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Abdomen-part 2
Exam 7
96
Anatomy
Graduate
09/28/2010

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Term
Intraperitoneal organs

almost completely covered with visceral peritoneum

Stomach
1st part of duodenum
Jejunum/Ilium
Appendix
Cecum
Transverse colon
Sigmoid colon
Liver/Gallbladder
Spleen
Definition
Term
Retroperitoneal organs

partially covered on just one surface by parietal peritoneum

2nd, 3rd, and 4th parts of duodenum
Ascending colon
Descending colon
Rectum
Kidneys/Adrenals
Pancreas
Ureters
Major blood vessels (IVC, aorta)
Definition
Term
4 Abdominal spaces:
Definition
Greater sac
Lesser sac
Paracolic gutters
Hepatorenal recess (Morrison’s pouch)
Term
The greater sac is separated from the lesser sac by the ________ and _______ _________.
Definition
greater and lesser omentum
Term
The greater sac is divided into the _________ compartment and the ___________ compartment which are further divided into the ________ space and ____ and _____ __________ compartments.
Definition
supracolic
infracolic
subphrenic
right and left infracolic
Term
The lesser sac can be accessed through the ________ _________, otherwise known as the ________ _________ or the _________ of _________.
Definition
epiploic foramen
omental foramen
foramen of Winslow
Term
Borders of the lesser sac:
Definition
anterior- hepatoduodenal ligament
posterior- IVC and right crus of diaphragm
superior- liver
inferior- first part of the duodenum
Term
The right and left paracolic gutters are the communication between the _________ and __________ compartments.
Definition
supracolic
infracolic
Term
The hepatorenal recess is the space between the right ______ and the ______ lobe of the ______.
Definition
right kidney
right lobe of the liver
Term
The esophagus extends from ___ to ___
and has ______ and _______ portions.
The esophagus passes through the esophageal hiatus formed by the ______ diaphragmatic ____ and ends at the _____________ junction.
Definition
CV6- TV10
thoracic and abdominal
right diaphragmatic crus
esophagogastric
Term
The _______ __________ sphincter is found at the end of the esophagus, and is otherwise known as the _______ sphincter or the ________ sphincter.
Definition
lower esophageal
cardiac
gastroesophageal
Term
The gastroesophageal sphincter has _________ muscle fibers under hormonal and ______ control.
Definition
circular
vagal
Term
2 muscle layers of the esophagus
Definition
inner circular
outer longitudinal
Term
Esophageal muscle fiber: proximal (superior) 1/3 is _______ and _________.
distal (inferior) 1/3 is ________.
middle 1/3 is __________ showing gradual changes.
Definition
voluntary and striated
smooth
combination
Term
The gastroesophageal sphincter is a __________ not __________ sphincter.
Definition
physiological not anatomical
Term
The inferior esophageal sphincter is formed by ___________ musculature at the ______. It prevents _______ of gastric contents into the esophagus.
Definition
diaphragmatic
hiatus
reflux
Term
The abdominal part of the esophageal artery supply comes from the ____ ______ artery and the ____ _________ _________ artery.
Definition
left gastric
left inferior phrenic
Term
The left _______ artery is a branch of the _______ ______.
Definition
gastric
celiac trunk
Term
Proximal esophageal venous drainage is _________, the esophageal veins drain into the _________ vein.
Distal esophageal venous drainage is _________, esophageal veins drain into the ______ ________ vein.
Definition
systemic
azygous
portal
left gastric
Term
3 areas of esophageal constriction:
Definition
Aortic arch
Left main bronchus
Diaphragm
Term
A _______ ________ uses barium as contrast material to visualize _____ of the esophagus to the __________.
Constriction of lumen as shown by ____ of contrast suggests tumor-formation or pressure from adjacent structures.
Definition
barium swallow
lumen
duodenum
lack
Term
Areas of esophageal constriction are common sites of ______ _____ __________.
