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Clinical Morphology > Week 5 > Flashcards

Week 5 Flashcards

1
Q

When is the primitive gut tube formed, and from what?

A

Body folding during week 4; from the top of the yolk sac

Also, during this time, the body cavity and anterolateral body wall are formed and the amnion encases the embryo

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2
Q

Which germ layer forms the epithelial lining of the gut tube?

A

endoderm

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3
Q

Which germ layer forms all other layers of the gut tube wall (except nerves and ganglia)?

A

mesoderm

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4
Q

What germ layer forms the serous membrane of the abdomen (peritoneum)?

A

mesoderm

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5
Q

What is a mesentery?

A

a double layer of peritoneum reflecting from the abdominal wall to enclose the viscera

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6
Q

What forms the boundaries of foregut, midgut, and hindgut?

A

The 3 arteries that branch off the anterior aorta: celiac trunk, superior mesenteric artery (SMA), and inferior mesenteric artery (IMA)

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7
Q

Liver buds

A

buds off the foregut into the ventral mesentery dividing it into the falciform ligament and the lesser omentum

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8
Q

What is septum transversum?

A

The mesoderm that the liver buds into; it forms the CT and blood vessels of the liver and also forms the diaphragm

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9
Q

Pancreas buds

A

off the foregut just above the midgut junction and has 2 buds: dorsal pancreas that buds into dorsal mesentery and ventral pancreas that buds into ventral mesentery

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10
Q

Stomach rotation in embryo development

A

it rotates 90 degrees clockwise on its longitudinal axis so the left side faces anteriorly

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11
Q

When the stomach rotates 90 degrees clockwise…

A

the dorsal mesentery of the stomach becomes the greater omentum, the liver moves to the right side of the abdomen and pushes the duodenum, pancreas, and part of the dorsal mesentery against the posterior body wall

Stomach growth and rotation creates the omental bursa or lesser peritoneal sac

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12
Q

spleen develops

A

from the mesoderm in the dorsal mesentery of the stomach. This makes the spleen a unique organ because it’s not derived from endoderm

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13
Q

Retroperitoneal organs

A

pancreas, most of the duodenum, ascending and descending colon, abdominal aorta, IVC

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14
Q

What are the names of the parts of the dorsal mesentery of the stomach that don’t fuse with the parietal peritoneum covering the posterior body wall?

A

splenorenal ligament, gastrosplenic ligament, and greater omentum

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15
Q

biliary duct system and gallbladder are formed from what?

A

the liver bud (hepatic diverticulum)

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16
Q

Physiological herniation

A

rapid growth of the midgut causes it to loop into the umbilical cord, where is it still connected to the rapidly resorbing yolk sac by the yolk stalk

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17
Q

Cranial limb of the midgut loop forms

A

the jenunum and upper ileum

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18
Q

the caudal limb of the midgut loop forms

A

the lower ileum through the proximal 2/3 of the transverse colon

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19
Q

Midgut loop rotation

A

by 10 weeks the midgut loop has rotated 270 degrees around the axis of the SMA

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20
Q

Order of organs returning to body cavity after physiological herniation

A

jejunum returns first, to the left side and then ileum to the right side. Cecum returns last, initially to the RUQ, but then moves dow the the RLQ

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21
Q

In rotation of the midgut, what happens to the mesenteries of the ascending and descending colon?

A

the mesenteries fuse with the posterior abdominal wall, so they become retroperitoneal

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22
Q

Transverse mesocolon fuses with

A

the greater omentum as the greater omentum passes anterior to it

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23
Q

What is mesentery proper

A

the mesentery of the small intestine

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24
Q

pyloric stenosis

A

results from hypertrophy of the muscularis externa of the pylorus, obstructing the pyloric canal and causing forceful (projectile) nonbilious vomiting

Etiology unclear, but may be multifactorial from both genetic and environmental factors. Symptoms usually begin 3-5 weeks of age

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25
Q

annular pancreas

A

sometimes ventral pancreatic bud has 2 lobes that move in opposite directions during foregut rotation. They form a ring around the 2nd part of the duodenum, which constricts the duodenum.

