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Raj Gross III exam 1

NYCC Dr. Raj Philomen Abdominal SP10

External Oblique ORIGIN fleshy slips from lower 8 ribs
External Oblique INSERTION Anterior 2/3 of outer Iliac crest, Linea alba, pubic symphysis, xyphoid process, pubic crest, pectin pubis, pectineal line
External Oblique INNERVATION lower 6 thoracic nerves
special features of EO: What is the defining feature of the EO? Inguinal ligament
Special EO features: The upper and posterior borders are _______ free
EO special features cont. The inferior border of the inguinal ligament is formed by ___________ folded upon itself to form the inguinal ligament aponeurosis
The EO aponeurosis forms the _________ _________ of the inguinal ligament. inferior border
The external oblique aponeurosis, along with: ________ _____________ _________ (2) forms the roof of the inguinal canal skin, superficial fascia (Camper's & Scarpa's)
The inguinal ligament extends from the ASIS to the pubic tubercle
1cm. above & lateral to the pubic tubercle there is an opening of the aponeurosis of the external oblique muscle called the superfical inguinal ring
the superficial inguinal ring emerges from the aponeurosis of the external oblique muscle
the superficial inguinal ring has a medial border called the medial crus
the superficial inguinal ring has a lateral border called the lateral crus
Structures passing through the superficial inguinal ring: Males - (what and where does it insert?) Females - (" ") Common to both males and females - Males - spermatic cord to insert on scrotum & Females - round ligament of the uterus inserts on labia majora & Common - ilio-inguinal nerve
Structures attached to the Inguinal Ligament: 1. fleshy fibers of the (muscle?) 2. fleshy fibers of the (muscle?) 3. small part of the (muscle?) 4. fascia _______ 1. internal oblique muscle 2. transversus abdominis muscle 3. cremaster muscle 3. fascia lata (thigh)
what passes through the superficial inguinal ring in males? females? both? spermatic cord; round ligament of uterus; ilio-inguinal nerve
what muscles attach to the inguinal ligament? transversus abdominis, internal oblique, cremaster, and fascia lata of thigh (Holden's line)
Extensions of the inguinal ligament: (the following are sites for anchoring sutures to the inguinal lig when hernia is repaired by medical doc) the small triangular part, its apex being attached to the pubic tubercle, is the lacunar ligament
the base of the lacunar ligament forms the __________ boundary of the __________ ring base, femoral
the femoral ring is the inner opening of the femoral canal
the lateral border of the femoral ring is the femoral vein
the medial border of the femoral ring lacunar ligament
the lateral border of the femoral ring femoral vein (NAVL - nerve, artery, vein, lymph)
the apex of the lacunar ligament is attached to the pubic tubercle
the small extension from the lacunar ligament is called the pectineal ligament
the pectineal ligament attaches to the pectineal line
from the lateral crus of the superficial inguinal ring to the linea alba is called the reflected part of the inguinal ligament
the reflected part of the inguinal ligament is from the lateral crus (inferior) to the linea alba
the internal oblique has fibers that pass (3) upwards, forwards, medially
the origin of the internal oblique (IO): a.) bone? b.) fascia? c.) ligament? a.) ant. 2/3 iliac crest b.) thoracolumbar fascia c.) inguinal ligament
IO inserts by fleshy fibers onto the _________ and by aponeuroses to (5): 1. 2. 3. 4. 5. lower 3 ribs (10,11, 12) 1. ribs 7, 8, 9 2. xyphoid process 3. linea alba 4. pubic crest 5. pectin pubis
Innervation of IO? lower 6 thoracic nerves, first lumbar nerve (L1)
The special feature of the external oblique is the inguinal ligament. What is the special feature of the internal oblique? the conjoint tendon (falx inguinalis)
the falx inguinalis is also called the conjoint tendon
the conjoint tendon is formed by the fused aponeurotic fibers of the __________________ and the lower fibers of the __________________ internal oblique + Transversus abdominis
the Transversus abdominis and the internal oblique aponeurosis fuse to form the Conjoint tendon
the conjoint tendon attaches to the pubic crest and pectin pubis
what can one do when repairing a hernia that involves the conjoint tendon (of the IO and TA)? attach sutures
the conjoint tendon is medially continuous with the __________ wall of the rectus ________. ANTERIOR (remember: posterior wall stops at arcuate line) wall of the RECTUS sheath
the conjoint tendon is free on one side, however a small extension of its CT may attach itself to the superior ramus of the pubis. This ligament is called interfoveolar ligament
why can't you anchor sutures to the interfoveolar ligament (of the conjoint tendon)? it's loose and not always present
the Transversus abdominis origins: lower 6 cartilages, thoracolumbar fascia, inner lip of iliac crest, inguinal ligament (lateral 1/3)
the Transversus abdominis inserts: by a a broad aponeurosis to the xyphoid p., linea alba, pubic crest, and pectin pubis
Innervation of Transversus abdominis: lower 6 thoracic nerves and 1st Lumbar
special features of the Transversus Abdominis: the lower fibers unite with the ________ oblique to form the __________ tendon internal, conjoint
the roof of the inguinal canal is formed by what two muscles? internal oblique and transversus abdominis
the conjoint tendon is formed by what two muscles? internal oblique and Transversus abdominis
the internal oblique and transversus abdominis form what structure and what aspect of another structure? merge to form the CONJOINT TENDON and form the roof of the INGUINAL CANAL
all of the nerves and vessels of the external abdomen lie between what two muscles? the Transversus abdominis and the internal oblique
In what space do nerves and vessels between the Transversus abdominis and the internal obliques lie? the Neurovascular Plane
the neurovascular plane lies between what two muscles of the abdomen? Transversus abdominis and internal oblique
the Rectus abdominis has fibers that pass straight upwards (vertically) to the ___________ _______________ above the level of the costal margin costal cartilages
what is the border of the Rectus abdominis called? Linea Semilunaris
how many heads of origin has Rectus abdominis? 2: medial head arises anterior pubis and lateral head arises from pubic crest
the medial head of the Rectus abdominis arises from the anterior pubis
the lateral head of R. abdominus arises from the pubic crest
innervation of R. abdominis? lower 6th thoracic nerves
insertion of Rectus abdominis? (2) costal cartilages 5,6,7 and xyphoid process
the entire Rectus abdominis is enclosed in a rectus sheath
anteriorly, there are 3 dividers of the Rectus sheath, called tendinous intersections
what are the 3 levels of tendinous intersections of the Rectus sheath? 1 - xyphoid, 2 - between 1st and 3rd, 3 - umbilicus
tendinous intersections represent segmental dev of the R. abdominis and ultimately serve to make the muscle stronger
the EO, IO, TA and RA (abdominals) all serve to protect the abdominal viscera
the muscle which specifically supports the abdominal contents against gravity is the internal oblique
all abdominal muscles take part in expulsive acts, such as (3) defecation, micturation, parturition
all abdominals play role in forceful expulsitory acts (clearing), such as coughing and sneezing
abdominal muscles participate in movement of the trunk (3) flexion, lateral flexion, rotation (external ob. of same side of rotation, internal ob. of opposite side of rotation)
the ___________muscle is well-developed in males ("ball-lifter") and not so much in females. cremaster
the cremaster has 2 heads of origin (one ligamentous, one bony): lateral head attached to inguinal ligament, medial head originates at pubic tubercle
the cremaster muscle is innervated by genital branch of genitofemoral n.
special features of the cremaster: when ___________ thigh is stroked, cremasteric reflex occurs medial
the cremaster elevates the testis on the same side T/F? True
if the cremasteric reflex is absent, what does this suggest? UMN lesion
the cremasteric reflex is ________ in children brisk
the ___________ is a small muscle at the origin of the R. abdominis muscle. pyramidalis
the origin of the pyramidalis anterior surface of body of pubis, anterior PUBIC LIGAMENT
insertion of pyramidalis linea alba
innervation of pyramidalis subcostal n. (T12), iliohypogastric n.
the subcostal n. and the ______________ n. innervate the pyramidalis muscle at the anterior surface of the body of pubis. iliohypogastric
what is the action of Pyramidalis? tense the linea alba
the Rectus Sheath is, by definition, an _____________ covering what 2 muscles? aponeurosis, R. abdominis and Pyramidalis muscles
the Rectus Sheath contains the (nerves?) and cutaneous ___________. lower 6 thoracic nerves,vessels
the Rectus sheath contains the superior and inferior ____________ arteries and veins EPIGASTRIC
what forms the Rectus sheath? the aponeurotic fibers of the external oblique, internal oblique, and Transversus abdominis
How many walls to the R. abdominis? 2: anterior wall, posterior wall
which R. abdominis wall is incomplete? POSTERIOR - none above costal cartilages and none below arcuate line
what does exist below the arcuate line, when the posterior wall of the rectus sheath ends? fascia transversalis
is the rectus sheath attached to the rectus abdominis? only at the tendinous intersections
above the level of the costal margins, what provides the posterior support for the rectus abdominis instead of the posterior wall of the rectus sheath? the costal cartilages themselves
above the level of the costal cartilages, what forms the anterior wall of the rectus sheath? The posterior wall? External oblique aponeurosis. The costal cartilages themselves.
Between the costal margin and the arcuate line, what muscle divides to form the posterior and anterior rectus sheath? internal oblique= fuses anteriorly with external oblique aponeurosis to form anterior wall and posteriorly with transversus abdominis to form post wall
what are the two divisions of internal oblique called from below costal margin to arcuate line? lamina (anterior and posterior)
the lamina of the ___________ _____________ muscle fuse with external oblique to form the anterior wall and transversus abdominis to form the posterior wall of the rectus sheath. internal oblique
the anterior and posterior walls of the rectus sheath fuse to form the linea alba
another word for ARCUATE LINE linea semi-circularis
the linea semi-circularis is alternately known as the arcuate line
what happens below the arcuate line? the posterior wall of the rectus sheath ends and the fascia transversalis takes over
the rectus abdominis rests on the _____________ ______________ below the arcuate line. fascia transversalis
what is contained within the rectus sheath? (4) rectus abdominis, pyramidalis, superior & inferior epigastric arteries and veins, lower 6 thoracic nerves
the rectus sheath checks the ________ of the rectus abdominis muscle and adds ___________ to the anterior abdominal wall. bowing, strength
the linea alba is a fibroaponeurotic tissue, extending from the _______ ________ to the ___________ __________ xyphoid process, pubic symphysis
compare upper and lower linea alba upper is wide (1cm), lower is thinner
multiparous women (3 or more children) have stretched linea alba. When the Dr. can place fingers through L.a. between rectus sheath and rectus abdominis, it's called: divarication of the recti
divarication of the recti is the result of having more than 3 kids
weakness of the linea alba means likelihood of protrusion, creating an epigastric hernia
name the abdominal pelvic fascia fascia transversalis
where does the fascia transversalis exist? behind all three abdominal muscles (behind transversus abdominis)
is the fascia transversalis dorsal or ventral to the extra-peritoneal connective tissue? ventral
superiorly, the fascia transversalis is continous with? the diaphramatic fascia
laterally, the fascia transversalis is continous with? the thoracolumbar fascia
inferiorly, the fascia transversalis forms the anterior wall of the femoral sheath that covers femoral vessels
the anterior wall of the femoral sheath that covers femoral vessels is the fascia transversalis
the opening in the fascia transversalis? DEEP inguinal ring (remember, f.t. is deep to all abdominal muscles)
what forms the opening of the superfical inguinal ring? an opening in the external oblique muscle
the circumference of the deep inguinal ring is prolonged in the spermatic cord as the internal spermatic fascia
the deep inguinal ring is formed by fascia transversalis
superfical inguinal ring is formed by opening in external oblique
the interior of the inguinal canal is formed by a continuation of the fascia transversalis that becomes the internal spermatic fascia (once it leaves the superficial inguinal ring)
~length of inguinal canal 4cm (1.5in)
the inguinal canal extends from what to what? deep inguinal ring to superficial inguinal ring
Anterior wall of inguinal canal (3 and one partial) skin, superficial fascia (Camper's and Scarpa's), external oblique APONEUROSIS, partially the internal oblique
anterior wall of inguinal canal (3 and one partial) skin, Scarpa and Camper superficial fascia, external oblique aponeurosis, partially by origin of internal oblique because its origin is the lateral 2/3 of inguinal ligament.
