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



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