Abdomen 1+2- Exam 4 Flashcards
(201 cards)
1
Q
The outer subcutaneous fat fascia of the abdominal wall
A
camper’s fascia
1
Q
the thicker underside fascia is called _____.
A
Scarpa’s fascia
2
Q
Which fascia layer is capable of holding a suture?
A
Scarpa’s fascia
3
Q
a ____ is a broad flat tendon
A
aponeurosis
4
Q
The ______ seals off the abdomen from the thigh. What layer is it part of?
A
inguinal ligamen
part of the external abdominal oblique aponeurosis
5
Q
the ____ separates the rectus abdominis muscles. The site of multiple muscle insertions
A
linea alba
6
Q
The _____ divides the external abdominal oblique muscles from the linea alba
A
linea semilunaris- more lateral
7
Q
When you are turning your torso to the right, what muscles are contracting?
A
Left external obliques
Right internal obliques
8
Q
The rectus abdominis muscles attaches from the ___ to ____
A
ribcage to the pubic bones
9
Q
The umbilicus is at what level?
The inginual/groin is at what level?
A
T10
L1
10
Q
What three arteries in the abdomen extend off the internal thoracic artery?
A
Superior epigastric artery
Musculophrenic artery
Pericardiacophrenic
11
Q
What artery supplies the rectus abdominis muscle?
A
Superior epigastric artery
12
Q
What artery supplies the lateral side of the abdominal body wall?
A
musculophrenic artery
13
Q
What artery supplies the rectus sheath?
A
Inferior epigastric artery
14
Q
What three arteries extend off the external iliac artery?
A
Inferior epigastric
Superficial epigastric
superficial circumflex iliac
15
Q
Posteriorly, the abdominal wall muscles get their blood from _____
A
lumbar segmental arteries
16
Q
For lymph above the umbilicus, where does it drain?
A
drains towards the axillary and parasternal nodes
17
Q
For lymph below the umbilicus, where does it drain?
A
towards superficial inguinal nodes
18
Q
What is the innermost layer of the abdominal wall? What does it secrete?
A
Parietal peritoneum
serous fluid
19
Q
Describe the rectus sheath above the arcuate line
A
1.5 layers in front (External abdominal and half of internal abdominal) and 1.5 layers behind (the other half of internal abdominal and transversus abdominis muscle) the rectus abdominis muscle
20
Q
Describe the rectus sheath below the arcuate line
A
All three layers are in front of the rectus abdominus
21
Q
What are the borders of the lumbar triangle. Why is it important?
A
external abdominal oblique
latissimus dorsi
iliac crest
site of frequent hernias
22
Q
Where does the psoas major attach?
A
proximal: lumbar transverse processes and bodies of T12- S1 vertebrae
Distal: lesser trochanter
23
Q
What is the innervation and major function of the psoas major?
A
Anterior rami of L2-4
flexion of the thigh at the hip
24
What are the attachments of the iliacus muscle?
proximal: iliac fossa and lateral sacrum
distal: lesser trochanter
25
What is the innervation and major function of the iliacus?
anterior rami of L2-4
flexion of the thigh at the hip
26
What causes extreme psoas tenderness and may minic appendicitis and femoral hernia?
psoas abscesses
27
What causes psoas abscesses?
tubercular infection of the vertebral bodies that spread to the psoas fascia
28
Attachments of the quadratus lumborum muscle?
P: lumbar transverse processes and 12th rib
D: iliac crest
29
What is the innervation and major function of the quadratus lumborum?
anterior rami of T12-L4
fixation of 12th rib during inspiration, lateral flexion of the spinal column
30
What is the nerve that runs below the 12th rib?
SUBcostal nerve- T12
31
The lateral cutaneous nerve of the thigh does what levels?
L2-3
32
The ____ nerve runs on the lateral side of the psoas major. What levels?
femoral nerve
L2 L3 L4
33
What are the paired arteries?
inferior phrenic
renal
gonadal
lumbar segmental
right and left common iliac
34
What are the unpaired arteries?
celiac trunk
superior mesenteric
inferior mesenteric
35
The _____ covers the quadrattus lumborum muscles
lateral arcuate ligaments
36
The ____ covers the psoas major muscles
medial arcuate ligament
37
the _____ covers the aorta
median arcuate ligament
38
At what level does the crura and median arcuate ligaments form the ______.
