GI and Abdomen

Question 1

• Camper’s fascia

Answer 1

superficial, fatty layer, absent in perineum

Question 2

• Scarpa’s fascia

Answer 2

deep, membranous layer, continues to the perineum but changes names to Colles’ fascia, continues to reproductive organs and becomes penile or clitoral fascia

Question 3

action of abdominal wall muscles

Answer 3

support the abdominal contents and compress the abdominal contents as for maximal expiration and coughing

Question 4

arcuate line

Answer 4

(lower limit of posterior layer of the rectus sheath)
• Anterior - external oblique, ½ of the internal oblique
• Below – all three layers (ExtO, IntO, InnO)
• This boundary is a site of weakness where hernias can occur (also in linea alba and umbilicus)

Question 5

Nerves down posterior wall, superior to inferior

Answer 5

• Subcostal nerve (T12)
• Iliohypogastric nerve (L1)
• Ilioinguinal nerve (L1)
• Lateral femoral cutaneous nerves (L2, 3)

Question 6

superior epigastric artery

Answer 6

from the internal thoracic, enters rectus sheath, goes deep to rectus abdominis, anastomoses with inferior epigastric artery here

Question 7

inferior epigastric artery

Answer 7

from the external iliac artery, enter rectus sheath at arcuate line
- Deep circumflex iliac artery: branches from the external iliac artery

Question 8

lymph above umbilicus

Answer 8

drain to axillary nodes

Question 9

lymph below umbilicus

Answer 9

drain to inguinal nodes

Question 10

Gubernaculum

Answer 10

– attaches scrotum and labia major to abdominal wall

- In males the testes descend down the canal called spermatic cord, has same layers as abdominal wall

Question 11

direct inguinal hernia

Answer 11

• Abdominal contents protrude directly (through the inguinal triangle) medial to the inferior epigastric vessels, and pass through the superficial inguinal ring into the scrotum/labium majus.

Question 12

indirect inguinal hernia

Answer 12

• Abdominal contents protrude indirectly (lateral to the inguinal triangle) through the deep inguinal ring (lateral to the inferior epigastric vessels), traverses the inguinal canal, and emerges through the superficial inguinal ring into the scrotum/labium majus.

Question 13

superficial inguinal ring

Answer 13

opening in the aponeurosis of the external abdominal oblique

direct unguinal hernia here

Question 14

deep inguinal ring

Answer 14

formed by opening in transversalis fascia, superior to inguinal ligament
Deep inguinal ring is located about midway between the anterior superior iliac spine and pubic symphysis, about one-centimeter superior to the inguinal ligament; lies just lateral to the inferior epigastric vessels

indirect inguinal hernia here

Question 15

Falciform ligament

Answer 15

separates the left and right lobes of the liver

Question 16

Round ligament of the liver

Answer 16

ligamentum teres hepatis, remnant of left umbilical vein

Question 17

Omental foramen

Answer 17

Epioloic foramen or Winslow – great clinical value to for surgeries to access the left kidney, adrenal gland, pancreas and posterior stomach

Question 18

lesser omentum

Answer 18

Hepatogastric ligament – from liver to stomach, smaller area than greater omentum
o Hepatoduodenal ligament – part of lesser omentum that contains:
• Hepatic triad
 Common bile duct – formed by junction of common hepatic and cystic ducts
 Proper hepatic artery – arises from common hepatic artery from celiac trunk of aorta, goes into liver
 Portal vein – carries blood from GI tract and accessory organs to liver
• Autonomic nerve fibers and lymphatics

Question 19

greater omentum

Answer 19

Extends from the greater curvature of the stomach to the posterior abdominal wall; composed of the following ligaments:
o Gastrocolic
o Gastrosplenic
o Splenorenal

Question 20

Referred pain in the peritoneal cavity

Answer 20

• Shoulder and neck via phrenic nerve can indicate blood or irritants in peritoneal cavity that collects near the diaphragm
• Pain to left shoulder can indicate splenic rupture and blood accumulation near left hemidiaphragm – Kehr’s sing

Question 21

abdominal aorta vessels and nerves of foregut

Answer 21

celiac trunk

greater splanchnic n.

