4 & 6- GI Organs Pt. 1 & 2 Flashcards
What are the GI organs and associated organs?
GI = Esophagus Stomach Small Intestine Colon Rectum Anal Canal
Associated = Spleen Pancreas Liver Gall Bladder
This abdominal plane is on the level of L1 and passes through the Pyloric Sphincter.
Transpyloric Plane
This abdominal plane is on the level of L2-3 and passes inferior to the costal margin.
Subcostal Plane
This abdominal plane is on the level of L5 and passes through the iliac tubercles.
Transtubercular Plane
This abdominal plane is on the level of S2 and passes through the ASIS.
Interspinous Plane
The esophagus passes through the _______ _______ at T10 vertebral level in the respiratory diaphragm to enter the abdomen. It turns sharply to the left of midline to enter the stomach at the _______ _______ at T11 vertebral level.
Esophageal Hiatus
Cardiac Orifice
This separates the esophagus from the fundus of the stomach.
Cardiac Notch
How far below the respiratory diaphragm does the esophagus extend?
1 inch
This is where the respiratory diaphragm effectively closes the inferior portion of the esophagus. It is not there anatomically, but is physiological.
Inferior Esophageal Sphincter
What are the esophageal constrictions?
Superior = Level of Cricoid Cartilage, juncture with pharynx (upper esophageal sphincter)
Middle = Crossed by Aorta and Left Main Bronchi (passes posterior to bronchi)
Inferior = Diaphragmatic sphincter by passing through Esophageal Hiatus
This type of hiatal hernia occurs when the cardia of the stomach is in normal abdominal position, but the peritoneum and fundus of the stomach are anterior to the esophagus. No regurgitation occurs.
Para-esophageal Hiatal Hernia
This type of hiatal hernia occurs when the esophagus, cardia of stomach, and fundus of the stomach protrude through the esophageal hiatus. Regurgitation occurs with this condition.
Sliding Hiatal Hernia
***Occurs especially when the patient lies down or bends over!
What is the volume of the stomach?
2-4 Liters
Where is the stomach located?
Commonly located in both RUQ and LUQ
***Also described in the epigastric, umbilical, and left hypochondrium regions
Where is the left end of the stomach fixed at?
Level of T10-11
Where is the right end of the stomach fixed at?
Level of L1
What are the parts of the stomach?
Cardia
Fundus
Body
Pylorus (including Pyloric Sphincter)
This part of the stomach is connected to the esophagus above and the body of the stomach below.
Cardia
This part of the stomach is superior to the Cardiac Orifice (junction with esophagus), at the level of the 5th rib. It rests against the left side of the diaphragm.
Fundus
This part of the stomach is the portion between the Fundus and Pylorus.
Body
This part of the stomach is the portion between the body of the stomach and the duodenum.
Pylorus
This is the wider portion of the Pylorus.
Pyloric Antrum
This is the narrow, distal portion of the Pylorus.
Pyloric Canal
This part of the Pylorus is normally closed. It regulates the flow of food into the duodenum.
Pyloric Sphincter
This is on the inferior border of the stomach and is where the Greater Omentum attaches.
Greater Curvature
***4-5x greater in length than Lesser Curvature!
This is on the superior border of the stomach and is where the Lesser Omentum attaches.
Lesser Curvature
What lies anterior to the stomach?
Anterior Abdominal Wall
Diaphragm
Left Lobe of Liver
What lies superior to the stomach?
Left dome of Diaphragm
What lies posterior to the stomach?
Lesser Sac (Omental Bursa) Pancreas Transverse Colon Transverse Mesocolon Left kidney Left suprarenal gland Spleen
This denervates the nerve supply to all of the stomach plus most of the GI tract and liver.
Truncal Vagotomy
This denervates branches of the Vagus N. going ONLY to the stomach.
Proximal Gastric Vagotomy
This specifically denervates the area of the stomach in which parietal cells are located (Fundus and Cardia).
Selective Proximal Vagotomy
The duodenum begins at the Pylorus and ends at the ________ ________ (flexure) at L2 vertebra. It’s shaped like a horseshoe and is molded around the head of the ________.
Duodenojejunal Junction
Pancreas
How long is the duodenum? What parts are intraperitoneal and retroperitoneal?
10 inches
1st inch is intraperitoneal, 9 inches are retroperitoneal
Describe the first part of the duodenum.
Length is 1 inch, most mobile part and is intraperitoneal.
Travels superior and posterior to the right.
Associated with Hepatoduodenal Ligament (Lesser Omentum), which contains the Portal V., Hepatic A., and Common Bile Duct.
This part of the duodenum is retroperitoneal and 3-4 inches long. It runs parallel and to the right of the Inferior Vena Cava.
2nd Part
The 2nd part of the duodenum contains the _________ ________, which is formed by the union of the common bile duct and the pancreatic duct.
