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๐˜พ๐™ก๐™ž๐™ฃ๐™ž๐™˜๐™–๐™ก ๐˜ผ๐™ฃ๐™–๐™ฉ๐™ค๐™ข๐™ฎ > 9. Abdomen III > Flashcards

9. Abdomen III Flashcards

1
Q

What are the 6 functions of the liver?

A
  • storage,metabolism and release of nutrients and some vitamins
  • detoxification and elimination of toxins, drugs and metabolites
  • synthesis of proteins : albumin and clotting factors
  • synthesis and secretion of bile, important for lipid digestion and absorption
  • role in immune function and clearance of intestinally absorbed bacteria
  • removal of red blood cells
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2
Q

What is the blood flow rate to the liver?

A
  • 1.5L/min
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3
Q

What ribs is the liver protected by?

A
  • 7-11
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4
Q

What areas of the abdomen does the liver occupy?

A
  • Starts in the right hypochondrium and extends to the epigastrium
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5
Q

What surface of the liver is not covered in peritoneum?

A
  • superior surface
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6
Q

Is the liver retro or intraperitoneal?

A
  • intraperitoneal
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7
Q

What are the 4 anatomical lobes of the liver?

A
  • Left lobe
  • Right lobe
  • Caudate lobe
  • Quadrate lobe
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8
Q

Why is the liver intraperitoneal?

A
  • develops in the ventral mesogastrium
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9
Q

What are the two surfaces of the liver?

A
  • diaphragmatic
  • visceral
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10
Q

How many functional segments of the liver are there?

A
  • 8
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11
Q

Label this diagram

A
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12
Q

What structure is the quadrate lobe close to?

A
  • gallbladder
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13
Q

What lobe does the quadrate lobe work with functionally?

A
  • the left lobe
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14
Q

What happens if you remove one of the segments of the liver and why?

A
  • nothing
  • Each segment (8) has its own individual blood supply
  • so if one segment is removed it wonโ€™t affect the other segments
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15
Q

What is the falciform ligament?

A
  • double fold of peritoneum connecting the liver to the anterior abdominal wall
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16
Q

What divides the left lobe from the right lobe?

A
  • falciform ligament
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17
Q

Label this diagram

A
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18
Q

What is the porta hepatis equivalent to?

A
  • the hilum of the lung
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19
Q

What is the thickening on the free edge of the falciform ligament?

A
  • round ligament (ligamentum teres)
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20
Q

What is the ligamentum teres?

A
  • embryological remnant of the umbilical vein (brings oxygenated blood from the placenta)
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21
Q

How is bile transported to the duodenum?

A
  • via the common bile duct
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22
Q

Where does the common bile duct receive bile from?

A
  • the common bile duct receives bile from the cystic duct which comes from the gallbladder
  • or it receives bile directly from the liver through the common hepatic duct
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23
Q

What 2 structures come together to form the common hepatic duct?

A
  • The right and left hepatic duct come together and form the common hepatic duct
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24
Q

What structures come together to form the common bile duct?

A
  • cystic duct will join the common hepatic duct to create the common bile duct
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25
Q

What does the proper hepatic artery divide into?

A
  • divides into the right hepatic and left hepatic artery
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26
Q

Where is the portal triad?

A
  • runs though the free edge of the lesser omentum
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27
Q

What is the lesser omentum?

A
  • double fold of peritoneum that attaches the liver to the stomach
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28
Q

What is โ€˜Pringleโ€™s manoeuvre?

A
  • hemostat is used to clamp the hepatoduodenal ligament (free border of the lesser omentum)
  • interrupting the flow of blood through the hepatic artery and the portal vein
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29
Q

What are the 5 structures that are contained in the porta hepatis?

A
  • common bile duct
  • left and right hepatic duct
  • cystic duct
  • hepatic portal vein
  • hepatic artery
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30
Q

Label this image

A
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31
Q

Label this image

A
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32
Q

What is the round ligament?

A
  • thickening of the falciform ligament
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33
Q

Label this image

A

*

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34
Q

What happens to the falciform ligament as it ascends?

A
  • it ascends and splits into two layers so one layer goes to the right and the other goes to the left because the falciform ligament is made of 2 layers
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35
Q

What is the falciform ligament called when it splits?

A
  • coronary ligament of the liver
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36
Q

What does the top surface of the coronary ligament attach to?

A
  • top surface attaches to the bottom of the diaphragm
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37
Q

What do the coronary ligaments fuse to become?

A
  • fuse and become the triangular ligament (left and right)
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38
Q

Label this image

A
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39
Q

Why does the bare area occur?

A
  • liver undergoes a really accelerated growth within vental mesogastrium so the two layers of peritoneum separate apart (like hulk and his clothes)
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40
Q

What are the boundaries of the bare area?

A
  • anterior and posterior coronary ligaments
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41
Q

Why is the bare area clinically important?

A
  • bare area of the liver is clinically important because of the portacaval anastomosis and it represents a site where infection can spread from the abdominal cavity to the thoracic cavity
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42
Q

What is the subphrenic space?