Can be asymptomatic, especially if incomplete. Symptoms present during neonatal period with feeding intolerance, vomiting, and abdominal distention. Vomit is usually nonbilious

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26
Q

omphalocele

A

results when the midgut loop fails to return to the abdominal cavity. The viscera herniate through the umbilical ring and are contained in a shiny sac of amnion covered parietal peritoneum at the base of the umbilical cord

It is often associated with genetic diseases and other congenital anomalies

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27
Q

gastroschisis

A

results when the abdominal viscera herniate through the body wall directly into the amniotic cavity, usually to the right of the umbilicus. Occurs due to a defect in the lateral folding of the embryo that leaves a gap or weakness in the anterior abdominal wall. It is usually an isolated defect

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28
Q

Meckel’s (ileal) diverticulum

A

persistence of the proximal portion of the yolk stalk (vitelline duct). It is present in 2% of the population and is 2x as common in males. Ectopic gastric mucosa may be present, leading to ulceration, perforation, or GI bleeding. Typically found about 2 ft from ileocecal junction

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29
Q

No rotation of the midgut

A

Causes the small intestine to end up on the right and large intestine on the left

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30
Q

What is malrotation of the midgut

A

mesentery doesn’t fuse correctly, so small intestine can twist around the SMA, resulting in volvulus (twisting). If SMA is obstructed, it can be life threatening. Babies present with vomiting, absence of stool and abdominal distention

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31
Q

Clockwise rotation of the midgut

A

large intestine enters first and is posterior to the duodenum

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32
Q

recanalization

A

lumen of midgut fills in from epithelial proliferation and then recanalizes to form villi and crypts.
Problems with recanalization can result in stenosis, atresia, septa, and cysts

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33
Q

duodenal atresia

A

an example of failed recanalization; it’s associated with polyhydramnios, bilious vomit, and a distended abdomen. Usually occurs distal to the major papilla

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34
Q

intussusception

A

occurs when a segment of intestine invaginates or telescopes into an adjacent semgent. It children, it may be caused by excessive peristalisis. Symptoms include intermittent abdominal pain, vomiting, bloating, and bloody stool

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35
Q

aganglionic megacolon (Hirschsprung’s disease)

A

results from lack of ganglia in the colon. Caused by a defect in the RET gene, a receptor tyrosine kinase involved in neural crest cell migration

Neural crest cells migrate to the gut during weeks 5-7 to form ganglia, but in this case, they fail to migrate to the hindgut.

80% of cases involve rectum to sigmoid colon leading to loss of peristalisis and immobility, fecal retention, and abdominal distention up to the transverse colon (megacolon)

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36
Q

lympatics of the stomach drain to

A

regional lymph nodes: splenic, gastric, gastro-omental, or pyloric

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37
Q

Where do the regional nodes of the stomach drain to?

A

celiac nodes

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38
Q

Where do celiac nodes drain?

A

the cisterna chyli and the thoracic duct

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39
Q

Regional lymph nodes for liver, gallbladder, pancreas, and duodenum

A

cystic, hepatic, pancreaticduodenal, and pancreatic

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40
Q

regional lymph nodes for liver, gallbladder, pancreas, and duodenum drain to

A

the celiac and superior mesenteric nodes

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41
Q

where do the superior mesenteric nodes drain

A

the cisterna chyli and the thoracic duct

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42
Q

regional lymph nodes of the small intestine and colon

A

mesenteric, ileocolic, right colic, middle colic, paracolic, sigmoid, and superior rectral

