129. Structure Abd Flashcards
What are the 3 arteries (and branches) flowing from the celiac trunk and what do they supply?
- L Gastric a. = upper half of lesser curve stomach
- Splenic a. (curvy/tortuous) = pancreas/spleen
- branch: short gastric a. = upper half greater curve stomach - Common Hepatic A.
- R Gastric a. = lower half lesser curve stomach
- R+L Gastroepiploic a. = lower half greater curve stomach
- Supraduodenal/Gastroduodenal = upper half duodenum
- Hepatic A. Proper: Cystic A. (gallbladder), L/R Hepatic A. (Liver)
- superior pancreaticoduodenal a. (anastamose with SMA)
What are the 4 branches of the SMA and what do they supply?
- Ileocolic: terminal ileum, cecum, part ascending colon
- R. Colic: ascending colon
- Middle Colic: transverse colon
- Many Intestinal Branches (small intestine)
What are the 3 branches of the IMA and what do they supply?
What are 3 features shared by parts of IMA and SMA?
- L Colic: Descending Colon
- Sigmoid Branches: Sigmoid Colon
- Superior Rectal: continuation of IMA to rectum
Arcades: looping anastamoses
Vasa Recta: straight arteries to wall of intestines
Marginal Artery: follow contours of colon
Describe the pathophysiology of Left Renal Vein Compression
- L Renal Vein needs to pass over aorta to get to IVC
- SMA branch off aorta passes over L renal vein as it goes over aorta (artery sandwich)
- L gonadal vein goes to left renal vein to avoid having to cross over itself (R gonadal vein to IVC)
SMA = compress L renal vein = impair L gonadal vein = L testicular varices (dilated veins)
Describe the difference between parasymp and symp innervation of GI tract
Parasymp: Vagus N. (foregut and midgut); pelvic splanchnics (S2-S4) to hindgut, short postsynaptics on wall of intestines
- Myenteric (Auerbach’s) Plexus: b/w smooth muscle laters of GI (longitudinal/circular) for contraciton
- Submucosal (Meissner’s) Plexus: submucosal for gland secretion, MM inervation
Symp: for artery contractions
Thoracolumbar splanchnics to autonomic (enteric) plexus via collageral ganglia on aorta (follow artery to target organ)
Visceral Sensory nerves follow both symps and parasymps
What visceral sensory spinal cord segments supply the following: heart pancreas stomach/liver/spleen Small intestine appendix R colic flexure L colic flexure Upper sigmoid colon
heart - T1 (shoulder, arm) pancreas (under diaphragm - C3-5: shoulder) stomach/liver/spleen - T7-9 small intestine - T9-10 appendix - T10 (umbilicus) R colic flexure - T12 L colic flexure - L1 Upper Sigmoid Colon - L2
View of liver from below:
What structures make up the R. bar, L. Bar, and cross-bar
R. Bar: adult structures (gallbladder - ant; IVC - post)
L. Bar: embryonic structures (ligamentum teres - ant; ligamentum venosum - post)
Cross bar: portal triad - bile duct, PV, HA
What veins are collected by the PV? Where are 3 key sites of PV anastamoses and signs of PHTN?
PV drains: L gastric vein, SMV, IMV
- Esophageal Varices: L gastric V = Esophageal Vein - Azygous vein
- Caput Medusa: SMV = superficial epigastric v.
- Hemorrhoids: IMV = internal iliac vein
How does the pancreas develop?
How does this relate to Anular pancreas?
What is the most common pancreatic congenital defect?
Ventral bud: swings around duodenum to join dorsal bud, its main pancreatic duct joint common bile duct, HEAD of pancreas
Dorsal bud: minor (accessory) pancreatic duct, BODY and TAIL of pancreas
Anular pancreas: ventral bud wraps around and constricts duodenum
Most common: failure of fusion of both buds (accessory duct becomes main duct)
Gallbladder:
- describe the flow of bile from gallbladder to small intestine
- what four structures does this touch? how is this clinically relevant?
GB - cystic duct + common hepatic duct - common bile duct + main pancreatic duct - sphincter of oddi - major duodenal papillae
- Liver
- Duodenum
- Transverse Colon
- Anterior Abd Wall
infected gallbladder can sent gallstone fistulas and pain to these organs