Definition
foreign body constriction
Term
___________ esophagus is due to chronic ____ ________ resulting in metaplasia of the mucosa
Definition
Barrett's
acid reflux
Term
Hiatal hernias can be ________ or ____________. Most common is ________. ____________ is most likely to result in stricture and discomfort.
Definition
sliding
paraesophageal
sliding
paraesophageal
Term
parts of the stomach:
Definition
Cardia
Fundus - from cardiac notch
Body
Pyloric region - antrum and canal
Pylorus
Pyloric sphincter
Term
________ curvature - attachment for greater _______
Lesser _________ - attachement for ______ omentum
Definition
greater
omentum
curvature
lesser
Term
internal features of stomach:
Definition
Cardiac orifice
Rugae - gastric folds/ridges
Gastric mucosa - seen histologically
Gastric canal
Pyloric orifice
Term
_______ ulcers range in size and can develop from multiple erosions. They may heal in acute stages or enlarge into ______ _______ ulcers.
More common in the body near the _______ part towards the ______ curvature
Definition
Gastric
single chronic
pyloric
lesser
Term
Chronic ulcers mainly present as __________ pain that radiates to the back.
Definition
epigastric
Term
An ulcer may perforate into the _______ sac (omental bursa) and can erode the _______ artery which is often fatal.
Definition
lesser
splenic
Term
peptic ulcers
Definition
ulcers caused by the acid production of gastric tissue
Term
Gastric ulcers are characterized by burning __________ pain usually _________ by eating. __% are associated with H. pylori. Numerous risk factors include H. pylori, _____ abuse, Zollinger-ellison syndrome, gastrin producing tumor, and ______.
Perforation can result in damage of the surrounding organs including the _______ and arteries (splenic, etc.)
Definition
epigastric
exacerbated
70%
NSAID abuse
stress
pancreas
Term
________ ulcers are characterized by burning epigastric pain usually _________ by eating. __% are associated with H. pylori. Have the same risk factors as ______ ulcers. Most commonly on the ________ wall of the abdomen. Perforation may result in damage of the surrounding structures (gastroduodenal artery etc.) Perforations in the _____ may result in pneumoperitoneum.
Definition
duodenal
relieved
90%
gastric
posterior
bowel
Term
The _________ is the first part of the small intestine, approximately _____ long, C-shaped, and has _________ folds.
Definition
duodenum
1 foot
semilunar
Term
_____ part of the duodenum: superior, overlapped by _____ and gallbladder, at ____ level
Definition
first
liver
LV1
Term
_____ part of the duodenum- ________, LV1-LV3, ______ _____ duct & major _________ duct; major duodenal papilla; ________ colon
Definition
second
descending
common bile
pancreatic
transverse
Term
____ part of the duodenum- ________, LV3, crossed over by _________ _________ artery and vein.
Definition
third
horizontal
superior mesenteric
Term
______ partof the duodenum - ________, ____ of LV3 and goes up to _______ border of LV2, ________ of _______(suspensory muscle of the duodenum), ________ starts here.
Definition
fourth
left
superior
ligament of Treitz
jejunum
Term
The suspensory muscle of the duodenum, the _______ of ______ marks the flexure and is the marker for the division between the duodenum and jejunum.
Definition
ligament of Trietz
duodenaljejunal
Term
The _____ ____ ____ and the ____ ________ _____ come together into the hepatopancreatic ampulla (of Vater) as the major ________ papilla.
Definition
common bile duct
main pancreatic duct
duodenal
Term
The muscle around the major _________ papilla that closes the ampulla is the _______________ ________ (of Oddi).
Definition
duodenal
hepatopancreatic sphincter
Term
Pyloric stenosis signs and symptoms:

Nonbilious vomiting that begins 2-3 weeks after birth

Failure to thrive

Palpable olive-like mass in RUQ

Stricture of the pylorus on barium swallow
Definition
Term
Duodenal atresia signs and symptoms:

