Anatomy Lecture Block 3 Part 2

gallbladder

• pear shaped

• 7-10cm long

gallbladder function

• concentrates and stores up to 50ml of bile

• reabsors water from bile

bile storage pathway

bile from liver → right/left hepatic ducts → common hepatic duct → cystic duct → gallbladder

cholecystokinin (CCK)

following a fatty meal, ___ from the duodenum stimulates gallbladder contraction

blood supply of the gallbladder

via doesnt cystic artery from the right hepatic artery

gall stones (cholelithiasis)

formed due to an imbalance in the concentration of cholesterol and bile salts in the bile

• precipitation of the salts/cholesterol out of solution→ gall stone formation

5F’s of gallstones

• female

• fertile

• fourty/fifty

• full-figured

• fair

what happens if gallbladder gets stuck in the distal end of hepatopancreatic ampulla of vater

if it blocks ampulla of vater → pancreatitis

how can we get jaundice from gallstones?

can block common bile duct → GI tract destruction → pain in right epigastric region that radiates on RIGHT SIDE OF BACK → bile backs up into systemic circulation → jaundice

how can we secondarily get pancreatitis from gallstones?

ampulla of vater is blocks → pancreatic juices/enzymes can flow through → juices/enzymes back up into pancreas → pancreas self digests

• vomitting, diarrhea

• pain in RIGHT/LEFT epigastric region that radiates to LEFT SIDE OF BACK

pancreas

• elongated

• 14-18cm

• 65-75g

• accessory digestive gland

• transverlsey between the duodenum and the spleen

• posterior to the stomach

• has 4 parts: head, neck, body, and tail

exocrine secretion of pancreas

• secretes bicarbonate secretion via Acinar cells w/ influence of secretin

• secretes enzyme secretion via acinar cells w/ influence of I endocrine cells

• fat

• carbohydrates

• proteins

in the pancreas:

• lipase breaks down ___

• amylase breaks down ___

• inactive proteases (chymotrpsinogen, trpsinogen, etc.) to break down ___

s endocrine cells

cells from the duodenal mucosa that secrete secretin

secretin

hormone that acts on the pancreas to increase bicarbonate secretion from acinar cells

I endocrine cells

cells from the duodenum that secret CCK (cholecystokinin)

cholecystokinin (CCK)

hormone that influences the pancreas to increase enzyme secretion from Acinar cells

types of cells and hormones found in the Islets of Langerhans part of the pancreas (endcrinesecretion)

• alpha cells → glucagon

• beta cells → insulin

• delta cells → somatostatin (growth hormone

purpose of glucagon and insulin

important for homeostasis of blood glucose

• endrine secretion as they release their hormones directly into the blood

glucagon

• released during flasting/excerise

• tells liver to breakdown glycogen into glucose

• increase blood glucose concentration

insulin

• released a4 eating

• increases cell permability to glucose

  • insulin receptors are found on most cells

• lowers blood glucose concentration

• important bc high glucose can damage endothelial cells

somatostatin

• inhibits insulin and glucagon

where does exocrine secretion pass through

passes through the main and accesosory pancreatic ducts into the duodenum

formation of the hepatopancreatic duct

• main pancreatic duct join w/ the common bile duct

how do bile and pancreatic secretions enter the small intestine

enter via the ampulla of vater → major duodenal papila in the 2nd part of the duodenum

blood supply of the pancreas

via common heptaic and splenic arteries

venous drainage of pancreas

hepatic and splenic veins → portal vein

innervation of the pancreas

sympathetic and parasympathetic innervation via vagus nerve

pancreatitis

inflammatory disease of pancreas → abdominal pain that radiates to the back

• can be acute or chronic

• acut pancreatitis can be resolved w/ persistant histologic changes

possible causes of pancreatitis

• gallstone in ampulla of vater (biliary tract disease)

• alcohol

• infections

• trauma

pancreatic cancer (pancreas head)

• head of pancreas cancers → block common bile duct entrance to ampulla of vater → jaundice

cystic fibrosis (mucovisidosis)

inherited disease caused by mutation in the transmebrane conductance regulatory gene (CFTR)

• chloride cant move out of cells and across plasma membrane → increase of thick secretomotor function → chronic bronchitis

• pancreatic ducts get clogged as result and cant reach duodenum → malabsorption, steatorrhea

  • accompanied by meconum ileus, azoospermia, and infertility

spleen

• in the left hypochondrium

• behind the stomach

hemopoietic

both the spleen and liver are ___ organs in fetal life but not in adulthood which means they made red blood cells and stoped later on (function now made by bone marrow)

erythropoiesis … granulopoiesis

only if the bone marrow becomes inadequate due to a disease, ___ and ____ restart in the spleen

function of the spleen

• old, fragile, weirdly shaped RBCs removed

  • breaks down old red blood cells (REDUCE, REUSE, RECYLE)

