Gross Anatomy - Exam 4 Flashcards
(203 cards)
1
Q
What are the subdivisions of the GI system
A
Foregut, midgut, hindgut
2
Q
Plane at T9 vertebral level
A
Xiphisternal plane
3
Q
Plane at L1 vertebral level
A
Transpyloric plane
4
Q
Plane at L3 vertebral level
A
Subcostal plane
5
Q
Plane at L4 vertebral level
A
Supracristal plane
6
Q
Plane at L5 vertebral level
A
Transtubercular plane
7
Q
Plane at S2 vertebral level
A
Interspinous plane
8
Q
Where is the suprapubic plane located?
A
No vertebral level. Located below S3
9
Q
Where does the terminal portion of the esophagus enter the abdomen and stomach?
A
Abdomen at T10. Stomach at T11.
10
Q
Where is the stomach located?
A
Tip of 8th costal cartilage at T11
11
Q
Where is the pylorus located?
A
½ inch from midline at transpyloric plane (L1)
12
Q
What are the parts of the stomach?
A
(4) Cardia, fundus, body, pyloric part
13
Q
What is the name of the fold located in the stomach?
A
Gastric rugae
14
Q
What are the curvatures of the stomach?
A
Greater curvature and lesser curvature
15
Q
Intraperitoneal vs. retroperitoneal
A
Intraperitoneal – structures within the peritoneum, mobile
Retroperitoneal – structures outside the peritoneum, fixed location
16
Q
What are the four parts of the duodenum and location?
A
1st part – anterior to posterior at L1
2nd part – fixed against body wall at L2
3rd part – fixed against body wall at L3
4th part – fixed against body wall at L2
17
Q
Which part(s) of the duodenum are intraperitoneal? Which are retroperitoneal?
A
1st part – intra
2nd, 3rd, and 4th – retro
18
Q
What are the folds within the small and large intestine called?
A
Plica circulares
19
Q
What are the projections located within the duodenum and where do they drain?
A
Minor duodenal papilla – insignificant amount of pancreas
Major duodenal papilla – liver, gallbladder, and pancreas
Cystic Duct + Common Hepatic Duct = Common Bile Duct
Common Bile Duct + Main Pancreatic Duct = Major Duodenal papilla
20
Q
How can you tell the difference between jejunum and ileum?
A
Jejunum – prominent plica circulares
Ileum – few/flattened plica circulares
21
Q
Are the jejunum and ileum intra or retroperitoneal?
A
Intraperitoneal
22
Q
Location of jejunum and ileum
A
Jejunum starts left of L2
Descends diagonal along root of mesentery to L5
Ends at ileocolic junction L5
23
Q
How long is the jejunum? The ileum?
A
Jejunum – 7-8 feet
Ileum – 6-12 feet
24
Q
Four characteristic features of large intestine
A
Taeniae coli
Haustra (segmental appearance)
Epiploic appendices
Plica semilunaris
25
What forms the appendix?
3 teniae coli coming together
26
Cecum and appendix location
Begins at transtubercular plane (L5)
Lies at interspinous plane (S2)
27
Ascending colon location
Extends from cecum to transpyloric plane (L1)
28
Transverse colon location
Begins right colic flexure (transpyloric plane L1)
Ends at left colic flexure T12
29
Descending colon location
Extends from T12 to transtubercular plane L5
30
Sigmoid colon location
Begins at transtubercular plane L5
Ends midline below interspinous plane S2
31
Order of pathway thru large intestine
Cecum/appendix > ascending colon > transverse colon > descending colon > sigmoid colon > rectum
32
What are the changes in direction in the large intestine?
Right colic/hepatic flexure
Left colic/splenic flexure
33
Determine whether each portion of the large intestine is intra or retroperitoneal
Cecum – intra
Ascending colon – retro
Transverse colon – intra
Descending – retro
Sigmoid colon – intra
Rectum – retro
34
What are the fat droplets on the intestine called?
Omental/epiploic appendices
35
Where is teniae coli NOT present in the large intestine?
Rectum
36
Location of upper and lower borders of the liver
Upper – T9
Lower – L3 on right, T9 on left
37
Four anatomical lobes of liver
Right, left, quadrate, caudate
38
What structures are found in the liver?