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43
Q

where do regional lymph nodes of the small intestines and colon drain

A

the superior and inferior mesenteric nodes

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44
Q

where do the inferior mesenteric nodes drain

A

the cisterna chyli and the thoracic duct

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45
Q

blood supply of foregut organs

A

branches of celiac trunk

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46
Q

what are the foregut organs

A

esophagus, stomach, proximal duodenum, liver, gall bladder, pancreas, spleen

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47
Q

blood supply of midgut organs

A

branches of superior mesenteric artery (SMA)

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48
Q

What are the midgut organs

A

distal duodenum, jejunum, ilium, cecum, appendix, ascending colon, proximal 2/3 transverse colon

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49
Q

Blood supply of the hindgut organs

A

branches of inferior mesenteric artery (IMA)

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50
Q

what are the hindgut organs

A

distal 1/3 of transverse colon, descending colon, sigmoid colon, rectum, anal canal

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51
Q

origin of sympathetic preganglionic neurons in foregut

A

T5-T9

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52
Q

origin of sympathetic preganglionic neurons in midgut

A

T5-T9 and T10-T11

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53
Q

origin of sympathetic preganglionic neurons in hindgut

A

L1-L2

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54
Q

sympathetic Preganglionic nerve fibers in foregut

A

greater splanchnic nerves

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55
Q

sympathetic Preganglionic nerve fibers in midgut

A

T5-T9: greater splanchnic nerves

T10-T11: lesser splanchnic nerves

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56
Q

sympatheticPreganglionic nerve fibers in hindgut

A

Lumbar and sacral splanchnic nerves

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57
Q

sympathetic Postganglionic nerve fibers in foregut

A

celiac plexus via the celiac ganglia

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58
Q

sympathetic Postganglionic nerve fibers in midgut

A

superior mesenteric plexus via the superior mesenteric ganglia

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59
Q

sympathetic Postganglionic nerve fibers in hindgut

A

inferior mesenteric plexus via the inferior mesenteric ganglia
Hypogastric plexus via the pelvic ganglia

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60
Q

area of referred pain from the foregut

A

epigastric via the greater splanchnic nerves

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61
Q

area of referred pain from the midgut

A

umbilical via the lesser splanchnic nerves

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62
Q

area of referred pain from the hindgut

A

pubic via the lumbar and sacral splanchnic nerves

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63
Q

parasympathetic preganglionic nerve fibers of foregut

A

vagus nerve

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64
Q

parasympathetic preganglionic nerve fibers of midgut

A

vagus nerve

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65
Q

parasympathetic preganglionic nerve fibers of hindgut

A

pelvic splanchnic nerves (S2-S4)

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66
Q

Four main layers of the GI tracts

A

hollow tube with lumen of variable diameter

Layers: mucosa, submucosa, muscularis, and serosa/adventitia

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67
Q

Mucosa of GI tract

A

consists of stratified squamous or columnar epithelial lining; lamina propria of loose CT rich in blood vessels, lymphatics, lymphocytes, and often containing small glands. It includes a thin layer of smooth muscle (muscularis mucosae) that separates it from the submucosa

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68
Q

Submucosa of GI tract

A

fibroelastic loose CT. contains larger blood vessels and lymphatics, often glands, and an important network of nerves and ganglia belonging to ANS (submucosal or meissner’s complex)

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69
Q

Muscularis of GI tract

A

consists of smooth muscle3 with inner circular and outer longitudinal orientations. Between the 2 layers is another network of nerves and ganglia known as the myenteric or Auerbach’s plexus. Contractions of the muscularis mix and propel luminal contents (peristalsis) and are generated and coordinated by myenteric plexus

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70
Q

adventitia/serosa

A

When facing the peritoneal cavity, this layer is encased with thin layer of simple squamous epithelium known as mesothelium. In this case the combined CT and mesothelium is called serosa.
In retroperitoneal surfaces where there is no mesotherlial lining and only CT is present, the outer tunic is called the adventitia