• matures red blood cells to save iron and stores it

• excess iron from hemoglobin given a brown color (hemosiderin)

• billirubin releaased into venous blood → filtered in liver

• participates in final maturation of RBC by removing Howell-Jolly bodies (tiny remnants of RBC nucleus after getting rid of organelles)

spleen pathology

• splenic rupture causes severe bleeding

• portal hypertension, liver cirrhosis, and malaria → splenomegaly

splenectomy

spleen is taken out during leukemia

• liver partially takes over the spleen’s function

blood supply of the spleen

• splenic artery from celiac trunk

• splenic vein and superior mesenteric vein which join to form the portal vein

innervation of the spleen

sympathetic and parasympathetic via vagus nerve branches

kidneys

• on each side of the vertebral colum

• T12-L3 lvl

• right kidney is half a segment lower than the left bc of the liver’s right love

what is the kidney covered by

• renal fascia on the outside

• fatty fascia in the middle

• fibrous fascia on kidney surface

3

in deep inspiration and in upright position, kidneys descend about ___cm

differences between cortical nephrons and juxtamedullary nephrons

• cortical:

  • short nephron loop

  • glomerulus further from the cortex-medulla junction

  • efferent arteriole supplies peritubular capiliaries

• juxtamed.:

  • long nephron loop

  • glomerulus closer to the cortex-medulla junction

  • efferen artiole supplies vasa recta

what are nephrons and their types?

functional unit of kidneys in thr renal cortex

• includes cortical (in cortex) and juxtamedullary (next to medullary)

• 1.5 million per kidey

cortical nephrons

• more common

• in the renal cortex

• dont concentrate urine as strongly

• responsible for filtration and reabsorption

juxtamedullary nephrons

• less common

• concentrate urine by reabsorbing more water

blood

• glomerulus

• granular cells

we want to incerase blood pressure by increasing ___ volume

• ___are tufts of capillaries used for filtration

• ___ are in the afferent arterioles

• water … metabolic

• electrolytes … pH

functions of the kidneys:

• produces urine by getting rid of excess ___ and harmful ____ products

• regulates ____ and water to maintain optimal body ___

• nephron … glomerulus

• ultra filtrate … protein

• 150 … 1.5

process of urine:

• blood enters the ___ via arterial network (___) where its filtered

• 1st: ___ of blood plasma is made and formed substances of blood except ___ are temporalily removed

• 2nd: ultra filtrate goes through parts of nephron and substances (glucose, Na+, and H2O) are reabsorbed to reduce volume from ___ liters per day to ___ liter of urine

• 3rd: urine goes the ureters and uriner bladder → eliminated

what is the renal corpuscle and what is it made of?

where filtration of blood begins

• glomerulus - tuft of fenestrated capillaries

• glomerular (bowman’s) capsule

  • parietal layer - simple squamousepithelium (doesn’t participate in filtration)

  • visceral layer - podocytes

filtration membrane of the glomerular

filter in between the blood in the glomerulus and filtrate in capsular (Bowman’s) space

3 layers of the glomerular filtration membrane

1. fenestrated capillary endothelium

2. podocytes foot processes

3. basement membrane

basement membrane … slit

• proteins

• water, ions, glucose, amino acids, and urea

the filtration membrane’s ___ and ___ diaphragm:

• hold back most ___

• allow passage of: ___

kidney granular cells

specialized cells that act as mechanoreceptors

• found in the wall of the afferent arteriole of the glomerulus

• normal bp is 50-55 mmHg

• part of the juxtaglomerular complex

how do the kdineys regulate blood pressure/volume when its low?

done via RAAS SYSTEM

• renin … angiotensinogen 2 … ACE … lung … adrenal … aldosterone … volume/pressure

RAAS PATHWAY:

• granular cells secrete ___→ renin released into blood → renin converts angiotensinogen (from liver) to ___ → angiotensinogen 1 turned into antiotensinogen 2 via ___from ___ epithelium → angiotensinogen 2 targets ___ gland and makes ___ to increase blood ___

mesangial cells

make erthropoeitin to influence RBC formation and Kalikrein hormone

kalikrein hormone

causes vascular expandsion via other molecules

macula densa cells

cells that act as chemoreceptors to regulate NaCl concentration

ureter

• 25-30 cm long

• mucosa has transitional epithelium

• function to transport urine to urinary bladder

kidney stones

stones that can obstruct the ureter → pain and bleeding from mucosal injury

what are the uretors crossed by in the male and female pelvic cavities?

