Week 10 Flashcards
1
Q
What is the cecum?
A
pouch-like structure at the beginning of the large intestine, where it connects to the small intestine.
2
Q
What are tenia coli?
A
Thickening of longitudinal muscle fivers in muscularis externa
3
Q
What is the purpose of the colon (large intestine)?
A
Water absorption, don’t want to be losing water, helps to concentrate the feces into stool
4
Q
Rectum details
A
- final part of the colon
- descends into the pelvis
- no tenia coli, but longitudinal muscles thickens in the muscularis externa
5
Q
What is the blood supply of the rectum?
A
Superior rectal artery: 1 branch from the IMA for the upper rectum
Middle rectal arteries: 2 branches from the internal iliac for the middle rectum
Inferior rectal arteries: 2 branches from the internal pudendal which a branch of the internal iliac for the lower rectum
6
Q
Anus Details
A
Internal anal sphincter - involuntary control, we do not have
External anal sphincter
- skeletal muscle so voluntary control
- us constantly deciding when to defecate
7
Q
What is the pectinate line?
A
Rectal (final section of large intestine) and anus (internal and external, opening)
- difference in epithelium composition
- above the line we get venous supply from the branches of the inferior mesenteric artery and portal venous system
- below is the internal pudendal artery that can be traced back into the internal iliac artery and systemic venous system (travel back to the inferior vena cava)
8
Q
Inferior Mesenteric Artery points
A
- branches from abdominal aorta
- around L3 vertebral level
- supplies hindgut
- travels ehind mesentery to reach organs
- Left Colic artery (marginal artery)
- sigmoidal artery
- superior rectal artery
9
Q
What is the purpose of the marginal artery?
A
Helping with midgut meeting hindgut
- Middle colic from the superior mesenteric artery connects with the left colic artery from the inferior mesenteric artery
10
Q
What does the sigmoidal artery supply?
A
- The curvy sigmoid colon
10
Q
What does the superior rectal artery supply?
A
- initally we have one superior rectal artery but it will continue to branch to supply both sides of the superior aspect of the rectum
11
Q
What is the Portal venous system?
A
- drain the intestinal system
- vessels for nutrient
- carbohydrates and proteins
12
Q
What happens when we absorb molecules from the bloodstream?
A
- we are bringing molecules from the lumen of the gut tube into the bloodstream, we’re absorbing it into the portal venous veins
- these are low in oxygen but nutrient rich
12
Q
Where does the blood go to beofre entering the system?
A
- oxygen poor, nutrient rich blood goes to the liver for toxification before it enters systemic circulation and pumped to the lungs to pick up lungs and go to the rest of the body
12
Q
What are the branches of the portal venous system?
A
- inferior vena cava goes to the splenic vein which attaches to the superior vena cava to create a common branch
13
Q
What detoxify the things in the veins?
A
the hepatocytes in the liver
14
Q
Portal Vein vs Hepatic Vein?
A
Portal Vein: brings nutrient-rich blood from the digestive organs (stomach, intestines, spleen) to the liver for processing
Hepatic Veins: carry blood away from the liver to the heart, after the liver has processed it
14
Q
Why do things need to be detoxified first?
A
First pass effect, a lot of tiems what we injest, we can’t initally use by the body and the cells. It has to be broken down further and metabolized first in the liver before it enters systemic circulation and then our cells can use it
- make it more bioavailable for our food
15
Q
Lymphatics
A
are where the lipids are absorbed
16
Q
How are lipids aborbed?
A
- There are lacteals similar to those in the portal veins
- they uptake the lipids from the lumen of the gut tube
- Travel to the cisterna chyli which is a system to all the lympathic in the abdomen and pelvis
- Travel to thoracic duct (ascends to through the thorax and dumps into the venous angle)
- Enter systemic venous circulation
17
Q
What is at the venous angle?