T12
form the aortic hiatus
39
The _______ travels through the diaphragm at the ____ level during expiration. It lies primarily in the fibers of the right crus and is usually compressed by the muscle.
esophageal hiatus
T10
40
The _____ travels through the diaphragm’s central tendon at the ___ level during expiration
caval opening
T8
41
The ____ nerve is the sole motor nerve to the diaphragm
phrenic
42
What level does the phrenic nerve arise from?
C3, 4, 5
43
What is hemidiaphragm most commonly caused by?
damage to the right or left phrenic nerves
44
______ branches superiorly and runs with phrenic nerve. What nerves does it branch off of?
Pericardiacophrenic artery
Internal thoracic artery
45
_____ terminal branch of internal thoracic, arising at the same time as the superior epigastric artery.
Musculophrenic artery
46
What two arteries supply the diaphragm that extend off the internal thoracic
Pericardiacophrenic
Musculophrenic
47
What two arteries of the abdomen come off the aorta itself?
Superior phrenic
inferior phrenic
48
The aorta itself gives off the
________ just before it enters the abdomen
superior phrenic artery
49
The aorta itself gives off the
________ immediately after entering the thorax
inferior phrenic artery
50
The _____ also contribute some blood to the lateral diaphragm
intercostal arteries
51
The superficial inguinal ring has a ____ and _____
lateral and medial crus
52
Why is the lateral and medial crus of the superficial inguinal ring important surgically?
good spot for hernias
53
indirect inguinal hernias are hernias at what spot?
inguinal ring
54
**the testicular artery/vein and ductus deferens pass through _____.
deep inguinal ring
55
**the deep inguinal ring is _____ to the inferior epigastric artery. What type of hernia exits here?
lateral
indirect
56
A direct inguinal hernia is ____ to the inferior epigastric artery/vein. Most common in (men/women)?
medial
women
57
_____ hernia pushed out in the gap next to external iliac vein/artery going into the thigh. More common in men/women?
femoral hernia
women
58
A direct inguinal hernia is ____ to the inferior epigastric artery/vein
medial
59
___ and ____ hernias are much more common in women
femoral and direct
60
_____ hernias are much more common in men
indirect
61
What is a hernia sac?
When the intestine pushes part of the peritoneum ahead of it as it falls out of the abdominal cavity
62
What kind of hernia exits at the yellow circle?
indirect hernia
63
What kind of hernia exits at the green circle?
direct hernia
64
What kind of hernia exits at the light blue circle?
femoral hernia
65
The ____ muscle is on top of the testicular cord allowing them to rise and fall with temperature changes. What muscle did it used to be a part of?
cremaster
internal abdominal oblique
66
____ hernias follow the same path as the spermatacord, can fill the scrotum
indirect hernias
67
What are the 3 components of Hesselbach's triangle?
Rectus abdominus
pubic bone
inferior epigastric vessels
68
What is this illustrating?
lumbar hernia
69
The adult teeth include: __ incisors, ___ canine, ___ premolars, and ___ molars
2 incisors
1 canine
2 premolars
3 molars (3rd is the “wisdom” tooth)
70
Layer of teeth: _____ outer layer of crown
Enamel
71
Layer of teeth: ____ lines the alveolar bone (tooth sockets)
cementum
72
layer of teeth: _____ found deep to the enamel and cementum, makes up the bulk of the tooth
dentin
73
_______ ligament allows the teeth to have a little wiggle and be able to shift with braces
peridontal
74
______ sharp extensions that cover most of the tongue, no taste buds.
Papillae filiform
75
_____ little pale dots on surface of tongue, have taste buds.
Fungiform papillae
76
_____ large circular papillae near the posterior 1/3rd of tongue, have taste buds & secretory glands
Circumvalate papillae
77
______ longitudinal folds on that lateral aspect of the tongue, have taste buds and secretory glands.
Foliate papillae
78
______ taste bud sensory cells contact the outside environment through a small pore
tastent
79
What are the two functions of the mucosa?
