129b - Structure of the Abdomen

Question 1

Inferior view of the liver:

Which structure is labeled by C?

Answer 1

Quadrate lobe

(anterior)

Question 2

Which artery might be compressed by a tumor in the head of the pancreas?

Answer 2

Superior mesenteric artery

Question 3

Dorsal or ventral pancreatic bud:

Comes from the liver bud

Answer 3

Ventral

Question 4

Which two strutures are most likely to be compresed by a pancreatic tumor?

Answer 4

Pancreatic duct and bile duct

Question 5

Which structure is labled by D?

Answer 5

(Common) Bile duct

Question 6

Which type of nerves will sense pain in the peritoneum?

Answer 6

Somatic sensory -> intense pain!

(Peritoneium is part of the body wall)

Question 7

Signs of Portal Hypertension in the abdomen:

• Portal vein:
• Systemic vein:
• Clinical sign:

Answer 7

Signs of Portal Hypertension in the abdomen:

• Portal vein: Para-umbilical
• Systemic vein: Superficial epigastric
• Clinical sign: Caput medusae

Question 8

Inferior view of the liver:

Which two structures are important for fetal blood flow?

Describe the flow

Answer 8

B - Umbilical vein

F - Ductus venosus

Blood flows from the umbilical vein -> ductus venosus -> IVC
(Bypasses the liver)

Question 9

Which artery is labeled by #1?

Which large artery is it a branch of?

Answer 9

Ileocolic

SMA

Question 10

Which 3 veins join to form the portal vein?

Answer 10

• Superior mesenteric vein
• Splenic vein
• Inferior mesenteric vein
  
  • Usually joins the splenic vein first, but variations exist

Question 11

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?

Answer 11

Hepatoduodenal ligament

• Epiploic foramen is just below the hepatoduodenal ligament
  
  • This will get you into the lesser peritoneal sac

Question 12

Which artery is labeled by #8?

Which large artery is it a branch of?

Answer 12

Superior rectal

IMA

Question 13

Signs of Portal Hypertension in the rectum:

• Portal vein:
• Systemic vein:
• Clinical sign:

Answer 13

Signs of Portal Hypertension in the rectum:

• Portal vein: Superior rectal
• Systemic vein: Internal iliac
• Clinical sign: Hemorrhoids

Question 14

Which structure is labled by A?

Answer 14

Left hepatic duct

Bring bile from liver -> gallbladder

(I think Dr. Cochard just wants us to know that these are the hepatic ducts)

Question 15

Why are left testicular varices more likely than right testicular varices?

Answer 15

Left renal vain can be compressed between the SMA and abdominal aorta

Question 16

What is the most seriors consequence of a gallstone lodged in the ampulla of the major duodenal papilla?

Answer 16

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

Question 17

Pain in the right colic flexure will be referred to the ____ dermatome

The patient will feel:

Answer 17

Pain in the right colic flexure will be referred to the T12 dermatome

The patient will feel:

Lower abdominal pain

Question 18

Which artery is labeled by #7?

Which large artery is it a branch of?

Answer 18

Sigmoid arteries

IMA

Question 19

Pain in the upper sigmoid colon will be referred to the ____ dermatome

The patient will feel:

Answer 19

Pain in the upper sigmoid colon will be referred to the L2 dermatome

The patient will feel:

Upper thigh/lower back pain

Question 20

Which 3 ligaments are part of the greater omentum?

Answer 20

• Splenorenal
• Gstrosplenic
• Gastrocolic

Question 21

Which artery is labeled by #5?

Answer 21

Inferior mesenteric artery

• Feeds into the left colic (6), sigmoid arteries (7), and superior rectal artery (8)

Question 22

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

Answer 22

E. Appendix

Question 23

Which structure is labled by E?

Which embryonic structure is it derived from?

What does it empty into?

