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Anatomy > Exam 2 - Abdomen > Flashcards

Exam 2 - Abdomen Flashcards

1
Q

what is the boundaries of the abdomen?

A

diaphragm -> pubic ramus
- includes part of rib cage

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2
Q

what are the three openings in the diaphragm, what things go through them into the abdomen?

A

caval -> IVC, right phrenic
esophageal -> esophagus, vagal trunks, lymphatics
aortic -> aorta, thoracic duct, azygos vein (sometimes)

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3
Q

what are other things that go through the diaphragm that aren’t in the three openings?

A

central tendon (location of muscle connections)
intercostal nerves
median, medial, and lateral arcuate ligaments

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4
Q

what is the pelvic inlet?

A

top of sacrum -> pubic symphysis (big hole in pelvis)

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5
Q

whats the location of the intertubercular plane?

A

L5
- tubercle of crest of ilium

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6
Q

whats the location of the supracristal plane?

A

L4
- top of iliac crest, below umbilicus

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7
Q

whats the location of the subcostal plane?

A

L3
- above umbilicus

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8
Q

whats the location of the transypyloric plane?

A

L1/2
- end of 9th costal cartilage

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9
Q

what important structures are at the transpyloric plane?

A

pyloris sphincter
kidneys
spleen
gallbladder
pancreas
origin of SMA & portal vein

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10
Q

what are the three regions of the abdomen? what regions are to the side of each region?

A

epigastric (L & R hypochondrium)
umbilical (L & R flank)
pubic (L & R groin)

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11
Q

what is the location of each of the regions in the abdomen? what referred pain goes to each?

A

epi = above subcostal plane, referred from foregut
umb = above intertubercular, referred from midgut
pubic = below intertubercular, referred from hindgut

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12
Q

what major organs are in the epigastric region?

A

esophagus
stomach
duodenum
liver
gallbladder
pancreas

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13
Q

what major organs are in the umbilical region?

A

jejunum

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14
Q

what major organs are in the pubic region?

A

ileum
cecum
appendix
sigmoid colon

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15
Q

what regions are the ascending colon, transverse colon, and descending colon in?

A

ascending = epigastric, umbilical
transverse = ALL THREE
descending = ALL THREE

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16
Q

what things branch off the gut tube?

A

liver
gallbladder
pancreas

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17
Q

what organs are in the abdomen but do NOT branch off the gut tube?

A

kidneys
suprarenal gland
spleen

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18
Q

what are the two layers of smooth muscle?

A

longitudinal
circular (circumferential)

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19
Q

what are the four functions of the muscle in the gut tube? where in the gut tube does these functions occur?

A

propulsion (all parts)
trituration / crushing (stomach)
mixing (small intestine)
reservoir (stomach, colon)

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20
Q

what is the INN of the enteric NS?

A

mainly parasympathetic (visceral nonsensory)
- some symp

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21
Q

where do the nerves run in the abdomen?

A

between the mesentery!

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22
Q

what are the two nerve plexuses in the abdomen? where are they? whats their main function?

A

myenteric plexus (circular muscle) = muscle contraction
meissner plexus (submucosa) = secretion of gut fluids

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23
Q

what is peristalsis initiated by?

A

distention of gut tube or brushing of vili

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24
Q

what muscles are relaxed and contracted in front of the moving bolus?

A

longitudinal contract
circular relax

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25
Q

what muscles are relaxed and contracted behind the moving bolus?

A

longitudinal relax
circular contract
* default myogenic state *

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26
Q

what is a physiological ileus?

A

no motility in small or large intestine

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27
Q

what organs are supplied by the celiac trunk?

A

liver
stomach
pancreas
spleen
gallbladder
part of duodenum

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28
Q

what organs are supplied by the superior mesenteric artery?

A

dudenum
jejunum
ileum
as. colon
trans. colon

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29
Q

what organs are supplied by the inferior mesenteric artery?

A

desc. colon
sigmoid
rectum

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30
Q

what are the five main sphincters? what is the sixth one that isn’t technically a sphincter, but acts like one?

A

lower esophageal
pyloric
sphincter of oddi
ileocolic
internal anal

diaphragm

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31
Q

what is achalasia?

A

failure to open sphincter

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32
Q

what is the peritoneum derived from?

A

celom

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33
Q

what is the periotneum? list the two types and then describe

A

parietal peritoneum: on body wall, INN VISCERAL
visceral peritoneum: closed bag incasing abdominal organs

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34
Q

what is intraperiotneal? retroperiotoneal? what are the retro organs?

A

intra = incased organs
retro = push periotoneum from behind
*aorta, esophagus, kidneys, parts of intestine

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35
Q

what is the mesentery?

