Abdomen
Quiz yourself by thinking what should be in
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| 1. What is the main blood supply to the internal organs? | Abdominal Aorta
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| 2. What separates the pelvis from the perineum? | Pelvic Diaphragm
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| 3. What separates the abdominal cavity from the thoracic cavity? | thoracic diaphragm
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| 4. What separates the abdominal cavity from the pelvic cavity? | no physical separation between the 2 cavities
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| 5. Where is the transpyloric plane? | crosses tips of the 9th costal cartilages anteriorly and the lower 1st lumber vertebra posteriorly
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| 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
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| 7. What innervates all of the superficial abdominal muscles? | 6 lower intercostals nerves and L1
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| 8. What is the linea alba? | Joining of the aponeurosis of the right and left external abdominal oblique muscles
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| 9. What is the lowest portion of the aponeurosis called? | inguinal ligament (false ligament)
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| 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.
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| 11. What is the cremaster muscle a continuation of? | Continuation of internal abdominal oblique muscle into the spermatic cord
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| 12. What innervates the cremaster muscle? | Genital branch of genitofemoral n.
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| 13. What are the afferent innervations of the cremasteric reflex? | Afferent- Femoral branch of the genitorfemoral nerve and/or ilioinguinal N.
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| 14. What are the efferent innervations of the cremasteric reflex? | Efferent- genital branch of the genitofemoral N.
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| 15. What is a prolapse of the uterus? | round ligament of uterus stretches out & uterus drops (after multiple pregnancies)
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| 16. What does the extension of the internal abdominal oblique muscle look like in females? | Thin fibers reach the round ligament of the uterus
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| 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)
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| 18. What is the origin of the epigastric vessels? | Internal thoracic artery (internal mammory artery)
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| 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.)
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| 20. Whats not contained in the rectus sheath? | 1. Illiohypogastric N.
2. Illioinguinal N.)
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| 21. What are the medial umbilical folds remnants of? | Umbilical arteries- brought deoxygenated blood from fetus to mother
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| 22. What becomes the round/teres ligament of the liver? | Umbilical vein- brought oxygenated blood from placenta to fetus
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| 23. What is the median umbilical fold (also called the median umbilical ligament or the urachal cord) a remnant of? | Urachus- embryonic urinary tract
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| 24. What two muscle aponeurosis join to make the conjoint tendon? | transverse abdominis & internal abdominal oblique muscle
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| 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
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| 26. When does an umbilical hernia usually occur? | during pregnancy (sometimes congenital)
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| 27. What is the difference between an inguinal hernia and a femoral hernia? | Inguinal is above inguinal lig. While femoral is below inguinal lig
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| 28. Where is the deep inguinal ring located? | Fascia transversalis
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| 29. Where is the superficial inguinal ring located? | Aponeurosis of external abdominal oblique muscles
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| 30. What are the contents of the inguinal canal in female ? | Female- round ligament of uterus, lymphatics
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| 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.
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| 32. Where do the left and right testicular veins drain? | 1. Left- left renal vein
2. Right- Inf. Vena Cava
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| 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
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| 34. What is cryptorchidism? | Testes fails to descend (typically results in infertility)
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| 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
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| 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
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| 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
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| 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
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| 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
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| 40. What are the symptoms of Guillian-Barre syndrome? | Symptoms: muscle weakness & numbness from arms/legs to rest of body
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| 41. What are the roots of the greater splanchnic nerve? | T5-T9 (referred pain in epigastric region)
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| 42. What are the roots of the lesser splanchnic nerve? | T10-T11 (referred pain in umbilical region)
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| 43. What are the roots of the least splanchnic nerve? | T12-L2
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| 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
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| 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
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| 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
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| 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
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| 48. What organs/vessels are infraperitoneal (below the peritoneum) | 1. Rectum (lower 1/3)
2. Urinary bladder
3. Distal ureters
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| 49. What type of membrane is the peritoneum? | Serous
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| 50. What is peritonitis? | inflammation (accompanied by pain) of peritoneum followed by abdominal injury. Ex. Stab
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| 51. What are ascites? | 1. Peritoneum exudes fluid
2. Can be caused by liver cirrhosis or congestive heart failure
3. Treatment is paracentesis
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| 52. What is paracentesis? | Puncturing the peritoneal cavity for aspiration of the fluid
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| 53. What is the mesentery? | double layer of the peritoneum containing nerves/fat- connects to intestine to posterior abdominal wall
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| 54. Where is the lesser sac (omental bursa)? | Lies behind the stomach: has an superior and inferior recess
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| 55. What is the opening to the lesser sac called? | Epiploic foramen (beneath the portal triad). Also called Foramen of Winslow
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| 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
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| 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
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| 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
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| 59. When does fluid accumulate in the rectouterine pouch? | Pelvic inflammatory disease (PID) or ovulation
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| 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
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| 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
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| 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
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| 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
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| 64. List the blood supply of the foregut, midgut, and hindgut: | Foregut: Celiac Truck
Midgut: Superior Mesenteric A
Hindgut; Inferior mesenteric A
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| 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)
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| 66. What is the sympathetic innervations of the lower esophagus to the anus? | Spinal segments of T5-T12
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| 67. Where does the esophagus begin and end? | 1. Begins C6 ends T10-T12
2. Lies on vertebral column
3. 25-30cm long
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| 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.
