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Flashcards in Anatomy Deck (67):
1

Retroperitoneal structures

GI structures that lack mesentery and non-GI structures.
SAD PUCKER
Suprarenal (adrenal) gland
Aorta and IVC
Duodenum (2nd/3rd parts)
Pancreas (except tail)
Ureters
Colon (not transverse)
Kidneys
Esophagus (lower 2/3)
Rectum (lower 2/3)

2

Injury to retroperitoneal structures

Can cause blood or gas accumulation in retroperitoneal space

3

Falciform ligament
Connects
Structures within
From

Liver to anterior abdominal wall
Ligamentum teres hepatis (derivatives of fetal umbilical vein)
Derivative of ventral mesentery

4

Hepatoduodenal ligament
Connects
Structures within
How to stop bleeding

Liver to duodenum, connects greater and lesser sacs
Portal triad: hepatic artery, portal vein, common bile duct
Pringle maneuver: ligament may be compressed between thumb and index finger placed in omental foramen to control bleeding

5

Gastrohepatic ligament
Connects
Structures within
Separates

Liver to lesser curvature of stomach
Gastric arteries
Separates greater and lesser sacs on the right
May be cut during surgery to access lesser sac

6

Gastrocolic ligament
Connects
Structures within
Part of

Greater curvature and transverse colon
Gastroepiploic arteries
Part of greater omentum

7

Gastrosplenic
Connects
Structures within
Separates

Greater curvature and spleen
Short gastrics, left gastroepiploic vessels
Separates greater and lesser sacs on the left

8

Splenorenal
Connects
Structures within

Spleen to posterior abdominal wall
Splenic artery and vein, tail of pancreas

9

Layers of gut wall inside to outside

MSMS
Mucosa - epithelium (absorption), lamina propria (support), muscularis mucosa (motility)
Submucosa - includes submucosal nerve plexus (Meissner's)
Mucularis externa - includes Myenteric nerve plexus (Auerbach's)
Serosa - when intraperitoneal and serosa with retroperiotneal

10

Ulcers hit what layer

Ulcers can extend into submucosa, inner or outer muscular layer.

11

Erosions hit what layer

Erosions are in the mucosa only

12

Basal electric rhythm
Stomach
Duodenum
Ileum

3 waves/min
12 waves/min
8-9 waves/min

13

Cell type of esophagus

nonkeratinized stratified squamous epithelium

14

Cell type of stomach

gastric glands

15

Cell type of duodenum

Villi and microvilli increase absorptive surface
Brunner's glands (submuosa) and crypts of Liberkuhn

16

Jejunum

Plicae circulares and crypts of Liberkuhn

17

Ileum

Peyer's patches (lamina propria, submuosa), plicae circulares (proximal ileum) and crypts of Liberkuhn
Largest number of goblet cells in the small intestine

18

Colon

Crypts but no villi, numerous goblet cells

19

Abdominal aorta and branches
Branch in what direction

Arteries supplying GI structures branch anteriorly
Arteries supplying non-GI structures branch laterally

20

SMA syndrome

Occurs when the transverse portion (third segment) of the duodenum is entrapped between the SMA and aorta, causing intestinal obstruction

21

Branches of Abdominal Aorta in order

Celiac trunk (T12)
Superior mesenteric artery (L1)
R/L Renal artery (L1)
Left testicular ovarian artery
Right testicular ovarian artery
Inferior mesenteric artery (L3)
Bifurcation of abdominal aorta (L4)
Median sacral artery
L/F common iliac arter

22

Foregut
Artery
PNS
Vertebral Level
Structures

Celiac
Vagus
T12/L1
Stomach to proximal duodenum, liver, gall bladder, pancreas, spleen (mesoderm)

23

Midgut
Artery
PNS
Vertebral Level
Structures

SMA
Vagus
L1
Distal duodenum to proximal 2/3 of transverse colon

24

Hindgut
Artery
PNS
Vertebral Level
Structures

IMA
Pelvic
L3
Distal 1/3 of transverse colon to upper portion of rectum; splenic flexure is a watershed region

25

Branches of the celiac trunk

Common hepatic, splenic, left gastric --> main supply of the stomach

26

Poor anastomoses between of splenic artery blockage

Short gastrics have poor anastomoses

27

Strong anastomoses in the stomach are

Left and right gastroepiploics
Left and right gastrics

28

Collateral circulation: what compensates for
Superior epigastric (internal thoracic/mammary)
Superior pancreaticoduodenal (celiac trunk)
Middle colic (SMA)
Superior rectal (IMA)

Inferior epigastric (external iliac)
Inferior pancreaticoduodenal (SMA)
Left colic (IMA)
Middle and inferior rectal (internal iliac)

29

Esophageal varices

Site of anastomosis is esophagus --> esophageal varices
Left gastric (portal) --> esophagael (systemic)

30

Caput medusae

Site of anastomosis is umbilicus --> caput medusae
Paraumbilical (portal) --> superficial and inferior epigastric (systemic) below the umbilicus, and superior epigastric and lateral thoracic above the umbilicus

31

Internal hemorrhoids

Site of anastomosis is rectum --> internal hemorrhoids
Superior rectal (portal) --> middle and inferior rectal (systemic)

32

Varcies of gut, butt, caput are commonly see with what condition?
How do you tx?

