Thoracic Viscera & Abdominal Cavity Lecture 12

Front 1

The sympathetic chain..

Back 1

links the paravetebral ganglion from the skull to the coccyx.

Front 2

Where are the preganglionic cell bodies found?

Back 2

The preganglionic cell bodies are ONLY found in the Thoracolumbar Outflow spinal cord levels of T1 - L2, which is paravetebral.

Front 3

Ganglion are located where and outflow from where?

Back 3

The entire spine has ganglion.
Cervical 3
T1-L2
Sacral and Coccyx region
but ONLY outflow from T1-L2

Front 4

Explain the mismatch of Ganglion to outflow

Back 4

The sympathetics for lower or higher levels enter the sum chain, enter the GRC at higher or lower level and synapse to into spinal nerves.

Front 5

Sympathetic Outflow is between ...

Back 5

ONLY T1 - L2.

This is the only place where preganglionic cell bodies are located.

Front 6

What levels are Grey Communicating Rami?

Back 6

All Levels and allow the communication with the spinal cord.

Front 7

What does Grey and White Communicating Rami transmit?

Back 7

The WCR transmit from preganglionic spinal nerves to sympathetic chain ganglia. They are the entrance ramp to the sympathetic chain highway.

The GCR transmit postganglionic sympathetics from ganglion to spinal nerves including all somatic motor neurons and split into dorsal or ventral rami. They are the exit ramp to off the sympathetic Chain highway into spinal nerves. GCR are the only exits off the sympathetic highway into spinal nerves.

Front 8

What are the purpose of the GRC and WRC?

Back 8

Connect to spinal nerves.

The spinal nerve enters from the ventral grey column as a ventral root. The ventral root enters the WCR and synapse. The neuron fiber then leaves through the GCR and into the spinal nerve.

Front 9

Where are parasympathetics not located?

Back 9

The Parasympathetics are not located in

1) extremities
2) Body walls
3) Abdominal and Thoracic Walls

Front 10

What is parasympathetic outflow called?

Back 10

Craniosacral Outflow

Front 11

Where does Craniosacral Outflow go?

Back 11

Craniosacral Outflow is only in the Body Cavities, Head and Neck region.

Front 12

What are the origins of the Craniosacral Outflow regions

Back 12

1) Cranial Nerves 3, 7, 9 - Cranial Ganglia very near structure- Head and Neck
2) Cranial Nerve 10 - terminal ganglia in the walls of the viscera- Viscera of the neck, thorax foregut, and midgut (much of the abdomen)
3) Pelveic Splanchnic Nerves S2 - S4 spinal cord levels - terminal ganglia in the walls of the viscera) - Hindgut & Pelvic Viscera (including the bladder and erectile tissue)(Perineum)

Front 13

Definition of ANS

Back 13

The part of the nervous system that is motor to smooth muscle (SM, cardiac ms, glands). Nervous system of visceral structures

Front 14

Somatic vs Visceral (ANS) System

Back 14

Somatic - ! neuron between CNS and Target

ANS - always 2 neurons between CNS and target and synapse in autonomic ganglion

Front 15

Sympathetic vs Parasympathetic

Back 15

Sympathetic - ganglion near CNS, pregang fibers short and post gang long

Parasympathtic: ganglia near/in target, pre gang fibers long and postgang fibers short

Front 16

What are the 8 structures of the superior mediastinum?

Back 16

1) Thymus
2) Brachiocehalic veins
3) SVC
4) Aortic arch and branches
5) phrenic and vagus nn
6) Trachea
7) esophagus
8) Thoracic Duct
9) Sympathetic Chain

Front 17

What are the structures of the Posterior Mediastinum?

Back 17

1) Esophagus
a) Esophageal Plexus
2) Descending Aorta
3) Azygos System of veins
4) Vagus Nerves
5) Sympathetic Chain

Front 18

Esophageal Plexus?

