Abdominal Cavity And Viscera

Front 1

Omentum

Back 1

-Double-layer peritoneum connecting the stomach to other intra peritoneal organs
-Allows for movement of viscera
-Migrates toward inflamed organs such as the appendix to protect peritoneum
-Cushions viscera

Front 2

Greater omentum

Back 2

-apron of peritoneum (forms a sac or bursa)
-runs from greater curvature of stomach to transverse colon

Front 3

Lesser omentum

Back 3

-omental foramen (foramen of Winslow, epiploic foramen)

Front 4

Omental foramen

Back 4

-free edge of hepatoduodenal ligament
-portal triad passes posterior

Front 5

Portal triad

Back 5

-portal vein
-hepatic artery
-bile duct

Front 6

Peritoneal dialysis

Back 6

-the use of the peritoneum for fluid and electrolyte restoration
-catheter placed into peritoneal cavity, dialysis solution is pumped into the cavity then drained out
-short-term use for kidney failure

Front 7

Ascites

Back 7

-excess fluid in peritoneal cavity from total-body sodium and water excess
-could result from cirrhosis (portal hypertension), intra-abdominal cancer, or peritonitis

Front 8

Pancreatic pseudocyst

Back 8

Fluid-filled inomental bursa with inflamed pancreas

Front 9

Gutters

Back 9

-Parietal-peritoneal covered ridges on lateral posterior abdominal wall
-Contain colon
-May be regions of collection of intraperitoneal fluid

Front 10

Intraperitoneal

Back 10

organs with a mesentery, such as the stomach, small intestine (jejunum and ileum), transverse colon, liver and gallbladder. These are not firmly fixed to the wall and thus may twist and turn (some more than others) within the abdomen

Front 11

Retroperitoneal

Back 11

organs without a mesentery and associated with posterior body wall, such as the aorta, inferior vena cava, kidneys, ureters and suprarenal glands

Front 12

Secondarily retroperitoneal

Back 12

organs which had a mesentery once and lost it during development, such as the pancreas, duodenum, ascending and descending colons

Front 13

Organization of viscera

Back 13

organized by blood supply into
-foregut
-midgut
-hindgut
Veins follow arteries by same name
lymphatic drainage back to nodes at aorta
nerve supply from ANS

Front 14

Organs of the foregut

Back 14

Esophagus
Stomach
Part of duodenum
Liver
Gallbladder, bile ducts
Pancreas
Spleen

Front 15

Arterial supply to foregut comes from what?

Back 15

Celiac trunk

Front 16

Arterial supply to midgut comes from what?

Back 16

Superior mesenteric artery (SMA)

Front 17

Arterial supply to hindgut comes from what?

Back 17

Inferior mesenteric artery (IMA)

Front 18

Esophagus (general)

Back 18

-transport tube
-mainly a structure of the mediastinum (only about 1-1.5cm is intra-abdominal)
-through diaphragm at T10
-esophagogastric junction in abdomen (T11) left side

Front 19

Esophagus (blood supply and nerve)

Back 19

blood supply: left gastric artery (off celiac) and left inferior phrenic

nerve: vagus nerve, sympathetics from thoracic trunk

Front 20

Stomach (function, blood supply, lymphatic drainage, innervation)

Back 20

function: storage and digestion
blood supply:
-Left gastric a
-short gastric aa
-left and right gastroepiploic aa
-right gastric a
lymphatic drainage: to preaortic nodes
innervation: vagus nerve and sympathetic fibers from thoracic splachnic/celiac plexus

Front 21

Why does the stomach rarely suffer from ischemic damage?

Back 21

Because it receives blood supply from so many sources

Front 22

Partial gastrectomy

Back 22

-For treatment of gastric ulcer, carcinoma, obesity
-May remove part of stomach without disrupting blood supply

Front 23

Duodenum (general)

Back 23

-beginning of small bowel, digestion
-first part intraperitoneal
-last parts secondarily retroperitoneal
-relatively fixed

Front 24

Duodenum (arterial supply and lymphatic drainage)

Back 24

arterial supply:
-celiac trunk to gastroduodenal artery to superior pancreacticoduodenal artery
-lymphatic drainage: follows venous drainage to celiac nodes

Front 25

The duodenum has an intimate relationship with what 3 organs?

