10/19: Abdomen and 10/20 ANS abdomen and 10/25 posterior abdominal wall and anterior Flashcards


Set Details Share
created 5 weeks ago by obhill
3 views
HAVE NOT WATCHED WHOLE LECTURES YET. I think i got up to 17 of first one. watch later for review and to check it
updated 4 weeks ago by obhill
show moreless
Page to share:
Embed this setcancel
COPY
code changes based on your size selection
Size:
X
Show:
1

portal hypertension: what causes?

what happens?

When bloodflow through the liver is impeded (e.g., by scarring from cirrhosis or a tumor),

  • Must make its way to superior or inferior vena cava (caval system) without passing through the portal vein (thru portacaval anastomoses)
2

para umbillical veins: what are they part of

portal system

3

caput medusa

result of the para-umbillical veins of portal system becoming anastomosed with the peri-umbillical superior epigastric veins (portal htn)

4

esophageal varices

  • Potentially life-threatening symptom that occurs due to dilation of esophageal veins as blood exploits another portacaval anastomosis
5

three anastomoses that may happen from portal hypertension

1. para-umbillical veins of anterior abdomen

with

2. peri umbillical superior epigastric veins

1. esophageal left gastric vein brances

with

2. higher esophageal branches from azygos

1. superior rectal and middle rectal

with

2. inferior rectal veins

6

internal hemorrhoids

can rupture and bleed: autonomic innervation means it is not really painful or irritating

result of portal htn anastomoses of rectal veins dilating

7

WhWhere is the diaphragm at rest

whet does it elevate to when someone exhales

rib 7 on the right, a little lower on the left bc liver on right

5th rib

8

superior boundary of abdominal cavity

diaphragm

9

is the GI tract/gut continuous

yes, from mouth to anus

10

foregut, midgut, hindgut structures AND blood supply

card image
11

is the esophagus in the abdominal cavity

i thnk foregut based on embryonic lecture

12

continuity of abdominal peritoneum

the parietal and visceral are continuous w each other

13

greater omentum

double-fold of peritoneal tissue that hangs down like an apron over the viscera

14

what membranous structure in the abdomen can slow down inflammation? how?

  • greater omentum
  • Can form adhesions around an area of inflammation to slow its spread and induce an immune response, reducing risk of sepsis
15

omental bursas and foramen

card image

lesser: area behind lesser omentum and stomach

greater omental bursa: area in front of the stomach/larger cavity

omental foramen is only passage thru (pic)

16

lesser omentum location

btwn liver and stomach/duodenum

17

what limits the spread of infection thru the cavity

lesser omentum bc separate omental bursa. keeps stuff behind stomach for a while for example

18

divisions of lesser omentum

hepatogastric and hepatoduodenal ligaments based on attachment regions

19

mesentery:

purpose (2)

what is it continuous with?

suspends small intestines from the posterior abdominal wall, encloses their vascular, continuous w both aspects of peritoneum

20
card image

mesentery role here

card image

mesentery is attached to peritoneal peritoneum, which attaches to visceral, which suspends small intestine

ALSO notice that the greater omentum is attached to transverse colon

21

retro vs intraperitoneal

Intraperitoneal organs are situated in the intraperitoneal space and lined by the peritoneum, whereas retroperitoneal organs are situated behind the intraperitoneal space and not lined by the peritoneum

22

peritoneal cavitymeaning

space btwn parietal and visceral peritoneal layers... usuallllly just contains serous peritoneal fluid, NO ORGANS!

23

ascites

buildup of excess peritoneal fluid

24

Most abdominal organs are

card image

intraperitoneal

25

retroperitoneal

examples (3)

kidney, PARTS OF duodenum, colon

develop or progress during development to a location outside peritoneal cavity

DEEP SURFACE STILL HAS PARIETAL PERITONEUM! (body wall on other side)

26

Spleen and gut relationship

  • *The Spleen is not derived from the gut, but is guilty by association, sharing common blood supply with foregut structures
27

developed as diverticula off the foregut

liver

gallbladder

pancreas

28

Stomach spatial relationships

card image
29
card image
card image
  • Cardia—trumpet-shaped superior end at base of esophagus
  • Fundus—bulges above the cardia
  • Body—large region of the stomach between the cardia and the pyloric canal
  • Pyloric canal—funnel-shaped distal end of the stomach; has a sphincter that controls release of chyme into duodenum
  • Greater curvature
  • Lesser curvature
30

Rugae

Gastric canal

Pyloric Sphincter

card image

Stomach:

  • Internal anatomy
  • Rugae (Gastric folds)—pronounced when the stomach is empty; flatten out when stomach is full
  • Gastric canal—temporary longitudinal furrow that forms during swallowing to allow the passage of saliva and fluids
  • Pyloric sphincter (to duodenum)—controls rate at which chyme can pass from stomach to duodenum
31

duodenum in relation to the vertebra: levels? (4 parts, also what are they called? locations of each

card image
32
card image
card image

hepatopancreatic ampulla: bile duct and main pancreatic duct drain into here

33

ascending part of the duodenum: why is its shape the way it is?

card image

flexed due to suspensory ligament

34

Head of pancreas: where?

where is the body?

tail?