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71
Q

Unique qualities of esophagus

A
  • lumen lined with thick, nonkeratinized stratified squamous epithelium to withstand abrasion
  • submucosa has esophageal glands
  • In distal 8 cm of esophagus, submucosal veins anastamose with branches of the portal vein
  • proximal 1/3 of muscularis externa is skeletal muscle, middle 1/3 is a mix, and distal 1/3 is all smooth muscle
  • thoracic esophagus has adventitia, abdominal esophagus has serosa
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72
Q

functions of stomach

A
  • continued digestion of carbohydrates initiated by salivary enzyme amylase
  • addition of acidic fluid to ingested fluids plus churning activity of muscularis to turn them into viscous mass called chyme
  • continued digestion of triglycerides initiated by pancreatic enzyme lipase
  • initial digestion of proteins with enzyme pepsin
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73
Q

unique qualities of stomach

A

•simple columnar mucosal lining consisting entirely of mucous-secreting cells
•surface epithelium invaginates into the lamina propria to make gastric glands
•in the fundus and body, gastric glands branch and open to gastric pits, which empty their contents into the lumen
has 3 layers of smooth muscle: inner oblique, middle circular, and outer longitudinal. Auerbach’s/myenteric plexus is between outer 2 layers
•submucosa has increased thickness, which is responsible for the rugae of the mucosa
•stomach has serosal layer

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74
Q

cell types in gastric glands

A

regenerative/stem cells, mucous cells, parietal cells, chief cells, and enteroendocrine cells

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75
Q

mucous cells of stomach

A

line the lumen of gastric pits and secrete thick, adherent, and highly viscous protective mucous layer that is rich in bicarbonate ions

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76
Q

parietal cells of stomach

A

predominate in the upper segment of the gastric gland; produce hydrochloric acid (important for the conversion of pepsinogen to pepsin) and intrinsic factor (essential for absorption of vitamin b12)

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77
Q

chief cells of stomach

A

secrete the inactive proenzyme pepsinogen, which is released into the lumen of the gland and then converted in the acidic environment of the stomach to pepsin

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78
Q

pepsin

A

a proteolytic enzyme capable of digesting most proteins

79
Q

enteroendocrine cells

A

several types that secrete hormones and have effects on gut motility (serotonin) and HCl secretion (gastrin)

80
Q

gastric glands in cardia and pyloric region of stomach

A

have roughly the same structure of those in the fundus and body, but primarily consist of mucus cells and a few enteroendocrine cells

81
Q

small intestine function

A

a tube approx 5-7 meters long
it continues digestion of chyme from the stomach using pancreatic enzymes and liver bile AND absorbs the resulting nutrients

82
Q

unique qualities of small intestine

A
  • luminal surface is thrown into circular folds called plica circulares that contain villi and significantly increase the SA necessary for absorption of nutrients from digested food
  • epithelium is simple columnar joined by extensive tight junctions. has enterocytes (absorptive), goblet cells (mucous-secreting), paneth cells (lysozyme secreting), enteroendocrine cells (hormone-secreting), and stem cells (replace enterocytes and goblet cells every 3-5 days)
83
Q

enterocytes in small intestine

A
  • to further increase the absorptive area, each is covered with numerous microvilli (brush border).
  • they absorb carbohydrates, proteins, lipids, vitamins, Ca2+ and Fe2+
84
Q

carbohydrate digestion in small intestine

A

digested to monosaccharides and transported to portal blood

85
Q

protein digestion in small intestine

A

digested to amino acids, dipeptides, and tripeptieds. Some further digestion may occur in enterocytes, and then amino acids are transported to the portal blood

86
Q

triglyceride digestion in small intestine

A

emulsified by bile salts and digested to fatty acids and monoacyclglycerols. Long chain fatty acids are packaged as chylomicrons that enter the lacteal center of the vilus. Short and medium chain fatty acids enter enterocytes directly and are delivered to portal blood

87
Q

water soluble vitamin b12 in small intestine

A

absorbed in the ileum and requires intrinsic factor

88
Q

Ca2+ in small intestine

A

requires vitamin d for absorption

89
Q

goblet cells in small intestine

A

interspersed among enterocytes covering the villi. The secrete mucous for lubrication fo small intestine. The further down the GI tract, the greater number of goblet cells.

