Term
| How far does the diaphragm rise on each side? |
|
Definition
Right dome- 5th rib
Left dome- 5th intercostal space |
|
|
Term
| What organs are protected by the lower ribs so can be injured in fractures of the lower ribs? |
|
Definition
|
|
Term
| What is in the R upper quadrant? |
|
Definition
| liver (right lobe), gallbladder, stomach (pylorus), duodenum (parts 1-3), pancreas (head), R suprarenal gland, R kidney, R colic (hepatic) flexure, ascending colon (superior part), transverse colon (right half) |
|
|
Term
| What is in the R lower quadrant? |
|
Definition
| cecum, vermiform appendix, most of ileum, ascending colon (inferior part), R ovary, R uterine tube, R ureter (abdominal part), R spermatic cord (abdominal part), Uterus (if enlarged), urinary bladder (if very full) |
|
|
Term
| What is in the L upper quadrant? |
|
Definition
| liver (left lobe), spleen, stomach, jejunum and proximal ileum, pancreas (body and tail), L kidney, L suprarenal gland, L colic (splenic) flexure, transverse colon (L half), descending colon (superior part) |
|
|
Term
| What are the 9 regions of the abdomen? |
|
Definition
divided by 2 vertical midclavicular planes, 2 horizontal planes: subcostal plane thru 10th costal cartilage (transpyloric plane) and transtubercular plane thru tubercles of iliac crest (level of Lv5)
Midline regions- epigastric, umbilical, hypogastric (pubic)
Lateral regions- hypochondrac , lateral (flank), inguinal (groin) |
|
|
Term
| What consists of the abdominal wall proper? |
|
Definition
| 5 lumbar vertebrae P and wings (alae) or ilia L |
|
|
Term
| What is in the superficial fascia of the anterolateral abdominal wall? |
|
Definition
| cutaneous nerves, including lateral/anterior cutaneous branches of thoracoabdominal nerves (T7-11- pain from disease of lower thoracic wall may be referred to abdomen, T10 innervates umbilicus), subcostal nerve (T12), iliohypogastric and ilioinguinal nerves (L1) |
|
|
Term
| What are the arteries of the anterolateral abdominal wall? |
|
Definition
| Superficial vessels branches of femoral artery- superficial epigastric arteries and superficial circumflex iliac arteries |
|
|
Term
| What are the arteries of the abdominal wall as deeper vessels? |
|
Definition
| inferior epigastric (external iliac) and superior epigastric (internal thoracic) which anastomosis as potential source of collateral circulation, deep circumflex iliac artery from external iliac artery |
|
|
Term
| What are the collateral routes for return of blood to the hear if inferior/superior vena cava is obstructed? |
|
Definition
|
|
Term
| What are the 2 anastomoseses to return blood to the heart if inferior/superior vena cava is obstructed? |
|
Definition
first-superficial epigastric vein (femoral vein) with lateral thoracic vein (axillary vein) to form thoracoepigastric vein
second- inferior epigastric vein (external iliac) with superior epigastric vein (brachiocephalic) w/in rectus sheath |
|
|
Term
| What is the lymphatic drainage from the anterolateral abdominal wall? |
|
Definition
| superficial lymphatic vessels above umbilicus draining mainly upward to axillary lymph nodes and below umbilicus downward to superficial inguinal lymph nodes, deep lymphatic vessels accompanying deep veins of abdominal wall |
|
|
Term
| What are the 2 layers of the superficial fascia inferior at level of the umbilicus? |
|
Definition
| superficial fatty layer- Camper's fascia, deep membraneous- Scarpa's fascia |
|
|
Term
| What is Scarpa's fascia continous with and what can this cause? |
|
Definition
| superficial penile fascia, dartos fascia of scrotum, and Colles' fascia of perineum- extravasated urine from ruptured penile urethra may spread upward into the A abdominal wall (doesn't spread to thigh because Scarpa's fascia fuses w/ fascia lata of thigh just below the inguinal ligament) |
|
|
Term
| What are the 3 muscles on each side of the anterolateral abdominal wall and what do they develop from? |
|
Definition
