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Digestive System and Peritoneal Cavity
N/A
112
Anatomy
Graduate
12/03/2011

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Cards

Term
What constitutes the digestive system?
Definition
Oral cavity, pharynx, esophagus, stomach, small intestines, large intestines, accessory digestive organs (salivary glands, liver, gallbladder, pancreas)
Term
What does the esophagus connect?
Definition
Pharynx and stomach
Term
What is the distribution of skeletal and smooth muscle in the esophagus?
Definition
Upper 1/3 = skeletal, Middle 1/3 = mixed, Lower 1/3 = smooth
Term
What is the function of the upper esophageal sphincter?
Definition
Prevents entrance of air during respiration, secondary line of defence against gastric reflux
Term
What is the function of the lower esophageal sphincter?
Definition
Gaurds against gastroesophageal reflux
Term
What are the three constrictions of the esophagus?
Definition
Cervical, thoracic, and diaphragmatic constrictions
Term
Cervical and diaphragmatic constrictions are caused by upper and lower esophageal sphincters, but what causes the thoracic constriction in the esophagus?
Definition
Arch of the aorta and left main bronchus
Term
Why must clinicians be familiar with the esophageal constrictions
Definition
Swallowed foreign objects often lodge at the constrictions, caustic fluids cause strictures at them due to delayed passage
Term
What is achalasia?
Definition
Esophageal motility disorder: absence of esophageal peristalsis and failure of lower esophageal sphincter to relax, may result from absence of autonomic ganglion cells within esophageal wall
Term
What are symptoms of achalasia?
Definition
Dsyphagia, possible regurgitation, chest pain, bird-beak appearance on a radiograph following barium swallowing
Term
Why is prevention of gastric reflux important?
Definition
Esophageal stratified squamous epithelium is vulnerable to damage
Term
What might cause metaplastic change of stratified squamous epithelium into columnar epitherlium?
Definition
Chronic gastric reflux causing Barrett's esophagus
Term
What might arise from columnar epithelium due to Barrett's esophagus?
Definition
Prone to ulceration and stricture development, may cause obstruction, may develop into adenocarcinoma
Term
What are the four parts of the stomach?
Definition
Cardia, fundus, body, pyloric part (pyloric antrum and canal)
Term
Where are the cardia and fundus sections of the stomach located?
Definition
Cardia = gastroesophageal junction, Fundus = dilated superolateral part below the left dome of the diaphragm, contains an air bubble in radiographs
Term
What remains tonically contracted except to allow the passage of chyme into the small intestines and separates the pylorus from the duodenum?
Definition
Pyloric sphyncter
Term
What indicates the junction of the body and pyloric part of the stomach?
Definition
Angular incisure which is a notch to the right of the lesser curvature
Term
What kind of stomach ulcer is most common?
Definition
Peptic ulcer from mucosal erosion
Term
Most ulcers are associated with what?
Definition
Bacterial infection of Helicobacter pylori (H. pylori)
Term
What factors can influence development of an ulcer?
Definition
Chronic anxiety and chronic use of nonsteroidal anti-inflammatory drugs (NSAIDS)
Term
What are complications of gastric ulcers?
Definition
Bleeding, perforation, obstruction, may be life threatening
Term
What accounts for 25% of ulcer deaths?
Definition
bleeding, may be first indication of ulcer
Term
What accounts for 2/3 of ulcer deaths?
Definition
Perforation, rare first indication of ulcer
Term
What complication is most often seen in chronic ulcers, often associated with pyloric channel ulcers, and may occur with duodenal ulcers?
Definition
Obstruction
Term
What is the most common cancer in the stomach?
Definition
Adenocarcinoma, <30% survival rate 
Term
The small instestine is broken up into what parts?
Definition
Duodenum, jejunum, ileum
Term
What are the circular folds of mucosa-submucosa in the small intestines called?
Definition
Plicae circulares
Term
What are the 4 parts of the duodenum in order?
Definition
Superior, descending, inferior/horizontal, ascending
Term
What parts of the duodenum have a distinct radiographic appearance using contrast medium?
Definition
Superior part, duodenal cap/ampulla within the first 2cm
Term
What is the clinical importance of the duodenal cap/ampulla in the superior part of the duodenum?
Definition
Frequent location of peptic ulcers
Term
What recieves the common bile duct and the main pancreatic duct?
Definition
Duodenum
Term
What forms the hepatopancreatic ampulla?
Definition
Joining of the bile duct and main pancreatic duct
Term
Where does the hepatopancreatic ampulla drain into?
Definition
Major duodenal papilla
Term
Where is the superior mesenteric artery and vein located along the small intestines?
Definition
Crosses anterior to the inferior/horizontal part of the duodenum
Term
What causes superior mesenteric artery syndrome?
Definition
Compression and obstruction of the artery as it crosses anterior to the inferior/horizontal part of the duodenum following sudden weight loss
Term
Why is the duodenojejunal junction an important clincial landmark?
