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Anatomy- Abdominal Pain Flashcards

1
Q

what are the parts of the small intestine

A

duodenum (short)
jejunum (about 3m)
ileum (about 4m)

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2
Q

what are the parts of the large intestine

A

colon, rectum, anal canal and anus

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3
Q

what are the parts of the colon

A

caecum, appendix, ascending colon, transverse colon, descending colon, sigmoid colon

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4
Q

what organs are in the foregut

A

oesophagus to mid-duodenum,
liver and gall bladder,
spleen,
1/2 of pancreas

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5
Q

what organs are in the midgut

A

mid-duodenum to proximal 2/3rds of transverse colon,

1/2 of pancreas

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6
Q

what organs are in the hindgut

A

distal 1/3rd of transverse colon to proximal 1/2 of anal canal

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7
Q

what are the four quadrants of the abdominal organs

A

right and left upper and lower

divided at the level of the umbilicus and down the midline

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8
Q

what are the nine quadrants of the abdomen

A

from top to bottom left to right

right hypochondrium, epigastric, left hypochondrium

right lumbar, umbilical, left lumbar

right inguinal, pubic, left inguinal

divided by the mid clavicular lines and subcostal and transtubecular

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9
Q

which of the four quadrants in the pancreas in

A

left and right upper

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10
Q

what are the layers of the abdominal wall

A

external oblique, internal oblique, transverse abdominus, parietal peritonium

rectus abdominus in the middle of stomach (abs)

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11
Q

which way do the fibres do in the muscles of the abdominal wall

A

external wall hands in pockets
internal hands on chest
transverse
abdmoninis transverse

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12
Q

describe the paradoxical movement of stomach guarding

A

when injury threatens or in peritonitis muscles contract to guard abdominal organs

abdomen descends when you breath in and ascends when you breath out

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13
Q

what is the peritoneum

A

a thin, transparent, semi permeable, serous membrane that is continuous and lines the walls of the abdominopelvic cavity and organs

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14
Q

what is the parietal peritoneal

A

in contact with (parietal on) the body wall

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15
Q

what is the visceral peritoneal

A

in contact with (engulfing) the organs

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16
Q

what is the peritoneal cavity

A

gap between visceral and parietal layers

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17
Q

what is in the peritoneal cavity

A

lubricating fluid

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18
Q

what is peritonitis

A

inflammation of the peritoneum

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19
Q

what can cause peritonitis

A

blood, pus or faeces in the peritoneal cavity

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20
Q

what is the difference between male and female peritoneal cavities

A

females have holes in due to preproductive organs

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21
Q

describe intraperitoneal organs

A

almost completely covered in visceral peritoneum- minimally mobile

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22
Q

what is a mesentary

A

when the visceral peritoneum wraps behind the organ and forms a double layer- lollipop wrapper

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23
Q

describe organs with a mesentery

A

(still intaperitoneal organs) covered with a visceral peritoneum, mesentery suspends the organ from the posterior abdominal wall, very mobile

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24
Q

describe retroperitoneal organs

A

only has visceral peritoneum on its anterior surface, locates behind the peritoneum, stuck to the back

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25
Q

where does the mesentery attach

A

connects organs to posterior body wall

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26
Q

what are the intraperitoneal organs

A

liver and gall bladder, stomach, spleen, parts of the small intestine, transverse colom

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27
Q

what are the retroperitoneal organs

A

kidneys, adrenal gland, pancreas, ascending and descending colon

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28
Q

what is the greater and lesser curvature of the stomach

A

outside and inside edge

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29
Q

what is the omentum

A

Double layer of peritoneum that passes from stomach to adjacent organs

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30
Q

describe the greater omentum and how it moves

A

like an apron- Greater overlays the other organs, moved by the movement of peristalsis towards areas of inflammation to contain it

