Anatomy
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| Organs in foregut | Esophagus, stomach, 1/2 duodenum, liver,gallbladder, pancreas
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| Artery in foregut | Celiac trunk
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| Veins in foregut | Gastric v., splenic v.
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| Lymph nodes in foregut | Celiac nodes
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| Organs in midgut | 1/2 duodenum, jejunum, ileum, cecum, appendix,ascending colon, 2/3 transverse colon
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| Artery/vein/lymph nodes in midgut | Superior mesenteric a./v./lymph nodes
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| Organs in hindgut | 1/3 transverse colon, descending colon, sigmoidcolon, rectum
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| Artery/vein/lymph nodes in hindgut | Inferior mesenteric a./v./lymph nodes
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| Transpyloric at level: | L1
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| Subcostal at level: | R10/L3
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| Transumbilical at level: | L4
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| Intertubercular at level: | L5
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| Abdominal planes | Vertical: Sagittal; midclavicular
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| Inguinal canal houses: | spermatic cord
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| Closed sac surrounding abdominal contents | Peritoneum
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| Parietal peritoneal layer drapes over: | Uterus, or bladder in males
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| WRT peritoneum, organs are: | Retroperitoneal or intraperitoneal
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| Peritoneal cavity contains: | Fluid only
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| Hangs from greater curvature of stomach | Greater omentum
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| Hangs from lesser curvature of stomach | Lesser omentum
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| Parasympathetics to foregut/midgut: | Vagus n.
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| Parasympathetics to hindgut: | Pelvic splanchnic n.
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| Sympathetics to hindgut: | Lumbar splanchnic nerves
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| Types of muscle in esophagus | Sk mx in upper part & smooth mx in bottom
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| Pharynx to cardiac stomach via: | esophageal hiatus in diaphragm
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| Greater and lesser omentum are formed by: | Folds of peritoneum
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| Thoracic esophagus pierces diaphragm at: | T10
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| Volume of stomach | 50 mL to 4L
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| Opening from stomach to duodenum | Pylorus
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| Normal radiographic finding in fundus of stomach | Gas bubble
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| Folds inside stomach | Rugae
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| Narrowing of stomach before pyloric sphincter | Pyloric canal
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| Curves around head of pancreas | Duodenum
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| Four lobes of liver | Right, Left, Caudate, Quadrate
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| Falciform ligament separates: | L and R lobes
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| Round ligament: | Remnant of umbilical vein
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| GB form & function | 10 cm long; Stores and concentrates bile
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| Parts of pancreas | Head, Neck, Body, Tail
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| Celiac trunk comes off: | Abd aorta at T12
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| Horizontal: | Transpyloric; Subcostal; Transumbilical; Intertubercular
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| 2 fascial abd layers & potential for infxn | Camper’s (superficial): fatty, so more infxn risk; Scarpa’s (deep): membranous, anchored to pubis, limits infxn spread to thigh
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| Fns of Abd wall mx’s | Ext/Int oblique & transverse abd: Posture & movements of torso; Protect abd organs; Forced expiration; Defecation, micturition, parturition; End medially in aponeurotic sheet (form sheath around rectus abd mx)
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| Arcuate line is at level of: | ASIS; superior to line = rectus sheath & transversalis fascia; inferior to line = only transversalis fascia
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| Abd wall layers | Superficial (=Camper’s fascia); Deep (=Scarpa’s fascia); Ext Obl; Int Ob; Trans abd; Transversalis fascia; Parietal peritoneum
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| Epigastric arteries run: | Inside rectus sheath deep to rectus abdominus
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| Levels of abd dermatomes | Cutaneous branches of T7-T12/L1 levels; Xiphoid = T5/6; Umbilicus = T10; Pubis = L1
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| Abd wall lymphatics | Above umbilicus: axillary lymph nodes; Below umbilicus: inguinal (groin) lymph nodes
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| As gubernaculum descends, what mx layers does it pierce? | Ext oblique, int oblique, transversalis fascia; NOT transv abd mx nor parietal peritoneum
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| In devt, testes are initially ______ and pull the _______ with them as they descend | Retroperitoneal; processus vaginalis
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| Contents of Inguinal canal | Testicular a.; Pampiniform plexus of veins; Ductus deferens; Lymphatics & nerves to testes
