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104 Cards in this Set

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  • Back
In what dermatome is the nipple?
T4
In what dermatome is the umbilicus?
T10
In what dermatome is the subcostal nerve?
T12
In what dermatome arethe ilioinguinal and iliohypogastric nerves?
L1
Where is the peritoneum in conjunction to the abdominal fascia?
Deep to Transversalis fascia (endopelvic)
2 Layers of Peritoneum:
-Parietal - lines internal abdominal wall
-Visceral - invests viscera
What is between the 2 peritoneum layers?
Peritoneal fluid
Difference in innervation of Parietal vs. Visceral peritoneum:
Parietal = highly segmented; pain is very localized.
Visceral = not segmented; pain is very vague
What is the major difference between Intraperitoneal and Retroperitoneal organs?
Intra = all the way IN - can put your hand around it.
Retro: not all the way in; only partly enclosed by peritoneum.
What is MESENTERY?
A fused double layer of parietal peritoneum which connects an organ to the abdominal wall and contains the major vessels supplying that organ.
What is the difference between Ventral or Dorsal Mesentery?
Ventral connects the organ to the anterior abdominal wall, Dorsal to the Posterior wall.
What defines an intraperitoneal organ?
It has a mesentery.
What defines a retroperitoneal organ?
No Dorsal Mesentary - It lost it during development.
What are the major intraperitoneal organs?
-Stomach
-Liver
-Transverse colon
What are the major retroperitoneal organs?
-Kidneys
-Pancreas
-Asc/Desc colon
-Abdominal aorta
What are the 3 main arterial branches off the Abdominal Aorta?
1. Celiac trunk
2. Superior mesenteric artery
3. Inferior mesenteric artery
What are the 3 branches of the Celiac trunk?
1. Left gastric
2. Splenic
3. Common hepatic
What does the Celiac artery supply?
Stomach, spleen, liver
What general area does the Superior mesenteric artery supply?
The MIDGUT derivatives (small intestine, asc/transverse colon)
What general area does the Inferior mesenteric artery supply?
The HINDGUT derivatives (Rest of colon, most of rectal vault)
At what verterbral level does the esophagus pierce the diaphragm?
T10
4 Main regions of the Stomach:
1. Cardiac
2. Fundus
3. Body
4. Pyloric
What results from an insecure connection between the esophagus and stomach?
GERD - gastro-esophageal reflux disease.
What is in the Cardiac region of the stomach?
Esophageal sphincter
What is the Fundus?
The most superior, dome-like portion of the stomach.
2 Portions of the Lesser Omentum:
-Gastrohepatic Ligament
-Duodenohepatic ligament
What does the Gastrohepatic ligament connect?
Connects the Lesser curvature of stomach to the liver.
What does the Duodenohepatic ligament connect?
Duodenum to underside of liver.
What 2 structures lie within the Duodenohepatic ligament?
-Bile duct
-Common hepatic artery
2 important parts of the Pyloric region of the stomach:
-Antrum
-Pyloric sphincter
The entire blood supply to the stomach comes from:
Celiac artery
What supplies blood to the Lesser Curvature?
-Right gastric a
-Left gastric a
What supplies blood to the Greater Curvature?
-Short gastric arteries
-Left gastroepiploic a
-Right gastroepiploic a
Short gastric aa.?
Splenic artery
Right gastric artery?
Proper hepatic
Left gastroepiploic a
Splenic artery
Right gastroepiploic a
Gastroduodenal artery
Major cause of acute GI bleeds:
Ulcers that erode the anastamosis between L/R Gastroepiploic arteries
2 Main Nerves supply the Stomach:
-Vagal trunks
-Greater Splanchnics
Nerve information carried in Vagus nerves to stomach:
-Parasympathetic Efferents
-Visceral Afferents
Nerve information carried in Greater Splanchnic nerves:
-Sympathetic Efferents from T5-T9
-Visceral afferents
What does parasympathetic innervation accomplish?
Digestion - glandular secretion and smooth muscle action.
What does sympathetic innervation accomplish?
Decreased digestion - constriction of blood vessels to divert flow to muscles.
How do the Greater Splanchnics get to the stomach from sympathetic trunk?
By synapsing at the Celiac Ganglion.
What primarily drains lymph from the body?
Thoracic duct - 75%
Where does the thoracid duct begin?
At cisterna chyli
How are stomach lymphatics situated?
Follow blood supply
Is the liver retro or intraperitoneal?
Intra
What is the falciform ligament?
Ventral mesentary that attaches the liver to the anterior abdominal wall
Inferior free edge of falciform ligament:
round ligament / Ligamentum teres
What is Ligamentum Teres?
Obliterated umbilical vein from fetal circulation
What is the Bare area?
The part of the liver attached to underside of diaphragm where there is no visceral peritoneum.
What forms the H of the liver?
Upper left: Fissure for ligamentum venosum
Lower left: Ligamentum teres
Upper right: IVC
Lower right: hepatus portus
Contents of Portis Hepatis:
-Common bile duct
-Proper hepatic artery
-Portal vein
-Branches of ANS
-Lymphatics
What is the common site of gall bladder stones?
