organization of the abdomen II Flashcards
(82 cards)
1
Q
what is the abdominopelvic cavity bounded by?
A
musculoskeleltal components of the abdominal wall
thoracoabdominal diaphragm
pelvic diaphragm
2
Q
what is the peritoneum
A
it is serous membranes which lines the internal surface of the abdominopelvic cavity (parietal layer) and covers the viscera (visceral layer)
secretes serous fluid
3
Q
what does the paretal layer line
what is it deep to
A
lines the body wall
found deep to the subserous fascia
4
Q
what are peritonealized (intraperiotneal) organs
A
- Completely covered with visceral peritoneum; associated with a mesentery.
5
Q
what are examples of peritonealized organs
A
stomach spleen parts 1 and 4 of duodenum jejunum ileum transverse and sigmoid colon
6
Q
what is a primary retroperitoneal organ
A
posterior to the peritoneum
no mesentary
7
Q
what are examples of primary retroperitoneal organs
A
(non-gut tube organs usually)
kidneys
ureters
suprarenal glands
8
Q
what is a secondary retroperitoneal organ
A
- During early development, the organ was peritonealized and associated with a mesentery; later in development, the mesentery is pushed against the posterior body wall and fuses with surrounding parietal peritoneum.
9
Q
examples of secondary retroperitoneal organs
A
most of duodenum
ascending colon
descending colon
pancreas
gut tube organs not associated with mesentary
10
Q
what is peritonitis
A
inflammation of the peritoneum
11
Q
what is the difference b/w visceral and parietal peritonitis and its presentation and the cause of the differing presentations
A
c. Parietal peritoneum is richly innervated by the same somatic nerves which innervate the body wall; sensitive to heat, cold, pressure, laceration.
Peritonitis is thus very painful and pain is well-localized.
e. Innervation to the visceral peritoneum is autonomic (thus pain is not well-localized; mostly registers information about stretch, chemical irritation).
12
Q
what occurs with paritoneal adhesions
A
a. Peritoneal adhesions = fusion of various parts of peritoneal membranes.
b. Causes: inflammation of organs, surgery, trauma, ulcers.
c. Can limit normal movement of viscera and cause chronic pain.
13
Q
what is a mesentery
A
double layer of peritoneum
14
Q
what is the function of mesentery
A
provide a pathway for blood vessels, lymphatics, and nerves to organs
attachment
15
Q
what are the 8 dorsal mesenteries
A
mesoesophagus greater omentum splenorenal phrenicocolic mesentery proper mesoappendix transverse mesocolon sigmoid colon
16
Q
where is the mesoesophagus
A
final inch of esophagus
17
Q
what are the three parts of the greater omentum
A
gastrocolic ligament
gastrosplenic ligament
gastrophrenic ligament
18
Q
where is the gastrocolic ligament
A
from stomach to transverse colon
19
Q
where is the gastrosplenic ligament
A
from stomach to spleen
20
Q
where is the gastrophrenic ligament
A
from fundus of stomach to diaphragm
21
Q
splenorenal ligament?
A
from spleen to posterior body wall (near kidney)
22
Q
phrenicocolic ligament (sustentaculum lienis)
A
diaphragm to left colic flexure
23
Q
what is the mesentary proper associated with
A
small intestine
24
Q
mesoappendix?
A
dorsal mesentary to appendix
25
transverse mesocolon?
dorsal mesentary to transverse colon
26
sigmoid mesocolon?
dorsal mesentery to sigmoid colon
27
what are the 4 ventral mesenteries
lesser omentum
falciform ligament
coronary ligaments
triangular ligaments
28
what are the 2 parts of the lesser omentum
hepatogastric ligament
| hepatoduodenal ligament
29
what is the falciform ligament and what does it contain
1. Peritoneal attachment of liver to anterior body wall.
| 2. Contains the ligamentum teres hepatis (obliterated umbilical vein).