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| Layers of Inguinal canal (superficial to deep) | Aponeurosis of ext oblique (=ext spermatic fascia); Mx of internal oblique (= cremaster mx); Transversalis fascia (=int spermatic fascia); (no contrib fr transversus abd mx
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| Inguinal canal (entrance/exit) | Entrance = deep inguinal ring (transversalis fascia); Exit = superficial inguinal ring (ext oblique)
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| Inguinal canal Walls: | Ant = ext oblique; Post = transversalis fascia; Roof = int oblique/ transv abd; Floor = inguinal ligament
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| Direct (acquired) hernia | Through abd wall; Bulge located medially; May exit superficial inguinal ring, although rarely enters scrotum
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| Indirect (congenital) hernia | Through inguinal canal (esp. deep ring); Most common: assoc w/patent processus vaginalis; eritoneal sac may protrude into scrotum
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| Peritoneum innervation | Parietal layer = somatic sensory innervation (pinpoint pain); Visceral layer = visceral sensory innervation (genl dull pain)
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| Intraperitoneal structures attach to abdominal wall via: | Mesentery
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| Mesentery | Double layered folds of peritoneum; Fn to suspend abd contents & keep them in place; contain blood, lymph, & nervous supply to tissue
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| Greater omentum | Primarily fatty tissue (highly vascular); drapes over the abd contents like an apron; hangs off stomach & transverse colon
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| Lesser omentum | Membrane that extends from the stomach to the liver
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| Adheres to structures in abd cavity & suppresses infxn | Greater omentum
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| 3 regions of gut embryology | Foregut, midgut, hindgut (Each has separate vasculature and lymphatics)
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| Gut Embryology: Foregut | Esophagus, stomach, 1/2 duod, liver, GB, pancreas; Artery: Celiac trunk; Veins: Gastric v., splenic v.; Lymph: Celiac nodes
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| Gut Embryology: Midgut | 1/2 duod, jejunum, ileum, cecum, appendix, asc colon, 2/3 transverse colon; Artery: Sup mesenteric a.; Vein: Sup mesenteric v.; Lymph: Sup mesenteric nodes
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| Gut Embryology: Hindgut | 1/3 transv colon, desc colon, sigmoid, rectum; Artery: Inf mesenteric a.; Vein: Inf mesenteric v.; Lymph: Inf mesenteric nodes
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| Sympathetics to foregut/midgut: | From sympathetic trunk via thoracic splanchnic nerves
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| Consequences of malfunctioning cardiac sphincter | Heartburn/ acid reflux / GERD; Hiatal hernia
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| Most common site of duodenal ulcers | Superior part (proximal 1/4) of duodenum
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| Fn of duodenum | Receives stomach contents, pancreatic juice & bile from accessory organs of foregut (liver, gallblader, pancreas)
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| GB adheres to: | Ventral/inferior surface of liver, between right and quadrate lobes
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| Pancreatic duct runs _____ & joins ______ | Length of gland; bile duct to form hepatopancreatic sphincter(=ampulla)
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| Spleen location & size | Superiormost border of upper L quadrant; Close proximity to L kidney, stomach, & tail of pancreas; typically size of a fist
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| AKA Porta Hepatis | Portal triad; Bile duct & hepatic artery proper & portal vein; in lower fold of lesser omentum (hepatoduodenal ligament)
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| ____ are not part of the gut, but are actually __________ | Liver, GB, pancreas; accessory organs
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| _____ runs length of pancreas, and joins bile duct to form ______ | Pancreatic duct; hepatopancreatic sphincter(=ampulla)
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| Tail of pancreas sits at: | Hilum of spleen
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| Site of nearly all chemical digestion and nutrient absorption | Small intestine
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| Boundary between duodenum and jejunum at: | duodenojejunal flexure
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| Boundary between jejunum and ileum: | Indistinct
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| Jejunum vs ileum: jejunum | Proximal 2/5ths; Thicker walled; Prominent plicae circulares (jejunum site of most absorption)
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| Jejunum vs ileum: ileum | Distal 3/5ths; Thinner walled; Fewer plicae circulares; Peyer patches
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| Colon: Begins with: | cecum and appendix in LRQ
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| Lg int: geog rel to small intestine | Ascending, transverse & descending colon frame the small intestine
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| Sigmoid colon is S-shaped portion leading: | down into pelvis
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| Flexures of large intestine | R colic (hepatic); L colic (splenic)
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| Greater omentum attached to ____ colon | Transverse
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| Large intestine: midgut/hindgut | Ascending & R 2/3 of trans = midgut; L 1/3 of trans & desc = hindgut
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| Colon innervation | Midgut: vagal (parasym??) (check this); hindgut: splanchnic n. (S2-S4) (parasym)
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| Ileocecal valve | At junction of ileum and cecum; prevents reflux from cecum to ileum
