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Anatomy Abdomen

Abdomen

QuestionAnswer
1. What is the main blood supply to the internal organs? Abdominal Aorta
2. What separates the pelvis from the perineum? Pelvic Diaphragm
3. What separates the abdominal cavity from the thoracic cavity? thoracic diaphragm
4. What separates the abdominal cavity from the pelvic cavity? no physical separation between the 2 cavities
5. Where is the transpyloric plane? crosses tips of the 9th costal cartilages anteriorly and the lower 1st lumber vertebra posteriorly
6. What organs are found at the level of the transpyloric plane? 1. pylorus of stomach 2. superior part of the duodenum 3. duedenojejunal flexture 4. Fundus of the gall bladder
7. What innervates all of the superficial abdominal muscles? 6 lower intercostals nerves and L1
8. What is the linea alba? Joining of the aponeurosis of the right and left external abdominal oblique muscles
9. What is the lowest portion of the aponeurosis called? inguinal ligament (false ligament)
10. What is the Superficial inguinal ring? is an opening in the external oblique abdominal aponeurosis. It lies medially above the inguinal ligament. It has a medial and a lateral crus and intercrural fibers.
11. What is the cremaster muscle a continuation of? Continuation of internal abdominal oblique muscle into the spermatic cord
12. What innervates the cremaster muscle? Genital branch of genitofemoral n.
13. What are the afferent innervations of the cremasteric reflex? Afferent- Femoral branch of the genitorfemoral nerve and/or ilioinguinal N.
14. What are the efferent innervations of the cremasteric reflex? Efferent- genital branch of the genitofemoral N.
15. What is a prolapse of the uterus? round ligament of uterus stretches out & uterus drops (after multiple pregnancies)
16. What does the extension of the internal abdominal oblique muscle look like in females? Thin fibers reach the round ligament of the uterus
17. What happens to the rectus sheath below the umbilicus (beneath the arcuate line)? All aponeurosis are anterior to the rectus abdominis (only posterior are transverse fascia and peritononeum)
18. What is the origin of the epigastric vessels? Internal thoracic artery (internal mammory artery)
19. What are the contents of the rectus sheath? 1. Rectus abdominis muscle 2. Inf/Sup epigastric vessels 3. 5 lower intercostals N. (including Subcostal N.)
20. Whats not contained in the rectus sheath? 1. Illiohypogastric N. 2. Illioinguinal N.)
21. What are the medial umbilical folds remnants of? Umbilical arteries- brought deoxygenated blood from fetus to mother
22. What becomes the round/teres ligament of the liver? Umbilical vein- brought oxygenated blood from placenta to fetus
23. What is the median umbilical fold (also called the median umbilical ligament or the urachal cord) a remnant of? Urachus- embryonic urinary tract
24. What two muscle aponeurosis join to make the conjoint tendon? transverse abdominis & internal abdominal oblique muscle
25. Describe an incisional hernia 1. Because linea alba is avascular, is often cut in surgery and doesn’t heal well. 2. After surgery, hernia can occur along scar because of weakening to area 3. Can occur at sight of any incision
26. When does an umbilical hernia usually occur? during pregnancy (sometimes congenital)
27. What is the difference between an inguinal hernia and a femoral hernia? Inguinal is above inguinal lig. While femoral is below inguinal lig
28. Where is the deep inguinal ring located? Fascia transversalis
29. Where is the superficial inguinal ring located? Aponeurosis of external abdominal oblique muscles
30. What are the contents of the inguinal canal in female ? Female- round ligament of uterus, lymphatics
31. What are the contents of the inguinal canal in Male? Male- spermatic cord (contains vas deferens, testicular vein and artery, illioinguinal N. genitofemoral N. lymphatics, cremaster N.