Extract nutrients from food
Protect the body from pathogens
80
What are the three layers in the mucosa?
epithelium
lamina propria
muscularis mucosae
81
_____ is a loose connective tissue that anchors the gut tube to nearby structures
Adventitia
82
_____ is a thin layer of connective tissue covered by simple squamous epithelium.
Serosa
83
_____ keeps the bowel mobile and prevents irritation that could lead to adhesions
Serosa
84
____ keeps the esophagus closed
upper esophageal sphincter
85
What kind of cells are present in the mucosa of the esophagus?
nonkeratinized stratified squamous epithelium
86
What is the first 1/3 of the esophagus composed of?
2nd 1/3rd?
last 1/3rd?
Inner circular layer
Outer longitudinal layer
skeletal -> smooth muscle
87
at the _______ there is a stark shift between stratified squamous epithelium of the esophagus and the simple columnar (but highly folded) epithelium of the stomach.
Gastroesophageal junction
88
Prolonged GERD can lead to metaplasia of the esophagus which is called _____ where the mucosa of the esophagus takes on the appearance and function of the cardiac region of the stomach.
Barrett's esophagus
89
What organ is found in the upper right quadrant?
liver
90
What is first thing you see when you remove the skin from the abdomine?
greater omentum
91
What are the 4 regions of the stomach?
Cardia
Fundus
Body
Pyloris
92
What regions of the stomach are responsible for secreting mucous?
Cardia and Pyloris
93
What parts of the stomach are responsible for digestion?
Fundus
Body
94
Folds in the stomach wall are called _____. What is their job?
rugae
facilitate the stomach's expansion
95
The stomach’s external wall consists of a protective layer called the _____ over three layers of smooth muscle.
tunica serosa
96
What direction is the outer layer of stomach muscle?
Longitudinal
97
The lesser curvature of the stomach is on what side?
Superior right side
98
The greater curvature of the stomach is on what side?
left inferior side
99
Cells in the stomach’s epithelium produce _____ to assist digestion of food
hydrochloric acid
100
The epithelium of the cardiac and pyloric regions consists almost entirely of ______ surrounding gastric pits.
mucus-producing cells
101
____ produce HCl to lower the pH of the stomach. They also release ____.
Parietal cells
intrinsic factor
102
what does intrinsic factor help with?
absorption of vit B12
103
_____ release precursors of digestive enzymes pepsin, rennin, and lipase
Chief cells
104
Excessive HCl secretion caused by an over production of ____
gastrin
105
infection with _____, a bacteria that can survive in the stomach’s acidic environment and destroys the epithelial lining
helicobacter pylorii
106
the ____ is 2/5th of the length of the small intestine and located in the Upper Left quad
jejunum
107
The ____ is 3/5th of the length of the small intestine and is located in the Lower Right quadrant
Ileum
108
____ are folds into the lumen of the small intestine
Plicae circularis
109
what are lacteal?
microscopic Villi, folds of mucosa with a lymphatic duct in the core
110
very very tiny ____ are seen on the surface of the actual absorptive cells
microvilli
111
During celiac and other autoimmune gut diseases, inflammation damages the ____, and the SA for absorption ____
villi
decreases
112
Mucous and bicarbonate secretions from ______ in the submucosa raise the pH to protect the remaining digestive tract and activate pancreatic enzymes
duodenal glands (Brunner glands)
113
The duodenum has 4 parts, name them.
superior
descending
inferior
ascending
114
What part of the duodenum receives gastric content?
superior
115
What part of the duodenum receives common bile duct from the liver and pancreas?
descending
116
What part of the duodenum is anchored by suspensory muscle/ligament and becomes the jejunum after?
