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82 Cards in this Set

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What three unpaired arteries arise from the abdominal aorta and what was their embryo derivative?
Celiac trunk A- Foregut
Superior mesenteric A- Midgut
Inferior mesenteric A – Hindgut
What organs are supplied by branches of the Celiac trunk?
Lower esophagus
Stomach
Upper Duodenum
Pancreas
Liver
Gallbladder
What organs are supplied by branches of the Superior Mesenteric artery?
Lower Duodenum, Ileum, Jejunum, Cecum/ Appendix, Ascending Colon, Proximal 2/3 of Transverse Colon
What organs are supplied by branches of the Inferior Mesenteric artery?
Distal 1/3 of Transverse Colon, Descending Colon, Sigmoid Colon (S3 Rectosigmoid junction), Rectum, Upper anal
What is the total rotation that the midgut made by the final configuration?
270 degrees counter clockwise
At what spinal level does the esophagus pass through the diaphragm?
What part of the diaphragm is it passing through?
T10
Right crus of the diaphragm
At what level does the esophagus end and where is it?
T11, at the Cardiac orifice
Name of the disorder where an incompetent esophageal valve allows acid to rise to the esophagus, tearing up the lining in chronic cases?
GERD (Gastroesophageal Reflux Disorder)
What is the clinical name for the change in epithelium in the previous clinical question?
Barrett Esophagus

draankers and smokers usually
What systems anastomose at the esophageal veins?
Caval venous drainage w/ Portal venous drainage
What is the clinical condition where portal hypertension causes dilation of the esophageal veins?
Esophageal Varices

***The dilated varices are prone to hemorrhage and is common cause of death for ppl with portal hypertension.
What is the clinical condition where the lower esophageal sphincter is paralyzed in a constricted state and the esophagus above it dilates? What is the cause?
Achalasia

Lower esophagus loses myenteric neurons (from Auerbach's plexus)
What is the lower section of the stomach that facilitates emptying the contents into the small intestine?
Pylorus --> Pyloric Sphincter --> Small intestine
What marks the junction between the foregut and midgut derived structures?
Ampulla of Vater
(aka Hepatopancreatic ampulla)

(from the Sphincter of Oddi)
________ _______results from the retention of bile. Bile pigments stain tissues such as the _______ of the eye.
It is associated with severe ___ pain.
(Obstructive) Jaundice, Sclera (white)

Back pain
What are some causes of Obstructive Jaundice?
(2 main ones)
Gallstone in bile duct and pancreatic cancer that is compressing the bile duct
The Spleen is derived from the foregut.
T/F?
FALSE
Trauma to left 9th-11th ribs could cause profuse internal bleeding bc?
RUPTURED SPLEEN
What is the purpose of the spleen? Where is it?
Immune organ; Highly vascularized,

Within left side of greater sac (9th-11th ribs)
What is the largest AND most vascular organ in the abdominal cavity?
LIVER
What are the liver's 2 surfaces?
Diaphragmatic and Visceral
What is the bare area of the liver?
Area in contact w diaphragm and NOT covered by visceral peritoneum.

Embryologically- its the area where it was against septum transversum
What parts of the liver are reflections of the visceral peritoneum?
Coronary and Falciform ligaments
Where would a gallstone cause pain? How would pain be referred to the right shoulder?
Causes severe epigastric or RUQ pain

If irritates diaphragm --> pain referred to right shoulder
What are common sites of gallstones?
Gallbladder
Bile, Cystic, and Hepatic ducts
Ampulla
What is cholangitis and what other condition does it usually lead to?
Cholangitis is bacterial infection from increased concentration of unconjugated bilirubin in bile

Usually leads to Brown pigment gallstones (or, Cholelithiasis)
What types of gallstones are females 3x more likely than men to get during reproductive years?
Cholesterol gallstones
What arteries are an anastomoses between the Celiac trunk and the Superior Mesentery Artery?
Pancreaticoduodenal Arteries
What spinal cord level innervates the foregut, and how are its pain afferents delivered?
T6- T9

Pain afferents run with sympathetics, but ALL OTHER afferents run with parasympathetics (Vagus)
What is the initial portion of the small intestines? What comes next (in order to most distal)
Duodenum (initial)
Jejunum - LUQ
Ileum (most distal) -RUQ
Less prominent arterial arcades and long vasa recta are features of the ___________.
Jejunum
Prominent plicae circulares and intestinal folds are features of the ________, while Peyer's Patches with less rominent plicae circulares and intestinal folds are features of the ____________.
Jejunum
Ileum
More prominent arterial arcades and shorter vasa recta are features of the ________.
Ileum
What is the Dilated saccular pouch in right iliac fossa of the large intestines/ colon?
Cecum
What are the 7 parts of the large intestines?
Cecum
Ascending colon
Transverse colon
Descending colon
Sigmoid colon
Rectum
Anal canal
What spinal cord level innervates the midgut, and how are its pain afferents delivered?
T8- T12

Pain runs with sympathetics, all other afferents run w parasymp (Vagus)
At the left colic flexure, there is an anastomosis between what 2 arteries?
SMA and IMA

(left colic flexure is vulnerable for ischemia)*****
If atherosclerosis occludes the opening to either the SMA or the IMA, what artery allows proper distribution of these arteries?
Marginal Artery
What condition causes the congenital aganglionic megacolon occuring from the failure of neural crest cells to migrate into the distal colon?
Hirschsprung's Disease
what receives all the blood from the GI tract and the spleen?
Portal Vein

