Abdomen and Organs Flashcards
(188 cards)
1
Q
What direction do the internal and external obliques go?
A
Externals go inferomedially.
Internals go superomedially.
2
Q
What ligament is the spermatic cord found in?
A
Inguinal ligament
3
Q
Where is the aponeurosis for the internal and external obliques found?
A
Medially, under the rectus abdominis.
4
Q
What parts of the abdomen are sutureable?
A
Scarpa’s fascia
Transversalis Fascia
5
Q
What muscle acts like a corset on the abdomen?
A
Transversus abdominis
6
Q
What kind of fluid does the parietal peritoneum secrete?
A
Serous fluid.
7
Q
What motions does the external oblique do?
A
Ipsilateral sidebending.
CONTRALATERAL rotation.
8
Q
What motions does the internal oblique do?
A
Ipsilateral sidebending.
IPSILATERAL rotation.
9
Q
What muscle connects the 12th rib to the ilium?
A
Quadratus lumborum
10
Q
Where is the linea semilunaris found?
A
Bilaterally, between the rectus abdominis and the obliques.
11
Q
Where are intercostal nerves found between?
A
Between the internal obliques and the transversus abdominis.
12
Q
What nerves make up the anterior and lateral cutaneous branches of the intercostal nerves in the abdomen?
A
T7-T12
13
Q
What spinal nerve makes up the iliohypogastric nerve?
A
L1
14
Q
When does the internal thoracic branch off going inferiorly? What does it branch into?
A
Past the costal margin, it branches medially to become the superior epigastric artery and laterally to become the musculophrenic artery.
15
Q
What artery anastomoses with the musculophrenic artery? What is it a branch off of?
A
The superficial circumflex iliac artery anastomoses with the musculophrenic artery around the transumbilical plane.
It is a branch of the external iliac artery.
16
Q
What artery anastomoses with the superior epigastric artery? What is it a branch off of?
A
The inferior epigastric artery. It is found deep to the rectus abdominis and is a large artery of concern during sx.
It is a branch of the external iliac artery.
17
Q
What is the most inferior epigastric artery?
A
Superficial epigastric artery. It is a branch of the external iliac artery.
18
Q
What are the branches of the internal thoracic artery?
A
Musculophrenic artery (lateral)
Superior epigastric artery (medial)
19
Q
What are the branches of the external iliac artery?
A
Inferior epigastric artery
Superficial epigastric artery
Superficial circumflex iliac artery
Note:
There are other branches, but these are abdominal wall branches.
20
Q
What supplies blood to the posterior abdominal wall?
A
Lumbar segmental arteries.
21
Q
What vein drains camper’s fascia?
A
Thoracoepigastric vein.
22
Q
What does the musculophrenic vein drain to?
A
Internal thoracic vein, so it heads superiorly.
23
Q
What does the superficial circumflex iliac vein drain to?
A
The femoral vein, heading inferiorly.
24
Q
What does the internal thoracic vein drain to?
A
Subclavian vein.
25
What do the inferior epigastric and superficial epigastric vein drain to?
Femoral vein.
26
Where is the determination for whether lymph flows superiorly or inferiorly?
Umbilicus.
Superior goes to axillary region.
Inferior goes to inguinal region.
27
What are the three folds of the umbilical?
Lateral umbilical fold
Medial umbilical fold
MEDIAN umbilical fold
28
Which umbilical fold is a remnant of the umbilical artery?
Medial umbilical fold.
29
What is the deepest part of the abdominal wall?
Parietal peritoneum.
30
Name the muscle layers of the abdominal wall.
Superficial to deep:
External obliques
Internal obliques
Transversus abdominis
Transversalis fascia
31
Name the layers that would appear in front of my rectus abdominis muscle above the arcuate line.
Skin
Camper's fascia
Scarpa's fascia
Aponeurosis of external abdominal oblique
1/2 aponeurosis of internal abdominal oblique
32
Name the layers that would appear in front of my rectus abdominis muscle below the arcuate line.
Skin
Camper's fascia
Scarpa's fascia
Aponeurosis of external, internal, and tranversus abdominis muscles.
33
What makes up the border of my lumbar triangle?
Inferiorly: Iliac crest
Anteriorly: External obliues
Posteriorly: Lats
34
Where does the psoas major originate and insert at?