___ peritoneal

main pancreatic duct...

card image
35

where are exocrine secretions of the pancreas released?

2nd part of duodenum in the presence of chyme

36

ucinate process

wraps around the superior mesenteric artery off of pancreas

37

largest internal organ

liver

38

largest gland in body

liver

39

what does the liver produce as a gland? (3)

  • serum albumen protein (for blood)
  • bile (emulsifier of fat).
  • Lymph
  • Liver produces ¼-½ of all the lymph received by the thoracic duct.
40
card image

Hilum of liver aka

what are the three parts

additionally...

card image

porta hepatis

The porta hepatis/hilum of the liver (on the liver’s inferior surface) gives passage to:

  • the hepatic portal vein
  • hepatic arteries
  • Hepatic ducts (COMMON BILE) (also right and left hepatic and common hepatic? idk)
  • (Also hepatic nerve plexus and lymphatic vessels.)

Note that the blood in both the common hepatic artery and hepatic portal vein is running toward the liver

41

Common bile duct

Carries bile (digestive enzymes produced by liver and stored in gallbladder) to duodenum to aid in digestion

42
card image
card image
43

Left and right lobe separation

  • Separated by ”falciform ligament”, a peritoneal structure containing a remnant of the umbilical vein (“round ligament” or “ligamentum teres” of liver); connects liver to anterior abdominal wall
44

Functionally, the liver can be subdivided into hepatic segments with

  • their own blood supply and venous and biliary drainage, facilitating partial liver transplantation
45

Gallbladder function

when does it contract? what does that do?

card image
46

where does bile enter the gallbladder from?

  • right and left hepatic ducts
  • converge into common hepatic duct

------ which Shunts bile to gallbladder through cystic duct

47
card image
card image
48

Largest lymphoid organ in body

  • SPLEEN
  • Filters blood for pathogens and senescent, injured, and infected blood cells
49

Where is the spleen

ULQ, behind stomach

50

what is the spleen in

card image

a capsule

this is what can rupture during trauma and cause major bleeding

51

Jejunum:

how much of the small intestine?

where is it in relation to ileum

~2/5 of small intestine

Continuation of small intestine distal to duodenum and proximal to ileum

Tends to be higher and further left than ileum

52

ileum amount of small intestine

3/5???

53

Ileum vs Jejunum:

walls

vascularization

digestion

card image
54

Quadrant of the ileocecal junction

lower right quadrant

55

vermiform appendix

Vermiform appendix suspends from cecum, which is a blind sac at the lower end of the ascending colon

56

R colic flexures and L colic flexures

R colic: aka hepatic. transition from ascending to transverse colon

L colic: aka splenic. transition from transverse to descending

57

peritoneal-ness of the colon

card image

ascending colon ia secondarily retroperitoneal,

transverse is intraperitoneal

descending: secondarily retroperitoneal

sigmoid: intraperitoneal

58

transverse mesocolon

mesentery that suspends the transverse colon

59

what quadrant is Sigmoid colon in

lower left

60

mesosigmoid

mesentary suspending sigmoid colon

61

body wall structure vascular supply vs abdominal viscera vascular supply

card image
62

Unpaired branches of the abdominal vasculature (arteries)

card image
63

2 things that the left gastric artery supplies

card image

lesser curvature of stomach

lower esophagus and stomach

64

cystic artery

comes off the right hepatic artery...

65
card image

Stomach Blood supply

card image
66

what artery is vulnerable to damage by severe pyloric ulcers?

card image

gastroduodenal artery... because it passes behind the first portion of the duodenum!

67

Pancreas arterial supply

card image

Common hepatic: Gastroduodenal:: anterior/posterior superior pancreaticoduodenal artery

Splenic artery: dorsal, great, inferior pancreatic artery

superior mesenteric: inferior pancreaticoduodenal

68
card image
card image
69

what does the superior mesenteric artery pass over? (organ)

inferior duodenum! (supplies midgut)

70

superior mesenteric artery and mesentery

fans out throughout... like an upside down christmas tree!

71
card image
card image

notice how the middle colic is like right over the body of pancreas?

