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Abdomen
Anatomy
| Question | Answer |
|---|---|
| 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) ¶nephric (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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