Bilious vomiting beginning immediately after birth

Failure to thrive

“double-bubble” sign on x-ray
Definition
Term
________ - _____ part of the small intestine, most of the ________ lies in the ___, attached to posterior abdominal wall via mesentery and is approx. __ _____ long.
Definition
jejunum
2nd
jejunum
LUQ
8 feet
Term
The _______ is large in ________ and has great ____________.
Definition
jejunum
diameter
vascularity
Term
The jejunum is deep ____ in color, has a _____ wall and the ____ ________ is long.
Definition
red
thick
vasa recta
Term
The _______ in the jejunum are few and long. There is less ___ in the mesentery and fewer ______ _________.
Definition
arcades
fat
lymph nodules
Term
The components of the small intestine that are large, tall, and closely packed giving it a feathery appearance.
Definition
plica circulares
Term
_____ - ___ part of the small intestine, approx. ____ _____ long, lies mostly in the ___, attached to posterior abdominal wall via mesentary.
Definition
ilium
3rd
12 feet
RLQ
Term
The _____ of the small intestine is ____ ____ in color and has a _____ vasa recta. The arcades have many short _____
with ____ fat in mesentary.
Definition
ilium
pale pink
short
loops
more
Term
The ____ _______ are low and sparse in the ______, and absent in the ______ part.
Definition
plica circulares
ilium
distal
Term
Peyer's patches are found in the ______ of the _____ _________.
Definition
ilium
small intestine
Term
__________ ____________ is a remnant of the ompalomesenteric (vitelline) duct
Definition
Meckel's diverticulum
Term
_____ diverticulum is an out-pouching of the lumen that is comprised of ____ of the layers of the gut wall.
Definition
True
ALL
Term
Rule of 2’s – 2 inches long, 2 feet from the ileocecal valve, present in 2% of the population, symptomatic in 2% of the afflicted, 2 possible ectopic tissues (gastric and pancreatic)
Definition
Term
Meckel's diverticulum manisfests as ______ ________ or ___ ________. May mimic the symptoms of ___________ with periumbilical pain which localizes to ___.
Definition
intestinal obstruction or GI bleeding
appendicitis
RLQ
Term
Complications of Merkel's diverticulum include:
Definition
Ulcerations
Inflammation
torsion ± strangulation
Intussusception (telescoping)
herniation
Term
The parts fo the large intestine include:
Definition
Appendix
Cecum
Ascending colon
Right (hepatic) flexure
Transverse colon
Left (splenic) flexure
Descending colon
Sigmoid colon
Rectum
Anal canal
Term
The ______ is the most likely portion of the colon to rupture due to the law of ________: wall tension ________ as radius __________.
Definition
cecum
Laplace
increases
increases
Term
Distinguishing features of the large intestine:
Definition
teniae coli
haustra
Omental (epiploic) appendices
caliber
Term
The teniae are ________ than the colon, causing the formation of ________. The teniae run from the base of the ________ to the rectosigmoid junction.
Definition
shorter
haustra
appendix
Term
Teniae coli
Definition
three thickened bands of muscle
Term
haustra
Definition
sacculations of the colon between the teniae
Term
Omental (epiploic) appendices
Definition
fatty projections of the omentum
Term
caliber
Definition
much larger internal diameter
Term
The _________ is completely peritonealized and has no ______ _______.
Definition
appendix
teniae coli
Term
4 different locations for the appendix:
Definition
retrocecal, retrocolic, subcolic, pelvic
Term
__________ _________ = Point of tenderness on anterior abdominal wall during _________ . Typically 1/3 the distance from the _____ to the ________.
Usually where the base of the appendix and _____ converge.
Definition
McBurney's point
appendicitis
ASIS
umbilicus
cecum
Term
____________ generally starts as periumbilical pain that migrates to the ____ followed by ________. ______ tenderness and ________ tenderness are present.
Definition
appendicitis
RLQ
vomiting
point
rebound
Term
___________ _____ – pain on passive internal rotation of the flexed thigh. Associated with ___________.
Definition
obturator's sign
appendicitis
Term
_____ ______ – Pain on passive extension at the hip
Definition
psoas sign
Term
