Quiz 4 - Upper GI Tract Flashcards Preview

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Flashcards in Quiz 4 - Upper GI Tract Deck (91):

the abdominal and pelvic cavities are ____ with each other

continuous; the abdominal portion is bounded by the diaphragm above and the plane of the pelvic inlet below



-serous lining of the abdomen
-has parietal and visceral layers


parietal peritoneum

-lines the interior of the body wall
-deep to the transversalis fascia and endopelvic fascia of the abdominopelvic cavity


visceral peritoneum

-reflects off the wall of the abdominal cavity
-suspends or encloses abdominal viscera


peritoneal (abdominal) cavity

-a potential space between the parietal peritoneum and the visceral peritoneum
-contains a small amount of serous fluid that lubricates the peritoneum and allows the mobile viscera to glide freely within the space


peritoneal ligaments, omenta, and mesenteries

-folds of peritoneum that suspend organs within the peritoneal cavity and limit the mobility of the mobile viscera



-double layers of visceral peritoneum that enclose an organ (e.g. intestines) and connect it to the posterior abdominal wall


peritoneal ligaments

-double layers of peritoneum that pass from one organ to another, or from an organ to the body wall to hold them in place



-folds of peritoneum extending from the stomach to other abdominal organs


greater sac

-main portion of the abdominal cavity
-essentially accounts for the entire peritoneal cavity outside of the lesser sac


what divides the greater sac into two compartments, and what are those two compartments?

-the transverse mesocolon (the mesentery attached to the transverse colon) divides the greater sac into the supracolic and infracolic compartments


how do the supracolic and infracolic compartments communicate with each other?

-via the right and left paracolic gutters


supracolic compartment

-superior to the transverse colon/mesocolon


infracolic compartment

-inferior to the transverse colon/mesocolon


lesser sac (omental bursa)

-a peritoneal lined cavity located posterior to the stomach and lesser omentum
-closed by 2 ligaments: gastrosplenic and splenorenal
-continuous with the larger general peritoneal cavity (greater sac) through the omental (or epiploic) foramen (also known as the foramen of Winslow)



-space between the posterior parietal peritoneum and the posterior abdominal wall
-primary retroperitoneal structures develop in this space


where do secondary retroperitoneal structures develop?

-initially, within the peritoneal cavity, but then they migrate into the retroperitoneum after the process of rotation, fusion, and resorption


structures in the right upper quadrant

-liver (largest solid organ in the body)
-gallbladder (just below costal margin halfway between right nipple and umbilicus)
-biliary tract


structures in the left upper quadrant



structures in the retroperitoneum

-adrenal glands
-major vessels and nerves
-celiac plexus
-L suprarenal gland


Murphy's sign

-a provocative maneuver used in the abdominal examination to indicate cholecystitis (inflammation of the gallbladder).
-to elicit Murphy's sign: have your pt breathe out completely before gently wrapping your fingers around the patient's right costal margin at the midclavicular line
-while maintaining pressure with your hand, instruct the pt to breathe in.
-Murphy's sign is positive if inspiration is halted suddenly



-largest solid organ in the abdomen
-located inferior to the right hemi-diaphragm
-extends across the midline to the left upper quadrant
-mostly protected by the lower ribs of the thoracic cage


metabolic functions of the liver

-interface between the digestive system and blood
-nutrient-rich venous blood is transported from digestive organs (GI tract) to the liver, where it is processed prior to rejoining the general circulation
-produces and secretes bile, which is necessary for digestion and absorption of lipids


2 surfaces of the liver

1. diaphragmatic surface: in contact w/ diaphragm
2. visceral surface: in contact w/ abdominal viscera

**separated by sharp inferior margin


what surrounds the liver?



falciform ligament

-double layer of peritoneum that reflects off the surface of the liver and attaches to the anterior abdominal wall
-divides the liver into "anatomic" right and left lobes
-contains the ligamentum teres (obliterated L umbilical vein) in its free margin


what happens to the two layers of the falciform ligament at the superior surface of the liver?

