Anat exam 7
Quiz yourself by thinking what should be in
each of the black spaces below before clicking
on it to display the answer.
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| What is the function of the peritoneum | to allow frictionless motion of the viscera
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| How does the peritoneum respond to trauma or infection | forms fibrin (forms a clot)… may lead to fibrous scar tissue
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| What assists in healing of surgical & traumatic wounds | the formation of fibrin
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| 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
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| What innervates the parietal peritoneum | somatic sensory nerves… same segmental distribution as abdominal wall
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| What innervates the visceral peritoneum sensory nerves which follow | sympathetic innervations of the organ
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| Where would you find cell bodies for visceral abdominal pain | dorsal root, ganglia at level of splanchnic nerves
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| Are visceral afferent nerves part of the Autonomic Nervous System | fuck NO
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| What are the 3 major sites of dorsal root ganglia concentration | embryologic origins of the celiac, superior and inferior mesenteric arteries
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| What supplies the foregut | celiac artery and greater splanchic nerve
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| What supplies the mid gut | superior mesenteric artery and less splanchic nerve
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| What supplies the hind gut | inferior mesenteric artery and lumbar splanchic nerve
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| At what level would fore gut visceral pain be referred to | T6-8
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| At what level would mid gut visceral pain be referred to | T9-10
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| At what level would hindgut visceral pain be referred to | T11-L1
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| What are the three mechanisms of pain | distention, ischemia, and mesenteric traction
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| What is peritonitis | thermal, tactile, and chemical irritation
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| What nerve senses somatic pain in the central diaphragm | phrenic nerve
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| What are the abdominal dermatomes | T6 to L1
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| Pain in neck and shoulder could be referred pain from where | the diaphragm known as Kehr’s sign
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| Where does parietal peritoneum lymph drain | above umbilicus to auxiliary and below umbilicus to inguinal
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| What is ascites | the production of excess fluid that exceeds absorption, Greek for bag
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| What can cause excess fluid build up | cirrhosis, chronic renal failure, and nephritic syndrome
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| peritoneum and peritoneal cavity part 2 |
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| What is the mesentery | double layer of peritoneum extending from abdominal wall to peritoneum
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| What is a peritoneal ligament | a double layer of peritoneum that attaches an organ to abdominal wall or another organ
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| What is the omentum | double layered sheet of fatty tissue
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| Where is the omentum attached | anterior greater curvature of the stomach
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| What is the peritoneal fold | raised edge of peritoneum overlying vessels and shit… its really just a damn stupid fold
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| What encloses the lesser sac | the greater omentum and posterior wall of stomach/ lt lobe of liver
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| Who is the greatest sac Isaac fuckin Kinney that’s who! |
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| Where do you find lesser sac recesses | superior and inferior
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| Where is the site of entrance into the lesser sac | foramen of winslow
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| What is the anterior wall of the foramen of Winslow | portal triad
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| What is the posterior wall of the foramen of Winslow | inferior vena cava and right crus
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| What is the superior wall of the foramen of Winslow | caudate lobe of liver
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| What is the inferior wall of the foramen of Winslow | duodenal bulb
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| What can occlude both the hepatic artery and the portal vein | compression of the hepatoduodenal also known as the Pringle maneuver
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| What is the clinical importance of peritoneal spaces | abscesses may form there
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| 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)
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| Where would you find abscesses from a perforation of the appendix and/or Lt colon | Right and left paracolic gutter
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| Many abscesses form in the | the pelvis since it is the most dependant region
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| Where does the fluid collected in the pelvis get absorbed to | toward the diaphragmatic lymphatic
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| 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
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| Esophagus | s
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| What occupies the posterior mediastinum in the chest and is exposed to low pressure | the esophagus
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| At what level would you find the esophageal hiatus | T10
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| At what point does the esophagus experience high pressure | once it enters the abdomen
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| What helps minimize esophageal reflux | the acute angle and a region high resting muscle tone
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| Does the esophagus contain an anatomic sphincter | NO
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| What is the “Z” line | where the squamous mucosa joins the gastric mucosa
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| When would you find the esophagogastric junction in the chest | with a hiatal hernia
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| What provides the parasympathetic innvervation of the esophagus | vagus nerve
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| Sympathetic innvervation of esophagus | celiac plexus
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| Afferent innervations of esophagus | follows upper thoracic sympathetic fibers
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| Intrathoracic esophagus arterial supply? | small esophageal and bronchial arterial branches off thoracic aorta
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| Arterial supply of Esophagogastric junction | branches of left gastric artery and inferior phrenic arteries (from aorta)
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| What is the venous return of thoracic esophagus | via azygous system
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| What is the venous return of gastroesphageal junction | via branches of left gastric (coronary vein)
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| What occurs if portal venous pressure exeeds systemic venous pressure | flow can reverse (THERE ARE NO VALVES!)