Lumbar transverse processes and bodies of T12-S1.
Insert: Lesser trochanter.
35
Where does the iliacus originate and insert at?
Origin: Iliac fossa and lateral sacrum
Insert: Lesser trochanter.
36
What innervates the iliacus and psoas major? What is their motion?
Anterior rami of L2-L4.
Flexion of hip.
37
What is a psoas abscess? Where does it originate?
A tubercular infection of the lower vertebral bodies, which spreads via the psoas fascia.
Symptoms include extreme psoas tenderness, appendicitis-like symptoms, bulging in the femoral vessels.
38
What is the innervation and function of the quadratus lumborum?
Anterior rami of T12-L4.
Fixation of 12th rib during inspiration, lateral flexion of spinal column.
39
What are the nerves of the posterior abdominal wall?
Superior to inferior:
Subcostal nerve (T12)
Iliohypogastric (L1)
Ilioinguinal (L1)
Genitofemoral (L1-L2), traveling along the anterior of the psoas major.
Lateral cutaneous of the thigh (L2-L3)
Femoral (L2-L4)
40
What are the unpaired arteries of the abdominal aorta?
Celiac trunk
Superior mesenteric
Inferior mesenteric
41
What are the paired arteries of the abdominal aorta?
Inferior phrenic
Renal
Gonadal
Lumbar segmental
Right and Left common iliac
42
What are the branches of the inferior vena cava?
Hepatic veins
Right inferior phrenic vein
Left renal vein (left inferior phrenic vein, left suprarenal vein, left gonadal vein)
Right renal vein
Right gonadal vein
Lumbar segmental vein
Right and Left common iliac
43
What covers the quadratus lumborum?
Lateral arcuate ligaments.
44
What covers the psoas major?
Medial arcuate ligaments.
45
What covers the aorta?
Median arcuate ligament.
46
What forms the aortic hiatus?
Left and right diaphragmatic crura and the median arcuate ligament at T12 vertebral level.
47
What forms the esophageal hiatus?
Right crus at T10 vertebral level.
48
What forms the caval opening?
The central tendon of the diaphragm at T8 vertebral level.
49
Anteriorly to posteriorly, name the 3 tubes that go the diaphragm.
IVC at T8 via the caval opening.
Esophagus at T10 via the esophageal hiatus.
Abdominal aorta at T12 via the aortic hiatus.
50
What innervates the diaphragm?
The phrenic nerve, C3, 4, and 5.
51
What causes hemidiaphragm?
Injury to one of the phrenic nerves, so injury to either left/right C3, 4, or 5.
52
What is unique about the phrenic nerve?
It carries both afferent and efferent fibers.
53
What mainly supplies the diaphragm with its blood flow?
Two branches of the internal thoracic.
Pericardiophrenic artery superiorly, running with the phrenic nerve.
Musculophrenic artery, off the internal thoracic artery as its terminal branch.
Superior phrenic artery, off the abdominal aorta prior to entering the abdomen.
Inferior phrenic artery, off the abdominal aorta after entering the abdomen.
Intercostal arteries contribute to the lateral diaphragm.
54
What makes up the inferior border of the external obliques and abdomen?
Inguinal ligament.
55
What are the layers of the inguinal region?
Superficial to deep:
Deep inguinal ring
Transversalis fascia
Internal obliques
External oblique aponeurosis
Superficial inguinal ring
56
What muscle allows the testes to elevate?
Cremaster muscle, which originates from the internal obliques.
57
What is contained within the spermatic cord?
Ductus deferens/artery
Testicular artery/vein
Lymphatics
Sympathetic/parasympathetics
58
Why is the inguinal canal a common site for herniation?
Weak spot in the abdominal wall.
59
What is Hesselbach's triangle?
A common site of direct inguinal hernias.
60
What are the two common sites for inguinal hernias?
Deep inguinal ring, located laterally to the inferior epigastric artery. Common indirect site.
Hesselbach's triangle, located inferomedially? to the inferior epigastric artery. Common direct site.
61
What are common hernia sites for the general abdominal area?
Inguinal
Femoral
Lumbar
62
What is the difference between a direct and indirect inguinal hernia?
Direct inguinal hernias show a bulge from the posterior wall of the inguinal canal.
Indirect inguinal hernias pass through the inguinal canal.