A

double layer of peritoneum that attaches the organs to the abdominal wall
- attaches vessels, nerves, lymphatics to organs
- INN vsiceral!

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36
Q

what is the greater omentum?

A

big layer of fat that runs from the stomach to the transverse colon (created by the mesentery folding)

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37
Q

what is the lesser omentum?

A

space under the liver and above the lesser curve of stomach

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38
Q

what is the lesser peritoneal sac? greater peritoneal sac?

A

lesser = area behind stomach, liver, and their connecting mesentery
greater = everything else!

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39
Q

what is the inferior recess?

A

behind greater omentum

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40
Q

what is the superior recess?

A

behind liver and stomach
- used to communicate to abdomen

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41
Q

in development, what does the cephalic limb of the primary intestinal loop turn into?

A

upper midgut
- distal duodenum
- jejunum
- part of ileum

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42
Q

in development, what does the caudal limb of the primary intestinal loop turn into?

A

lower midgut
- distal ileum
- cecum
- appendix
- as. colon
- 2/3 trans. colon

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43
Q

describe the rotation of the gut?

A
  • caudal end twists upward, now caudal is on top & cephalic is on bottom
  • cephalic limb starts to get wiggly & herniation reduces
  • cecum descends & final form starts
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44
Q

what supplies the foregut, midgut, and hindgut of the developing embryo at 4 weeks?

A

celiac a = foregut
SMA = midgut
IMA = hindgut

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45
Q

what are the layers of the abdominal wall in order?

A

skin
campers fascia (fatty layer)
scarpa’s fascia
ex. oblique
int. oblique
transversus abdominalis
transversalis fascia
extraperitoneal fascia (fatty layer)
parietal peritoneum

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46
Q

what is the insertion and origin of the external oblique?

A

rib 5-12
iliac crest

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47
Q

what is the insertion and origin of the internal oblique?

A

ribs 10-12
iliac crest

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48
Q

what is the insertion and origin of the transversus abdominalis?

A

ribs 6-12
pubic bone

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49
Q

what is the insertion and origin of the rectus abdominalis?

A

xiphoid
pubic bone

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50
Q

what is the line called where the rectus sheath ends?

A

accuate line

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51
Q

what symp. intercostal nerve supplies organs int he umbilicus region?

A

T10

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52
Q

what intercostal region is at the top of the iliac crest?

A

T11

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53
Q

what region includes the last rib?

A

T9

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54
Q

what is the blood route of the abdomen starting at the aorta?

A
  1. aorta
  2. subclavian
  3. internal thoracic a -> musclophrenic, superior epigastric a
  4. sup. epigastric anastimosis w/ inferior epigastric a
  5. external iliac a. -> deep circumflex iliac, femoral a
  6. femoral a. -> superficial circumflex iliac, superficial epigastric a.
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55
Q

what are the trunk flexors?

A

erector spinae
obliques
psoas (when thigh is fixed)

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56
Q

what are the trunk extensors?

A

erector spinae

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57
Q

why are the erector spinae muscles and rectus abdominus enclosed in a tight sheath? what is those tight sheaths called?

A

restricts lateral expansion of muscle and increases axial force
- waste energy for muscle to bulge outwards
- thorcolumbar fasic, erector sheath

58
Q

what allows for lateral flexion?

A

quadratus lumborum
ipsilateral obliques
psoas

59
Q

what allows for rotation?

A

external obliques (front to opposite)
internal obliques (front to same)
psoas

60
Q

what creates the intrabdominal pressure? what does this pressure help with?

A

contraction of anterior wall muscles, sucking in
- aids in micturation (urination), defecation (shitting), respiration, childbirth, coughing

61
Q

what does the psoas connect to on the vertebrae?

A

T12-L4

62
Q

when do the testes descend into the scrotum?

A

26 weeks of development on the 2-3rd day
- 3% do not have descended testes

63
Q

what is the area of weakened transversalis fascia called?

A

Hesselbach’s triangle

64
Q

what two ligaments is the hesselbach’s triangle b/w?

A

medial and lateral umbilical ligament

65
Q

what are the two rings for teste descent? where are they?

A

deep inguinal ring
superficial inguinal ring
* above inguinal lig & below apopneurosis of ex oblique

66
Q

what layers is pinched off when the testes descend? what new layer does this create?

A

parietal peritoneum is pinched off to create the tunica vaginalis

67
Q

what are the layers of the spermatic cord?

A

skin
dartos fascia
external spermatic fascia
cremaster muscle & fascia
internal spermatic fascia
loose fascia (surround vessels, nerves, ductus deferens)

68
Q

what are the layers of the scrotum?

A

skin dartos fascia
external spermatic fascia
cremaster muscle & fascia
internal spermatic fascia
loose fascia (surround vessels, nerves, ductus deferens)
tunica vaginalis testis *

69
Q

what is an indirect inguinal hernia?

