Stuff I cant remember Flashcards
(202 cards)
1
Q
what nerve must be accounted for with a gridline incision?
A
iliohypogastric
2
Q
what two muscle layers does the iliohypogastric nerve run through?
A
TA, IO
3
Q
what is the medial inguinal fossa also known as? why is this area significant?
A
hesselbachs triangle
common site of direct hernias
4
Q
what does an epigastric hernia go through?
A
linea alba, cause shit body folding
5
Q
what is a spligelian hernia?
A
hernia through linea semilunaris
6
Q
What is considered a high risk incision? 2
A
at the inguinal level cause of potential injury to ilioinguinal nerve
at rectus abdominis-can damage nerve supply
7
Q
describe the descent of the testes.
A
start at 10 –> follows gubernaculum through processus vaginalis and is carried through layers of fascia till it gets there
8
Q
what does the gubernaculum become in women?
A
round ligament
9
Q
what structures pass through the deep inguinal ring?
A
vas deferens, gonadal arteries/nerves round ligament spermatic cord ilioinguinal pops in through the wall of the canal
10
Q
what structures pass through the superficial inguinal ring?
A
spermatic cord, round ligament
11
Q
what two nerves are in the inguinal canal?
A
genitofemoral
ilioinguinal
12
Q
what nerve does motor innervation for the cremaster muscle?
A
genitofemoral n
13
Q
what are the contents of the inguinal canal?
A
spermatic cord/round ligament
ilioinguinal n
genitofemoral n
gonadal arteries/veins
14
Q
following lymph where would testicular/ovarian cancer spread?
A
upper pelvic ln –> lumbar ln –> pre aortic ln
15
Q
what are the boundaries of the inguinal canal?
A
roof-internal oblique aponeurosis
floor-inguinal ligament
anterior-external oblique
posterior-transversalis fascia
16
Q
boundaries of superficial ring?
A
roof-medial crus of external oblique
floor-lacunar ligament
anterior-external oblique aponeurosis
posterior-conjoint tendon
17
Q
boundaries of deep inguinal ring?
A
roof-tansversalis fascia
floor-iliopubic tract
anterior-internal oblique and lateral crus
posterior-transversalis fasia
18
Q
what does the inguinal canal arise from?
A
internal oblique
19
Q
what does the inguinal ligament arise from?
A
external oblique
20
Q
what does the external spermatic fascia arise from?
A
external oblique aponeurosis
21
Q
what does the cremaster muscle arise from?
A
internal oblique apon
22
Q
what does the internal spermatic fascia arise from?
A
transversalis fascia
23
Q
what does the parietal and visceral layer of tunica vaginalis arise from?
A
processus vaginalis
24
Q
what does the dartos arise from?
A
superficial fascia
25
what is an external supervesicular hernia? what nerve is at risk?
rare hernia medial to direct, iliohypogastric during repair
26
how would you fully anesthetize the scrotum?
anteriolateral part-ilioinguinal n
| posterior part-pudendal S3
27
what 3 ligaments make up the greater omentum?
gastrosplenic
gastrocolic
gastrophrenic
28
what are the boundaries of the lesser sac?
```
superior-liver/diaphragm
inferior-transverse mesocolon, duodenum
right-epiploic foramen
left-spleen, gastrosplenic ligament
anterior-stomach, gastrohepatic, lesser omentum
posterior-pancreas, IVC, aorta, kidneys
```
29
what are the boundaries of the epiploic foramen?
anterior-hepatoduodenal l
posterior-IVC, r crus of diaphragm
inferior-proximal duodenum
superior-liver/diaphragm
30
what area do the paracolic gutters provide access to?
hepatorenal rescess, subphrenic recess, retrovesical pouch
31
what is posterior to the pancreas?