63
What are the first set of teeth called? How many teeth do we have when we're young?
Deciduous set.
2 incisors
1 canine
2 molars.
64
How many teeth do we have when we become an adult?
2 incisors
1 canine
2 premolars
3 molars (3rd is the wisdom tooth)
65
What are the three tissues of the teeth?
Enamel: outer layer of crown
Cementum: lines tooth socket/alveolar bone.
Dentin: Deep to both, makes up the bulk of a tooth.
66
What are cavities also called?
Carries
67
Why is it bad if our enamel is eroded?
Dentin is much softer, and gets eroded far more quickly.
68
What are the 4 papillae of the tongue?
Filiform
Fungiform
Circumvalate
Foliate
69
What are filiform papillae?
NON TASTE BUDS
Sharp extension covering most of the tongue, similar to a cat's tongue.
70
What do fungiform papillae look like?
Little pale dots, taste buds.
71
What do circumvalate papillae look like?
Large, circular papillae near the posterior 1/3.
Taste buds + secretory glands.
72
What do foliate papillae look like?
Longitudinal folds on lateral tongue.
Taste buds + secretory glands.
73
What kind of tissue is the tongue?
Keratinized, stratified squamous epithelium.
74
What two papillae have glands?
Circumvalate and Foliate
75
What papillae can't taste?
Filiform
76
What papillae are circular in appearance?
Circumvalate and fungiform.
77
How long does it take sensory cells to turnover in the tongue?
10 days.
78
What are the layers of the generic gut tube?
Epithelium
Lamina propria
Muscularis mucosae
Submucosa (containing submucosal glands)
Circular muscularis externa
Longitudinal muscularis externa
Adventitia/serosa
79
What 3 layers make up the mucosa?
Epithelium: stratified squamous/columnar
Lamina propria: loose CT
Muscularis mucosae: Smooth muscle
80
What is the goal of the mucosa?
Extract nutrients from food.
Protect body from pathogens.
81
What does the submucosa and muscularis externa contain?
Large vessels
Submucosal ganglia: nerve cells
Submucosal glands
Large lymph nodules (inconstant)
82
What extra layer does the muscularis externa sometimes contain?
Myenteric ganglia: nerve cells
83
What is the difference between adventitia and serosa?
Adventitia is a loose CT anchoring the gut tube to nearby structures.
Serosa is a thin layer of CT covered by simple squamous.
It secretes fluid to lubricate the gut tube to keep it mobile and prevent irritation.
84
What are the layers of the esophagus?
Mucosa:
Nonkeratinized stratified squamous epithelium
Lamina propria
Muscularis mucosa
Submucosa
Muscularis externa:
Inner circular
Outer longitudinal
Skeletal => smooth muscle
85
What signifies the difference between the esophagus and the stomach?
Gastroesophageal junction, marked by the transition of stratified squamous epithelium converting to simple columnar.
86
What keeps the gastric acid out of the esophagus?
Lower esophageal sphincter.
87
What does prolonged GERD lead to?
Barrett's esophagus.
Metaplasia of the esophageal mucosa, mimicking the cardiac region of the stomach and increasing susceptibility for adenocarcinoma.
88
What is the greater omentum?
It is an organ extending off the GREATER curvature of the stomach like an apron, covering everything below it.
89
Why is the greater omentum important?
It is mobile and can migrate around to wall off areas of inflammation/infection. It can also leave adhesions.
90
What regions of the stomach are mucous?
Cardia (upper opening)
Pyloris (lower opening)
91
What regions of the stomach are digestive?
Fundus (upper)
Body (everything else)
92
What are folds in the stomach called? What is their purpose?
Rugae.
Faciliate expansion of the stomach's muscularis externa.
93
What kind of digestion does the stomach do?
Mechanical via muscularis externa.
Chemical via hydrochloric acid.
94
What is the outer layer of the the stomach called?
Tunica serosa, which covers 3 layers of smooth muscle.
Outer layer is mainly longitudinal.
95
What direction do the 3 muscular layers of the stomach go?
Deep: obliquely
Middle: Circularly, thickening at the pyloric sphincter.
Outer: Longitudinal.
96
What are the two cells of the stomach?
Parietal cells, which lower pH via HCl secretion.
Release intrinsic factor, which helps reabsorb B12.
Chief cells, which release proenzymes for pepsin, rennin, and lipase.