| external oblique, internal oblique, and transversus abdominis; develop from same 3 layers of hypomere in embryo as 3 layers of the intercostal muscles of the thoracic wall |
|
|
Term
| Where does the external oblique muscle originate and insert? |
|
Definition
| arises from lower 8 ribs and courses inferomedially, has posterior fibers inserting into iliac crest and A has broad external oblique aponeurosis that helps form A layer of rectus sheath |
|
|
Term
|
Definition
| where aponeurotic fibers intersect w/ fibers from other side |
|
|
Term
| Where is the external oblique aponeurosis? |
|
Definition
| Between anterior superior iliac spine and pubic tubercle, forms inguinal ligament, spermatic cord lies in shallow gutter formed by inguinal ligament |
|
|
Term
| Where does the internal oblique muscle originate and insert? |
|
Definition
| arises from thoracolumbar fascia, iliac crest, and lateral 1/2 of inguinal ligament, fiber course superomedially at R angle to external oblique and continue into internal oblique aponeurosis |
|
|
Term
| What do the inferior fibers of the internal oblique join to form the conjoint tendon (falx inguinalis)? |
|
Definition
| deeper transversus abdominis muscle, tendon arches over spermatic cord to attach into pubic crest and pecten pubis |
|
|
Term
| What separates the two sides of the rectus abdominis muscle? What is it bounded by? |
|
Definition
linea alba- no major nerves/BVs corss so can do surgical incisions here
linea semilunaris which is more obvious in thin/muscular individuals |
|
|
Term
| How is the rectus sheath different above and below the arcuate line? |
|
Definition
Above- the internal oblique aponeurosis splitting to contribute to both A/P layers
Below- all 3 aponeuorses passing A to rectus abdominis, P surface is in contact with transversalis fascia |
|
|
Term
| What are the functions of the anterolateral abdominal muscles? |
|
Definition
| support/protection of organs (involuntary spasms may occur due to inflammation that irritates nerve supply (appendicitis) or palpation w/ cold hands), relaxation/contraction in breathing, increase intra-abdominal pressure (micturition-emptying bladder, defection, coughing/sneezing, parturition-giving birth), movement (flexion of trunk-bilateral contraction, lateral felxion-one side contracts/ipsilateral, rotation of trunk-one internal oblique and contralateral external oblique to side of internal oblique) |
|
|
Term
| What is in the inguinal region? |
|
Definition
area of weakness, contains inguinal canal- transmits large spermatic cord or round ligament of uterus
extends inferomedially from deep inguinal ring to superficial inguinal ring w/in external oblique aponeurosis |
|
|
Term
| What are the boundaries of the inguinal canal? |
|
Definition
anterior wall- external oblique aponeurosis w/ reinforcement laterally from internal oblique aponeurosis
posterior wall- transversalis fascia reinforced medially by conjoint tendon
roof- arching fibers of internal oblique and trasversus abdominis
floor- inguinal ligament reinforced medially by lacunar ligament |
|
|
Term
| What is a hernia and where does it occur in the abdominal region? |
|
Definition
hernia- protrusion of an organ/other structure from its normal anatomic enclosure
may be through congenital or acquired defect in abdominal wall (external hernia) or through internal opening (internal hernia)
msot occur in inguinal, umbilical, or epigastric region |
|
|
Term
| What are the 2 types of hernias? |
|
Definition
| follow path of testis (indirect inguinal hernia-leaves abdominal cavity lateral to inferior epigastric artery) or push directly though weak area of abdominal wall more medially (direct inguinal hernia) |
|
|
Term
| What causes an indirect inguinal hernia? |
|
Definition
follows the path of embryonic descent of testis through inguinal canal and exits the superficial inguinal ring, is due to persistance of evagination of peritoneum on each side (processus vaginalis)
considered congenital since its a persistent processus vaginalis, may be in women if have peritoneal pouch (canal of Nuck) |
