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85 Cards in this Set

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abdominal cavity
space bounded by the abdominal wall; separated from thoracic cavity by diaphragm; continuous with pelvic cavity inferiorly (“abdominopelvic cavity”)
peritoneum
serous membrane that lines the walls and organs of the abdominal cavity; two continuous parts: parietal and visceral peritoneum
parietal peritoneum
lines the internal aspect of the abdominopelvic wall; sensory innervation via nerves of the abdominal wall; pain tends to be acute (can be localized)
visceral peritoneum
invests the organs; lacks innervation
peritoneal cavity
potential space between the parietal and visceral peritoneum; contains thin layer of fluid that keeps surfaces moist and lubricated; does not contain organs
ascites
excess fluid in the peritoneal cavity; can be caused by infections, metastasis of cancer cells, and perforations of the GI tract
peritoneal cavity - males vs. females
closed in males; open in females, as there is a communication with the outside world via the uterine tubes, uterus, and vagina
retroperitoneal space
located between the parietal peritoneum and the muscles of the abdominal wall; contains fat, vessels (e.g. abdominal aorta, IVC) and some organs (e.g., kidneys; primarily retroperitoneal organs)
ontogeny of gut tube
as the abdominal organs develop from the embryonic gut tube, they become invested in visceral peritoneum; form intraperitoneal organs aand secondarily retroperitoneal organs
intraperitoneal organs
completely enclosed by the visceral peritoneum; these organs are mobile (e.g., stomach)
primarily retroperitoneal
organs occupying the retroperitoneal space
secondarily retroperitoneal
entirely enclosed by visceral peritoneum early in development, but came to be pushed up against the posterior abdominal wall, losing their mobility (e.g., ascending colon)
messenteries (aka ligaments)
two layers of peritoneum that suspend an intraperitoneal organ from the body wall or another organ; nerves and vessels travel between the two layers to reach the organs
omenta
mesenteries associated with the stomach; greater and lesser
greater omentum
extends from the greater curvature of stomach and proximal duodenum; forms adhesions to wall off inflamed organs, protecting adjacent viscera
lesser omentum
extends from lesser curvature of stomach/proximal duodenum to the liver; composed of hepatogastric ligament and the hepatoduodenal ligament
hepatogastric ligament
between stomach and liver
hepatoduodenal ligament
between duodenum and liver; contains the portal triad
portal triad
contains portal vein, proper hepatic artery, bile duct ; found in hepatoduodenal ligament of lesser omentum
greater sac
larger sac of peritoneal cavity that extends from diaphragm to pelvic region
lesser sac
aka omental bursa; smaller sac that is posterior to the stomach and lesser omentum
omental foramen
aka epiploic foramen; opening deep to the hepatoduodenal ligament that allows for communication between the greater and lesser sacs
divisions of gut tube
foregut, midgut, hindgut; organs derived from the same division share a common blood supply and route of venous and lymphatic drainage
foregut derivatives
pharynx, esophagus, stomach, proximal duodenum, liver, gallbladder, pancreas
foregut blood supply
celiac trunk
foregut venous drainage
gastric veins, splenic vein
foregut lymphatics
celiac lymph nodes
esophagus
primarily a thoracic organ; passes through esophageal hiatus of diaphragm (T10); abdominal portion is intraperitoneal and only 1-1.5 cm long
acid reflux
regurgitation of stomach contents into the thoracic esophagus; prevented by the contraction of the diaphragm (functions as sphincter)
hiatal hernias
hernias of abdominal esophagus and proximal stomach through the esophageal hiatus, into the thoracic cavity.
