Ga-8-29-06

Front 1

Ductus arteriosus

Back 1

-shunts blood from pulmonary artery to aorta in fetus

Front 2

Four Quadrants of Abdomen

Back 2

1. Right upper (contains liver)
2. Left upper (contains stomach and spleen)
3. Right Lower (contains ileum, jejunum, colon, appendix)
4. Left Lower (contains ileum, jejunum, colon)

Front 3

Greater omentum

Back 3

-first thing seen when abdominal wall is ipened
-double layered reflection of peritoneum
-hangs down from greater curvature of stomach
-attaches to transverse colon
-functions in fat storage
-adheres to areas of infection, enclosing and sealing off area

Front 4

Peritoneal organs

Back 4

-invested in peritoneum
Include:
1. Stomach
2. Spleen
3. Gallbladder
4. Liver
5. Jejunum
6. Ileaum
7. Transverse colon
8. Sigmoid colon

Front 5

Retroperitoneal organs

Back 5

-posterior to peritoneum
-anterior to abdominal wall
Include:
1. Kidneys
2. Ureters
3. Suprarenal glands
4. Pancreas

Front 6

Secondarily Retroperitoneal Organs

Back 6

-originally had a mesentery that attached them to the abdominal wall but during development have become attached posteriorly
-Include:
1. Ascending colon
2. Descending colon
3. Pancreas
4. Parts of duodenum

Front 7

Transverse colon

Back 7

-attached to posterior abdominal wall by transverse mesocolon

Front 8

Transverse mesocolon

Back 8

-attaches transverse colon to posterior abdominal wall

Front 9

Greater Sac of Abdominal Cavity

Back 9

-contains most of the abdominal organs
-liver and stomach superiorly, colon and small intestines

Front 10

Mesentery

Back 10

-extension of the peritoneum containing blood vessels, nerves, lymphatics

Front 11

Lesser Sac/Omental Bursa of Abdominal Cavity

Back 11

-behind the stomach and inferior to the liver
-has superior and inferior recess
-connected to greater sac by epiploid foramen
-ends laterally at border of spleen
-lies anterior to retroperitoneal structures
-allows stomach to move in different planes as we digest food
-peritoneum secretes fluid allowing movement

Front 12

What connects the Lesser Sac to the Greater sac and where?

Back 12

-Foramen of Winslow/Epiploic Foramen
-lies posterior to the hepatoduodenal ligament

Front 13

Boundaries of Foramen of Winslow

Back 13

1. Anterior= hepatic portal vein, hepatic artery proper, bile duct contained w/in hepatoduodenal ligament
2. Posterior= inferior vena cava and right crus of the diaphragm covered w/ parietal peritoneum
3. Superior= caudate lobe of the liver covered w/ visceral peritoneum
4. Inferior= first part of the duodenum covered with visceral peritoneum

Front 14

Inferior recess of lesser peritoneal sac

Back 14

-extends inferiorly as far as greater omentum
-during development extended between the layers of the greater omentum

Front 15

Superior recess of lesser peritoneal sac

Back 15

-highest part of lesser peritoneal sac
-lies anterior to diaphragm and posterior to the caudate lobe of liver

Front 16

What does the peritoneum that covers the pancreas form part of the posterior wall to?

Back 16

-lesser peritoneal sac

Front 17

What innervates the walls of the abdomen?

Back 17

-costal nerves

Front 18

Are intestines and other abdominal organs sensitive to pain?

Back 18

-no
-they are sensitive to being expanded or stretched though

Front 19

Hepatoduodenal ligament

Back 19

-attaches the duodenum to the liver
-contains three major structures on lateral edge: common bile duct, hepatic artery proper, hepatic portal vein

Front 20

Foregut

Back 20

Includes:
-esophagus
-stomach
-pancreas
-liver
-gall bladder
-bile ducts
-spleen
-duodenum
-blood supply by way of celiac trunk

Front 21

What does the celiac trunk supply?