|
|
Term
| What are the 3 fascial coverings of the spermatic cord? |
|
Definition
| internal spermatic fascia (from transversalis fascia), cremasteric fascia (from internal oblique muscle), external spermatic fascia (from external oblique aponeurosis) |
|
|
Term
| What is the risk associated with an indirect inguinal hernia? |
|
Definition
| significant risk of becoming entrapped (incarceration) w/bowel obstruction and possible loss of blood supply (strangulation) |
|
|
Term
| Where does the direct inguinal hernia leave? |
|
Definition
| abdominal cavity medial to inferior epigastric artery, pushes directly into inguinal canal through or around a weak conjoint tendon, protrudes through inguinal (Hesselbach's) triangle formed by inferior epigastric artery laterally, rectus abdominis meidally, and inguinal ligament inferiorly |
|
|
Term
| What are the characteristics of a direct inguinal hernia? |
|
Definition
| has hernial sac formed by transversalis fascia, fains outer covering by external spermatic fascia as it protrudes though superficial inguinal ring, less likely to descend into scrotum than an indirect inguinal hernia, classfied as acquired lesion |
|
|
Term
| What are the factors that oppose inguinal hernia formation? |
|
Definition
| contraction of internal oblique/transversus abdomins muscle fibers(indirect), pressure of posterior wall of inguinal canal toward the anterior wall (indirect), location of conjoint tendon (direct) |
|
|
Term
|
Definition
| severe congenital hernia- due to failure of bowel to return to body cavity following its normal embryonic herniation, covered by amnion |
|
|
Term
|
Definition
| due to herniation of abdominal contents through the body wall lateral to umbilicus into amniotic cavity, viscera are NOT covered by amnion |
|
|
Term
| What are incisional hernias? |
|
Definition
| protrusions of omentum or organs thru sites of surgical incisions, may result from improper healing of abdominal wall following surgery or from weakness of abdominal wall muscles following the cutting of their motor nerve supply |
|
|
Term
| What does the digestive system consist of? |
|
Definition
| oral cavity, pharynx, esophagus, stomach, SI, LI, accessory digestive organs: salivary glands, liver, gallbladder, pancreas |
|
|
Term
| What kind of muscle makes up the esophagus? |
|
Definition
| upper 1/3 skeletal, middle 1/3 mixed, lower 1/3 smooth |
|
|
Term
| where is the lower esophageal sphincter located? |
|
Definition
| at esophageal hiatus of diaphragm |
|
|
Term
| what are the 3 constrictions of the esophagus? |
|
Definition
cervical- caused by upper esophageal spincter at pharyngoesophgeal junction
thoracic- caused by arch of aorta and left main bronchus
diaphragmatic- caused by lower esophageal spincter at the esophageal hiatus of diaphragm |
|
|
Term
|
Definition
| esophageal motility disorder, may cause absence of esophageal peristalsis and failure of lower esophageal sphincter to relax, signs/symptoms result from absence of autonomic ganglion cells w/in wall of esophagus, pt experiences dysphagia w/ possible regurgitation and chest pain (bird beak) |
|
|
Term
| What happens in Barrett's esophagus? |
|
Definition
| stratified squamous epithelium undergoes metaplastic change into columnar epithelium, columnar epithelium is prone to ulceration and strictures may develop causing obstruction; the metaplastic epithelium may undergo malignant transformation into adenocarcinoma |
|
|
Term
| What are the 4 parts of the stomach? |
|
Definition
cardia/cardiac region- at gastroesophageal junction
fundus- dilated superolateral part below L dome of diaphragm
body-major part
pyloric part- funnel shaped, which consists of wide pyloric antrum leading into narrow pyloric canal |
|
|
Term
| What indicates the junction of the body and pyloric part? |
|
Definition
| angular incisure, also has lesser curvature on top and greater curvature on bottom |
|
|
Term
| What increase the SA in the small intestine? |
|
Definition