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| 69. What are the 3 narrowing’s of the esophagus? | 1. Upper sphincter
2. Aortic narrowing
3. Diaphragmatic narrowing
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| 70. What is the innervation of the esophagus? | Sympathetic & parasympathetic Vagus N
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| 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.
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| 72. What is the venous drainage of the esophagus? | 1. Inf Thyroid vein
2. Azygos vein
3. Hemiazygos vein
4. Gastric vein
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| 73. Where do the gastric veins drain into? | Into Portal vein (portal-caval anastomosis)
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| 74. What type of cells line the esophagus? | 1. Stratisfied non-keratinized squamous epithelium
2. In cardia it is simple columnar epithelium
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| 75. What is esophageal varices? | Enlargement of sub mucosal veins due to portal hypertension (liver cirrhosis)
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| 76. What are the layers of the esophagus? | 1. Mucosa (epithelium)
2. Muscularis mucosa
3. Submucosa
4. Tunia muscularis
5. Adventitia fascia
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| 77. What is esophageal atresia? | Distal end of the esophagus is closed, blocking digestive tract
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| 78. What is a tracheoesophageal fistula? | 1. Hole between esophagus & trachea
2. Liquid gets into respiratory tract causing problems
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| 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)
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| 80. Diverticulum of esophagus: | 1. True(all 3 layters protrude)
2. False (only muscle protrudes)
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| 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
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| 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
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| 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
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| 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
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| 85. What is Barrett’s esophagus? | 1. Lining of esophagus damaged by stomach acid
2. Squamous epithelium is replaced by columnar epithelium
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| 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
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| 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
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| 88. What do G cells secrete? | Gastrin- which stimulates acid secretion & growth of parietal cells
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| 89. What is Zollinger-Ellison syndrome? | gastrin secretion by non-beta cells of the pancreas
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| 90. What is pepsinogen? | protein splitting enzyme activated by HCL of stomach into pepsin to break food
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| 91. What stimulates the secretion of gastric juices? | 1. Nervous secretion (Vagus N.): taste, smell, sight
2. Gastric/digestive phase secretion: food ingestion
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| 92. Where are the oblique fibers of the muscle layer of the stomach NOT located? | not in pyloric & lesser curvature
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| 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.)