1. Ligamentum venosum
2. Ligamentum teres hepatis (aka round ligament)
3. Porta hepatis (hepatic portal vein, proper hepatic artery, common hepatic duct)
39
Functions of liver
Synthesize plasma proteins
Production of bile
Detoxification
Glycogen storage
Production of hormones
40
What separates right and left lobes of liver?
IVC
41
What separates left and caudate lobes of liver?
Ligamentum venosum
42
What separates left and quadrate lobes of liver?
Ligamentum teres hepatitis/round ligament
43
What is in the portal triad? Where does it enter?
Portal triad: hepatic portal vein, proper hepatic artery, common hepatic duct
Enters liver at porta hepatis
44
Ligamentum venosum developmental origin
Ductus venosus
45
Ligamentum teres hepatis developmental origin
Umbilical vein
46
Name and location of the 4 parts of the pancreas
Head of pancreas – L2 (in ‘C’ of duodenum)
Neck, body, and tail – L2, L1, T12 (ends in spleen hilium)
47
Determine whether each part of pancreas is intra or retroperitoneal
Head, neck, and body – retro
Tail – intra
48
Which parts of the pancreas are considered “ventral pancreas”? Which parts are “dorsal pancreas”?
Head and neck – ventral
Body and tail – dorsal
49
What structures enter the pancreas connecting with major or minor duodenal papilla?
Main pancreatic duct (MOSTLY) to major duodenal papilla
Minor pancreatic duct to minor duodenal papilla
50
Gallbladder location
Tip of 9th costal cartilage on right at transpyloric plane (L1)
51
What drains the gallbladder?
Cystic duct into common bile duct
52
What are the arterial vasculatures and location?
1. Celiac axis – T12
2. Superior mesenteric – L1
3. Renal (paired) – L2
4. Gonadal (paired) – L2/L3
5. Inferior mesenteric – L3
53
Branches of celiac artery
(3) Left gastric, common hepatic, splenic
54
Branches off common hepatic artery
(2) Proper hepatic and gastroduodenal arteries
55
Branches off proper hepatic arteries
(3) Right gastric, left hepatic, and right hepatic
56
Branch off right hepatic artery
Cystic artery
57
Branches off gastroduodenal artery
(4) Supraduodenal, right gastroepiploic, and anterior and posterior superior pancreaticoduodenal
58
Branches off splenic artery
(3) Pancreatic, short gastric, left gastroepiploic
59
Structure that surrounds greater curvature of the stomach
Greater omentum
60
What arterials anastomose at the greater curvature? What about the lesser curvature?
Greater: right and left gastroepiploic arteries
Lesser: right and left gastric arteries
61
What are the branches off the superior mesenteric artery?
1. Anterior and posterior inferior pancreaticoduodenal
2. Jejunal mesenteric
3. Ileal mesenteric
4. Ileocolic
5. Right colic
6. Middle colic
62
How to tell between the jejunum and ileum based on vasa recta and arcades
Jejunum: vasa recta are long and spread; arcades are large and fewer in number
Ileum: vasa recta are short and compact; arcades are small and layered
63
What are arcades?
Anastomotic loops located in small intestine
64
What are the branches off inferior mesenteric artery
(3) Left colic, sigmoid, and superior rectal arteries
65
Tributaries of portal vein
(2) Superior mesenteric and splenic veins
66
What are the portacaval anastomoses?
Esophageal veins, rectal veins, para-umbilical veins, and retroperitoneal veins (colic and splenic veins with body wall veins)
67
What are issues with using the anastomoses paths? Which vein is most life threatening if it breaks?
Blood is not clean and overworks these veins
Varacies: stretching or enlargement of vein
Esophageal vein is most life threatening
68
What germ layers are responsible for GI system
Mesoderm and endoderm
69
The GI is a hollow tube extending from ___ to the ___.
Buccopharyngeal membrane (future mouth); cloacal membrane (future anus)
70
Name of membranes resulting in future mouth and anus
Mouth: buccopharyngeal membrane (breaks down at 3rd week of development)
Anus: cloacal membrane (breaks down at 7th week of development)
71
Germ layer of epithelial lining of organs? Muscular walls and serous coats?
Endoderm – epithelial lining
Mesoderm – muscular walls and serous coats
72
What is the name of the cavity where the GI develops? What does it turn into?