| circular folds (plicae circulares) of mucosa-submucosa, villi, microvilli |
|
|
Term
| Where is the C shaped loop of the duodenum? |
|
Definition
| around head of pancreas, continuous w/ jejunum at duodenojejunal junction |
|
|
Term
| What are the 4 parts of the duodenum? |
|
Definition
| superior, descending, inferior/horizontal, ascending |
|
|
Term
| What is the most frequent location of peptic ulcers? |
|
Definition
| duodenal cap/ampulla- in superior part of duodenum |
|
|
Term
| What structure enters the descending part of the duodenum? |
|
Definition
| receives common bile duct carrying bile and main pancreatic duct carrying pancreatic enzymes (join in common chamber-hepatopancreatic ampulla-which drains into duodenum at major duodenal papilla) |
|
|
Term
| Where can the superior mesenteric artery/vein be compressed/obstructed following sudden weight loss? |
|
Definition
| inferior/horizontal part (superior mesenteric artery syndrome) |
|
|
Term
| What suspends the duodenojejunal junction? |
|
Definition
| suspensory muscle of the duodenum (ligament of Treitz) from diaphragm, junction b/w upper GI bleeding and lower GI bleeding which have different clinical characteristics |
|
|
Term
| What do the jejunum and ileum look like in a barium swallow? |
|
Definition
| feathery appearance of jejunum due to numerous large mucosal-submucosal folds (plicae circulares) in wall, smooth walls of distal ileum |
|
|
Term
| What is the embryonic remnant attached to the ileum? |
|
Definition
| ileal (Merkel's) diverticulum- remnant of embryonic vitelline duct (yolk stalk), contains all layers normally found in intestinal wall, may contain ectopic gastric or pancreatic tissue and cause hemorrhage, bowel obstruction, perforation, and/or pain (mimic appendicitis) |
|
|
Term
| How is the large intestine distinguished from the small intestine? |
|
Definition
| omental appendices (small fatty projections), teniae coli (3 bands of longitundinal smooth muscle), haustra (sacculations) |
|
|
Term
| What are the parts of the large intestine? |
|
Definition
| cecum, appendix, colon (ascending, transverse, descending, sigmoid), rectum, anal canal |
|
|
Term
| What does the appendix suspend from? |
|
Definition
| cecum, inferior to ileocecal junction |
|
|
Term
| Define: intussusception, volvulus, gallstone ileus |
|
Definition
intussusception: telescoping of proximal segment of intestine into a more distal part
volvulus- twisting of intestine of itself
gallstone ileus- gallstone blocks ileocecal junction |
|
|
Term
|
Definition
| intestinal diverticulum that contains lymphoid tissue, variable in postion- most commonly retrocecal |
|
|
Term
| What causes appendicits? What can happen if it isn't removed? |
|
Definition
| occlusion of lumen or infection, may become gangrenous or perforate causing peritonititis |
|
|
Term
| What are the 4 parts of the colon? |
|
Definition
| ascending, transverse, descending, sigmoid |
|
|
Term
| Where does the ascending colon meet the transverse colon? Where does the transverse colon meet the descending colon? |
|
Definition
| right colic (hepatic) flexure, left colic (splenic) flexure |
|
|
Term
| Where are the rectum and anal canal located? |
|
Definition
| pelvis (rectum) and perineum (anal canal) |
|
|
Term
| What are the digestive system accessory organs? |
|
Definition
| salivary glands, liver, gallbladder, pancreas |
|
|
Term
| What are the functions of the liver? |
|
Definition
| production of bile, storage of glycogen, receives all nutrients absorbed by alimentray tract except lipids |
|
|
Term
| What are the fissures dividing the anatomical lobes of the liver? |
|
Definition
| left sagittal fissure formed by fissure of the round ligament of the lvier (ligamentum teres hepatis) and fissure for the ligamentum venosum (right lobe includes quadrate and caudate lobes) |
|
|
Term
| What divides the functional (portal) lobes? |
|
Definition
imaginary right sagittal fissure passing through gallbladder fossa and fossa of I vena cava on visceral side
