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56 Cards in this Set
- Front
- Back
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What is contained in the Splenorenal Ligament?
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Splenic Artery and Vein
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what is the muscle under neath the internal oblique?
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transversus abdominus
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Which side of the vertebral column is the aorta normally displaced to?
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LEFT SIDE
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CT SCAN
Ligaments and their location? |
Falciform (ant to liver)
Lesser Omentum (between stomach and portal triad) Gastrosplenic Splenorenal |
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Where's the Falciform ligament come from? contains?
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Derivative of Fetal Umbilical Vein
Ligamentum Teres hepatis |
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What does the hepatoduodenal ligament contain?
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Portal Triad
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what is contained in the Gastrohepatic Ligament?
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Gastric Arteries
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What is contained in the Gastrocolic ligament?
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Gastroepiploic arteries
(part of greater omentum) |
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Layers of the Gut (inside to out)
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Mucosa
Submucosa Muscularis externa Serosa/Adventitia |
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Layers of the Mucosa?
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Epithelium
Lamina Propria Muscularis mucosae |
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where are the nerve plexi in the gut wall?
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Submucosa: Meissner's Plexus
Muscularis Externa: Auerbach's Plexus (myenteric) between inner (circular) and outer (longitudinal) muscle layers |
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Frequency of basal electric rhythm of GI tract?
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Stomach: 3 waves/min
Duodenum: 12 Ileum: 8-9 |
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Fxn of Auerbach's Plexus?
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Myenteric:
Coordinates Motility along entire GI tract Contains some PANS effector neurons |
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Fxn of Submucosal/Meissner's Plexus?
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Regulates SECRETIONS, blood flow, and absorption
Contains some PANS neurons between mucosa and inner layer of smooth muscle of GI tract |
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Muscle distribution of Esophagus?
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Upper 1/3 = striated
Middle 1/3 = Striated and Smooth Lower 1/3 = Smooth |
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Embryonic Gut Region and its blood supply?
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Foregut = Celiac Artery
Midgut = SMA Hindgut = IMA |
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Embryonic Gut Region and their PANS innervation?
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Foregut = Vagus
Midgut = Vagus Hindgut = Pelvic |
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Embryonic Gut Region and their eventual location (mostly)?
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Foregut = T12/L1
Midgut = L1 Hindgut = L3 |
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Mature Structures of the Embryonic Foregut?
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Stomach to Proximal Duodenum
Liver Gallbladder Pancreas |
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Mature Structures of the Embryonic Midgut?
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Distal Duodenum to Proximal 2/3 of Transverse Colon
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Mature Structures of the Embryonic Hindgut?
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Distal 1/3 of Transverse Colon to Upper Rectum
(Splenic Flexure is a watershed region) |
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Branches of the Celiac Trunk?
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Common Hepatic
Splenic Left Gastric (these comprise main supply to stomach) |
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Where does the stomach have good/bad collateral circulation?
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Short Gastrics (to fundus from splenic) has poor anastomoses
Strong anastomoses exist between left and right Gastroepiploics (from splenic and gastroduodenal, resp) AND Left and Right Gastrics (from celiac trunk and common hepatic, resp) |
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Who are the Collateral Circulations if the Abd Aorta gets blocked?
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Internal Thoracic/Mammary <-->Superior epigastric (internal thoracic)<--->Inf epigastric (ext. ilaic)
Superior Pancreaticoduodenal (Celiac T)<-->Inf Pancreaticoduodenal (SMA) Middle Colic (SMA)<-->Left Colic (IMA) Sup Rectal (IMA)<-->Middle Rectal (internal iliac) |
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Where are the Portosystemic Anastomoses? clinical sign occuring there?
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ESOPHAGUS
Left gastric v<-->esophageal v Varices UMBILICUS paraumbilical v (port)<-->superficial and inf epigastric v Caput Medusae RECTUM sup rectal (port) <--> mid and inf rectal Internal Hemorrhoids |
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Rx for Portal HTN?
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Place a Shunt between Splenic and Left Renal Vein
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What forms the Pectinate Line? where is it?