A

pushed over inguinal ligament and gets stuck in deep inguinal ring, pushed through spermatocord

70
Q

what is a direct inguinal hernia?

A

pushed over inguinal lig and through hesselbach’s triangle

71
Q

what is a femoral hernia?

A

pushed through femoral canal under the inguinal lig

72
Q

what are the four mucosa types? which organs have them?

A

protective (esophagus, anal canal)
secretory (stomach)
absorptive (small intestine)
absorptive / protective (colon)

73
Q

what is the muscle like in the esophagus?

A

upper 1/3 is striated muscle
lower 2/3 is smooth muscle

74
Q

what is the INN of the esophagus?

A

vagus
symp T1-5

75
Q

what is the blood supply of esophagus?

A

branches of left gastric a

76
Q

what is the function of the esophagus?

A

transport food, prevent emesis, peristalsis

77
Q

what are the two types of peristalsis in the esophagus? describe them

A

primary = initiated by swallowing
secondary = if food doesn’t go down, mechanoreceptors initiate another round

78
Q

what is GERD?

A

stomach acid flowing upwards into the esophagus

79
Q

what is Barret’s esophagus?

A

since the stomach and esophagus are genetically the same (just have different genes active) the stomach acid converts the cells in the esophagus due to GERD
- leads ot adenocarcinoma (cancer)

80
Q

what are the two sphincters of the esophagus? what are their INN?

A

lower esophageal (vagus) -> smooth muscle
diaphragm (phrenic) -> striated muscle

81
Q

what is the structure of the lower esophageal sphincter?

A

incomplete muscle ring that makes clasp fibers
- these fibers convert to sling fibers and fuse w/ the deepest layer of the stomach, oblique

82
Q

what are the three muscle layers of the stomach?

A

longitudinal, circular, oblique

83
Q

what is the INN of the stomach? referred pain?

A

vagus
symp T5-7
- referred to epigastric & left hypochondriac

84
Q

what is the blood supply of the stomach?

A

L & R gastric a
gastroepipolic a
short gastric

85
Q

what are the branches off of the celiac trunk?

A

left gastric
hepatic
splenic

86
Q

what branches off of the hepatic a?

A

hepatic prosper -> left & right liver lobes
right gastric
gastroduodenal -> gastroepipolic, superior pancreaticoduodneal

87
Q

what branches off the splenic a?

A

left gastropipolic
short gastric

88
Q

what are the two main functions of the stomach? describe them

A

proximal / upper stomach (reservoir)
- tonic contractions (slow, sustained)
- maintains constant pressure on contents

antral region (muscle contractions)
- phasic contractions (rapid, drastic)
- if stomach is closed, retropulsion back into stomach

89
Q

what is the migrating motor complex? (MMC)

A

interdigestive mechanism in the small intestine
- moves food & clears contents very slowly
- moves bile through, preventing concentration of bile
- prevents bacterial growth

90
Q

what INN is involved with the initiation of mixing in the small intestine?

A

vagus efferents

91
Q

what are the four parts of the duodenum, in order?

A

superior, descending, inferior, ascending

92
Q

what is the function of the duodenum?

A

mixes chyme with bile & pancreatic secretions

93
Q

what is the INN of the duodenum? referred pain?

A

vagus
symp T7-9
- referred to epigastric & right shoulder

94
Q

what is the blood supply of the duodenum?

A

supraduodenal a
gastroduodenal a
pancreaticoduodenal a (sup, inf)

95
Q

where on the duodenum is the foregut-midgut transition?

A

ampula of vater
- area for bile & pancreatic secretions

96
Q

what are the branches off of the SMA? what do they supply blood to?

A

jejunal branches -> ileum branches, ileocolic (cecum, lower part of as. colon)

right colic (upper part of as. colon)

middle colic (majority of trans. colon)

97
Q

what are the branches off of the IMA? what do they supply blood to?

A

left colic (desc. colon, part of trans. colon) -> sigmoid branches
superior rectal

98
Q

what runs through the root of mesentery?

A

SMA, SMV along with other veins, nerves, and lymphatics
- at the 4th part of duodenum -> ileocostal junction)

99
Q

where is the jejunum mostly?

A

umbilical region
- 2/5 of small intestine
- wrinkled apperance in xrays

100
Q

where is the ileum mostly?

A

pubic region
- 3/5 of small intestine

101
Q

what supplies blood to the jejunum and ileum?

A

j = jejunal branches of SMA
i = ileal branches of SMA

102
Q

what does the lymphatics of the gut do?

