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Peritoneum, Abdominal Viscera (82 cards)

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1
Q

What is the peritoneum?

A

continuous transparent serous membrane

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2
Q

What is the parietal peritoneum and what is it sensitive to?

A

lines abdominal cavity wall; sensitive to pressure, pain, heat, cold, and laceration

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3
Q

What is the visceral peritoneum?

A

covers abdominal viscera; insensitive to touch, heat, cold, and laceration; sensitive to stretch & chemical irritation; pain referred to the region the organ belongs to (foregut, midgut, hindgut)

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4
Q

What does the peritoneal cavity develop from and what does it do?

How much peritoneal fluid does it contain?

A

develops from visceral mesoderm and folds over gut tube as it develops

wraps around & suspends portions of gut from dorsal wall and ventral wall

there are no organs within the cavity

contains ~50mL

Notes: very complex shape; surface area is larger than skin

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5
Q

What is the mesentery?

A

double layer of peritoneum that connects intraperitoneal organ to abdominal wall

other mesenteries: transverse & sigmoid mesocolons; mesogastrium, mesoappendix

Notes: small intestine mesentery commonly called “the mesentery”

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6
Q

What is the omentum?

A

double layered extension or fold of peritoneum that passes from stomach & proximal duodenum to adjacent organs

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7
Q

Where is the greater omentum?

A

4 layers; from greater curve of stomach to proximal duodenum & folds back to attach to anterior surface of transverse colon

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8
Q

Where is the lesser omentum located?

A

smaller, 2 layers; connects lesser curve of stomach to liver

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9
Q

What is the peritoneal ligament?

A

double layer peritoneum that connects an organ to another organ or the abdominal wall

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10
Q

The liver connects to the anterior abdominal wall via what ligament?

A

falciform ligament

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11
Q

The liver connects to the stomach via what ligament?

A

hepatogastric ligament

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12
Q

The liver connects to the duodenum via what ligament?

A

hepatoduodenal ligament

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13
Q

What does the transverse mesocolon divide the peritoneal cavity into and what does it contain?

A

divides cavity into supracolic compartment

contains: stomach, liver, spleen, AND an infracolic compartent containing small intestine, ascending & descending colon

infracolic compartment is posterior to greater omentum and is divided into L and R infracolic spaces (by mesentery of small intestine)

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14
Q

What are paracolic gutters?

A

communicating passages between the infra & supracolic compartments

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15
Q

What does the digestive tract consist of?

A

esophagus, stomach, small intestines, large intestines

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16
Q

What are the accessory organs of digestion?

A

liver, gallbladder, pancreas

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17
Q

What is the foregut comprised of and where is pain referred?

A

esophagus, stomach, duodenum (proximal to bile duct), liver, & biliary ducts

pain referred to epigastrium

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18
Q

What organs comprise the midgut & where is pain referred?

A

small intestine (distal to bile duct), cecum, appendix, ascending colon & most of transverse colon

pain referred to periumbilical area

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19
Q

What organs comprise the hindgut and where is the pain referred?

A

distal transverse colon, descending colon, sigmoid colon, & rectum

pain is reffered to the hypogastrum

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20
Q

What is the purpose of the esophagus and where are the constriction points located?

A

conveys food bolus from pharynx to stomach

1) pharyngoesophageal junction
2) bronchoaortic
3) diaphragmatic constriction

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21
Q

What are the two muscles layers of the esophagus for peristalsis and where does it pass through the diaphragm?

A

internal circular layer & external longitudinal layer (proximal 1/3 of external muscle is under voluntary striated muscle control, inferior 1/3 is smooth muscles, middle 1/3 is mix)

Passes through elliptically shaped esophageal hiatus of diaphragm just L of midline of T10

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22
Q

Where is the stomach related to the peritoneal cavity and what are the 4 parts?

A

intraperitoneal

cardia, fundus, body, pyloric

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23
Q

Where is the cardia located?

A

surrounds the opening into the superior stomach; ~6th L costal cartilage; T11 level

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24
Q

Where is the fundus of the stomach located?