90
Q

Goble cells in HandE section

A

appear clear

91
Q

crypts of lieberkuhn

A

epithelium at base of villi in small intestine invaginates into the lamina propria to form these short glands

92
Q

paneth cells

A

found at the base of crypts of lieberkuhn and stain orange-red color in HandE stain.
They have numerous cytoplasmic granules filled with lysosome (antibacterial), tumor necrosis factor-alpha (TNF-alpha, proinflammatory) and defensins (antibacterial and antiparasitic)

93
Q

dysfunction of paneth cell biology

A

contributes to pathogenesis of chronic inflammatory bowel disease

94
Q

What do enteroendocrine cells secrete in small intestine

A

cholecystokinin, secretin, gastric inhibitory peptide, and glucagon like peptide

95
Q

cholecystokinin

A

secreted in response to small peptides, amino acids, and fatty acids in gut lumen. Stimulates secretion from pancreatic acinar cells and release of bile from gall bladder

96
Q

secretin

A

secreted in response to H+ and fatty acids in gut lumen. Stimulates release of HCO3 from pancreas and biliary tract of liver

97
Q

gastric inhibitory peptide

A

released in response to glucose, amino acids, and fatty acids in gut lumen. stimulates insulin secretion from pancreatic islets

98
Q

glucagon like peptide

A

released in response to glucose, amino acids, and fatty acids in gut lumen. stimulates insulin secretion AND inhibits glucagon secretion

99
Q

Brunner’s glands

A

found only in submucosa of duodenum adjacent to the stomach. They secrete alkaline mucus via ducts that empty into the bases of the crypts fo help neutralized th acidic chyme

100
Q

lymphocytes in small intestine

A

large numbers are found throughout the lamina propria. Highest concentration will be present in the ileum, as individual cells or as groups of lymphoid nodules (peyer’s patches, also called gut associated lymphoid tissue GALT)

101
Q

Large intestine function

A

a large diameter tube that absorbs about 4/5 of the water, Na+, and Cl- from the fluid presented to it by the ileum, concentrating it and solidifying to form solid feces

102
Q

unique qualities of large intestine

A
  • mucosa lacks villi and has no major folds, except in rectum
  • Many goblet cells exist in glands created by invaginations of epithelium
  • serosa has small, pendulous protuberances of adipose tissue called appendix epiploica
103
Q

teniae coli

A

outer layer of smooth muscle in muscularis of large intestine is gathered into 3 longitudinal bands

104
Q

epithelium of mucosa in large intestine

A

simple columnar

105
Q

appendix

A

small blind ended diverticulum of the cecum. Characteristic features: accumulations of lymphoid tissues present within lamina propria

106
Q

Salivary gland function

A

moisten and lubricate ingested food and oral mucosa, initiate digestion of carbohydrates and lipids with amylase and lipase

107
Q

bile

A

made in liver, stored and concentrated in gallbladder

108
Q

liver function

A

plays major role in carbohydrate and protein metabolism, inactivated many toxic substances and drugs, and synthesizes most plasma proteins and factors necessary for blood coagulation

109
Q

exocrine portion of pancreas

A

make up about 80% of the organ; consist of numerous acinar cells aggregated into lobules that can be seen grossly.

