3. Anatomy (Abdomen Continuation) Flashcards
(153 cards)
1
Q
layers of abdominal wall
A
skin superficial fascia (camper, scarpa) Deep fascia muscles transversalis fascia extraperitoneal fat parietal perotineum
2
Q
dartos fascia is a derivative of
A
superficial fascia
3
Q
external spermatic fascia is a derivative of
A
external oblique
4
Q
cremaster muscle is a derivative of
A
internal oblique muscle
5
Q
internal spermatic fascia is a derivative of
A
transversalis fascia
6
Q
tunica vaginalis is a derivative of
A
peritoneum
7
Q
potential space between the parietal and visceral layers of the peritoneum
A
peritoneal cavity
8
Q
peritoneal cavity is within this cavities
A
abdominal and pelvic
9
Q
how does peritoneal cavity in males and women differ?
A
completely closed in males
in females- pathway through Uterine tubes , Uterine cavity and vagina
10
Q
Subdivisions of peritoneal cavity
A
Greater sac
Lesser sac / Omental bursa
11
Q
this subdivision of the peritoneal cavity lies posterior to the stomach and lesser omentum
A
lesser sac/ omental bursa
12
Q
two recesses of lesser sac
A
superior recess
and inferior recess
13
Q
is the passage of communication between the general cavity and omental bursa
A
epiploic foramen/ foramen of Winslow
14
Q
boundaries of the foramen of winslow
A
A: hepatoduodenal ligament, portal vein, hepatic artery, bile duct
P: IVC
S: caudate lobe of the liver
I: superior part of the duodenum
15
Q
extensions of the Visceral peritoneum
A
Peritoneal reflections
16
Q
Peritoneal reflections (3)
A
mesentery
ligaments
omentum - greater and lesser
17
Q
Peritoneal reflection that supports hollow viscus to the body wall
provides neurovascular communication
allows mobility of vicera
A
mesentery
18
Q
connects viscera to each other or to the body wall
A
ligaments
19
Q
connects the stomach with other viscera
A
omentum
20
Q
peritoneal reflection composed of 4 layers
A
greater omentum
21
Q
abdominal policement
A
greater omentum
22
Q
omentum found in the greater curvature of the stomach
A
greater omentum
23
Q
greater omentum will cover these organs
A
greater curvature of the stromach and proximal part of the duodenum
24
Q
3 parts of the greater omentum
A
gastrophrenic
gastrosplenic
gastrocolic
25
connects lesser curvature of the stomach, duodenum and proximal part of the duodenum to the liver
lesser omentum
26
2 ligaments of lesser omentum
hepatoduodenal ligament
| hepatoagastric ligament
27
this ligament contains the portal triad
hepatoduodenal ligament
28
portal triad consists of
Posterior: portal vein
Anterior and to the right: common bile duct
Anterior and to the left: hepatic artery
29
inflammation of the parietal peritoneum may exhibit
rebound tenderness
guarding
sharp localized pain
30
accumulation of fluid in the peritoneal cavity due to peritonitis from congestion of venous drainage of the abdomen
ascites
31
sx management ascites
paracentesis
32
sites of paracentesis
2 cm below the umbilicus through the LINEA ALBA
2-4 CM superomedial to ASIS
33
2 recommended areas for abdominal wall entry of paracentesis
* 2 cm below the umbilicus in the midline (through the linea alba)
* 3-5 cm superior and medial to the ASIS on either side
34
Paracentesis
from superficial to deep
midline
```
Midline
•Skin
•Superficial fascia
•deep fascia
•linea alba
•transversalis fascia
•extraperitoneal fat
•parietal peritoneum
```
35
Paracentesis
from superficial to deep layers
lateral to inferior epigastric artery , above the deep circumflex artery
* Skin
* Superficial fascia
* deep fascia
* ext oblique
* internal oblique
* transversalis fascia
* extraperitoneal fat
* parietal peritoneum
36
primitive gut (endoderm) divisible into
foregut - celiac trunk
midgut -sup. mesenteric artery
hindgut - inf. mesenteric artery
37
Abdominal aorta branches
I. Anterior unpaired visceral
a. celiac
b. superior mesenteric
c. inferior mesenteric
II.lateral paired visceral
a. supraprenal
b. renal
c. gonadal
III. lateral paired abdominal
a. inferior phrenic
b. lumbar
IV. terminal
a. common iliac
b. median sacral
38
foregut
| gut tube proper
pharynx
esophagus
stomach
proximal duodenum
39
midgut
| gut tube proper
proximal duodenum to right half of transverse colon
40
hindgut
| gut tube proper
left half of transverse colon to anus
41
derivatives of foregut
```
thyroid
parathyroid
tympanic cavity
trachea
bronchi
lungs