A
Thoracic duct
- left subclavian vein and left internal jugular
18
Q
Autonomics to the Abdomen
A
- everything in the abdomen is under involutnary control
19
Q
Parasympathetic innervation
A
- right and left vagus nerves are wrapping around the esophagus
- left vagus nerve in close proximity with the arch of the aorta
- esophageal plexus
- really long preganglionic neuron
- synapse within the organ
- short post-ganglionic neuron
20
Q
Sympathetic Innervation
A
- thoracic splanchnic nerves (preganglionic)
- T1-L2 Level
- sympathetic chain where a lot of neurons are synapsing
- the specific splanchnic nerves that go to the abdomen are the greater, lesser and least splanchnic nerves
21
What is another name for the splanchnic nerves?
Paravertebral ganglion (sympathetic chain), groups of nerve cells located next to the spine
- beside vertebral column
21
Where do the splanchnic nerves go?
- greater, lesser and least splanchnic nerves without synapsing go through the sympathetic chain (paravertebral ganglia). They are going to descend into the abdomen to the prevertebral ganglion in front of the vertebral column, on top of the abdominal aorta (this is where the splanchnic nerves synapse)
- they then go to their target organ
22
What do the sympathetic arteries have to go through before going to target organ?
The mesentery
23
Diverticulitis
- Low fiber diet leads to more strain on the muscles of the digestive tract to push food along (food going through our system is not very slippery)
- fiber loosens up the food in there, makes it slippery and easier for it to go through the GI tract
- if you're on a low fiber diet, the muscles have to push a lot harder and it pushes it puts a lot more strain on the intestines
- mucosa herniates away from the lumen (diverticulosis)
Diverticulosis: mucosal pouches become infected
24
How can diverticulum be treated?
antibiotics
- short term you might be put on a clear liquid diet to give the colon a break
25
Ulcerative Colitis
- a type of inflammatory bowl disease
- immune response leading to ulcers and inflammation along the mucosa of the colon
26
How is ulcerative colitis treated?
- anti-inflammatory and immunosuppressants
- if left untreated, it can greatly increase the risk of colon cancer
27
Abdominopelvic Cavity
- the abdominal cavity is continuous with the pelvic cavity
- respiratory diaphragm --> pelvic diaphragm muscles
- separated by connective tissue boundaries
28
Peritoneal cavity development
During development the gut tube develops and pushes into the peritoneum
- intraperitoneal organs
- retroperitoneal organs
29
Intraperitoneal
Visceral peritoneum = serrosa
- Parietal peritoneum
30
What happens to the peritoneal space as we grow older?
- The space becomes a lot more convoluted and smaller in the adult form because we've got way more organs filling that space than just a tiny tube
31
Parietal space verses parietal cavity
peritoneal cavity is everything encapsulated by the parietal peritoneum including the organs
32
What is the mesentery for the gut tube?
- creates a vacuum seal for the neural vasculature to travel to and from the gut tub
32
How are the intraperitoneal organs connected to the aorta wall?
- intraperitoneal organs are free in the peritoneal cavity but are anchored to the anchored to the aorta wall via their blood supply
- root of the mesentery (double layer)
33
What organs are the intraperitoneal organs?
- stomach, distal part of the duodenum, ileum, jejunum, spleen, liver, gallbladder, transverse/sigmoid colon
34
Retroperitoneal organs
- secured to the abdominal wall
- behind the peritoneal sac
- part of duodenum, ascending/descending colon, pancreas, kidneys
35
What is the greater omentum?
- made of four layers coming from the stomach and the duodenum
- covers the rest of the organs
- fatty tissue
35
Reflections
Layers of peritoneum created by the folding and orientation of the gut tube
36
What is the lesser omentum (2 layers)
Connections between the liver and stomach and duodenum
- Hepatogastic Ligament
- Heptaduodenal Ligament
creates like a curtain, there is a little hole called the epiploic foramen
37
Appendicitis
- pain in the lower right quadrant of the abdomen and well as nausea and low-grade fever
- inflammation of the appendix
- blockage and dysregulation of bacteria in the appendix, IBD
- antibiotics, surgery (appendectomy)
37
What is the greater sac?
- Everything else
- entire peritoneal cavity except lesser sac
38
What is the lesser sac?
