IFS 2 Unit 2 PDF

○ Transversus Abdominis Internal intercostals 6. Which comes first during inspiration, the expansion of the chest followed by bulk flow of air or bulk flow of air followed by expansion of the chest? Expansion of the chest followed by the bulk flow of air Unit 2: Abd...

○ Transversus Abdominis Internal intercostals 6. Which comes first during inspiration, the expansion of the chest followed by bulk flow of air or bulk flow of air followed by expansion of the chest? Expansion of the chest followed by the bulk flow of air Unit 2: Abdominal Region, Metabolism, & Systems Look at the themes in the Mock Exam: 1. Arterial supply to abdominal organs/intestines The celiac trunk (T12) The left gastric artery: To the stomach The splenic artery: Supplies the spleen , pancreas, and parts of the stomach. Common Hepatic Artery: Supplies the liver, gallbladder, pancreas and parts of the stomach. Supper Mesenteric Artery (L1) Supplies the “right side”. Small intestine (except proximal duodenum) Cecum, Appendix, Ascending colon, and the first part of the transverse colon. Inferior Mesenteric Artery (L3): Supplies the descending colon, sigmoid colon, and the rectum. 2. Venous return from abdominal organs/intestines (general path – major veins making the hepatic portal) - Blood from the abdominal organs has to travel to the liver to get filtered before returning to the heart. - Superior Mesenteric Vein Small intestine, cecum, ascending colon, right two thirds of the transverse colon, parts of the pancreas and duodenum. Inferior Mesenteric Vein: Left one third of the transverse colon, descending colon, sigmoid colon and the rectum. Typically drains into the splenic vein. Splenic vein:  Drains the spleen, pancreas, and parts of the stomach. The splenic vein combines into the SMV to form the Hepatic Portal Vein. Left gastric vein Stomach, connects to the splenic vein. Right Gastric Vein: Right side of the stomach, into the portal vein directly. 3. CNS connection At the abdomen sensation is at T6-T1 levels. Spinothalamic pathway: Pain, temp, crude touch. Ascends ipsilaterally but it decussates to the opposite side. Composed of anterior and lateral, together anterolateral system. The lateral spinothalamic is specific to pain and temp, the anterior is specific to crude touch. Dorsal Column Medial Lemniscus Pathway: Fine touch, vibration, pressure, proprioception. Ascends ipsilaterally and decussates to the opposite side. Anterior/Medial Corticospinal Tract: Voluntary control of the proximal muscles, shoulders, trunk, etc. Posture, balance. It decussates at the level of the spinal cord. Cerebellar influence: The cerebellum is responsible for smoothness, coordination, and timing of movements, in this unit specifically abdominal movement. Basal Ganglia influence: A motor circuit, (stop, go, no-go-pathway). Go: Initiation. Stop: Termination. No-Go-Pathway: involuntary movement Also plays a role in posture control. 4. Musculature Muscles of the Anterolateral wall External oblique: Bilaterally flexes the trunk. Ipsilateral contraction flexes on the same side. Contralateral contraction rotates the trunk to the opposite side. Forced expiration and abdominal pressure. Internal Oblique: Bilaterally flexes the trunk. Unilateral contraction rotates the trunk to the same side. Abdominal pressure. Transverse Abdominis: Primary action is to compress the abdominal contents and increase pressure. Stabilizes the spine. Forced expiration. Rectus Abdominis: Flexes the vertebral column, aids in forced expiration and increasing abdominal pressure.  Rectus sheath It envelops the rectus abdominis, created by the intersecting aponeurotic fibers of the external oblique, internal oblique, and the transversus abdominis. It allows the abdominal muscles to interact for overall congruence. Posterior Abdominal Wall Diaphragm: It marks the superior border of the posterior abdominal wall. Crura of the diaphragm attach to the anterior vertebral bodies of L1-L3. Three apertures 1. Caval opening (T8 level): Inferior vena cava, right phrenic nerve 2. Esophageal (T10 level): esophagus and vessels, vagus nerves. 