129b - Structure of the Abdomen Flashcards
Inferior view of the liver:
Which structure is labeled by C?
Quadrate lobe
(anterior)
Which artery might be compressed by a tumor in the head of the pancreas?
Superior mesenteric artery
Dorsal or ventral pancreatic bud:
Comes from the liver bud
Ventral
Which two strutures are most likely to be compresed by a pancreatic tumor?
Pancreatic duct and bile duct
Which structure is labled by D?
(Common) Bile duct
Which type of nerves will sense pain in the peritoneum?
Somatic sensory -> intense pain!
(Peritoneium is part of the body wall)
Signs of Portal Hypertension in the abdomen:
- Portal vein:
- Systemic vein:
- Clinical sign:
Signs of Portal Hypertension in the abdomen:
- Portal vein: Para-umbilical
- Systemic vein: Superficial epigastric
- Clinical sign: Caput medusae
Inferior view of the liver:
Which two structures are important for fetal blood flow?
Describe the flow
B - Umbilical vein
F - Ductus venosus
Blood flows from the umbilical vein -> ductus venosus -> IVC
(Bypasses the liver)
Which artery is labeled by #1?
Which large artery is it a branch of?
Ileocolic
SMA
Which 3 veins join to form the portal vein?
- Superior mesenteric vein
- Splenic vein
- Inferior mesenteric vein
- Usually joins the splenic vein first, but variations exist
A patient has an accumulation of peritoneal fluid in the lesser peritoneal sac. What landmark do you look for to insert a drainage canula into the epiploic foramen to enter the lesser sac?
Hepatoduodenal ligament
- Epiploic foramen is just below the hepatoduodenal ligament
- This will get you into the lesser peritoneal sac
Which artery is labeled by #8?
Which large artery is it a branch of?
Superior rectal
IMA
Signs of Portal Hypertension in the rectum:
- Portal vein:
- Systemic vein:
- Clinical sign:
Signs of Portal Hypertension in the rectum:
- Portal vein: Superior rectal
- Systemic vein: Internal iliac
- Clinical sign: Hemorrhoids
Which structure is labled by A?
Left hepatic duct
Bring bile from liver -> gallbladder
(I think Dr. Cochard just wants us to know that these are the hepatic ducts)
Why are left testicular varices more likely than right testicular varices?
Left renal vain can be compressed between the SMA and abdominal aorta
What is the most seriors consequence of a gallstone lodged in the ampulla of the major duodenal papilla?
Pancreatitis
- Bile cannot get out
- Backs up into the common bile duct and the major pancreatic duct
- Remember, they converge just before the spincter of Oddi
- Bile is corrosive to the pancreas
Pain in the right colic flexure will be referred to the ____ dermatome
The patient will feel:
Pain in the right colic flexure will be referred to the T12 dermatome
The patient will feel:
Lower abdominal pain
Which artery is labeled by #7?
Which large artery is it a branch of?
Sigmoid arteries
IMA
Pain in the upper sigmoid colon will be referred to the ____ dermatome
The patient will feel:
Pain in the upper sigmoid colon will be referred to the L2 dermatome
The patient will feel:
Upper thigh/lower back pain
Which 3 ligaments are part of the greater omentum?
- Splenorenal
- Gstrosplenic
- Gastrocolic
Which artery is labeled by #5?
Inferior mesenteric artery
- Feeds into the left colic (6), sigmoid arteries (7), and superior rectal artery (8)
A patient with pain in the T10 dermatome might have pathology in which of the following organs?
A. Esophagus
B. Stomach
C. Liver
D. Jejunum
E. Appendix
E. Appendix
Which structure is labled by E?
Which embryonic structure is it derived from?
What does it empty into?
Accessory pancreatic duct
Derived from the dorsal bud
(Bigger bud -> smaller duct)
Empties into the minor duodenal papilla
Pain in the appendix will be referred to the ____ dermatome
The patient will feel:
Pain in the appendix will be referred to the T10 dermatome
The patient will feel:
Pain around the naval
Tumors in the posterior right lobe of the liver extending into the caudate lobe might affect:
A. Paraumbilical veins in the proximal falciform ligament
B. Inferior vena cava
C. Hepatic portal vein
D. Gall bladder
E. Ligamentum venosum
B. Inferior vena cava
Which artery is labeled by #3?
