Where is the lienorenal ligament situated? What does it contain?
contains the splenic vessels and is situated between the left kidney and spleen
Where is the gastrosplenic ligament situated? What does it contain?
contains the branches of the splenic artery to the stomach and the accompanying veins, it lies between the stomach and spleen
Where is the rectouterine pouch? Whats another name(s) for it?
its only in FEMALES, its produced by the peritoneum between the rectum and the uterus
-aka douglas pouch
the OVARY is suspended by a double layer of PERITONEUM called _________
The greater omentum is an apronlike fold of peritoneum extending downward from the _________ of the _________, turning upward at its free edge to pass BEHIND the ___________ and finally attaches to the __________
greater curvature (left border), stomach, transverse colon, posterior abdominal wall
What is the transverse mesocolon? Where is it?
-the messentary surrounding the transverse colon, its made up of a double layer of peritoneum
-the transverse mesocolon passes behind the transverse colon as a posterior layer of its messentary, before finally reaching/attaching to the posterior abdominal wall
Which is NOT true about The greater omentum:
A. prevents the visceral peritoneum from adhereing to the parietal paritoneum
B. is considered the "abdominal policeman", protects agains infection or inflammatory conditions in the abdominal cavity
C. protects against injuries to the abdominal organs
D. Has some mobility, moves towards an infectous area
E. acts as an insulator against loss of body heat
none, they are all true
N: Where does the messentary of the small intestine attach?
attaches to the posterior abdominal wall between the duodenojejunal flexure at the LEFT SIDE of the L2 vertebrae
N: How long is the messesntary from where it attaches on the left side to the iliocecal junction on the right side? BUT, the peculiar arrangement of the small intestine of the abdominal cavity allows for the messentary to surround it for ______ cm
about 6 inches long (15 cm, never more than 20 cm), 150-700 cm
What/where is the mesoappendix?
when the messentary of the small intestine is continuous with the short messentary of the vermiform appendix
T/F The attachment of the transverse mesocolon is located below the attachment of the messentary of the small intestine
Does the greater omentum attach to the transverse mesocolon?
Yes, it becomes the posterior layer of the transverse mesocolon before it attaches to the posterior abdominal wall
T/F When the greater omentum is raised, the transverse colon is also raised
What is one way to gain access into the LESSER SAC and the posterior wall of the stomach?
cut through the transverse mesocolon
What/where is the sigmoid mesocolon?
A double layer of peritoneum suspending the sigmoid colon,
-attaches to the posterior pelvic wall on the LEFT side close to the left sacroiliac joint area in an inverted V-shaped structure, extends medially to the middle of the sacrum (around S3 area)
Where are the left and right subphrenic spaces?
they are found between the diapragm and the liver on both sides of the falciform ligament
Where are the right and left parietocolic recesses?
-right parietocolic recess is between the asending colon and the lateral abdominal wall
-left parietocolic recess is between the descending colon and the lateral abdominal wall respectively
Where is the right subhepatic space? What is another name for this space
-aka hepatorenal pouch of Morison
-situatued between the LIVER and the RIGHT KIDNEY, and the second section of the duodenum lies posterior to it
What space/compartment is the lowest part of the abdominal cavity when lying flat (supine position)?
Right subhepatic space aka hepatorenal pouch of Morison
After surgery or in Ascites (which can also be from Liver Cirrhosis) if the patient is not moving properly, fluid acculturation may occur in which space/compartment? what further complications can this cause?
-Right subhepatic space aka hepatorenal pouch of Morison
-Can causerespiratory problems by irritating the diaphragm
Where is the mesenterocolic recesses?
below the transverse mesocolon, above the root of the messestery (where it attaches)
What is the space/compartment where fluid accumulates in pelvic inflammatory diseases (PID)?
Which of these pouches is found only in Males?
A. Rectouterine pouch
B. Rectovesical pouch
C. Vesicouterine pouch
Which of these pouches is found only in Females?
A. Rectovesical pouch
B. Vesicouterine pouch
C. Rectouterine pouch
B and C
What layer of the peritoneum conveys sensory information such as pain, Laceration, cold/heat, and pressure?