97
What are the 3 usual causes of peptic ulcers?
Excessive HCl secretion caused by overproduction of gastrin.
Long-term NSAID use.
H. pylori infection.
98
What are the functions of the small intestine?
Raise pH of food bolus
Add bile from liver and digestive enzymes from the pancreas
Absorb nutrients
99
What are the 3 regions of the small intestine?
Duodenum (20-25cm)
Jejunum (2/5 of length), located in the LUQ
Ileum (3/5 of the length, located in the RLQ.
6-7m total.
100
What are microscopic folds of the small intestine called?
Villi, with a lymphatic duct core called a lacteal.
101
What are the luminal folds of the small intestine called?
Plicae circularis
102
Where are microvilli found in the small intestine?
On the surface of the absorptive cells.
103
Why is celiac disease so detrimental?
Damages the villi, which are used in absorption. Celiac disease will cause eventual malabsorption, blunting and shortening the villi.
104
What is the job of the duodenum?
Neutralizing acidity
Controlling pancreatic enzyme and bile release.
105
What are the glands found in the duodenum? What is their function?
Brunner glands, which secrete mucus and bicarb. This raises pH to product the rest of the digestive tract and to activate pancreatic enzymes.
106
What are the 4 regions of the duodenum?
Region 1: Superior, receives gastric contents
Region 2: Descending, receives commone bile from liver/pancreas.
Region 3: Inferior, passes posterior to the superior mesenteric vessels.
Region 4: Ascending, anchored by suspensory muscle/ligament, becomes jejunum after.
107
What is the origin of the suspensory ligament?
It is an extension of the RIGHT diaphragmatic crura, often an important surgical landmark.
It is known as the ligament of Trietz.
108
What is a mesentery?
A sheet of tissue wall that connects the guts to the gut wall.
109
What covers the jejunum and ileum?
The greater omentum.
110
Where is the jejunum usually found? Ileum?
ULQ for the jejunum
LRQ for the ileum
Note:
You need to usually look at their lumen or blood supply.
111
What is unique about the jejunum?
2/5 of the SI length.
Usually the typical SI when viewed microscopically.
Contains plicae, no special structures in submucosa.
Villi are broad and have visible lacteals.
112
What do proteins and carbs usually travel through?
Intestinal veins, to the liver.
113
What do fatty molecules usually travel through?
Lymphatic ducts, aka lacteals.
Goes to L subclavian, bypassing liver.
114
What is the main difference between the ileum and the jejunum?
Longer length.
Peyer patches, located in the lamina propria.
These are large lymph nodules.
115
What does B-12 deficiency result in usually? What causes this deficiency?
Pernicious anemia.
Careless removal of parts of the stomach or ileum.
The stomach secretes intrinsic factor.
The ileum absorbs the B12.
116
What separates the ileum from the cecum?
Ileocecal valve.
117
What are the two types of ileocecal valves?
Papillary form
Labial form
118
What is located just inferior to the ileocecal valve?
Orifice of the vermiform appendix.
119
What is it called when the ileocecal valve folds into the large intestine?
Intussusception.
120
What is the function of the large intestine?
Recover water and electrolytes from the food bolus.
121
What are the main regions of the large intestine?
Cecum (and appendix)
Colon
Rectum
Anorectal junction
Anal canal
122
What is the appendix and its function?
It is a small extension of the cecum, with a narrow lumen and lots of lymphatic nodules.
It is posited that it is a reservoir to replenish intestinal normoflora after severe diarrheal diseases.
123
What suspends the cecum and ascending colon?
Nothing!
Only the appendix and ileum are suspendede by mesenteries in this area.
124
What are tenia coli? Why are they significant?
They are the longitudinal muscles of the colon.
You can follow them to find the appendix if its hiding.
125
How does appendicitis typically present in terms of pain?
Dull and diffuse early, because it can irritate the entire parietal peritoneum.
It becomes sharper and well-localized as it progresses, most commonly at McBurney's point in the RLQ.
126
Describe the path of the large intestine.
1. Cecum in the RLQ.
2. Ascending colon ascends to the URQ, making a right angle turn known as the hepatic flexture.
3. Transverse colon goes across from the URQ to the ULQ. (MESENTERY)
4. Right angle turn downwards towards the LLQ is the descending colon at the splenic flexture.
5. The descending colon becomes the sigmoid colon (S-shaped with a mesentery).
6. The sigmoid colon goes to the rectum and loses its mesentery in the pubis.
127
What are the folds of the large intestine called?