Ascending
117
The suspensory muscle / ligament of the duodenum ______ is an extension of the right diaphragmatic crura and is an important surgical landmark. Where the duodenum becomes the jejunum
ligament of Trietz
118
**What quadrant is the jejunum located?
Upper Left
119
**What quadrant is the ileum located in?
Lower Right
120
_____ are where bacteria in the gut are located that aid in healthy digestion
Peyer's patch in the ileum
121
In the jejunum, there are ____ arcades and _____ vasa recta
fewer arcades
long vasa recta
122
In the ileum, there are ____ arcades and _____ vasa recta
many arcades
short vasa recta
123
In the jejunum, what is different about their submucosa?
no special structures
124
____ and ____ generally travel through intestinal veins and are then transported to the liver
Proteins and carbohydrates
125
Fatty molecules tend to get absorbed by _____, which transport them through the lymphatic ducts, bypassing ____. Where do they end up?
lacteals
the liver
LEFT subclavian vein
126
How is the ileum different from the jejunum?
contains large lymph nodules in the lamina propria
127
_____ and are a major component of our immune maintenance over the normaflora of the gut and response to infection. Where are they found?
Peyer patches
in the ileum
128
You need ___ and ____ in order to properly digest Vit B12
Stomach and ileum
129
Vitamin B12 deficiency can lead to ______
pernicious anemia
130
At the terminal end of the ileum is a thickening (not a true sphincter) of the muscularis externa that prevents release of the food bolus into the large intestine unless relaxed. What is this called?
Ileocecal valve
131
What is an intussusception?
ileum pushes itself into the cecum and turns itself inside out
"de-gloving"
132
What quadrant is the appendix located?
Lower RIGHT
133
The _____ is suspended by a mesentery but the ____ and _____ are not
ileum
cecum
ascending colon
134
Does the appendix have a mesentery?
yes, tiny mesentery that carries the blood supply
135
What is the McBurney's point? What does it indicate?
half way between the umbilicus and the ASIS
appendicitis
136
What quadrant is the cecum located?
Lower right
137
What quadrant is the ascending colon located in?
Upper Right
138
Where does the ascending colon become the transverse colon?
at the right colic (hepatic) flexture
139
What quadrant is the transverse colon in? Does it have a mesentry?
upper left
Yes
140
Where does the transverse colon become the descending colon?
at the left colic (splenic) fixture
141
The descending colon is in what quadrant?
Lower left quadrant
142
Does the sigmoid colon have a mesentry?
yes
143
The sigmoid colon loses its mesentry as it becomes the ____ within the pelvis
rectum
144
Large intestine is distinctive in appearance due to the ___ and _____
wide lumen and 3 tenia coli
145
What is this? What are the pink dots?
Large intestine
tenia coli
146
What organ? What is the arrow pointing at?
Large intestine
Haustra
147
What are the yellow fatty things?
Omental appendages
148
The internal anal sphincter is ___ muscle
smooth
149
the external anal sphincter is ___ muscle
skeletal
150
What kind of cells make up the rectum?
simple columnar, mostly goblet
151
What kind of cells make up the anus?
stratified squamous epithelium
152
Name some functions of the liver
-generates albumin
-stores and distributes glucose and vitamins
-detoxifies substances by making them soluble for excretion by the kidneys.
-creates clotting factors.
-creates and secretes bile.
-iron metabolism is intimately involved with the liver
153
The liver and the stomach are closely connected by ____
the lesser omentum
154
What is the portal triad?
portal vein, hepatic artery, and bile ducts
155
If the liver was bleeding profusely where you would put your fingers?
around the hepatoduodenal ligament to close off the blood supply
156
** What organs make up the foregut?
esophagus
stomach
liver
gallbladder
bile ducts
pancreas
proximal duodenum
157
**What organs make up the midgut?
distal duodenum
jejunum
ileum
cecum
appendix
ascending colon
transverse colon
158
**What organs make up the hindgut?
descending colon
sigmoid colon
rectum
159
** What organs have a visible mesentery?
stomach
liver
spleen
1st and 4th portion of duodenu
160
**What organs are considered intraperitoneal?
jejunum
ileum
appendix
transverse colon
sigmoid colon
161
**What is intestinal atresia? What other feature does it present with?
blockage in the small intestine distal to the common bile duct insertion
presents with bilious emesis
162
**What are the major events in midgut development?
1. Rotation
2. Elongation
163
The ___ duct extends off the ileum and normally disappears during development, but if a blind pouch remains it is know as a _____
ileal (Meckel's diverticulum)
164
The ____ and _____ will become the bladder and urethra
urogenital sinus
allantois
165
The portal triangle is found within what ligament?