Back 25

-head of the pancreas
-the gallbladder
-common bile duct
(mass of any of these structures will compress other structures)

Front 26

Duodenal ulcer

Back 26

if it perforates, may inflame nearby structures (i.e. pancreas) and ulcerate into gastroduodenal artery causing bleeding into the peritoneal cavity (very common)

Front 27

Liver (general)

Back 27

-largest gland
-portal venous system delivers all digested substances from intestines for filtration through liver prior to distribution of nutrition to the body
-moves with respiration
-not normally found below costal margin

Front 28

Functions of the Liver

Back 28

-Storage of glycogen and production of bile
-Production of blood proteins
-Processing of hemoglobin for iron removal
-Production of clotting factors
-Production of immune factors

Front 29

Right lobe of liver (location)

Back 29

4-5th ICS to 10th ICS (10 cm)

Front 30

Left lobe of liver (location)

Back 30

across midline to 5th ICS

Front 31

Falciform ligament

Back 31

-separates right and left lobes of the liver

Front 32

Accessory lobes of the liver

Back 32

caudate lobe and quadrate lobe (lobes are NOT functional divisions i.e. can't remove one lobe and have the liver function normally)

Front 33

Ligamentum teres (of the liver)

Back 33

umbilical vein during fetal development

Front 34

Porta hepatis

Back 34

Liver entrance and exit of:
Portal v
Hepatic a
Lymph vessels
Hepatic nerves
Hepatic ducts

Front 35

Liver - arterial supply and venous drainage

Back 35

arterial supply: celiac trunk to common hepatic artery to hepatic proper to right and left hepatic artery

venous drainage: hepatic veins to IVC

Front 36

Portal vein

Back 36

-Delivers venous blood from intestines for filtration by liver
-Formed by SMV and SV

Front 37

Portal hypertension

Back 37

-obstruction of the portal vein
-the venous connections of the system dilate causing varicosities in the abdominal wall vessels (paraumbilical), esophageal veins or hemorrhoidal veins. Esophageal and hemmorrhoidal varicosities are especially prone to bleeding in a patient with portal hypertension

Front 38

Gallbladder function

Back 38

bile storage and concentration

Front 39

Extrahepatic biliary tree

Back 39

delivers bile to the gallbladder for storage and to the duodenum for digestion

Front 40

Arterial supply of gallbladder and ducts

Back 40

celiac trunk to common hepatic artery to hepatic artery proper to cystic artery

Front 41

Cholecystitis

Back 41

-the condition of inflammation of the gallbladder
-In most cases, this is associated with the presence of gall stones.

Front 42

Cholelithiasis

Back 42

-The presence of gallstones within the gallbladder
-This may occur without inflammation or symptoms

Front 43

Choledocholithiasis

Back 43

the presence of gallstones within the common bile duct. This is almost always accompanied by symptoms of crampy abdominal pain and constitutes a surgical emergency as the complete obstruction of the CBD may cause irreversible liver damage

Front 44

Gallstone Ileus

Back 44

erodes, get stuck at iliocecal valve

Front 45

Pancreas and function

Back 45

mostly retroperitoneal
functions:
-production of pancreatic enzymes
-production and regulation of glucagon and insulin

Front 46

Ampulla

Back 46

-location where common bile duct joins main pancreatic duct

Front 47

Pancreas in relation to duodenal C and splenic artery

Back 47

-duodenal C wraps around head of pancreas
-splenic artery runs posteriorly on the superior rim of the pancreas

Front 48

Because of anatomical relationship between pancreas and splenic artery, what happens in resection of the pancreas?

Back 48

Spleen is also resected

Front 49

Arterial supply to pancreas

Back 49

-gastroduodenal artery to superior pancreaticoduodenal artery
-splenic artery branches
-superior mesenteric artery to inferior pancreaticoduodenal artery

Front 50

Spleen (general information and function)

Back 50

function: blood reservoir and removal of expended cells
-between ribs 9-11
-moves with respiration
-nonpalpable in normal adults
-vulnerable to injury with rib fracture

Front 51

Arterial supply to spleen

Back 51

celiac trunk to splenic artery!

Front 52

Jejunum and Ileum

Back 52

-organs of nutrient absorption
-duodenum becomes jejunum after Ligament of Treitz (at duodenal jejunal junction)
-both held in place by mesentery

Front 53

Ileocecal valve

Back 53

allows for passage of contents from SB to colon

Front 54

Valvulae conniventes

Back 54

-large valvular flaps projecting into the lumen of the bowel, slow digestion and allow for increased surface for absorption

Front 55

Jejunum and ileum arterial blood supply

Back 55

-superior mesenteric artery (very important for bowel function)
-jejunal and ileal arteries
-ileocolic artery

Front 56

Mesenteric ischemia

Back 56

occlusion of the superior mesenteric artery may cause various levels of small and large bowel ischemia depending on the location and the amount of occlusion

Front 57

Meckel's Diverticulum

Back 57

This is a congenital true diverticulum (involving all layers of the intestinal wall) which occurs in the small intestine. If the lumen becomes obstructed, it presents like appendicitis.

Front 58

What is a divericulum?