Haustra
128
What is the appearance of the large intestine?
Wide lumen
3 tenia coli
Lots of folds/haustra
129
What is diverticula?
Weak spots of the colon's lumen.
Looks like holes.
130
What are polyps?
Proliferating masses growing into the lumen.
131
What happens to tenia coli as it gets to the anus?
They become a longitudinal layer.
The inner, circular layer becomes the internal anal sphincter.
132
What is the difference between the internal and external anal sphincters?
Internal is non-voluntary. It contributes to the sense of urgency.
External has skeletal muscle, so we can voluntarily control it.
133
Why does the rectum have folds? What are they called?
Rectal folds of Houston, which prevent fecal matter from clumping together.
There is a superior transverse, middle transverse, and inferior transverse fold.
134
What are the 3 parts of the external anal sphincter?
Deep part, found most superiorly.
Superficial, found below the deep.
Subcutaneous part, found below the superficial.
135
What is the source of blood from hemorrhoids?
Mainly the internal rectal venous plexus.
There is also an external rectal venous plexus.
136
What part of the anus can form a fistula?
Anal sinus.
137
What is the external anal sphincter an extension of?
Levator ani
138
What is the end of the digestive tract?
Anus
139
What is the change between the rectum and anus in terms of epithelium?
The rectum is mainly simple columnar with goblets.
The anus is mainly stratified squamous epithelium.
140
What are all the functions of the liver?
Generate plasma proteins (albumin)
Store/distribute glucose & vitamins
Detoxifies substances
Create clotting factors
Create/secrete bile
Iron metabolism/storage
141
What connects the stomach to the liver?
Lesser omentum
142
What does the left lobe of the liver touch?
Stomach, gallbladder, right colic flexture (hepatic), R kidney, and duodenum.
143
Where is most of the liver found?
URQ
144
What is the liver covered in?
Visceral peritoneum, which makes it shiny.
145
How many lobes does the liver have?
4.
Anteriorly, it only shows 2.
146
What are the ligaments that attach the liver to the body?
Right triangular ligament
Left triangular ligament
147
Which liver lobe is biggest?
Right lobe.
148
What separates the left and right lobes of the liver?
Falciform ligament.
149
Where is the gallbladder located relative to the liver?
Under the right lobe.
150
What are the 4 lobes of the liver? What separates them?
Posteriorly, you can view all 4 lobes.
The falciform ligament and ligamentum venosum separates the left lobe from the caudate lobe and quadrate lobe.
The caudate lobe is more superior to the quadrate lobe, and is separated by the portal triad.
151
What supplies blood to the liver?
Portal triad.
Arterial blood from aorta.
Venous blood from GI tract.
Bile from liver.
152
Where do I find the portal triad?
Lesser omentum, within the hepatoduodenal ligament, which is also next to the hepatogastric ligament.
153
What are the spaces between hepatocytes called?
Hepatic sinusoids, in which blood flows.
154
What stabilizes hepatocytes?
Type 3 reticular fibers. These do not impede blood flow.
Note:
Type 1 reticular fibers make up skeletal muscle, which are like steel beams.
Type 3 are more akin to steel cables.
155
What are the 3 vessels of the portal triad?
Portal vein, the largest, carrying deoxygenated blood from the gut tube and associated organs.
Hepatic artery, the smallest, carrying oxygenated blood from the aorta.
Bile duct, carrying bile FROM the liver. (has a bunch of circular cells in its center)
Note:
The lymph vessels do exist in the triad, but are not always visible.
156
What veins supply the liver and drain the liver?
Portal veins go to the liver, supplying it.
Hepatic veins leave the liver, draining their blood to the IVC.
157
Describe the venous blood flow of the liver.
Portal veins enter the liver, going through the hepatic sinusoids and draining to a central vein. Central veins combine, making 2-3 hepatic veins which go to the IVC.
158
What does the portal triad do once it enters the liver?
Branches into different segments, creating different, well-vascularized segments, all of which are separated by CT.
Individual segments are not on exam.
159
Where does most of the blood in the liver come from?