Hepatopancreatic Ampulla (of Vater)
What are the internal features of the 2nd part of the duodenum?
Major Duodenal Papilla
Sphincter of Oddi
What opens at the Major Duodenal Papilla and Minor Duodenal Papilla?
Main Pancreatic Duct opens at Major Duodenal Papilla
Accessory Pancreatic Duct opens at Minor Duodenal Papilla
What lies medial to the 2nd part of the duodenum?
Head of Pancreas
What lies anterior to the 2nd part of the duodenum?
Gall Bladder (Fundus)
Right Lobe of Liver
Transverse Colon
What lies posterior to the 2nd part of the duodenum?
Right kidney
Ureter
This part of the duodenum is 4 inches and retroperitoneal. It travels transverse (crosses midline) from right to left.
3rd Part
What is anterior to the 3rd Part of the duodenum?
Superior Mesenteric A. and V.
Root of Mesentery
Jejunum
What is superior to the 3rd Part of the duodenum?
Head of Pancreas
This part of the duodenum is 1 inch and retroperitoneal. It ascends to the left side of the Aorta.
4th Part
The 4th Part of the duodenum joins with the jejunum at the _________ _________ (or flexure). A sharp bend occurs at this point where the duodenum joins the jejunum.
Duodenojejunal Junction
This is a suspensory muscle that attaches the 4th Part of the duodenum to the Posterior Abdominal Wall. It functions to widen the opening of this portion of the duodenum and anchors it to the right crus of the diaphragm.
Ligament of Treitz
What is located posteriorly to the 4th Part of the duodenum?
Left Margin of Aorta
Inferior Mesenteric V.
Psoas M.
This is defined as the proximal 2/5s of the small intestine and is located in the LUQ. It is intraperitoneal and held in place by the mesentery.
Jejunum
The jejunum possesses well-developed mucosal folds called _______ _______, which diminish in size from proximal to distal (they are completely absent in the distal ileum).
Plicae Circulares
In the jejunum, the amount of _______ in the mesentery increases from proximal to distal.
Fat
In the jejunum, the number of ________ arcades in the mesentery increases from proximal to distal. There are long ______ ______ that branch from these arcades.
Arterial Vasa Recta (Straight Arteries)
This part of the small intestine is located in the RLQ and is intraperitoneal. It’s held in place by the mesentery and is defined as the distal 3/5s of the small intestine.
Ileum
The ileum has compound vascular arcades with shorter ______ ______.
Vasa Recta (Straight Arteries)
This consists of 2 layers of peritoneum and attaches the jejunum and ileum to the posterior body wall.
Mesentery
What is contained within the mesentery?
Superior Mesenteric A. and V.
LNs
Fat
Autonomic Nerves
What structures does the mesentery cross over?
3rd and 4th Parts of duodenum Abdominal Aorta Inferior Vena Cava Right Ureter Right Psoas Major M. Right Gonadal A. and V.
What are the parts of the colon?
Cecum Appendix Ascending Colon Transverse Colon Descending Colon Sigmoid Colon
How long is the colon?
Approx. 5 feet
Where does the colon start?
Ileocecal Junction
***Contains Ileocecal Valve!
These are external features of the colon that are composed of 3 longitudinal bands of smooth muscle, sacculations (haustra), and appendices epiploicae that store fat.
Tenia Coli
This is a blind pouch (intraperitoneal) that is continuous with the ileum and ascending colon. The appendix is attached to it (its position is variable).
Cecum
The appendix is usually attached to the posterior-medial part of the cecum and supported by the __________.
Mesoappendix
The cecum is continuous with the ________ ________, which is 8-10 inches long.
Ascending Colon
The appendix contains several _______ _______ (part of immune system).
Lymphoid Nodules
Within the cecum is the ______ ______, which is a cone-like projection of the ileum into the cecum.
Ileal Papilla
What is lateral to the ascending colon (retroperitoneal)?
Right Paracolic Gutter
The ascending colon becomes continuous with the ________ ________ at the ________ ________ ________.
Transverse Colon Right Colic (Hepatic) Flexure
The transverse colon is 10-14 inches long, and is suspended by the…
Transverse Mesocolon
The transverse colon becomes continuous with the ________ ________ at the ________ ________ ________.
Descending Colon Left Colic (Splenic) Flexure
What is lateral to the descending colon (retroperitoneal)?
Left Paracolic Gutter
The descending colon becomes continuous with the ________ _________ at the brim of the pelvis.
Sigmoid Colon
This part of the colon is “S-shaped” and averages 12 inches in length.
Sigmoid Colon
The sigmoid colon is attached to the _______ _______ and becomes continuous with the rectum at the level of ______ vertebra.