A
  • gap between the liver and diaphragm
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43
Q

What is the clinical significance of the peritoneal recesses of the liver?

A
  • the liver recesses are areas where fluid can fill if there is an infection
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44
Q

What is the pouch of Morrison?

A
  • gap between the liver and the kidney
  • hepatorenal pouch (of Morrison)
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45
Q

What is the subhepatic space?

A
  • space is between the inferior surface of the liver and the kidney
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46
Q

Label this image

A
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47
Q

Label this image with :

pouch of morrison

subphrenic space

right subhepatic space

A
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48
Q

What does the gastric artery supply and where does it go?

A
  • left and right go inbetween the lesser omentum to supply the stomach
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49
Q

Label this image

A
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50
Q

Label 1 and 2

A
  • 1) hepatogastric ligament
  • 2) hepatoduodenal ligament
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51
Q

Where does the portal triad run?

A
  • free edge of lesser omentum
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52
Q

What are the superior, inferior, posterior and anterior borders of the lesser sac?

A
  • superior : caudate process of liver
  • inferior : 1st part of duodenum
  • posterior : inferior vena cava and right crus of diaphragm
  • anterior : portal triad (in free edge of lesser omentum)
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53
Q

How many vessels is the liver supplied by?

A
  • two
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54
Q

What vessels make up the livers dual supply?

A
  • 25% is from the hepatic artery proper
  • 75% of the blood comes from the GI tract through the hepatic portal vein
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55
Q

Where is blood processed?

A
  • blood is processed in the sinusoids
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56
Q

What veins unite to form the hepatic portal vein? Draw a schematic below.

A
  • three main vessels:
  • the gastric, pancreaticomesenteric, and lienomesenteric veins
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57
Q

After blood is processed in the sinusoids of the liver what happens?

A
  • sinusoids collect into the central vein and unite into the three hepatic veins and the hepatic veins join directly into the IVC
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58
Q

What brings blood to the liver from the midgut?

A
  • superior mesenteric vein brings blood from the midgut
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59
Q

Where does the inferior mesenteric vein bring blood from?

A
  • hindgut
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60
Q

Label this image

A

1) hepatic portal vein
2) superior mesenteric vein
3) splenic vein
4) inferior mesenteric vein

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61
Q

How does portal hypertension arise?

A
  • When scarring and fibrosis from cirrhosis obstruct the portal vein in the liver
  • pressure rises in the portal vein and its tributaries producing portal hypertension
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62
Q

Why can the spleen become enlarged with cirrhosis?

A
  • The splenic vein enters directly into the hepatic portal vein
  • If the vessel is blocked and blood canโ€™t flow out of the spleen, it will continue to grow and you get splenomegaly
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63
Q

What are portosystemic anastomoses?

A
  • blood can flow into the portal system or straight into the systemic venous circulation so it is not processed by the liver
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64
Q

What are the oseophageal portal and systemic veins?

A
  • portal via left gastric
  • systemic via azygos vein
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65
Q

What are the anal portal and systemic veins?

A
  • portal via inferior mesenteric veins
  • systemic via inferior and middle rectal veins
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66
Q

What are the portal and systemic peri-umbilical veins?

A
  • portal via paraumbilical veins
  • systemic via epigastric veins
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67
Q

What is caput medusae?

A
  • If the portal system is blocked and blood canโ€™t flow through the paraumbilical veins
  • the majority of the blood will travel via the epigastric veins, (like a traffic jam)
  • so more blood is flowing through them and they become more dilated
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68
Q

How does the biliary system develop?

A
  • as an outgrowth of the foregut
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69
Q

Where is bile produced and where does it go?

A
  • Bile is produced in the liver and travels through the right or left hepatic duct to enter the common hepatic duct
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70
Q

Label this image

A
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71
Q

Where is the gallbladder located?

A
  • behind the tip of the right 9th costal cartilage, where the lateral margin of rectus abdominis crosses the costal margin
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72
Q

What are the 2 routes bile can take once it reaches the common hepatic duct?

A
  • can travel through the cystic duct to be stored in the gallbladder
  • or it can travel down the common bile duct to fuse with the main pancreatic duct to form the hepatopancreatic ampulla of vater
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73
Q

Where does the ampulla of vater open into?

A
  • major duodenal papilla which enters into the lumen of the duodenum
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74
Q

What is the release of bile controlled by?

A
  • spiral folds
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75
Q

What artery supplies the gallbladder and where does it arise?

A
  • cystic artery
  • arises from right hepatic artery
76
Q

Label this image with

1) right and left hepatic ducts
2) common hepatic duct
3) cystic duct
4) common bile duct
5) hepatico-duodenal ampulla of vater
6) major duodenal papilla
7) fundus
8) body
9) neck

A
77
Q

What is cholelithiasis?

A
  • formation of gallstones
78
Q

What is Hartmannโ€™s pouch?

A
  • diseased states of the gallbladder, a dilation or pouch appears at the junction of the neck of the gallbladder and the cystic duct
79
Q

Where do gallstones normally collect?