32. Where do the left and right testicular veins drain? 1. Left- left renal vein 2. Right- Inf. Vena Cava
33. When do the testis begin and end moving out of the abdominal cavity? Begins at 7 weeks (of fetus life) and ends by 7th month
34. What is cryptorchidism? Testes fails to descend (typically results in infertility)
35. What are the 1-3 characteristics of a direct inguinal hernia? 1. Medial to epigastric vessels 2. Parallels spermatic cord 3. Low risk of strangulation
36. What are the 4-6 characteristics of a direct inguinal hernia? 4. Almost always acquired 5. Typically middle aged man 6. Smaller in size
37. What are the 1-3 characteristics of an indirect inguinal hernia? 1. Lateral to epigastric vessel 2. Passes through deep inguinal ring 3. Pushes into spermatic cord
38. What are the 4-7 characteristics of an indirect inguinal hernia? 4. High risk of strangulation 5. Can be congenital 6. In younger people 7. Bigger in size
39. What is Guillian-Barre syndrome? 1. Acute polyneuropathy 2. Can be caused by infection 3. Segmental demyelination occurs 4. Can be fatal if respiratory paralysis occurs
40. What are the symptoms of Guillian-Barre syndrome? Symptoms: muscle weakness & numbness from arms/legs to rest of body
41. What are the roots of the greater splanchnic nerve? T5-T9 (referred pain in epigastric region)
42. What are the roots of the lesser splanchnic nerve? T10-T11 (referred pain in umbilical region)
43. What are the roots of the least splanchnic nerve? T12-L2
44. What organs/vessels are intraperitoneal 1-8 (enveloped by the peritoneum, generally mobile)? 1. Stomach 2. 1st part of duodenum 3. Jejunum 4. Ileum 5. Cecum 6. Appendix 7. transverse colon 8. Sigmoid colon
45. What organs/vessels are intraperitoneal 9-15? 9. Rectum 10. Liver 11. Spleen 12. Tail of pancreas 13. Uterus 14. Fallopian tubes 15. ovaries
46. What organs/vessels are retroperitoneal 1-6 (behind the peritoneum, relatively fixed in their location) 1. 2nd part of duodenum 2. Ascending colon 3. Descending colon 4. Rectum (middle 1/3) 5. Pancreas (rest of it) 6. Kidney
47. What organs/vessels are retroperitoneal 7-12? 7. Adrenal gland 8. Proximal ureters 9. Renal vessels 10. Gonadal blood vessels 11. IVC 12. Aorta
48. What organs/vessels are infraperitoneal (below the peritoneum) 1. Rectum (lower 1/3) 2. Urinary bladder 3. Distal ureters
49. What type of membrane is the peritoneum? Serous
50. What is peritonitis? inflammation (accompanied by pain) of peritoneum followed by abdominal injury. Ex. Stab
51. What are ascites? 1. Peritoneum exudes fluid 2. Can be caused by liver cirrhosis or congestive heart failure 3. Treatment is paracentesis
52. What is paracentesis? Puncturing the peritoneal cavity for aspiration of the fluid
53. What is the mesentery? double layer of the peritoneum containing nerves/fat- connects to intestine to posterior abdominal wall
54. Where is the lesser sac (omental bursa)? Lies behind the stomach: has an superior and inferior recess
55. What is the opening to the lesser sac called? Epiploic foramen (beneath the portal triad). Also called Foramen of Winslow
56. What is significant about the epiploic foramen? 1. Is the site of internal herniation 2. Surgery is performed here 3. Artery to gall bladder (Cystic A.) can be reached through here
57. What is the purpose of the greater omentum? 1. Prevents the visceral peritoneum from adhering to parietal peritoneum 2. Can move to infected area
58. What is the purpose of the greater omentum cont.? 3. Protects against infection & inflammatory conditions 4. Called the abdomen policemen 5. Protects against injury 6. insulates
59. When does fluid accumulate in the rectouterine pouch? Pelvic inflammatory disease (PID) or ovulation
60. What does excess fluid in the right hepatorenal pouch of Morrison cause? e.g. after surgery, If patient is laying down, the excess fluid can stimulate the diaphragm causing coughing
61. List the parts of the foregut: Foregut: 1. Esophagus 2. Stomach to 2nd part of duodenum 3. Liver 4. Biliary system 5. Gall bladder 6. Pancreas
62. List the parts of the midgut: 1. Lower half of 2nd part of duodenum 2. Jejunum 3. Ileum 4. Cecum 5. Ascending colon 6. Right 2/3 of the transverse colon
63. List the parts of the hindgut: 1. Left 1/3 of transverse colon 2. Descending colon 3. Sigmoid colon 4. Rectum 5. Upper part of anal canal
64. List the blood supply of the foregut, midgut, and hindgut: Foregut: Celiac Truck Midgut: Superior Mesenteric A Hindgut; Inferior mesenteric A
65. What is the parasympathetic innervations of the gut? 1. Esophagus up to 2/3 right of transverse colon Vagus N. 2. 1/3 left of transverse colon to anal canal- Splanchnic N( S2-S4)
66. What is the sympathetic innervations of the lower esophagus to the anus? Spinal segments of T5-T12
67. Where does the esophagus begin and end? 1. Begins C6 ends T10-T12 2. Lies on vertebral column 3. 25-30cm long
68. What is clinically important about the distal part of the esophagus? 1. May act as sphincter 2. 40cm from incisor teeth 3. Accompanied by 2 vagus n.