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Where hindgut meets ectoderm
In my butt |
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What goes on above the Pectinate Line? problems? arterial supply? venous drainage?
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Internal Hemorrhoids
Adenocarcinoma Sup Rectal Artery Drains via Sup Rectal V-->IMV-->portal system |
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What goes on below the pectinate line? problems? arteries? veins?
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External Hemorrhoids
Squamous Cell Carcinoma Inferior Rectal Artery (from internal pudendal artery) Inf rectal-->int pudendal--->int iliac--->IVC |
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Difference between int and ext hemorrhoids?
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Int: visceral innervation, so not painful
Ext: somatic innervation (inf rectal nerve from pudendal nerve), so their painful: |
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What do the different sides of hepatocytes face?
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Apical surface faces bile canaliculi
Basolateral surface faces sinusoids |
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Zones of the liver?
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Zone 1: Periportal
Zone 2: Intermediate Zone Zone 3: Pericentral Vein (centrilobular) |
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Which zone is first affected by ischemia?
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Centrilobular zone
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Which zone is first affected by viral hepatitis?
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Periportal zone
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Which zone contains the P450 system?
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Centrilobular Zone
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Which zone is most sensitive to toxic injury?
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Centrilobular/Pericentral vein
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Which zone gets screwed by alcoholic hepatitis?
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Centrilobular/Pericentral vein
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What are liver sinusoids?
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Irregular "capillaries" w/ fenestrated endothelium, no BM
Allow macromolecules of plasma full access to basal surface of hepatocytes through perisinusoidal space |
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Oddi vs Vater?
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Oddi is the sphincter
Vater is the lumen of the duct |
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What's going on in the "femoral triangle?
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Lateral to medial:
Nerve-Artery-Vein-Empty Space-Lymphatics NAVEL venous near the penis |
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What is in the femoral sheath? where is it?
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3-4cm below inguinal ligament
Contains femoral vein, artery, and canal (deep inguinal LN's), but NOT femoral nerve |
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Which is more superior, internal/deep or external/superficial inguinal ring?
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Internal/deep is more superior and more lateral
External/superficial is more inferior and medial |
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Where are indirect and direct hernias located?
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Indirect comes out the Internal/Deep inguinal ring
Direct comes out Abd. wall...ouch |
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Location of the median and medial ubilical ligaments?
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Median is right at linea alba and thus medial to the medial ligaments
medial-median-medial |
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what is in the the inguinal canal?
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Spermatic Cord
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what are the layers of the spermatic cord?
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external spermatic fascia
cremasteric muscle and fascia internal spermatic fascia |
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What is a Hiatal Hernia? most common type?
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stomach through esophageal hiatus in diaphragm
Sliding HH is most common (hourglass stomach) |
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What is a paraesophageal hernia?
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GE junction is normal, but Cardia moves into the thorax
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OK, what is an Indirect Inguinal Hernia?
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Goes through internal (deep) inguinal ring, external inguinal ring, and into scrotum
Enters Int. Inguinal ring Lateral to Inf. Epigastric Artery |
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Why do we see Indirect Hernias in infants?
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Failure of processus vaginalis to close
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What is a Direct Inguinal Hernia?
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Protrudes through Inguinal (hesselbach's) Triangle.
Bulges directly through abd wall Medial to Inf. Epigastric Artery. ONLY goes through External/superficial Inguinal Ring Covered by only external spermatic fascia (internal was covered by all 3 layers) |
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What is the type of hernia more common in females?
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Femoral Hernia
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Location of a femoral hernia?
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Protrudes below inguinal ligaments through femoral canal below and lateral to pubic tubercle
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What is the leading cause of bowel incarceration?
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femoral hernia
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Way to remember location of Direct vs Indirect Hernias in relation to the Inf Epigastric Artery?
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MD's don't LIe
Medial to inf. epigastric is the Direct Lateral to inf epi is the Indirect |
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what form's Hesselback's Triangle (inguinal)?
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Inferior Epigastic Artery (superiolateral)
Lateral border of Rectus Abdominis (medial) Inguinal Ligament (inferiolateral) |