IVC, aorta, right kidney, splenic vessels, r crus of diaphragm, bile duct
32
what type of epithelium is the esophagus?
stratified squamous
33
what is located in the lamina propria of the esophagus?
cardiac esophageal glands
34
what is important about the submucosa of the esophagus?
contains venous plexus and you get esophageal varicies with liver failure
35
what is important about the serosa layer of the esophagus?
has adipose instead of mesothelium
36
What is the epithelium of the stomach?
simple columnar epithelium
37
what is significant about the submucosa of the stomach?
no glands
38
what is significant about the muscularis externa layer of the stomach?
inner circular, outer longitudinal AND oblique
39
how does the gastric microvasculature facilitate protection of the mucosa?
submucosal arterial plexus has fenestrated capillaries that provide bicarbonate delivery to neutralize acid
40
what area of the GI system does the vagus nerve innervate?
esophagus to splenic flexure
41
what area of the GI system do the pelvic splanchnic nerves innervate?
splenic flexure to proximal rectum
42
what is the orad area of the stomach?
cardia and fundus and part of the body
| relaxes during swalling
43
what is the caudad area of the stomach?
pyloric and last half of body, regulates emptying
44
how would you ID cardiac glands of the stomach?
very coiled so they look like stacked coins only in this region
45
how would you ID fundus/body glands of the stomach?
have put neck and body
46
how would you ID pyloric glands?
they are deeper and more branched than body/fundus glands, deeper pits larger lumen
47
what do pyloric glands secrete thats different? what else do they have lots of?
lysozyme, lots of GALT tissue
48
how would you ID a chief cell?
its deep in the gastric gland and has zymogen granules, anything else is probably parietal
49
what is the function of gastrin? what cells secrete?
G cells, acid secretion
50
what is the function of somatostatin, what cells?
suppress gastrin, D cells
51
what is the function of ghrelin?
triggers hunger
52
what is menetriers disease?
TGF-a induced hyperplasia of surface mucous cells
| GI bleeds, N/V/D
53
what are the 3 constrictions of the esophagus?
cervical-cricopharyngeal muscle
thoracic-aorta and broncho
diaphragmatic-when it enters the diaphragm at T10
54
what level does the esophagus enter the stomach?
T11
55
What level is the transpyloric plane? what structures are here
L1, pylorus, duodenum, gall bladder, bile duct
56
what is on the anterior surface of the stomach?
left lobe of liver, diaphragm, anterior abdominal wall
57
what are the posterior relationships of the stomach?
LESSER SAC, pancreas (middle bulk), spleen (more superior), colomesocolic surface .(bottom), phrenic (most superior)
58
what are some problems that can arise from gastric ulcers?
- can perforate stomach and spill into lesser sack,
- can cause liver, gall, pancreas to become inflamed and adhere to each other
- erosion of gastroduodenal artery
- can enter the peritoneal cavity
59
what part of the duodenum is prone to ulcers and connected to the hepatoduodenal ligament? what spinal level?
1st, L1
60
what are the relationships of the 2nd part of the duodenum?
L1 --> L3,
anterior-gall bladder, left liver
posterior-right kidney
medial-pancreas
61
what are the relationships of the 3rd part of the duodenum?
L3
superior-pancreas
anterior-jejunum
posterior to SMA
62
what are the relationships of the 4th part?
L2
suspensory ligament of treitz holds it
anterior to IMA, aorta
posterior to root of mesntery and jejunum
63
what features does the jejunum have compared to ileum?
```
both supplied by SMA
LUQ instead of RLQ
2/5 of it
thicker, more plicae
more vascular
fewer loops
longer arcades and vasa recta
less fat
darker
```
64
what is inside THE mesentery?
SMA, lymph, autonomic nerves (lesser splanchnic)
65
what spinal level is THE mesentery?
L2-L5
66
what structures does THE mesentery cross? (6)
```
last half of duodenum
aorta
IVC
right ureter
right psoas major
right gonadal vessles
```
67
what are the relationships of the spleen?
anterior-pancreas, stomach
posterior-diaphragm
inferior-left splenic flexure
medial-phrenicocolic ligament
68
what quadrant/9drant/ribs is the spleen?
left 9-11, left hypochondriac, LUQ
69
what divides the physiological lobes of the liver?
cantile line
70
what divides the anatomical lobes of liver?
falciform ligament
71
what physiological lobe is lefft functionally but right anatomically
IV
72
what ligaments connect the liver to the diaphragm?
left and right triangular, coronary
73
what area of the liver do the hepatic veins drain into the IVC?
the posterior surface not covered by visceral peritoneam, defined by coronary ligaments
74
what separates the caudate and quadrate lobes?
transverse fissure, contains portal triad
75
what is the embryological origin of the ligamentum teres?
umbilical vein
76
what is the embryological origin of ligamentum venosum?
ductus venosus
77
where does the gallbladder lie?
hepatic fossa
78
what costal cartiladge does the gallbladder touch?