Cavity: intraembryonic coelom
Future: peritoneal cavity
73
What are the subdivisions of the developmental digestive system?
Foregut, midgut, and hindgut
74
What is the arterial supply of the foregut?
ALL celiac artery
Esophagus (overlaps): celiac and esophageal arteries
Pancreas (overlaps): celiac and superior mesenteric arteries
(Duodenum parts 1 and 2)
Spleen is not a GI organ but also celiac artery
75
What is the parasympathetic innervation of the foregut?
Vagus/Cranial n. X
76
What is the arterial supply of the midgut?
ALL superior mesenteric
(Duodenum parts 3 and 4)
77
What is the parasympathetic innervation of the midgut?
Vagus/Cranial n. X
78
What is the arterial supply of the hindgut?
ALL inferior mesenteric
79
What is the parasympathetic innervation of the hindgut?
S2, S3, S4 aka. Pelvic splanchnics
80
What structures are part of the foregut?
(7) Esophagus, stomach, duodenum parts 1 and 2, liver, gallbladder, and pancreas
81
What structures are part of the midgut?
(8) Duodenum parts 3 and 4, jejunum, ileum, appendix, cecum, ascending colon, and transverse colon
82
What structures are part of the hindgut?
Descending colon, sigmoid colon, and rectum
83
Explain development of stomach
First visible at 4th week of development
Suspended from dorsal wall by DORSAL MESOGASTRIUM
Rotates 90 degrees clockwise, trapping part of right side of INTRAEMBRYONIC COELOM posterior to stomach/omental bursa
84
Explain development of duodenum part 1 and 2
Gets C shape when stomach rotates
85
What occurs at the 6th, 9th, and 12th week of development in the liver?
6 – hematopoiesis occurs
9 – liver reaches max proportional size
12 – bile formation begins
86
What does the liver develop from?
From hepatic bud as an outgrowth of 2nd part of duodenum
87
What does the gallbladder develop from
As an outgrowth from the hepatic bud
88
Where does the pancreas develop from?
Ventral bud – outgrowth of hepatic bud -> HEAD AND NECK
Dorsal bud – outgrowth of 2nd part of duodenum -> BODY AND TAIL
** think on all fours like dog
89
What becomes a source of major drainage of the adult pancreas?
Duct of ventral bud
90
Explain development of midgut
Elongates along an axis around superior mesenteric artery via VITEILLOINTESTINAL DUCT
Rotates 270 degrees
91
Explain development of hindgut
Supplied by inferior mesenteric artery
Cloacal membrane separates and breaks open
92
What forms the bony pelvis?
(3) Ilium, ishium, and pubis
93
What is the “wing” of the pelvis?
Ala
94
What are the bony landmarks of the anterolateral wall?
1. Iliac crest – most superior aspect
2. Iliac tubercle – bony, widest part of ala
3. ASIS – most anterior component of pelvis
4. Pubic tubercle – most inferior component
95
Why is the pelvis tilted?
Tilted forward because we walk upright and mimics locomotion
96
Who has a smaller inlet? Wider? (M/F)
Male has smaller (90 degrees or less)
Female has wider for ample room to deliver (100 degrees or more)
97
What structures are formed by the fusion of aponeuroses on the lateral wall muscle?
Linea alba, linea semilunaris, inguinal ligament, and tendinous intersections
98
What are the abdominopelvic regions?
Right hypochondriac, epigastric, left hypochondriac
Right lumbar, umbilical, left lumbar
Right iliac, hypogastric, left iliac
99
What are the abdominopelvic quadrants
Right upper, left upper
Right lower, left lower
100
What are the fascia of the abdominal wall?
Camper’s fascia (fatty, more membranous layer)
Scarpa’s fascia (membranous)
101
What are the muscles of the abdominal wall?
1. External oblique
2. Internal oblique
3. Transversus abdominus
4. Rectus abdominus
102
Function of abdominal muscles
Assist in respiration
Increase thoracic/abdominal pressure
Keep abdominal contents in place
Maintain posture
Flexion of trunk
103
What is the Valsalva maneuver?
Forced expiration against a closed glottis
Affects venous return, CO, arterial pressure, HR
Used to correct abnormal heart rhythms (supraventricular tachycardia and stimulate vagus n.)