Definition
It is the junction between upper and lower GI bleeding
Term
Where is the suspensory muscle of the duodenum (ligament of Treitz) and why is it clinically important?
Definition
Suspends the duodenojejunal junction from the diaphragm, is a surgical landmark
Term
What gives the jejunum a feathery appearance?
Definition
Large mucosal-submucosal folds known as plicae circulares
Term
Where is the ileal (Mechel's) diverticulum?
Definition
Attached near the opening of the ileum at the ileocecal junction, is an embryonic vitelline duct
Term
What may be contained in the ileal (Meckel's) diverticulum
Definition
Ectopic gastric or pancreatic tissue, may cause hemorrhage, bowel obstruction, or perforation
Term
What features distinguish the large intsetines from the small intestines?
Definition
Omental appendices, taniae coli, haustra or sacculations
Term
What are omental appendices?
Definition
Small fatty projections found in the large intestines
Term
What are teniae coli?
Definition
Three bands of longitudinal smooth muscle found in the large intestines
Term
What are the partitions of the large intestines?
Definition
Cecum and appendix, colon (ascending, transverse, descending, sigmoid), rectum, anal canal
Term
What is the function of the cecum?
Definition
Receives the contents of the ileum through the ileocecal junction, location of the appendix
Term
What are the types of intestinal obstruction that can occur at the ileocecal junction and the cecum?
Definition
Intussusception, Volvulus, Gallstone ileus
Term
What is intussusception?
Definition
The telescopig of a proximal segment of the intestine into a more distal segment
Term
What is volvulus?
Definition
Twisting of the intestine on itself
Term
What is gallstone ileus?
Definition
Gallstone blockage of the ileocecal junction
Term
What is the appendix?
Definition
An intestinal diverticulum that contains lymphoid tissue, variable location in the cecum 
Term
What might cause appendicitis?
Definition
Occlusion of the lumen or infection, may become gangrenous or perforate, causing peritonitis
Term
Where does the ascending colon meet the transverse colon?
Definition
Right colic (hepatic) flexure
Term
Where does the transverse colon meet the descending colon?
Definition
At the left colic (splenic) flexure
Term
At what verterbal level does the sigmoid colon join the rectum?
Definition
S3 
Term
What are the accessory organs of the digestive system?
Definition
Salivary glands, liver and gallbladder, pancreas
Term
What is the largest gland within the body?
Definition
Liver
Term
What are the two surfaces of the liver?
Definition
Diaphragmatic surface related to the inferior surface of the diaphragm, Visceral surface related to other abdominal organs
Term
What divides the liver into two anatomical right and left lobes?
Definition
A sagittal fissure formed by the fissure for the ligamentum teres hepatis and the fissure for the ligamentum venosum
Term
Which anatomical lobes of the liver also includes the quadrate and caudate lobes?
Definition
Right lobe of the liver
Term
What forms the portal triad?
Definition
Each liver lobe has its own branch of the hepatic artery, portal vein, and bile duct, branches join in the portal triad to form proper hepatic artery, hepatic portal vein, and the common bile duct
Term
Where does the portal triad enter the liver?
Definition
Visceral surface at the porta hepatis
Term
What is the arrangement of the contents of the portal triad?
Definition
Bild duct = right side, Proper hepatic artery = left side, Portal vein = posterior to other structures
Term
What are some causes of cirrhosis, fibrous connective tissue replacement of hepatocytes (liver cells)
Definition
Chronic alcoholism, hepatitis B & C
Term
What are the three partitions of the gallbladder?
Definition
Fundus, Body, Neck
Term
Describe the fundus of the bladder and where it is located
Definition
Blund end projecting from inferior border of the liver at the tip of the right 9th costal cartilage
Term
What is the function of the neck of the gallbladder?
Definition
Narrow tapering end, usually makes an S-turn to become continuous with the cystic duct
Term
What is another name for gallstones?
Definition
Cholelithiasis
Term
What ducts carry bile and from where?
Definition
Common hepatic duct from the liver, Cystic duct from the gallbladder, Common bile duct from union of the former two, joins pancreatic duct at the hepatopancreatic ampulla
Term
What is the vertebral location of the pancreas?
Definition
L1-2
Term
What are the 4 parts of the pancreas?
Definition
Head (lies within the C-shaped concavity of the duodenum), neck, body, tail (near the spleen)
Term
Where does the main pancreatic duct originate from?
Definition
Tail of the pancreas
Term
What pancreatic duct drains part of the head of the pancreas?
Definition
Accessory pancreatic duct
Term
Why does cancer of the head of the pancreas cause jaundice?
Definition
May obstruct bile duct
Term
Though it is initially painless, pancreatic cancer may eventually cause mild or severe pain where?
Definition
Radiating to the mid or lower back
Term
What is the fourth leading cause of cancer death in the US?