30
what is the coronary ligament
1. Peritoneal attachment of liver to inferior surface of diaphragm.
2. Left and right; anterior and posterior portions.
31
what are the triangular ligaments (right and left
where anterior and posterior coronary ligaments meet
32
what is the peritoneal cavity
| what is it filled with
1. Space between visceral and parietal peritoneal layers; filled with serous fluid allowing organs to move freely
33
where is the location of the lesser sac
aka the omental bursa
posterior to the stomach and lesser omentum
34
what is the superior recess of the lesser sac bounded by?
| inferior recess?
b. Superior recess – bounded superiorly by the diaphragm.
| c. Inferior recess – between the two layers of greater omentum.
35
what are the three parts of the greater sac (peritoneal cavity)
supracolic
infracolic
paracolic gutters
36
where is the supracolic compartment?
| what does it contain?
1. Superior to transverse mesocolon.
| 2. Contains the stomach, liver, spleen, gall bladder.
37
where is the infracolic compartment?
what does it contain?
what separates this compartment into left and right?
1. Inferior to transverse mesocolon.
2. Contains small intestine, ascending colon, descending colon.
3. Separated into right and left compartments by mesentery proper.
38
where are the paracolic gutters
between the posterolateral body walls and ascending/descending colon
39
what is the epiploic foramen
what are the anterior, posterior, superior, inferior borders
communication between greater and lesser sacs
Boundaries
1. Anterior: hepatoduodenal ligament
2. Posterior: IVC
3. Superior: liver
4. Inferior: first part of the duodenum
40
what is ascites?
| what are some causes
a. Excess fluid in the peritoneal cavity (ascitic fluid).
b. Ascitic fluid can become purulent and lead to abscesses.
c. Causes: cirrhosis with portal hypertension; kidney failure; congestive heart failure; ruptured ulcer; abdominal cancers; internal bleeding.
41
where does peritoneal fluid from the left infracolic compartment flow?
right infracolic compartment?
1. Fluid in the left infracolic compartment freely communicates with the pelvic peritoneal cavity.
2. Fluid in the right infracolic compartment is prevented from moving into the pelvic cavity because of the junction of the mesentery proper with the cecum and ascending colon. Thus, fluid must first pass to the left infracolic compartment before draining into the pelvic peritoneal cavity.
42
where does peritoneal fluid spread from the paracolic gutters (right and left)
1. Right paracolic gutter is open to the hepatorenal and subphrenic recesses superiorly. Fluid can pool in these spaces and cause abscesses which can dissect through the diaphragm into the thoracic cavity.
2. Left paracolic gutter is closed superiorly by the phrenicocolic ligament.
3. Fluid within both right and left paracolic gutters can drain into the pelvic peritoneal cavity.
43
where does fluid from the supracolic compartment (including the hepatorenal recess) flow ?
d. Fluid from the supracolic compartment (including the hepatorenal recess) can also pass through the epiploic foramen to the lesser sac.
44
what are the three main unpaired arteries that are branches of the aorta that provide blood to most of the GI tract from distal esophagus to proximal anal canal?
Celiac trunk
superior mesenteric
inferior mesenteric
45
what vertebral level is the celiac trunk
T12
46
what vertebral level is the superior mesenteric artery
L1
47
what vertebral level is the inferior mesenteric artery
L3
48
what is the artery of the foregut
celiac trunk
49
what are the 3 arteries that branch off the celiac trunk?
left gastric artery
splenic artery
common hepatic
50
what are does the celiac trunk supply?
supplies distal esophagus to second portion of duodenum
51
what does the celiac trunk anastomoses with and where?
SMA around the duodenum and pancreas
52
what are the branches off the left gastric artery
esophageal branch
| aberrant or accessory left hepatic a.
53
what are the two main branches off the common hepatic a
gastroduodenal
| proper hepatic
54
what are the 5 branches off the gastroduodenal artery
```
supraduodenal
retroduodenal
posterior superior pancreaticoduodenal
anterior superior pancreaticoduodenal
right gastroepiploic
```
55
what are the 3 main branches off the proper hepatic artery
right gastric
left hepatic
right hepatic
56
what is the small branch off the right hepatic
cystic artery
57
what are the 4 branches off the splenic
pancreatic branches
short gastric
left gastroepiploic
splenic branches (4-5)
58
what are the 3 splenic branches
dorsal pancreatic
pancreatica manga
caudal pancreatic aa.