9th
79
what is a cholecysto-enteric fistula? what organs could this affect?
an adhesion between gallbladder and transverse colon and abdominal wall, gall stones can enter
80
what happens if you block the cystic duct? symptoms?
cholecystitis
| tachy, fever, postive murpheys sign
81
what is the pathway of the bile duct starting in the liver?
right and left hepatic ducts join to make common hepatic duct --> common hepatic duct joins with cystic duct to make bile duct --> runs posterior to 1st part of duodenum and pancreas (in the hepatoduodenal ligament)
82
where will you most likely find diverticulosis?
sigmoid on mesenteric side
83
what can cause a displaced stomach?
pancreatic psudocysts or abscesses in omental bursa
84
what spinal level do things cross the diaphragm?
I 8 10 eggs at noon (12)
| IVC T8, esophagus T10, aorta T12
85
what level does the esophagus enter the stomach?
T11
86
what level is the pylorus of stomach?
L1 (transpyloric plane)
87
What level is each part of the duodenum?
L1, L3, L3, L2
88
what spinal level is the mesentery?
L2-L5 (transtubercular plane)
89
what level is the ileocecal valve?
L5 transtubercular plane
90
what level is the cecum?
L5 transtubercular plane
91
what level is the appendix?
S2, mcburneys point
92
what levels does the ascending colon cross?
L5 --> L3
93
what level does the transverse colon cross?
L1 hepatic flexure--> T12 splenic flexure
| middle part gets as low as L3
94
what levels descending colon?
T12 --> L5
95
what levels sigmoid colon?
transtubercular L5 --> interspinous S2
96
level of liver?
upper-xiphisternal plane T9
| lower-right-9th rib, left -8th rib
97
level of gall bladder?
9th costal cartilage
| transpyloric plane L1
98
level of pancreas?
head-L2
| neck-L1
99
What organs does the celiac trunk supply?
T12
| distal esophagus --> proximal duodenum
100
what organs does the SMA supply?
L1
| proximal duodenum --> proximal transverse colon
101
what orrgans does the IMA supply?
L3
| distal transverse colon --> proximal recturm
102
what is the anastomosis between the celiac artery and the SMA?
superior/inferior pancreaticoduodenal arteries
103
what is the anastomosis between the SMA and IMA?
the marginal artery of drummond, a good one can prevent intestinal ischemia
104
what supplies blood to the rectum?
superior rectal artery--IMA
middle rectal artery--internal iliac
inferior rectal--internal pudendal
105
what arteries are contained in the hepatoduodenal ligament?
portal v, proper hepatic a, bile duct
106
what arteries are contained in the hepatogastric ligament.?
right and left gastric arteries
107
what arteries are contained in the gastrocolic ligament?
right gastroepiploic a
108
what arteries are contained in the gastrocsplenic ligament?
short gastric
| left gastroepiploic
109
what arteries are contained in the splenorenal ligament?
splenic a/v
110
What are the 4 portal anastomoses (where blood would go if portal circulation blew and it had to go back to systemic
1. esophageal
2. rectal
3. paraumbilical
4. retroperitoneal
111
what two vessels are involved in the esophageal portal anastomosis?
left gastric v, azygos v
| causes esophageal varicies in the submucosal layer of the esophagus!
112
what two vessels are involved in the rectal portal anastomosis?
superior rectal with middle and inferior rectal
| causes hemmheroids
113
what two vessels are involved in the paraumbilical anastomoses? what sign shows here?
superficial epigastric v and paraumbilical v
| caput mudusae
114
what two vesssles are involved in the retroperitoneal anastomosis?
colic v and systemic retroperitoneal v
115
what anastomesis is used if the IVC is blocked? 2
lumbar veins --> azygos veins
| superficial epigastric and --> internal and lateral thoracic veins
116
what is the pathway of the lumbar splanchnic nerves?
L1-L2 -->
inferior mesenteric ganglion --> hindgut
intermesenteric plexus --> renal, testical, ovaties, uterus
superior hypogastric plexus --> uteric/testicular plexus
117
what is the pathway of the pelvic splanchnic nerves?
