Week 10 Flashcards
What is the cecum?
pouch-like structure at the beginning of the large intestine, where it connects to the small intestine.
What are tenia coli?
Thickening of longitudinal muscle fivers in muscularis externa
What is the purpose of the colon (large intestine)?
Water absorption, don’t want to be losing water, helps to concentrate the feces into stool
Rectum details
- final part of the colon
- descends into the pelvis
- no tenia coli, but longitudinal muscles thickens in the muscularis externa
What is the blood supply of the rectum?
Superior rectal artery: 1 branch from the IMA for the upper rectum
Middle rectal arteries: 2 branches from the internal iliac for the middle rectum
Inferior rectal arteries: 2 branches from the internal pudendal which a branch of the internal iliac for the lower rectum
Anus Details
Internal anal sphincter - involuntary control, we do not have
External anal sphincter
- skeletal muscle so voluntary control
- us constantly deciding when to defecate
What is the pectinate line?
Rectal (final section of large intestine) and anus (internal and external, opening)
- difference in epithelium composition
- above the line we get venous supply from the branches of the inferior mesenteric artery and portal venous system
- below is the internal pudendal artery that can be traced back into the internal iliac artery and systemic venous system (travel back to the inferior vena cava)
Inferior Mesenteric Artery points
- branches from abdominal aorta
- around L3 vertebral level
- supplies hindgut
- travels ehind mesentery to reach organs
- Left Colic artery (marginal artery)
- sigmoidal artery
- superior rectal artery
What is the purpose of the marginal artery?
Helping with midgut meeting hindgut
- Middle colic from the superior mesenteric artery connects with the left colic artery from the inferior mesenteric artery
What does the sigmoidal artery supply?
- The curvy sigmoid colon
What does the superior rectal artery supply?
- initally we have one superior rectal artery but it will continue to branch to supply both sides of the superior aspect of the rectum
What is the Portal venous system?
- drain the intestinal system
- vessels for nutrient
- carbohydrates and proteins
What happens when we absorb molecules from the bloodstream?
- we are bringing molecules from the lumen of the gut tube into the bloodstream, we’re absorbing it into the portal venous veins
- these are low in oxygen but nutrient rich
Where does the blood go to beofre entering the system?
- oxygen poor, nutrient rich blood goes to the liver for toxification before it enters systemic circulation and pumped to the lungs to pick up lungs and go to the rest of the body
What are the branches of the portal venous system?
- inferior vena cava goes to the splenic vein which attaches to the superior vena cava to create a common branch
What detoxify the things in the veins?
the hepatocytes in the liver
Portal Vein vs Hepatic Vein?
Portal Vein: brings nutrient-rich blood from the digestive organs (stomach, intestines, spleen) to the liver for processing
Hepatic Veins: carry blood away from the liver to the heart, after the liver has processed it
Why do things need to be detoxified first?
First pass effect, a lot of tiems what we injest, we can’t initally use by the body and the cells. It has to be broken down further and metabolized first in the liver before it enters systemic circulation and then our cells can use it
- make it more bioavailable for our food
Lymphatics
are where the lipids are absorbed
How are lipids aborbed?
- There are lacteals similar to those in the portal veins
- they uptake the lipids from the lumen of the gut tube
- Travel to the cisterna chyli which is a system to all the lympathic in the abdomen and pelvis
- Travel to thoracic duct (ascends to through the thorax and dumps into the venous angle)
- Enter systemic venous circulation
What is at the venous angle?
Thoracic duct
- left subclavian vein and left internal jugular
Autonomics to the Abdomen
- everything in the abdomen is under involutnary control
Parasympathetic innervation
- right and left vagus nerves are wrapping around the esophagus
- left vagus nerve in close proximity with the arch of the aorta
- esophageal plexus
- really long preganglionic neuron
- synapse within the organ
- short post-ganglionic neuron
Sympathetic Innervation
- thoracic splanchnic nerves (preganglionic)
- T1-L2 Level
- sympathetic chain where a lot of neurons are synapsing
- the specific splanchnic nerves that go to the abdomen are the greater, lesser and least splanchnic nerves
What is another name for the splanchnic nerves?
Paravertebral ganglion (sympathetic chain), groups of nerve cells located next to the spine
- beside vertebral column
Where do the splanchnic nerves go?
- greater, lesser and least splanchnic nerves without synapsing go through the sympathetic chain (paravertebral ganglia). They are going to descend into the abdomen to the prevertebral ganglion in front of the vertebral column, on top of the abdominal aorta (this is where the splanchnic nerves synapse)
- they then go to their target organ
What do the sympathetic arteries have to go through before going to target organ?
The mesentery
Diverticulitis
- Low fiber diet leads to more strain on the muscles of the digestive tract to push food along (food going through our system is not very slippery)
- fiber loosens up the food in there, makes it slippery and easier for it to go through the GI tract
- if you’re on a low fiber diet, the muscles have to push a lot harder and it pushes it puts a lot more strain on the intestines
- mucosa herniates away from the lumen (diverticulosis)
Diverticulosis: mucosal pouches become infected
How can diverticulum be treated?
antibiotics
- short term you might be put on a clear liquid diet to give the colon a break
Ulcerative Colitis
- a type of inflammatory bowl disease
- immune response leading to ulcers and inflammation along the mucosa of the colon
How is ulcerative colitis treated?