Answer 23

Accessory pancreatic duct

Derived from the dorsal bud
(Bigger bud -> smaller duct)

Empties into the minor duodenal papilla

Question 24

Pain in the appendix will be referred to the ____ dermatome

The patient will feel:

Answer 24

Pain in the appendix will be referred to the T10 dermatome

The patient will feel:

Pain around the naval

Question 25

Tumors in the posterior right lobe of the liver extending into the caudate lobe might affect: ## Footnote A. Paraumbilical veins in the proximal falciform ligament B. Inferior vena cava C. Hepatic portal vein D. Gall bladder E. Ligamentum venosum

Answer 25

B. Inferior vena cava

Question 26

Which artery is labeled by #3? Which large artery is it a branch of?

Answer 26

Middel colic SMA

Question 27

Pain in the **foregut** will be referred to the ____ dermatome The patient will feel:

Answer 27

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\*\*

Question 28

**Dorsal** or **ventral** pancreatic bud: Gives rise to the major pancreatic duct

Answer 28

Ventral

Question 29

Which blood vessels runs alongside the falciform ligament?

Answer 29

Paraumbilical veins

Question 30

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

Answer 30

B. Left gastric

Question 31

Which artery is labeled by #6? Which large artery is it a branch of?

Answer 31

Left colic IMA

Question 32

**Dorsal** or **ventral** pancreatic bud: Joins the common bile duct

Answer 32

Ventral (Main pancreatic duct -\> major duodenal papilla)

Question 33

Fluid from which of the following locations can pass most easily from the abdominal cavity (greater peritoneal sac) into the pelvic cavity? ## Footnote A. Left paracolic gutter B. Lesser sac C. Space above the phrenicocolic ligament D. Space to the right of the dorsal mesointestine

Answer 33

A. Left paracolic gutter

Question 34

If neural crest cells do not migrate into the celiac ganglion, which of the following would be diminished or impaired? ## Footnote A. Arterial muscle tone B. Peristalsis C. Gastric ulcer sensation D. Bile excretion E. Glandular secretion

Answer 34

A. Arterial muscle tone *(Thank you @Will Schwartz!)*

Question 35

Which ligament surrounds the bare area of the liver?

Answer 35

Coronary ligament

Question 36

Which artery is labeled by #2? Which large artery is it a branch of?

Answer 36

Right colic SMA

Question 37

Which structure is labled by C?

Answer 37

Common **hepatic** duct

Question 38

**Dorsal** or **ventral** pancreatic bud: Gives rise to the lesser pancreatic duct

Answer 38

Dorsal

Question 39

Which structure is labled by B?

Answer 39

**Cystic** duct

Question 40

Pain in the **left colic flexure** will be referred to the ____ dermatome The patient will feel:

Answer 40

Pain in the **left colic flexure** will be referred to the **_L1_** dermatome The patient will feel: **Pelvic pain**

Question 41

Where are the two places in the abdominal cavity where blood and/or infection can accumulate/localize? Why?

Answer 41

* 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

Question 42

Inferior view of the liver: Which structure is labeled by D?

Answer 42

Caudate lobe

Question 43

Inferior view of the liver: Which 3 structures are contained in A?

Answer 43

Portal vein Hepatic artery Bile duct (The portal triad)

Question 44

Which 4 strucutres does the gallbladder touch? What is the significance?

Answer 44

* Anterior abdominal wall * Liver * Duodenum * Transverse colon An infected gallbladder can form a fistula - worst in the duodenum

Question 45

Which ligament divides the liver into the right and left lobe?

Answer 45

Falciform ligament

Question 46

Which part of the GI tract is most susceptible to ischemia?

Answer 46

Left colic flexure * In the territory between the middle colic branch of the SMA and the left colic branch fo the IMA

Question 47

Which structure is labled by F? Which embryonic structure is it derived from? What does it empty into?

Answer 47

Main pancreatic duct Derived from the **ventral** bud (Smaller bud -\> bigger duct) Empties into the **major duodenal papilla** (Sphincter of Oddi is here)

Question 48

Which artery is labeled by #4?

Answer 48

Superior mesenteric artery * Feeds into the middle colic (3), right colic (2), and ileocolic (1)

Question 49

Function * Myenteric (Auerbach) plexus: * Submucosal (Meissner) plexus:

Answer 49

Function * Myenteric (Auerbach) plexus: * **Smooth muscle contraction** * Submucosal (Meissner) plexus: * **Glandular secretion, muscularis mucosae**