A

collect extracellular fluid in the vascular capillary beds
- including pathogens, lymphocytes, cell debris
- have tight junctions to ensure only the right things pass thru

103
Q

what is an important structure of the small intestine lymphatic system? describe them

A

lacteals
- drain chylomicrons to lymph system
- major route for the transport of fat from intestine to bloodstream
- important clinically, because this bypasses the liver, making the concentration of materials higher in blood (DRUGS!)

104
Q

what two types of cells are involved with things such as Peyer’s Patches?

A

M-cells
dendritic cells

105
Q

what is the INN of the ileocecal junction? referred pain?

A

vagus
symp 10
- referred to umbilicus

106
Q

what is the function of the appendix?

A

hides the good bacteria when power propulsion happens
- makes it so the good bacteria can grow after being striped from lumen

107
Q

what pathways does referred pain follow?

A

sympathetic nerve paths
- multiple sensory neurons converge on a single ascending tract

108
Q

what is the thin tendon that runs through the middle of the large intestine?

A

taeniae coli

109
Q

what are the little fat blebs that come off the taeniae coli?

A

appendices epiploicae

110
Q

what two things doe the large intestine hit? where?

A

right colic fissure hits liver
left colic fissure hits spleen

111
Q

what are the permanent swellings of the large intestine called?

A

haustrae

112
Q

what is the INN of the large intestine?

A

switches from vagus -> pelvic splanchnic at left colic fissure

113
Q

what is the blood supply of the large intestine?

A

switches from SMA -> IMA (left colic) at left colic fissure

114
Q

what is the hepatorenal recess?

A

below liver, above post. side of kidney

115
Q

what is the subphrenic recess?

A

above liver in front

116
Q

what are some functions of the liver?

A

produce bile
metabolizes carbs, fats, proteins
filtration of blood from intestines

117
Q

what is the INN of the liver? referred pain?

A

vagus
symp T7-9
- referred to epigastric and right hypocondrium

118
Q

what is the blood supply of the liver?

A

hepatic prosper a (30%, 50% o2)
portal vein (70%, 50% o2)

119
Q

where does the portal vein and hepatic prosper a blood mix in the liver?

A

sinusoids

120
Q

what carries the blood back to the hear for the liver?

A

hepatic veins -> IVC -> heart

121
Q

describe the stages of liver failure

A

fatty liver -> overproduction of fat stays in liver
liver fibrosis -> fat turns into fibrous connective tissue (scaring)
cirrhosis -> fully scared over

122
Q

what cells help the liver regenerate?

A

hepatocytes

123
Q

how many functional liver segments are there?

A

8
- each have their own vascular inflow, outflow, and biliary drainage
- veins drain at boarders of segments

124
Q

where does the bile go if the sphincter of oddi is open?

A

duodenum -> distal ileum to be absorbed by SMA -> liver

125
Q

what makes bile? where does this bile go to?

A

hepatocytes -> canaliculi

126
Q

what is the function of the gallbladder?

A

concentrates by absorbing water and storing bile

127
Q

what is the INN of the gallbladder? what does each contract & relax? referred pain?

A

vagus (contract GB, relax sphincter)
symp T7-9 (relax GB, contract sphincter)
- goes through phrenic n to right shoulder & C3-4

128
Q

what is unique about duodenum histology?

A

short-leaf like vili
brunners glands in submucosa

129
Q

what do brunner’s glands do?

A

neutralize acid in stomach

130
Q

what is unique about jejunum histology?

A

long club like vili
no glands in submucosa

131
Q

what is unique about ileum histology?

A

short slender finger vili
Peyer’s patches in submucosa
more goblet cells

132
Q

what do peyer’s patches do?

A

lymaphatics

133
Q

what is unique about appendix histology?

A

no vili, only a few crypts
lymphoid follicle in lamina propria

134
Q

what is unique about colon histology?

A

no vili, only lots of crypts
lots of goblet cells
no cells at bottom of crypts

135
Q

what is unique about esophagus histology?

A

stratified epithelium
glands in submucosa

136
Q

what is unique about fundus histology?

A

straight vili
shallow gastric pits
long glands

137
Q

what types of glands are in the fundus? what are their functions?

A

parietal cells -> secrete gastric juice
chief cells -> secrete pepsin
neuroendocrine -> hormones

138
Q

what is unique about pylorus histology?

A

coiled vili
deep gastric pits
G-cell in lamina propria

139
Q

what do G-cells do?

A

secrete gastrin and stimulate fundus

140
Q

what is unique about cardia histology?

A

coiled vili
pits are not as deep as pylorus
few glands

141
Q

what are the layers for histology in this unit?

A
  1. epithelium
  2. lamina propria
  3. muscularis mucosa (smooth muscle)
  4. submucosa
  5. oblique (stomach), circular muscle
  6. longitudinal muscle
  7. serosa or adventitia

Anatomy (4 decks)

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