Definition
Pancreatic cancer, typically does not present until metastasis
Term
What is contained in the peritoneum?
Definition
Organs of the digestive system and urinary tract
Term
In what cases is the paritoneal cavity closed or open?
Definition
Closed in males, connected to the genital organs in females, uterine tubes open into the peritoneal cavity, a potential pathway for spread of infection
Term
What is ascites?
Definition
Excess peritoneal fluid accumulation, may be drained as treatment
Term
What might cause ascites?
Definition
Cirrhosis of the liver, heart failure, ovarian cancer, etc.
Term
What is peritonitis?
Definition
Bacterial infection of the peritoneum
Term
What might cause peritonitis?
Definition
Perforation of a peptic ulcer, penetrating wound, etc. 
Term
Describe peritoneal flow
Definition
Normally flows superiorly toward diaphragm, rapidly absorbed
Term
During bacterial peritonitis, how is the patient often positioned?
Definition
Seated > 45 degrees
Term
Why are patients with bacterial peritonitis usually seated?
Definition
Encourages infection fluid to flow downward where absorption is slower
Term
When might peritoneal adhesions occur?
Definition
Peritonitis due to trauma or infection causing chronic pain and bowel or uterine tube obstruction
Term
What does it mean when an abdominal cavity organ is intraperitoneal?
Definition
Invaginating the peritoneal sac from behind and suspended from the body wall by a double layer of peritoneum (mesentary)
Term
What does it mean when an organ of the abdominal cavity is retroperitoneal?
Definition
Located posterior to the peritoneum
Term
What is characteristic of intraperitoneal organs?
Definition
Covered in visceral peritoneum, suspended by mesentery
Term
What is the name for peritoneum lining the body wall?
Definition
Parietal peritoneum
Term
How are intraperitoneal organs supplied blood and innervation?
Definition
Blood vessels and nerves reach through the mesentery
Term
Where are retroperitoneal organs located?
Definition
Posterior to the parietal peritoneum between the posterior abdominal wall, only partially covered by parietal peritoneum
Term
What are the intraperitoneal organs?
Definition
Abdominal esophagus, stomach, small intestines (only proximal duodenal cap), large intestines, liver, gallbladder, tail of pancreas, spleen
Term
What are the retroperitoneal organs?
Definition
Duodenum (except duodenal cap), ascending colon, descending colon, pancreas (except tail), kidneys and ureters, abdominal aorta, inferior vena cava
Term
What are the peritoneal formations consisting of double layers of peritoneum?
Definition
Mesentaries, Omenta, Peritoneal ligaments
Term
What does the omenta connect?
Definition
Peritoneal double layer formation, connects the stomach and proximal duodenum to other organs
Term
What do the peritoneal ligaments connect?
Definition
Abdominal organs to each other or to the abdominal wall
Term
Where is the greater omentum suspended from?
Definition
Greater curvature of the stomach
Term
What does the lesser omentum connect?
Definition
Lesser curvature of the stomach and the proximal duodenum to the liver
Term
What is the function of the greater omentum?
Definition
Mobile, moves to wall off infections within the peritoneal cavity to keep them localized, helps prevent peritonitis
Term
Where does the lesser sac (omental bursa) lie?
Definition
Posterior to the stomach and lesser omentum
Term
How do the greater sac and omental bursa communicate?
Definition
Omental (epiploic) foramen
Term
What are the boundaries of the omental foramen?
Definition
Anteriorly by hepatoduodenal ligament, posteriorly by inferior vena cava, superiorly by caudate lobe of liver, inferiorly by superior part of duodenum
Term
How is an internal hernia into the omental foramen treated?
Definition
None of the boundaries of the foramen can be incised, so the swollen intestines are decompressed with a needle to free it
Term
What divides the greater sac?
Definition
Transverse colon and transverse mesocolon
Term
What are the subdivisions of the greater sac?
Definition
Supracolic compartment, Infracolic compartment
Term
What is contained within the supracolic compartment?
Definition
Stomach, liver, spleen
Term
What is contained within the infracolic compartment?
Definition
Small intestines, ascending/descending colon, subdivided by mesentary of the small intestines into right and left spaces
Term
How does the abdominal cavity communicate with the pelvic cavity?
Definition
Right parcolic gutter lateral to the ascending colon and left parcolic gutter lateral to the descending colon, both are a pathway for spread of infection or cancer
Term
What is the lowest part of the abdominal portion of the peritoneal cavity in the supine position?
Definition
Hepatorenal recess (Morison's pouch)
Term
Where is the hepatorenal recess (Morison's pouch) located?
Definition
Between the right lobe of the liver and the right kidney
Term
How does infected fluid enter the hepatorenal recess?
Definition
From the omental bursa or subphrenic recess 
Term
What produces the pouched segmentation known as haustra characteristic of the large intestines?
Definition
Sacculation
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