liver
gallbladder
pancreas
```
42
Duodenum
| primitive gut
second part
•proximal - foregut
•distal - midgut
43
Transverse colon
| primitive gut
Upper 2/3 - right side : midgut
| lower 1/3 - left side : hindgut
44
Anal canal
| primitive gut
upper part : hindgut
| lower part - proctoderm : ectoderm
45
celiac artery is at this level
T12
46
superior mesenteric artery
is at this level
L1
47
celiac artery branches
A. left gastric
•gastric branches
•esophageal branches
```
B. Splenic
•left gastroepiploic
•short gastric
•branches to the spleen
•branches to the body and tail of pancreas
```
```
C. Hepatic
•Proper hepatic artery
–left branch of proper hepatic artery
–right gastric artery
–right branch of proper hepatic artery
•Gastroduodenal
–right gastroepiploic
–sup. pancreaticoduodenal
```
48
Superior mesenteric artery branches
* inferior pancreaticoduodenal
* middle colic
* right colic
* ileo-colic
* jejunal-ileal
49
inferior mesenteric artery level
L3
50
inferior mesenteric artery
| branches
left colic
sigmoid
superior rectal
51
aortic aneurysm
| common site
just proximal to the bifurcation of the aorta at the level of L4 vertebra
52
(+) pulsating mass at the midline
aortic aneurysm
53
celiac artery occlusion
pain is referred to
pain referred in the shoulder
54
if celiac artery is occluded
| this may develop
collateral circulation may develop at the head of pancrease
| by way of anastomoses between pancreaticoduodenal branches of SMA and gastroduodenal
55
celiac artery occlusion
| what 3 branches maybe eroded
1. splenic - penetrating ulcer of posterior wall of stomach
2. left gastric - lesser curvature of tomach
3. gastroduodenal - posterior wall of the first part of duodenum
56
inferior vena cava branches
```
A. anterior visceral
–right/ left hepatic
B. Lateral visceral
–right suprarenal
–R/L renal
–R gonadal
```
C. lateral abdominal
–Inferior phrenic
–lumbar
D. veins of origin
–R/L common iliac
–median sacral
57
portal vein is formed by the union of ____ behind the neck of pancreas
superior mesenteric vein
| splenic vein
58
The vessel is formed by the union of the common iliac veins at the L5 vertebral level.
inferior vena cava
59
IVC
It ascends superiorly, and leaves the abdomen by piercing the central tendon of the diaphragm at
T8 level (the caval hiatus)
60
They drain the lower limbs and gluteal region.
common iliac veins
61
drain the posterior abdominal wall.
lumbar veins
62
drain the kidneys, left adrenal gland and left testis/ovary.
renal veins
63
drain the diaphragm.
inferior phrenic veins
64
There are no tributaries from the spleen, pancreas, gallbladder or the abdominal part of the GI tract – as these structures are first drained into the
portal venous system
65
It is the point of convergence for the venous drainage of the spleen, pancreas, gallbladder and the abdominal part of the gastrointestinal tract.
portal vein
66
portal vein is found at level
L2
| posterior to neck of pancreas
67
portal vein receives additional tributaries from
Right and left gastric veins – drain the stomach.
Cystic veins – drains the gallbladder.
Para-umbilical veins – drain the skin of the umbilical region.
68
Tributaries to the splenic vein include:
Short gastric veins – drain the fundus of the stomach.
Left gastro-omental vein – drains the greater curvature of the stomach.
Pancreatic veins – drain the pancreas.
Inferior mesenteric vein – drains the colon.
69
drains blood from the rectum, sigmoid colon, descending colon and splenic flexure. It begins as the superior rectal vein and ascends, receiving tributaries from the sigmoid veins and the left colic veins. As it ascends further it passes posteriorly to the body of the pancreas and typically joins the splenic vein.
inferior mesenteric vein
70
drains blood from the small intestine, cecum, ascending colon and transverse colon.
SMA
71
SMA
begins in the _____
as a convergence of the veins draining the terminal ileum, cecum and appendix. It ascends within the mesentery of the small intestine, and then travels posteriorly to the neck of the pancreas to join the splenic vein.
right iliac fossa
72
tributaries of MSA
Right gastro-omental vein – drains the greater curvature of the stomach.
Anterior and posterior inferior pancreaticoduodenal veins – drain the pancreas and duodenum.
Jejunal vein – drain the jejunum.
Ileal vein – drain the ileum.