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| What drains the lower segment of the esophagus celiac axis | lymph nodes
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| What drains the intrathoracic portion | mediastinal nodes
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| Patients with esophageal malignancies should be wary of metastasis if what is present | enlarged noded
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| Which esophageal pathology can lead to carcinoma | Barrett’s esophagus
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| Stomach |
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| What portion of the stomach is in contact with the diaphragm | the fundus
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| What portion of the stomach is just distal to the “Z” line or esophageal-gastric junction | cardia
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| What portion of the stomach has peristaltic waves | Pyloric antrum
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| What portion of the stomach is the narrowed and enters the duodenum | pylorus
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| The upper short concave border of the stomach is the | lesser curve
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| What is located 2/3 the distance along the lesser curve | angular incisures
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| The longer convex inferior border of the stomach | the Greater curvature
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| Which direction does the rugae run | longitudinally
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| Does the pyloric channel have an anatomical sphincter? | hells yes
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| What regulates the emptying of the stomach | pyloric channel
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| What can lead to severe gastritis or EVEN esophagitis | reflux of duodenal juice
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| Gastric blood supply comes from branches of | celiac trunk
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| The right gastric artery is a brach of | hepatic
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| The Left gastro-omental artery is a branch of | splenic artery
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| The short gastric arteries are a branch of | splenic artery
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| Parasympathetic of stomach | vagal
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| Function of sympathetic innervations | inhibits smooth muscle contraction and constricts arterial supply
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| Sympathetic of stomach is | celiac ganglion and plexus
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| What can induce erosive gastritis | NSAIDS
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| Venous drainage of stomach | portal vein
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| 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
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| An ulceration of the stomach can be caused by | H. pylori
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| Gastric carcinoma can be caused by | chronic irritation
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| Jejunum and Ileum |
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| 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
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| Why is the jejunum and Ileum susceptible to the effects of chemo and radiation | ‘cuz of the high rate of mucosal cell turnover
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| 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)
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| Of the Jejunum and ileum, which one has the most vasa recta | the ileum
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| What is the trend as you move distally in the small intestine | the plicae circulares decrease
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| What is the small intestine tethered by | mesentery
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| What is the trend (regarding length) of the vasa recta of the superior mesenteric artery | longer in the jejunum and shorter in the ileum
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| What is the arterial supply of the small intestine | superior mesenteric a.