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31
Q

describe the lesser omentum

A

attaches stomach and duodenum to the liver

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32
Q

what are the peritoneal ligaments

A

Double layer of peritoneum connect organs to one another or body wall

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33
Q

what is in the core of the mesentery

A

blood and lymph vessels, nerve, lymph nodes and fat

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34
Q

what is the mesentery proper

A

the mesentery of the small intestine

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35
Q

what attaches the colon to the posterior body wall

A

transverse and sigmoid mesocolon

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36
Q

what attaches the appendix to the posterior body wall

A

mesoappendix

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37
Q

how much motility does the mesentery provide

A

high level of motility

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38
Q

how many layers does the greater omentum have

A

four

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39
Q

where does the greater omentum attach to

A

attaches the greater curvature of the stomach to the transverse colon

40
Q

how many layers days the lesser omentum have

A

two

41
Q

where does the lesser ometum connect between

A

lesser curvature of the stomach and duodenum to the livr

42
Q

which omentum has a free edge

A

lesser omentum

43
Q

how are the greater and lesser sacs of the omentum created

A

greater sac folds over on itself

44
Q

what is at the free edge of the lesser omentum

A

portal triad

45
Q

what is in the portal triad

A

a branch of the hepatic portal vein, a branch of the hepatic artery, and a bile duct

46
Q

how do the lesser and greater omentum sacs communicate

A

omental foramen (foramen of winslow)

47
Q

what two ligament make up the lesser omentum

A

hepatogastric ligament

hepatoduodenal ligament

48
Q

which ligament of the lesser omentum is the free edge

A

the heptoduodenal ligament

49
Q

how do you block the blood supply to the liver

A

the pringle manoeuvre at the omental foramen

50
Q

what ligament connects the left kidney to the spleen

A

splenorenal ligament

51
Q

what ligament connects the spleen to the stomach

A

gastrosplenic ligament

52
Q

what ligament connects the stomach to the liver

A

hepatogastric ligament

53
Q

describe the inferior aspect of the peritoneum

A

drapes over the superior aspect of the pelvic organs

54
Q

what is the difference between peritoneum pouches in males and females

A

one pouch in the males; rectovesical

two pouches in females; vesico-uterine, recto-uterine pouch

55
Q

what is the pouch of douglas

A

recto-uterine pouch

56
Q

what does vesico mean

A

chamber

57
Q

how is a collection off fluid in the peritoneum pouch treated

A

drainage- needle transrectally in males, transvaginally in females

58
Q

what is ascites most commonly caused by

A

liver disease- cirrhosis reduces functionality of liver and causes a build up of blood in the portal system= portal hypertension

59
Q

how can ascitic fluid be drained

A

from the peritoneal cavity by a procedure called paracentesis (abdominocentesis)

60
Q

what else can cause ascites

A

heart failure and starvation

61
Q

in a paracentesis where should the needle be placed

A

lateral to the rectus sheath

62
Q

what must be avoided in a paracentesis

A

inferior epigastric artery

63
Q

where does the inferior epigastric artery go

A

ascends in anterior abdominal wall deep to rectus abdominus

64
Q

where do inguinal hernias most commonly happen

A

inferior to the epigastric vessels

65
Q

what is visceral pain

A

pain from an organ, dull, achy and nauseating

66
Q

what is somatic pain

A

from body wall, sharp and stabbing

67
Q

what nerves supply the organs in the abdominal cavity and the visceral peritoneum

A

visceral afferents (sensory), the enteric nervous system, the autonomic nervous system

68
Q

how can you remember that afferents are sensory

A

as they arrive at the CNS from the organs

69
Q

how can you remember that para speeds up peristalsis

A

rest and digest

70
Q

what nerves supply the abdominal wall (from skin to parietal peritoneum)

A

somatic sensory nerves, somatic motor nerves, sympathetic nerve fibres

71
Q

where the sympathetic nerves that supply the abdominal organs leave the spinal chord