Back 58

outpouching

Front 59

Rule of two's

Back 59

Meckel's diverticulum follows this rule
-2% of the population
-2 feet (from the ileocecal valve)
-2 inches (in length)
-2% are symptomatic
-2 types of common ectopic tissue (gastric and pancreatic)
-Commonly presents at 2 years
-Males are 2x as likely to be affected

Front 60

Large intestine

Back 60

-organ of water absorption and waste elimination

Front 61

Arterial supply of large intestine from appendix to transverse colon

Back 61

-superior mesenteric artery
-right colic artery
-middle colic artery
-some left colic artery too

Front 62

Arterial supply of large intestine from descending colon to anal canal

Back 62

-IMA
-Left colic artery
-Sigmoid arteries
-Superior rectal artery
-Middle rectal (Internal iliac)
-Inferior rectal (Internal pudendal)

Front 63

Appendicitis

Back 63

-If the lumen of the appendix becomes obstructed, appendix becomes inflamed
-pain usually begins periumbillically and then becomes localized at McBurney's point (1/3 the distances from the ASIS to the umbilicus)
-position: retrocecal, pelvic

Front 64

Referred pain of appendicitis

Back 64

T10

Front 65

Check for appendicitis using musculature

Back 65

Psoas sign: extension of psoas will hurt with appendicitis
Obturator sign: stretch of obturator muscle will hurt with appendicitis

Front 66

Diverticulosis

Back 66

Presence of multiple diverticuli in the colon (most common in sigmoid colon)

Front 67

Diverticular disease

Back 67

Colonic diverticuli are acquired “false” diverticuli. Inflammation of a colonic diverticulum is known as diverticulitis
-common in the sigmoid colon

Front 68

Sigmoid volvulus

Back 68

-although sigmoid colon is secondarily retroperitoneal, it is floppy and can twist about the mesentery
-called a "volvulus" when it twists and causes signs/symptoms of colonic obstruction
-common in the elderly

Front 69

Kidneys (info and arterial/venous)

Back 69

Surrounded by perinephric fat
Organs of fluid and electrolyte management
Cortex and Medulla
Arterial supply: renal artery and accessory renal arteries
Venous drainage: renal vein

Front 70

Suprarenal glands (info and arterial supply)

Back 70

Endocrine gland
Cortex: corticosteroid and androgens
Medulla: SNS, epi and norepi
Arterial supply : suprarenal a (off renal a, inferior phrenic a and aorta)

Front 71

Ureters

Back 71

Transports urine to bladder
In abdomen: colonic vessels anterior to left ureter
In pelvis: lateral wall of pelvis

Front 72

What are ureters crossed by in male and female?

Back 72

In male: vas deferens
In female: ovarian artery

Front 73

Renal/uretal calculi

Back 73

-stones formed by the kidney may travel down the ureter, getting “stuck” in regions of natural narrowing along the way
-these areas are: at the junction of ureter and renal pelvis, at the pelvic brim and at entrance into bladder

Front 74

Abdominal aorta

Back 74

-conveys oxygenated blood
-bifurcates at L4

Front 75

Unpaired visceral branches of AA

Back 75

-celiac artery
-SMA
-IMA

Front 76

Paired visceral branches of AA

Back 76

-renal arteries
-suprarenal arteries
-gonadal arteries

Front 77

Abdominal Aortic Aneurysm (AAA)

Back 77

-irregular enlargement of the aorta which can result in a tear (dissection) will be palpated just left of midline as a pulsating mass

Front 78

IVC

Back 78

-begins at union of common iliac veins
-ascends on right side of posterior abdomen
-recieves deoxygenated blood from lower body and portal blood from digestive system (via hepatic veins)

Front 79

Unpaired visceral branches of IVC

Back 79

-celiac vein
-superior mesenteric vein
-inferior mesenteric vein

Front 80

Paired visceral branches of IVC

Back 80

-renal veins
-suprarenal veins
-gonadal veins (right off IVC, left off of renal vein)

Front 81

Psoas major/iliacus (action and innervation)

Back 81

action: major hip flexors, hip stabilizers
innervation: anterior rami L1-L3

Front 82

Quadratus lumborum (action)

Back 82

lateral flexion of trunk, extension of lumbar spine

Front 83

Transversus abdominis (action)

Back 83

supports abdominal viscera

Front 84

Nerves of retroperitoneum

Back 84

T12-L4

Front 85

T12 subcostal nerve

Back 85

anterior lateral abdominal wall muscles and skin

Front 86

L1 iliohypogastric nerve and ilioinguinal nerve

Back 86

anterior abdominal wall and skin of inguinal region

Front 87

L1-L2 genitofemoral nerve

Back 87

-skin of femoral triangle
-scrotum/labia

Front 88

L2-L3 lateral femoral cutaneous nerve

Back 88

-lateral thigh skin

Front 89

L2-L4 femoral nerve

Back 89

anterior thigh muscles and skin

Front 90

L2-L4 obturator nerve

Back 90

adductors of thigh and skin

Front 91

Referred pain in Quadratus Lumborus strain

Back 91

-Lumbar plexus overlays the muscle
-Spasm will irritate the nerves