stomach
intraperitoneal; typically located in the left upper quadrant, occupying transpyloric plane; highly variable in shape and distribution; parts: lesser/greater curvature, cardia, fundus, body, pyloric portion, rugae
lesser curvature
superior concave margin; associated with lesser omentum
greater curvature
inferior convex margin; associated with greater omentum
cardia
narrow proximal region
fundus
dome of the stomach; located inferior to left dome of the diaphragm; distinguishable in x-rays due to typical presence of a radiolucent gas bubble
pyloric portion
wide pyloric antrum; narrow pyloric canal; muscular pyloric sphincter
pyloric sphincter
located at the L1 vertebral level (transpyloric plane); circular smooth muscle; controls release of stomach contents into duodenum
rugae
internal folds of gastric mucosa
gastric ulcers
the mucosal lining of the stomach becomes eroded; usually treated with antibiotics; treatments also include vagotomies
proximal duodenum
located in the right upper quadrant; four parts
superior (1st) part of duodenum
intraperitoneal (associated with hepatoduodenal ligament); lies on the transpyloric plane (L1)
descending (2nd) part of duodenum (include location)
secondarily retroperitoneal; runs parallel to (and just to the right of) IVC; curves around head of pancreas; contains major/minor duodenal papilla
major duodenal papilla
found in descending (2nd) part of duodenum; contains opening of the hepatopancreatic ampulla
hepatopancreatic ampulla
fused bile duct and main pancreatic duct; opening found in major duodenal papilla of 2nd part of duodenum
minor duodenal papilla
located superior to the major papilla in 2nd duodenum; associated with accessory pancreatic duct
pancreas
secondarily retroperitoneal; located in right upper and left upper quadrants; located posterior to stomach, between duodenum on right and spleen on left; contains head (surrounded by 2nd part of the duodenum), body, tail (in contact with hilum of the spleen), pancreatic duct, accessory pancreatic duct
pancreatic duct
courses from the tail to the head of the pancreas; smooth muscle sphincter of the pancreatic duct; merges with bile duct to form hepatopancreatic ampulla (>2nd duodenum)
liver
intraperitoneal; covered with peritoneum except at bare area, adjacent to diaphragm; located mostly in right upper quadrant, deep to ribs 7-11; extends partially into left upper quadrant; located just inferior to the diaphragm; has falciform and hepatoduodenal ligament
falciform ligament
attaches liver to the anterior abdominal wall; round ligament of liver found in inferior margin
lobes of liver
right lobe, left lobe, caudate lobe, quadrate lobe (C & Q seen in posterior view only)
segments of liver
8 Segments; each supplied by a branch of the left or right hepatic artery and portal vein; each drained by a branch of the left or right hepatic duct; hepatic veins lie intersegmentally, eventually draining into the IVC
bile duct pathways
left and right hepatic ducts > common hepatic duct > cystic duct > bile duct

bile duct > pancreatic duct > hepatoduodenal ampulla > major duodenal papilla
gallbladder
located in the right upper quadrant; store bile when bile duct sphincter
bare area of liver
part of liver uncovered by peritoneum, adjacent to diaphragm
bile duct sphincter
bile duct has a smooth muscle sphincter associated with it; when contracted, this sphincter forces the bile back into the cystic duct and gallbladder, where it is stored
spleen
intraperitoneal; located in the left upper quadrant, deep to ribs 9-11; typically the size of a fist; lies just inferior to the diaphragm and is in close proximity to the left kidney, tail of the pancreas, and stomach
splenomegaly
enlargement of the spleen due to disease; can result in the spleen being palpable inferior to the left costal margin
hilium
where vessels/nerves enter/exit the spleen; tail of pancreas is in contact with hilum
abdominal aorta
extends from the aortic hiatus of diaphragm (T12) to its bifurcation into left and right common iliac arteries (L4)
paired branches of abdominal aorta
supply primarily retroperitoneal organs (e.g., kidneys, suprarenal glands) and gonads
unpaired branches of abdominal aorta
supply the abdominal organs; celiac trunk (T12); superior mesenteric artery (SMA, L1); inferior mesenteric artery (IMA, L3)
celiac trunk branches
supply foregut derivatives and spleen; 3 branches emerge immediately: left gastric artery, splenic artery, common hepatic artery
left gastric artery
branch of celiac trunk; courses along lesser curvature (in lesser omentum); feeds to esophageal arteries
splenic artery
branches off celiac trunk; tortuous course posterior to the body and tail of the pancreas; splits into short gastric arteries and left gastro-omental artery (courses along greater curvature in greater omentum)
common hepatic artery
branches off celiac trunk; splits into proper hepatic and gastroduodenal artery
proper hepatic artery
branches from common hepatic artery; courses in hepatoduodenal ligament; part of portal triad; splits into right gastric artery and right and left hepatic arteries
right gastric artery
branches from proper hepatic artery; courses along lesser curvature (in lesser omentum); anastomoses with left gastric artery
right and left hepatic arteries
branches from proper hepatic artery; terminal branches of proper hepatic artery that supply the liver; cystic artery usually arises from the right hepatic a.