• male: vas deferens

• females: uterine artery and vein on each side

bladder

collapsible muscular sac that stores and expels urine

• has transitional epithelium

differences between an empty and full bladder?

• empty: lies entirely within the pelvis

• full: becomes spherical shape and expands into the abdominal cavity

blood supply of kidneys

via renal arteries (branches of abdominal aorta and give rise to inferior suprarenal arteries)

• renal arteries enter kidney at the hilum and divide into segmental, interlobar, arcuate, and interlobular arteries

inferior suprarenal arteries

arteries that supply the adrenal gland

• branch of the renal artery

variable blood supply of the kidneys

• originally develop in the pelvis and get blood from the common iliac arteries

• as they ascend, they get new branches from iliac arteries, lower/mid/upper abdominal aorta

  • original blood supply usually lost but can persist sometimes which is important to be preserved during surgery

venous drainage of the kidneys

VIA RENAL VEINS THAT DRAIN INTO THE IVC

• IVC on the right side → left renal vein is longer than the right

gonadal veins drainage

• left gonadal vein → left renal vein

• right gonadal vein → IVC directly

glometrulonphritis

inflammation of the glomeruli

pyelonephritis

UTI that beings in the urethra/bladder

poylycystic diseases of kidney

inherited disorder of cysts replacing normal kidney tissue

congenital anomalies of the kidneys andd ureter

• bifid renal pelvis/ureter

• horseshoe kidney - joined kidney crossed anteriorly by the inferior mesenteric artery

• ectopic kidney that stays in the pelvis

renal and ureteric calculi (kidney stones)

crystals that form in the kidney/ureter which obstruct urine flow

suprarenal (adrenal) gland

• superior to the kidneys

• covered in suprarenal fat

• have a cortex from mesoderm

• have a medullary from neural crest

3 layers of the suprarenal gland’s cortex

zona glomerulosa, zona fasciculata, zona reticulata

zona glomerulosa

layer of suprarenal cortex that makes mineralocorticoids

• regulates electrolytes and fluid homeostasis

zona fasciculata

later of the suprarenal gland that makes glucocoricoids

• regulates carbohydrates, lipis, and protein metabolism

zona reticulata

layer of spurarenal gland that makes small quantities of sex hormones that supplement gonadal sex hormones and androgens

adrenal medulla

part of the suprareal gland that secrete fight/flight catecholamine hormones:

• adrenaline (epinephrine)

• noradrenaline (norepinephrine)

  • regulated by sympathetic system

• inferior phrenic

• abdominal aorta

• renal arteries

blood supply of the adrenal gland:

• superior suprarenal arteries comes from ___ artery on both sides

• middle suprarenal arteries come from ___ directly

• inferior supreneal arteries come from ___ on both sides

venous rainage of adrenal gland

• via one vein on the left → goes to left renal vein

• via vein on the right → goes to right renal vein or directly to IVC

innervation of adrenal gland

• sympathetic and parasympathetic

what is the diaphragm and posterior abdominal wall made of?

• psoas major and minor muscles

• quadratus lumborum muscle

• lumbar plexus and its related nerves

major … iliacus … iliac … femur

psoas ___ joins together w/ ___ to form the ilopsoas under the ___ crest which anchors on the lesser ancor of ___

where does the lumbar plexus end and begin

• starts at T12

• ends at L4

nerves T12-L1 of Lumbar plexus

iliohypogastric nerve

nerves L1 of lumbar plexus

ilioinguinal nerve

nerves L1-L2 of lumbar plexus

genitofemoral nerve

nerves L2-L3 of lumbar plexus

lateral femoral cutaneous nerve

nerves L2-L4 of lumbar plexus

obturator nerve

nerves L2-L4 of lumbar plexus

femoral nerve

what bones make up the pelvic girdle?

• 2 ox coxae

• ilium

• ischium

• pubic

posteriorly … pubic sentises

os coxae bones articulates w/ the sacrum and coccyx ____ and at the ___ anteriorly

pubic sentises

thick pad of fribrocartilage that relxes during pregnancy via relaxin hormone

clinical significance of the pelvic girdl

its iliac crest common site for bone marrow biopsy and grafting becasuse its easily accessible and has lots of red bone marrow

sacrum, coccyx, greater sciatic notch in females

• sacrum is wider, shorter, and has accendtuated sacral curvature

• coccyx is more moveble and straighter

• greater sciatic notch is wide and shallow

sacrum, coccyx, greater sciatic notch in males

• sacrum is narrow, longer, and sacral promontory is ventral

• coccyx is less movable and curves ventrally

• greater sciatic notch is narrow and deep

pelvic inlet/brim and outlet in females

• pelvic inlet/brim is wider and oval shaped

• pelvic outlet is wider; ischial tuberosities are shorter and further apart, and everted