104
What is defecation syncope
Elevate arterial pressure, bradycardia, decrease BP, decrease blood to brain (leads to cardiac event/failure)
105
External oblique origin and insertion
O: ribs 5-12
I: anterior ½ of iliac crest, linea alba, and pubic crest and tubercle
106
External oblique innervation
T7-T12 and L1
107
External oblique function
Flexion of trunk
Lateral flexion
Rotation of vertebral column (opposite/contralateral side)
108
Internal oblique origin and insertion
O: thoracolumbar fascia, ant 2/3 of iliac crest, and lat 2/3 of inguinal ligament
I: ribs 10-12, linea alba, and pubis (conjoint tendon)
109
Internal oblique innervation
T7-T12 and L1
110
Internal oblique function
Lateral flexion
Rotation (same/ipsilateral side)
111
Transversus abdominis origin and insertion
O: thoracolumbar fascia, Ant 2/3, Lat 1/3 of inguinal ligament, and lower 6 costal cartilages
I: linea alba and pubic crest (conjoint tendon)
112
Transversus abdominus innervation
T7-T12 and L1
113
Transversus abdominus function
Compress abdominal contents
114
Rectus abdominus origin and insertion
O: pubic symphysis
I: xiphoid process and costal cartilages 5-7
115
Rectus abdominus innervation
T7-T12
116
Rectus abdominus function
Flexion of trunk
117
What is the rectus sheath?
Aponeurosis of 3 flat muscles (external, abdominal, and oblique muscle)
118
Landmarks of rectus sheath
Linea alba (xiphoid to pubic symphysis)
Linea semilunaris (subcostal margin to inguinal ligament)
Arcuate line (1/3 distance from umbilicus to pubic crest)
119
What structures are above the arcuate line
Anterior rectus sheath (external oblique and ½ internal oblique)
Posterior rectus sheath (1/2 internal oblique and transversus abdominus)
120
What structures are below arcuate line?
Anterior rectus sheath (external oblique, internal oblique, transversus abdominus)
NO POSTERIOR RECTUS SHEATH only transversalis fascia
121
What arteries come off aorta in anterior abdominal wall?
10th and 11th posterior intercostal arteries
Subcostal artery
122
What arteries come off internal thoracic artery in anterior abdominal wall?
Superior epigastric and musculophrenic arteries
123
What artery comes off external iliac artery in anterior abdominal wall?
Inferior (deep) epigastric artery
124
What artery comes off femoral artery?
Superficial epigastric (runs thru superficial tissues/fascia)
125
What are the nerves of the anterior wall?
Thoracoabdominal (T7-11)
Subcostal (T12)
Iliohypogastric (L1)
Ilioinguinal (L1)
126
Where do the T7-T12 nerves lie?
Between internal oblique and transversus abdominis and penetrates rectus
127
Sensory distribution of anterolateral wall generalizations
T7-9 - above the umbilicus
T10 – umbilicus
T11, T12, L1 – below umbilicus
128
Where do the testes develop, pass thru, and enter?
Develop: lumbar area attached to gubernaculum on inf. Pole
Pass: thru inguinal canal and pick up muscle/fascial layers from ant. Wall
Enter: scrotum
129
What structures are derived from external oblique?
Inguinal ligament (ASIS to pubic tubercle)
Superficial ring
130
What is the inguinal canal?
Passageway thru abdominal wall to scrotum for testes and spermatic cord
131
What is a hernia?
Protrusion of parietal peritoneum and/or viscera thru opening from cavity which they belong
132
What are the types of hernias?
femoral, direct, indirect
133
Describe femoral hernia
Most common in females at femoral triangle/canal
134
Describe direct hernia
Most common over 50 years old, bulges at superficial ring, and medial to inferior epigastric a.
135
Describe indirect hernia
Congenital, most common under 50 yo, begins at deep inguinal ring, lateral to inferior epigastric a.
136
What is Hesselbach’s Triangle?
Site of direct hernia
Borders: inguinal ligament, inferior epigastric artery, lateral border of rectus abdominis
137
What are the visceromotor targets?
(3) Cardiac muscle, smooth muscle, and glands
138
Function of parasympathetics in abdomen
Stimulates peristalsis
139
Where do parasympathetic fibers originate?
CN X and pelvic splanchnic S2-4
140
Function of sympathetics in abdomen
Decrease blood flow in viscera/inhibit digestion
141
Where are the sympathetic preganglionic cell bodies for GI located?
