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