-pain is sharp and localized so this layer is sensitve to touch/ heat etc
What is the general blood supply and innervation of both the layers of the peritoneum
-the parietal layer is supplied by the vessels and nerves that innervate the underlying muscle
-the visceral layer is the same, is supplied by the same vessels and nerves (autonomic) that supply the visceral organs
Which layer of the peritoneum is NOT sensitive to touch, heat/cold,etc? Can this layer feel pain?
Visceral layer, but stretching and chemical irritants can provoke pain but the pain is not sharp and localized like it is in the parietal layer
If there is any pain in the VISCERAL LAYER of the peritoneum, its not gonna be sharp and localized, so where does it radiate to?
to the midline parts of the dermatomes:
-the Epigastric region for lesions of the Foregut structures
-the Umbilical region for lesions of the Midgut structures
-The Pubic region for hindgut derivatives
CP: What is peritonitis?
Inflammation (accompanied by pain) of the peritoneum following an abdominal injury like a stab wound, perforated ulcer, or appenicitis
CP: What is Ascites?
When the peritoneum exudes fluid and cells in response to injury or infection such as peritonitis.
-Commonly seen in patients with liver cirrhosis
CP: What is Paracentesis?
A medical procedure involving puncturing of the peritoneal cavity to drain fluids from a body caivty, as in ascites.
Food is moved down the digestive tract by _________ contractions, and the food particles are absorbed in the form of ____________ (4)
peristalic contractions (propulsive movements and forward flow.
-food particles are digested in the form of amino acids and small peptides (from proteins), small sugars (from carbohydrates), fatty acids, and glycerol from the digestion of fat
CP: What is congenital atresia?
Atresia is a condition in which a body orifice or passage in the body is abnormally closed or absent.
What are the foregut structures?
The foregut structures include the esophagus and stomach, down to the middle part of the duodenum. The liver, biliary system, gall bladder, and pancreas are also foregut derivatives
What are the midgut structures?
Lower half of the second part of the duodenum, jejunum, ileum, and colon (including the cecum, ascending colon, and the right/proximal two thirds of the transverse colon
What are the hindgut structures?
Left distal one-thirds of the transverse colon, descending colon, sigmoid colon, rectum, and the upper part of the anal canal
The internal covering (epithelium) of the primitive gut tube is derived from the _______. but its infrastructures, connective tissues and muscle layers are derived from the ______
BS: The blood supply to the primitive gut comes mainly from the _______
3 large branches of the abdominal aorta
BS: What are the FOREGUT structures supplied by? What are these structures again?
-The foregut structures include the esophagus and stomach (down to the middle part of the duodenum), liver, biliary system, gall bladder, and pancreas
BS: What are the MIDGUT structures supplied by? What are these structures again?
-Superior Messenteric artery
-Lower half of the second part of the duodenum, jejunum, ileum, and colon (including the cecum, ascending colon, and the right/proximal two thirds of the transverse colon
BS: What are the HINDGUT structures supplied by? What are these structures again?
-Inferior Messenteric Artery
-Left distal one-thirds of the transverse colon, descending colon, sigmoid colon, rectum, and the upper part of the anal canal
VD: What is the general venous drainage of the digestive tract?
The blood of digestive tract returns through the superior and inferior messenteric veins and the splenic vein, to the portal vein, and onto the liver
I: What are the roots of the Pelvic Splanchnic Nerve?
S2, S3, S4
I: What is the abdominal viscera innvervated by?
-Parasympathetic: primarily the VAGUS nerve, which innervates it down to the proximal/right two thirds of the transverse colon. The PELVIC SPLANCHNIC NERVES (S2, S3, S4) innervate it from the one third of the left of the transverse colon down to the anal canal.
-Sympathetic: the T5-T12 spinal segment innervate it from the lower esophagus to the upper part of the anal canal
GI motility is due to the unity of _________, except for the _________ which are composed of ___________
SMOOTH muscle contractions. Except for the pharynx, upper 1/3 of the esophagus, and the external anal splincter, which are composed of striated muscle
Contraction of what muscles leads to a DECREASE in the DIAMETER of that segment of the GI?