72

where is the superior and inferior mesenteric artery anastomoses?

the left colic flexure ?

73

2 branches of inferior mesenteric artery

both anastomose

other branch

left colic, sigmoid

superior rectal, most medial

74

left colic artery: what does it supply? anastomose

anastomoses with middle colic artery at marginal artery

descending colon

75

sigmoid artery: what does it supply?

anastomoses

sigmoid colon and superior rectum

anastomoses with inferior rectal artery

76

corresponding veins of sigmoid and rectal arteries (middle/inferior)

drain into the caval system

sooo... are these paired?

77

Lymphatic Drainage of abdomen viscera: all is bound for...

cysterna chyli and thoracic duct !

78

Emulsified fats from the blood enter...

the lymph before blood! as lacteals

79

lymphatic pathways of abdomen:

located near...

and what are these important to understand?

near major arteries

important for understanding routes of cancer metastasis

80

Portal Venous system: what drains into it?

blood from the three unpaired arteries of gut does not drain directly back into the ivc! goes thru the hepatic portal vein for filtration

ALSO: by products of RBCs from spleen

81

hepatic portal vein oxygen status

what veins join to form it?

To conceptualize the function of the portal system:

  • At the GI tract, blood gives away some oxygen, but also absorbs nutrients, etc.
  • This blood is carried to the liver for filtration before absorbed substances are returned to the heart for circulation
  • The vessel that carries this blood to the liver for filtration is the portal vein

so... is it like partially oxygenated???

splenic vein and superior mesenteric vein!!!

82

inferior mesenteric vein drainage

drains into the portal system, and often into the splenic vein, but variable

83
card image
card image
84

all blood from the liver eventually drains into...

the hepatic veins into the IVC

85

hepatic portal vein contributions

  • Recall that the hepatic portal V. is part of the portal triad
  • 70% of blood volume and 40% of oxygen to liver????
  • (30% of volume and 60% of oxygen come from arterial blood via the hepatic artery proper)?????
86

what does the sympathetic nervous system do to the bronchi?

inhibits parasympathetic constriction!

google says it actually dilates too (bc says inhibits parastalsis only idk)

87

what two things does the sympathetic nervous system inhibit

peristalsis

parasympathetic bronchiole constriction

88

sympathetic ganglion

where many of the neurons synapse, passing the impulse to a new neuron so that the second neuron travels to a target organ!

AT EACH VERTEBRAL LEVEL

89

true or false: all sympathetic neurons have to pass thru the sympathetic trunk

true

90

sympathetic nerves that are bound for visceral cavities...

do not have spinal nerves, so they form their own!

autonomic only are called splanchnic nerves!

91

vertebral levels and ganglion area

Greater splanchnic nerve

Lesser

lumbar splancnic

t5-t9 (diff from first lecture???), synapse at the celiac ganglion

t10-t11, synapse at the superior mesenteric ganglion

L1-L2, synapse at inferior mesenteric ganglion

92

what does the least splanchnic nerve supply?

what are the neurons from

kidneys

(neurons from t12)

93

L1-L2 sympathetics supply what?

pelvic viscera

94

parasympathetic nerves are simpler than sympathetic because...

they do not synapse until they reach a target organ

95

what supplies the thoracic and abdominal viscera? ("guts)

vagus nerve

96

Pelvic splanchnic nerves supply what?

hindgut and pelvic viscera

97

Enteric nervous system: what?

3 parts

parasympathetic abdominal neurons and interneurons

1. provides gut motility via:

A. meissner's submucosal plexus: helps with peristalsis movement of bowels

B. myenteric plexus of auerbach

98

Parasympathetics/sympathetics: motor/efferent or sensory/afferent

motor duh

99

pathway of efferent and afferent autonomics

run along same

100

referred pain

  • Structures that only have autonomic innervation ( no somatic innervation) send signals back to the CNS through spinal nerves
  • We usually don’t consciously feel much
  • When visceral pain reaches a threshold, we become consciously aware of it
  • Our brains think it’s coming from the somatic nerve at that level
101

See abdominal ans slides 28-31 on monday (she will discuss it then)

...