-they separate and form the coronary ligaments, leaving a portion of the liver in direct contact with the diaphragm (aka no intervening peritoneum) - this region is called the "bare area"


the coronary ligaments eventually...

...reverse direction to travel along the posterior surface of the liver and meet once again


2 small lobes of the liver

-the quadrate lobe next to the gallbladder and ligamentum teres
-the caudate lobe next to the IVC and ligemantum venosum


hilum of the liver

-"porta hepatis"
-branches of the hepatic artery, portal vein, and bile duct enter/leave the liver in this location.
-it is in the center of the 4 lobes: R, L, quadrate, caudate


portal triad

-hepatic artery
-portal vein
-bile duct

*divides into primary right and left branches and then subdivides further


the functional lobes of the liver

-defined by the distribution of the portal triad
-divided into 8 'functional' segments each being fed by a branch of the portal triad


greater omentum

-descends from the greater curvature of the stomach and first part of the duodenum
-extends between stomach and transverse colon
-drapes over the transverse colon and small intestine and then folds back upon itself and ascends back as far as the transverse colon to which it is adherent (although separable)


left border of the greater omentum

-continuous with the gastrosplenic ligament


what does the greater omentum do?

-stores fat and limits peritoneal infection by migrating to areas of inflammation and ischemia and wrapping around organs
-contains numerous macrophages and fibroblasts


2 parts of the lesser omentum

1. hepatogastric ligament: attaches along the lesser curvature of the stomach; contains the L and R gastric vessels and branches of the vagus nerve
2. hepatoduodenal ligament: thickened free border of the lesser omentum between the porta hepatis and the first portion of the duodenum.


what 3 structures travel thru the hepatoduodenal ligament?

-the proper hepatic artery (off the common hepatic art.)
-the portal vein
-the bile duct


where is the lesser omentum?

-extends between the liver and the esophagus/stomach/1st part of the duodenum


epiploic (omental) foramen (of Winslow)

-passes deep to the hepatoduodenal ligament



-an expanded part of the digestive tract in the LUQ of the abdomen under the diaphragm
-lies between the intra-abdominal esophagus and the duodenum
-liquefies and macerates food to form chyme which is released, after a variable delay, into the duodenum


4 parts of the stomach

1. cardia - surrounds the orifice near the esophagus
2. fundus - dilated superior portion related to the left hemi-diaphragm
3. body - between the fundus and the pyloric antrum
4. pylorus composed of pyloric antrum (funnel-shaped part leading to the pylorus) and the pyloric canal (thickened by a sphincter muscle which controls the discharge of chyme into the duodenum)


fold created by the junction of the esophagus and the cardia of the stomach is called

-cardiac incissura (lies below the level of the diaphragm - important in maintaining the lower esophageal sphincter and preventing reflux of stomach contents into the esophagus)


fold between the body and the pyloric antrum is called

-angularis incissura


2 curvatures of the stomach

1. lesser curvature
2. greater curvature



-longitudinal folds on the interior of the stomach


gastroesophageal (squamocolumnar) junction

-junction between esophagus and stomach
-creates a fold called the cardiac incissura



-emulsifies fat and aids in digestion
-secreted by the liver and stores and concentrated in the gallbladder


release of bile from the gallbladder is primarily under what kind of control?

-hormonal (cholecystokinin - CCK)
-when acidic fatty chyme enters the duodenum from the stomach, CCK is released into the blood stream. This stimulates:
-the gallbladder to contract
-the hepatopancreatic sphincter to relax
-bile to enter the duodenum and mix with the chyme



-pear-shaped reservoir for bile lodged in the gallbladder fossa of the liver
-lies within the main portal fissure on the visceral surface of the liver
-except where it is in direct contact with the liver, the gallbladder is covered by peritoneum


the proper hepatic artery and the portal vein enter the _____ and divide to furnish blood to each of the 8 hepatic segments

porta hepatis


extrahepatic biliary ductal system

-forms when the R and L hepatic ducts arise from their respective lobes of the liver and leave at the porta hepatis, and join to form the common hepatic duct
-when the common hepatic duct joins the cystic duct, they form the common bile duct


when the _____ joins the ______, they form the common bile duct

common hepatic duct joins the cystic duct


where does the common bile duct run?