the hepatoduodenal ligament
165
166
The _____ connects the stomach and liver
lesser omentum
167
Between hepatocytes are _____, through which blood flows.
hepatic sinusoids
168
Hepatocytes are stabilized by ______. What type of collagen are they?
reticular fibers
type III collagen
169
Which are smaller type I or type III collagen?
type III are smaller than type I and do NOT impede blood flow
170
The portal triangle contains what three structures?
portal vein
hepatic artery
bile duct
171
______ deoxygenated blood from the gut tube and associated organs to the liver
Portal vein
172
______ carries oxygenated blood from the aorta to the live
hepatic artery
173
_____ carries bile from the liver
bile duct
174
Blood from both the hepatic arteries and portal veins empty into the _____ and drain to a ______.
hepatic sinusoids and drain to a central vein
175
Central veins fuse to become _____, which eventually drain into the inferior vena cava.
2-3 hepatic veins
176
Cirrhosis of the liver leads to ___ cells releasing ____ to replace the reticular fibers. This leads to hepatocytes forming _____ instead of cords which causes blood to back up.
Ito (NOT hepatocytes)
type I collagen
clumps
177
What is hemochromatosis? What is an obvious sign?
a build up of too much iron and it damages the liver and other organs
"rusty" skin pigmenting
178
Hepatocytes produce ____ but keep it rigidly separated from the sinusoidal capillaries. Bile enters specialized ____ that are sandwiched on either side by neighboring hepatocytes
bile
canaliculi
179
Bile drains to larger ducts alongside the _____ and ______ before entering the duodenum at the _______.
hepatic artery
portal vein
hepatopancreatic ampulla.
180
True/False: Bile production can slow down or accelerate but never stops
True
181
Where is excess bile stored and concentrated?
gall bladder
182
What happens when bile gets into the blood?
jaundice
183
How does the gall bladder remove the water in the bile?
through tiny microvilli in the gall bladder's lining
184
How does the gall bladder know when to release bile?
Fat in the duodenum stimulates release of hormones that cause the gall bladder to contract and release bile into the duodenum
185
What are Rokitansky-Aschoff Sinuses?
A frequent feature of gallbladder specimens is a sinus from the lumen extending into and past the muscularis externa
These act as reservoirs for bacteria, predisposing to chronic infections and bile stone formation
186
What are cholelithiasis?
Gall stones
187
The pancreas manufactures digestive _____ that are excreted into the major and minor pancreatic ducts and released into the ________.
proenzymes
descending portion of the duodenum
188
How do the pro-enzymes of the pancreas become active?
when the pH drops (usually in the stomach because of the low pH in the stomach)
189
Clusters of endocrine cells, the _______ secrete hormones that regulate metabolism directly into the blood stream.
pancreatic islets (of Langerhans)
190
The pancreatic islets (of Langerhans) are readily visible on H&E stain and contain cells that synthesize ______ that are released into the extensive blood supply that floods the organ.
endocrine hormones
191
What are the big three pancreatic hormones?
insulin
glucagon
somatostatin
192
What is the main cause of pancreatitis? Usually caused by ?
when proenzymes become activated and begin to digest itself
gall stone obstructing the hepatopancreatic ampulla
193
What quadrant is the spleen located in?
Upper left
194
If ribs 8-11 are lacerated, what organ is it most likely to hit?
the spleen
195
What organs are the spleen in contact with?
stomach
transverse colon
left kidney
diaphragm
196
Where do vessels of the spleen enter/exit?
hilum
197
What is the function of the spleen?
-filters blood
-forms lymphoid cells
-eliminates or deactivates blood-borne antigens
-destroys aged platelets and erythrocytes
-participates in fetal hematopoiesis
198
Within the spleen, where does the red blood cell turnover?
red pulp
199
Within the spleen, where do you find clusters of immune lymphocytes?
white pulp