110
Q

pancreatic exocrine secretion

A

merocrine secretion of proenzymes by the acinar cells is regulated by secretin and cholecystokinin from the enteroendocrine cells of the duodenum and jejunum as well as stimulation from the vagus nerve

111
Q

what stimulates secretin release

A

gastric acid in the intestinal lumen

112
Q

what does secretin cause in the pancreas

A

ductal cells add water and bicarbonate to the fluid making it alkaline, rick in electrolytes, and poor in enzyme activity. This fluid naturalizes chyme so that pancreatic enzymes can function at optimal neutral pH

113
Q

what stimulates the release of cholecystokinin

A

long-chain fatty acids, gastric acid, and some essential amino acids in the gut

114
Q

what does the hormone cholecistokinin do

A

promotes secretion of an enzyme-rich (but less abundant) fluid

115
Q

endocrine portion of pancreas

A

found in the aggregates of lightly staining cells called islets of langerhans that can only be seen histologically

116
Q

3 major cell types in endocrine pancreas

A

alpha, beta, delta

they can only be recognized with special staining techniques

117
Q

product of alpha cells in pancreatic islets

A

glucagon

118
Q

product of beta cells in pancreatic islets

A

insulin

119
Q

product of delta cells in pancreatic islets

A

somatostatin

120
Q

function of glucagon

A

increases blood glucose, gluconeogenesis, and glycogenolysis

121
Q

function of insulin

A

promotes decrease of blood glucose, stimulates storage of glucose as glycogen

122
Q

function of somatostatin

A

inhibits secretion of glucagon and insulin

123
Q

liver organization

A

liver parenchyma organized into hepatic lobules (hexagonal in shape). The center of the lobule is indicated by the presence of the efferent central vein, which is surrounded by hepatocytes arranged radially in plates or cords

124
Q

portal triads

A

located at the periphery of a hepatic lobule; contain a branch of the hepatic artery, portal vein, and bile duct (with lymphatics and nerves)

125
Q

3 functional zones of liver lobule

A

centrilobar (zone III), midlobar (zone II), and peripheral (zone I)

126
Q

blood flow in lobule

A

always flows from the periphery to the center of each hepatic lobule
this means oxygen and metabolites reach the peripheral cells first

127
Q

zone I hepatocytes

A

can rely on aerobic metabolism and are often more active in protein synthesis

128
Q

zone III hepatocytes

A

exposed to lower concentrations of nutrients and oxygen and are more involved with detoxification and glycogen metabolism

129
Q

bile production and flow

A

produced in hepatocytes and then flows into bile canaliculi that eventually connect to the small bile ducts in the portal triads. Bile flow progresses in a direction opposite to that of blood (center of lobule to periphery)

130
Q

sinusoids of liver cell

A
  • emerge where peripheral branches of portal vein and hepatic artery converge on lobules central vein.
  • lined by fenestrated endothelial cells that allow plasma to move into space of disse
  • contain phagocytic Kupffer cells
131
Q

Kupffer cells

A

found in sinusoid of liver; important in phagocytosis of ages RBCs, bacteria and other debris in the portal blood

132
Q

Ito cell

A

lives in the space of Disse and stores vitamin A and other fat-soluble vitamins

133
Q

gallbladder

A

pear-shaped organ that occupies space on posterior aspect of right lobe of liver. Composed of a blindly ending fundus, central body, and narrow neck. concentrates, stores, and releases bile

134
Q

bile volume per day

A

about 1000 mL flows into gallbladder and after concentration, about 30-50 mL is stored

135
Q

unique qualities of gallbladder

A
  • lacks muscularis mucosae and submucosa
  • epithelial cells capable of secreting small amounts of mucous; have active sodium-transporting mechanism necessary for concentration of bile
136
Q

epithelium of gallbladder

A

luminal folds lined by single layer of simple columnar

137
Q

cholecystokinin function in gallbladder

A

its released in response to presence of dietary fats in small intestine and induces contraction of gallbladder

138
Q

major types of salivary glands

A

parotid, submandibular, and sublingual

139
Q

organization of salivary gland

A

surrounded by CT capsule; septa extend from capsule into gland to create lobes; CT septae further divide lobes into smaller lobules; secretory component organizes as an acinus; have myoepithelial cells (basket cells)

140
Q

myoepithelial cells (basket cells)

A

flat and have long cytoplasmic processes that aid in contraction. they lie between epithelial cells and basal lamina of acini

141
Q

duct system transport in salivary glands

A

transports saliva from gland to oral cavity and modifies its ionic composition by reabsorbing Na+ and Cl- making it more hypotonic.

