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SHB Exam 3 > Abdomen III > Flashcards

Abdomen III Flashcards

1
Q

At what level does the SMA appear?

A

L1

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2
Q

What is the direction of the branches of the SMA?

A

SMA branches enter the mesentery and move to the right toward the right iliac fossa (colic side) EXCEPT the jejunal and ileal branches to the left small intestine.

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3
Q

The SMV is located ___________ to the SMA.

A

lateral

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4
Q

What are the branches of the SMA and the organs they supply?

A

Inferior pancreaticoduodenal: ½ duodenum & pancreas

Middle colic: right 2/3 of Transverse colon

Right colic: ascending colon

Ileocolic: cecum + appendix artery

Jejunal and ileal branches

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5
Q

What are the branches of the ileocolic artery?

A

Anterior cecal artery
Posterior cecal artery
Appendicular artery
Ileal artery

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6
Q

At what level does the IMA appear?

A

L3

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7
Q

What is the direction of the branches of the IMA?

A

The IMA runs downwards behind the 3rd part of the duodenum toward the Left iliac fossa. All three branches are to the Left.

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8
Q

How does the IMA end?

A

The IMA ends by crossing the left common iliac artery and becoming the superior rectal artery

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9
Q

What is the marginal artery of drummond?

A

The marginal artery of Drummond is an arterial arcade along the colon that interconnects the right, middle and left colic arteries.

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10
Q

What are the branches of the IMA and the organs they supply?

A

Left colic - left 1/3 of transverse colon and upper end of descending colon

Sigmoid arteries - lower end of descending colon and sigmoid colon.

Superior rectal - sigmoid colon and rectum (direct continuation of IMA)

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11
Q

Name the arterial anastamoses of the GI tract.

A

Pancreatic duodenal arteries anastamose (from SMA and Celiac Trunk)

Marginal Artery of Drummond

Anastomoses within the celiac trunk

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12
Q

True or False: The entire small intestine is retroperitoneal. Explain.

A

FALSE. The 1st part of the duodenum is intraperitoneal. The 2nd, 3rd, 4th parts of the duodenum, and the jejunum and ileum are retroperitoneal.

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13
Q

What artery supplies the jejunum and ileum?

A

Ileac and jejunal branches of the SMA.

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14
Q

Describe vascularity of the jejunum versus the ileum.

A

Jejunum: Greater
Ileum: Less

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15
Q

Describe the vasa recta of the jejunum versus the ileum.

A

Jejunum: Long
Ileum: Short

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16
Q

Describe the arterial arcades of the jejunum versus the ileum.

A

Jejunum: few large loops
Ileum: many short loops

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17
Q

Describe the mesentery fat and walls of the jejunum versus the ileum.

A

Jejunum: less fat; thicker wall
Ileum: more fat; thinner wall

18
Q

Where does the jejunum and ileum begin and end.

A

The jejunum begins at the duodenojejunal flexure and the ileum ends at the ileocecal junction/valve.

19
Q

What is the blood supply of the large intestine?

A

The SMA (middle colic, right colic, ileocolic) and IMS (all 3 branches)

20
Q

Describe the 3 unique features of the large intestine.

A
  1. Appendices epiploicae (Omental appendices) - small pouches filled with fat that look like the appendix
  2. Taenia Coli - longitudinal band muscle that causes formation of Haustra
  3. Sacculations (Haustra) - rows of pouches.
21
Q

True or False: The entire large intestine is retroperitoneal. Explain.

A

FALSE. Only the ascending and descending colon and rectum are retroperitoneal. The mesoappendix, transverse mesocolon, and sigmoid mesocolon are intraperitoneal.

22
Q

What are the most common regions of the appendix?

A

1st most common: retrocecal

2nd most common: pelvic

23
Q

What is the landmark of the appendix for surgery?

A

The 3 taeniae coli meet at the base of the appendix which is a useful landmark in surgery.

24
Q

What is McBurney’s Point?

A

McBurney’s Point is the point of maximum tenderness in acute appendicitis.

25
Q

How do you find McBurney’s Point?

A

McBurney’s point is at the center of a fake line connecting the Right anterior superior iliac spine to the umbilicus.

26
Q

To what dermatome is referred pain from acute appendicitis?

A

T10 (umbilicus)

27
Q

What are the 2 differential diagnoses for acute appendicitis?

A

Ectopic pregnancy (if missed period)

Meckel’s diverticulitis

28
Q

What is Meckel’s diverticulitis?

A

An intestinal duct that should be obliterated after birth becomes inflamed.

29
Q

What features differentiate Meckel’s diverticulitis from acute appendicitis?

A

Syndrome of 2’s

2 feet from IC valve
2 inches long
2% of population
2% are symptomatic
2 types of ectopic tissue (gastric and pancreatic)
2 years of age at clinical presentation,
2 X more common in boys
30
Q

Which veins form the portal vein?

A

The splenic (with received IMV) and the superior mesenteric veins form the portal vein.

31
Q

What is the function of the portal vein at the liver?

A

The portal vein branches right and left at the porta hepatis of the liver to supply it with 75% of its blood and 50% of the required oxygen.

32
Q

What is the order of vessels in the porta hepatis?

A

The portal vein is the most posterior structure arranged in VAD (portal Vein, hepatic Artery, hepatic Duct) from posterior to anterior

33
Q

Which of the following is NOT a real vein?

Superior mesenteric vein (SMV) 
Splenic vein 
Celiac Vein
Right & Left gastric veins
Cystic vein 
Gastroduodenal Vein
Paraumbilical veins
A

The Celiac Vein and Gastroduodenal Vein do NOT exist.

34
Q

What is Portosystemic anastomosis?

A

Anastomosis of veins between with the systemic caval system (IVC+ Azygos) and the portal (liver) system.

35
Q

What are the 3 most important Portosystemic anastomoses?

A

Left gastric vein and the esophageal vein

Superior rectal vein and the middle and inferior rectal veins

Paraumbilical veins and the superficial epigastric veins

36
Q

What are the results of liver cirrhosis?

A

Portal hypertension that leads to:

Esophageal varices -Hematemesis (vomiting blood)

Rectal varices (Hemorrhoids) - bleeding per rectum

Caput medusae - varicose veins radiating from the umbilicus (Medusa’s head)

37
Q

What is the action of sympathetic innervation in the GI tract?

A

Inhibits peristalsis and activates sphincters.

38
Q

What is the action of parasympathetic innervation in the GI tract?

A

Activates peristalsis and inhibits sphincters.

39
Q

Describe parasympathetic innervation of the foregut, midgut, and hindgut.

A

Foregut & midgut - Vagus nerves

Hindgut - Pelvic splanchnic nerves (S2, 3, 4)

All these fibers are preganglionic and will relay in the terminal ganglia of their organs.

40
Q

Describe sympathetic innervation of the foregut, midgut, and hindgut.

A

Foregut & midgut - Thoracic splanchnic nerves; Greater (T5-T9), Lesser (T10- T11) and Least (T12) splanchnic nerves

Hindgut - Lumbar splanchnic nerves

SHB Exam 3 (14 decks)

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