posterior wall of inguinal canal (3 and 3 partials) fascia transversalis, extra-peritoneal CT, parietal peritoneum (deep to e.p.CT)then partially formed by conjoint tendon, medially the reflected part of inguinal ligament, laterally interfoveolar ligament
posterior wall of inguinal canal (3 and 3 partials) fascia transversalis, extra-peritoneal CT, parietal peritoneum, partially -conjoint tendon, reflected ing. lig. medial, interfoveolar lig. lateral
roof of inguinal canal (2) internal oblique & transversus abdominis
floor of inguinal canal (2) inguinal ligament, and more medially the lacunar ligament
roof and floor of inguinal canal roof: internal oblique and transverus abdominis floor: inguinal ligament and lacunar ligament
male structures passing through inguinal canal spermatic cord
female structures passing through inguinal canal round ligament of uterus
common structure passing through inguinal canal ilioinguinal n. (but not through spermatic cord!)
when the testes descend into the scrotum, they carry blood vessels, nerves, and lymphatics. Because they travel from the deep inguinal ring through the superfical inguinal ring, what 4 coverings do they take with them? 1) internal spermatic fasica from transverus abdominis, 2) cremasteric muscle and fascia from internal abdominal oblique, and 3) external spermatic fascia from external abdominal oblique aponeurosis
Contents of the spermatic cord always: ARTERIES: testicular, deferential, cremasteric, NERVES: cremasteric (genital branch of genitofemoral n.), sympathetic nerves, VEINS: pampiniform plexus of veins, LYMPHATIC vessels, PROCESSUS VAGINALIS
Does the ilioinguinal nerve go into the spermatic cord? no, it arrives after the deep inguinal ring, joins the ductus deferens as it travels through the inguinal canal, then exits the superficial inguinal ring but then innervates dorsal penis area and scrotum externally.
name the two accessory structures that may or may not be found inside the spermatic cord Accessory spleen (with splenicoli) and Cortical tissue of suprarenal gland
is a sessile appendix or a pedunculated appendix found in the spermatic cord? Where? No, they are both potentially found on the testes (sessile) or epididymis (pedunculated) but NOT in the spermatic cord.
cortical tissue of the suprarenal gland is sometimes found in the spermatic CORD
accessory spleen is sometimes found in the spermatic CORD
sessile appendix is sometimes found in the testes
pedunculated appendix is sometimes found in the epididymis
why are various mechanisms needed to keep the inguinal canal closed? because it is a weakness in the lower abdominal wall and hernias could result
what compensates for the weakness in the lower abdominal wall due to the presence of the inguinal canal? abdominal muscles use 5 mechanisms to keep the canal shut
flip-valve mechanism anterior wall to posterior wall (curtains closing)
shutter mechanism roof to floor (like eyelids snapping shut)
ball-valve mechanism cremaster muscle plugs superficial I. ligament (tennis ball in a tailpipe)
slit valve mechanism median and lateral crus meet (like pinching fingers together to seal end of a straw)
3 main types of hernias direct, indirect, femoral
another term for indirect hernia oblique hernia
direct hernias affect males
indirect hernias affect young males
FEMoral HERnias affect women
any abnormal protrusion of abdominal contents through an abdominal canal is a hernia
direct hernias occur in people (mostly ______) over age men, 40
why would direct hernias tend to occur in men over 40? they have weak abdominal walls, possible due to surgery and lack of strengthening
where does the hernial sac lie in a direct hernia? medial to the inferior epigastric artery
in a direct hernia, what is the area called that the hernia will pass through? Hesselbach's triangle, which reaches the inguinal canal
3 borders of Hesselbach's triangle (direct hernia, male over 40) linea semilunaris, inguinal ligament, inferior epigastric artery (a fishook facing inwards)
hook an older man directly under the half moon and he'll be yours, Hassel-free! Hasselbach's triangle (semilunaris, inguinal ligament, inferior epigastric) men over 40 Direct hernia
where does the hernial sac of a direct hernia lie? medial to the inferior epigastric artery
what kind of hernia is most common in young males? indirect/oblique hernia
an indirect or oblique hernia in young men is Lord of the Rings! why? the hernia passes through the deep inguinal ring, the inguinal canal, and out through the superficial inguinal ring
if an indirect hernia, the Lord of the Rings, completely sucks, what happened? it went to the bottom of the scrotum; hence, "complete indirect inguinal hernia"
If an indirect hernia didn't completely suck, if it did not finish the job and go all the way to the scrotum but just popped through the last ring and stayed, what is it? an incomplete, indirect hernia. Only makes it through superfical inguinal ring and stops.
Because an indirect/oblique hernia passes through the Rings and the inguinal canal, would it be medial or lateral to the inferior epigastric artery? lateral! the inguinal canal is as lateral as you can get without falling off the hip! It is "indirect" because it isn't right smack on the weakest part of the abdomen and aims obliquely towards center.
what hernia is common in women? FEMoral HERnia
where does a femoral hernia pass through? the FEMoral canal
why doesn't Holden's line prevent a femoral hernia? because Holden's line is from the pubic tubercle, 8cm laterally on the thigh to the iliac crest (remember: Scarpa's was continuous with it) and the Fem canal is BELOW the inguinal ligament and lateral to pubic tubercle
what tests for a hernia? Reduction technique (reduce the pain, see if it returns)
Reduction technique tests for hernia 1 of 3 ways
place pressure over DEEP inguinal ring; if hernia hits finger on way out, what kind of hernia? indirect (Lord of the Rings) because it goes through the rings but especially the deep ring! Deep magic, deep ring, indirect hernia, young man
place pressure over superficial inguinal ring and deep inguinal ring; if hernia hits finger covering SUPERFICIAL inguinal ring, then it's Direct (Hesselbach's half moon, medial to inferior epigastric, older man)
place pressure over Great Saphenous opening; if hernia hits finger, it's a FEMoral HERnia
PETIT'S triangle latissimus dorsi, post border of external oblique, and iliac crest (where your thumbs rest when you put hands on your own hips)
what kind of hernia passes through Petit's triangle? LUMBAR hernia
what kind of hernia passes through the lateral border of R. abdominis, below the arcuate line (ie, through the fascia transversalis)? SPIEGELIAN hernia (lateral ventral hernia)
Adriaan van den Spiegel first described malaria, was an anatomist at the same university that Vesalius attended, and described the Spiegelian hernia. It passes through the ... lateral border of R. abdominis (danger of strangulation high with this rare hernia in older men), and below the arcuate line where no posterior ab wall exists. this is why it pokes through the muscle and is dangerous
other hernias are named based on the contents of the hernial sac. Name and describe 3 OMENTOcele-inside peritoneum (popped through greater omentum). ENTEROcele-inside guts, hence enteric. LITTRE's hernia- inside Meckel's diverticulum (Meckel likes litter)
the scrotum is an ___-__________ bag for the testes air-conditioned
what does the testes provide for the spermatozoa? provides optimum temperature (cooler outside of body than in)
the scrotum is divisible into left and right halves by the Median Raphae
in the scrotum, the Dartos muscle has replaced what, that was in the spermatic cord? superfical fascia has become Dartos muscle
the dartos muscle replaces the superficial fascia of the spermatic cord
name the 5 layers of the scrotum skin, dartos muscle, external spermatic fascia, cremasteric fascia, internal spermatic fascia
arteries and veins supplying scrotum (4) -creamy pudding with nuts- superficial external pudendal, deep external pudendal, internal pudendal, cremasteric branch (creamy pudding with nuts)
what great arteries supply the scrotal branches? femoral (external pudendals), internal iliac (internal pudendal), internal epigastric (cremaster)
what vein supplies venous drainage to scrotum? great saphenous vein (*site of femoral hernia reduction test)
cutaneous innervation of the scrotum is divided into 2 segments of the spinal cord: 1. 2. 1. L1-TOP (anterior 1/3) i.e. ilioinguinal and genital branch of genitofemoral nerve 2. S3-BOTTOM (posterior 2/3) i.e. posterior scrotal nerve, posterior femoral cutaneous nerve
nerves associated with L1 ilioinguinal and genital branch of genitofemoral n.
nerves associated with S3 posterior scrotal nerve and posterior femoral cutaneous nerve
posterior scrotal nerve is what segment? S3
ilioinguinal nerve is what segment? L1
genital branch of genitofemoral nerve is what segement? L1
posterior femoral nerve is what segment? S3
what can occur on the scrotum as a result of bad hygiene? (eg, wash your balls) sebaceous cysts
sebaceous cysts of the scrotum can occur due to the large presence of hair and sebaceous glands there. Also, cysts could occur as the result of what parasitic (Mosquito)infection? Wuchereria bancrofti
what does Wuchereria bancrofti turn into if left untreated? elephantisis (cured by doxicycline if filarial)
because we know Wuchereria bancrofti travels into the lymph and then scrotum and legs, which lymph nodes supply the scrotum? superficial inguinal lymph
the penis consists of a _______ and a ______ (parts) root and body
the root of the penis is attached and the body of the penis is unattached. T/F? True
the root of the penis is formed by 2 _____ and 1 ______ crura (sing. "crus), bulb
the two crura of the penis are attached to the ______ arch and covered by the _____________ muscle pubic, ischiocavernosus
if the root is attached at the ischium and is called the ischio-cavernosus muscle, then the body, which is free, is called the corpus cavernosum (dorsal aspect leading to blind end)
what are the 5 parts of the BODY of the penis: glans penis, corpus cavernosum of penis, corpus spongiosum (underside), urethra, deep artery of penis
what are the 5 parts of the ROOT of the penis: deep artery of penis, urethra, crus of penis (pl. is 'crura'), ischiocavernosus muscle covering crura, bulb of penis centered with bulbospongiosus muscle of body
what membrane is the bulb of the penis attached to between the ischiopubic rami? perineal membrane
what terminates the corpus SPONGIOSUM glans penis
another word for the foreskin that covers the glans penis prepuce
birth defect locations for external urethral meatus? hypospadius - below, epispadius - above
layers of the penis: (4) skin, superficial fascia, fascia penis (tunica albuginea), septum of penis
the tunica albugenia of the penis is also called fascia penis
the fascia penis/tunica albugenia is made of 2 layers: superficial layer that encloses the erectile muscles together and a deep layer that encloses them separately
the superficial fascia is not the same as fascia penis. the superficial fascia contains the dorsal vein of the penis
the fascia penis has the 2 layers: superficial layer and deep layer
the superficial layer of fascia penis contains the 3 erectile muscles: 2 corpus cavernosum (one on each side) and 1 corpus spongiosum (on plantar side in middle)
the 2 corpus cavernosum of penis, surrounded by the skin, superficial fascia and fascia penis, contains the deep artery of penis (remember* superficial fascia contains the dorsal vein)
the corpus spongiosum of penis contains the urethra on the plantar side/underneath
the superficial layer of fascia penis contains 3 things, apart from the 3 erectil muscles (2 corpus cavernosum, 1 corpus spongiosum): deep dorsal vein, dorsal artery of the penis, dorsal nerve of the penis DEEP DORSAL V.A.N.
