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Anat exam 7

What is the function of the peritoneum to allow frictionless motion of the viscera
How does the peritoneum respond to trauma or infection forms fibrin (forms a clot)… may lead to fibrous scar tissue
What assists in healing of surgical & traumatic wounds the formation of fibrin
How does the peritoneum respond to infection intracellular gaps in the contact with a network of vasculature allows monocytes and neutrophils entry to wall off the infection
What innervates the parietal peritoneum somatic sensory nerves… same segmental distribution as abdominal wall
What innervates the visceral peritoneum sensory nerves which follow sympathetic innervations of the organ
Where would you find cell bodies for visceral abdominal pain dorsal root, ganglia at level of splanchnic nerves
Are visceral afferent nerves part of the Autonomic Nervous System fuck NO
What are the 3 major sites of dorsal root ganglia concentration embryologic origins of the celiac, superior and inferior mesenteric arteries
What supplies the foregut celiac artery and greater splanchic nerve
What supplies the mid gut superior mesenteric artery and less splanchic nerve
What supplies the hind gut inferior mesenteric artery and lumbar splanchic nerve
At what level would fore gut visceral pain be referred to T6-8
At what level would mid gut visceral pain be referred to T9-10
At what level would hindgut visceral pain be referred to T11-L1
What are the three mechanisms of pain distention, ischemia, and mesenteric traction
What is peritonitis thermal, tactile, and chemical irritation
What nerve senses somatic pain in the central diaphragm phrenic nerve
What are the abdominal dermatomes T6 to L1
Pain in neck and shoulder could be referred pain from where the diaphragm known as Kehr’s sign
Where does parietal peritoneum lymph drain above umbilicus to auxiliary and below umbilicus to inguinal
What is ascites the production of excess fluid that exceeds absorption, Greek for bag
What can cause excess fluid build up cirrhosis, chronic renal failure, and nephritic syndrome
peritoneum and peritoneal cavity part 2
What is the mesentery double layer of peritoneum extending from abdominal wall to peritoneum
What is a peritoneal ligament a double layer of peritoneum that attaches an organ to abdominal wall or another organ
What is the omentum double layered sheet of fatty tissue
Where is the omentum attached anterior greater curvature of the stomach
What is the peritoneal fold raised edge of peritoneum overlying vessels and shit… its really just a damn stupid fold
What encloses the lesser sac the greater omentum and posterior wall of stomach/ lt lobe of liver
Who is the greatest sac Isaac fuckin Kinney that’s who!
Where do you find lesser sac recesses superior and inferior
Where is the site of entrance into the lesser sac foramen of winslow
What is the anterior wall of the foramen of Winslow portal triad
What is the posterior wall of the foramen of Winslow inferior vena cava and right crus
What is the superior wall of the foramen of Winslow caudate lobe of liver
What is the inferior wall of the foramen of Winslow duodenal bulb
What can occlude both the hepatic artery and the portal vein compression of the hepatoduodenal also known as the Pringle maneuver
What is the clinical importance of peritoneal spaces abscesses may form there
What can cause abscesses 1. Perforated gall bladder (subphrenic or sub heptic abscess), 2. Spleen removal can lead to accumulated blood becoming infected, 3. Perforation of ulcer or appendix (peritonitis)
Where would you find abscesses from a perforation of the appendix and/or Lt colon Right and left paracolic gutter
Many abscesses form in the the pelvis since it is the most dependant region
Where does the fluid collected in the pelvis get absorbed to toward the diaphragmatic lymphatic
What are your retroperitoneal structures SADPUCKER... suprarenal glands, aorta/IVC, duodenum (except first segment), pancreas (except tail), ureters, colon (ascending and descending), kidneys, esophagus, rectum
Esophagus s
What occupies the posterior mediastinum in the chest and is exposed to low pressure the esophagus
At what level would you find the esophageal hiatus T10
At what point does the esophagus experience high pressure once it enters the abdomen
What helps minimize esophageal reflux the acute angle and a region high resting muscle tone
Does the esophagus contain an anatomic sphincter NO
What is the “Z” line where the squamous mucosa joins the gastric mucosa
When would you find the esophagogastric junction in the chest with a hiatal hernia
What provides the parasympathetic innvervation of the esophagus vagus nerve
Sympathetic innvervation of esophagus celiac plexus
Afferent innervations of esophagus follows upper thoracic sympathetic fibers
Intrathoracic esophagus arterial supply? small esophageal and bronchial arterial branches off thoracic aorta
Arterial supply of Esophagogastric junction branches of left gastric artery and inferior phrenic arteries (from aorta)
What is the venous return of thoracic esophagus via azygous system
What is the venous return of gastroesphageal junction via branches of left gastric (coronary vein)
What occurs if portal venous pressure exeeds systemic venous pressure flow can reverse (THERE ARE NO VALVES!)