Sigmoid Mesocolon
S3
The ________, which resides entirely in the pelvis, has no mesentery and is approximately 5 inches long.
Rectum
The rectum is defined as being both _________ and _________ due to its relationship to visceral peritoneum.
Retroperitoneal
Subperitoneal
There are three transverse rectal folds that overlie the thickened parts of the circular muscle layers. What are their names?
Superior Rectal Fold
Intermediate Rectal Fold
Inferior Rectal Fold
The rectum is continuous with the _______ _______, the terminal part of the intestinal tract.
Anal Canal
This is a congenital anomaly that occurs in 1-2% of the population. It’s located 50 cm from the ileocecal junction in adults. It may be free (74%) or attached to the umbilicus (26%). Can become inflamed and mimic pain produced by acute appendicitis.
Ileal (Meckel’s) Diverticulum
This is the term for the rotation and twisting of the mobile loop of the sigmoid colon and sigmoid mesocolon. Results in the obstruction of the lumen of the descending colon and any part of sigmoid colon proximal to the twisted segment. Acute surgical emergency.
Volvulus of Sigmoid Colon
***Obstipation and ischemia of the looped portion of sigmoid colon may result!
Describe the anal sphincters.
Internal Anal Sphincter - Smooth Muscle
External Anal Sphincter - Skeletal Muscle
The anal canal contains anal columns, anal valves, and anal sinuses. The _______ _______ is located at inferior ends of anal valves.
Pectinate Line
The external opening of the anal canal is known as the…
Anus
This organ is located in the left hypochondriac region, parallel to the left ribs 9-11. It is located along the mid-axillary line, between the stomach and diaphragm.
Spleen
***Not palpable below costal margin!
The spleen is intraperitoneal and attached to what ligaments?
Gastrosplenic Ligament
Splenorenal Ligament
What are the relationships of the spleen?
Anterior = Stomach and Tail of Pancreas Posterior = Diaphragm Inferior = Left Colic Flexure Medial = Left Kidney and Phrenicocolic Ligament
This organ is retroperitoneal except for its tail, and is located at the level of L1-L2 vertebrae.
Pancreas
What are the parts of the pancreas?
Head
Neck
Body
Tail
This part of the pancreas lies in the curvature of the duodenum.
Head
This part of the pancreas is indistinct. It joins the head to the body and overlies the Superior Mesenteric A.
Neck
This part of the pancreas is located within the Splenorenal Ligament. Its tip is adjacent to the hilum of the spleen.
Tail
On the pancreas, the _______ _______ is adjacent to the head and superior to the 3rd Part of the duodenum.
Uncinate Process
This duct begins in the tail of the pancreas and courses to the head. It contains a sphincter, which prevents bile from entering the pancreas.
Main Pancreatic Duct
The Main Pancreatic Duct is usually accompanied by the Accessory Pancreatic Duct, and joins the ________ ________ _________ on the duodenum.
Common Bile Duct
If the Accessory Pancreatic Duct does not join the Main Pancreatic Duct, then it may have a separate opening in the duodenum called the…
Minor Duodenal Papilla
What is the opening of the Common Bile Duct and Main Pancreatic Duct (Hepatopancreatic Ampulla) into the duodenum?
Major Duodenal Papilla
This is formed by the union of the Common Bile Duct and the Main Pancreatic Duct. It is associated with the sphincter of Oddi and the Major Duodenal Papilla.
Hepatopancreatic Ampulla
***Sphincter of Oddi is around the Hepatopancreatic Ampulla, while the Main Pancreatic Sphincter is ONLY around the Main Pancreatic Duct!
What lies anterior and posterior to the pancreas?
Anterior = Lesser Sac and Stomach
Posterior = Aorta, IVC, Splenic V., Common Bile Duct, Right Crus of Diaphragm, Left kidney and vessels, Left suprarenal gland, Superior Mesenteric A. and V.
What is to the right and left of the pancreas?
Right = 2nd Part of duodenum Left = Spleen
What is inferior to the pancreas?
3rd Part of duodenum
What percent of body weight is the liver in adults and infants?
5% of body weight in infants
2% of body weight in adults
This organ is located in the RUQ or epigastric and right hypochondriac regions.
Liver
Where is the left lobe of the liver located?
LUQ
What are the surfaces of the liver?
Diaphragmatic Surface
Visceral Surface
This surface of the liver conforms to the concavity of the diaphragm. It is covered by peritoneum except where it is in direct contact with the diaphragm (bare area of liver). The IVC is in direct contact with this surface.
Diaphragmatic Surface
This surface of the liver is covered with peritoneum except where the gall bladder and porta hepatis are located. It transmits the portal triad (proper hepatic artery, portal vein, and common bile duct).