Portal HTN
Tx: transjugular intrahepatic portosystemic shunt (TIPS) between the portal vein and hepatic vein percutaneously relieves portal HTN by shunting blood to systemic circulation

33

Pectinate (dentate) line

Formed where endoderm (hindgut) meets ectoderm

34

Above pectinate line
Dz
Arterial and venous supply
Lymph

Internal hemorrhoids (visceral innervation so not painful), adenocarcinoma
Supply from superior rectal artery (branch of IMA)
Venous drainage is to superior rectal vein --> inferior mesenteric vein --> portal system
Lymph: deep nodes

35

Below pectinate line
Dz
Arterial and venous supply
Lymph

External hemorrhoids (somatic innervation so painful), squamous cell carcinoma
Arterial supply from inferior rectal artery (branch of internal pudendal artery)
Venous drainage to inferior rectal vein --> internal pudendal vein --> internal iliac vein --> IVC
Lymph: superficial inguinal nodes

36

Apical surface of hepatocytes faces
Basolateral surface faces

Bile canaliculi
Sinusoids

37

Zones of Liver
What dz states in each zone

Zone I: periportal zone - affected 1st by viral hepatitis
Zone II: intermediate zone
Zone III: pericentral vein (centrilobular) - affected 1st by ischemia, contains P450 system, most sensitive to toxic injury, site of alcoholic hepatitis

38

Gallstones that reach the common channel at ampulla of Vater can block

Both the bile and pancreatic ducts

39

Tumors that arise in the head of the pancreas can cause

Obstruction of the common bile duct

40

Sphincter of Oddi

around the the common bile duct

41

Femoral region organization of artery, nerve, vein, lymph

Lateral to medial to find NAVEL
Nerve-Artery-Vein-empty-Lymph

42

Femoral triangle

Contains femoral vein, artery, nerve (venous near the penis)

43

Femoral sheath

Fascial tube 3-4 cm below inguinal ligament
Contains femoral vein, artery, and canal (deep inguinal lymph nodes) but NOT THE NERVE

44

Internal inguinal ring - pathology

Site of protrusion of indirect hernia

45

Layers of abdominal wall Lateral inner to outer

Parietal peritoneum
Extraperitoneal tissues
Transversalis fascia
Transversus abdominis muscle
Internal oblique muscle
Aponeurosis of external oblique msucle
Inguinal ligament

46

Abdominal wall pathology

Site of protrusion of direct hernia

47

Layers of abdominal wall medial inner to outer

Parietal peritoneum
Extraperitoneal tissues
Transversalis fascia
Rectus abdominis muscle
Pyramidalis muscle
Conjoined tendon (transversus abdominis and internal oblique)
Aponeurosis of external oblique msucle
Linea alba

48

Superficial inguinal ring

Spermatic cord
Internal spermatic fascia (transversalis fascia)
Cremasteric muscle and fascia (internal oblique)
External spermatic fascia (external oblique)

49

Hernias

A protrusion of peritoneum through an opening usually a site of weakness

50

Diaphragmatic hernia
MC

Abdominal structures enter the thorax; may occur in infants as a result of defective development of pleuroperitoneal membrane
MC hiatal hernia: stomach herniates upward through the esophageal hiatus of the diaphragm

51

Sliding hiatal hernia

is most common
GE junction is displaced upward "hourglass stomach"

52

Paraesophagael hernia

GE junction is normal
Fundus protrudes into the thorax

53

Indirect inguinal hernia
In infants?
MC gender?

Goes through the internal (deep) inguinal ring, external (superficial) inguinal ring and into the scrotum.
Enters internal inguinal ring lateral to inferior epigastric artery (occurs in infants owing to failure of processus vaginalis to close (can form hydrocele) --> MC in males

Follows path of descent of testes (covered by all 3 layers of spermatic fascia)

54

Direct inguinal hernia
Age? Gender?

Protrudes through the inguinal (Hesselbach's) triangle; bulges directly through abdominal wall medial to inferior epigastric artery. Goes through the external (superficial) inguinal ring only.
Covered by external spermatic fascia.
Usually in older men.

55

MDs don't LIe

Medial to inferior epigastric artery = direct hernia
Lateral to inferior epigastric artery = indirect hernia

56

Femoral hernia
Gender?
Leads to?

Protrudes below inguinal ligament through femoral canal below and lateral to pubic tubercle. More common in women.

Can lead to bowel incarceration

57

Hasselbach's triangle

Inferior epigastric vessels
Lateral border of rectus abdominis
Inguinal liagment

58

4 Parts of the stomach

Cardia
Fundus
Body
Antrum

59

Location of Parietal cells in stomach

Body of stomach (release HCL and IF)

60

Location of chief cells in stomach

Body of stomach (release pepsinogen)

61

Location of G cells in stomach

Antrum of stomch
Vagal stimulation of G cells by way of GRP --> releases gastrin to circulation to stimulate parietal cells (HCl and IF)

62

Location of D cells in stomach

Antrum near pyloric sphincter
Releases somatostatin

63

Location of mucous cells in stomach

Antrum
Releases of mucus

64

Location of I cells

Duodenum near pyloric sphincter
Releases CCK

65

Location of S cells

Duodenum
Releases secretin

66

Location of K cells

Duodenum
Releases GIP

67

Gastrin does what to acid secretion through what cells

Gastrin increase acid secretion primarily through its effects on ECL cells (leading to histamine release) rather than through its direct effect on parietal cells