bulges, you’re in the rectum
Anal canal
-opens to the exterior of the body at the anus
Colon
Ascending: extends superiorly from ileocecral juntion to hepatic flexure
Transverse: extends from hepatic flexure to splenic flexure
Descending: extends from splenic flexure to left iliac fossa
Sigmoid: begins in left iliac fossa, terminate at S3
Pancreas
-stretches across the posterior abdominal wall from duodenum to spleen
-head, neck, body, tail
Function: Exocrine-produce digestive enzymes
Endocrine-produces hormones to maintain blood glucose level
Accessory spleen
-spleen cells embedded in tail of pancreas
Spleen
- Largest single mass of lymphatic tissue
- between stomach and diaphragm on left side of body
- total protection by rib cage
Spleen function in adults
- production of antibodies(WBC)
- phagocytosis of bacteria and bad RBC and platelets
- reservoir for blood platelets (hold them until you need)
Spleen function in fetus
- hemopoesis-formation of formed elements of blood
- RBC and WBC
Kidneys
-in all 4 quads
-4-5 inches in length, 2-3 in width, 1 thick
-between T12 and L3 vertebrae on either side of body(belly button at L3/L4)
-PARTIALLY protected by 11 and 12 ribs
-positioned between peritoneum and posterior wall of the abdomen (retroperitoneal)
-each gives rise to a ureter
Function: produce hormones, absorb materials, filter blood, produce urine)
Adrenal glands
-suprarenal glands
-one on superior pole of each kidney
-capsule of DENSE IRREGULAR connectve tissue
-adrenal cortex
-innermost adrenal medulla
Function
Cortex: secretes steroid hormones(DHEA) in really small amounts
Medulla: secrete epi and norepi as part of the sympathetic system
Cardial and pyloric sphincters
- smooth muscle tissue
- around orifices
- cardial is looser so you can throw up if you swallow something bad
- pyloric is tighter cause you don’t want that shit coming back up
Peritoneum
serous membrane lining abdominal and pelvic cavity walls(parietal)
-covers surface of abdominal and pelvic organs–stomach, intestines(Visceral)
Peritoneal Cavity
potential space between parietal and visceral peritoneal layers
-has serous fluid
Intraperitoneal organs
- organs within the abdominal cavity and wrapped in peritoneum
- every organ that is not considered retroperitoneal
Retroperitoneal organs
-located behind peritonium
-SAD PUCKER
Suprarenal glands
Abdominal aorta(and IVC)
Duodenum(2-4 part)
Pancreas(all but tail)
Ureters
Colon(ascending and descending)
Kidneys
Esophagus(lower 2/3)
Rectum
Ligaments
-pass between 2 organs or between organs and the abdominal wall
-made of serous membrane
-NOT DENSE REGULAR CONNECTIVE TISSUE
Function: to hold organ in place, transmit neurovascular structures to and from organs
Falciform Ligament
- peritoneal fold connecting liver to diaphragm and anterior abdominal wall
- Contains: round ligament of the liver
Gastrosplenic ligament
-peritoneal fold connecting spleen to stomach
Contains: short gastric vessels(going to the stomach) AND left gastroepiploic vessels(travel curvature of the stomach)
Lesser omentum
- fold of peritoneum
- connecting stomach and 1st part of duodenum to liver
- has 2 parts!!
Hepatogastric ligament
- part of the lesser omentum
- real thin and not sturdy
- connects liver to lesser curvature of stomach
Hepatoduodenal ligament
- part of lesser omentum
- structurally sound
- veins ducts and arteries run through it
Greater Omentum
- hangs superficially from stomach in front of loops of jejunum and ileum
- consists of 4 peritoneal layers
- policeman: if surgery or tumor, greater omentum will surround area and attempt to cut it off
Mesentery
- fold of peritoneum
- in small intestine
- suspending jejunum and ileum from posterior abdominal wall(holds loops)
- transmits neurovascular structures(superior mesenteric vessels and intestinal vessels)
- innervates and supplies blood
Median umbilical fold
- attaches to urachus(urine will come out umbilicus)
- only active in fetus
Medial umbilical fold
- carry deoxygenated blood
- obliterated umbilical artery
Lateral umbilical fold
-raised by inferior epigastric vessels
Nerve supply for parietal peritoneum
-pain originates from parietal peritoneum is SEVERE AND LOCALIZED
-localized because of dermatomes
Nerves:
Phrenic-C3,4,5-sends signals to shoulder, but it is for diaphragm
Lower 5 intercostals
subcostals
iliohypogastric
ilioinguinal
Umbilicus innervation
T10
-intercostals
Nerve supply for visceral peritoneum
-DULL AND POORLY LOCALIZED
Nerves
-visceral afferent sensory fibers traveling with autonomic nerves that supply organs or travel in the mesenteries