what layer contains the superficial dorsal vein of penis? the superficial layer of fascia penis
the deep layer of fascia penis does what to the 3 erectile muscles? encloses them separately, as deep fascia does
the 4th and final layer of the penis is the septum of penis
the septum of penis is like the corpus callosum of the brain - it does what? joins the 2 halves of corpus cavernosum
skin of penis________ superficial fascia of penis______________ fascia penis ____________________________ septum of penis______________ skin:outermost/superficial fascia of penis:superficial dorsal vein/fascia penis: superficial layer of deep dorsal vein, dorsal artery, dorsal nerve and deep layer/septum:separates corpus cavernosum muscles
blood supply to penis deep artery of penis-in deepest of corpus cavernosusm, dorsal artery of penis-in fascia penis, artery to bulb of penis
venous drainage of penis superficial dorsal vein in superficial fascia of penis and deep dorsal vein in superficial layer of fascia penis
the DEEP dorsal vein of penis drains into PROSTATIC plexus of veins
dorsal vein of penis drains into superficial external pudendal - great saphenous - femoral vein
the scrotum is supplied by lymph of the superficial inguinal nodes. What is the lymph of the penis? lumbar
what nerves for penis? ilioinguinal, dorsal nerve of penis (then artery, then dorsal vein), prostatic plexus
prostatic plexus of veins does what drains the deep dorsal vein of penis
prostatic plexus of nerves innervates what penis
ilioinguinal nerve and prostatic plexus and dorsal nerve of penis all innervate penis
motor innervation of penis is __________ pudendal nverve
autonomic innervation of penis is ___________ prostatic plexus
what is the male reproductive organ? testis
how is the testis attached to body wall? spermatic cord in scrotum
1.5" long, 1" wide, 3/4" thick describes? testis
what are the innervation segements of testis T10, T11
what segments innervate the penis T10, T11
the testis has 2 poles: upper pole, lower pole
the testis has 4 borders: anterior, posterior (under epididymis), lateral, medial
where is the sinus on the testis and what's it called? sinus epididymis, space under epididymis
outermost covering of testis tunica vaginalis
tunica vaginalis has 2 layers: parietal and visceral
tunica vaginalis is a remnant of _________ _________ processus vaginalis
the two layers of the tunica vaginalis are continuous with one another at what junction? sinus epididymis
fluid accumulating between the 2 layers of tunica vaginalis is called hydrocele (vaginal)
if blood accumulates between the 2 layers of tunica vaginalis, it's called hematocele
2nd layer of testis, under tunica vaginalis, is tunica albuginea
3rd and deepest layer of testis is tunic vasculosa
what is the site of spermatogenesis seminiferous tubules
what is the blood supply to the testicles? testicular artery
the testicular artery, which supplies the testicles, is a branch of what major vessel? abdominal aorta
what is the vein within the spermatic cord that drains the testis? pampiniform plexus of veins
There is a testicular artery; there must be a testicular ______ vein
what becomes the testicular vein on the way out? pampiniform plexus of veins
what happens to the testicular vein (from pampiniform plexus)? it splits into R/L veins
the right testicular vein drains into inferior vena cava (this makes spatial sense)
the left testicular vein drains into left renal vein
order of vein drainage of testicles pampiniform plexus of veins, testicular vein, split R to inferior vena cava, split L to L renal vein
what drains lymph of testis lateral aortic or lumbar group of post ab wall
testes descent months 2-9 2: descent, 3: iliac fossa, 4-6: deep inguinal ring, 7: inguinal canal, 8: superficial inguinal ring, 9: scrotum
by what year should the testes have fully descending into the scrotum? 1st (said 2nd in class but notes say 1st)
absence of testis on one side is called monorchism
absence of testes on both sides (failure to descend) is called anarchism
"hidden testis", usually in the inguinal canal, is called cryptorchidism
which condition can be left alone to sort itself? cryptorchidism
if testes are seen outside the normal route of descent (iliac fossa, deep inguinal ring, inguinal canal, superficial inguinal ring, bottom of scrotum), then they are called Ectopic (wandering)
Ectopic testes could be cancerous
varicocele swelling of pampiniform plexus of veins
why does varicocele usually occur on the left side? (3) spermatic cord LONGER on Left, left testicular vein drains into left renal vein at 90* angle, left testicular vein is crossed by sigmoid colon
the left nut hangs lower to avoid squishing - what are the three obstacles of the left testicle due to it being lower 1-spermatic cord longer, 2-drains into left renal vein, 3-is traversed by sigmoid colon
varicocele feels like a bag of _______. Is it dangerous? worms, not usually nor is it painful, but could lead to sterility
the ___________ is a coiled tube consisting of a head, body, and tail epididymis
the tail of the epididymis is continous with the vas deferens
the epididymis functions to store spermatozoa
remnant of the paramesonephrenic duct on the testis appendix of testis (sessile)
remnant of mesonephrenic duct on epididymis appendix of epididymis (peduncular)
II. PERITONEUM is a _________ sac of *___________ and loose CT serosal, *mesothelium ("meso" means middle)
often pain in the abdominal cavity is ________ pain referred
2 layers of peritoneum; 1-parietal, 2-visceral
parietal (body) peritoneum is derived from the embryonic * *somato(body)pleure of lateral plate mesoderm
the somatopleure is lateral plate _*________ *mesoderm (middle)
the parietal peritoneum lines the inner surface of the abdominal wall
what innervates the parietal peritoneum somatic (body) nerves
pain in the abdominal cavity is usually referred
two layers of peritoneum visceral and parietal
the visceral layer is derived embryologically from the inner * *splanchnopleure of lateral plate mesoderm
the parietal (lining of body - what word means "body") layer is derived from the outer * *SOMAtopleure of mesoderm
*mesoderm splits in the embryo, the ____________ adhering to the endoderm and the _______________ adhering to the ectoderm (What word means "organs" in Greek, what word means "body"?) *spanchnopleure is visceral, somatopleure (body wall) is parietal
visceral peritoneum lines the organs. What innervates the organs? *Can the viscera feel pain? Autonomic nervous system (usually *pain insensitive)
the parietal peritoneum lines the abdominal cavity. what innervates it? *Can the (somatopleure) parietal peritoneum feel pain? Somatic (body)nervous system (*pain-sensitive)
how many folds in the peritoneum? 3
Name the 3 folds of the Peritoneum: 1-omenta, 2-mesentery/mesocolon, 3-ligaments
*2-mesentery/mesocolon MESENTERY/MESOCOLON=INTESTINES (sm & lg)
*3-ligaments of peritoneum LIGAMENTS=ALL ELSE (ie, falciform ligament, coronary ligaments, triangular ligaments, round ligament)
name the 3 peritoneal folds omentum (stomach), mesentery (lg & sm intestines), ligaments (all else)
the peritoneal cavity is a *____________ space between the _________ & ___________ layers of the peritoneum *potential, parietal & visceral
is the peritoneal cavity seen under normal circumstances? *NO, only in pathology
2 regions of the peritoneal cavity greater sac, lesser sac
the lesser sac of the peritoneal cavity is located behind the (3) *liver, stomach, greater omentum. It is the INSIDE of the Greater Omentum
"epiploic" means pertaining to the... pertaining to the omentum (epiploic probably means a "communication")
*the area (hole) of communication between the greater and lesser omentum is called Foramen of Winslow, or Epiploic foramen
epiploic foramen *communication hole between greater and lesser omentum
what is between the bladder and rectum? recto-vesicular pouch (part of greater omentum)
what, in males, is continuous with the diaphragm? (pertaining to pouches) recto-vesical pouch
what, in females, is continous with the diaphragm (pertaining to puches)? vesicouterine pouch and rectouterine pouch (bladder-vup-uterus-rup-rectum) - der olde Vup & Rup!
the lesser sac of the peritoneum is located behind (3) stomach, liver, 2nd layer of greater omentum
boundaries of the epiploic foramen: (going right to left) what segmental level is the epiploic foramen located? T12
anterior epiploic foramen bounded by right free margin of lesser omentum (because it's to the R of the stomach)
anterior epiploic foramen is bounded by: lesser omentum (that contains hepatic duct, bile duct, portal vein) HPB
the hepatic duct, bile duct, and portal vein are all contained in the lesser omentum and form the anterior boundary of the foramen of Winslow
Between the two layers of the lesser omentum, close to the right free margin, are the hepatic artery, the common bile duct, the portal vein, lymphatics, and the hepatic plexus of nerves—all these structures being enclosed in a fibrous capsule (________) Glisson's capsule
the hepatic artery lies to the left of the ____,(and where is the portal vein?) bile duct, the portal vein being deep
the epiploic foramen is bounded posteriorly by the inferior vena cava
the epiloic foramen is bounded superiorly by the caudate process of the liver
the epiloic foramen is bounded inferiorly by 1st part of duodenum
the peritoneal fold is embryologically important for suspending the developing gut
the developing gut is suspended to the body wall by 2 mesenteries: dorsal mesentery and ventral mesentery
see slides for mesentery development see slides for epiploic location
In what mesentery does the embryonic liver develop? ventral mesentery proper, before ventral and dorsal portions of ventral mesentery are formed
the ventral mesentery gives rise to a __________ part and a _________ part ventral (Vv), dorsal (Vd)
Ventral part of the ventral mesentery (Vv) grows ligaments (4) *think: connects liver to peritoneum 1-falciform ligament, 2-coronary ligament, 3-left and right triangular ligaments
what folds attach the liver to the anterior abdominal wall? falciform ligament, coronary ligament, left and right triangular ligaments (all in Vv)
dorsal part of ventral mesentery (Vd) grows the (2) stomach and lesser omentum
the lesser omentum extends from the stomach to the liver
from the stomach to the liver extends the lesser omentum, ergo this is what develops in the dorsal part of the ventral mesentery
spleen develops in which mesentery? dorsal (proper)
ventral portion of dorsal mesentery (Dv) *think: what connects the stomach to the spleen, the diaphragm and the protects? gastrophrenic ligament, gastrosplenic ligament, greater omentum
gastrophrenic ligament (Dv) connects stomach to diaphragm
gastosplenic ligament (Dv) connects stomach to spleen
the dorsal part of the dorsal mesentery (Dd) gives rise to the lienorenal ligament (or the SPLENICORENAL LIGAMENT)
"Lineal vessels" lienal vessels (splenic artery and vein) pass between the two layers of the lienorenal/splenorenal ligament
Greater Omentum extends from the __________ to the _________ Greater curvature of stomach, anterior border of body and head of pancreas
where does the Greater Omentum attach posteriorly? anterior border of body and head of PANCREAS
Arteries contained by the Greater Omentum (2) R gastroepiploic artery, L gastroepiploic artery
The Right Gastroepiploic Artery inside the Greater Omentum is a branch of the gastroduodenal artery (duodenum on right)
The Left Gastroepiploic Artery inside the Greater Omentum is a branch of the splenic artery (spleen on left)
If there is a gastroepiploic artery, there must be an accompanying gastroepiploic vein (R & L)
VEINS from the gastroepiploic system in the greater omentum form a separate system called the PORTAL VENOUS SYSTEM
The lesser omentum is attached above to the liver
the lesser omentum is attached below to the lesser curvature of the stomach and duodenum
where is the lesser omentum attached? above=liver, below=lesser curvature of stomach and duodenum
the lesser omentum has 2 ligaments: Hepatogastric and hepatoduodenal ligaments
hepatogastric ligament of lesser omentum goes from liver to lesser curvature of stomach and also forms an attached border
near the stomach, the hepatogastric ligament carries 2 arteries in its attached lesser curvature along the stomach: right gastric artery and left gastric artery
The hepatoduodenal ligament is the portion of the lesser omentum extending from duodenum to liver
The hepatoduodenal ligament of the lesser omentum contains 3 things: *think: it comes off the liver and bottom of gallbladder, forming a tent over 3 vessels hepatic artery, bile duct to the right, portal vein dorsal
MESENTERY PROPER means the mesentery of what organ? small intestine
the MESENTERY PROPER is a fan-shaped fold that contains superior mesenteric vessels, branches and tributaries
how is the MESENTERY PROPER of the small intestine attached? by a RooT 6" in length
what runs from the duodenal-jejunal flexure to the Right sacroiliac joint? the RooT of the MESENTERY PROPER of the small intestine
the upper attachment of the RooT of the MESENTERY PROPER of the small intestine is what segment L2
the RooT of the MESENTERY PROPER of the small intestine crosses downward and towards the right over 4 structures; abdominal aorta, inferior vena cava, R psoas mjr., R ureter
what is the job of the foramen of Winslow? communication between greater and lesser sacs
*upper border of foramen of Winslow *caudate process of the liver
*anterior border of foramen of Winslow *hepatic artery, bile duct, portal vein (the tent or hepatoduodenal ligament and contents form this anterior wall)
*lower border of foramen of Winslow *1st part of duodenum
*posterior border of foramen of Winslow *Inferior Vena Cava at T12
*what kind of hernia can you get at the epiploic foramen of Winslow? *internal hernia
*(visualize the 3 holes of liver, foregut, spleen in the peritoneal embryology development -see slide) Name the 4 mesenteries of peritoneal dev. ventral part of ventral mesogastrium (mesentery), dorsal part of ventral mesogastrium, ventral part of dorsal mesogastrium, ventral part of dorsal mesogastrium
*ventral part of ventral mesogastrium and dorsal part of ventral mesogastrium surround what embryonic organ? liver
*dorsal part of ventral mesogastrium and ventral part of dorsal mesogastrium surround what? foregut
*ventral part of dorsal mesogastrium and dorsal part of dorsal mesogastrium surround what? spleen
*what connects liver to ventral mesentery? falciform ligament and liver ligaments (coronal and triangular)
*what connects liver to foregut? lesser omentum
*what connects foregut to spleen? gastrophrenic and gastrosplenic ligaments and greater omentum
*what connects spleen to dorsal mesentery? lienorenal ligament (splenico-renal ligament)
ventral part of ventral mesogastrium contents: liver to ventral mesentery via falciform ligament and other liver ligaments (coronary, triangular)
dorsal part of ventral mesogastrium contents: liver to foregut via lesser omentum
ventral part of dorsal mesogastrium contents: foregut to spleen via gastrophrenic lig, gastrosplenic lig., greater omentum
dorsal part of dorsal mesogastrium contents: spleen to dorsal mesentery via lienorenal (splenorenal) ligament
the ________ develops in the ventral mesentery; the ___________develops in the dorsal mesentery liver (ventral), spleen (dorsal)
the Greater Omentum goes from what to what? stomach to pancreas and transverse colon
greater omentum starts at ________ curvature of stomach greater
the greater omentum displays what kind of movement during injury/infection? chemotactic (chemotaxis) movement
what two arteries run along the greater curvature of the stomach and anastamose in the middle? R gastroepiploic artery anastamoses with L gastroepiploic artery
why is gastro-epiploic an appropriate name for the arteries and veins under the stomach? because gastro means stomach and epiploic means pertaining to the Omentum
what 2 arteries and veins are contained within the greater omentum? R and L gastroepiploic arteries and accompanying veins
the R gastro-epiploic (stomach-greater omentum) artery is a branch of Gastroduodenal artery (stomach-duodenum)
the L gastro-epipolic (stomach-greater omentum) artery is a branch of splenic artery
veins from the gastrointestinal system form a separate venous system called the portal venous system
the PORTAL VENOUS SYSTEM is a separate venous system derived from the gastrointestinal system
why is the gastrointestinal venous system special? it has its own system called the PORTAL VENOUS SYSTEM
the lesser omentum goes from the what to the what lesser curvature of stomach and duodenum to the liver above
the lesser omentum goes from stomach to liver and from duodenum to liver. What are the two ligaments of the lesser omentum? hepatogastric ligament, hepatoduodenal ligament
why would the hepatogastric ligament and the hepatoduodenal ligament be in the lesser omentum? because the lesser omentum stretches the short distance between stomach and duodenum to the liver above and it needs 2 adjacent ligaments to do it!