69. What are the 3 narrowing’s of the esophagus? 1. Upper sphincter 2. Aortic narrowing 3. Diaphragmatic narrowing
70. What is the innervation of the esophagus? Sympathetic & parasympathetic Vagus N
71. What is the blood supply of esophagus? 1. Upper- Inf. Thyroid A. 2. Middle- Thoracic Aorta & bronchial A. 3. Lower- left gastric A and Inf Phrenic A.
72. What is the venous drainage of the esophagus? 1. Inf Thyroid vein 2. Azygos vein 3. Hemiazygos vein 4. Gastric vein
73. Where do the gastric veins drain into? Into Portal vein (portal-caval anastomosis)
74. What type of cells line the esophagus? 1. Stratisfied non-keratinized squamous epithelium 2. In cardia it is simple columnar epithelium
75. What is esophageal varices? Enlargement of sub mucosal veins due to portal hypertension (liver cirrhosis)
76. What are the layers of the esophagus? 1. Mucosa (epithelium) 2. Muscularis mucosa 3. Submucosa 4. Tunia muscularis 5. Adventitia fascia
77. What is esophageal atresia? Distal end of the esophagus is closed, blocking digestive tract
78. What is a tracheoesophageal fistula? 1. Hole between esophagus & trachea 2. Liquid gets into respiratory tract causing problems
79. Where and in whom is esophageal cancer most common? 1. Where: transition between epithelia 2. Low in north America but high in Iran/China (spice/ hot tea/opium)
80. Diverticulum of esophagus: 1. True(all 3 layters protrude) 2. False (only muscle protrudes)
81. What is Zenker’s diverticulum? 1. Outpouching of posterior pharyngeal wall above esophagus 2. Mainly in older adults 3. If symptomatic 4. Treatment: surgery or endoscopic stapling
82. What are the symptoms of Zenker’s diverticulum if symptomatic? 1. Dysphagia 2. Food regurgitation 3. Coughing 4. Halitosis 5. Ulceration 6. Bleeding 7. Inflammation
83. What is achalasia? 1. Disorder of lower esophageal sphincter 2. It fails to relax during swallowing 3. Absence/decrease of neurons in myenteric plexus 4. Can be caused by chagas disease
84. What are symptoms of achalasia? 1. Restrosternal pain 2. Dysphagia for solids & liquids 3. Dilated proximal esophagus 4. Aperistalsis 5. Bird beak sign in barium swallow 6. Increased LES pressure
85. What is Barrett’s esophagus? 1. Lining of esophagus damaged by stomach acid 2. Squamous epithelium is replaced by columnar epithelium
86. What is gastric mucusa and its significance? 1. Numerous gastric folds and pits 2. Gastric glands 3. Mucosa and pits covered by columnar epithelium 4. Epithelial cells produce mucus protects epithelium against auto digestion
87. What 3 types of cells are found in the gastric glands (found in body and fundus) and what do they secrete? 1. Mucoid cells- mucous 2. Chief cells- pepsinogen 3. Parietal cells- HCL & intrinsic factor
88. What do G cells secrete? Gastrin- which stimulates acid secretion & growth of parietal cells
89. What is Zollinger-Ellison syndrome? gastrin secretion by non-beta cells of the pancreas
90. What is pepsinogen? protein splitting enzyme activated by HCL of stomach into pepsin to break food
91. What stimulates the secretion of gastric juices? 1. Nervous secretion (Vagus N.): taste, smell, sight 2. Gastric/digestive phase secretion: food ingestion
92. Where are the oblique fibers of the muscle layer of the stomach NOT located? not in pyloric & lesser curvature
93. What is the blood supply of the stomach? 1. Left gastric A. (from celiac A.) 2. Right gastric A. (from common hepatic A.) 3. Short gastric A. (from splenic A.) 4. Left gastroepiploic A. (from splenic A.) 5. Right gastroepiploic A. (from gastroduodenal A.)