Contraction of what muscles leads to a DECREASE in the LENGTH of that segment of the GI?
T/F contraction of longitudinal muscles leads to a decrease in the length of that segment of the GI tract
Where do PHASIC contractions occur?
in the esophagus, gastric antrum, and the small intestine that contract and relax periodically
Where do TONIC contractions occur?
in the lower esophageal splincter, the orad (upper part) of the stomach, and the iliocecal and internal anal splincters
What are SLOW WAVES of the GI tract?
they spontaneously occur in oscillating membrane potentials in the SMOOTH MUSCLES of some parts of the GI
T/F Slow waves are action potentials
false, they are not action potentials but they can determine the pattern of action potentials and pattern of contractions
What are action potentials of the GI tract and when are they produced?
they are produced at the top of the background of slow waves, which INITIATE CONTRACTION OF THE SMOOTH MUSCLES
I: What is the intrinsic (enteric) innervation of the digestive tract (parasympahtic) ? What are these nerves responsible for?
-parasympathetic: supplied by 2 different plexus in its wall, the submucosal plexus of Meissner and the myenteric plexus of Auerback. These plexus contain the ganglionic neurons that innervate the digestive tract with their POSTGANGLIONIC FIBERS.
-these parasympathetic fibers are intergrate and coordinate motility, as well as the secretory and endocrine functions of the GI tract
What are the sympathetic fibers that innervate the GI tract responsible for?
mediate other functions of the intestine such as tone of the splincters, and conveying sensory information to the CNS
N: The esophagus is a _____ long muscular tube, which begins at the ___ vertebrae, and it continuous with the _______, and passes through the esophageal hiatus of the thoracic diaphragm at ____
25-30 cm, C6 (at level of cricoid cartilage), HYPOpharynx, T10
N: Where is the gastroesophageal junction?
below the diaphragm between T10-T12
N: The abominal section of the esophagus is about ____ cm long, and its from the ______ to the _______
1.25 cm, esophageal hiatus to the cardiac orifice of the stomach
The esophagus is accompanied by 2 nerves, what are they? and these nerves form a nerve plexus around it, what is it called?
vagus nerves (trunks), esophageal plexus
How many narrowings are there in the esophagus?
What/where is the upper esophageal splincter (UES)? What is it formed by? What is its function?
-one of the 3 main constrictors of the esophagus
-formed by the skeletal muscles at the junction of the pharynx and the esophagus
-functions to close the esophagus, preventing air from getting in the esophagus, and preventing gastric acid reflux from entering the pharynx via the esophagus
What surrounding muscles help the UES to close? What muscles help the UES open/relax during swallowing or vomiting?
-inferior pharyngeal constrictor and cricopharyngeus muscle help the UES close
-thyrohyoid and geniohyoid help relax/open the UES
N: Where are the other narrowings of the esophagus other than the 3 main ones?
-The other narrowings are at the tracheal bifurcation (T4),
-and where the LEFT MAIN BRONCHUS crosses the ESOPHAGUS,
-and at the LEFT ATRIUM level
Where are the other 2 main constrictors of the esophagus other than the one formed by the UES?
-the aortic narrowing, where it is crossed by the arch of aorta
-diaphragmatic narrowing, at the esophageal hiatus of the thoracic diaphragm
What/where is the phrenicoesophageal ligament?
its the ligament situated between the diaphragm and the esophageal hiatus
The lower esophageal splincter (LES) is ________ the gastroesophageal junction and contraction of the ________ in the area helps the lower esophagus (LES) function as a splincter
A. above, circular smooth muscle
B. below, longitudinal smooth muscle
C. Above, lamina propina
D. below, longitudinal smooth muscle
In case there is increased stomach content or GE reflux, what helps close the LES ? What helps open (relax) the LES when swallowed food reaches the area?
the acute angle of esophagus entering the stomach, thickening of the mucus membrane at the GE junction, tissues surrouding the esophagus, intra-abdominal pressure, longitudinal tension of esophagus, right crus of the diaphragm, and the submucosal pad of veins at the GE junction
-all these things can also help open (relax) it too
CP: What happens in the esophagus after food is swallowed?