Back 21

-foregut

Front 22

Midgut

Back 22

-small intestine
-blood supply by superior mesenteric artery

Front 23

Hindgut

Back 23

-colon
-blood supply by inferior mesenteric artery

Front 24

What artery supplies the midgut?

Back 24

-superior mesenteric artery

Front 25

What artery supplies the hindhgut?

Back 25

-inferior mesenteric artery

Front 26

Esophagus

Back 26

-passes through esophageal hiatus of diaphragm
-connects to stomach

Front 27

Esophageal sphincter

Back 27

-prevents reflux of stomach contents
-formed by diaphragmatic fibers
-physiological sphincter

Front 28

Barret Esophagus

Back 28

-chronic peptic ulceration of lower esophagus caused by damage done by reflux of HCL and food contents

Front 29

What can GERD be treated with?

Back 29

-H2 blockers
-these drugs inhibit secretion of excess acid

Front 30

Zig-zag line

Back 30

-junction of smooth portion of esophagus with rugae of stomach
-below the diaphragm

Front 31

Cardiac notch

Back 31

-also called "cardial notch"
-to the left of the junction of the stomach w/ esophagus
-betweem esophagus and fundus

Front 32

Fundus

Back 32

-dilated superior part of stomach that is related to the left dome of the diaphragm and is limited inferiorly by horizontal plane of cardial orifice
-superior part of fundus usually reaches 5th intercostal space

Front 33

Rugae

Back 33

-folds in the stomach wall
-allow for increased surface area of acid secreting cells

Front 34

Phrenoesophageal ligament

Back 34

-joins stomach to diaphragm on each side of esophagus

Front 35

Chyme

Back 35

-digested food and hydrochloric acid

Front 36

Greater Curvature of Stomach

Back 36

-greater omentum attaches here

Front 37

Parts of the Stomach

Back 37

1. cardiac = located superiorly, esophagus joins it
2. fundus
3. body
4. pyloric antrum
5. pylorus

Front 38

Pyloric canal

Back 38

-dumps into duodenum

Front 39

Pyloric sphincter

Back 39

-regulates the flow of digestive fluid from stomach to duodenum
-can use barium tracer to see if this sphincter is functioning properly

Front 40

Pyloric orifice

Back 40

-junction between pyloric portion of stomach and duodenum

Front 41

Gastrectomy

Back 41

-excision of a part of the stomach

Front 42

Why is stomach cancer usually a very poor prognosis?

Back 42

-drainage of stomach into hepatic portal vein has many lymph nodes surrounding it

Front 43

Pancreas

Back 43

-both exocrine (secretes digestive enzymes and endocrine (secretes hormones)gland
-secondarily retroperitoneal

Front 44

Parts of Pancreas

Back 44

-head (with uncinate process)
-neck
-body
-tail

Front 45

Where does the tail of the pancreas end?

Back 45

-hilum of spleen

Front 46

What are the two pancreatic ducts and what do they empty into?

Back 46

1. Principle (Wirsung) pancreatic duct
2. Accessory (Santorini) pancreatic duct
-empty into descending portion of duodenum

Front 47

Hepatopancreatic duct

Back 47

-common bile duct joins with main pancreatic duct to enter Greater Papillae of duodenum

Front 48

Acute pancreatitis

Back 48

-very deadly
-from viral infections or problems w/ gall bladder

Front 49

Cancer of pancreas

Back 49

-almost always involves the head and is deadly
-cancer of the tail often good prognosis

Front 50

Liver

Back 50

-peritoneal structure
-attached to inferior border of diaphragm by coronary ligament
-has right and left triangular ligaments
-produces proteins, bile, storage of carbohydrates, detoxification
-all blood from abdominal organs passes through here for detox.
-produces serum albumin from breakdown of proteins
-attached to anterior abdominal wall by falciform ligament
-four lobes

Front 51

Coronary ligament

Back 51

-attaches liver to inferior border of diaphragm

Front 52

Serum Albumin

Back 52

-produced by the liver from breakdown of proteins
-vitally important to maintenance of oncotic pressure
-albumin levels are reflection of ingested protein
-if level drops below 2, patient can't maintain enough fluid in cardiovascular system and begins to "third space" it