102
card image
card image
103

Structures transmitted thru the diaphragm between the thorax and abdomen (last two i did not realize)

esophagus

IVC

aorta

lymphatics

nerves

104
card image

also, which dome is higher? why?

where does each dome rise to during ____?

also: arcuate ligaments. what do they do? how many? what do they pass over?

card image

RIGHT is higher (typo)

105

Openings of diaphragm: name their Opening spots, Vertebral level, action during diaphragmatic CONTRACTION, and what goes thru it

card image
106

Posterior Abdominal viscera:

what are organs embedded in?

visceral vs body wall surface

card image
107

Perineal vs pararenal fat

card image
  • The kidney has a proximal layer of “perirenal fat” embedded in renal fascia
  • ”pararenal” fat refers to the outer layer of extraperitoneal fat that the kidney and its perirenal fat are embedded in

(PERI: surrounding. PARA: alongside of)

108

Kidneys:

vertebral level

arteries vs. vein: which is deeper

T12-L3, RIGHT IS SLIGHTLY LOWER bc liver!!!

arteries are DEEPER

109
card image

also, what is a major and minor calyx?

card image

Pyramids are seprated by renal columns

pyramids' apex goes into the papilla...

  • projects into a minor calyx
  • several minor calyces combine to form a major calyx
  • The major calyces drain into the renal pelvis, the dilated upper end of the ureter.
110

Location of ureters throughout their course to the bladder

  • Retroperitoneal throughout their course
  • Pass dorsal to gonadal vessels
  • Cross pelvic brim near bifurcation of common iliac aa.
111

3 natural constrictions of the ureters

junction of ureter and renal pelvis

brim of pelvic inlet

as they pass thru the bladder wall

112
card image
card image
113

Suprarenal Glands

2 regions/secretions

Arterial Supply

Venous Drainage

card image
114
card image
card image
115
card image
card image

notice how the right gonadal and suprarenal vein drain into IVC, while the left gonadal and suprarenal vein drain into the left renal vein

116

Gonads during development

where are they relative to peritoneum

ductus deferens

during evelopment, the gonads descend

they develop as posterior abdominal organs

ductus deferens=testicular drainage

117

need to know slide 16 of posterior wall photos?

...

118

Vertebral levels:

Celiac Trunk

Superior mesenteric

Inferior mesenteric

Bifurcation of Aorta

T12

L1

L3

L4

119
card image
card image

notice that the inferior phrenic artery is above the celiac trunk

120

What does the inferior phrenic artery supply?

Renal?

Lumbar?

Gonadal?

  • Inferior Phrenic aa.
  • Supplies abdominal side of diaphragm and sends a branch to adrenal glands
  • Renal aa.
  • Supply kidneys and send a branch to adrenal glands
  • Lumbar aa.
  • Supply posterior abdominal wall muscles
  • Gonadal aa.
  • Supply testes/ovaries
121

3 unpaired branches that drain into the portal vein

paired branches that supply structures of abdominal wall and drain into the IVC

celiac trunk, superior and inferior mesenteric

inferior phrenic artery, renal artery, lumbar artery, gonadal artery, aorta bifurcation

122

Superior Mesenteric Artery syndrome (SMA syndrome)

what may cause it? (2)

  • Superior mesenteric artery partially or completely obstructs distal duodenum by impinging it against aorta at the point where it crosses ventral to the gut.
  • May be caused by:
  • rapid weight loss in which the loss of abdominal fat causes repositioning of the SMA
  • Congenital malformations (e.g. of suspensory ligament or SMA origin)
123

Suspensory Ligament

card image

The suspensory muscle of duodenum is a thin muscle connecting the junction between the duodenum, jejunum, and duodenojejunal flexure to connective tissue surrounding the superior mesenteric artery and coeliac artery.

124
card image

SMA syndrome... note that the stomach and duodenum are greatly distended on this CT

125

Nutcracker syndrome

what 3 symptoms may occur?

what may it go with

treatments

card image
126
card image

Nutcracker syndrome: the SMA is impinging the left renal vein against the aorta

127

Neurovasculature of the gut

card image
128
card image

what does each carry? where does each synapse?

card image

Greater Splanchnic Nerve: carries presynaptic sympathetic fibers from T5-T9, SYNAPSE is in celiac ganglion

Celiac ganglion: receives presynaptic fibers from splanchnic nerve!... postsynaptic fibers leave the ganglion for distribution to foregut structures. run alongside celiac trunk branches!

Superior mesenteric ganglion: receives presynaptic fibers from LESSER splanchnic nerve (T10-t11)... postsynaptic fibers leave ganglion for distribution to midgut structures, running w branches from SMA!

inferior mesenteric ganglion: receives pre-synaptic fibers from lumbar splanchnic nerve (L1-L2)... postsynaptic fibers leave ganglion for distribution to hindgut structures, running w IMA branches!

Sympathetic trunk: continues down into sacrum, distributing sympathetic fibers below the L2 level!

Sacral splanchnics supply sympathetics to pelvic viscera (NOT PELVIC SPLANCHNIC!)