just as the R & L gastroepiploic arteries ran along the greater curvature of stomach and anastamosed inside the greater omentum, the lesser curvature sports 2 arteries inside the lesser omentum: R and L Gastric arteries that anastamose along lesser curvature inside lesser omentum
the R gastric artery along the lesser curvature of stomach in lesser omentum is a branch of gastroduodenal-common hepatic-celiac trunk-abdominal aorta
the L gastric artery along the lesser curvature of the stomach in the lesser omentum is a direct offshoot of the celiac trunk
what ligament in the lesser omentum would be involved with the left and right gastric arteries running along the lesser curvature of stomach? hepatogastric ligament (gastrohepatic in some texts)
the free margin of the lesser omentum is supported by the _______________ ligament. (The lesser curvature of stomach to liver is Not a free margin so rule out that ligament) hepatoduodenal ligament
The hepatoduodenal ligament supports the free border of the lesser omentum. What 3 structures live alonginside the free margin? hepatic artery proper (straight up!), bile duct (even further up) and the portal vein (behind both of these)
3 structures of lesser omentum, where, what ligament? liver to stomach via hepatogastric ligament, liver to duodenum via hepatoduodenal ligament housing common hepatic, bile duct and portal vein
the Mesentery Proper refers to the mesentery of the Small Intestine
the name of the mesentery of the small intestine the Mesentery Proper of the Small Intestine
the Mesentery Proper of the small intestine is a ____ shaped fold that contains __________ mesenteric vessels, branches and tributaries. fan-shaped, superior
what artery is THE artery of the Mesentery Proper of the small Intestines? Superior Mesenteric Artery (SMA)
the Mesentery Proper has an attached border or ______ that is 6" in length root
the root of Mesentery Proper extends from the what to what (soft tissue landmarks) duodenal-jejunal flexure to the ileocecal junction *******(Different from copy shop printout. He said this in class)
the root of Mesentery Proper extends from what to what (bony landmarks)? L2 (upper attachment) to right SI joint (lower attachment)
4 things crossed by root of Mesentery Proper of small intestine: abdominal aorta, inferior vena cava, R psoas major, R ureter
what crosses the abdominal aorta, inferior vena cava, R psoas mjr, and R ureter? Root of Mesentery Proper of small intestines
In the Mesentery Proper, what are the 3 branches of the S.M.A. middle colic artery, Right colic artery, ileocolic artery (and jujenal + ileal branches, accompanying veins)
The free border of the Mesentery Proper of the small intestine completely encloses what? the jejunum and ileum
what suspends the vermiform appendix? MESOappendix (the middle mesentery of the appendix)
the MESOappendix also contains the appendicular artery
from where is the MESOappendix that holds the vermiform appendix and appendicular artery derived? Mesentery Proper of small intestine
which cadaver is the only one in the lab to present with a vermiform appendix? ours!
if I were a suspensory ligament for the transverse colon in the middle of the body, what would I be called? the Transverse Mesocolon
the Transverse Mesocolon extends from the posterior abdominal wall
the Transverse Mesocolon suspends the transverse colon and inbetween its two layers, contains what branch of the SMA? the middle colic artery and vein (R & L branches)
what branch of the SMA feeds Transverse colon and how? middle colic artery (R&L branches)and vein between the 2 peritoneal layers of the transverse mesocolon
if I were to support the sigmoid/pelvis colon in a "V" shape, what would I be called? Sigmoid or Pelvic mesocolon
what artery is THE artery of the sigmoid mesocolon? Inferior Mesenteric Artery
the IMA has two branches that supply the sigmoid mesocolon: left colic artery (because sigmoid colon is on the left) and sigmoid branches (2-3 in number)
what embryonic gut is IMA associated with? hindgut
what are the small pouches around the duodenum and caecum, not seen in adults, that may be sites of internal hernias? PERITONEAL FOSSAE
what two sites so far could sport internal hernias? epiploic foramen of Winslow and the Peritoneal Fossae
4 functions of Peritoneum: 1-mesothelium of serous membrane that lines surfaces to permit lubricated, smooth peristalsis, 2-protects viscera via chemotaxis, 3-semi-permeable membrane for absorption, 4-fat storage
4 peritoneum fcns: 1.peristalsis, 2.protects, 3.absorption, 4.fat storage
2 possible clinical pathologies of peritoneum: Ascites, peritonitis
Ascites accumulation of fluid in potential space between visceral and parietal peritoneum
reasons for ascites (3) portal hypertension, TB, congestive heart failure
Peritonitis is a generalized infection of the peritoneum, i.e. due to appendicitis. What is the hallmark of peritonitis? absence of bubble (digestive) sounds during ascultation. Rigid and tender.
the Spleen is a ___________ organ lymphoid
spleen 1,3,5,7,9,10,11 1 inch thick, 3 inches broad, 5 inches long, 7 oz in weight, related to 9,10,and 11th ribs
what rib does spleen run along? 10th (the only even number you need to know about spleen)
which side of spleen is notched? Superior border
the superior border of spleen is __________, so you can id the spleen no matter how big it is. NOTCHed
the superior border of the spleen characteristics: notched, separates gastric surface from diaphramatic surface
the posterior border of spleen characteristics: blunt, rests on upper pole of kidney
the inferior border of spleen characteristics: round, separates renal surface from diaphramatic surface
the intermediate border of spleen characteristics: separates gastric from renal surface
the anterior end of spleen characteristics: pointy, points to mid-axillary line
spleen has two ligaments - where are they? one above (gastrosplenic ligament) and one below (lienorenal ligament)
"lienorenal" means? spleen to kidney, it would be below the spleen attaching it to kidney
the gastrosplenic ligament contains short gastric arteries
the lienorenal (splenicorenal) ligament contains splenic artery and vein, tail of pancreas
where does the splenic artery and vein lie? inside the lie-norenal ligament
the spleen has no direct lymphatic drainage = what does it have? capsule has lymphatics that drain to pancreaticolieno group of lymph nodes, red pulp has none
what group of lymphatics drain the spleen pancreatico-lieno (pancreas-spleen)
a spleen in any other position besides its normal position in the left hypochondrium and epigastrium is>>> an accessory spleen
they can occur in the gastro_____ ligament, __________ omentum, _____renal ligament, gastro______ ligament, and in spermatic cord or round ligament of uterus gastrophrenic ligament, greater omentum, lienorenal ligament, gastrosplenic ligament, spermatic cord, round ligament of uterus
innervation of spleen celiac plexus of nerves
the celiac plexus innervates the spleen (t/f?) true
3 fcns of spleen phagocytosis, hematopoiesis, organ of immune response ----spleen is a lymph organ that can make RBC's
under normal conditions, is the spleen palpable? no, only when 2x normal size
conditions considered mild to moderate spleenomegaly: (4) tmla typhoid, malaria, lymph node enlargement like Hodgkins, hemolytic anemia
severe spleenomegaly is caused by (2) ls chron myeloid leukemia, hereditary sphereocytosis (abnormal RBC)
a ____________ is required during rupture or to cure blood disorders caused by this organ splenectomy
what enters the hilus of the spleen? splenic artery enters
what exits the hilus of the spleen? splenic vein exits hilus
what ligament extends from the anterior surface of the kidneys to the spleen lienorenal (splenicorenal) ligament
what is inside the lienorenal ligament of spleen? splenic artery and vein, tail of pancreas
what is inside the gastrosplenic ligament? one branch of the splenic artery called short gastric arteries
three branches of arteries arising off abdominal aorta supplying gut celiac trunk, Superior Mesenteric artery, Inferior Mesenteric artery
celiac trunk is the artery for all the ________ derivates (embryological gut) foregut=celiac
from what segment level does the celiac trunk arise T12
the celiac trunk is short, about ___" long, that's why it resembles a trunk, not a branch 1/2"
clockwise (+thetaZ) name the 3 branches of the celiac trunk 1- LEFT gastric artery, 2-Splenic artery, 3-Common hepatic artery
Name the 3 branches of the S.M.A. plus the uppermost and the branches along the small intestine arcades and vasa recta Middle colic, Right colic, Ileocolic (MRI), uppermost is pancreatico-duodenal artery, jejunal and ileal branches
Name the 2 branches of I.M.A. with the Superior Rectal artery and the name of the smaller branches supplying descending colon Left colic, Sigmoid branch(es) and marginal arteries supplying sigmoid colon
the _________ ____________ are seen only in the jejunum and ileum arterial arcades
which has a longer vasa recta: jejunum or ileum? Jejunum (upper left)
Which has more arterial arcade layers and shorter vasa recta: Jejunum or Ileum? Ileum (lower right)
the celiac trunk branches in clockwise L gastric artery, splenic artery, common hepatic artery
the Left Gastric artery arises from the ________trunk and passes upwards to the left along the _______ curvature of the stomach. celiac, lesser
what artery does L. gastric from celiac trunk anastamose with? where? R. gastric artery along lesser curvature of stomach
the left gastric artery from the celiac trunk has two branches, one to the __________ and one to the ___________. esophagus, stomach (why else would they call it "gastric?")
what two organs does the Left gastric artery supply and via what arteries? esophagus with esophageal branch of L gastric a. and stomach with gastric branch of L gastric artery
2nd major branch of celiac trunk after L. gastric artery (clockwise) splenic artery
the splenic artery passes __________ the stomach and courses along the upper border of the _____________ behind the stomach, along upper border of pancreas
the splenic artery passes behind the stomach along the upper border of spleen and enters the lienorenal ligament (along with the tail of pancreas and splenic vein)
once the splenic artery enters the LIENOrenal ligament, it splits into 3 branches. Where do they go? Pacreatic branches for tail, Left gastroepiploic (stomach and omentum), short gastric artery for fundus
what is the major blood supply for the pancreas? pancreatic branch of splenic artery
what supplies the fundus of stomach with blood? short gastric branch of splenic artery
what supplies the greater curvature of the left side of stomach? L. gastroepiploic branch of splenic artery
the HepAttic hepatic artery is 3rd on celiac trunk, clockwise from Left gastric, then splenic artery. What are the branches of common hepatic artery proper closest to the celiac trunk? from celiac on common hepatic artery: RIGHT gastric artery (anastamoses with L.g.a. on lesser curve), GASTRODUODENAL artery (branches to right gastroepiploic a. and superior pancreaticoduodenal a.)