S2-S4 --> inferior hypogastric plexus
118
what is the pathway of the vagus nerve?
vagus --> anterior and posterior vagal trunk --> abdominal aortic plexus and periarterial plexus
119
what area does the vagus innervate?
everything up until the splenic flexure
120
how does pain travel in the GI tract?
travels with sympathetics until the splenic flexure
| pelvic splanchnics after
121
how do reflexes travel in the GI tract?
vagus until splenic flexure
| pelvic splanchnics after
122
how is the anal canal innervated?
superior to pectinate line -- sympathetics via lumbar and parasympathetics via splancic
inferior to pectinate line --> somatic via pudendal
123
what are the 4 degrees of folding in the small intestine lumen?
1. plicae circulares-folds of mucosal layer, cannot be flattened like stomach
2. villi-folds of mucosa to increase surface area
3. crypts of liebarkans/glands-invagination of mucosa
4. microvilli-brush border on apical domain of enterocytes
124
what makes the colon distinguishable on a histological slide?
gobs of goblet cells, all colon is the same
125
what are some key features to distinguish the duodenum? what is the funciton of this?
brunners glands in SUBMUCOSA, looks like white spots
| secretes bicarb
126
what are some key features to distinguish the jejunum?
no brunners glands, lots of lymphoid tissue in the lamina propria
127
how can you tell youre looking at the gastroduodenal junction?
the somach has thicker muscularis walls and shallower gastric pits, intestine gets much more finger like and will have brunners glands
128
how can you tell youre looking at the ileum?
peyers patches, follicles in the submucosa
129
where are paneth cells and what is their function?
bases of the crypts of lieberhan
- secrete antimicrobial proteins
- defensins, lysozyme, AGN4
130
how would you find an enterocyte?
they are the simple columnar cells with the brush border
131
how would you ID a goblet cell? what is their function?
theyre white blobs within the enterocytes, secrete mucous granules
132
what keeps microvilli upright?
actin filaments attach to a terminal web rootlet that attaches to an intermediate filament
133
what do enteroendocrine cells secrete?
gastrin
cholecystokinin
secretin
134
what is the function of gastrin?
stimulates HCl
135
what is the function of cholecystokinin?
slows stomach emptying and releases bile
136
what is the function of secretin?
bicarb, opposes gastrin
137
what is in the muscularis layer of the colon?
taeniae coli
| haustra
138
what is in the serosa layer of the colon?
appendices epiploicae
139
what would a biopsy for hirschsprungs disease show?
thick irregular nerve bundles with no ganlion, and AchE staining
140
how is bloodflow distributed in the small intestine at the histological level?
vasculature located in submucosa
villous capillary plexus does upper portion of crypts
pericryptal capillary plexus does lower
lacteals poke up into villi as well which are GALT
141
upper and lower rectum distinction?
upper will have goblet cells and tubular glands, simple columnar
lower will have non-keritnazed stratified squamous epithelium
142
what are some key features of the veriform appendix?
no villi, shallow crpts, lots of lymphoid fillicles that extend to mucosa
143
what layer is affected in ulcerative colitis?
mucosa of large intestine
144
how does crohns disease work?
usually in the terminal ilium, inflammatory bowel cells produce cytokines and bring neutrophils to the crypts
145
what are the three types of gland? what is predominant in the GI system?
merocrine****
apocrine
holocrine
146
how do merocrine glands work?
exocytosis of secretory vessels
147
what type of glands are in the large intestine?
simple tubular
148
what type of glands are in the sweat glands?
simple coiled
149
what type of glands are branched tubular?
stomach
150
what type of glands are compound branched tubular?
brunners
151
what type of glands are compound alveolar acinar?
pancreatic
152
what type of gland is tubular alveolar/acinar?
submandibular
153
what type of glands are simple tubular?
large intestine glands
154
what type of glands are in the stomach?
simple branched
155
what type of glands are brunners?
compound branched tubular
156
what kind of glands are pancreatic?
compound alveolar/acinar
157
what type of glands are submandiblar?
tubular alveolar, mumcoserous, looks like white cells wearing a purple hat, but mostly serous
158
what type of gland is in the sublingual gland?
mucous acini but has some serous, cloudy cytoplasm, white clouds
159
what type of gland is the parotid?
serous acini, parotid=pink
160
how do you know youre looking at a salivary gland?
septa dividing the lobules, intercalated/striated ducts
161
what is a hepatic lobule?