Cell body #1 – IML T1-L2
142
Where are the sympathetic cell bodies for upper GI to diaphragm?
IML T1-6
143
Where are sympathetic cell bodies for GI to rectosigmoid junction?
T7-11
144
Where are the sympathetic cell bodies for rectum/anal canal?
T12-L2
145
Where does the sympathetic chain run?
Chain ganglia runs from base of skull to coccyx
146
What are the splanchnic nerves of the abdomen?
1. Greater T5-9
2. Lesser T10-11
3. Least T12
4. Lumbar L1-4
147
Where does the anterior vagal trunk come from? What does it innervate/supply?
From CN X
Comes from left vagus and becomes anterior vagal trunk when is passes thru esophageal hiatus
Supplies anterior surface of stomach and sends branch to liver
148
Where does the posterior vagal trunk come from? What does it innervate/supply?
From CN X
Come from right vagus nerve
Supplies posterior stomach and sends branch to celiac plexus
149
What are the pelvic splanchnics? Where do they come from? What does it innervate/supply?
Parasympathetics to hindgut
Cell body in IML L1/L2
Supplies descending and sigmoid colon rectum
Exit as preganglionic
150
What do pelvic splanchnics travel with?
Spinal nerves S2-S4
151
What are the sympathetic ganglia of the abdomen? What fibers synapse here?
Celiac ganglion – greater splanchnics (T5-9)
Superior mesenteric ganglion – lesser splanchnics (T10-11)
Aorticorenal ganglia (paired) – least splanchnics (T12)
Inferior mesenteric ganglion – lumbar splanchnics (L1-4)
152
What are the autonomic plexi?
(5) Celiac, superior mesenteric, renal, inferior mesenteric, hypogastric (pelvis)
153
What do thoracic and lumbar splanchnic nerves contain?
Preganglionic sympathetic fibers
Synapse on prevertebral ganglia in abdomen – contribute to plexi
The postganglionic sympathetic fibers innervate targets
154
How do preganglionic parasympathetic fibers from CN X and pelvic splanchnics travel?
Thru plexi or directly to viscera
DO NOT synapse in plexus
Fibers travel to viscera of wall where ganglia is present to synapse
Postganglionic fibers project to targets
155
What do the autonomic plexi of gut consist of?
Postganglionic sympathetic fibers and preganglionic parasympathetic fibers
156
Visceral vs. Parietal Pain
Visceral pain: general visceral afferent (GVA)
Parietal pain: general somatic afferent (GSA)
157
What type of neuron for GVA and GSA?
Pseudo unipolar, sensory neuron
158
Describe GVA fibers/viscerosensory
Nociceptors (noxious stimuli)
Cell body in DRG
Sensitive to stretch, ischemia and inflammation
Insensitive to cutting or burning sensations
159
How do GVA fibers interact with ANS?
It is NOT part of but distribute WITH ANS
Sympathetics run w/ splanchnics (greater, lesser, least, lumbar)
Parasympathetics run w/ S2-4, CN X
160
What is visceral pain and examples?
Vague, poorly localized pain
E.g. intestinal obstruction, cholecystitis, and early appendicitis
161
Describe GSA fibers
Cell bodies in DRG
Info includes pain, touch, temp
Nociceptors (noxious stimuli)
162
GSA fibers follow what?
Somatic innervation
Carried in all spinal nerves except C1
163
What is parietal pain and example?
Sharp, well localized pain, pt can tell you where it hurts
E.g., acute appendicitis
164
What is referred pain?
Pain perceived to be in unrelated area
Sensory picked up by viscera
Transmitted by ANS fibers/nerves
Perceived as originating from somatic structure but in reality, it is from visceral fibers
165
Ascending sensory pathway
Nociceptor in viscera > afferent fibers relay sensory info in splanchnics > enter sympathetic trunk > join spinal nerve via white rami > ascend to cortex (post central gyrus) to interpret pain
166
What is Convergence Ho?
Collaterals from visceral afferents synapse on somatosensory cell bodies
Pain interpreted as coming from “somites” (e.g., skin/muscle)
167
What is an angina?