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| What is the venous pathway of the jejunum and Ileum | jejunal and ileal veins to superior mesenteric to portal
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| What causes “nutcracker syndrome” | the compression of the left renal vein and 3rd portion of the duodenum by superior mesenteric artery
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| 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)
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| Parasympathetic innervation of the jejunum and Ileum | branches of vagus nerve
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| What simulates motility of the bowel | parasympathetic system
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| Sympathetic innervations of jejunum and ileum | aortic-renal and superior mesenteric ganglia
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| Where are most of the sympathetic preganglionic fibers from | lesser splanchnic nerve T9-T11
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| Afferent innervation of the jejunum and ileum | follows the sympathetic nerves
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| What happens if the omphalomesenteric duct fails to obliterate | ileal diverticulum
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| 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)
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| colon |
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| What are tenia coli | longitudinal thickened bands of smooth muscle fibers
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| What are Haustral folds | sacculations of wall of colon interrupted by tenia
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| What makes haustral folds different from concentric plicae ciculares of small intestine | they are interrupted by tenia
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| What are the fatty appendages of the colon surface | omental appendices
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| What segments of the colon are intraperitoneal | cecum, transverse colon, sigmoid
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| What segments of the colon are retroperentoneal | ascending, descending, rectum
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| How does the ascending and descending colon become retroperitoneal | during embryological development they fuse to the retroperitoneum
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| What appearance does the transverse colon take | triangular
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| How can you determine if an endoscope is in the transverse colon | if the colon has a triangular appearance
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| What is the flap-like opening between the ileum and the cecum | ileocecal valve
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| Does the ileocecal valve work in everyone | el NO only 70% of people
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| What is the function of the ileocecal valve | prevents colonic content from regurgitating back into small intestine
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| Why is the ileocecal valve importante | because you don’t want bacteria from the colon entering the small intestine
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| What is the arterial supply of the proximal 2/3 of the colon | superior mesenteric via the ileocolic, right and middle colic arteries
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| What is the arterial supply of the distal 1/3 of the colon | inferior mesenteric via the left colic, sigmoidal and superior rectal arteries
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| What is the venous return of the colon | via the portal vein except the distal rectum (rectal venous plexus)
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| Parasympathetic innervation of the colon to left colon flexure | vagus
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| Parasympathetic innervations of descending, sigmoid, and rectum | pelvic splanchic nerves from sacral plexus
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| What does the parasympathetic innervations stimulate | peristalsis
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| Sympathetic innervations of colon to left colon flexure | superior mesenteric ganglion
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| Sympathetic innervations of distal colon | Inferior mesenteric ganglion
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| How would you name the colonic lymph nodes | according to adjacent major blood vessels
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| What is the commonly know diverticuli | pseudo diverticuli
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| Where do diverticuli occur | at sites of entry of mucosal arteries as they pass through the muscularis
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| What may occur if an individual generates high colonic intraluminal pressure | colonic diverticuli
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| What is the most common gastrointestinal malignancy in US | colon carcinoma
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| What is the danger of colonic polyps | they can be pre-malignant
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| appendix |
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| Where does the appendix arise | at the convergence of the three tenia of the cecum
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| When are the two peaks of incidence of appendicitis | childhood to early 30’s then 70-80 yo
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| What percent of the US population gets operated on for appendicitis | 8%
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| What causes appendicitis | inflammation from fecalith or lymphoid hyperplasia obstructing the lumen
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| What are the most common malignancies of the appendix | carcinoid, lymphoma, or adenocarcinoma
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| What can appendiceal neoplasias present as | acute appendicitis
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| kidneys |
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| What muscle do the kidneys rest on | psoas
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| What rests at the superior pole of the kidney | the adrenal glad
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| What contains most abscesses and hematomas of the kidneys | a dense fat surrounded by renal fascia
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| What is the arterial supply of the ureters | renal, lumbar, iliac, vesical arteries
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| Where does shit enter and exit the kidneys | renal hilum
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| Where is the renal collecting system situated | posterior aspect of the hilum
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| The cortex of the kidney is predominately what | glomeruli
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| What is the medulla composed of | collecting duct
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| 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
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| Sympathetic innervations? | preganglionic carried by lesser and least splanchnic to celiac & aorticorenal ganglion
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| Afferent innvervation? | lesser and least splanchnic & pain lateralizes to the side of pathology T9 to L2
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| What are common complications of nephrilithiasis | obstruction of the renal collecting system & ureter
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| What are the 3 typical sites of renal & ureteral colics | ureteropelvic junction, vesicle-ureteral junction, and urethral-vesicle junction
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| What is the name of an upper UTI | pyelonphritis (fever and CVA pain + tenderness)
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| Hematuria or renal mass may be signs of | renal carcinoma
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| What methods may be used to detect a renal cyst | CT or ultrasound
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| What is urolithiasis | points of obstruction (kidney stones)
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| Suprarenal Glands (adrenal glands) |
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| What do adrenal glands | steroid hormones
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| What does the deeper medulla secrete | neurotransmitters into blood, catecholamines (norepinephrine and epinephrine)
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| What may cause a hypersecretion of steroid hormones | cortical adenoma
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| What is a tumor of the suprarenal medulla | pheochromocytoma
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| What may pheochromocytoma cause | over secretion of epinephrine/norepinephrine causing hypertension and tachycardia
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| What are small periaortic rests of neural crest tissue | paraganglioma
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| diaphragm |
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| What is the diaphragm penetrated by | inferior vena cava, aorta, esophagus, internal thoracic arteries, and phrenic nerves for diaphragm innervations
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| What innervates the central portion of the diaphragm | C3,4, & 5 nerve roots (both sensory and motor)
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| What innervates the costal margins | intercostals nervers
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| What innervates the abdominal side of diaphragm | phrenic nerve
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| What nerves are essential for normal respiratory function | C3-5
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| What is the blood supply of the diaphragm | phrenic artery – branches of aorta/left gastric A.