Front 53

Falciform ligament

Back 53

-attaches liver to anterior abdominal wall
-remnant of ventral mesentery during embryological development

Front 54

Ligamentum teres

Back 54

-in inferior posterior edge of falciform ligament
-remnant of umbilical vein

Front 55

Four anatomic lobes of liver

Back 55

1. Right
2. Left
3. Caudate
4. Quadrate

Front 56

Inferior border of liver

Back 56

-H shaped group of fissures
-gall bladder and IVC form one leg
-hepatic portal area forms transverse part of H
-Round ligament and ligamentum venosum form other leg of H
-these fissures form the boundaries of anatomical lobes

Front 57

Hepatoduodenal ligament

Back 57

-surrounds portal vein, common bile duct, and hepatic artery as they enter and exit the liver at the hepatic portal area

Front 58

what is the largest organ in the body?

Back 58

liver

Front 59

Bile

Back 59

-produced by liver for emulsification, absorption, and digestion of fats in digestive tract

Front 60

Gall Bladder

Back 60

-stores and concentrates bile from liver
-located in gall bladder fossa in right edge of quadrate lobe
-Parts = fundus, body, neck, cystic duct

Front 61

Cystic Duct

Back 61

-connects gall bladder to common bile duct

Front 62

Common bile duct

Back 62

-formed by common hepatic duct joined with cystic duct
-drains (inferiorly) into the major duodenum papilla of Vater along with the major pancreatic duct

Front 63

Spleen

Back 63

-largest lymphatic organ in body
-peritoneal organ
-suspended from gastrosplenic ligament and splenorenal ligaments in left upper quadrant
-splenic artery and vein enter and exit through hilum
-can be removed

Front 64

Duodenum

Back 64

-chyme from stomach passes into here
-mucosa has permanent folds called plicae curculares
-superior portion joins stomach at pyloric sphincter
-descending portion is retroperitoneal and contains the major duodenal papilla
-horizontal portion is retroperitoneal and passes between superior mesenteric artery and aorta
-ascending portion is both retroperitoneal and peritoneal, swings up then anteriorly

Front 65

Plicae circulares

Back 65

-permanent folds in mucosa of duodenum

Front 66

Major duodenal papilla (of Vater)

Back 66

-main opening for common bile duct and pancreatic duct
-in second (descending) portion of duodenum

Front 67

Superior mesenteric artery

Back 67

-major branch to intestines

Front 68

Duodenojejunal Flexure

Back 68

-where ascending portion of duodenum joins jejunum

Front 69

Ligament of Treits/Suspensory ligament of duodenum

Back 69

-attaches ascending (fourth) part of duodenum to right crus of diaphragm
-located just proximal to duodenojejunal junction

Front 70

What portion of the duodenum contains the major duodenal papilla?

Back 70

-descending(retroperitoneal) portion

Front 71

What portion of the duodenum passes between the superior mesenteric artery and aorta:

Back 71

-horizontal (third) portion
-retroperitoneal

Front 72

What portion of the duodenum is both retroperitoneal and peritoneal?

Back 72

-Ascending (fourth) portion

Front 73

What portion of the duodenum joins the jejunum at the duodenojejunal flexure?

Back 73

-Ascending portion

Front 74

Where does the fourth (ascending) part of the duodenum become peritoneal?

Back 74

-as it joins the jejunum

Front 75

Major ampulla

Back 75

-located in second (descending) portion of duodenum
-receives the junction of the major pancreatic duct and common bile duct

Front 76

Major duodenal papilla/Vater

Back 76

-where descending duodenum receives the hepatopancreatic ampulla

Front 77

Secondary/minor duodenal papilla

Back 77

-usually superior to major duodenal papilla
-receives accessory pancreatic duct of Santorini

Front 78

Where does Santorini duct join duodenum?

Back 78

-Minor duodenal papilla

Front 79

Where does the suspensory ligament of Treitz attach to the diaphragm?