Pain from heart disease
Pain/squeezing/pressure behind sternum
Usually radiates down left arm but sometimes in neck, jaw, TMJ
168
Angina pathway for referred pain
1. Afferent fiber from heart enters sympathetic chain thru thoracic cardiac n. or cervical cardiac n.
2. Same segments receive GSA input from dermatomes of chest and arm
3. Post cells GSA can be activated by collateral GVA fibers from heart
4. Cortex interprets pain as if its from chest even if its from heart
169
What are the three regions of the posterior abdominal wall?
Above 12th rib, below 12th rib and iliac crest, and below iliac crest
170
What are the two sides of the posterior abdominal wall
Divided by aorta and IVC
171
What are the contents of the posterior abdominal wall?
Kidneys and ureters, suprarenals (adrenal glands), spleen, and BVs and nerves
172
What forms the iliopsoas?
Psoas major and iliacus
173
Function of psoas major
Flexion of femur
174
Function of iliacus
Flexion of femur
175
Function of quadratus lumborum
Lateral flexion of vertebral column
176
Function of psoas minor
Not always present, but (weak) flexion of lumbar vertebral column
177
Where are hernia of Morgagni and Bochdalek located? Which is more life threatening?
Hernia of Morgagni: anterior and retrosternal
Hernia of Bochdalek: posterolateral, most life threatening
178
Surface anatomy and location of spleen
Upper pole – T10
Hilum - T12
Lower pole – T12
Location: parallels 10th rib
179
What organs do the spleen contact?
(4) Stomach, pancreas, kidney, and large intestine
180
Can you palpate for spleen?
Normally not! Unless enlarged 3-5x normal
Splenomegaly – enlargement of spleen (e.g., due to mono)
181
Surface anatomy of kidney and distance from midline
Upper pole – T12, 1 inch
Hilum – L1, 1.5 inches
Lower pole – L3, 3 inches
182
Which is higher: left or right kidney
Left kidney is usually ½ inch higher bc liver is above right
183
Are kidneys intra or retroperitoneal?
Retroperitoneal
184
Surface anatomy of ureter
Begins at hilum of kidney @ L1
Travels 1.5 inch from midline until it reaches bladder
185
What are the unpaired visceral branches of the abdominal wall?
(3) Celiac, superior mesenteric, and inferior mesenteric arteries
186
What are the paired visceral branches of the abdominal wall?
Renal, gonadal, and suprarenal arteries
187
What are the suprarenal arteries? What do they come off of?
1. Superior suprarenal off inferior phrenic a.
2. Middle suprarenal off aorta
3. Inferior suprarenal off renal a.
188
What are the paired parietal/body wall branches of the abdominal wall?
Inferior phrenic and lumbar aa.
189
What veins come off IVC in abdominal area?
*only need to know these three
1. Hepatic veins
2. Right suprarenal vein
3. Left/right gonadal veins
190
What are the nerves of the posterior abdominal wall?
1.2 Subcostal n.
2. Iliohypogastric n. (more superior n.)
3. Ilioinguinal n. (more inferior n.)
4. Lateral femoral cutaneous n.
5. Genitofemoral n.
6. Femoral n.
7. Obturator n.
191
What is the vertebral origin of the subcostal n?
T12
192
What is the vertebral origin of the iliohypogastric n?
L1
193
What is the vertebral origin of the ilioinguinal n.?
L1
194
What is the vertebral origin of the lateral femoral cutaneous n.?
L2, L3
195
What is the vertebral origin of the genitofemoral n.? What are the branches of this n? What do each branch supply?
L1, L2
1. Genital branch – cremaster
2. Femoral branch – sensory on thigh
196
What is the vertebral origin of the femoral n.?
L2, L3, L4
197
What is the vertebral origin of the obturator?
L2, L3, L4
198
Name of membrane that encloses vasculature of intestines (e.g. arcades and vasa recta)
Mesentery proper/peritoneal ligaments
199
Which week does the stomach become visible in development
4th week
200
When does the buccopharyngeal membrane break down and what does it become
Breaks down at 3rd week
Mouth
201
When does the cloacal membrane break down and what does it become
Breaks down at 7th.
The anus
202
Three places we can get kidney stones
Uretoropelvic junction
Ureterovesical junction
Crossing of iliac a
203
What do the branches of L1 pierce?
Branches: iliohypogastric and ilioinguinal
Penetrate/pierce thru internal oblique around ASIS, then continue to run between internal and external obliques