Question 22

abdominal aorta vessels and nerves of midgut

Answer 22

superior mesenteric a.

less splanchnic v.

Question 23

abdominal aorta vessels and nerves of hindgut

Answer 23

inferior mesenteric a.

sacral splanchnic .

Question 24

regions of stomach

Answer 24

o Cardia – right after esophagus, contains cardial notch
o Fundus – top of stomach
o Body – main large segment
o Pylorus
• Pyloric antrum – after angular incisure
• Pyloric canal – between stomach and duodenum

Question 25

main pancreatic duct

Answer 25

joins the common bile duct to form the hepatopancreatic ampulla, which opens onto the major duodenal papilla

Question 26

accessory pancreatic duct

Answer 26

from jejunum into pancreas and connects main pancreatic duct

Question 27

blood supply of pancreas

Answer 27

both the celiac trunk and superior mesenteric artery

Question 28

lobes of the liver

Answer 28

- Right lobe – largest - Left lobe – smaller - Quadrate lobe – between gallbladder and ligamentum teres on visceral surface - Caudate lobe – little section between inferior vena cava and ligamentum venosum on visceral surface

Question 29

common hepatic duct

Answer 29

from the liver, convergence of right and left hepatic ducts

Question 30

cystic duct

Answer 30

comes from the gallbladder | merges with common hepatic duct to make common bile duct

Question 31

common bile duct

Answer 31

convergence of common hepatic and cystic, merges with pancreatic duct to make ampulla of Vater into the duodenum; penetrates the head of the pancreas and unites with the main pancreatic duct within the wall of the duodenum to form the hepatopancreatic ampulla

Question 32

cystohepatic triangle of Calot

Answer 32

contains cystic artery, must be ligated during surgery

Question 33

branches of celiac trunk

Answer 33

``` 1. Common hepatic artery – branch of celiac trunk; splits into: o Proper hepatic artery • Left hepatic artery • Right hepatic artery  Cystic artery o Gastroduodenal artery • Right gastroepiploic artery  Superior pancreaticoduodenal artery 2. Splenic artery – branch of celiac trunk; splits into: • Short gastric arteries • Left gastroepiploic artery • Splenic branches 3. Left gastric artery – branch of celiac trunk ```

Question 34

Superior mesenteric vein receives blood from ____

Answer 34

jejunal, ileal and colic veins

Question 35

is there a celiac vein?

Answer 35

no, ultimately drain into portal vein that takes all the blood from the intestinal area to liver capillary beds for detox, formed by convergence of superior mesenteric and splenic v

Question 36

celiac plexus

Answer 36

network of nerves surrounding the celiac trunk and containing two large celiac ganglia, one on each side of the celiac trunk; its efferent contributions are: - Preganglionic parasympathetic efferent fibers which pass through the celiac plexus are derived from the anterior and posterior vagal trunks - Preganglionic sympathetic efferent fibers to the celiac plexus are derived from the greater splanchnic - they synapse in the celiac ganglia on postganglionic sympathetic cell bodies, which give rise to postganglionic sympathetic fibers

Question 37

Mid gut extends from ____ to _____

Answer 37

mid gut extends from midway along the duodenum to midway along the transverse colon

Question 38

Hind gut extends from ____ to _____

Answer 38

hind gut extends from midway along the transverse colon to the anal canal

Question 39

duodenum

Answer 39

first part of small intestine and encloses the head of the pancreas - Its proximal half, including the major duodenal papilla, is a foregut derivative; its distal half, although derived from the midgut, is included with the foregut for simplicity halfway along its length, the major duodenal papilla (aka ampulla of Vater) opens into its lumen, common bile duct enters here

Question 40

jejunum

Answer 40

2nd part of small intestine and has the most developed circular folds for absorption - Histologically, it lacks Brunner’s glands (duodenum) and Peyer’s patches (ileum)

Question 41

ileum

Answer 41

3rd part, contains large lymph vessels (Peyer’s patches) | - Ileocecal valve between this and cecum, prevents backflow at ileal papilla

Question 42

taeniae coli

Answer 42

longitudinal smooth muscle bands to large intestine

Question 43

haustra

Answer 43

small pouches that give segmented appearance to large intestine

Question 44

cecum

Answer 44

pouch connecting large and small intestine

Question 45

appendix

Answer 45

vermiform diverticulum of the cecum

Question 46

colon

Answer 46

large intestine o Ascending colon – up the right side o Transverse colon – across horizontally o Descending colon – down the left side o Sigmoid colon – S shaped curve o Anal canal – will be covered in the pelvis outline

Question 47

superior mesenteric artery

Answer 47

the “artery of the midgut" – arises from the aorta (Level of L1) - Inferior pancreaticoduodenal artery – splits into anterior and posterior - Middle colic artery – supplies transverse colon - Right colic artery – supplies ascending colon - Ileocolic artery – supplies cecum - Intestinal (jejunal and ileal) arteries -

Question 48

inferior mesenteric artery

Answer 48

the artery of the hindgut – arises from the aorta (Level of L3) - Left colic artery – supplies descending colon - Sigmoid arteries – supplies sigmoid colon - Superior rectal artery – supplies rectum

Question 49

marginal artery

Answer 49

(of Drummond) – anastomosis of inferior and superior mesenteric arteries

Question 50

superior mesenteric vein drains into the ____

Answer 50

portal v

Question 51

inferior mesenteric vein drains into the ____

Answer 51

splenic v

Question 52

posterior abdominal wall muscle innervation and blood supply

Answer 52

Blood supply: superior phrenic, inferior phrenic, musculophrenic, and pericardiacophrenic vessels Innervation: phrenic nerves; derived from ventral rami C3, 4, and 5.

Question 53

quadratus lumborum

Answer 53

action - lateral flexion of verebrae inn. - lumbar nn blood - lumbar branch of iliolumbar a

Question 54

psoas major and minor

Answer 54

flexion of hip and lumbar vertebrae inn. - lumbar nn blood - lumbar branch of iliolumbar a

Question 55

iliacus

Answer 55

action - flexes hip inn - femoral n blood supply - iliac branches of iliolumbar a

Question 56

unpaired branches of abd aorta

Answer 56

- Unpaired branches (three) o celiac trunk (level of T12) o superior mesenteric artery (level of L1) o inferior mesenteric artery (level of L3)

Question 57

paired branches of abd aorta

Answer 57