Back 18

Made of parasympathetics from the vagus n and Post ganglionic sympathetic that have synapsed in the Sym Chaim

Front 19

Anterior and Posterior Vagal Trunk?

Back 19

TheEnter the abdomen through the Esophageal Hiatus at T10 and provide innervation for Foregut and Midgut viscera of the abdomen

Front 20

Thoracic Duct

arises from

Back 20

Cisterna chyli in the abdomen

Front 21

Thoracic Duct

Passes thru _1_
Runs with _2_
Passes to the _3__ side behind __4__
and empties into 5

Back 21

1) diaphragm
2) azygous vein R side
3) left side
4) heart
5) L Brachiocephalic vein where the L subclavian and L internal jugular give rise to it

Front 22

Thoracic Duct and Rt Lymphatic duct

Drains

Back 22

Lower Limbs
3/4 of the thorax
1/2 upper head and Neck

Rt lymphatic duct drains
R upper limb
R Thorax
R Head and Neck

Drains into the Subclavian

Front 23

Azygos System of veins

Begin

Back 23

in the abdomen typically on the right side

Front 24

Azygos System of veins

Left side has and drains

Back 24

Hemiazygos
and maybe accessory azygous

Drains
Posterior intercostals

Front 25

Azygos System of veins

Runs

Back 25

right side and just posterior to the heart on the superficial surface of the heart

Front 26

Sympathetic outflow is called

Back 26

Thoracolumbar Outflow

Front 27

Name the 3 types of Thoracolumbar Outlflow and their origins.

Back 27

Spinal Cord Levels T1-L2

Thoracic Splanchnic Nerves T5-L2

Lumbar Splanchnic Nerves L1, L2

Front 28

Name the site of synapse for each of the 3 Thoracolumbar Outlflow regions

Back 28

Spinal Cord Levels T1 - L2 at synapse at the Sympathetic Chain ganglia

Thoracic Splanchnic Nerves T5-L2 synapse at Prevertebral Ganglia (after passing diaphragm) associated with major arteries. The post sympathetic nerve fibers then travel on the arteries to the targeted structure. eg. Celiac Ganglion/Trunk, Superior Mesenteric ganglia/Trunk

Front 29

Name the innervations of each of the Thoracolumbar Outflow regions

Back 29

Spinal Cord levels T1-L2 - SM, cardiac muscle, glands of the body wall,, head and thoracic viscera

Thoracic Splanchnic NervesT5-L2 - SM and glands of foregut and midgut

Lumbar Splanchnic nerves L1-L2 - SM, and glands of the pelvic viscera and hindgut

Front 30

The Thoracic Splanchnic Nerves are __1__ that get through the diaphragm by __2___ at level __3___ synapse around _4__ of the aorta, which are ___5__

Back 30

1) Preganglionic sympathetic
2) Esophageal Hiatus
3) T10
4) 3 unpaired branches
5) Celiac, Superior Mesenteric, Inferior Mesenteric

Front 31

Greater Splanchnic Nerve emanates at what level?

Back 31

T5-T9

Front 32

Name the level(s) of Parietal Pericardium

Back 32

Fibrous
Serous

Front 33

Collateral Circulation around the Thorax - Describe it

Back 33

Aorta -> Posterior Intercostals -> Anterior Intercostals -> Internal Thoracics -> Superior & inferior epigastric -> Proximal thigh -> aorta after blockage

Front 34

Name the 4 planes of the of the abdominal region

Back 34

1) Midclavicular L & R
2) Subcostal Plane
3) Transtubercular Plane -Turbercles of the Iliac Crest
4) Midinguinal point

Front 35

What are the 9 Sections R TO L AND U to D?