94. What is the venous drainage of the stomach? 1. Portal Vein 2. Splenic vein 3. Right gastroepiploic vien
95. Where does the lymph from the stomach and the lower part of the esophagus drain into? Gastric and celiac lymph nodes
96. What is the parasympathetic innervations of the stomach? Anterior/ posterior vagus trunks – stimulates glandular secretion & peristalsis
97. What is the sympathetic innervations of the stomach? Sympathetic postganglionic fibers from synapse of splanchnic N. in celiac ganglion – inhibits peristalsis & gastric secretion, cause pyloric secretion, convey pain
98. What is a vagotomy and what is it used for? 1. Cutting Vagus N. 2. To treat gastric ulcers not responding to drug therapy 3. Can cause dumping syndrome: feeling of fullness
99. What are the two types of hiatal hernias and symptoms? Sliding Hiatus: (1. Abdominal part of esophagus, cardia, & part of fundus slide up through esophageal hiatus 2. Symptoms: regurgitation & heartburn)
100. What are the two types of hiatal hernias and symptoms? Paraesophageal hiatus: (1. Cardia doesn’t move 2. Part of fundus & peritoneum pass through the esophageal hiatus 3. Usually no regurgitation)
101. What is the surgery called to correct gastroesophageal reflux? fundoplication
102. What is gastritis? 1. Inflammation of gastric mucosa 2. Erosive/non-erosive 3. Acute/chronic
103. What is hypertrophic gastritis? 1. Giant regal folds stimulating cancer 2. Atrophic mucosa 3. Associated protein loss 4. Also called menetriers disease
104. What are gastric ulcers? 1. From defective mucosa barriers 2. Most common of lesser curvature 3. Pain increased by eating (acid secretion)
105. What are surgical treatments for gastric ulcers? Hemigastrectomy: 1. Billroth A 2. Billroth B 3. Vagotomy 4. antrectomy
106. What is hypertrophic pyloric stenosis? 1. Narrowing pyloric lumen 2. Can obstruct food passage 3. Can cause vomiting after feeding
107. What causes hypertrophic pyloric stenosis and what is the treatment? 1. Due to progressive hypertrophy of circular muscles in pyloric sphincter 2. Treatment: longitudinal pyloromyotomy
108. What are the three parts of the small intestine? 1. Duodenum 2. Jejunum 3. Ileum
109. What is the function of the small intestine? Digestion and absorption of food
110. Where is the bile added to the digestion mix? In the duodenum
111. What is the 1st part of the duodenum and its important clinical points? 1st part (superior) 1. Anterior to portal vein & common bile duct 2. Most common place for ulcer (duodenal cap) 3. Has some mobility
112. What is the 2nd part of the duodenum and its important clinical points? 2nd part (descending) 1. Opening for common bile duct 2. Major duodenal papilla (main pancreatic duct) 3. Minor duodenal papilla
113. What is the 3rd part of the duodenum and its important clinical points? 3rd part- horizontal