Back 79

-right crus

Front 80

Jejunum and Ileum

Back 80

- 6-7 m long
- extend from ligament of Treitz to ileocecal junction
- jejunum is shorter than ileum
-both suspended from posterior body wall by the mesentery
-supplies by SMA
-drained by SMV

Front 81

Jejunum

Back 81

- shorter than ileum (~2/5 of entire length)
-less fat in its mesentery than ileum
-vasa recta are long and straight
-wall thick and heavy
-deeper red in color
-large, tall, closely packed circular folds
-few lymphoid nodules
-more vascularity

Front 82

Ileum

Back 82

- longer than jejunum
-more fat in mesentery than jejunum
-vasa recta shorter w/ more complex arcades
-paler pink in color
-thin and light wall
-less vascularity
-circular folds low and sparse, absent in distal part
-many lymphoid nodules

Front 83

Colon

Back 83

-for absorption, dehydration, and lubrication of fecal material
-Ascending, transverse, descending, and sigmoid portions

Front 84

Teniae coli

Back 84

-feature of large intestine
-3 longitudinal bands of fascia running along large intestine

Front 85

Haustra

Back 85

-feature of large intestine
-sacculation or pouches of colon between teniae coli

Front 86

Epiploic/Omental Appendices

Back 86

-small, fatty appendices of colon

Front 87

Transverse colon

Back 87

-largest and most mobile portion of colon
-extends from hepatic flexure to left colic flexure
-attached to abdominal wall by transverse mesocolon
-supplied by middle colic artery, branch of SMA
-drained by SMV

Front 88

Transverse mesocolon

Back 88

-mesentery of transverse colon
-root lies along inferior border of the pancreas and is continuous w/ parietal peritoneum posteriorly

Front 89

Appendix

Back 89

-small portion that hangs off cecum of ascending colon
-blind intestinal diverticulum
-has a short triangular mesentery called mesoappendix which derives from posterior side of mesentery of terminal ileum
-usually retrocecal
-lies deep to McBurney Point
-Supplied by appendicular artery, a branch of the ileocolic artery
-drained by ileocolic vein

Front 90

Ileocecal junction

Back 90

-where ileum empties into colon

Front 91

Ascending colon

Back 91

-continuous w/ transverse colon at right colic flexure (hepatic colic flexure)
-passes superiorly on the right side of the abdominal cavity from the cecum to the right lobe of the liver
-narrower than cecum
-retroperitoneal
-separated from anterolateral abdominal wall by greater omentum
-has vertical groove lined w/ parietal peritoneum (right paracolic gutter) on lateral aspect
-supplied by ileocolic and right colic arteries (branches of SMA)
-drained by ileocolic and right colic veins (branches of SMV)

Front 92

Descending colon

Back 92

-secondarily retroperitoneal
-passes from left colic flexure into left iliac fossz
-continuous w/ sigmoid colon
-covered by peritoneum anteriorly and laterlly
-bound to posterior abdominal wall by peritoneum
-short mesentery in iliac fossa in 33% of people
-passes anterior to lateral border of left kidney
-paracolic gutter on lateral aspect
-supplied by left colic and sigmoid arteries (branches of IMA)
-drained by IMV

Front 93

Sigmoid colon

Back 93

-S shaped loop of colon linking descending colon to rectum
-variable in length
-extends from iliac fossa to third sacral segment where it joins the rectum
-termination of tenia coli indicates rectosigmoid junction
-usually has long mesentery called sigmoid mesocolon
-supplied by sigmoid artery (branch of IMA)
-drained by IMV

Front 94

Root of sigmoid mesocolon

Back 94

-inverted V shaped attachment
-extends medially and superiorly along the external iliac vessels and then medially and inferiorly from the bifurcation of the common iliac vessels to the anterior aspect of the sacrum

Front 95

Marginal artery

Back 95

-formed by anastamoses of all or most of the branches of arteries supplying blood to colon
-forms a continuous anastamotic channel
-iliocolic a., right, middle, and left colic aa., sigmoid aa.