142
Q

intercalated duct of salivary glands

A

first segment out of acini and is lined with squamous or low cuboidal epithelium. empties into the striated or interlobar ducts located in CT septae that subsequently lead into main excretory duct system

143
Q

parotid glands

A

serous acini consist of pear-shaped groups of epithelial cells surrounded by distinct basement membrane. have dense cytoplasm and basal nucleus in epithelial cells. Acini have central lumen

144
Q

sublingual glands

A

mucous acini have abundant cytoplasm filled with clear mucus. cells are pyramidal with flattened basal nucleus

145
Q

submandibular glands

A

mixed acini chan be characterized by crescent-shaped formation of serous cells capping a mucous acinis (serous demilune) or by a mixed pattern of serous and mucous acini

146
Q

serous acini

A

secrete enzymes and other proteins

147
Q

mucous acini

A

secrete mucins that provide lubricating properties to saliva

148
Q

secretion of salivary glands

A

stimulated by ANS. Parasympathetic secretion, in response to taste or smell of food, promotes vasodilation and copious watery secretion. Sympathetic stimulation produces a small amount of viscous saliva

149
Q

micturation

A

urination

150
Q

defacation

A

bowel movement

151
Q

parturition

A

childbirth

152
Q

3 flat muscles of abdominal wall

A

external oblique, internal oblique, and transverse abdominus.
They are a continuation of the 3 intercostal muscle layers of the thorax

153
Q

rectus abdominus

A

the vertical muscle on the abdominal wall and lies within the rectus sheath, which is the aponeurosis of the flat muscles

154
Q

linea alba

A

“white line”
where the aponeurosis from each side interdigitate in the midline between paired rectus muscles
Has tendinous intersections that make the “six pack”

155
Q

anterior rectus sheath

A

formed by aponeurosis of external oblique and part of that from internal oblique

156
Q

posterior rectus sheath

A

formed by rest of aponeurosis from internal oblique and that of transverse abdominus

157
Q

arcuate line

A

where the posterior rectus sheath ends. the inferior 1/3 is absent

158
Q

layers of abdominal wall superficial to deep

A

skin, superficial fascia (split into Camper’s and Scarpa’s), external oblique, internal oblique, transverse abdominus, transversalis fascia, and a serous membrane (parietal peritoneum)

159
Q

direct inguinal hernia

A

a weakening in the abdominal wall in an area called Hasselbach’s triangle that allows abdominal contents to protrude. Occurs above the inguinal ligament

160
Q

indirect inguinal hernia

A

a congenital defect in the inguinal canal. Occurs above the inguinal ligament.
In males, the spermatic cords pass through here, which are bigger than the round ligament of the uterus in females. Thus more common in males.

161
Q

femoral hernia

A

occurs more commonly in women and is below inguinal ligament. portion of abdominal contents protrude through the medial-most compartment of the femoral triangle

162
Q

neurovascular supply of abdomen

A

nerves and vessels of anterolateral abdominal wall travel between deep and middle layers of muscle (transvers abdominus and internal oblique)
The nerve are the ventral rami of spinal nerves T7-L1

163
Q

anterior rami of T7-T11

A

are continuations of the intercostal nerves

164
Q

anterior rami of T12

A

the subcostal nerve

165
Q

anterior rami of L1

A

splits into iliohypogastric and ilioinguinal nerves

166
Q

superior and inferior epigastric arteries

A

run posterior to the abdominus muscle, within the posterior rectus sheath

167
Q

transumbilical plane

A

level of T10, splits the upper and lower quadrants of abdomen

168
Q

McBurney’s point

A

1/3 between anterior superior iliac spine and the umbilicus. It is where the appendix attaches to the cecum

169
Q

abdominal regions

A

demarcated by 2 vertical midclavicular planes and 2 horizotal planes (subcostal and intertubercular planes)

right to left and top to bottom they are:
right hypochondrium, epigastric, left hypochondrium
right flank, umbilical, left flank
right groin, pubic, left groin

170
Q

peritoneum

A

simple squamous (serous) epithelium lining abdominal cavity

171
Q

What is found in the peritoneal cavity?