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| Appendix location | Variable; usually retrocecal; McBurney = 1/3 btw ASIS & umbilicus
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| Sup mes artery | Blood supply to midgut; off of abdominal aorta at L1; above duod
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| Inf mes artery | Blood supply to hindgut; off of abdominal aorta at L3; below duod
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| Marginal artery found: | running around the large intestine; SMA & INF form anastomoses
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| All blood from gut drains to: | hepatic portal vein, via Gastric, splenic, SMV, IMV
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| Main anastomoses of hepatic portal: | Gastroesophageal jct.; Rectal veins; Ant abd wall
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| Hepatic caval veins become enlarged: | Esophageal varices; Hemorrhoids; Caput medusae at umbilicus
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| hemorrhoids: | blood drains into caval system (instead of portal system)
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| Caput medusae: | blood flows to inf/sup epigastric v, flows to ext iliac; will lead to enlarged epigastric v
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| Infantile ductus venosus becomes: | Ligamentum venosum
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| Abd (pre-aortic) lymphatics | Foregut: Celiac nodes; Midgut: Sup mes nodes; Hindgut: Inf mesenteric nodes
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| Iliopsoas mx fn | hip flexion
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| Quadratus lumborum fn | Stabilize RXII and laterally bend trunk
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| Abd Aorta: Unpaired branches | Celiac trunk; SMA; IMA
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| Renal vasc/innerv/lymphatics | Renal a./v. (asymmetric); Innervation same as fore/midgut; Lateral aortic (lumbar) nodes near renal arteries
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| Abd Aorta: Paired branches | Middle suprarenal a.; Renal a.; Gonadal a.
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| Abd Aorta: Inferior bifurcation into: | R/L common iliac a. (then Internal iliac a. & External iliac a.)
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| Abd veins | Hepatic, renal, gonadal, common iliac v.
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| Sup suprarenal a. comes off: | Inf phrenic a.
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| Inf suprarenal a. comes off: | Renal a.
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| Middle suprarenal a. comes off: | aorta directly
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| Suprarenal cortex produces: | corticosteroids
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| Suprarenal medulla produces: | epi & norepi
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| Kidneys are surrounded by: | perinephric (around) ¶nephric (next to) fat
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| Kidney positions | T12-L3; R sits lower than L
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| Kidney morpho variations | Pelvic kidney; Horseshoe kidney; Accessory renal arteries (devt remnant)
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| How many calyces in kidneys? | 1 minor calyx per pyramid; 2-3 major per kidney
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| Passage of urine from kidney to bladder | via ureter by peristalsis
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| Kidney parts | Tough outer fibrous capsule; Renal cortex
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| Urethral sphincter ctrl | Internal urethral sphincter = involuntary (autonomic) ctrl; ext sphincter = vol ctrl
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| Bladder trigone composed of: | sm mx
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| Bladder position | when deflated, entirely within pelvic cav; distended, may extend into abd cav
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| Lumbar plexus: location/pierces: | L1-L3 spinal levels; all ventral rami; pierces psoas mx
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| Lumbar plexus innervates: | Abd musculature; Skin of upper thigh and inner leg (e.g. calf)
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| Lumbar plexus: 2major named branches | Obturator n. (Medial thigh); Femoral n. (Ant. Thigh)
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| Peyer patches: lymphoid or myeloid cells? | lymphoid
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| Adaptive immune system in GI tract is what type of tissue? | MALT/GALT (gut-associated lymphoid tissue)
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| 3 neuron types in enteric nervous system (intrinsic innervation) | IPAN (intrinsic primary afferent neurons); interneurons; secretomotor (efferent) neurons
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| Extrinsic innervation in GI tract | sympathetic & parasympathetic nerves (cell body outside the gut wall; part of brain-gut axis)
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| Neurotransmitters used by GI preganglionic nerves (vagus & pelvic n.) | Acetylcholine (Ach): activates nicotinic receptors on enteric neurons, which use Ach (on muscarinic receptors) and neuropeptides
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| Pathway of extrinsic GI sensory nerves | Parasympathetic: gut to cell bodies in nodose ganglia to brainstem. Sympathetic: gut to cell bodies in dorsal root ganglia to spinal cord
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| Network of cells interacting with enteric nerves and smooth muscle cells, AKA: | interstitial cells of Cajal (ICC)
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| Substance produced by parietal cell membranes that allows HCl secretion | H+-K+ATPase (active transport)
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| What is the suspensory ligament of the duodenum? | Ligament of Treitz
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Created by:
Abarnard
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