75% from the portal vein, so hepatocytes are poorly-oxygenated.
160
What is liver cirrhosis? Why is it so detrimental?
The reticular fibers that support the hepatocytes get damaged. Ito cells will replace type 1 collagen to replace them, which causes clumps to form instead of cords. Blood cannot drain through the sinusoids, which are now occluded.
161
What is hemachromatosis?
Excess iron storage. Causes diffuse pain, liver damage, and rusty skin pigmentation.
162
What is the main risk factor for hemachromatosis? Treatment?
1 in 200 european people have it.
Bloodletting is the usual treatment, aka frequent blood donations.
163
How does bile get from the liver to the gall bladder?
Hepatocytes sandwich together, making very tiny canals called bile canaliculi, which drain to the bile ducts. It then drains to larger ducts alongside the hepatic artery and portal veins before it enters the hepatopancreatic ampulla.
Note: Bile production cannot be halted, only slowed or accelerated.
164
Describe the flow of bile from the liver.
The left and right hepatic ducts combine to form the common hepatic duct.
The common hepatic duct and cystic duct combine to form the common bile duct, going down to the hepatopancreatic sphincter. The pancreatic duct also joins right before the sphincter.
Note:
The left hepatic duct contains bile from 3 lobes.
165
What connects the gallbladder to the common bile duct?
Cystic duct.
166
What is the job of the gallbladder?
Store, concentrate, and release bile made by the liver.
167
What absorbs most of the water in bile?
The tiny microvilli of the gallbladder, which can absorb 90% of the water.
168
What triggers the gallbladder to release its bile?
Fat in the duodenum.
169
What are the sinuses in the gallbladder called? Why are they an issue?
Sinuses that extend past the lumen into the muscularis externa are called Rokitansky-Aschoff sinuses. They are blind pouches, prone to chronic infections and bile stone formation.
170
Where do the gallbladder and pancreas meet?
Hepato-pancreatic ampulla, AKA ampulla of Vater.
The sphincter itself is called the hepatopancreatic sphincter, aka the sphincter of Oddi.
171
Where is the pancreas located?
Posteriorly to the stomach, forming the omental bursa's posterior wall.
172
Where is the head of pancreas located? Tail?
The head is located in the fold of the duodenum, centered.
The tail is located extending to the left, touching the spleen.
173
Why is the pancreas known as both an endocrine and exocrine organ?
The endocrine part is from the islets of Langerhans, which secrete hormones straight into the bloodstream.
The exocrine part is from the rest of the pancreas, which makes proenzymes and secretes them into the minor/major pancreatic ducts into the duodenum.
174
What kind of pH do pancreatic enzymes activate in?
Low pH, because the pancreas does not want itself to get digested.
175
Where is the major pancreatic duct found?
It is found through the body of the pancreas.
176
What are the three hormones the pancreas secretes?
Insulin
Glucagon
Somatostatin
177
Where are the islets of Langerhans found?
They are clusters of cells surrounded by the exocrine cells.
178
Why is pancreatitis bad?
It can activate the proenzymes early, causing the pancreas to digest itself.
179
Why do gallstones sometimes cause pancreatitis?
Gallstones can obstruct the hepatopancreatic ampulla, preventing release of bile and pancreatic enzymes into the duodenum, so it backs up.
180
How do I locate the spleen?
ULQ, under ribs 8-11.
181
What does the spleen come in contact with?
Stomach, transverse colon, L kidney, and diaphragm.
182
Where do the splenic vessels enter and exit?
Hilum
183
What does the spleen do?
Filters blood
Forms lymphoid cells
Eliminates/deactivates blood-borne pathogens
Destroys old platelets and RBCs
Helps with fetal hematopoiesis
184
What are the 3 areas of the spleen?
Renal area (inferiorly)
Colic area (anteriorly)
Gastric area (superiorly)
185
What is significant about the spleen for surgery?
It has a thin capsule and a lot of vascularity, so if it gets cut, it is typically completed removed.
186
What are the main things I see if I cut a spleen open?
RBCs (a lot of red pulp)
and immune lymphocytes (white pulp)
187
Where is the hilum located for the spleen?
Towards the inferior border, towards the L kidney.
188
What is the function of a splenic sinus?
It is to test RBCs to see if theyre flexible enough to enter capillaries. It involves them squeezing through annual fibers.