gastroduodenal artery
branches from common hepatic artery; courses posterior to the 1st duodenum; branches into right gastro-omental artery and anterior and posterior superior pancreaticoduodenal arteries
(which anastomose with APIPA)
right gastro-omental artery
branches from gastroduodenal artery; courses along greater curvature (in greater omentum); anastomoses with left gastro-omental artery
left gastro-omental artery
branches from splenic artery; courses along greater curvature (in greater omentum); anastamoses with right gastro-omental
caval (systemic) system of abdomen
these veins drain structures in the retroperitoneal space, parallel to the paired branches of the aorta, and drain into the inferior vena cava (IVC)
portal system
has three main tributaries:
splenic vein, superior mesenteric vein, inferior mesenteric vein; oxygen poor/nutrient rich blood from the abdominal organs eventually drains into the portal vein, which enters the liver; liver detoxifies /processes the blood, which then empties into the IVC via the hepatic veins (part of the caval system of veins);
what are portal-caval anastomoses?
portal system vessels have no valves so can flow either direction; anastomoses between portal and caval vessels provide alternative routes for venous circulation if blood flow through the liver is obstructed (portal hypertension)
areas of portal-caval anastomoses (4)
umbilicus; distal esophagus; colon (ascending/descending); rectum / Anus
portal-caval anastomoses around the distal esophagus
esophageal veins drain into either the azygos system (caval) or left gastric vein (portal); dilated esophageal varices can rupture, resulting in potentially fatal bleeding
portal system in foregut
there is no ‘celiac vein’ but otherwise, the veins course alongside and share the names of the arteries
portal vein
part of portal triad that courses in hepatoduodenal ligament; tributaries: cystic veins, R/L gastric veins, splenic vein (short gastric veins, L gastro-omental vein), superior mesenteric vein (R gastro-omental vein, APSPV)
fetal circulation in abdomen
oxygen rich blood enters the fetus via the umbilical vein;
oxygen rich blood then bypasses the liver via the ductus venosus; oxygen poor blood leaves the fetus via the umbilical arteries
foregut lymphatics
lymph drains to the celiac lymph nodes; lymph then travels to the chyle cistern, and onto the thoracic duct
foregut parasympathetic innervation
Preganglionic cell bodies: brain (CN X); Preganglionic fibers: vagus nn. ; Postganglionic cell bodies and fibers: walls of organs
foregut sympathetic innervation
Preganglionic CB: lateral horn of the thoracic spinal cord; Preganglionic fibers: ventral root > spinal nerve > white ramus communicans > sympathetic trunk > greater splanchnic nerve (T5-T9); postganglionic CB: celiac ganglion; postganglionic fibers: follow arterial branches to their organ targets
foregut visceral pain innervation
follow the sympathetic pathways back to the spinal cord; foregut visceral pain is typically referred to the area at and inferior to the costal margin
round ligament of liver
adult remnant of umbilical vein; found in the inferior margin of the falciform ligament
medial umbilical ligaments
adult remnants of umbilical arteries