each lobe receives its own branch of the hepatic artery and portal vein and is drained of bile by its own hepatic duct (together the portal triad) |
|
|
Term
| What is in the portal triad and where does it enter? |
|
Definition
branch of each of the proper hepatic artery and portal vein along with bile duct
structures enter visceral surface of liver at transverse fissure, porta hepatis |
|
|
Term
| What is the arrangement of the portal triad? |
|
Definition
| traverses hepatoduodenal ligament, bile duct is located anteriorly on R, proper hepatic artery is A on L, portal vein is located posterior to these 2 structures |
|
|
Term
| What can cause cirrhosis? |
|
Definition
| chronic alcoholism, hepatitis B and C |
|
|
Term
| What are the parts of the gallbladder? |
|
Definition
fundus- blunt end that project from inferior border of liver at tip of R 9th costal cartilage
body- main portion, in contact w/ visceral surface of liver, duodenum, and transverse colon
neck- narrow tapering end that usually makes S-shaped turn to become continuous with cystic duct |
|
|
Term
| Define: cholelithiasis, cholecystitis, fistula, cholecystenteric fistula, gallstone ileus |
|
Definition
cholelithiasis- gallstones
cholecystitis- gallstones obstruct passage of bile and cause inflammation
fistula-opening
cholecystenteric fistula- opening that develops in superior part of duodenum or transverse colon
gallstone ileus- gallstone in small intestine that may obstruct ileocecal valve |
|
|
Term
| What are the ducts that carry bile? |
|
Definition
| Common hepatic duct (from liver, formed by union of R and L hepatic ducts from lobes of liver), cystic duct (bile from gallbladder), common bile duct (union of cystic duct and common hepatic duct, joins main pancreatic duct at hepatopancreatic ampulla to drain into duodenum) |
|
|
Term
| Where does the pancreas lie? |
|
Definition
| transversely across vertebrae L1-2 |
|
|
Term
| What are the 4 parts of the pancrea? |
|
Definition
head- lies w/in C shaped concavity of duodenum
neck- pancreas overlying the superior mesenteric artery and vein
body- longest part
tail- closely related to spleen |
|
|
Term
| What are the 2 ducts of the pancreas? |
|
Definition
main pancreatic duct- begins at tail and runs through body, neck, and head and joins w/ bile duct at hepatopancreatic ampulla to drain at major duodenal papilla
accessory pancreatic duct- drains part of the head of the pancreas |
|
|
Term
| Where does cancer of the pancreas usually happen and what does this cause? |
|
Definition
| head of pancreas, may obstruct bile duct causing jaundice- symptoms include painless jaundice and severe pain radiating to mid to lower back |
|
|
Term
| When does cancer in body and tail of the pancreas occur? |
|
Definition
| not until metastasis has occured, 4th leading cause of cancer death in US |
|
|
Term
| Why is the peritoneal cavity not closed in females? |
|
Definition
| vagina, uterus, and uterine tubes connect to peritoneal cavity- the uterine tubes open into peritoneal cavity providing pathway for spread of infection |
|
|
Term
| Define: ascites, paracentesis |
|
Definition
ascites- peritoneal fluid accumulates
paracentesis- removal of excess fluid |
|
|
Term
|
Definition
|
|
Term
| Why do we prop up a patient with bacterial peritonitis? |
|
Definition
| usually fluid flows superiorly towards diaphragm and is rapidly absorbed, propped up so that infected fluid flows downward into pelvic cavity where absorption is slower, likelihood of infection spreading though diaphragm to pleura from subphrenic space is reduced |
|
|
Term
| When do adhesions (fibrous bridges) develop and what do they cause? |
|
Definition
| may result from peritonitis due to trauma or infection, may cause chronic pain and bowel/uterine tube obstruction |
|
|
Term
| Define: intraperitoneal, retroperitoneal |
|
Definition
intraperitoneal- invaginating the peritoneal sac from behind and suspended form the body wall by double layer peritoneum (mesentery)
retroperitoneal- located posterior to peritoneum |
|
|