What drains the lower segment of the esophagus celiac axis lymph nodes
What drains the intrathoracic portion mediastinal nodes
Patients with esophageal malignancies should be wary of metastasis if what is present enlarged noded
Which esophageal pathology can lead to carcinoma Barrett’s esophagus
What portion of the stomach is in contact with the diaphragm the fundus
What portion of the stomach is just distal to the “Z” line or esophageal-gastric junction cardia
What portion of the stomach has peristaltic waves Pyloric antrum
What portion of the stomach is the narrowed and enters the duodenum pylorus
The upper short concave border of the stomach is the lesser curve
What is located 2/3 the distance along the lesser curve angular incisures
The longer convex inferior border of the stomach the Greater curvature
Which direction does the rugae run longitudinally
Does the pyloric channel have an anatomical sphincter? hells yes
What regulates the emptying of the stomach pyloric channel
What can lead to severe gastritis or EVEN esophagitis reflux of duodenal juice
Gastric blood supply comes from branches of celiac trunk
The right gastric artery is a brach of hepatic
The Left gastro-omental artery is a branch of splenic artery
The short gastric arteries are a branch of splenic artery
Parasympathetic of stomach vagal
Function of sympathetic innervations inhibits smooth muscle contraction and constricts arterial supply
Sympathetic of stomach is celiac ganglion and plexus
What can induce erosive gastritis NSAIDS
Venous drainage of stomach portal vein
What are the main anatomical relations of the stomach right lobe of liver, left kidney and suprarenal gland, left dome of diaphragm, spleen, and body of pancreas
An ulceration of the stomach can be caused by H. pylori
Gastric carcinoma can be caused by chronic irritation
Jejunum and Ileum
What are the most common mechanical problems due to adhesions, metastatic tumor or hernia and Inflammatory Bowel Disease (Crohn’s disease), bleeding, ischemia and perforation
Why is the jejunum and Ileum susceptible to the effects of chemo and radiation ‘cuz of the high rate of mucosal cell turnover
What is the continental divide for the fore gut and mid gut Ligament of Treitz (suspensory ligament of duodenum) (separates upper and lower GI bleeding)
Of the Jejunum and ileum, which one has the most vasa recta the ileum
What is the trend as you move distally in the small intestine the plicae circulares decrease
What is the small intestine tethered by mesentery
What is the trend (regarding length) of the vasa recta of the superior mesenteric artery longer in the jejunum and shorter in the ileum
What is the arterial supply of the small intestine superior mesenteric a.