follow the common hepatic artery towards gallbladder, after right gastroepiploic and southward gastroduodenal artery branch, then what? commmon hepatic shoots north, vertical to become HEPATIC ARTERY PROPER. Tiny branch to right = Cystic duct to Gallbladder, then all the way up to liver, branches into R & L Hepatic arteries
sensibly, what would the left hepatic artery supply with blood? the left lobe of the liver
what does the R hepatic artery supply after sprouting the cystic duct for the gallbladder? the R lobe of liver
name the vertebral segments associated with the origins of the 3 major abdominal arteries celiac trunk (T12), S.M.A. (L1), I.M.A. (L3)
embryonic guts associated with each of three major abdominal arteries: celiac=foregut, SMA=midgut, IMA=hindgut
the superior pancreaticoduodenal artery is a branch of gastroduodenal artery from common hepatic artery
the _____ gastroepiploic artery is a branch of the gastroduodenal artery from the common hepatic artery Right
The SMA (superior mesenteric artery) has 3 major branches: middle colic, right colic, ileocolic (MRI)
what side of the abdomen does the superior mesenteric artery supply R upper concave (moves downward to right making concavity)
the SMA arises from the abdominal aorta at the level of L1
the SMA passes between the top/right and bottom/left layers of the Mesentery Proper of the small intestines
the SMA heads downward and right toward the ileoeacal junction
the superior pancreaticoduodenal artery is a branch of the gastroduodenal artery - where does the inferior pancreaticoduodenal artery come from? it is the uppermost branch of the SMA
the Middle colic artery from SMA supplies the transverse colon
The right colic artery from SMA supplies the ascending colon
the convexity of the SMA supplies the COILS OF THE SMALL INTESTINE: upper supplies jejunal arteries and lower supplies ileal arteries
What is a common site for thrombosis and embolisms in the abdomen? Superior Mesenteric Artery = intestinal obstruction
a number of tributaries at the ____________ junction forms the Superior Mesenteric Vein (ie, where does the SMA end? then the vein must begin here) Ileocecal junction
the Superior Mesenteric VEIN courses upward to join what artery before joining the portal vein Splenic
Splenic vein + ________________=Portal Vein superior mesenteric vein
you know the SMA are MRI and jejunal and ileal arteries. What are the tributaries of the Superior Mesenteric Vein? middle colic vein, right colic vein, ileocolic vein, jejunal and ileal veins
The INferior mesenteric Artery has 3 major branches: Left colic artery, Sigmoid branches, superior rectal artery
which 2 branches of the IMA are we concerned with? left colic artery and sigmoid branches
the left 1/3 of the transverse colon is supplied by marginal branch of IMA
the transverse colon ends in what is sometimes called the splenic flexure on left (vs colic flexure on right0
if the marginal artery of the IMA feeds the left 1/3 of the transverse colon and the full descending colon, what must it also feed between the two? the splenic flexure of the colon
the IMA supplies the ___________ derivatives of the gut hindgut
the parts of the colon supplied by IMA: left 1/3 transverse colon, splenic flexure, descending colon, sigmoid colon, rectum, anal canal.
is the IMA peritoneal or retroperitoneal? retroperitoneal
the Marginal Artery is formed by anastamoses of branches from the IMA and the SMA
the marginal artery will send blood to any area of the colon where one or more branches of the _______ & _______ has been occluded SMA & IMA
Marginal artery feeds entire colon
The rectal artery is as far as we go; what is the name of the vein which must begin here? Internal Rectal Venous Plexus begins venous return of IMV
internal rectal venous plexus becomes the Inferior Mesenteric VEIN
Into what does the IMvein drain? splenic vein
Inferior mesenteric vein + splenic vein + superior mesenteric vein + superior pancreaticoduodenal vein = portal vein (below)
the branches of straight arteries given off by the arterial arcades are called vasa recta
the 4 branches "above" which form the portal vein: Right portal vein, Left portal vein, Right gastric vein, Left gastric vein
the 3 branches from "below" which form the portal vein Superior pancreaticoduodenal vein, Superior Mesenteric Vein, Splenic vein (picks up IMA)
which has longer vasa recta, jejunum or ileum? jejunum
which has more arterial arcades, jejunum or ileum? ileum
the stomach is a ________ bag muscular
what 3 regions does the stomach occupy? umbilical, left hypochondrium, epigastrium
capacity of the average J-shaped stomach: at birth? at puberty? adult size? at birth - 30ml, at puberty - 1000ml, adult - 1500-2000ml
external features of stomach: 2 orifices? cardiac and pyloric
2 curvatures of stomach? greater curvature and lesser curvature
2 ends of stomach? pyloric and esophageal
2 surfaces of stomach? anterior and posterior
2 notches of stomach? cardiac and ANGULAR notch (at pylorus)
2 parts of stomach? cardiac and pyloric regions
cardiac region of stomach has fundus and body
pyloric region of stomach has pyloric ANTRUM and pyloric CANAL
the pyloric ________ is right after the body of the cardiac portion of stomach and contains the angular notch. ANTRUM
the pyloric sphincter is in what region of the stomach? pyloric CANAL
if you draw a horizontal line at the cardiac notch, what do you get? the fundic and body portions of the cardiac region of stomach
the posterior surface of the stomach in relation to 8 structures is called the stomach bed
the 8 structures of the stomach bed: S, SA, LSG, LK, TrM, SF, P, D
the 8 structures of the stomach bed: spleen, splenic artery, left suprarenal gland on left kidney, left kidney, transverse mesocolon, splenic flexure, pancreas, diaphragm
the lesser sac is behind the liver, stomach, and greater omentum
the anterior surface of the stomach faces what 3 structures? liver, diaphragm, anterior abdominal wall
the blood supply to the stomach has all arteries that contain the word _______ gastric
6 arteries to stomach: Gastroduodenal, Short Gastric, Right gastric, Left gastric, Right gastroepiploic, Left gastroepiploic
the venous drainage of the stomach Superior Mesenteric Vein, Splenic Vein, Portal Vein
where are the short gastric arteries of the stomach? 5-7 small branches that arise off the splenic artery and appear to feed the cardiac fundus
what is the ultimate destination of the superior mesenteric vein and splenic vein before they return to vena cava? Portal vein
what is the ultimate destination of the venous return of the stomach? portal vein
the lymphatics of the stomach ultimately drain into the? celiac group of lymph nodes
the sympathetic nerve supply of stomach is derived from what segments? T6-T10
the sympathetic fibers of the stomach (T6-10) are the chief sensory pathways for PAIN from the stomach
what inhibits peristalsis by gastric musculature, the sympathetic or parasympathetic nerve fibers? sympathetic
the _____________nerve fibers inhibit peristalsis sympathetic
the parasympathetic fibers of stomach are derived from what large nerve? VAGUS- X CN
we know the vagal trunk wraps around the esophagus with left side supplying __________ and right side supplying __________. anterior (left), posterior (right)
the anterior of the stomach is supplied by the ______ side of the vagus, the posterior of the stomach is supplied by the _______ side of the vagus. anterior (left), posterior (right)
the Vagus increases what activity of the stomach? peristalsis
is the vagus sympathetic or parasympathetic? parasympathetic
increasing the parasympathetic actions of the vagal nerve for the stomach increases peristalsis
3 fcns of stomach reservoir, mixer, absorber of water and salt (and alcohol)
the gastric disorder characterized by anorexia, nausea, and vomiting is called dyspepsia
gastric pain will always be felt in the epigastric region
the increased production of HCl often results in an ulcer
the surgical procedure of removing a selected stomach portion: selective vagotomy
a peptic ulcer can either be gastric or duodenal
a congenital ulcer seen in children and occurring when food cannot pass beyond the pylorus of the stomach but has peristent peristalsis is called pyloric ulcer
an acquired ulcer seen in adults and occurring when food cannot pass beyond the pylorus of the stomach but has persistent peristalsis is called pyloric ulcer
gastric ulcers always occur in the lesser curvature of stomach, because food is directed here and accumulates
a gastric carcinoma occurs in the greater curvature of stomach
a duodenal ulcer always occurs in the first part of the duodenum and is called pyloric stenosis
3 kinds of GI bleeding causes: gastric ulcer, gastric carcinoma, duodenal ulcer (pyloric stenosis)
pyloric stenosis/duodenal ulcer is seen in kids as a sausage-shape in epigastrium
appendices epiploicae large intestine
Taniae Coli large intestine
sacculations large intestine
calibre (size of lumen of small and large intestines)? large intestine: wider small intestine: smaller
fixity (greater part of intestines to body wall) large intestines are fixed, small intestines are freely mobile (mesentery proper)
villi small intestine
transverse mucosal folds small intestine (folds are called plicae like "pleated")
Peyer's patches small intestine
effect of infection on small intestine diarrhea
effect of infection on large intestine dysentery with blood
folds of peritoneum containing fat and found only on the large intestine appendices epiploicae
condensation of longitudinal muscle cords of intestinal wall, converging towards base of vermiform appendix teniae coli
the part of the duodenum that is freely movable is suspended by mesentery
name of suspensory ligament for duodenum hepatoduodenal ligament
most parts of duodenum are fixed and ___________ (placement in peritoneal cavity) retroperitoneal
what parts of the intestine are freely movable jejunum and ileum (and tiny bit of duodenum hanging from hepatoduodenal ligament)
what parts of the intestine are fixed? caecum, ascending colon, hepatic flexure, transverse colon, splenic flexure are all retroperitoneal and therefore fixed.
the innermost lining of the small intestine is a __________ membrane (histologically) which shows finger-like projections called mucous, villi (small intestine only)
the folds of the innermost lining of small intestine are called plicae
where are Peyer's patches found and what are they? in the small intestines: aggregates of lymphatic follicles
what could cause blood to present in a loose stool and why? dysentery, because of eroded GI tract valves
where is the jejunum located? upper left abdominal wall
where is the ileum located? lower right abdominal wall
part of the small intestine with thicker, more vascular walls jejunum
part of the small intestine with thinner, less vascular walls ileum
part of small intestine with wider, empty lumern jejunum (does not "collect" waste)
part of small intestine with narrower, loaded lumen ileum (collects)
part of small intestine with less fatty mesentery jejunum
part of small intestine with fattier mesentery ileum
part of small intestine with longer vasa recta and fewer arterial arcades jejunum
part of small intestine with shorter vasa recta and numerous stacked arterial arcades ileum
the villi of this small intestine is larger, leaf-like jejunum
the villi of this small intestine is smaller and finger-like ileum
Jejunum is derived from the adjective jejune, which means "fasting" or "hungry" in Early Modern English. It was so called because this portion of the intestine was found "________" following death.[citation needed][Latin: jejunus, fasting; barren] empty
Brunner's glands are only present in the duodenum
the jejunum is ________, the ileum is _______ empty, full
the ___________duct connects the midgut with the yolksac in the embryo vitelline
the vitelline duct may persist and develop into a __________ ___________ if it persists proximally Meckel's Diverticulum
Meckel's Diverticulum is the result of the proximal peristence of the vitelline vein
the vitelline duct may persist into adulthood -if it persists distally, towards the umbilicus, it becomes a weeping umbilicus, or raspberry tumor
Meckel's diverticulum has similar traits to that of appendicitis
a Meckel's diverticulum may be a free end of the ____ _______ resulting in no complications small intestine
when Meckel's diverticulum is connected to the anterior abdominal wall by a ligamentous structure, what 5 complications may result? peptic ulcer, Littre's hernia (indirect/oblique), resemble appendicitis, intusseption
intusseption part of the gut is invaginated into its distal portion, leading to severe abdominal obstruction. cured by saline
the caecum is a blind sac and the start of the Large Intestines
what 3 structures does the caecum communicate with? ascending colon, ileum (end), vermiform appendix
the caecum occupies the right _____ fossa, and is 2.5 inches long, _____ inches broad. iliac, 3
what branch of the SMA supplies the caecum? Ileocolic artery
what supplies the venous drain for caecum? superior mesenteric vein
the caecum is sympathetically innervated segmentally by T11-L1
the caecum is parasypathetically innervated by the vagus nerve (all abdominal organ)
78% of vermiform appendices are attached to the caecum this way ampullary
caecus "blind"
3 possible configuratins of the vermiform appendix.) conical, intermediate, ampullary (78% freq
junction between caecum and ileum inside caecum ileocecal valve
4 parts of ileocecal valve upper lip, left frenulum, lower lip, right frenulum
function of the ileocecal valve prevents reflux of cecal contents into ileum and regulates slow passage of ileal contents into caecum
what is thrilled to take up residence in the caecum? amoebas
amoebas (trophocytes) get loaded in the caecum and cause amoebaisis
amoebaisis in the caecum creates an ameoboma (tumor full of amoebas) and/or amoebic cysts
what 2 conditions besides amoebaisis affect the caecum? tuberculosis and cancer
amoebaisis, tuberculosis, and cancer are conditions of the caecum
how long is the vermiform appendix in adults 2-9", although more in children
what is in the appendix? lymphoid tissue
what is the point of attachment of the vermiform appendix base of appendix
tip of appendix points in 1 or 6 clockface directions. Name them 11 - paracolic, 12 - retrocolic, 2 - splenic, 3 - promonteric, 4 - pelvic, 6 - mid inguinal
the vermiform appendix valve into the caecum is called the orifice of the vermiform appendix
How is the ileocaecal valve controlled? sympathetic fibers permit TONIC contraction and it closes mechanically due to distention (stretching)
tonic contraction and mechanical closure due to distension control what valve in the body? Ileocaecal valve
in the junction of the transtubercular plane and the Right Lateral Plane is the base of the appendix
what is the site of maximum tenderness in appendicitis, along the spinoumbilical line? McBurney's point
the spinoumbilical line connects what to what? ASIS to umbilicus, used in McBurney's point
appendicitis occurs in young women how old? 15-16
3 symptoms of appendicitis: 1. pain in the 2. 3. pain in the right iliac fossa, nausea, vomiting
1st sign of appendicitis Positive Rebound pain - doc removes pressure created by her hand, and pain REBOUNDs like with a hernia
2nd sign of appendicitis Rovising sign= doc applies pressure on left iliac fossa, gas in the intestines is displaced to the right side and pain will be felt on the right iliac fossa
Blood supply to appendix appendicular artery, (a branch of ileocolic artery off Superior mesenteric artery)
venous drainage of the appendix portal vein
nerve supply of the appendix - parasympathetic vagus is parasymp to appendix
nerve supply of appendix - sympathetic T9-T10
pain from appendicitis begins around the umbilicus
segment for appendix T10 T10 T10 T10 T10 T10 T10 T10 T10
Ascending colon to... Right colic flexure (hepatic) to transverse colon to left colic flexure (splenic) to descending to sigmoid to rectum to anus
the ascending colon is ___" in length and extends from 5", caecum to liver (hepatic flexure)
Right colic flexure (hepatic) lies on lower part of right kidney
the transverse colon is __" in length and extends from the right colic flexure to the left colic flexure (hepatic to splenic)
what suspends the transverse colon the transverse mesocolon
the left colic flexure lies on the lower part of the left kidney
the descending colon is ____" in length and extends from the left colic flexure to the sigmoid colon
the ascending and descending colon are RETROPERITONEAL
the Transverse colon is suspended by the transverse mesocolon and the sigmoid colon is suspended by the sigmoid mesocolon
the Transverse colon and sigmoid colon are Peritoneal
the ___________is the shortest, widest, most fixed part of the small intestine (remember how you had to practically shoe-horn it out of the cadaver?) duodenum
the duodenum extends from the pylorus to the duodenal-jejunal flexure
the duodenum curves around the head of the pancreas
the duodenum lies against what segments? L1-3
how long is the duodenum 10"
how many parts to the duodenum? I, II, III, IV + duodenal cap/bulb
if the duodenum is 10", how long is each segment I = 2", II = 3", III = 4", IV = 1"
duodenum parts description I = 2" and superior, II = 3" and descending, III = 4" and horizontal/transverse, IV = 1" and vertical
what ligament is holding up the duodenal-jejunal flexure The Ligament of Treitz
the Ligament of Treitz is also called the suspensory ligament of the duodenum
the Ligament of Treitz attaches to the duodenum by extending from the right crus of the diaphragm to that of the duodenal-jejunal flexure and the III and IV parts of duodenum
blood supply to the duodenum (lucky 7) superior and inferior pancreatico-duodenal arteries (anastamosing around the head of the pancreas), right gastric artery, retroduodenal artery, supraduodenal artery, hepatic artery, Right gastroepiploic artery
the retroduodenal artery and supraduodenal artery are branches of the hepatic artery
three arteries to the duodenum have the word "duodenal" in them. What are the branches which don't have that word? R gastric, R gastroepiploic, R hepatic
the venous drainage of the duodenum, like everything else in the abdomen, is the portal vein or Superior Mesenteric or Splenic V
lymph drainage of the duodenum is the ____________ lymph trunk and ultimately the intestinal, Cisternae chyli
innervation of duodenum parasymp is VAGUS, symp is T9-T10 like the vermiform appendix
both the duodenum and the vermiform appendix are innervated by VAGUS and segements T9, T10
when using a barium contrast, the _____ segment of the duodenum is visible first part appears like a cap (duodenal cap or bulb)
what is attached to the superior part of the duodenum and the greater curve of stomach and the liver via the gastrohepatic and gastroduodenal ligaments and forms the lesser sac? the Lesser omentum!