A

between t5 and l2

72
Q

how do the sympathetic nerves reach the abdominal organs form the CNS

A

enter the sympathetic chains but do not synapse, leave sympathetic chains within the abdminopelvic splanchnic nerves, synapse at prevertebral ganaglia which are located anterior to the aorta at the exit points of the major branches of the abdominal aorta, then go to different organs via parietal plexus

in symp- pre ganglionic short, post ganglionic long

73
Q

what are examples of prevertebral ganglia

A

celiac, superior mesenteric, aortico-renal, inferior mesenteric

74
Q

are symp nerves alone in the parietal plexus’

A

no, para fibres and visceral afferents there too

75
Q

what is the arteries role in the symp fibres getting to the abdominal organs

A

they “hitch a ride” with the arteries, and their branches, towards (or away from if sensory) the smooth muscle and glands of the organs

76
Q

what abdominal organs symp innervation is unique

A

the adrenal gland

77
Q

how do symp nerves get to the adrenal gland

A 
leave CNS at T10-11
enter abdominopelvic splanchnic nerves 
DO NOT synpase ar prevertebral ganglia 
are carried with parietal plexus to the adrenal gland 
synapse directly onto cells

acts more like a para nerve

78
Q

how does the vagus nerve reach the abdominal organs

A

leaves medulla oblongata
presynaptic para nerve fibres enter abdominal cavity on the surface of the oesophagus (vagal trunks)
travel into parietal plexus around the abdominal aorta
carried to the walls of the organs where the synapse in ganglia

79
Q

what abdominal organs does the vagus nerve supply

A

GI tract + abdominal organs up to the distal end of the transverse colon

80
Q

where do the pelvic splanchnic nerves leaves the CNS

A

S2,3 and 4

81
Q

what are pelvic splanchnic nerve fibres and what do they innervate

A

pre synaptic nerve fibres, smooth muscle/ glands of the descending colon to anal canal

82
Q

where does pain from organs in the foregut tend to be felt

A

epigastric region

83
Q

where does pain from organs in the midgut tend to be felt

A

umbilical region

84
Q

where does pain from organs in the hindgut tend to be felt

A

pubic region

85
Q

how do visceral afferent nerve fibres get from the abdominal organs to the CNS

A

Pain fibres from the vast majority of the abdominal organs run alongside sympathetic fibres back to the spinal cord

86
Q

where do visceral afferents from foregut structures enter the spinal chord

A

approx T6-T9

87
Q

where do visceral afferents from the midgut structures enter the spinal chord

A

approx T8-T12

88
Q

where do visceral afferents from the hindgut structures enter the spinal chord

A

T10-L2

89
Q

describe reffered pain from abdominal structures

A

pain from these organs tends to be perceived by the patient in the dermatomes of the levels at which they enter the spinal cord (there is a little overlap)
Spinal chord doesn’t know whether it is from organ or body wall so makes pain so assumes its from body wall

90
Q

the somatic motor, somatic sensory and sympathetic nerve fibres supplying the structures of the abdominal wall are conveyed within what nerves

A

thoracoabdominal nerves,
subcostal nerve,
iliohypogastric nerve,
ilioinguinal nerve

91
Q

describe the thoracoabdominal nerves

A

extensions of the intercostal nerves (pass costal margin and become thorcoabdominal nerves)

7th to 11th intercostal nerves, travel anteriorly, leave intercostal spaces, travel in the plane between the internal oblique and the transverse abdominus

92
Q

what is the origin of the subcostal nerve

A

T12 anterior ramus

93
Q

what is the origin of the iliohypogastric nerve

A

half of L1 anterior ramus

94
Q

what is the origin of the ilioinguinal nerve

A

other half of L1 anterior ramus

95
Q

describe the pain felt during an appendicitis

A

initially felt as a dull, aching pain but then becomes a sharper pain in the right iliac fossa

96
Q

explain the pain of an appendicitis

A

Pain from Midgut organs tends to be felt in the Umbilical region because the visceral afferents from these organs enter the spinal cord between levels T8-T10 (appendix is T10 – umbilicus)

As appendicitis worsens, the appendix will start to irritate the parietal peritoneum in the right iliac fossa, which lies anterior to it. The parietal peritoneum is part of the soma

GI (64 decks)

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