Term
| What is associated with intraperitoneal organs? |
|
Definition
| covering of visceral peritoneum, suspended by mesentery, peritoneum lining body wall is parietal peritoneum |
|
|
Term
| What are the intraperitoneal organs? |
|
Definition
| abdominal esophagus, stomach and proximal duodenum (duodenal cap), jejunum and ileus, cecum, transverse colon, sigmoid colon, liver and gallbladder, tail of pancreas, spleen |
|
|
Term
| What are the retroperitoneal organs? |
|
Definition
| duodenum (except duodenal cap), ascending colon, descending colon, pancreas (except tail), kidneys and ureters, abdominal aorta, inferior vena cava |
|
|
Term
| What are the 3 structures formed by double layers of peritoneum? |
|
Definition
| mesenteries, omenta (connect sotmach and proximal duodenum to other organs), peritoneal ligaments (connect abdominal organs to each other or to abdominal wall) |
|
|
Term
| Where does the omentum attach? |
|
Definition
greater omentum-suspended from greater curvature of stomach
lesser omentum-connecting lesser curvature (hepatogastric ligament) and proximal duodenum (hepatoduodenal ligametn) to liver |
|
|
Term
| What is the function of the greater omenutum? |
|
Definition
| moves to wall off infections w/in peritoneal cavity keeping them localized to prevent generalized peritonitis |
|
|
Term
| Where are the greater and lesser sacs of the peritoneal cavity? |
|
Definition
greater- main larger part
lesser (omental bursa)- lies posterior to stomach and lesser omentum |
|
|
Term
| How do the greater sac and omental bursa communicate? |
|
Definition
| through omental (epiploic) foramen |
|
|
Term
| What is the omental foramen bounded by? |
|
Definition
anteriorly-hepatoduodenal ligament (forms free right edge of lesser omentum)
posteriorly-inferior vena cava
superiorly- caudate lobe of liver
inferiorly- superior (first) part of the duodenum |
|
|
Term
| What disease state happens at the omental foramen? |
|
Definition
| internal hernia when a loop of small intestine becomes entrapped w/in it, since none of the boundaries of the foramen can be incised the swollen intestine must be decompressed with a needle to free it |
|
|
Term
| What is the greater sac divided by and into what compartments? |
|
Definition
subdivided by transverse colon and transverse mesocolon
supracolic compartment- contains stomach, liver, spleen
infracolic compartment- contains small intestine, ascending colon, descending colon (infracolic compartment subdivided by mesentery of small intestie into R and L infracolic space) |
|
|
Term
| How does the abdominal cavity communiate with the pelvic cavity providing pathways for the spread of infection/cancer? |
|
Definition
right paracolic gutter-lateral to ascending colon, connects supracolic compartmetn and pelvic cavity
left paracolic gutter- lateral to descending colon |
|
|
Term
| Where is the heptorenal recess (Morison's pouch) and how does it communicate with other spaces? |
|
Definition
| located b/w right lobe of liver and right kidney; communicates medially with omental bursa through omental foramen and anteriorly with subphrenic recess b/w liver and diaphragm (common site for abscesses) |
|
|
Term
| What are the derivatives of the embryonic gut supplied by in terms of arteries? |
|
Definition
supplied by unpaired ventral branches of abdominal aorta
caudal foregut- celiac trunk (celiac artery)
midgut- superior mesenteric artery
hindgut- inferior mesenteric artery |
|
|
Term
| What does the embryonic caudal foregut form? |
|
Definition
| abdominal portion of esophagus, stomach, duodenum as far as its union w/ bile and pancreatic ducts, liver and gallbladder, pancreas |
|
|
Term
| What are the branches of the celiac trunk that supply derivatives of the caudal foregut? |
|
Definition
| left gastric artery, splenic artery (left gastro-omental, short gastric), common hepatic artery (gastroduodenal-right gastro-omental, superior pancreaticoduodenal; proper hepatic-right hepatic/cystic, left hepatic) |
|
|
Term