- Posterior to the lesser omentum and stomach
- Accessed through the epiploic foramen
38
Anterior abdominal wall: External Oblique (anterior inferior direction)
Internal Oblique (anterior-superior)
- as we move medially it becomes
38
Anterior abdominal wall
- skin, superficial fat and fascia, anterior abdominal wall muscles, parietal peritoneum
39
Anterior abdominal wall: External Oblique (anterior inferior direction)
- as we move closer to the midline, it gets very tendency: external oblique aponeurosis
40
Anterior abdominal wall: Rectus Abdominis
- find it in the midline
- 6 pack muscles
- vertical muscle fiber direction
- rectus sheath on the deep aspect of this muscle
40
Anterior abdominal wall: Transversus Abdominis
- Horizontal
- posterior aspect of the rectus sheath
41
What layers (superficial to deep) would the surgeon have to cut through in order to access and remove the appendix?
- skin
- fat and fascia
-muscle layers: external oblique, internal oblique, rectus abdominis, rectus sheath tranversus abdominis
- peritoneum
42
What is the order of the process of digestion?
1. Ingestion
2. Propulsion
3. Mechanical Breakdown
4. Digestion
5. Absorption
6. Defecation
43
List the accessory organs
- Liver, Gallbladder and pancreas
44
Where is the liver located spatially?
- right hypochondriac region and epigastric region
44
Label all of these
45
Label all of these
45
Label all of these
46
Label all of this
47
Label all of this
48
What vessel allows for drainage of oxygen poor but nutrient rich blood from the liver?
Hepatic vein --> Inferior Vena Cava
48
What arterial blood vessel provides oxygen rich blood to the liver?
Celiac Trunk --> Common Hepatic Artery --> Proper Hepatic Artery
48
What are the functions of the Liver?
1. Produces bile - to break down fats
2. Glycogen storage - taken from glucose found in the blood
3. Detoxification site
4. Creates blood proteins
Liver cells - Hepatocytes
49
What makes up the portal triad?
Portal arteriole, portal venule, bile duct
49
What does the bile duct do?
Which carries bile away from the liver globules ( small, rounded droplets of fat or liquid), our portal venial and our portal arterial
50
What do the Bile Canaliculi?
- allows bile to flow from the hepatocytes, towards the bile duct and dumps the content there.
- biles can locally and travels through the bile cannaliculi empty into the bile ducts at the portal triad
50
What is the pathway of blood in the hepatocyte?
- first through the hepatic portal vein and hepatic artery travel through the sinusoids
- through the hepatic veins and then drain into the inferior vena cava
50
What are the sinusoids?
- receive blood from both the portal vasculature and carries in inward to reach the central vein
51
What are the three anatomical regions of the gallbladder?
- neck, body, fundus
51
Where is the gallbladder located?
Muscular sac that rests in a shallow depression on the visceral surface
- located just deep to the right lobe of the liver
52
What is the travelling path of the bile?
Right and left hepatic duct --> Common hepatic Duct --> Bile Duct
52
What is the function of the gallbladder?
- concentrates and stores bile from liver (removing any water or electrolytes from bile to make it more potent and digest for digestion)
- releases bile in response to meals containing fat that pass-through duodenum
53
What are the parts of the pancreas?
- head, neck, body, tail
- tail which is pointing directly towards the spleen. Inferior to the neck
53
Where does the pancreas sit?
- Epigastric region and left hypochondriac region
54
Label all of these
54
What controls the flow of bile and pancreatic juice into the duodenum?
The hepatopancreatic ampulla (Ampulla of Vater) is where the bile duct and pancreatic duct meet and release their contents into the duodenum. The hepatopancreatic sphincter (Sphincter of Oddi) is the muscle that controls this release.
54
Where does the accessory duct drain into?
the minor duodenal papilla
55
What are the two functions of the pancreas?
- Exocrine: Secretion of pancreatic enzymes into the pancreatic duct that are essential for digestion
Endocrine: Islets of Langerhans produce hormones such as insulin and glucagon to control blood sugar levels.
56
Gallstones
56
2. build up of bile in the liver. Jaundice
3. Jaundice and pancreatitis which is an infection or inflammation of the pancreas
56
What is this?
- liver filling up most of the upper right side
56
What is this?
The stomach
56
What is this?
The transverse colon
56
What is the thing in the yellow for?