Back 35

RH - R Hypochodriac - Liver
E _ Epigastic
LH - L Hypogastric

RL - R Lumber (Laterals)
U - Umblicus
LL - L Lumbar (laterals)

RI - Right Inguinal
P - Pelvic
LI - Left Inguinal

Front 36

Name the 4 Abdominal Quadrants with examples

Back 36

RUQ - R upper quadrant - R kidney, Gallballader
LUQ - L Kidney
RLQ - R lower quadrant - Appendix, Cecum
LLQ - Sigmoid

Front 37

The third serous membrane of the body is

Back 37

Peritoneum

(Pleura, Pericardial)

Front 38

Define Parietal and Visceral Peritoneum.

Back 38

Parietal - lines the internal aspect of the abdominal wall.

Visceral - covers the the surface of organs

Front 39

What are the layers of peritoneum?

Back 39

Peritoneum,
Extraperitoneal Connective Tissue (which contains VAN)
Endoabdominal Fascia (Transversalis Fascia Anteriorly)
Subcutaneous Superficial Fascia
Muscle

Front 40

3 major types of invaginating relationships <> organs and peritoneum

Back 40

1) Retroperitoneal - Pancreas, Kidney, Ureturs, IVC, Abdominal Aorta,

2) Partially Peritonealized (secondarily retroperitoneal) - Ascending and descending Colon

3) Completely Peritonealized - Stomach, liver, TC, Jejunum, Ilium - MEsentary

Front 41

Define Mesentary

Back 41

has 2 layers of peritoneum with VAN and attaches it organ to the body wall. Completely peritonealized.

Front 42

Pain

Parietal Peritoneum -Inn by and type of pain?

Back 42

Innervated by somatic afferent nerves of the body wall and have sharp localized pain. Ie kidney,

Front 43

Pain

Visceral Peritoneum Inn by and type of pain?

Back 43

Visceral Afferents nerves and has dull,generalized (poorly localized) pain.

Exception is completely peritonealized viscera touches the body cavity than will have sharp, localized pain. i.e. appendix until appendicitis

Front 44

Pathway of a Bolus of food

Back 44

Mouth -> esophagus-> stomach -> pyloric valve-> duodenum-> jejunum-> ilium-> iliocecal valve -> cecum -> ascending colon -> transverse colon -> descending colon -> sigmoid colon -> rectum-> anal canal-> anus

Front 45

What abdominal organ is not of the GI Tract?

Back 45

Spleen

Front 46

Where are the kidneys located?

Where is the pancreas located?

Back 46

Kidney's are behind the liver

The head and neck of the pancreas is in the duodenal loop and the tail almost touches the spleen.

Front 47

NAme the region of the stomach

Back 47

Fundus
Cardiac
Body
Pyloric

Front 48

Name the corners of the Transverse Colon

Back 48

Right (Hepatic) Flexure

Left (Splenic) Flexure

Front 49

Where is the spleen located?

Back 49

LUQ behind the upper portion of the stomach

Front 50

Lesser Omentum

Attachments
2 Parts
Name the Entry
Name the Cul de Sac

Back 50

1) Hepatogastric - attachment from the lesser curvature of the stomach to the liver

2) Hepatodudodenal - liver to first part of the duodenum

3)Entry is the Epiploic Foramen

4) Omental Bursa (lesser sac)

Front 51

Greater Omentum

Attachments
Contents
Blood Supply

Back 51

1) Greater Curvature of the Stomach

2) Gastrocolic Ligament of the transverse colon (not a true ligament)

3) VAN

4) R Gastroepiploic - arises from gastroduodenal, which comes from the ecommon hepatic

5) L Gastroepiploic - arises from splenic artery

Front 52

Mesentary of the Transverse colon is called ?

TC completely peritonealized?

Back 52

Transverse mesocolon and is completely peritonealized

Front 53

What is the pathology pancreatitis?

Back 53

The common bile duct could be closed and lead to jaundice

Front 54

LIVER

Name the 7 parts

Back 54

1) Right lobe
2) Left Lobe
3) Flaciform Ligament w/ round ligament (FL not real ligament)
4) Gallbladder (posterior right side)
5) IVC at right superior side
6) Coronary Ligament - mesentery <> liver and diaphragm
7) Bare spot no mesentery