| What do the left gastric and splenic arteries supply? |
|
Definition
Left gastric- supplies stomach and lower esophagus
splenic artery- supplies neck, body, and tail of pancreas; spleen, sends branches to stomach |
|
|
Term
| What do the branches of the common hepatic artery (gastroduodenal and proper hepatic) supply? |
|
Definition
gastroduodenal- supplies sotmach, head of pancreas, duodenum
proper hepatic- supplies liver, gallbladder; sends right gastric branch to somtach, right hepatic artery gives off cystic artery to the gallbladder |
|
|
Term
| What are the aberrant/accessory arteries that may occur? |
|
Definition
abberant right hepatic artery branching from superior mesenteric artery
abberent left hepatic artery branching from left gastric artery |
|
|
Term
| What structures does the midgut form? |
|
Definition
| duodenum distal to its union w/ bile and pancreatic ducts, jejunum and ileum, cecum and appendix, ascending colon, right 2/3 of transverse colon |
|
|
Term
| What are the branches of the superior mesenteric artery that supply the midgut? |
|
Definition
inferior pancreaticoduodenal
intestinal branches of jejunal and ileal arteries
middle colic-right and left branches
right colic-ascending and descending branches
ileocolic- appendicular artery, A/P cecal branches, ascending and ileal branches |
|
|
Term
| What do the branches of the superior mesenteric artery supply? |
|
Definition
inferior pancreaticoduodenal- head of pancreas, duodenum
intestinal branches- jejunum and ileum
middle colic- transverse colon
right colic- ascending colon
ileocolic- terminal ileun, cecum, ascending colon- gives off appendicular artery to appendix |
|
|
Term
| What does the hindgut form? |
|
Definition
| L 1/3 of transverse colon, descending colon, sigmoid colon, rectum and upper anal canal |
|
|
Term
| What are the branches of the inferior mesenteric artery that supply hindgut? |
|
Definition
left colic artery- ascending and descending branches
sigmoid arteries
superior rectal artery |
|
|
Term
| What do the branches of the inferior mesenteric artery supply? |
|
Definition
left colic artery- descending colon
sigmoid arteries- sigmoid colon
superior rectal artery- rectum and anal canal |
|
|
Term
| What is the marginal artery formed by? What can it be used for? |
|
Definition
| parallel to wall of large intestine, formed by branches of ileocolic, right colic, middle colic, left colic arteries; may become dilated to provide collateral circulation during slow occlusion of superior or inferior mesenteric arteries and may allow ligation of inferior |
|
|
Term
| What is in the left colic (splenic) flexure in terms of vasculature? |
|
Definition
| "watershed area" where anastomoses b/w branches of middle and left colic arteries to form marginal artery may be absent or insufficient therefore systemic hypotension or inferior mesenteric artery stenosis may result in ischemia and infarction (ischemic bowel disease) |
|
|
Term
| Where does blood from the GI system and spleen drain? |
|
Definition
| into hepatic portal vein for transport to liver; different from rest of body which passes direct tribuitaries to vena cava |
|
|
Term
| What is the hepatic portal vein formed by? What drains blood into the inferior vena cava? |
|
Definition
hepatic portal vein- formed posterior to neck of pancreas by union of superior mesenteric vein and splenic vein, inferior mesenteric drains into splenic
hepatic veins drain blood from liver into inferior vena cava |
|
|
Term
| Where is the spleen located? Why is it associated with GI system even though it isn't a part of the digestive system? |
|
Definition
located deep to left lower ribs 9-11 with long axis parallel to rib 10
considered with digestive system because of its proximity and shared blood supply |
|
|
Term
| What is the vasculature of the spleen? |
|
Definition
supplied by splenic artery (celiac trunk) may develop aneurysm in pregnant women who smoke causing aneurysm rupture
drained by splenic vein which joins w/ superior mesentic vein to form portal veins, inferior mesenteric drains tinto splenic vein |