the duodenum is peritoneal or retroperitoneal? retro peritoneal
if there is distortion in the duodenal cap upon the xray after barium meal contrast, we suspect something is wrong such as a duodenal ULCER
superior part I of duodenum is associated with what test barium meal contrast for duodenal ulcer
the descending II part of the duodenum has the (opening) Ampulla of Vater or the hepatopancreatic ampulla
the Ampulla of Vater is prone to obstruction
the descending II part of the duodenum is associated with what opening and what pathology Ampulla of Vater, obstruction
the horizontal III part of the duodenum is crossed by the SMA veins and arteries
Because the SMA veins and arteries cross the horizontal III part of the duodenum, it is prone to obstruction
the horizontal III part of the duodenum is crossed by and is prone to what pathology crossed by SMA, obstruction
when the ligament of Treitz only attaches to the duodenal-jejunal flexure and not the duodenum itself, what occurs the angle of the d-j flexure increases so as to cause an obstruction
the ascending IV part of the duodenum is liable to obstruction when the ligament of Treitz is incompletely attached, ergo only at the d-j flexure and not the duodenum itself. When suspensory muscle contracts, it increases the angle too much at the flexure
contraction of modified Ligament of Treitz results in contraction and squeezing of angle, obstructing what part of what organ ascending IV duodenum
what two branches in the abdomen form the portal vein SMV and Splenic V
why doesn't the IMA form a branch of the portal vein because it drains into the splenic vein, which IS one of the 2 branches
the portal vein collects blood from: the abdominal part of the alimentary tract (digestion), the gallbladder, pancreas, spleen
how long is the portal vein 3"
the portal vein function convey blood to liver
the portal vein passes upward and behind the neck of the ______ and part ____ of the duodenum pancreas, I (superior)
the portal vein is seen in the ________omentum lesser
what is the triad of vein, artery, duct in the liver called Porta Hepatis (hepatic triangle)
when the portal vein reaches the liver, it divides into left and right branches
the LEFT branch of the portal vein gives rise to the caudate and quadrate lobe branches (the right side of the liver is the biggest so it needs everything the right branch brings and the cystic vein is small)
3 tributaries that drain directly into the portal vein and one for the right branch: 1. left gastric vein 2. right gastric vein 3. superior pancreatico-duodenal vein 4. cystic vein drains into right branch
the left gastric vein, the right gastric vein, the superior pancreaticoduodenal vein and the cystic vein all do what? drain into the portal vein
where must blood go before it reaches the heart and what structure assures this happens blood must go through the liver for filtration before it reaches the heart - the PORTAL VEIN makes this happen
what is the name of the system which shunts blood to the liver first, before it sends it to the vena cava and then heart? portal system
do all veins drain into the portal system? no, the Systemic venous drainage goes directly into the Inferior Vena Cava
is there anastamoses between the portal system and the systemic venous blood return? yes, the veins draining into the liver will have anatamoses with systemic
the 3" hepatic portal vein is sitting where near the lesser omentum right free margin (where foramen of Winslow/gastroepiploic foramen lives)
portal is GI, liver, spleen
GI, liver, spleen is portal
portal is GI, liver, spleen
the three regions of portal-systemic anastamoses: umbilical, esophagus, rectal
the portal-systemic UMBILICAL anastamoses is: portal: paraumbilical veins, systemic: veins of the anterior abdominal wall
paraumbilical veins open to which portal branch and sit on either side of the right portal branch, either side of ligamentum teres
the portal-systemic ESOPHAGEAL anastamoses: portal: esophageal veins of the left gastric vein (clockwise wheel of vagus around eso same here) to splenic vein to portal systemic: accessory hemiazygous vein to azygous to superior vena cava
the portal-systemic RECTUM & ANAL CANAL anastamoses: portal: superior rectal vein from IMA systemic: middle and inferior rectal veins join internal iliac to common iliac to IVC
PORTOANASTAMOSIS 1..2..3 umbilicus - paraumbilicus with anterior abdominal wall veins accompanies ligamentum teres esophagus- esophageal tributaries (which drain left gastric vein) anastamose with hemiazygous v rectal and anus - superior rectal (portal) with inf and mid rectal
left portal branch receives: (1 tributary, 2 branches, and a ligament) paraumbilical veins surrounding ligamentum teres, caudate lobe, quadrate lobe, ligamentum venosum
the Right portal branch receives the cystic vein from the gallbladder
caput medusae engorged veins seen on anterior abdominal wall from umbilical region, due to abdominal obstruction
esophageal varices obstruction of esophageal branches when anastoamosing hemiazygous and Left gastric veins around esophagus engorge
hemorrhoids or piles engorgement of the veins around the rectal and anal regions
Increased portal hypertension caput medusae, esophageal varices, hemorrhoids or piles
what does the extra billiary apparatus do? collects bile from the liver, stores bile in gallbladder, then transmits the bile to the duodenum
the right and left hepatic ducts drain the right and left hepatic lobes, respectively
the right and left hepatic ducts unite to form the common hepatic duct
what joins the common hepatic duct to form the common bile duct cystic duct of gall bladder
the bile duct joins the pancreatic duct at the ampulla of Vater
what sphincter controls the common bile duct before it opens to Ampulla of Vater Sphincter of BOYDEN ("B" for Bile duct)
what sphincter controls the Ampulla of Vater as it opens to the major duodenal papilla? Sphincter of Oddi (as in Odd Water)
what 3 components to the Porta Hepatis Common HEPATIC duct, HEPATIC artery, HEPATIC vein
the cystic duct begins from the neck of the gallbladder and drains into the common hepatic duct
the gallbladder has 3 parts: fundus, neck, body
what is represented on the body surface by a point located on the lateral border of rectus abdominis, linea semilunaris, and 9th costal cartilage the FUNdus of gallbladder
the gall bladder is a pear shaped reservoir for bile
the gall bladder is 1.5" long and can hold ____ml of bile 30ml
along the posteromedial wall of the neck of the gall bladder is a small dilation called the pouch of Hartman
what does Hartman's Pouch of the gall bladder collect? gall stones
the _____ ______ is formed by the common hepatic duct and the cystic duct fusing into one bile duct
the hepatopancreatic ampulla is also called the ampulla of Vater (Oddi WAter)
the Ampulla of Vater opens into the duodenum via the major duodenal papillae
the terminal opening of the bile ducts is guarded by the sphincter of Boyden (B for Bile)
the ampulla of Vater is guarded by the sphinchter of Oddi (Odd Water/Vater)
blood supply to extrahepatic billiary apparatus cystic artery, Right hepatic artery, superior pancreatico-duodenal artery
the cystic artery traverses the Triangle of Calot (C for Cystic and Calot)
boundaries of the triangle of Calot inferior surface of liver (roof), Common Hepatic DUCT, Cystic duct
the Triangle of Calot is commonly called the CYSTO-HEPATIC TRIANGLE
the CYsto-HEPatic triangle is a tiny space with 3 boundaries hepatic duct, inferior liver, bile duct
contents of cysto-hepatic triangle (of Calot) Right hepatic artery, cystic artery, lymph nodes
venous drainage of extrahepatic billiary apparatus (think organs, their veins, their common venous dump) cystic vein, hepatic vein, dump into portal vein
lymphatics of extra hepatic billiary apparatus lymph nodes drain to cystic group of lymph nodes
the extra hepatic billiary apparatus is innervated by a plexus CYSTIC plexus
what nerves form the cystic plexus parasympathetic from VAGUS sympathetic from T7-9 phrenic nerve of diaphragm
what symphathetic nerves innervate cystic plexus T7-9
what nerve usually runs with the parasymp Vagus? the phrenic
when gallbladder is inflamed due to parasympathetic innervation (VAGUS), where is pain referred to stomach or epigastrium
when gallbladder is inflamed due to sympathetic innervation (T7-9), where is pain inferior angle of scap is T7
what nerve supplies the shoulder region? phrenic
If gallbladder is inflamed due to phrenic nerve, where is pain RIGHT shoulder
functions of gall bladder () store bile, absorb water from bile and concentrate it
acute choleocystitis inflammation of the gall bladder
if doc taps 9th costal cartilage upon patient inhale and pain, the gall bladder is inflamed. This is called a positive Murphy's sign
cholelisthiasis gall stones (lith means stones like lithics in anthropology)
2 types of gall stones cholesterol type, pigment type
what the hell is a pigment gall stone? I don't know - YOU look it up on Wiki. I typed all these cards.