-passes behind the first portion of the duodenum and through the head of the pancreas
-prior to opening into the medial aspect of the second (descending) portion of the duodenum, the pancreatic duct enters the common bile duct


immediately after joining with the pancreatic duct, the common bile duct has a dilation called ____

-the ampulla of Vater, which is surrounded by an annular smooth muscle called the sphincter of Oddi, which controls the release of bile and pancreatic exocrine secretions into the intestine


common bile duct terminates as ____

-the major duodenal papilla in the postero-medial aspect of the descending (second) portion of the duodenum
-so bile duct empties into duodenum



-secondary retroperitoneal organ
-has exocrine (digestive enzymes) and endocrine functions
-stretches transversely across the posterior abdominal wall forming part of the posterior boundary of the omental bursa (lesser sac)
-lies at the level of L1-L2 and extends from the "C" loop of the duodenum toward the hilum of the spleen


parts of the pancreas

-also has a projection (the uncinate process) that lies posterior to the superior mesenteric vessels


main pancreatic duct of Wirsung

-from ventral pancreatic bud
-empties into the 2nd (descending) portion of the duodenum through the major duodenal papilla (end of the common bile duct) via the common channel


accessory pancreatic duct of Santorini

-from dorsal pancreatic bud
-when present, enters the 2nd (descending) portion of the duodenum independently at the minor duodenal papilla, which is proximal (and cranial) to the major duodenal papilla



-largest lymphoid organ in the body
-site of immune surveillance, response, and lymphocyte proliferation
-cleanses the blood of debris as well as aged and defective blood cells
-recycles many of the products
-capable of reverting back to erythrocyte production (a fxn it had in fetal life)


where is the spleen located?

-deep in the LUQ of the abdomen along the 9th to 11th ribs posterolaterally
-separated from the ribs by the diaphragm and left costophrenic (costodiaphragmatic) recess
^important clinical relationship!

*a normal spleen is not palpable below the costal margin!


3 main ligaments that support the spleen

-gastrosplenic ligament
-splenorenal ligament
-phrenicocolic ligament


gastrosplenic ligament

-goes between the greater curvature of the stomach and the hilum of the spleen
-the short gastric vessels (branch of splenic artery off celiac trunk) and the origin of the left gastroepiploic vessels run thru this ligament


the gastrosplenic ligament envelops the spleen and rejoins posteriorly, forming the _________-

splenorenal ligament


splenorenal ligament

-goes from the spleen to the peritoneum of the posterior abdominal wall overlying the kidney
-the splenic vessels run between the two leaves of the splenorenal ligament


phrenicocolic ligament

-continuation of the splenorenal ligament running from the splenic flexure of the colon to the lateral portion of the diaphragm
-forms a partial barrier to fluid running up the L colic gutter


first major branch of the abdominal aorta

-the celiac trunk (aka celiac axis)
-thru its 3 major branches, it provides the arterial circulation to the abdominal foregut and its derivatives


3 major branches of the celiac trunk

1. L gastric artery
2. splenic artery
3. common hepatic artery


L gastric artery (branch of celiac trunk)

-follows the lesser curvature of the stomach and supplies blood to the stomach


splenic artery (branch of celiac trunk)

-a coiled artery running in a groove along the cranial border of the pancreas
-supplies blood to the spleen and also gives small branches to the body and tail of the pancreas
-close to its termination, it gives rise to the:

1. left gastroepiploic artery
2. short gastric vessels


left gastroepiploic artery (terminal branch of splenic artery, which is a branch of the celiac trunk)

-supplies a portion of the greater curvature of the stomach and the greater omentum


short gastric vessels (terminal branch of splenic artery, which is a branch of the celiac trunk)

-run in the gastrosplenic ligament to supply blood to the fundus of the stomach


common hepatic artery (branch of celiac trunk)

-divides into the:

1. proper hepatic artery
2. gastroduodenal artery


proper hepatic artery (branch of the common hepatic artery)

-heads toward the hilum of the liver in the hepatoduodenal ligament
-after giving off the tiny right gastric artery that recurves back along the lesser curvature of the stomach, the proper hepatic artery continues and then divides into the L and R hepatic arteries which enter the hilum.


right hepatic artery (branch of the proper hepatic artery, which is a branch of the common hepatic, which is a branch of the celiac trunk)

-gives off the cystic artery to the gallbladder just prior to entering the hilum of the liver


gastroduodenal artery (branch of the common hepatic artery)

-runs just posterior to the 1st portion of the duodenum
-gives rise to the R gastroepiploic artery, which supplies the stomach and greater omentum.
-it then continues to give off both the anterior and posterior pancreaticoduodenal arteries, which supply blood to the duodenum and head of the pancreas


liver has a ____ blood supply

-70-80% of the blood comes from the portal vein that contains all the blood from the intestines, spleen, pancreas, and gallbladder
-20-30% of it is arterial blood from the hepatic artery


portal system

-blood going thru two capillary exchange beds before returning to the heart
-blood passes thru the first capillary bed in the intestinal tract, pancreas, spleen, and gallbladder
-blood is then "collected" and brought to the second capillary bed in the liver via the portal vein!


does the portal vein have valves?

no; therefore permits reversal of blood flow in certain conditions


splenic vein

-receives blood from the spleen and pancreas and travels across the abdomen just posterior to the upper border of the pancreas
-merges with the superior mesenteric vein to form the portal vein


what forms the portal vein?

-splenic vein + superior mesenteric vein


where does the portal vein travel?

-in the hepatoduodenal ligament, where it lies posterior to the hepatic artery and common bile duct


important venous tributaries from the stomach, duodenum, pancreas, and gallbladder enter the ____

-proximal portal vein


left gastric (coronary) vein

-drains blood from the esophagus as well as the lesser curvature of the stomach

**tributaries of this vein may develop varices and rupture, causing internal bleeding


after passing thru the liver, venous blood is collected by the ____

-hepatic veins, which drain into the IVC on the posterior aspect of the liver just beneath the diaphragm


aortic plexus

-a very large and dense network of autonomic nerves on the anterior surface of the abdominal aorta
-is a visceral plexus (like the cardiac plexus in the thorax) that is formed by sympathetic and parasympathetic neurons


thoracic splanchnic nerves

-sympathetic preganglionic fibers that enter the most superior part of the aortic plexus
-leave thoracic levels of the sympathetic chain and pass thru the diaphragm to synapse in prevertebral ganglia (specifically the ganglia near the celiac trunk).


postganglionic fibers of aortic plexus

-travel with branches of the celiac trunk to be distributed to the upper abdominal organs


parasympathetics enter the celiac plexus via...

-the vagus nerve passing thru the esophageal hiatus
-preganglionic nerves: either go directly to organs or pass thru the plexuses without a synapse to reach the appropriate organ where it synapses close to or within the wall


sympathetic effects on abdomen

-shunts blood away from the intestine (vasoconstriction)
-inhibits gastrointestinal mobility (peristalsis) by relaxing smooth muscle
-contracting sphincters
-inhibiting glandular secretion


parasympathetic effects via the vagus nerve on abdomen

-aimed at conserving and restoring energy by:
-increasing peristalsis of the GI tract
-stimulating glandular secretion
-opening sphincters