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| Where does the diaphragm insert | costal margins
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| How is the diaphragm attached to the spine | dense arcuate ligaments
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| What curvature does the diaphragm have at rest | convex
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| What injury may impair respiration | a cervical spine injury at or above C5
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| What is the esophageal hiatus | is a muscular opening
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| What may cause the intraabdominal pressure to exceed normal | pregnancy, COPD, obesity, & ascites
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| What is a Hiatus hernia | displacement of the hiatus into the chest
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| What can a Hiatus hernia cause | eliminates much of the valve function of EGJ causing increase risk of GERD
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| What is the most common form of hiatal hernia | sliding
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| What is a sliding hiatal hernia | an acquired protrusion of stomach above diaphragm through a weakened esophageal hiatus
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| If majority of the stomach is in the chest what may occur | a volvulus
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| Do hiatal hernias require surgery | yes because of possible obstruction and gangrene
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| What may impair absorbtion of lymph drainage of diaphragm | positive intra thoracic pressure as it compresses the lymph vessels
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| Posterior abdominal wall |
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| What innervates the psoas muscle | L1-L3 off of lumbar plexus
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| Where does the psoas muscle originate | T12- L5 vertebrae
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| What ligament does the psoas muscle pass beneath | inguinal ligament
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| Where does the psoas muscle insert | the femur
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| What is the major action of the psoas muscle | thigh flexion
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| What innervates the quadrates lumborum | brances of T12, L1-L4
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| What is the action of the quadrates lumborum | lateral flexion of torso
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| What are the psoas and the quadrates lumborum both fused to | the posterior-inferior aspect of the diaphragm
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| What are you segments of the abdominal aorta | SIR GLIC – superior mesenteric, inferior mesenteric, renal & suprarenal, gonadal, lumbar, iliacs, celiac
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| What is the largest branch of the celiac trunk | splenic artery (important not to cut, will bleed out)
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| What is the most common cause of chronic arterial occlusion | atherosclerosis
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| What can happen when patients with atherosclerosis exert themselves | the flow through the collaterals may not be enough and may hemorrhage
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| What can cause occlusion of the IVC | thrombosis or tumor compression on the IVC
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| Which vessels assist blood return to the Rt. Atrium | Collaterals esp. lumbar vein
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| Where does the lymphatic drainage converge from | the lower body cysterna chili then to thoracic duct
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| Lumbar plexus |
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| What root of the lumbar plexus does the subcostal nv arise from | ONLY T12
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| What root of the lumbar plexus does the genitofemoral nv arise from | L1 & L2
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| What root of the lumbar plexus does the lateral femoral cutaneous nv arise from | L2 & L3
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| What root of the lumbar plexus do the ilioinguinal & iliohypogastric nvs arise from | L1
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| What root of the lumbar plexus does the femoral nv arise from | L2-L4
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| What root of the lumbar plexus does the obturator nv arise from | L2-L4
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| What root of the lumbar plexus does the lumbosacral trunk arise from | L4-L5
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| What are the nerves of the lumbar plexus | Subcostal, Ilioinguinal & iliohypogastric, gentiofemoral, lateral femoral, femoral, oburator, and lumbosacral trunk
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| What does the lumborsacral trunk pass over | ala (wing) of sacrum
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