Pyloric sphincter that controls the exit of the stomach contents into the next segment which is the duodenum
56
What is this for?
Duodenum
- C shaped, first segment of the small intestine
- within in the C, you have part of the pancreas
56
What do these do?
Blue = pancreatic duct which joins with the pancreatic duct (yellow) coming from the liver, and empties into the duodenum
- neutralize the acidic contents that are coming from the stomach
56
What is this part under the stomach?
The jejunum
- fills the middle left side that transitions into the ileum which is in the lower right side
56
What is this?
The ileum that is going to join up with the large intestine or the ascending colon right here
57
What is this?
- the ascending colon
57
What is this?
The ileocecal junction.
57
What is this area called?
Cecum
57
What is this?
The ascending colon
58
What is this called?
The transverse colon
58
58
What is this turn called?
The hepatic flexure
- right under the liver
59
What is this called, posterior to the colon? The starting of it
The appendix
- sometimes called the veriform appendix "worm shaped"
59
What is this turn called?
the splenic flexure
59
What is this part of the colon called?
The sigmoid colon
- S shape
60
What are the pouches called?
The haustra
61
What are these called?
The teniae coli
- instead of a full layer of muscle, these muscles form three thick bands that run along the outside
61
What are these called?
epiploic fat tags on the large intestine
62
What is this called?
The celiac trunk
63
What is this?
The left gastric artery
- goes and supplies the terminal portion of the esophagus as well as the lesser curvature of the stomach
63
What artery is this?
Splenic artery
- posterior to the pancreas
64
What artery is this?
The common hepatic artery
65
What artery is this?
Gastroduodenal supplying the duodenum
- branch of the common hepatic artery
65
What is this artery called?
Hepatic artery proper which splits into right hepatic artery and left hepatic artery
66
What is this artery called?
Superior Mesenteric Artery
- that artery is going to supply the small intestine
- branches will go to the jejunum
- branches will go to the ileum
- branches
66
What branches are these from?
Superior mesenteric artery branches will go the small intestine, jejunum
67
What are these branches from?
The superior mesenteric artery
- colic arteries branches
- that will supply the ascending and transverse colon up until the point of the splenic flexure
68
At what point does the inferior mesenteric artery take over?
The splenic flexure
68
What is this artery called?
The Inferior Mesenteric Artery
- supplying the descending colon, down to the rectum
68
Parasympathetic Innervation to the abdominal cavity
- vagus nerve, supplies the thoracic cavity
- only go to a certain point
- supply the smooth muscle in the digestive tract, cause peristalsis so to contract the muscles up until this point
-
69
What innervates the rest of the splenic flexure and the descending colon?
Pelvic Splanchnic parasympathetic nerve s
- which will come back up the pelvis
69
What is the sympathetic innervation of the abdominal cavity?
- Thoracic sympathetic chain as the splanchnic nerves
- they pass through the sympathetic chain without synapse and then cross into the abdominal cavity
- counteract the parasympathetic
69
What covers the liver?
The visceral peritoneal layers
70
Where do these layers merge?
The visceral peritoneal layers come together and merge right here
- Falciform ligament
71
Where does the falciform ligament reflect to?
The anterior abdominal wall
Anterior Abdominal Wall: This is the front part of your abdomen. It's made up of several layers of muscles, including:
Rectus abdominis: The "six-pack" muscles.
External oblique:
Internal oblique:
Transversus abdominis:
72
What is on the anterior abdominal wall?
- parietal peritoneum
72
How is the liver connected to the stomach?
Hanging by the visceral peritoneum
73
What side of the liver is this?
Right side
- pushes the diaphragm up into the right area, compressing the lung
74
What is this called and what is the purpose of this?
Round ligament of the liver, or ligamentum teres
- part of the fetal circulation where the liver is bypassed
- blood coming from the umbilical cord would bypass the liver and go directly into the inferior vena cava
75
What is this ligament called?
The falciform ligament, where both sides of the visceral peritoneum come together and meet
- this is attached to the anterior abdominal wall
76
What is this vessel called in the hilum of the liver?
Hepatic artery proper, which is also bringing blood into the liver
76
What sides of the liver are these?
- The pink is the left side and the purple is the right side
76
What is this called?