1) the UES relaxes to allow the food to enter the esophagus, and then contracts to prevent the reflux of food into the pharynx
2) A primary peristaltic contraction creates an area of high pressure behind the food, moving it down
3) The primary contraction is followed by a secondary contraction, moving any residual food in the esophagus
4) The LES relaxes together with the orad region (the upper part) of the stomach which allows food to move in to the stomach
CP: What is Zenker's diverticulum? What age group does it happen in?
What is the therapy?
-diverticulum is just a pouch
-Zenker's diverticulum is an out-pouching of the posterior pharyngeal wall ABOVE the esophagus
-affects mainly older adults
-Therapy: surgery, endoscopic stapling, or other nonsurgical strategies
CP: What are the symptoms of Zenker's diverticulum?
it may be asymtomatic, but in symptomatic cases, it leads to dysphagia, regurgitation of food, coughing, halitosis, ulceration, bleeding, and inflammation
CP: What is achalasia (cardiospasm)? What causes it?
- A disorder of the lower esophageal splincter (LES) when it fails to relax during swallowing.
-its a Neuromotor disease caused by the absense or decrease in nuerons in the Myenteric plexus (similar to hirschsprung's disease in large intestine). CHAGAS DISEASE caused by Trypanosoma cruzi can also lead to achalasia (secondary achalasia).
CP: What are the symptoms of achalasia?
retrosternal pain, dysphagia (difficulty swallowing) for solids/liquids, dialated proximal esophagus and aperistalsis (absense of contraction), bird beak sign observed in a barium swallow, and a possible increase in LES pressure
What are the layers of the esophagus gut (from outer to inner)?
mucus membrane, lamina mucosa, muscularis mucosa, submucosa, tunica muscularis (consisting of inner circular and outer longitudinal muscles), and the adventitia on the outside
What type of cells (epithelium) are in the mucosa of the esophagus? what about in the cardia?
-the mucosa of the esophagus is stratified, nonkeratinized squamous epithelium
-in the cardia, where it joins the stomach, the epithelium is SIMPLE COLUMNAR, LIKE THE REST OF THE INTESTINAL TRACT
What can be seen in the transition between the esophagus epithelium?
a zigzag line (Z line), this can be viewed MACROscopically
CP: What is barrett's esophagus? What causes it?
a pathological condition due to columnar cell metaplasia of the squamous epithelium as a result of Acid Injury
BS: What is the blood supply to the Upper part (cervical portion) of the esopagus? Where does this artery originate from?
inferior thyroid artery from the thyrocervical trunk, which originates from the subclavian artery
BS: What is the blood supply to the Middle part (thoracic portion) of the esopagus? Where does this artery originate from?
supplied by 4-5 esophageal arteries, as well as from bronchial arteries originating from the thoracic aorta
BS: What is the blood supply to the Lower part (including the abdominal portion) of the esopagus? Where does this artery originate from?
supplied by the left gastric artery (from the celiac trunk) and left inferior phrenic artery (from the abdominal aorta)
VD: What is the venous drainage of the Esophagus? (upper, middle, and lower parts)
-upper portion of esophagus drains into the INFERIOR THYROID VEINS
-middle portion drains into the AZYGOS VEIN
-lower part drains into the PORTAL VEIN by the LEFT GASTRIC VEIN
What is a portocaval anastamoses?
links between the portal and systemic circulation
Where is the portal caval anastomses associated with the esophagus?
there is a connection between the MIDDLE AND INFERIOR ESOPHAGEAL VEINS along the esophagus
CP: What is a tracheoesophageal fistula? What does it result from? What are the symptoms? How can it be treated?
-An abnormal connection between the esophagus and the trachea
-results from a failure in the seperation of the esophagus and trachea during embryogenesis
-Newborns have difficulty feeding, as food from the esophagus finds it way into the respiratory tract, causing severe respiratory problems. Air may also enter the digestive tract
-can be treated by surgery
I: What is the sympathetic innervation of the esophagus? Parasympathetic?