Visceral Surface
This is a transverse fissure in the visceral surface of the liver. It contains the hepatic portal vein, hepatic artery proper, nerve plexus, hepatic (bile) ducts, and lymphatic vessels.
Porta Hepatis
This is in the visceral surface of the liver and contains the Ligamentum Teres (Obliterated Umbilical V.).
Left Sagittal Fissure
This is in the visceral surface of the liver and contains the gall bladder and IVC.
Right Sagittal Fissure
What are the lobes of the liver?
Right Lobe
Left Lobe
Caudate Lobe
Quadrate Lobe
***Right Lobe contains the Caudate and Quadrate Lobes!
This lobe of the liver is larger and contains the Caudate and Quadrate Lobes.
Right Lobe
The Left Lobe of the liver is smaller than the Right Lobe, and they are separated by the…
Falciform Ligament
This lobe of the liver is between the IVC and Falciform Ligament.
Caudate Lobe
This lobe of the liver is between the gall bladder and Falciform Ligament.
Quadrate Lobe
Functional lobes of the liver (what is used clinically) is based on the division of the portal triad and blood supply. The right and left liver are divided by the…
Cantile Line
For functional lobes of the liver, what segments do the right and left liver include?
Right Liver = Segments 5-8
Left Liver = Segments 1-4
What are the left liver segments?
1 = Caudate Lobe 2 = Left Posterior Lateral Segment 3 = Left Anterior Lateral Segment 4 = Left Medial Segment
What are the right liver segments?
5 = Right Anterior Medial Segment 6 = Right Anterior Lateral Segment 7 = Right Posterior Lateral Segment 8 = Right Posterior Medial Segment
This is a reflection of visceral peritoneum from the liver to the respiratory diaphragm. It surrounds the bare area of the liver.
Coronary Ligament
The Lesser Omentum consists of what 2 parts?
Hepatogastric Ligament
Hepatoduodenal Ligament
This part of the Lesser Omentum passes from the Porta Hepatis to the lesser curvature of the stomach.
Hepatogastric Ligament
This part of the Lesser Omentum passes from the Porta Hepatis to the duodenum (1st Part). It contains the Proper Hepatic A., Hepatic Portal V., Common Bile Duct, lymphatic vessels, and hepatic nerves.
Hepatoduodenal Ligament
This is the most common type of cirrhosis, and is characterized by hepatomegaly and “hobnail” appearance of the liver surface, resulting from fatty changes and fibrosis.
Alcoholic Cirrhosis
The Biliary System begins as microscopic _______ _______ which collect bile from individual liver cells. These merge to form interlobular bile ducts which merge to form the right and left _______ _______ (drain the lobes of the liver).
Bile Canaliculi
Hepatic Ducts
The right and left hepatic ducts merge to form the _______ _______ _______, which joins the cystic duct to form the _______ ________ ________.
Common Hepatic Duct
Common Bile Duct
The Common Bile Duct contains a ________ that prevents pancreatic secretions from entering the biliary system.
Sphincter
This is the organ that stores and concentrates bile.
Gallbladder
The gallbladder lies in the hepatic fossa and contacts the anterior abdominal wall at the ______ costal cartilage. _______ covering is located on its posterior and inferior surfaces.
9th
Peritoneal
What are the parts of the gallbladder?
Fundus
Body
Neck
This part of the gallbladder projects below the inferior border of the liver.
Fundus
This part of the gallbladder contacts the visceral surface of the liver.
Body
This part of the gallbladder is narrow and tapered. It is “S-shaped” and contains a spiral mucosal fold that keeps the lumen open.
Neck
What is the clinical term for gall stones?
Cholelithiasis
Gall stones are made of ________ ________, and they can be lodged in several structures such as the cystic duct, hepatic duct, or the hepatopancreatic ampulla.
Cholesterol Crystals
Blockage of the hepatopancreatic ampulla blocks both the common bile duct and main pancreatic duct. This results in bile backing up into the pancreas, causing __________.
Pancreatitis
Blockage of the cystic duct may result in what?
Cholecystitis Biliary Colic (intense spasmodic pain)
What are the extrahepatic bile ducts?
Right Hepatic Duct Left Hepatic Duct Common Hepatic Duct Cystic Duct Common Bile Duct
The Common Bile Duct is part of the _______ _______, and travels posterior to the 1st Part of the duodenum and head of pancreas to enter the 2nd part of the duodenum.
Portal Triad
What are common risk factors for gall stones and gall bladder disease?
Female:Male (2 to 1) Obese (fat) Forty's -- risk increases with age Fertile (pre-menopausal) Pregnancy Ethnicity -- American Indians & Mexican Americans Diabetes Estrogen replacement therapy
***Remember the “4 F’s” – Female, Fat, Forty, Fertile!
Gall stones inside the common bile duct and biliary tree and an important cause for developing…
Obstructive Jaundice