59
what is the artery of the midgut
superior mesenteric artery
60
where does the superior mesenteric artery run
from the 3rd part of the duodenum to the distal 2/3rd of transverse colon
61
what does the superior mesenteric artery anastomoses with? and where?
anastomoses with the inferior mesenteric artery around the distal 2/3rd of the transverse colon
62
what are the 5 branches off the superior mesenteric artery
```
inferior pancreaticoduodenal
middle colic
jejunal and ileal branches
right colic
ileocolic
```
63
what are the 2 branches off the inferior pancreaticoduodenal artery
anterior inferior pancreaticoduodenal a.
| posterior inferior pancreaticoduodenal a
64
what are the 5 branches off the ileocolic
```
anterior cecal
posterior cecal
appendicular
ileal
ascending colon
```
65
what is included in the large marginal artery anastomoses
Anastomosis between ileocolic, right colic, middle colic, left colic, sigmoidal aa
note some people don't have link between middle and left colic arteries
66
what is the artery of the hindgut
inferior mesenteric
67
where does the inferior mesenteric artery run
from distal 1/3rd of transverse colon to anorectal region
68
what does the inferior mesenteric artery anastomoses with ?
with the middle and inferior rectal arteries at the anorectal junction
69
what are the three branches off the inferior mesenteric artery
left colic
sigmoidal branches (usually 5)
superior rectal artery
70
via what does the abdominal viscera drain? and into what vein
for the most part, abdominal viscera drain via comitantes
however, instead of draining to the IVC these veins drain into the hepatic portal vein
71
what is a portal vein
a vein that begins and ends in a capillary bed
72
in the case of the hepatic portal vein where is the first capillary bed and where is the second?
the first is in the wall of the abdominal GI tract (from distal esophagus to rectum; including all accessory glands)
second is in the liver
73
what does the hepatic portal vein receive
```
all nutrients (except some fats) from food digestion
secretions from accessory organs of digestion (pancreas, gall bladder)
products of RBC breakdown from the spleen and delivers these to the liver for processing
```
74
what merges to form the portal vein
| where and at what vertebral level is this occurring
splenic vein merges with superior mesenteric vein to form the portal vein
this forms posterior to the neck of the pancreas
anterior to IVC
LV2
75
where does the inferior mesenteric vein typically join the splenic vein
posterior to the body of the pancreas
76
what does the portal vein travel with to get to the liver
travels with portal triad within the hepatoduodenal ligament to the liver
77
what is the portal caval (portal-systemic) anastomoses
venous anastomoses between tributaries of portal vein and IVC
78
what is the clinical significance of the portal and IVC containing no valves
in cases of portal HTN (due to liver cirrhosis etc.) blood will reverse flow through portal system and return to the heart via the IVC or SVC
when this occurs the vessels involved become dilated forming varices
79
what region and vessels are involved with esophageal varices (dilated veins)
submucosa of inferior esophagus:
vessels:
tributaries of SVC: esophageal vein
tributaries of portal system: left gastric vein
bleeding from these varicosities can sometimes be very severe and sometimes fatal
80
what region and vessels are involved in the formation of Caput Medusa (dilated veins)
paraumbilical region
tributaries of IVC and SVC: superior and inferior epigastric veins
tributaries of portal system: paraumbilical veins
81
what region and vessels are involved in hemorrhoids
submucosa of anal canal
tributaries of IVC: middle and inferior rectal veins
tributaries of portal system: superior rectal veins
82
what vessels are involved in the formation of dilated veins in the retroperitoneal region (no specific name)
tributaries of IVC: gonadal and renal veins
| tributaries of portal system: ileocolic, right, middle, left colic veins