|
|
Term
| Where is pain referred in issues with the spleen? How can it be ruptured? |
|
Definition
left shoulder via phrenic nerve
blunt trauma to abdomen, may be lacerated with fractures of lower left ribs |
|
|
Term
| What recess is located near the spleen and is important in a splenic needle biopsy? |
|
Definition
| costodiaphragmatic recess which descends to level of 10th rib in midaxillary line, be careful not to enter or can cause pleuritis |
|
|
Term
| What are the ganglia and plexuses form from the esophagus to anus? |
|
Definition
| intrinsic ganglia and nerve plexuses that form enteric nervous system- capable of independently maintaining function of digestive tract but activities influenced by sympathetic/parasympathetic nervous sytems |
|
|
Term
| What are the main intrinsic nerve plexuses that form enteric NS? |
|
Definition
| submucous (Meissener's)w/in submucosa, myenteric (Auerbach's) w/in muscularis externa |
|
|
Term
| What does the sympathetic nervous innervation of abdominal organ consist of? |
|
Definition
| preganglionic nerve fibers that reach prevertebral ganglia through abdomniopelvic splanchnic nerves, postganglionic nerve fibers from nerve cell bodies w/in prevertebral ganglia that follow arteries to organs |
|
|
Term
| At what origins along the abdominal aorta are the prevertebral ganglia found? |
|
Definition
celiac trunk- celiac ganglia
superior mesenteric artery- superior mesentic ganglion
inferior mesenteric artery- inferior mesenteric ganglion
renal arteries- aorticorenal ganglia |
|
|
Term
| What are the splanchnic nerves that carry preganglionic sympathetic nerve fibers from cell bodies w/in the IMLCC to prevertebral ganglia? |
|
Definition
thoracic splanchnic nerves- greater (T5-9), lesser (T10-11), least (T12)
lumbar splanchnic nerves (L1-2, occasionally L1-3) |
|
|
Term
| What do the 2 division of the splanchnic nerves supply? |
|
Definition
thoracic (preganglionic) splanchnic nerves- foregut (celiac trunk) and midgut (superior mesenteric artery)
lumbar (preganglionic) splanchnic nerve- hindgut (inferior mesenteric artery) |
|
|
Term
| Since the autonomic fibers to visceral organs follow blood vessels, what do they supply? |
|
Definition
celiac ganglia nerve fibers- foregut derivatives: stomach, proximal duodenum, liver, gallbladder, pancreas, spleen
aorticorenal ganglia- renal artery branches to kidneys and renal glands
superior mesenteric ganlia- midgut derivatives: distal duodenum, jejunum and ileum, cecum and appendix, ascending and transverse colon
inferior mesenteric ganglia- hindgut derivatives: descending colon, sigmoid colon, rectum, upper anal canal |
|
|
Term
| What does the sympathetic NS do? |
|
Definition
| vasoconstriction in blood vessels of viscera, reduced glandular secretion, reduced peristalsis |
|
|
Term
| Where does preganglionic parasympathetic innervation of abdominal organs come from? |
|
Definition
vagus nerve (CN X) which innervates foregut/midgut derivatives
pelvic splanchnic (S2-4) which innervates hindgut derivatives |
|
|
Term
| What structures does the vagus nerve provide parasympathetic innervation? |
|
Definition
| foregut and midgut derivatives- distal esophagus, stomach, liver, gallbladder, pancreas, duodenum, jejunum, ileum, ascending colon, transverse colon |
|
|
Term
| What strucutures does the pelvic splanchnic nerves innervate? |
|
Definition
| hindgut: descending colon, sigmoid colon, rectum, upper anal canal (only splanchnic nerve that carry parasympathetic fibers) |
|
|
Term
| What do parasympathetic fibers do? |
|
Definition
| increase glandular secretion, increase peristalsis, inhibit pyloric sphincter |
|
|
Term
| What accompany the sympathetic nerves, carrying pain? |
|
Definition
|
|
Term
| Where would irritation of phrenic nerve be referred? |
|
Definition
| to ipsilateral shoulder, phrenic nerve (C3,4,5) enter same spinal cord segments as supraclavicular nerves (C3,4) which supply cutaneous innervation to the shoulder |
|
|