A

superior segment- lies against L diaphragm (when supine: pos to L 6th rib at MCL)

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25
Where is the pyloric portion of the stomach located and what is it's function?
funnel-shaped outflow region w/widest intake area called **pyloric antrum** --\> **pyloric canal** --\> **pyloris/pyloric sphincter** which controls the flow of **chyme** into SI
26
What are rugae and what is their purpose?
internal gastic folds allow for expansion of stomach and increase surface area for digestion
27
What is the vasculature of the stomach and what is the drainage of the veins?
**all arterial supply comes from branches off the celiac trunk (a branch of the abdominal aorta)** **all veins drain into hepatic portal system for blood to be cleaned by liver**
28
What lymphnodes drain the superior 2/3rds of stomach?
**gastric nodes & pancreatosplenic nodes**
29
What lymphnodes drain the right 2/3rds or inferior 1/3rd of the stomach?
**the pyloric nodes**
30
What lymphnodes drain the left 1/3 or inferior 1/3 of stomach?
**pancreaticoduodenal nodes**
31
What are the parasympathetic nerves supplying the stomach?
anterior vagal trunk and posterior vagal trunk
32
What is the anterior vagal trunk dervied from and what nerve branches does it give off?
from L vagus nerve; gives off **hepatic, duodenal, & anterior gastric** nerve branches
33
What is the posterior vagal trunk derived from, what does it supply, & what branches does it give off?
from R vagus nerve; supplies anterior & posterior stomach; gives off **celiac plexus & anterior gastric branch**
34
Where are the sympathetic nerves of the stomach located?
**from T6-T9 & pass through greater splanchic nerve to celiac plexus around gastric & gastro-omental arteries**
35
Where is the duodenum located and what are the segments?
most is fixed to abdominal wall by peritoneum (partially retroperitoneal) superior, descending, inferior (horizontal), ascending
36
What is the hepatopancreatic ampulla?
where **common bile duct and pancreatic duct** joins to enter the posteriomedial portion of the descending duodenum
37
What is the vascular supply hepatopancreatic ampulla supplied by?
**celiac trunk branches- gastroduodenal & superior pancreaticoduodenal arteries**
38
What is the vascular supply distal to hepatopancreatic ampulla supplied by?
**from superior mesenteric artery branch- inferior pancreaticoduodenal artery**
39
What do the anteror lymphatic vessels of the duodenum drain into?
**into pancreaticoduodenal nodes then into pyloric nodes**
40
What do the posterior vessels of the duodenal lymphactics drain into?
**superior mesenteric nodes**
41
Where is the nerve supply from to the duodenum?
**from vagus and greater and lesser splanchnic nerves via celiac & superior mesenteric plexuses**
42
Where is the jejunum & ileum located?
intraperitoneal; attached to posterior abdominal wall by "the mesentery"
43
What is the vascular supply to the jejunum & ileum?
**superior mesentery artery branches --\> jejunal arteries, ileal arteries**
44
What are the lymphatic vessels in the intestinal villi called, what do they do, and where do they drain?
called **lacteals;** absorb fat from gut & drain via intramesenteric vessles into 3 sets of nodes: juxta-intestinal, mesenteric, and superior central
45
Where do the sympathetic and parasympathetic fibers of the jejunum and ileum originate from?
Sympathetic: from T8-T10 SC levels Parasympathetic: from **posterior vagal trunk**
46
What are the 3 controls of motility and secretion?
What are the 3 controls of motility and secretion? enteric NS, autonomic, intrinsic
47
What are the plexuses of the enteric NS and what does it control?
**auerbach & meissner plexus (both internal)** auerbach: b/t smooth muscle; controls and coordinates motility along entire gut meissner: in submucosal layer; controls local motility & secretion and blood flow
48
Intrinsic intenstinal motility has what type of character and how long does it take?
smooth muscle cells have intrinsic slow-wave activity; 12/min in duodenum, 8-9/min in ileum
49
What organs are in the foregut and what is it supplied by?
**esophagus, stomach, duodenum (proximal to bile duct), liver, biliary ducts** **supplied by branches from the celiac trunk**
50
What organs are in the midgut and what is it supplied by?
**duodenum [distal to bile gut], jejunum, ileum, cecum, ascending colon, most of transverse colon** **supplied by branches from the superior mesenteric artery**
51
What is in the hindgut and what is it supplied by?
**distal transverse colon, descending colon, sigmoid colon, rectum** **supplied by branches from the inferior mesenteric artery**
52
What comprises the large intestines?
cecum (w/appendix), ascending colon, transverse colon, descending colon, sigmoid colon, rectum, anal canal
53
What is the cecum and where does it attach?
first part of large intestine & continuous w/ascending colon commonly attached to lateral abdominal wall by one or more peritoneal folds (cecal folds) Notes: blind pouch, ~7.5cm; enveloped in peritoneum; can be lifted freely from R iliac fossa