Ileocolic vein – drains the ileum, colon and cecum.
Right colic vein – drains the ascending colon.
Middle colic vein – drains the transverse colon.
73
is a connection between the veins of the portal venous system, and the veins of the systemic venous system.
porto-systemic anastomosis
74
major sites of
porto-systemic anastomosis
Oesophageal – Between the oesophageal branch of the left gastric vein and the oesophageal tributaries to the azygous system.
Rectal – Between the superior rectal vein and the inferior rectal veins.
Retroperitoneal – Between the portal tributaries of the mesenteric veins and the retroperitoneal veins.
Paraumbilical – Between the portal veins of the liver and the veins of the anterior abdominal wall.
75
A portal venous pressure in excess of___ is defined as portal hypertension.
20mmHg
76
causes portal hpn
liver cirrhosis
77
porta-caval shunts may involve anastomosis of portal vein to
anterior wall fo IVC
| behind the entrance into the lesser sac
78
s a treatment for portal hypertension. A connection is made between the portal vein, which supplies 75% of the liver's blood, and the inferior vena cava, the vein that drains blood from the lower two-thirds of the body.
portacaval shunt (or portal caval shunt)
79
in porta caval shunts
| what is anastomosed
portal vein- anterior wall of IVC
| splenic vein - left fenal vein (if spleen is removed due to congestive enlargement)
80
R and L hepatic veins drains into
IVC
81
R gonadal and right suprarenal vein
| drains into
IVC
82
L gonadal and L suprarenal
drains into
L renal
83
R gastroepiploic
drains into
SMV
84
L gastroepiploic
drains into
splenic vein
85
R colic
drains into
SMV
86
L colic
drains into
IMV
87
how long is the esophagus
10 inches/ 25 cm long
88
straight muscular tube that extends from the pharynx to stomach
esophagus
89
Esophagus -continuous above with the laryngeal part of the pharynx opposite this level
6th cervical vertebra
90
Esophagus
| passes through the diaphragm at this level
T10
91
importance of esophageal constrictions
* common sites of carcinoma in the esophagus
* strictures develop
* diff to pass an esophagoscope
* sites where swallowed foreign bodies can lodge
92
esophageal constrictions
* Upper/Pharyngoesophageal - cricopharyngeus muscle
* Middle/thoracic - by aortic arch and left main bronchus
* Inferior/Diaphragmatic - esophageal hiatus
93
anatomic division of esophagus
* Cervical - 18 cm from incisors
* Thoracic - 18-23 cm
* Mid thoracic 24-32 cm
* Lower thoracic -32-40 cm
* Abdominal - 32-40 cm
94
esophagus
| from lower end of pharynx (C6; lower border cricoid cartilage) extends to thoracic inlet (suprasternal notch)
cervical
95
esophagus
| from thoracic inlet to tracheal bifurcation
thoracic
96
this nerve accompanies the esophagus through the diaphragm
vagus nerve
97
Arterial supply of the esophagus
Upper 1/3 : inferior thyroid artery (from subclavian artery)
Middle 1/3 : descending thoracic aorta
Lower 1/3 : left gastric artery from celiac trunk of abdominal aorta
98
venous drainage
| of esophagus
Upper 1/3 : inferior thyroid vein
Middle 1/3 : azygous vei
Lower 1/3 : left gastric vein
99
lymph drainage of esophagus
Upper- deep cervical
Middle- mediastinal
Lower- celiac
100
* 56 year old experiences GERD
* sliding hiatal hernia
* what other structure might be compressed by hernia that courses through the same opening in the diaphragm
vagal trunks
101
substernal burning pain that is worse when lying down
incompetent LES
GERD
102
difficulty swallowing liquids and solids
| failure of relaxation of inferior esophageal sphincter
achalasia
103
hernia at the esophageal hiatus
hiatal hernia
104
most common type of hiatal hernia. It occurs when the gastroesophageal junction, along with a portion of the stomach, migrates into the mediastinum through the esophageal hiatus
sliding type hiatal hernia
105
tx for esophageal hemorrhage from esophageal varices
gastric balloon anchors the tube against the esophageal gastric junction; occludes he varices by counter pressure
sengstaken- blakemore balloon insertion
106
ave distance between external orifices of the nose and stomach
17.2 inches
| 44 cm
107
stomach has this capacity
1.5 L
108
4 parts of the stomach
cardia
fundus
body
pylorus
109
dilated superior part of the stomach
fundus
110
pylorus is divisible into
pyloric andtrum
| pyloric canal
111
a sharp indentation that approximates the junction of the body and pyloric part of the stomach
angular incisure / notch
112
cardiac orifice level
6th costal cartilage
| 2-4 cm from the median plane at T10 or T11
113
fundus position
5th, L rib
| midclavicular plane
114
position
| greater curvature
10th left costal cartilage
115
pyrloric antrum level
9th costal cartilage
L1 vertebra
pyloric orifice 1.25 cm left of midine
116
pyloric canal
| position
right side
| L2 to L4
117
* associated with projectile vomiting after feeding
| * small palpable mass at the right costal margin
hypertrophic pyloric stenosis
118
muscularis external in the pyloric region hypertrophies - narrow pyloric lumen that obstructs the passage of food
hypertrophic pyloric stenosis
119
on which the stomach rests when a person is in supine position is formed by structures forming the posterior wall of the omental bursa
stomach bed
120
stomach bed
| superior to inferior
```
left dome of diaphragm
spleen
left kidney
suprarenal gland
splenic artery
pancreas
transverse mesocolon
colon
```
121
The pyloric sphincter demarcates the transpyloric plane at the level of
L1 `
122
surrounds the superior opening of the stomach at the T11 level.