What is the venous pathway of the jejunum and Ileum jejunal and ileal veins to superior mesenteric to portal
What causes “nutcracker syndrome” the compression of the left renal vein and 3rd portion of the duodenum by superior mesenteric artery
What is the path of the lymphatics of the small bowel follow the arterial supply and merge in cysterna chyli (a dilated sac at the lower end of the thoracic duct that flows from the intestinal trunk and the lumbar lymphatic trunk)
Parasympathetic innervation of the jejunum and Ileum branches of vagus nerve
What simulates motility of the bowel parasympathetic system
Sympathetic innervations of jejunum and ileum aortic-renal and superior mesenteric ganglia
Where are most of the sympathetic preganglionic fibers from lesser splanchnic nerve T9-T11
Afferent innervation of the jejunum and ileum follows the sympathetic nerves
What happens if the omphalomesenteric duct fails to obliterate ileal diverticulum
What are the rules of 2’s for the ileal diverticulum 2% population, symptomatic by age 2, 2 proximal to ileo-cecal valve, 2 inches long, 2 types of ectopic mucosa (HCL secreting and pancreatic tissue)
What are tenia coli longitudinal thickened bands of smooth muscle fibers
What are Haustral folds sacculations of wall of colon interrupted by tenia
What makes haustral folds different from concentric plicae ciculares of small intestine they are interrupted by tenia
What are the fatty appendages of the colon surface omental appendices
What segments of the colon are intraperitoneal cecum, transverse colon, sigmoid
What segments of the colon are retroperentoneal ascending, descending, rectum
How does the ascending and descending colon become retroperitoneal during embryological development they fuse to the retroperitoneum
What appearance does the transverse colon take triangular
How can you determine if an endoscope is in the transverse colon if the colon has a triangular appearance
What is the flap-like opening between the ileum and the cecum ileocecal valve
Does the ileocecal valve work in everyone el NO only 70% of people
What is the function of the ileocecal valve prevents colonic content from regurgitating back into small intestine
Why is the ileocecal valve importante because you don’t want bacteria from the colon entering the small intestine
What is the arterial supply of the proximal 2/3 of the colon superior mesenteric via the ileocolic, right and middle colic arteries
What is the arterial supply of the distal 1/3 of the colon inferior mesenteric via the left colic, sigmoidal and superior rectal arteries
What is the venous return of the colon via the portal vein except the distal rectum (rectal venous plexus)
Parasympathetic innervation of the colon to left colon flexure vagus
Parasympathetic innervations of descending, sigmoid, and rectum pelvic splanchic nerves from sacral plexus
What does the parasympathetic innervations stimulate peristalsis
Sympathetic innervations of colon to left colon flexure superior mesenteric ganglion
Sympathetic innervations of distal colon Inferior mesenteric ganglion
How would you name the colonic lymph nodes according to adjacent major blood vessels
What is the commonly know diverticuli pseudo diverticuli
Where do diverticuli occur at sites of entry of mucosal arteries as they pass through the muscularis
What may occur if an individual generates high colonic intraluminal pressure colonic diverticuli
What is the most common gastrointestinal malignancy in US colon carcinoma
What is the danger of colonic polyps they can be pre-malignant
Where does the appendix arise at the convergence of the three tenia of the cecum
When are the two peaks of incidence of appendicitis childhood to early 30’s then 70-80 yo
What percent of the US population gets operated on for appendicitis 8%
What causes appendicitis inflammation from fecalith or lymphoid hyperplasia obstructing the lumen
What are the most common malignancies of the appendix carcinoid, lymphoma, or adenocarcinoma
What can appendiceal neoplasias present as acute appendicitis
What muscle do the kidneys rest on psoas
What rests at the superior pole of the kidney the adrenal glad
What contains most abscesses and hematomas of the kidneys a dense fat surrounded by renal fascia
What is the arterial supply of the ureters renal, lumbar, iliac, vesical arteries
Where does shit enter and exit the kidneys renal hilum
Where is the renal collecting system situated posterior aspect of the hilum
The cortex of the kidney is predominately what glomeruli
What is the medulla composed of collecting duct
Where does the urine enter the collecting system and what is its flow the papillae at the apex of the renal pyramid then drains into minor calices then to major calices then single renal pelvis and ureter
Sympathetic innervations? preganglionic carried by lesser and least splanchnic to celiac & aorticorenal ganglion
Afferent innvervation? lesser and least splanchnic & pain lateralizes to the side of pathology T9 to L2
What are common complications of nephrilithiasis obstruction of the renal collecting system & ureter
What are the 3 typical sites of renal & ureteral colics ureteropelvic junction, vesicle-ureteral junction, and urethral-vesicle junction
What is the name of an upper UTI pyelonphritis (fever and CVA pain + tenderness)
Hematuria or renal mass may be signs of renal carcinoma
What methods may be used to detect a renal cyst CT or ultrasound
What is urolithiasis points of obstruction (kidney stones)
Suprarenal Glands (adrenal glands)
What do adrenal glands steroid hormones
What does the deeper medulla secrete neurotransmitters into blood, catecholamines (norepinephrine and epinephrine)
What may cause a hypersecretion of steroid hormones cortical adenoma
What is a tumor of the suprarenal medulla pheochromocytoma
What may pheochromocytoma cause over secretion of epinephrine/norepinephrine causing hypertension and tachycardia
What are small periaortic rests of neural crest tissue paraganglioma
What is the diaphragm penetrated by inferior vena cava, aorta, esophagus, internal thoracic arteries, and phrenic nerves for diaphragm innervations
What innervates the central portion of the diaphragm C3,4, & 5 nerve roots (both sensory and motor)
What innervates the costal margins intercostals nervers
What innervates the abdominal side of diaphragm phrenic nerve
What nerves are essential for normal respiratory function C3-5
What is the blood supply of the diaphragm phrenic artery – branches of aorta/left gastric A.