- anti-inflammatory and immunosuppressants
- if left untreated, it can greatly increase the risk of colon cancer
Abdominopelvic Cavity
- the abdominal cavity is continuous with the pelvic cavity
- respiratory diaphragm –> pelvic diaphragm muscles
- separated by connective tissue boundaries
Peritoneal cavity development
During development the gut tube develops and pushes into the peritoneum
- intraperitoneal organs
- retroperitoneal organs
Intraperitoneal
Visceral peritoneum = serrosa
- Parietal peritoneum
What happens to the peritoneal space as we grow older?
- The space becomes a lot more convoluted and smaller in the adult form because we’ve got way more organs filling that space than just a tiny tube
Parietal space verses parietal cavity
peritoneal cavity is everything encapsulated by the parietal peritoneum including the organs
What is the mesentery for the gut tube?
- creates a vacuum seal for the neural vasculature to travel to and from the gut tub
How are the intraperitoneal organs connected to the aorta wall?
- intraperitoneal organs are free in the peritoneal cavity but are anchored to the anchored to the aorta wall via their blood supply
- root of the mesentery (double layer)
What organs are the intraperitoneal organs?
- stomach, distal part of the duodenum, ileum, jejunum, spleen, liver, gallbladder, transverse/sigmoid colon
Retroperitoneal organs
- secured to the abdominal wall
- behind the peritoneal sac
- part of duodenum, ascending/descending colon, pancreas, kidneys
What is the greater omentum?
- made of four layers coming from the stomach and the duodenum
- covers the rest of the organs
- fatty tissue
Reflections
Layers of peritoneum created by the folding and orientation of the gut tube
What is the lesser omentum (2 layers)
Connections between the liver and stomach and duodenum
- Hepatogastic Ligament
- Heptaduodenal Ligament
creates like a curtain, there is a little hole called the epiploic foramen
Appendicitis
- pain in the lower right quadrant of the abdomen and well as nausea and low-grade fever
- inflammation of the appendix
- blockage and dysregulation of bacteria in the appendix, IBD
- antibiotics, surgery (appendectomy)
What is the greater sac?
- Everything else
- entire peritoneal cavity except lesser sac
What is the lesser sac?
- Posterior to the lesser omentum and stomach
- Accessed through the epiploic foramen
Anterior abdominal wall: External Oblique (anterior inferior direction)
Internal Oblique (anterior-superior)
- as we move medially it becomes
Anterior abdominal wall
- skin, superficial fat and fascia, anterior abdominal wall muscles, parietal peritoneum
Anterior abdominal wall: External Oblique (anterior inferior direction)
- as we move closer to the midline, it gets very tendency: external oblique aponeurosis
Anterior abdominal wall: Rectus Abdominis
- find it in the midline
- 6 pack muscles
- vertical muscle fiber direction
- rectus sheath on the deep aspect of this muscle
Anterior abdominal wall: Transversus Abdominis
- Horizontal
- posterior aspect of the rectus sheath
What layers (superficial to deep) would the surgeon have to cut through in order to access and remove the appendix?
- skin
- fat and fascia
-muscle layers: external oblique, internal oblique, rectus abdominis, rectus sheath tranversus abdominis - peritoneum
What is the order of the process of digestion?
- Ingestion
- Propulsion
- Mechanical Breakdown
- Digestion
- Absorption
- Defecation
List the accessory organs
- Liver, Gallbladder and pancreas
Where is the liver located spatially?
- right hypochondriac region and epigastric region
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What vessel allows for drainage of oxygen poor but nutrient rich blood from the liver?
Hepatic vein –> Inferior Vena Cava
What arterial blood vessel provides oxygen rich blood to the liver?
Celiac Trunk –> Common Hepatic Artery –> Proper Hepatic Artery
What are the functions of the Liver?
- Produces bile - to break down fats
- Glycogen storage - taken from glucose found in the blood
- Detoxification site
- Creates blood proteins
Liver cells - Hepatocytes
What makes up the portal triad?
Portal arteriole, portal venule, bile duct
What does the bile duct do?
Which carries bile away from the liver globules ( small, rounded droplets of fat or liquid), our portal venial and our portal arterial
What do the Bile Canaliculi?
- allows bile to flow from the hepatocytes, towards the bile duct and dumps the content there.
- biles can locally and travels through the bile cannaliculi empty into the bile ducts at the portal triad
What is the pathway of blood in the hepatocyte?
- first through the hepatic portal vein and hepatic artery travel through the sinusoids
- through the hepatic veins and then drain into the inferior vena cava
What are the sinusoids?
- receive blood from both the portal vasculature and carries in inward to reach the central vein
What are the three anatomical regions of the gallbladder?
- neck, body, fundus
Where is the gallbladder located?
Muscular sac that rests in a shallow depression on the visceral surface
- located just deep to the right lobe of the liver
What is the travelling path of the bile?
Right and left hepatic duct –> Common hepatic Duct –> Bile Duct
What is the function of the gallbladder?
- concentrates and stores bile from liver (removing any water or electrolytes from bile to make it more potent and digest for digestion)
- releases bile in response to meals containing fat that pass-through duodenum
What are the parts of the pancreas?
- head, neck, body, tail
- tail which is pointing directly towards the spleen. Inferior to the neck