Which large artery is it a branch of?
Middel colic
SMA
Pain in the foregut will be referred to the ____ dermatome
The patient will feel:
Pain in the foregut will be referred to the T7-T9 dermatome
The patient will feel:
Upper abdominal pain
**But peritonitis under the diaphragm -> Shoulder; C3-5**
Dorsal or ventral pancreatic bud:
Gives rise to the major pancreatic duct
Ventral
Which blood vessels runs alongside the falciform ligament?
Paraumbilical veins
Surgical resection of the cardiac part of the stomach near the esophagus would require ligation of branches from what artery?
A. Splenic
B. Left gastric
C. Right gastric
D. Gastroduodenal
E. Right gastroepiploic
B. Left gastric
Which artery is labeled by #6?
Which large artery is it a branch of?
Left colic
IMA
Dorsal or ventral pancreatic bud:
Joins the common bile duct
Ventral
(Main pancreatic duct -> major duodenal papilla)
Fluid from which of the following locations can pass most easily from the abdominal cavity (greater peritoneal sac) into the pelvic cavity?
A. Left paracolic gutter
B. Lesser sac
C. Space above the phrenicocolic ligament
D. Space to the right of the dorsal mesointestine
A. Left paracolic gutter
If neural crest cells do not migrate into the celiac ganglion, which of the following would be diminished or impaired?
A. Arterial muscle tone
B. Peristalsis
C. Gastric ulcer sensation
D. Bile excretion
E. Glandular secretion
A. Arterial muscle tone
(Thank you @Will Schwartz!)
Which ligament surrounds the bare area of the liver?
Coronary ligament
Which artery is labeled by #2?
Which large artery is it a branch of?
Right colic
SMA
Which structure is labled by C?
Common hepatic duct
Dorsal or ventral pancreatic bud:
Gives rise to the lesser pancreatic duct
Dorsal
Which structure is labled by B?
Cystic duct
Pain in the left colic flexure will be referred to the ____ dermatome
The patient will feel:
Pain in the left colic flexure will be referred to the L1 dermatome
The patient will feel:
Pelvic pain
Where are the two places in the abdominal cavity where blood and/or infection can accumulate/localize?
Why?
- Around the spleen (left of the stomach)
- Phrenicolic ligament blocks the easy passage of fluid/blood/infection inferiorly
- To the right of the dorsal mesointestine (in the midgut loop)
- Contained by the midgut loop
Fluid in other spots drains into the pelivc cavity via paracolic and dorsal mesointestine gutters
Inferior view of the liver:
Which structure is labeled by D?
Caudate lobe
Inferior view of the liver:
Which 3 structures are contained in A?
Portal vein
Hepatic artery
Bile duct
(The portal triad)
Which 4 strucutres does the gallbladder touch?
What is the significance?
- Anterior abdominal wall
- Liver
- Duodenum
- Transverse colon
An infected gallbladder can form a fistula - worst in the duodenum
Which ligament divides the liver into the right and left lobe?
Falciform ligament
Which part of the GI tract is most susceptible to ischemia?
Left colic flexure
- In the territory between the middle colic branch of the SMA and the left colic branch fo the IMA
Which structure is labled by F?
Which embryonic structure is it derived from?
What does it empty into?
Main pancreatic duct
Derived from the ventral bud
(Smaller bud -> bigger duct)
Empties into the major duodenal papilla
(Sphincter of Oddi is here)
Which artery is labeled by #4?
Superior mesenteric artery
- Feeds into the middle colic (3), right colic (2), and ileocolic (1)
Function
- Myenteric (Auerbach) plexus:
- Submucosal (Meissner) plexus:
Function
- Myenteric (Auerbach) plexus:
- Smooth muscle contraction
- Submucosal (Meissner) plexus:
- Glandular secretion, muscularis mucosae