****Blood from kidney does NOT go here
What two veins form the Portal vein and at what spinal level does it happen?
Splenic Vein and Superior Mesenteric Vein

L2
What do the kidneys drain into?
IVC
What vein drains into the Splenic vein shortly before it joins the SMV to become the portal vein?
Inferior Mesentary Vein
What are the four sites of anastomosis in the Portal-Caval system?
Esophageal veins
Paraumbilical veins
Veins of anal canals
Retroperitoneal veins (not as pertient)
What anastomising veins are often associated with alcohol abuse and cirrhosis?
Esophageal veins and Paraumbilical veins
What does the Pectinate Line divide in terms of embryological derivation?
Ectoderm (above) <end of hindgut> from
Endoderm (below)
What are changes in lymphatic drainage that occur around the pectinate line?
ABOVE LINE----
Top of anal canal drains along Inferior Mesenteric artery
Middleof anal canal drains along Internal Iliac artery

BELOW LINE----
Bottom of anal canal drains along Superficial Inguinal Artery
What spinal section innervates the hindgut? What course do the afferents take?
T12-L2
Pain- sympathetics
All other afferents- parasympathetics (Pelvic Splanchnic nerves)
What is the sympathetic supply to the foregut and midgut?
Parasympathetic?
Symp- Thoracic Splanchnics

Para - Vagus Nerve

Remember ** Vagus innervation stops after left 1/3 of transverse colon
What is the sympathetic supply to the hindgut?
Parasympathetic?
Symp- Lumbar and Sacral Splanchnics

Para - Pelvic Splanchnics

Look over slide 93
The Spleen develops in association with the gut and therefore, remains an essential part of the gut.
T/F
FALSE

It developed with the gut, but is a LYMPHOID organ
GERD and Barrett Esophagus is an example of anaplasia.
T/F
FALSE

Metaplasia (from strat squamous to simple columnar= from esophageal epithelium to one like that of the stomach)
_______ hypertension would impede blood from crossing the __(organ)___, forcing the blood to anastomose and travel through the _________ veins.
Portal
Liver
Esophageal
The loss of a functional Lower-Esophageal Sphincter in pt's with Achalasia causes Gastric _______ .
Reflux
What are the 3 parts of the stomach that mix food with pepsin acid?
Fundus (top)
Body
Pylorus
(Pylorus Sphincter on bottom)
^ What are the folds within the stomach called and what is their purpose?
Rugae, allow expansion of stomach when food enters without increased pressure
**What vertebral level is the first part of the duodenum?
L1
**At what vertebral level does the Inferior Mesenteric Artery rise behind the 3rd part of the duodenum?
L3
* What portion of the intestines is C-shaped and holds the head of the pancreas?
Duodenum
Where does the duodenum lie on the right kidney?
Over the Hylum
**What is the only portion of the pancreas that passes POSTERIORLY to the superior mesenteric vessels?
Uncinate Process
What is the ligament that that attaches the diaphragm to the duodenum? What types of muscle are both areas?
Suspensory Ligament of Treitz (Skeletal muscle)

Duodenum- smooth muscle
What happens to the pancreas embryologically?
There is a dorsal and ventral bud of the pancreas on either side of the gut tube. As the tube rotates, the ventral bud is pulled over to the dorsal bud and folded together.
What two vessels empty into the Ampulla of Vater?
Pancreatic duct and Common Bile duct
What is the blood supply change that occurs at the Ampulla of Vater?
It is where the Celiac trunk stops supplying the gut and the Superior Mesenteric a. takes over

(Junction of foregut and midgut)
What is the name of the Sphincter that protrudes into the Ampulla of Vater?
Sphincter of Oddi
The human body will recover from the loss of a spleen.
T/F
TRUE
Liver will take over its function
How would one palpate to see if the spleen is enlarged?
A normal liver cannot be palpated, only percussed.

Enlarged= reaches anterior axillary line
Normal= reaches midaxillary line
What vessels are in the Splenorenal ligament?
Splenic artery and vein
What vessels are in the Gastrosplenic ligament?
Short gastric vessels and left gastro-epiploic vessels
What organ is stuck to the bottom of the liver?
Gallbladder
In the embryo, the ductus venosum carried oxygenated blood from the _______ through the left umbilical vein, bypassed the _______, and went straight to the ________.
Placenta
Liver
Heart

**left umbilical vein becomes Ligamentum Teres and Ductus Venosum becomes ligamentum venosum
What are the left and right borders of the Quadrate lobe of the liver?
Left: ligamentum teres

Right: Gallbladder
What is the left border of the bare area?
IVC

(Know Slide 44 of abdominal viscera)
The liver is able to be ressected into pieces due to what characteristic?
Segmentation (lots of fused pieces with indiv. blood source)
What effect does a fatty meal have on the gallbladder?
Makes the gallbladder and ducts contract, sometimes spasm, and cause pain
How does the body recover from gall bladder removal?
The common bile duct forms a substitute reservoir for bile.
What vertebral level does the Inferior Mesenteric Artery branch out on?
L3
What part of the colon has mesentery?
Sigmoid colon
What are the 3 longitudinal smooth muscle ribbons on the outside of the sigmoid colons? What organ do they converge at?
Taenia Coli

Appendix (and rectum)
What are the fatty appendages characteristic of the large intestines?
Epiploic appendages
Where does the junction of the sigmoid colon and the rectum occur?
S3