a hexagonal functional unit of the liver, has portal triads at angles and central venule
162
what is a portal lobule?
several hepatic lobules that drain bile into a portal triad
163
what is a liver acinus?
a division based on distance from the portal triad creating an O2 gradient, zone 1 is closest and produces most products, zone 3 is mostly for detox purposes
164
what does the apical and basal side of a hepatocyte do?
basal-drains plasma proteins into sinusoid side
apical-drains bile into the bile canaliculi
165
what do bile canaliculi look like on a histological slide?
brown sticks
166
what separates the hepatocyte from the sinusoidal space?
perisinusoidal space of disse
| space of mall drains into lymph
167
what occurs in chronic liver disease?
perisinusoidal space cannot proliferate unless activated by kuppfer cells and hepatocytes leading to fibrosis
168
what is hemochromatosis?
increased iron in lysosomal hepatocytes, causes cirrhosis
169
what is wilsons disease?
impaired copper metabolism, causes copper deposits in hepatic lysosomes
170
what are the stages of alcohol damage to the liver?
fatty liver, steatohepatitis (inflammation), cirrhosis-collagen proliferation or fibrosis
171
what is hepatitis? chronic causes? A, B ,C ?
inflammation of liver due to virus, bacteria, fungi
chronic is fibrosis and hepatocyte necrosis
A-food
B-Sex/drugs
C-blood transfusions
172
what is released during gallbladder injury?
gallstones, bile?
173
what occurs in pancreatitus?
premature activation of digestive enzymes such as trypsinogen to trypsin
acute-alcohol, large meal
chronic-fibrosis and destruction of pancreatic tissue
174
what do kuppfer cells look like on a slide?
black spots
175
what is the function of the smooth ER in a hepatocyte?
glycogen, detox
176
what is the function of the rough ER in a hepatocyte?
plasma proteins
177
what is the function of the golgi in a hepatocyte?
glycosylation of proteins, sorts enzymes
178
what is the function of the lyososmes in a hepatocyte?
iron storage, degradation of glycoproteins
179
what is the function of the peroxisomes in a hepatocyte?
beta oxidation of fatty acids, braeks down hydrogen peroxide
180
what gland is the pancreas?
branched tubuloacinar serous
181
how do you ID a pancreas histo slide?
looks like salivary glands but has zymogen granules in the centroacinar cells
182
what types of substances are secreted from centroacinar cells?
bicarb, Na, H20, amylase (for high carb), protease (for high protein)
183
what anterior rami innervates quadratus lumborum?
T12-L4
184
what anterior rami innervates psoas muscles?
L1-L3
185
what anterior rami innervates iliacus?
femoral n L2-L4
186
what is the medial arcuate ligament?
a thickening of the psoas fascia as it passes through the diaphragm
187
what is the lateral arcuate ligament?
a thickening of the quadratus lumborum fascia
188
what is the median arcuate ligament?
aorta passing through diaphragm
189
what spinal level is the right crus?
L3-L4m
190
what spinal level is the left crus?
L2-L3
191
what are the suprarenal glands located near? what spinal level innervates?
the crus of each side of diaphragm, T10-T11
192
what is posterior to kidney? what rib levels?
quadratus lumborum mostly
| 11 and 12, extend to about L3, right one is lwoer
193
what nerves lie posterior to the kidney?
subcostal, iliohypogastric, ilioinguinal
194
what are the 3 constrictions of the ureter?
renal pelvis and ureter junction
pelvic brim
entering bladder
stones get stuck here
195
motor and sensory function of subcostal n?
motor: transversus abdominis
sensory: skin aboev iliac crest
196
motor and sensory function of iliohypogastric?
motor: IO, TA
sensory: skin in pubic region
197
motor and sensory function of ilioingional?
motor: IO, TA
sensory: anterior scrotum/labia, mons pubis, upper medial thigh,
198
motor and sensory function of genitofemoral n?
motor: cremaster
sensory: antieror scrotum, anterior upper thigh
199
motor and sensory function of lateral femoral cutaneous
motor: none
sensory: lateral thigh
200
motor and sensory function of femoral n
motor: anterior compartment of thigh
sensory: anterior thigh
201
motor and sensory function of obturator n
motor: medial thigh
202
what is the embryologic origin of kuppfer cells, stromal cells, and stellate cells?
splanchnic mesoderm.