The rectum is the point of the GI tract where the _____ spread out and fatty omental __________ are discontinued.
Definition
teniae
appendices
Term
The rectal ______ of ________ have 3 lateral flexures that create 3 ________ folds. Their function is to ________ the weight of feces and to _________ the urge to deficate.
Decreases urge to deficate
Definition
valves of Houston
transverse
support
decrease
Term
Where the rectum joins the anal canal
Definition
anorectal junction
Term
The anorectal junction is located at the __________ part of the anal _______.
Definition
superior
columns
Term
The anal columns are located along the __________ ________.
Definition
longitudinal ridges
Term
The anal valves are located at the ________ end of the anal _________.
Definition
inferior
columns
Term
The anal _______ secrete _____ that aids in the evacuation of feces.
Definition
sinuses
mucus
Term
The _________ ______ is the inferior part of the anal valves which forms the junction of the superior part of the anal canal with the inferior part.
Definition
pectinate line
Term
The superior part of the anal canal differs from inferior part in: (4)
Definition
blood supply, innervation, lymphatic and venous drainage
Term
_______ _____ _____ - between external and internal anal sphincters, below this point lymph drains to superficial ______ _______. Epithelium changes from _____________ to ____________.
Definition
Hilton's white line
inguinal nodes
non-keratinzed
keratinized
Term
rectum venous drainage
Definition
portacaval system
Term
The rectum is innervated by both ___________ and _____________ nerves.
Definition
sympathetic
parasympathetic
Term
sympathetic rectal innervation
Definition
sympathetic trunk and superior hypogastric plexus
Term
parasympathetic rectal innervation
Definition
pelvic splanchnic nerves (S2,3,4)
Term
anal canal venous drainage, divided by the pectinate line
Definition
Superior to pectinate line - portal system
Inferior to pectinate line - caval system
Term
Anal canal innervation: superior to pectinate line - ________ from inferior __________ ______ (sympathetic and parasympathetic fibers), sensitive only to stretching
Definition
visceral
hypogastric plexus
Term
Anal canal innervation- inferior to pectinate line - ________ from inferior _____ ______ (branches of the pudendal), sensitive to pain, touch, temp.
Definition
somatic
anal nerves
Term
____________ cancer is one of the ___ most common cancers. It is most commonly seen as an _____________ and occurs in the _______ and up into the __________ junction.
Definition
colorectal
3
adenocarcinoma
rectum
rectosigmoid
Term
Colorectal cancer is often ____________.
Tumors may be palpable on ______ ______ exam and there is generally a positive _____ ______ _____ test.
Patient may present with _______.
Most commonly metastasizes to the _____.
Definition
asymptomatic
digital rectal exam
fecal occult blood test
anemia
liver
Term
A _________ typically occurs in the sigmoid colon and involves the bowel turning around itself causing bowel obstruction.
Definition
volvulus
Term
________ ______________ affects 10% of Americans who are 40 or older and 50% who are 60 or older.
Definition
colonic diverticulosis
Term
Colonic _____________ is characterized by outpouchings (sacs) of intestinal wall in the colon that do not contain a full layer of intestinal wall.
Definition
diverticulosis
Term
Colonic diverticulosis is often __________ but can include mild _____, bloating, and constipation.
Complications can include bleeding, _________, perforations, tears, or _________.
Definition
asymptomatic
cramps
infections
blockages
Term
Colonic diverticulosis is most common in the _______ colon or the ______ colon and when inflamed is called ______________.
Definition
sigmoid
distal
diverticulitis
Term
In __________ ________ a portion of the colon is dilated (megacolon) due to absence of _________ _________ (parasympathetic) in the intestinal wall _______ to the dilated segment. Absence of ganglia is due to arrest in ________ of ______ ______ cells.
Dilation is due to failure of ____________ in the aganglionic segment.
Definition
Hirschprung's disease
autonomic ganglia
distal
migration
neural crest
peristalsis
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