54
What is the ileal orfice and ileocecal valve?
ileal orifice: distal opening of ileum to cecum ileocecal valve: not true sphincter muscle (a "flap")
55
What is the appendix and where does it attach?
blind intestinal diverticulum (pouch) w/masses of lymphoid tissue attaches to cecum via mesoappendix mesentery; **most common location is retrocecal** BUT may be found in any position
56
What is the blood supply to the cecum and appendix?
cecum: ileocecal artery (branch of SMA) appendix: appendicular artery (branch of ileocecal) venous return via ileocecal vein to SMV
57
What are the lymphatics to the cecum and appendix?
ileocecal nodes to superior mesenteric nodes
58
What are the nerves of the cecum and appendix?
superior mesenteric plexus (both sympathetic [lower T SC] and parasympathetic [vagus nerve])
59
What are the 4 parts of the colon?
ascending, transverse, descending, and sigmoid
60
Where is the ascending colon located?
from cecum --\> R lobe of liver (hepatic flexure) becoming the transverse; **retroperitoneal**
61
Where is the transverse colon located?
from hepatic flexure horizontally ascross abdomen to spleen (splenic flexure) becoming the descending; **intraperitoneal**
62
Where is the descending colon located?
from splenic flexure to L iliac fossa & sigmoid colon; **retroperitoneal**
63
Where is the sigmoid colon located?
s-shaped- from L ilac fossa to rectum in midline (~S3); **intraperitoneal**
64
Where is the rectum located?
terminal colon; retro & subperitoneal
65
What is the function of the liver, where is it located, and how does it move?
**produces bile continuously** located in RUQ moves with respiration
66
What are the lobes of the liver and which have hepatic ducts?
right (largest) and left (both have hepatic ducts) right lobe has 2 accessory lobes called caudate & quadrate
67
What is the blood supply to the liver?
dual afferent supply from hepatic artery and hepatic portal system hepatic artery is a **branch off celiac trunk** & supplies mostly to hepatic ducts (non-parenchymal) hepatic portal system delivers blood from GI tract to liver & provides nutrition & oxygen
68
How does the lymphatic system drain through the liver?
drains to **hepatic nodes and phrenic nodes** then to celiac nodes to **cisterna chyli** (distal end of thoracic duct)
69
Where is the innervation of the liver derived from?
derived from hepatic plexus (from celiac plexus) and travel w/hepatic arteries & portal veins sympathetic fibers from celiac plexus parasympathetic fibers from anterior & posterior vagus trunks
70
What comprises the common hepatic duct and how does it travel?
R & L hepatic ducts (one from each lobe) converge to form **common hepatic duct** which converges with the **cystic duct** (from GB) to form **bile duct (formerly common bile duct)** 75% of population **bile duct & pancreatic duct** join to form **short hepatopancreatic duct**; **hepatopancreatic duct** enters posteromedial descending duodenum at the **ampulla of vader** each duct (bile & pancreatic) has a sphincter muscle at terminal end BEFORE forming the **hepatopancreatic duct**
71
Where is the sphincter of oddi located & what does it control?
It is located in the ampulla of vader & controls flow of juices from liver/GB and pancreas
72
Where is the liver located and how much bile can it hold?
located in GB fossa of liver along superior portion of duodenum & can hold up to 50mL of bile
73
What is the function of the pancreas and where is it located?
exocrine and endocrine functions in "C" of duodenum projecting behind stomach toward LUQ w/tail ending at spleen **retroperitoneal**
74
How does pancreatic juice travel?
exocrine secretions (pancreatic juice) flows to duodenum via **pancreatic duct AND accessory pancreatic duct**
75
Where does the pancreas attach and where is the bile duct located?
head is attached via peritoneal ligaments to duodenum bile duct lies in groove on pos side of pancreas OR embedded within the substance of the head
76
How does the main pancreatic duct travel?
runs from tail through parenchyma of pancreas to head where it joins w/bile duct to enter the duodenum at ampulla of vater
77
How do the lymphatics of the pancreas travel?
follow blood vessels to **pancreaticosplenic nodes** along splenic artery OR to pyloric nodes
78
What are the nerves that supply the pancreas?
nerve branches from vagus and splanchinic nerves
79
What is the function of the spleen and how far does it extend?
most delicate & vulnerable organ largest lymohatic organ; proliferation of lymphocytes NML sized doesn't extend lower than L costal margin
80
What is the blood supply to the spleen?
supplied from splenic artery and is returned via splenic vein to SMV to hepatic portal vein
81
What are the lymphatics of the spleen?
nodes in hilum to pancreaticosplenic nodes along superior pancreas to celiac nodes
82
What is the innervation of the spleen?
from celiac plexus following branches of splenic artery

Gastroenterology (5 decks)

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