114. What is the 4th part of the duodenum and its important clinical points? 4th part (ascending) has some mobility
115. What is the function of the duodenum? Regulate stomach and gallbladder emptying in response to acid chyme
116. What three things the duodenum secrete? Secretin: 1. inhibits gastric acid secretion (due to high acid) 2. Cholecystokinin: induces gall bladder contraction (due to fatty chime) 3. Enterogastrone: inhibits stomach peristalsis
117. What is cast syndrome? 1. Typically in young skinny women 2. Suppression of sup. Mesenteric A. & duodenum because little or no fat present
118. What are the symptoms/characteristics of duodenal ulcers? 1. Location: typically close to pylorus on anterior wall 2. More frequent than gastric ulcers 3. Pain weakness at night 4. Pain is relieved by eating (opp of gastric ulcers)
119. What is duodenal atresia? 1. Discontinuity of the lumen owing to failed recanalization 2. Associated with polyhydramniosis, bile containing vomitus, and distended stomach
120. What is the purpose of the villi and microvilli in the intestine? increase surface area & absorption capacity
121. What does the Brunner’s gland secrete and where is it located? 1. Located in duodenum 2. Produces alkaline solution to protect mucosa from acidic chime & bring it to the optimal PH for pancreatic enzymes
122. Where are iron/folate and B12 absorbed primarily? 1. Iron: duodenum 2. Folate: jejunum 3. B12: Ileum
123. List the characteristics of the jejunum: Jejunum: 1. Left upper quadrant 2. More vascular 3. Red color 4. Thick wall 5. Long vasa recta 6. Less arcades 7. Window in mesentery 8. No/few peyers patches 9. Many circular folds
124. List the characteristics of the ileum: Ileum: 1. Right lower quadrant 2. Less vascular 3. Pale pink 4. Thin wall 5. Short vasa recta 6. More acrades 7. More fat 8. No window in mesentery 9. Many peyers patches 10. Few/low circular folds
125. What is the Sympathetic innervations of the small intestine? Sympathetic splanchnic N.: 1. Inhibition of peristalsis 2. Contraction of ileocecal sphincter 3. Vasoconstriction of vessels
126. What is the parasympathetic innervations of the small intestine? Parasympathetic Vagus N.: 1. Stimulates peristalsis 2. Stimulates glandular secretion
127. What is Meckels diverticulum? 1. Located 50-75cm of ileocecal valve. 2. Congenital anomaly from persistence of vitelline duct 3. May be free or attached by chord to umbilicus
128. What are the symptoms of Meckels diverticulum? 1. Mimic pain of appendicitis 2. About half cause ulceration 3. Inflammation/GI bleeding due to presence of ectopic acid
129. What is the rule of 2’s for meckels diverticulum? 1. occurs about 2% of children 2. 2 feet from ileocecal valve 3. 2 types of ectopic mucosa (gastric and pancreatic) 4. Usually occurs in 2 years olds