A

only serous peritoneal fluid, which allows the viscera to move without friction

172
Q

Difference in men vs women for peritoneal cavity

A

its closed in men, but in women the uterine tubes open into the peritoneal cavity, creating a potential route for spread of infections

173
Q

any organ that has mesentery is said to be

A

intraperitoneal

174
Q

pain from parietal peritoneum

A

it shares sensory information with abdominal wall, spinal nerves T7-T11, so pain is sharp, somatic pain localized along a dermatome

175
Q

pain from visceral peritoneum

A

it shares sensory innervation with the viscera, so pain is diffuse, referred pain

176
Q

pain from foregut organs

A

refers to epigastric region

177
Q

pain from midgut organs

A

refers to umbilical region

178
Q

pain from hindgut organs

A

refers to pubic (aka hypogastric) region

179
Q

epiploic foramen (of Winslow)

A

the entrance to the lesser sac of the peritoneal cavity; the greater and lesser sacs (aka omental bursa) communicate through this

180
Q

ascites

A

excess peritoneal fluid accumulating due to pathology. In this case, it usually flows downward as opposed to the typical upward flow of peritoneal fluid

181
Q

supracolic and infracolic compartments

A

the transverse mesocolon divides the greater sac into these 2 regions

182
Q

anastamosis at the foregut-midgut junction

A

the superior pancreaticoduodenal artery (branch of celiac trunk) anastamoses with the inferior pancreaticoduodenal artery (branch of the SMA)

183
Q

anastamosis at the midgut-hindgut junction

A

the middle colic artery (branch of SMA) anastamoses with the left colic artery (branch of the IMA)
If this anastamosis is not “robust,” this “watershed” area is vulnerable to ischemia

184
Q

marginal artery

A

an arterial arch formed by anastamoses between left, middle, and right colic arteries

185
Q

Why are loops of the small intestine suscepible to ischemia?

A

intestinal branches of the SMA do not anastamose with branches of the celiac trunk or IMA

186
Q

anastamosis on the rectum (hindgut)

A

between superior rectal (terminal branch of IMA) and the middle and inferior rectal arteries (off the internal iliac artery)

187
Q

cisterna chyli

A

the dilated proximal end of the thoracic duct where lymph is returned

188
Q

blood entry to the liver

A

30% from hepatic artery and 70% from portal vein

it leave liver via hepatic veins, which drain into IVC

189
Q

spleen

A

functionally a large lymph node that lies in the LUQ (hypochondrium)

190
Q

engorged veins from increased blood flow at liver can cause

A

esophageal varices, hemorrhois, and caput medusae (cutaneous engorged veins around umbilicus)

191
Q

cirrhosis of liver (fibrosis)

A

disrupts portal blood flow, leading to portal HTN and engorgement of portosystemic anastamoses

192
Q

AAA (abdominal aortic aneurysm)

A

localized abnormal dilation of the aorta that occurs when the structure of the aortic wall is compromised (usually at the IMA)
HTN and atherosclerosis are the major causes
Symptoms can include abdominal and back pain, nausea, and early satiety. Up to 75% are asymptomatic. Sharp tearing pain accompanies rupture of AAA

193
Q

SAD PUCKER

A 
mnemonic to remember which organs are retroperitoneal:
S = Suprarenal (adrenal) glands
A = Aorta/Inferior Vena Cava
D = Duodenum (second and third segments)
P = Pancreas
U = Ureters
C = Colon (ascending and descending only)
K = Kidneys
E = Esophagus
R = Rectum

Clinical Morphology (25 decks)

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