3. Aortic Hiatus (T12 level): Aorta, Thoracic Duct, Aortic plexus (sympathetic) Five lumbar vertebrae and associated IV discs. Psoas major Quadratus lumborum Iliacus Transversus Abdominis Oblique muscles laterally Thoracolumbar fascia (3 layers, anterior, anterior middle, and posterior layer.) Abdominal part of the aorta and inferior vena cava Lumbar plexus Vessels and lymph nodes ORGANS Stomach (smooth muscle) Longitudinal muscle (outer), Circular (middle) and oblique (innermost) layers. Contract to churn food with gastric juices to form chyme and push to the small intestine. In the stomach the pyloric canal, and cardia are important because they stop retrograde. Small intestine Longitudinal muscle layer for peristalsis. Large Intestine Tenia Coli : three distinct bands of longitudinal muscle layers for peristalsis  Haustra: Helps with the absorption of water. Ureters (smooth muscle) Its walls has smooth muscle to allow for peristaltic contractions to transfer urine from kidney to bladder, Bladder (smooth muscle) Detrusor muscle for urination 5. Fascia and omentum Greater Omentum: 4 layers, extends from the greater curvature of the stomach and drapes anteriorly. It protects the organs. Lesser Omentum: Double layer of peritoneum extends from the lesser curvature of the stomach to the proximal duodenum, and liver. Mesentery Peritoneum: a serous membrane that covers or envelops and lubricates structures (wall). Connects organs to the body wall. Pathway for neurovascular structures. Two layers parietal and visceral. Parietal lines the wall and visceral is around the organs. Transverse mesocolon: Attaches the transverse mesocolon to the posterior abdominal wall. Separates the abdominal cavity into superior and inferior components. 6. Fascia and movement Peritoneal Cavity Formed by the parietal and visceral cavity. Is a POTENTIAL SPACE, it contains peritoneal fluid, no organs are found here but it is a potential space for movement, if the organs have move. Falciform Ligament Connects the anterior surface of the liver to the anterior abdominal wall and diaphragm. 7. Function of the kidneys, liver and pancreas Kidneys: Fluid and electrolyte balance they maintain extracellular fluid volume which is crucial for nutrient, oxygen delivery and waste removal. Blood pressure regulation, manage blood volume, vessel constriction and dilation via hormones like renin and aldosterone.  Essential for overall cardiovascular health and facilitating various endocrine system interactions. Liver: Removes toxins from blood, produces bile, processes the nutrients absorbed by the intestines, produces clotting factors. Gall bladder: Located in the liver, function is to store concentrate and release bile. Pancreas It has two pancreatic ducts that drain digestive enzymes into the duodenum, the main pancreatic duct and the accessory pancreatic duct. Exocrine function: Secretion of digestive enzymes such as amylase, lipase, and proteases to aid in digestion of carbs, fats, and proteins. Via vagus nerve stimulation. Produces insulin, that promotes the uptake of glucose into cells for energy production or storage. This lowers glucose levels. Produces Glucagon that stimulates the release of glucose from liver stores, to raise glucose levels. Produces somatostatin to inhibit insulin and glucagon levels, helping maintain a balance. 8. Innervation Parasympathetic Connection Cranial Sacral Division Anterior and posterior trunks of the vagus nerve. Sacral Splanchnic nerves Sympathetic Thoracolumbar division Thoracic splanchnic nerves Lumbar Splanchnic nerves Nerves of the posterior wall (lumbar plexus, anterior rami of spinal nerves deep to psoas major) Subcostal (T12): External Oblique. Sensory to the lower abdomen and anterolateral abdominal wall.  Iliohypogastric (L1): Internal oblique, transversus abd. Sensory to the skin of the lower abdomen and hypogastric region. Ilioinguinal (L1): Internal oblique, transversus abd Genitofemoral (L1/L2): Cremaster muscle in males. Skin of femoral triangle and labia majora in females. Lateral Cutaneous Nerve to the thigh (L2/L3): Sensory to the skin of lateral thigh Obturator Nerve (L2/L3/L4): Hip adductors. Sensory to the skin of the medial thigh. Femoral Nerve (L2/L3/L4): Anterior thigh muscles, quadriceps, sartorius. Sensory to skin in the anterior thigh, medial leg and foot. Lumbosacral Trunk (L4/L5): Contributes to the sciatic nerve *the obturator nerve and femoral nerve comes from the same area but from a different part of the trunks* Femoral anterior and obturator posterior lumbar plexus trunks. 9. Referred Pain Patterns