Common bile duct
Common bile duct is formed by:
-Common hepatic duct
-Cystic duct
What is NOT in Portis Hepatis?
Hepatic veins - these drain to the inferior vena cava.
3 Sources of Innervation to the liver:
-Greater Splanchnic nerve
-RIGHT Phrenic nerve
-Vagus nerve
What sympathetic branches supply the Greater splanchnic nerve fibers to the liver?
T5-T9
What nerve information re: liver runs in the r. phrenic nerve?
Visceral afferents - thats why you can feel pain in dermatomes C3-4-5
Where are the digestive enzymes made by the pancreas released?
Duodenum - part 2
Is the pancreas retro or intraperitoneal?
Retro - except for the tail.
What are the 3 sources of blood supply to the pancreas?
1. Gastroduodenal a.
2. Splenic a.
3. Superior mesenteric A
How is the Superior Mesenteric A situated in relation to the pancreas?
-POSTERIOR to pancreas
-ANTERIOR to duodenum parts 3/4
What supplies the HEAD of the pancreas with blood?
BOTH
-Gastroduodenal
-SMA
What area of the pancreas is supplied by the Splenic A.?
How does it get there?
Runs on top of the pancreas to supply te Body/tail.
What can a DUODENAL ULCER result in? Why?
Severe Acute GI bleed - because the duodenum is situated on TOP of the gastroduodenal artery.
Where is most pancreatic cancer located?
At the head.
What nerves supply the Pancreas with sympathetic innervation?
-Greater splanchnic
-Lesser splanchnic
Where do the Splanchnic nerves synapse?
PREVERTEBRAL ganglia:
-Greater at Celiac ganglion
-Lesser at Superior mesenteric ganglion
Where do the postganglionic symp fibers to the pancreas go?
Via blood vessels to the pancreatic blood supply.
How does referred pain from Pancreatic fibers differ from that of the Liver?
Pancreatic: can be felt over whole lower back, none upper.
Liver: only on right side, may be felt in cervical region.
What nerves stimulate the pancreas to secrete digestive juices?
Vagus nerves
What lymph nodes will be enlarged in pancreatic cancer?
Probably CELIAC TRUNK nodes b/c the HEAD of the pancreas is the common site of cancer.
How does Pancreatic digestive fluid get into the duodenum?
It enters the Major Duodenal Papillae with the Common Bile Duct.
In what part of the duodenum is the papillae?
2nd
What is the exact portion of the Common bile duct where the Pancreatic Duct enters?
Hepatopancreatic Ampulla
What is the Sphincter of Oddi?
The sphincter that controls release of pancreatic digestive fluid into the common bile duct.
What is the MINOR duodenal papilla?
Where an accessory pancreatic duct would open if present.
What is the MAJOR DIFFERENCE between kidneystones vs. gall stones?
Gall stones won't have pain - they will present with JAUNDICE due to bile duct obstruction.
What is the Ligament of Treitz
Important landmark for the division btwn Duodenum and Jejunum
What is the function of the ligament of Trietz?
Suspends the duodenum from the musc fibers of right Diaphragm crus.
What will an ulcer in the duodenal bulb injure?
SMA - cause acute GI bleeding.
What separates parts 3/4 of the duodenum?
SMA - ARTERY runs behind the duodenum, VEIN runs in FRONT.
What supplies blood to the duodenum?
-SMA
-Gastroduodenal artery
What is the Duodenal-Jejunal junction important for?
Diagnosing/differentiating a GI bleed - upper vs. lower
What is the GREATER SAC?
The abdominal cavity when you stick your hand in and touch abdominal organs.
What is the lesser sac also called?
Omental bursa
What 2 ligaments define the lesser sac?
-Duodenohepatic
-Gastrohepatic
(both of the lesser omentum)
What runs within the duodenohepatic ligament?
All contents of the portis hepatis
What is not in the duodenohepatic ligament?
Hepatic portal vein
What allows communication from the Greater to lesser sac?
Epiploic foramen
Is the spleen intra or retroperitoneal?
Intra
Is the duodenum intra or retroperitoneal?
RETRO
Is the jejunum intra or retroperitoneal?
Intra
Which has a more complex blood supply; jejunum or ileum?
Ileum
Which has more folds inside the intestine lumen; jejunum or ileum?
Jejunum
What are Peyers Patches? What part of the small intestine has them?
Accumulations of lymph node tissue on the Ilium mucosal lining - not in the jejunum.
What are taenia? Where are they?
Bands of longitudinal muscle on the LARGE INTESTINE
What is the marginal artery?
An anastamosis briding the artery supply from the SMA and IMA
What nerves supply the ilium/jejunum, and large intestine?
Greater and lesser splanchnic nerves
Where do the greater and lesser splanchnic nerves synapse?
At the superior mesenteric ganglion
How far up does a colonoscopy go?
To the ileocecal junction
What is the Large intestine innervated by?
Up to Midpoint of Colon: VAGUS
Past that point: Sacral Plexus