The caudate lobe
77
What is this hole called?
The Inferior Vena Cava
77
What is this called?
The gallbladder
77
What is this called?
The Quadrate Lobe
78
What is this vessel called in the hilum of the liver?
Hepatic Bile duct which will drain/go into the gallbladder
78
What is this vessel for in the hilum of the liver?
Portal vein
- brings blood into the liver
79
What is this ligament called?
Round ligament of the liver
- Ligamentum Teres
80
What is this called?
Ligamentum Venosum
- where the blood from the umbilical cord would bypass the liver and go directly into the inferior vena cava to get to
circulated around the blood
81
What is this ligament on the top of the right lobe called?
The coronary ligament
- where the superior portion of the liver is connected to the diaphragm
82
What is this area on the superior right lobe called?
Bare area
- not covered with visceral peritoneum
- liver tissue that comes into direct contact with the diaphragm
83
What is venous drainage for?
Brings all the contents of the digestion
- everything that gets absorbed from the stomach from the small intestine
- taken up into venous circulation and gets processed
84
Where are the two capillary beds?
First is in the small intestine
- Second is through the liver
84
What is the portal vein for?
carry blood from the digestive organs
85
What is this vessel called?
The portal vein
- consists of contributions from the superior mesenteric vein, splenic vein which will take contributions from the inferior mester
86
What vein comes here?
Superior Mesenteric Vein
86
Where does the portal vein go?
- enters at the hilum of the liver and provides nutrient rich blood and then it pass through the liver and the liver will take the components it needs
86
Where will venous blood go after the liver is done using it?
- Hepatic veins which will then directly go into the inferior vena cava and go back to the heart
87
What is this called?
The gallbladder
88
How does bile go into the gallbladder?
Common hepatic ducts that bring bile out of the liver and then goes into the gallbladder
89
What part of the gallbladder is this?
Neck of the gallbladder
90
What is this called?
Cystic duct
90
What is this called?
Bile duct
- common hepatic duct and the cystic duct come back together to form the bile duct
91
What is this called?
Hepatic Artery Proper
92
What is this?
Hepatic duct
- coming from the hilum of the liver
92
What is this?
The cystic duct
92
What is this called?
cystic branch of the cystic artery supplying the gallbladder
92
What is this?
The common bile duct
93
What organ is this?
The duodenum
93
What is the purpose of the pancreas?
- endocrine function: where it produces hormones such as insulin, insulin gets released into the bloodstream and has an effect
- exocrine portion where it releases contents into a duct system
94
What is this called?
The uncinate process and the head of the pancreas
-
94
What is this?
The splenic artery that travels just posterior to the pancreas
94
What is this large dome on the right side caused by?
The liver
95
What is this called?
The esophagus
96
What is this?
The hepatic bile duct
96
What is this?
The cystic duct
96
What is this called?
96
What is this called?
The splenic artery
97
What creates the mesentery?
The mesentery is formed from folds of the visceral peritoneum
- the mesentery are essentrially te attachment poitnts to the posterior abdominal wall
98
What vessel is this?
The superior mesenteric artery
- branch to supply the small intestine
98
What is this?
The greater omentum
- containing variable amounts of adipose tissue
- comes down and reflects back up and under and connects to the transverse colon
- 2 layers from the stomach and 2 layers from the transverse colon
98
What is the omentum between the liver and the stomach?
The lesser omentum
98
What are the nerves that supply 1.
Liver
PNS - vagus nerve
SNS - thoracic splanchic nerves synapsing on the celiac trunk
98
What are the nerves that supply 2.
Ascending colon
PNS - vagus nerve
SNS - splanchnic nerves synapsing on the celiac ganglion
99
What are the nerves that supply 3.
Stomach
PNS - vagus nerve
SNS - splanchnic nerves synapsing on the celiac ganglion
100
What are the nerves that supply 4.
Transverse colon - splenic flexure
PNS - vagus nerve
SNS - splanchic nerves synapsing on the inferior mesenteric ganglion
100
What are the nerves that supply 5.
Transverse colon
PNS - vagus nerve
SNS splanchnic nerves synapsing on superior mesenteric ganglion
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