129

Vertebrae Levels of:

Subcostal n

Iliohypogastric and ilioinguinal nn

Lateral Femoral Cutaneous

Genitofemoral

Femoral

Obturator

Lumbosacral trunk

card image
130

What does the ilioinguinal nerve supply?

Lateral femoral cutaneous?

genitofemoral?

ilioinguinal passes through inguinal canal to supply inguinal region with cutaneous innervation (level of L1 dermatome)

; passes under inguinal ligament to supply cutaneous innervation to skin of superolateral thigh

Supplies cutaneous innervation to medial thigh and lateral scrotum/labia majora

Carries both afferent and efferent branches of cremasteric reflex in males (stroking inner thigh causes reflexive contraction of ipsilateral cremaster

131

What does the femoral nerve supply?

Obturator?

Lumbosacral Trunk?

motor innervation to thigh

medial compartment of thigh

lumbar contribution to lumbosacral plexus deep into sacral region

132
card image

Useful landmarks on anterior abdominal wall:

describe as well

card image
133
card image

Layers of anterior abdominal wall

card image
  • Scarpa’s fascia: (membranous layer)----------Below umbilicus; essentially follows “bikini line” and fades toward umbilicus
  • Accounts for less bulging during pregnancy, etc.
134

Lateral wall of anterior abdomen:

3 layers of muscle

Anterior wall:

2 muscles

what are each homologous to?

card image
135

where do anterior abdominal muscles meet?

the midline at the aponeurosis (sheet like, tendinous attachment)

136
card image
card image
137

External oblique fiber orientation

  • External Oblique muscle
  • Most superficial
  • Postero-superior to antero-inferior fiber orientation
  • (slipping your hand into a pocket)
138

Internal oblique muscles orientation

posterior inferior to antero-superior

like the internal intercostals

perpendicular to the external

139

Transverse abdominus layer

card image
140

Rectus abdominis

also what is its action? (2)

card image
141

rectus sheath

above and below arcuate line (and where is that found)

card image

arcuate line is found 1/3 way from umbillicus to pubis

142

what covers the anterior abdominal wall's posterior surface?

card image
143
card image
card image
144

Anterior abdominal wall blood supply

predominantly paire, segmented lumbar arteries

also, superior and inferior gastric arteries

145
card image
card image
146

venous drainage of the anterior abdominal wall (3)

around umbillicus

above

below

card image

periumbillical: large collection of veins that drain superficial arteries? paired w the arteries of anterior abdominal wall

above umbilicus:

---drains towards axillary vein by THORACOEPIGASTRIC

below the umbillicus:

---drains into femoral vein via SUPERFICIAL EPIGASTRIC VEIN

147

Anterior abdominal wall nerve supply:

predominantly:

costal margin

umbillicus

inguinal ligament

card image
148

Vas deferens

drains gametes (sperm) to urethra

149

Gubernaculum

pulls testes thru the abdominal wall and into the scrotum during development

150

where do the testes develop?

what is their arterial supply

posterior abdominal wall, near the kidneys

testicular artery of aorta

151

need to know slide 21 pic on ant abd?

...

152

As the testis descend thru the layers of the abdominal wall, each layer...

processus vaginalis:

contributes to the spermatic cord

processus vaginalis is an outpouching of peritoneum that is pulled with the testes. this wraps around the testis to form the tunica vaginalis

153

what becomes the internal spermatic fascia

transversalis fascia

154

does the aponeurosis of the transversus abdominus contribute to the spermatic cord?

no

155

cremasteric fascia and cremaster muscle:

part of what

what contributes to it

nervous supply of the muscle

purpose of the muscle

  • The aponeurosis of the internal oblique muscle and slips of muscle contribute to the cremasteric fascia and cremaster muscle of the spermatic cord.
  • The cremaster muscle is supplied by the genital branch of the genitofemoral n.
  • pulls the testis closer to the body in response to cold temperatures.
156

where does the external spermatic fascia come from?

external oblique aponeurosis

157

deep inguinal ring formation

superficial inguinal ring formation

deep: formed as the testis passes thru the transversalis fascia

superficial: as the testis pass thru the external oblique aponeurosis

158

What is the scrotum

an outpouching of skin and dartos fascia

159

Spermatic cord contents

card image
160

pampiniform venous plexus:

what does it do, what is it a part of, what does it drain to

it cools arterial blood

drains into the testicular vein

is part of the spermatic cord

161

female round ligament of the uterus: what is it a remnant of?

remnant of the fetal gubernaculum

162

inguinal canals male vs females

smaller

163

Inguinal Hernias

what is an indirect one? (what does it do, where does it start?)

card image
164

Direct inguinal hernia

card image