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| 94. What is the venous drainage of the stomach? | 1. Portal Vein
2. Splenic vein
3. Right gastroepiploic vien
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| 95. Where does the lymph from the stomach and the lower part of the esophagus drain into? | Gastric and celiac lymph nodes
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| 96. What is the parasympathetic innervations of the stomach? | Anterior/ posterior vagus trunks – stimulates glandular secretion & peristalsis
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| 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
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| 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
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| 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)
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| 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)
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| 101. What is the surgery called to correct gastroesophageal reflux? | fundoplication
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| 102. What is gastritis? | 1. Inflammation of gastric mucosa
2. Erosive/non-erosive
3. Acute/chronic
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| 103. What is hypertrophic gastritis? | 1. Giant regal folds stimulating cancer
2. Atrophic mucosa
3. Associated protein loss
4. Also called menetriers disease
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| 104. What are gastric ulcers? | 1. From defective mucosa barriers
2. Most common of lesser curvature
3. Pain increased by eating (acid secretion)
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| 105. What are surgical treatments for gastric ulcers? | Hemigastrectomy:
1. Billroth A
2. Billroth B
3. Vagotomy
4. antrectomy
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| 106. What is hypertrophic pyloric stenosis? | 1. Narrowing pyloric lumen
2. Can obstruct food passage
3. Can cause vomiting after feeding
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| 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
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| 108. What are the three parts of the small intestine? | 1. Duodenum
2. Jejunum
3. Ileum
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| 109. What is the function of the small intestine? | Digestion and absorption of food
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| 110. Where is the bile added to the digestion mix? | In the duodenum
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| 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
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| 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
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| 113. What is the 3rd part of the duodenum and its important clinical points? | 3rd part- horizontal
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| 114. What is the 4th part of the duodenum and its important clinical points? | 4th part (ascending) has some mobility
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| 115. What is the function of the duodenum? | Regulate stomach and gallbladder emptying in response to acid chyme
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| 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
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| 117. What is cast syndrome? | 1. Typically in young skinny women
2. Suppression of sup. Mesenteric A. & duodenum because little or no fat present
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| 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)
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| 119. What is duodenal atresia? | 1. Discontinuity of the lumen owing to failed recanalization
2. Associated with polyhydramniosis, bile containing vomitus, and distended stomach
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| 120. What is the purpose of the villi and microvilli in the intestine? | increase surface area & absorption capacity
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| 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
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| 122. Where are iron/folate and B12 absorbed primarily? | 1. Iron: duodenum
2. Folate: jejunum
3. B12: Ileum
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| 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
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| 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
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| 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
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| 126. What is the parasympathetic innervations of the small intestine? | Parasympathetic Vagus N.:
1. Stimulates peristalsis
2. Stimulates glandular secretion
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| 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
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| 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
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| 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
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| 130. Which part of the large intestine has mesentery? | sigmoid and transverse colon
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| 131. Where does pain from appendicitis radiate? | appendix in mid gut around the umbilicus
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| 132. What is the blood supply of colon? | 1. Ileococlic A
2. Cecal A.
3. Appendicular
4. Right and middl colic A.
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| 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
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| 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
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| 135. What are absent from the rectum? | Haustra and teniae
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| 136. What are the names of the pouches in male and female? | 1. Male- rectovesical pouch
2. Female Rectourine pouch
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| 137. Which of the anal sphincters is voluntary? | external
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| 138. What is the innervations of the anal canal below the pectinate line? | pudendal N. (sensitive to pain)
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| 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
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| 140. Which type of hemorrhoids are painful? | External (which are below the pectinate line)
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| 141. Why are suppositories given? | drugs are more effective because they bypass portal system (can go sublingually)
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| 142. What is Hirschsprung’s disease? | 1. Defieciency of ganglion cells
2. Associated with down syndrome and chagas disease
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| 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
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| 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
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| 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
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| 146. What is diverticulosis and diverticulitis? | 1. In colon
2. Older people (55+)
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| 147. Prolapse of rectum: | may occur through anus due to trauma (child birth) and age
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| 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)
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| 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
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| 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
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| 151. What is the blood supply to the pancreas? | 1. Sup/Inf pancreaticoduodenal A.
2. Arteries from splenic A.
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| 152. Pancreatitis: | 1. Inflammatory disease of pancreas
2. Alchohol, biliary tract disease, infection
3. Severe abdominal pain radiating to back
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| 153. Accelerated development of pancreas islets | in fetus of diabetic mother- overweight at birth
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| 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
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| 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)
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| 156. What is the ligamentum venosum? | remnant of ductus venosos (shunted blood from umbilical vein to IVC in order to bypass portal vein)
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| 157. Why are stab wounds at the 5th intercostal space dangerous? | level of liver which is easily ruptured (can bleed to death
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| 158. Is the liver capable of regeneration? | Yes (whole piece can regenerate)
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| 159. What can cause inflammation of the liver (hepatitis)? | 1. Hepatocellular necrosis
2. Hepatitis A-E
3. Alcohol and drugs
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| 160. What is the function of gallbladder? | Storage of bile
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| 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)
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| 162. What is the function of the spleen? | 1. Clears out old RBC’s
2. Takes part in immunological responses
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| 163. What organ can take over the function of the spleen if it has to be removed? | Liver (has macrophages)
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| 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)
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| 165. What are the ureters crossed by? | 1. Male- vas deferens
2. Female- Uterine A. & vein
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| 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
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| 167. What does the adrenal medulla secrete? | Catecholamine hormones-> adrenaline/noradrenaline- stimulated by sympathetic
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| 168. What regulates the adrenal medulla? | Sympathetic system
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