predisposing factors to gall stones (5 F's) fair, fatty, forty, female, fertile
besides acute cholecystitis and cholelisthaisis, the gall bladder can harbor typhoid. What is the name of the bacteria that causes it? Salmonella typhi
the organ which is both an endocrine and an exocrine gland pancreas
the pancreas lies transversely across the posterior abdominal wall, behind the stomach
the head of the pancreas is tucked into the duodenal concavity
the pancreas is a J-shaped structure of 6-8" long and 1.5" wide. Name 5 parts Head, neck, body, tail, uncinate process
tubar omentale presented at the body of pancreas
what is the tuber omentale of pancreas? (omental eminence): prominence on body of pancreas near the head that is produced by the vertebral column and projects into the omental bursa
what segmental level for pancreas position L1, L2
where in the pancreas are the Islets of Langerhans most prevalent tail of pancreas
the pancreatic duct joins the ____ ______ to form the bile duct, ampulla of Vater
how many pancreatic ducts 2
name the 2 pancreatic ducts main or pancreatic duct of Wirsung, Accessory pancreatic duct or duct of SAntorini
Wirsung and Santorini crossed in the pancreas and drained separately - how could this be? Santorini drains the uncinate process and heads to north duodenum to the minor duodenal papillae, while Wirsun drains the tail, body, neck and some of the head, then heads south to the major duodenal papillae
what artery runs right alongside the pancreas and supplies it splenic artery
pancreatica magna to ______, caudae pancreatis to ______ head, tail (caudae)
the pancreas is venously drained by the portal system
the lymph of the pancreas are the ______________ nodes (2 organs) pancreatico-lienal lymph nodes
parasympathetic supply of pancreas is, like most abdominal organs, the VAGUS
sympathetic supply of pancreas are fibers arising from the plexi surrounding the arteries (assume splenic)
the exocrine role of pancreas is to secrete __________ to break down food enzymes
endocrine role of pancreas is (2) glucagon and insulin
if there is an increase in insulin, what disease? diabetes mellitus
inflammed pancreas is called pancreatitis
what are the symptoms of pancreatitis acute? pain & vomiting
pancreatitis severe? collapse
when duodenum is completely encircled by pancreas, it is called ___________ pancreas annular
is annular pancreas dangerous can obstruct duodenum (asymptomatic)
carcinoma of the pancreas occurs in the _______ of the pancreas head
the ___________ is the largest gland in the body LIVER
the liver occupies a little of the left hypochondrium, sometimes the right lumbar region, but definitely the (2) right hypochondrium and epigastrium
what is the only visible border of the liver (think Triangle of Calot) inferior border
5 surfaces of liver right, superior, inferior = quadrate lobe, posterior = caudate lobe, anterior
there are two types of liver lobes anatomical and physiological (tangible and intangible)
what ligament divides the anterior liver falciform
what ligament divides the inferior liver ligamentum teres
name 4 liver lobes right, left, caudate , quadrate
what ligament divides the posterior liver ligamentum venosum
is the quadrate lobe posterior, anterior, superior or inferior inferior and anterior
boundaries for quadrate lobe right is gall bladder fossa, left is fissure for ligamentum teres, posterior sits the porta hepatis
boundaries for caudate lobe connected to right lobe via caudate process and has groove for IVC right above process, left is fissure for ligamentum venosum, inferior is the porta hepatis
what is the common boundary for both caudate and quadrate liver lobes? porta hepatis
3 structures in porta hepatis DAV bile Duct/hepatic Artery/hepatic Vein
ligaments of the liver 2 triangular, 2 cornonary, 1 ligamentum teres, 1 falciform ligament, lesser omentum (hepatogastric and hepatoduodenal)
the right lobe of liver is associated with (2) hepatic flexure & right kidney
the left lobe of the liver is associated with (3) duodenum, stomach, and part of splenic flexure
arterial supply to liver is 20%_____ and 80%________ 20% HEpatic artery, 80% portal vein
the veins of the liver drain into the hepatic veins which drain into the Inferior Vena Cava
lymphatic supply of liver hepatic group to CELIAC gp.
liver pathology due to cancer hepatomegaly or hepatoma (primary but most often secondary)
palpaple left lobe under epigastric region suggests cirrhosis
hepato-cellular damage is presented as jaundice or icterus
"icterus" means stained with bile pigment (hence pigmented tumor of gallbladder)
hepatitis can be contracted from (3) parasite, amoebas, viral (like Hep A, Hep B)
does cirrhosis of the liver make it larger or smaller, softer or harder and why? small, hard, due to fibrosis
left lobe of the liver is palpated in the epigastric region
what segmental region is the liver T7-9
up to the level of Right 2/3 of transverse colon, what is parasympathetic innervation? VAGUS, baby!
after the level of Right 2/3 of transverse colon, what is parasympathetic innervation of left 1/3 transverse colon to anus? PELVIC SPLANCHNIC
the VAGUS, baby! innervates what part of the colon? from caecum to Right 2/3 of transverse colon
the Pelvic SPLANCHNIC nerve innervates what part of the colon? from the left 1/3 of transverse colon to anus
Autonomic Nervous System for this exam is (3) lumbar sympathetic chain. celiac plexus. superior hypogastric plexus.
name the ANS traveling along the aorta , celiac ganglion, celiac plexus, aortic plexus, inferior mesenteric plexus, superior hypogastric plexus
which sympathetic chain is located bilaterally in front of the vertebral column? lumbar sympathetic chain
why do you see 4 ganglia of the lumbar sympathetic chain instead of 5 (one for each vertebra)? the first two ganglia fuse to form L1
branches of the lumbar sympathetic chain are spinal nerves ___-___, which are most lateral spinal nerves L1-L5
what are located between the spinal nerves and the ganglia? Grey and White Rami Communicantes
only ________ Rami Communicantes are located at L1 WHITE
order lateral to medial is: spinal nerves L1-5, grey & white rami communicantes (w at L1 only) - ganglia - _______________________________ lumbar splanchnic nerves (most medial)
where does the lumbar splanchnic nerve plexus occur? at L5
lumbar ganglia 4 sympathetic ganglia of lumbar vertebral column
lumbar splanchnic nerves 4 nerves arising from the lumbar sympathetic trunk forming a plexus on the fifth lumbar vertebra
nerve plexus lying anterior to and on both sides of the aorta. It extends from the celiac plexus to the aortic bifurcaton, receiving fibers from both superior lumbar ganglia, and continues caudally as the superior hypogastric plexus. ABDOMINAL AORTIC PLEXUS
Nerve plexus around the celiac trunk that communicates with the adjacent plexuses. It receives fibers from the first two splanchnic nerves (L1, L2) and the vagus nerve and the celiac ganglia. CELIAC PLEXUS
plexuslike comminication between the abdominal aortic plexus and inferior hypogastric plexus that mostly lies anterior to the fifth lumbar vertebra. It contains branches from the lumbar sympathetic ganglia. SUPERIOR HYPO-GASTRIC PLEXUS
collection of ganglion cells that comminicates with the celiac plexus andlies on the right and left of the aorta adjacent to the celiac trunk celiac ganglia
abdominal aortic plexus extends from the _____________ to the ____________ celiac plexus to the aortic bifurcation
what two lumbar ganglion fibers does the abdominal aortic plexus receive before it turns into the superior hypogastric plexus/ L1-2 fused, L3 - collectively called the superior lumbar ganglia
the celiac plexus is a nerve plexus around the celiac trunk and communicates with the adjacent plexuses. It receives fibers from (4) L1 and L2 lumbar splanchnic, celiac ganglia, vagus, and phrenic
liver functions prothrombin, protective organ (phagocyte), storage (iron, fat, Vit A + D)
what is the largest ganglia seen in the body celiac ganglia
what forms the celiac plexus celiac ganglia, L1-2 lumbar splanchnic, vagus, phrenic
secondary branches of celiac plexus (5) splenic, renal, hepatic, SM, aortic
splenic plexus, renal plexus, hepatic plexus, Superior Mesenteric plexus, and aortic plexus are all secondary branches of the celiac plexus
white communicating rami are only at L1
why are there only 4 lumbar ganglion? because the first and second fuse
the superior HYPO-gastric plexus is also called the presacral nerve (because it turns into the two hypogastric nerves)
the presacral nerve/superior hypo gastric plexus communicates with the inferior hypogastric plexus, uteric and testicular plexuses
what feeds the superior hypogastric plexus parasympathetic fibers? pelvic splanchnic nerve
what feeds the superior hypogastric plexus fight or flight fibers? 3+4th splanchnic nerves and aortic plexus above it at the aortic bifurcation
what level is the celiac ganglion L1
what level is the celiac plexus L2
what level is the aortic plexus L3
what level is the Inferior Mesenteric plexus L4
what level is the superior hypogastric plexus L4-5
the function of the sympathetic fibers to the gut (4) vasomotor (constrictive) to blood vessels, motor to sphincters, inhibits peristalsis, mostly sensory to viscera
the sympathetic and parasympathetic fibers go to which two plexuses (diagram) celiac plexus and superior hypogastric plexus
the parasympathetic fibers to the celiac and superior hypogastric plexuses are motor to the gut and secretomotor to the glands
are glands at the mercy of parasympathetic or sympathetic fibers? parasympathetic
fight or flight to your celiac and superior hypogastric plexuses would do what shut peristalsis, vasoconstrict blood vessels, close anal sphinchter (unless you think you are dying), and provide sensation to viscera (hence, butterflies)
sympathetic control of guts would encourage peristalsis, cause the glands to secrete
viscerae are insensitive to cutting, crushing, or burning. what does hurt them? ischemia (true visceral pain), spasms, excessive distension
what travels with the celiac artery to the hepatic and splenic plexuses to control the size of lumen of vessels? VAGUS - Vasomotor function
vasomotor means can control size of vessel lumen
a removal of the lumbar sympathetic chain is called a lumbar sympathectomy
malfunction of the lumbar sympathetic chain would cause overconstriction of the blood vessels
constriction of the lumbar sympathetic chain that causes pain upon walking is called _________ disease Buerger's (too many burgers makes it hard for your fat ass to walk)
why wouldn't a man want his L1 sympathetic ganglion removed (sympathectomy) to cure Buerger's disease but could have L2, L3 removed? L1 removal would cause impotence because it supplies the corpus cavernosum
are presacral neurectomies for painful dysmenorrhea performed any more? no
where is the presacral nerve it is the superior hypogastric plexus at the base of aortic bifurcation
suprarenal glands are endocrine or exocrine? Endocrine
where are the suprarenals located along the upper poles of each kidney
each suprarenal gland only weighs 5gm but are differently shaped from one another. Describe the right suprarenal gland related to liver and inferior vena cava and is TRIANGULAR in shape
describe left suprarenal gland related to spleen, stomach, splenic artery, pancreas and is SEMILUNAR in shape
what two organs do both suprarenals touch on their respective sides diaphragm and kidneys
difference in blood supply (arteries)for right and left suprarenal glands none, both have superior, middle and inferior suprarenal arteries from same structures
difference in blood drain (veins)for right and left suprarenal glands inferior vena cava is on right side of body so left suprarenal has different drain: superior suprarenal vein drains into closer left renal vein whereas right superior suprarenal vein drains directly into the closer IVC
What other veins to the IVC drain differently because of their proximity to it? Left gonadal vein drains to left renal artery (because it's closer) and right gonadal vein drains directly into the IVC (because IVC also sits on right)
superior suprarenal artery is a branch of the inferior phrenic artery (of diaphragm)
middle suprarenal artery is a branch of the abdominal aorta
inferior suprarenal artery is a branch of the renal artery
an increase in suprarenal CORTICAL secretions may lead to Cushing's Syndrome (C for Cushings & Cortical)
obesity, hirsuitism, diabetes, masculinization of females and feminization of males may indicate an increase in CORTICAL secretions = Cushing's Syndrome (C for Cushings & Cortical)
in children, adenogenital syndrome causes precocious puberty and may indicate Cushing's Syndrome
a decrease in cortical secretions (of suprarenal gland) may cause Addison's disease (John Kennedy had this)
muscular weakness, LBP, anemia, skin pigmentation, can lead to kidney failure are signs of Addison's disease (JFK had this)
3 layers of kidney zona glomerulosa, zona fasiculata, zona reticularis
a tumor in the medulla region of the suprarenal gland causes heart palpitations, headache, sweating, palor pheo-chromo-cytoma
the suprarenal gland is an endocrine organ; the kidney is an _________ organ excretory
the kidney occupies the epigastrium, hypchondrium, lumbar and umbilical regions and is found where in the posterior abdominal wall (retroperitoneal)
Right kidney touches (5) suprarenal, liver, duodenum, hepatic/colic flex, jejunum
Left kidney touches (5) suprarenal, stomach, spleen, pancreas, splenic/colic flex, jejunum
what comes out of the hilum of a kidney renal artery, vein, renal plexus, ureter, aortic group of lymph connection
kidney has 2 ________, 2 ___________, 2__________ poles, borders, surfaces
2 kidney poles: upper and lower
2 kidney borders: lateral and medial
2 kidney surfaces: anterior and posterior
which kidney is higher left because it is related to 11 & 12th ribs
3 muscles kidneys related to psoas, quadratus lumborum, transversus abdominis
what 3 nerves popping out of T12 area would kindey be related to? subcostal, iliohypogastric, ilioinguinal nerves
how many capsules around each kidney? 3 (renal, fat, fibrous)
name parts of kidney inside: outer cortex, renal pyramids, renal columns, renal papillae, minor caylx (calices), major caylx, renal pelvis, renal artery, renal vein, renal plexus, lymph to aortic
can you usually feel the kidneys? no
disease of the kidney always presents with what symptom(s) edema in face, (edema in legs=hear failure)
an intravenous pyelogram (IVP) can assess kidney function for obstruction
an intravenous pyelogram can show kidney, ureter, bladder on xray
a pair of muscular tubes that lie in the posterior abdominal wall, as well as lateral pelvic wall ureters
how many constrictions does the normal ureter have? 3
where are the 3 ureter constrictions kidney pelvis, brim of bony pelvis, bladder entrance
blood supply of the ureters renal, gonadal, abdominal aorta, CIA, IIA, inferior VESICAL artery, Men: middle rectal, Women: uterine artery
difference in blood supply of ureters between men and women women: uterine artery, men: inf. rectal artery
venous drain of ureters renal vein
nerve supply to ureters ureteric plexus (T10,11 symp, pelvic splanchnic parasymp)
renal stones leads to renal colic - pain from loin to groin to scrotum or labia majora
where are renal stones located? at one of 3 constrictions (kidney pelvis, bony pelvis, bladder entrance)
if ureters are blocked by stones or uterine fibroids, what happens to the calices of the kidney dialation and eventual hydronephrosis
diaphragm forms a partition between thoracic and abdominal cavities
diaphragm is the muscle of inspiration
level of IVC opening in diaphragm T8
level of esophagus in diaphragm T10
level of abdominal AORTA in diaphragm T12
thoracic opening levels of diaphragm 8.10.12 (IVC, Es, AA)
3 arcuate ligaments of diaphragm median over abdominal aorta at T12/L1, medial over psoas, lateral over QL
where is the medial arcuate ligament over the psoas - diaphragm connection
where is the lateral arcuate ligament over the quadratus lumborum - diaphragm connection
where is the median arcuate ligament over the abdominal aorta - diaphragm connection (T12/L1)
how many points of origin for diaphragm 4: sternal, costal, lumbar, R & L crura
sternal origin of diaphragm 2 fleshy slips from xyphoid process
costal origin of diaphragm lower 6 costal cartilages and ribs
lumbar origin of diaphragm upper 3 lumbar vertebrae, medial and lateral arcuate ligaments (psoas and QL)
the medial and lateral arcuate ligament origins of the diaphragm are also called the lumbocostal arches
there is a right and left ______ origin of diaphragm crus
the T8 inferior vena caval opening of diaphragm also transmits what nerve PHRENIC (the diaphragm nerve!!!)