cardia
123
the rounded, often gas filled portion superior to and left of the cardia.
fundus
124
the large central portion inferior to the fundus of stomach
body
125
Pylorus – This area connects the stomach to the duodenum. It is divided into the
pyloric antrum, pyloric canal and pyloric sphincter
126
forms the long, convex, lateral border of the stomach
greater curvature
127
supply branches to the greater curvature.
The short gastric arteries and the right and left gastro-omental arteries
128
forms the shorter, concave, medial surface of the stomach
Lesser curvature
129
The most inferior part of the lesser curvature ____ , indicates the junction of the body and pyloric region.
angular notch
130
lesser curvature gives attachment to this ligament
hepatogastric ligament
131
lesser curvature
| blood supply
left gastric artery and right gastric branch of the hepatic artery.
132
inferior oesophageal sphincter
| level
T11
133
hangs down from the greater curvature of the stomach and folds back upon itself where it attaches to the transverse colon
greater omentum
134
It contains many lymph nodes and may adhere to inflamed areas , therefore playing a key role in gastrointestinal immunity and minimising the spread of intraperitoneal infections.
greater omentum
135
its main fx is to attach the stomach and duodenum to the liver.
lesser omentum
136
continuous with peritoneal layers of the stomach and duodenum, this smaller peritoneal fold arises at the lesser curvature and ascend to attach to the liver.
lesser omentum
137
the greater and lesser omenta divide the abdominal cavity into two:
the greater
| lesser sac
138
a hole in lesser omentum
epiploic foramen
139
greater and lesser sacs communicate via the
epiploic foramen
140
The arterial supply to the stomach comes from the
celiac trunk
141
right and left gastric veins drain into the
hepatic portal vein
142
short gastric vein, left and right gastro-omental veins ultimately drain into the
superior mesenteric vein
143
stomach innervation
* Parasympathetic nerve supply arises from the anterior and posterior vagal trunks, derived from the vagus nerve.
* Sympathetic nerve supply arises from the T6-T9 spinal cord segments
144
Lymphatics stomach
drains into the gastric and gastro-omental lymph nodes found at the curvatures
–> celiac LN
145
There are three main causes of reflux disease:
Dysfunction of the lower oesophageal sphincter
Delayed gastric emptying
Hiatal hernia
146
occurs when a part of the stomach protrudes into the chest through the oesophageal hiatus in the diaphragm.
Hiatal hernia
147
The lower oesophageal sphincter slides superiorly. Reflux is a common complication, as the diaphragm is no longer reinforcing the sphincter.
sliding hiatal hernia
148
The lower oesophageal sphincter remains in place, but a part of the stomach herniates into the chest next to it. This type of hiatus hernia is more likely to require surgical correction to prevent strangulation of the herniated pouch.
rolling hiatal hernia
149
blood supply
| stomach
1. Right gastric – branch of the common hepatic artery, which arises from the coeliac trunk.
2. Left gastric – arises directly from the coeliac trunk.
3. Right gastro-omental – terminal branch of the gastroduodenal artery, which arises from the common hepatic artery.
4. Left gastro-omental – branch of the splenic artery, which arises from the coeliac trunk.
150
gastric ulcers most often occur
lesser curvature, above the incisura angularis
151
carcinomas of the stomach most commonly found in
pylorus
152
nostril to cardiac orifice of stomach
17.2 inches / 44 cm
153
3 sites of esophageal narrowing may offer resistance to NGT
1st part : 18 cm
2nd: 28 cm
3rd : 44 cm