130. Which part of the large intestine has mesentery? sigmoid and transverse colon
131. Where does pain from appendicitis radiate? appendix in mid gut around the umbilicus
132. What is the blood supply of colon? 1. Ileococlic A 2. Cecal A. 3. Appendicular 4. Right and middl colic A.
133. Where is the marginal A. of Drummond? 1. Formed by anastomosis of superior and inferior mesenteric A. 2. Lies in mesentery close to colon 3. Important anastomosis if one of A. is blocked
134. What is the significance of the Puborectalis muscle? 1. Continued fecal continence 2. Also called rectal sling 3. Contracts during peristaltic contraction if defection is not to occur
135. What are absent from the rectum? Haustra and teniae
136. What are the names of the pouches in male and female? 1. Male- rectovesical pouch 2. Female Rectourine pouch
137. Which of the anal sphincters is voluntary? external
138. What is the innervations of the anal canal below the pectinate line? pudendal N. (sensitive to pain)
139. Describe Internal hemorrhoids? 1. Prolapses of rectal mucosa containing superior rectal veins 2. Occur above pectinate line. 3. Painless bleeding 4. Autonomic nerve supply
140. Which type of hemorrhoids are painful? External (which are below the pectinate line)
141. Why are suppositories given? drugs are more effective because they bypass portal system (can go sublingually)
142. What is Hirschsprung’s disease? 1. Defieciency of ganglion cells 2. Associated with down syndrome and chagas disease
143. What are symptoms of Hirschsprung’s disease? 1. 90% restricted to rectum 2. Bowel is dilated proximal to defect 3. Inability of peristalsis to push stool 4. Fecal rentention 5. Rectal biopsy
144. What is ulcerative colitis and symptoms? 1. Chroni relapsing ulceroinflammatory disesase 2. Young adult with fever 3. Left side abdominal pain 4. Bloody diarrhea 5. Rectal bleeding
145. What is crohn’s disease and it’s symptoms? 1. chronic granulomatous inflammatory bowel disease 2. Crampy pain in R lower quad 3. Fever, diarrhea, rectal bleeding
146. What is diverticulosis and diverticulitis? 1. In colon 2. Older people (55+)
147. Prolapse of rectum: may occur through anus due to trauma (child birth) and age
148. Describe the exocrine secretions of the pancreas: 1. Acinar cells do the secreting 2. Enzymes and bicarbonate 3. Stimulated by secretin (bicarbonate) & cholecystokinin (enzymes)
149. Describe the exocrine secretions of the pancreas cont: 4. Enzymes secreted are zymogens: activated by enterokinase in small intestine 5. Secreted through main and accessory pancreatic duct
150. Describe the endocrine secretions of the pancreas 1. Alpha cells: glucagon- increases blood sugar and decreases cell sugar 2. Beta cells: insulin- Decreases blood sugar and increases cell sugar 3. Delta cells: somatostatin- regulates growth, alt inhibitor
151. What is the blood supply to the pancreas? 1. Sup/Inf pancreaticoduodenal A. 2. Arteries from splenic A.
152. Pancreatitis: 1. Inflammatory disease of pancreas 2. Alchohol, biliary tract disease, infection 3. Severe abdominal pain radiating to back
153. Accelerated development of pancreas islets in fetus of diabetic mother- overweight at birth
154. What is Zollinger-Ellison syndrome? 1. Gastrin secreting tumor in pancreas 2. Leads to increased acid secretion 3. Can lead to peptic ulcer disease
155. What is the function of the liver? 1. Produce bile (which emulsifies fat in intestines) 2. Involved in carb/protein metabolism 3. Storage of glycogen & other substances 4. Vitamin/protein production 5. Drug detoxification (like alcohol)
156. What is the ligamentum venosum? remnant of ductus venosos (shunted blood from umbilical vein to IVC in order to bypass portal vein)
157. Why are stab wounds at the 5th intercostal space dangerous? level of liver which is easily ruptured (can bleed to death
158. Is the liver capable of regeneration? Yes (whole piece can regenerate)
159. What can cause inflammation of the liver (hepatitis)? 1. Hepatocellular necrosis 2. Hepatitis A-E 3. Alcohol and drugs
160. What is the function of gallbladder? Storage of bile
161. In whom is it most common for gallstones to form? 5 F’s: 1. Female, 2. Fertile 3. Forty/fifty 4. Fatty (overweight) 5. Fair (Caucasian)
162. What is the function of the spleen? 1. Clears out old RBC’s 2. Takes part in immunological responses
163. What organ can take over the function of the spleen if it has to be removed? Liver (has macrophages)
164. List the hormones the kidney secrete and their functions: 1. Renin- Increases blood pressure 2. Erythropoietin- encourages RBC formation 3. Kalikrein- causes vascular expansion 4. Prostaglandins- mediators (lots of reg functions)
165. What are the ureters crossed by? 1. Male- vas deferens 2. Female- Uterine A. & vein
166. What are the 3 layers of the cortex of the adrenal glands and what do they produce? 1. Glomerulosa- steroid hormones 2. Fasciculata- sugar- glucocorticoids 3. Reticulate- sex hormones
167. What does the adrenal medulla secrete? Catecholamine hormones-> adrenaline/noradrenaline- stimulated by sympathetic
168. What regulates the adrenal medulla? Sympathetic system
Created by: xchengster