Lower Abdomen Flashcards by John Fixari

Name the major features of the Stomach

Cardiac Orifice
Pyloric sphincter
Rugae

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Cardiac Orifice

Entrance to the stomach from the esophagus

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Pyloric sphincter

Exit to the duodenum from the stomach

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Rugae

Temporary fold in the stomach that have the capability to expand

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What are the divisions of the small intestines

Duodenum
Jejunum
Ilium
Plica circularis

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Features of the Duodenum, including the divisions

Fixed and relatively immobile
4 divisions (prox. to dist)
-Superior part
-Descending part
-Inferior part
-Ascending part

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Jejunum

2nd division of the small intestines
Tethered but very mobile
Longer vasa recta, and short, simple aracades

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Ilium

Final division of small intestine
Tethered but very mobile
Shorter vasa recta, and more complex arcades

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Plica circularis

Permanent folds within the small intestines
Become more diffuse distally
Allow for more surface area

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What are the divisions of the large intestines? (prox. to distal)

Cecum
Ascending segment
Transverse segment
Descending segment
Sigmoid

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What are the 2 flexures of the large intestines and where are they?

Right colic flexure (hepatic) - between ascending colon and transverse colon
Left colic flexure (splenic) - between the transverse colon and descending colon

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Tenaie coli

3 longitudinal muscle bands along the length of the colon

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Haustra coli

Out-pouching of the colon due to muscle band constriction

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Epiploic appendages

Fat tags around the colon

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What is a Meckel’s diverticulum?

Remnant of the embryonic yolksac
Appears as a finger-like outpouch tethered to the umbilicus
Located about 1 m proximal to iliocecal calce
If it gets inflamed, it can mirror appendicitis

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Veriform appendix

Opens to the cecum inferior to the iliocelcal orifice

Commonly retrocecal, but the orientation varies greatly

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Mesoappendix

Small triangular mesentery that helps anchor the appendix

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Progression of pain associated with appendicitis

Vague pain begins in periumbilical region around T10 level
Progresses into severe pain in lower right quadrant - from irritation of the peritoneum of the posterior abdominal wall
Pain is most severe over the spinoumbilical point between ASIS and umbilicus

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Celiac Trunk

First major branch of the abdominal aorta

Supplies the liver, gallbladder, esophagus, stomach, pancreas, and spleen

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3 major branches of the celiac trunk

Common Hepatic
Left Gastric
Splenic

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Superior Mesenteric Artery

Second major branch of the abdominal aorta
About 1cm inferior to celiac trunk
Sends 15-18 intestinal arteries to small intestines
Supplies the proximal 2/3 of the transverese colon - via ileocolic, R colic, and middle colic
Has arcades

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Arcades

Anastamotic loops of small intestine arterial supply

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Ileocolic artery

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Branch of SMA

Supplies the Iliocecal junction

R colic artery

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Branch of SMA

Supplies ascending colon

Middle colic artery

Branch of SMA | Supplies the proximal 2/3 of the transverse colon

Variations of the SMA and IMA

The pattern of SMA and IMA branching is extremely variable Anastomoses exist between colic branches for collateral circulation These form a consistent vasculature around the colon - via the marginal artery of drumond

Arterial anastomoses of the Pancreas

Gastroduodenal artery gives off the Superior Pancreaticoduodenal arteries SMA gives off Inferior Pancreaticoduodenal artery -the SPD and IPD anastamoses and supply the duodenum and head of the pancreas -the splenic artery supplies the rest of the pancreas

Renal arteries

Lateral branches of aorta, lateral to the SMA Enter the hilum of each kidney to supply it Send off branches to suprarenal glands and uterus

Suprarenal gland blood supply

Branches from renal arteries, Inferior phrenic artery, and aorta

Gonadal arteries

Lateral branches of abdominal aorta Come off just inferior to renal arteries Ovarian arteries and Testicular arteries

Ovarian arteries

Lateral branch of aorta, inferior to renal arteries Cross over ureters and iliac vessels Descend to pelvis and supply the ovaries

Testicular arteries

Lateral branch of aorta, inferior to renal arteries Cross over ureters and enter the inguinal canal Descend into the scrotum and supply the testicles

Inferior Vena Cava

Largest vein in the body | Begins at L5 level at the union of the common iliac vein

Inferior Vena Cava drainage

Drains the lower left, most of the back, abdominal wall, and abdominopelvic viscera to Right atrium of the heart

Portal Vein

Formed by the union of the Splenic and Superior Mesenteric Veins (at L2 level)

Portal Vein drainage

Return from spleen, pancreas, gallbladder and GI tract to the IVC

Gastric vein anastomoses with...

Esophageal vein

Paraumbilical vein anastomoses with...

Epigastric veins

Superior rectal vein anastomoses with...

Middle/Inferior Rectal vein

Colic veins anastomoses with...

Retroperitoneal vein

Describe the portal-caval anastomoses

Portal venous system has no valves, so reversal of blood flow is possible. Portal hypertension restricts bloodflow, causing caval veins to be engorged and dilated - potentially causing vascular rupture and hemorrhaging

Dilated esophageal vein produces...

Esophageal varicose veins

Dilated Epigastric veins produce...

Caput medusae

Dilated Inf. and Mid. Rectal veins produce...

Hemorrhoids

Where do the sympathetic fibers of the abdomen originate?

T5-L2/3 - Thoracocolumbar plexus

Where do the parasympathetic fibers of the abdomen originate?

CN X and S2-4 - Craniosaral plexus

Where do preganglionic sympathetic splanchnic nerves of the abdomen synapse?

Collateral ganglia

Where do postsynaptic sympathetic fibers of the abdomen travel?

All major arterial branches, and supply the organ that the branches they travel with supply.

Where do preganglionic nerves from CNX travel?

On upper abdominal arterial branches - Celiac trunk, SMA, renal arteries, and their branches Supply the same organs as the arteries they run with

Where do preganglionic nerves from S2-S4 travel?

On lower abdominal arterial branches - IMA and its branhces | Supply the same organs as the arteries they run with

Where do pregangionic sympathetic fibers of the abdomen synapse?

Within their effector organs

Describe the Celiac ganglion

Plexuses travel with celiac trunk branches | Receive thoracic splanchnic nerves and CN X

Describe the Superior Mesenteric ganglion

Plexuses travel with SMA branches | Receive thoracic splanchnic nerves and CN X branches

Describe the Aorticorenal ganglion

Plexuses travel with renal branches | Receive thoracic splanchnic nerves and CN X branches

Describe the Inferior Mesenteric ganglion

Plexuses travel with IMA branches | Receive lumbar splanchnic nerves and S2-S4 branches

Lower Abdomen Flashcards

(55 cards)