the _______ tendon of the diaphragm is towards the anterior central
the T8 inferior vena caval opening transmits not only the phrenic nerve and IVC, but also opens into the central tendon of the diaphragm
what nerve always runs along the esophagus vAguS (clockwise steering wheel)
what comes out of the T10 Esophageal opening of the diaphragm, along with the esophagus? the VAGUS, anterior and posterior gastric nerves
what is the origin vertebra of psoas? L1
what is the insertion vertebra and rib of quadratus lumborum? L1, 12th rib
which crus is longer, right or left, of diaphragm Right
from which vertebrae does the right crus (longer) of diaphragm originate upper 3 lumbar
the upper 2 lumbar are a good bet for origin of which crus? left, because it's shorter
what comes out of T12 abdominal aortic opening of diaphragm with abdominal aorta? azygous vein and thoracic duct
the azygous vein and thoracic duct come out of where in the diaphragm T12 abdominal aorta median arcuate ligament azygos thoracic duct
motor nerve supply of diaphragm (if you hurt your spinal cord at C3-5, -especially C4- you can't breathe) phrenic
sensory to diaphragm is phrenic and lower 6 thoracic
the diaphragm takes part in all expulsive acts true
hiccups are an irritated diaphragm, spasms altering interabdominal pressure
pain in the diaphragm can be felt in the _______________ and why? shoulder, because both are supplied by C4
the foramen of Morgahpi at xyphoid where it meets diaphragm - hernias occur here because abdominal contents pass through into thoracic
congenital diaphragmatic hernias are harmless if they are behind the sternum (retrosternal)
a posterolateral hernia occuring through the lateral side of the diaphragm is dangerous!!!!
be able to draw diagram of lumbar plexus draw it now
the aorta lies to the _______ of the IVC left
name 4 unpaired arteries off abdominal aorta celiac trunk, S.M.A., I.M.A., median sacral artery
where does the thoracic duct come out?Where does the Azygos vein come out? of the abdominal aortic opening in the diaphragm at level T12 (remember 8.10.12), under the median arcuate ligament.
all __________arteries lie medial unpaired
all __________arteries lie lateral paired
where does the azygos vein come out? what comes out with it? what level? at abdominal aortic opening T12 under median arcuate ligament, with abdominal aorta and thoracic duct
name the 7 paired arteries of the abdominal aorta 1-superior suprarenal, 2-inferior phrenic, 3- middle suprarenal, 4-RENAL, 5-gonadal, 6-lumbar, 7-common iliac
what segmental level is aortic bifurcation L4
what happens at L4 abdominal aorta aortic bifurcation
L4 ventral rami joins genitofemoral of dorsal L1, ventral L2, ventral L3 to become obdurator n. (ventral)
L4 dorsal rami joins dorsal L2, dorsal L3 to become femoral n. (dorsal)
abdominal aorta, thoracic duct, azygos vein all exit at what segmental level T12
7 paired abdominal aortic arteries (lateral) superior suprarenal, inferior phrenic (supply diaphragm from below), middle suprarenal, renal, gonadal, lumbar, common iliac
Superior Intelligence May Reveal Gonads Lying Close Superior suprarenal artery, Inferior phrenic artery, Middle suprarenal artery, Renal artery, Gonadal artery, Lumbar artery, Common iliac artery
the IVC receives tributaries from 4 paired, 2 unpaired... 2 unpaired are Right suprarenal vein and Right gonadal vein, 4 paired are renal veins, hepatic veins, lumbar veins, common iliac vein
Super Gonad is RIGHT! RIGHT superior suprarenal vein and RIGHT gonadal vein enter IVC directly
why does the left suprarenal vein go to renal vein instead of IVC directly? too far to travel
why does the left gonadal vein go to renal vein instead of IVC directly? too far to travel
L1 and L2 veins join the ascending lumbar vein, which joins the subcostal vein, which then (depending on side), either joins Azygos or crosses at T9 to join from Hemiazygos to Azygos
Draw the Azygos, Hemiazygos, and Accessory Hemiazygos channel did you draw it?
the ________ ____________ is a lymphatic sac, 2-3" long that collects three channels of lumbar lymph trunks Cysterna Chyli
where is the cysterna chyli located? at Right Crus of Diaphragm (longer crus that originates from upper 3 lumbar vertebrae) + at level of RENAL vein
what is found at the right crus of diaphragm and renal vein level? cysterna chyli
the right, intestinal, and left channels of lymphatic lumbars drain to the cysterna chyli
the intestinal lumbar LYMPH trunk drains the pancreas, spleen, liver, stomach, intestines (SIPLS)
from the right side, the _______ _______ will cross to left side and dump lymph at junction between internal subclavian and internal jugular vein thoracic duct
through what opening does the thoracic duct ascend? abdominal aortic hiatus at T12 in diaphragm, along with AZYgos
azygos and thoracic duct ascend through the diaphragm via abdominal aortic hiatus
why would the Azygos choose to ascend with the abdominal aorta and thoracic duct, instead of the IVC? Azygos, hemiazygos and accessory hemiazygos lie directly on the spinal column, and the aortic hiatus does, too. The Caval opening lies in the middle of the diaphramatic roof, and would be too far away for the Azygos to reach
what trunk flexor is absent in 30% of all people (or 1/3 of people) psoas minor
origin of psoas minor T12
insertion of psoas minor pectin pubis and iliopectineal eminence
innervation of psoas minor (remember: nerves emerge below the vertebrae in thoracic and lumbar) L1 (muscle originates at T12)
what is the action of psoas minor weak flexor of hip
psoas major originates on the ________ __________ of all lumbar vertebrae and the bodies of _______-_______ and IVD's all transverse processes of lumbar, T12-L5 bodies, and IVD's
psoas major inserts at the lesser trochanter of the femur
innervation of psoas major L2,L3
action of psoas major flexer of hip, posture of trunk, unilateral flexion, lateral hip rotator
bilateral, unilateral, lateral flexion and posture are the jobs of psoas major
quadratus lumborum originates on the _________ _________ and t.p. of L5 Iliolumbar LIGament, L5 (remember: QL comes from below, grabs last rib and holds on like doing pull-up to fix the rib during inspiration)
insertion of Q.L. last rib (twelfth) and tp's of lumbars
innervation of Q.L. L1,L2,L3,L4
action of Q.L. fixes 12th rib during diaphragm descension/inspiration, lateral flexion and extension of lumbar (hip hiker)
innervation of psoas minor, psoas major, and quadratus lumborum L1 - L2,L3 - L1,L2,L3,L4
iliacus origin upper 2/3 of iliac fossa, iliolumbar ligament, iliac crest inner lip, sacrum
iliacus insertion joins psoas major to insert on lesser trochanter of femur
innervation of iliacus FEMORAL n of pelvis
femoral nerve of pelvis innervates which muscle iliacus
action of iliacus hip flexor
at what level does accessory hemiazygos cross T8
at what level does hemiazygos cross T9
embryologically, the foregut is supplied by celiac trunk
embryologically, the midgut is supplied by SMA
embryologically, the hindgut is supplied by IMA
name the 3 "derms" ectoderm, mesoderm, endoderm
the embryo undergoes cranial to ______ folding and ________ folding on the sides cranial to caudal, lateral
a small portion of the ______ _______ incorporates into embryo gut tube yolk sac
what connects the gut with the yolk sac in the embryo vitello-intestinal duct
if the vitellointestinal duct that connects the yolk sac with the gut tube does not disappear at birth, what does appear Meckel's diverticulum or raspberry umbilicus
foregut goes from pharynx to duodenal ampulla of vater - bile duct (sphincter of Boyden) beginning
pharynx, esophagus, stomach, duodenum proximal to bile duct opening are all given by the embryological foregut
what gives rise to the ileocecal valve midgut (remember: forgut only goes to duodenal level of bile duct entrance)
what parts of duodenum does foregut give rise to I,II (upper 2 levels before bile duct meets pancreatic duct)
what does the midgut give rise to III-IV duodenum, jejunum, ileum, caecum, ascending colon, 1/3 transverse colon
hindgut gives rise to 2/3 transverse colon, descending colon, sigmoid, rectum, ureters, urinary bladder
what gut gives rise to IV duodenum midgut
what gut gives rise to vermiform appendix midgut (gives rise to caecum)
what gut gives rise to rectum hindgut
what gut gives rise to first 1/3 of transverse colon midgut
what gut gives rise to the esophagus foregut
what gives rise to lateral 2/3 transverse colon hindgut
embryological innervation of guts sympathetic fibers are through sympathetic chain; parasympathetic are VAGUS & PELVIC SPLANCHNIC NERVES
the vagus innervates the embryo parasympathetically from pharynx to 2/3 of transverse colon true
the vagus innervates the fetus from pharynx to 2/3 of transverse colon
what innervates fetus GI after 2/3 transverse colon? pelvic splanchnic
the pelvic splanchnic n. innervates the fetus from lateral 1/3 of transverse colon to anus
what parasympathetic nerve innervates fetus first 1/2 of transverse colon? vagus (to lateral 2/3 mark of transverse colon)
what sympathetic nerve innervates fetus at esophagus sympathetic fibers of sympathetic chain
what parasympathetic nerve innervates fetus rectum pelvic splanchnic
what gut gives rise to the stomach foregut
what gut gives rise to the superior duodenal flexure and part I duodenum foregut
the liver as primordium grows a single diverticulum
the single diverticulum of the liver bud develops into the bile duct
the ____________surrounding the developing liver bud and diverticulum gives rise to the blood vessels mesenchyme
how many diverticul(um) does the pancreas have 2
the pancreas has _______ & ________pancreatic buds, growing toward one another dorsal & ventral
when the gut tube rotates, which diverticulum of the pancreas is carried around? VENTRAL is vented! It moves! It is brought to dorsal aspect and lies below it.
which aspect, dorsal or ventral, of pancreatic diverticulum lies inferiorly ventral (ventral is vented and swings around to rest on bottom)
what is all that remains after the ventral has swung around, settled on bottom, and joined the dorsal pancreatic bud? ventral duct is what we see as the exteranl part of Pancreatic duct
the lower part of the ______ and the _______ ________ develop from ventral portion of pancreas that swung around and settled on bottom head, uncinate process
the major portion of pancreatic duct develps from the upper larger DORSAL (longer!) pancreas
main pancreatic duct normally opens into major duodenal papillae
how far away is the major duodenal papillae from pylorduodenal junction? 5"
what does an accessory pancreatic duct open into? Minor duodenal papillae
the umbilicus is a watershed because veins above it carry blood superiorly, veins below it carry blood inferiorly
Created by: hecutler
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