``` - Paired branches (6 pairs) o Inferior phrenic arteries o Middle suprarenal arteries o Renal arteries (level of L1) o Testicular/ovarian arteries (level of L2) o Lumbar arteries (four pairs) o Common iliac arteries • External and internal iliac arteries ```

Question 58

lumbar plexus

Answer 58

o iliohypogastric and ilioinguinal nerves (L1) – posterior abdominal wall o Genitofemoral nerve (L1, 2) – pierces psoas major o Lateral femoral cutaneous nerve (L2, 3) – posterior wall, behind psoas, down wall to leg o Femoral nerve (L2, 3, 4) – large nerve that goes into femoral triangle, largest branch of lumbar plexus, supplies anterior thigh o Obturator nerve (L2, 3, 4) – run next to the lumbosacral trunks, inferior, posterior, medial o Lumbosacral trunk (L4, 5) – contributes to lumbosacral plexus (later) - Lumbar sympathetic trunks – connects lumbar plexus with sacral plexus

Question 59

cortex of kidney

Answer 59

outer portion between capsule and medulla, glomeruli are here

Question 60

medulla of kidney

Answer 60

innermost part of kidney where the following are located: • Renal pyramids – subdivisions of medulla where tubules are located • Renal papilla – point of pyramid towards hilum • Renal columns (extensions of the cortex) between pyramids

Question 61

renal arteries

Answer 61

have blood from heart to kidneys to be filtered

Question 62

renal veins

Answer 62

filtered blood from kidneys to inferior vena cava o Drain into the inferior vena cava (note that left suprarenal vein and left testicular ovarian vein drain into the left renal vein)

Question 63

adrenal glands (areas and what they do)

Answer 63

retroperitoneal organs on superomedial aspect of the kidney, lie at T12 o Cortex – secrete mineralocorticoids, glucocorticoids and androgens o Medulla – secretes adrenaline o Three arteries - Superior, middle and inferior arteries o Single vein drainage – right gland empties into the IVC; left gland empties into left renal vein o Innervated by sympathetic nerves – least splanchnic