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Flashcards in GI-Anatomy Deck (55):
1

What is a retroperitoneal structure?

Organs are retroperitoneal if they have peritoneum on their anterior side only. Structures that are not suspended by mesentery in the abdominal cavity and that lie between the parietal peritoneum and abdominal wall are classified as retroperitoneal

2

What are the retroperitoneal structures of the abdomen?

SAD PUCKER

Suprarenal (adrenal) glands

Aorta and IVC

Duodenum (2nd through 4th parts only)

Pancreas (except tail)

Ureters

Colon (descending and ascending)

Kidneys

Esophagus (thoracic portion)

Rectum

3

What does the falciform ligament do?

it connects the liver to the anterior abdominal wall

4

What structures are found within the falciform ligament?

ligamentum teres hepatis 

5

Where does the ligamentum teres derive from?

the umbilical vein

6

T or F. The ligamentum teres is a derivative of the ventral mesentery

T.

7

What does the hepatoduodenal ligament do?

connects the liver to the duodenum

8

What structures are contained within the hepatoduodenal ligament?

portal triad: proper hepatic a., portal vein, and common bile duct

9

What is a pringle maneuver?

pinching the heaptoduodenal ligament in between the thumb and index finger while placed in the omental foramen to control bleeding

10

What does the gastrohepatic ligament do?

connect the liver to the lesser curvative of the stomach

11

What does rhe splenorenal ligament do? What structures are contained within it?

it connects the spleen to the posterior abdominal wall and contains the splenic a. and v., and the tail of the pancreas

12

What are the layers of the gut wall from luminal to internal?

MSMS

Mucosa (includes the epithelium, lamina propria, and the muscularis mucosa)

Submucosa (including the Meissner plexus)

Muscularis externa (including the Auerbach nerve plexis)

Serosa 

13

What is the epithelium of the esophagus?

nonkeratinized stratified squamous 

14

What are the branches of the aorta at T12?

Celiac trunk anteriorally and two inferior phrenic aa. laterally

15

What are the branches of the aorta at L1?

the SMA anteriorally and the left middle suprarenal a. and

slightly below these two branch the left and right renal aa.

16

What branches anteriorally off the aorta just below the left and right renal aa. at about L2?

the left and right testicular/ovarian aa.

17

What branches from the aorta at L3?

the inferiror mesenteric. a

18

Where does the aorta bifurcate?

L4

19

20

Describe the arterial supply, parasympathetic innervation, and vertebral levels of the foregut

Celiac a.

Vagus n.

T12-L1

21

Describe the arterial supply, parasympathetic innervation, and vertebral levels of the midgut

SMA

Vagus

L1

22

Describe the arterial supply, parasympathetic innervation, and vertebral levels of the hindgut

IMA

Pelvic n.

L3

23

What structures are supplied by the embryonic foregut?

pharynx (vagus n. only)

low esophagus to proximal duodenum

liver, gallbladder, pancreas, spleen

24

What structures are supplied by the embryonic midgut?

distal duodenum to proximal 2/3 of the transverse colon

25

What structures are supplied by the embryonic hindgut?

Distal 1/3 of transverse colon to upper portion of rectum above the pectinate line

26

What are the branches of the celiac trunk?

common hepatic a.

splenic a.

left gastric a. 

27

What is the pectinate line?

this forms in the rectum where the endoderm (hindgut) meets ectoderm

28

What are some associations above the pectinate line?

internal hemorrhoids, adenocarcinoma

29

What is the arterial supply above the pectinate line?

superior rectal a. from the IMA

30

What is the venous drainage above the pectinate line?

superior rectal vein to the inferior mesenteric vein to the portal system

31

Are internal hemorrhoids painful? Why or why not?

No, because they receive visceral innervation

32

What is the lymphatic drainage above the pectinate line?

internal iliac nodes

33

What are some associations below the pectinate line?

external hemorrhoids, anal fissures, and squamous cell carcinomas

34

What is the arterial supply below the pectinate line?

the inferior rectal a., a branch of the internal pudendal a.

35

What is the venous drainage below the pectinate line?

inferior rectal vein to the internal pudendal vein to the internal iliac vein to the common iliac vein to the IVC

36

Why are external hemorrhoids painful?

they receive somatic innervation from the inferior rectal branch of pudendal n. and are thus painful if thrombosed

37

What is the lymph drainage below the pectinate line?

superficial inguinal

38

What hepatic zone is affected first by viral hepatitis?

Zone 1 aka periportal zone (also the site for ingested toxins like cocaine)

39

What zone is affected by yellow fever?

Zone II (intermediate zone)

40

Describe the pericentral vein (centrilobular) zone

-affected 1st be ischemia

-contains CYP P450s

-most sensitive to metabolic toxins

-site of alcoholic hepatitis

41

Describe the flow of bile

the right and left hepatic ducts combine to form the common hepatic duct which combines with the cystic duct from the gallbladder to form the common bile duct which combines with the main pancreatic duct to empty into the 2nd part of the duodenum at the ampulla of vater

42

Describe the organization of the femoral region

Lateral to medial: NAVEL

Nerve-Artery-Vein-Empty Space- Lymphatics (contained in the femoral ring-site of femoral hernias)

43

What structures are contained within the femoral sheath?

femoral vein, artery, and canal but not femoral nerve

44

What are the main types of hernias?

-diaphragmatic

-Indirect inguinal

-direct inguinal 

-Femoral 

45

What is a diaphragmatic hernia?

herniation of abdominal structures upward through the diaphragm

46

What are the most common causes of diaphragmatic hernias?

typically congenital due to defect in the pleuroperitonel membrane, or as a result of trauma.

NOTE: These msot commonly occur on the LEFT side due to relative protection of right hemidiaphragm by the liver

47

What is the most common type of diaphragmatic hernia?

A hiatal hernia, in which the stomach herniates through the esophageal hiatus at T10 and more specifically, a sliding hiatal hernia (center below) in which the gastroesophageal junction is displaced upward ("hourglass" stomach)

48

What is a paraesophageal hernia?

a diaphragmatic hernia in which the gastroesophageal junction is not displaced but the stomach fundus protrudes into the thorax

49

What is an indirect inguinal hernia?

this is herniation of abdominal contents via the following route:

through the deep ingunal ring LATERAL to the INFERIOR EPIGASTRIC A., out of the external (superficial) inguinal ring and into the scrotum (i.e. the path of the testes when they descend to the scrotum)

50

T or F. Indirect inguinal hernias are covered by all 3 layers of spermatic fascia (i.e. the internal spermatic fascia, cremasteric fascia and muscle, and external spermatic fascia)

T.

51

52

Why would an indirect hernia occur in infants?

due to failure of the processus vaginalis to close properly

53

What is a direct inguinal hernia?

herniation through Hesselbach's triangle, located between the rectus abdominis muscle medially, the inguinal ligament inferiorly, and the inferior epigastric vessels laterally (thus this occurs MEDIAL to the inferior epigastric vessels)

54

A direct inguinal hernia goes through the _____ inguinal ring only

superficial (so it is covered by the external spermatic fascia only). These usually occur in older men than indirect

 

55

Describe femoral hernias

these are protrusions below the inguinal ligament through the femoral canal more commonly in FEMALES