-sympathetic: innervated by the sympathetic nerves (thoracic sympathetic nerve and the greater splanchnic nerve T5-T10)
-parasympathetic: vagus nerve (CN X)
I: In the parasympathetic innervation of the visceral organs in the abdomen, the ___ganglionic fibers of the _____ nerve reach the wall of the organs ans synapse in the ganglionic neurons close to the wall. The ___ ganglioninc fibers are usually short, and innervate the visceral organ
Pre, vagus, post
I: What is the main Parasympathetic nerve that innervates the Pelvis? What are its roots? Where does it synapse?
-Pelvic splanchnic nerve (S2,S3,S4)
-synapses in the ganglionic neurons in the wall of the pelvic organs. The post ganglionic fibers innervate the muscles, glans, and other structures in the pelvis
I: What is the sympathetic innervation system of the Pelvis?
SS: What are esophageal varices? Why may esophageal varices appear in liver cirrhosis?
-esophageal varices are extremely dilated sub-mucosal veins in the lower third of the esophagus.
-They appear in liver cirrhosis becuase they are a consequence of portal hypertension, commonly due to cirrhosis.
-In situations where portal pressures increase, such as with cirrhosis, there is dilation of veins in the anastomosis, leading to esophageal varices
SS: What are the signs and symptoms of esophageal cancers?
-Dysphagia (difficulty swallowing) and odynophagia (painful swallowing) are the most common symptoms of esophageal cancer. Dyshagia is the first symptom.
-Other symptoms are pain behind the sternum or in the epigastrium, which is worsened by swallowing any form of food, and an unusually husky, raspy, or hoarse-sounding cough, a result of the tumor affecting the recurrent laryngeal nerve.
-The presence of the tumor may disrupt normal peristalsis (the organized swallowing reflex), leading to nausea and vomiting, regurgitation of food, coughing and an increased risk of aspiration pneumonia.
SS: Describe the two types of hiatal hernias
-The most common (95%) is the sliding hiatus hernia, where the gastroesophageal junction moves above the diaphragm together with some of the stomach.
-The second kind is rolling (or paraesophageal) hiatus hernia, when a part of the stomach herniates through the esophageal hiatus and lies beside the esophagus, without movement of the gastroesophageal junction. It accounts for the remaining 5% of hiatus hernias
Which organ is the most dialated part of the digestive tract?
What region is the stomach located in?
upper left quadrant
The stomach is a food reservoir involved in the breakdown of food particles with the help of ACID SECRETION, converting it into a pasty liquid called the _______. This _______ then passes into the __________ for further digestion
chyme, chyme, duodenum
The cardiac notch is on the______
A. left side of the GE junction
B. right side of the GE junction
T/F The muscular layer of the stomach consists of Smooth Muscles
How are the layers of the stomach similar to the intestine
It has an inner circular and outer longitudinal muscle layer like the intestine, but in addtion, it also has a third layer: the OBLIQUE FIBERS extending from the cardiac notch to the body of the stomach.
In the stomach, where are the oblique fibers (3rd mucle layer of the stomach) missing?
in the pyloric section and the lesser curvature
The permanent rugae of the stomach can be seen in the _________
N: How many contractions occur in the stomach that help mix the food?
3-5 per minute
The _______ region of the stomach should relax for food to enter the stomach, this is called __________
orad(proximal), receptive relaxation
What do contractions of the distal section (caudal region) do in the stomach? What happens after these contractions occur?
propel food back into the stomach to help and chop the food again. After these contractions occur, the CAUDAL region relaxes, and the CHYME produced in the stomach reaches the duodenum
T/F Both the caudal and orad regions contract to hlep mix the food in the stomach
true, first the orad region relaxes and food is mixed, then the caudal region also relaxes to help with further mixing
What is the Migrating Myoelectric Complex?
A contraction of the stomach that empties the stomach every 90 minutes in order to move any residual gastric contents or gastric secretions produced between food-taking intervals or during fasting
N: The migrating myoelectric complex is a contraction of the stomach that happens every _____