Where does the diaphragm insert costal margins
How is the diaphragm attached to the spine dense arcuate ligaments
What curvature does the diaphragm have at rest convex
What injury may impair respiration a cervical spine injury at or above C5
What is the esophageal hiatus is a muscular opening
What may cause the intraabdominal pressure to exceed normal pregnancy, COPD, obesity, & ascites
What is a Hiatus hernia displacement of the hiatus into the chest
What can a Hiatus hernia cause eliminates much of the valve function of EGJ causing increase risk of GERD
What is the most common form of hiatal hernia sliding
What is a sliding hiatal hernia an acquired protrusion of stomach above diaphragm through a weakened esophageal hiatus
If majority of the stomach is in the chest what may occur a volvulus
Do hiatal hernias require surgery yes because of possible obstruction and gangrene
What may impair absorbtion of lymph drainage of diaphragm positive intra thoracic pressure as it compresses the lymph vessels
Posterior abdominal wall
What innervates the psoas muscle L1-L3 off of lumbar plexus
Where does the psoas muscle originate T12- L5 vertebrae
What ligament does the psoas muscle pass beneath inguinal ligament
Where does the psoas muscle insert the femur
What is the major action of the psoas muscle thigh flexion
What innervates the quadrates lumborum brances of T12, L1-L4
What is the action of the quadrates lumborum lateral flexion of torso
What are the psoas and the quadrates lumborum both fused to the posterior-inferior aspect of the diaphragm
What are you segments of the abdominal aorta SIR GLIC – superior mesenteric, inferior mesenteric, renal & suprarenal, gonadal, lumbar, iliacs, celiac
What is the largest branch of the celiac trunk splenic artery (important not to cut, will bleed out)
What is the most common cause of chronic arterial occlusion atherosclerosis
What can happen when patients with atherosclerosis exert themselves the flow through the collaterals may not be enough and may hemorrhage
What can cause occlusion of the IVC thrombosis or tumor compression on the IVC
Which vessels assist blood return to the Rt. Atrium Collaterals esp. lumbar vein
Where does the lymphatic drainage converge from the lower body cysterna chili then to thoracic duct
Lumbar plexus
What root of the lumbar plexus does the subcostal nv arise from ONLY T12
What root of the lumbar plexus does the genitofemoral nv arise from L1 & L2
What root of the lumbar plexus does the lateral femoral cutaneous nv arise from L2 & L3
What root of the lumbar plexus do the ilioinguinal & iliohypogastric nvs arise from L1
What root of the lumbar plexus does the femoral nv arise from L2-L4
What root of the lumbar plexus does the obturator nv arise from L2-L4
What root of the lumbar plexus does the lumbosacral trunk arise from L4-L5
What are the nerves of the lumbar plexus Subcostal, Ilioinguinal & iliohypogastric, gentiofemoral, lateral femoral, femoral, oburator, and lumbosacral trunk
What does the lumborsacral trunk pass over ala (wing) of sacrum
Created by: ljacob2010