A
  • Infundibulum/ Hartmannโ€™s pouch
80
Q

What is Hartmannโ€™s pouch caused by?

A
  • dilation above the neck of the gallbladder and is a pathological entity produced by a contained gallstone
81
Q

How can gallstones enter the duodenum?

A
  • If a peptic duodenal ulcer ruptures, a false passage may form between the infundibulum and the superior part of the duodenum, allowing gallstones to enter the duodenum
82
Q

What are the 2 types of gallstones?

A
  • Cholesterol (yellow) versus pigment (dark brown or black) gallstones
83
Q

What are the common associations of gallstones? (5 Fs)

A
  • female
  • fair
  • fat
  • forty
  • fertile
84
Q

Where can gallbladder pain be referred?

A
  • back of the shoulder
85
Q

What 3 things is the neck of the pancreas anterior to?

A
  • SMA
  • SMV
  • portal vein
86
Q

What is the head of the pancreas anterior to?

A
  • portal vein
87
Q

What is anterior and posterior to the body of the pancreas?

A
  • posteriorly - peritoneum
  • anterior surface - bed of stomach, floor of lesser sac
88
Q

Where does the tail of the pancreas pass?

A
  • between folds of splenorenal ligament
89
Q

Is the tail of the pancreas intra or retro peritoneal?

A
  • intraperitoneal
90
Q

What passes anterior to the uncinate process of the pancreas?

A
  • SMA
  • SMV
91
Q

When does jaundice arise?

A
  • when the normal passage of bile into duodenum is blocked, either partially or wholly
92
Q

What are the 3 types of jaundice?

A
  • pre-hepatic
  • hepatocellular
  • post-hepatic
93
Q

What is pre-hepatic jaundice caused by?

A
  • excessive red cell breakdown
94
Q

What is hepatocellular jaundice caused by?

A
  • dysfunction of hepatic cells
95
Q

What is post-hepatic jaundice caused by?

A
  • obstruction of biliary drainage e.g. gallstones or tumours
96
Q

What are the 3 signs of post-hepatic jaundice?

A
  • Dark urine
  • Pale stools
  • Yellow discoloration of sclera and skin
97
Q

Why does inflammation of the gallbladder cause shoulder pain?

A
  • The gallbladder is very closely related to the diaphragm
  • The diaphragm is supplied by the phrenic nerve (C3,C4,C5)
  • The dermatomes of the shoulder are also C3,C4, and C5
  • Inflammation of the gallbladder can cause irritation of the diaphragm
98
Q

Label this image

A
99
Q

What can be used to visualize the biliary system?

A
  • Endoscopy and fluoroscopy
100
Q

How does endoscopy and fluoroscopy work?

A
  • An endoscope is passed through the pylorus and a cannula is inserted through the ampulla of vater.
  • Radiocontrast medium is injected into the CBD allowing visualisation of the biliary tree.
101
Q

What is the procedure called to visualize the biliary tree?

A
  • Endoscopic retrograde cholangiopancreatography (ERCP)
102
Q

What is the clinical term for inflammation of the gallbladder?

A
  • cystitis
103
Q

What is Murphyโ€™s sign?

A
  • patients with acute cholecystitis by asking the patient to take in and hold a deep breath while palpating the right subcostal area.
  • If pain occurs on inspiration, when the inflamed gallbladder comes into contact with the examinerโ€™s hand, Murphyโ€™s sign is positive
104
Q

What are the main functions of the pancreas?

A
  • exocrine - pancreatic juice : acinar cells
  • endocrine - glucagon and insulin : pancreatic islets of Langerhans
105
Q

Where is the splenic artery and vein in relation to the body of the pancreas?

A
  • splenic vein runs immediately posterior to the length of the body of the pancreas
  • in front of the pancreas
106
Q

What vertebral level is the transpyloric plane and where does it pass?

A
  • through neck of pancreas
  • L1
107
Q

Where does the accessory pancreatic duct?

A
  • accessory pancreatic duct enters into the minor duodenal papilla
108
Q

What is the pancreas supplied by?

A
  • pancreas is mainly supplied by branches of the celiac trunk and from the superior mesenteric artery
109
Q

Where do the celiac trunk and the SMA arise with?

A
  • abdominal aorta
110
Q

What are the head and the uncinate process of the pancreas supplied by?

A
  • head and the uncinate process are supplied by branches of the gastroduodenal artery
111
Q

What does the superior pancreaticoduodenal artery anastomose with and where does this arise from?

A
  • inferior pancreaticoduodenal artery which arises from the superior mesenteric artery
112
Q

What does the pancreas develop from?

A
  • from the ventral and dorsal buds
113
Q

How does the pancreas develop?

A
  • The duodenum rotates as it develops and rotates to the right causing the ventral bud to migrate around the back of the duodenum and fuse with the dorsal bud
114
Q

What is annular pancreas?

A
  • Annular pancreas is a condition where a ring of pancreatic tissue surrounds and constricts the duodenum
115
Q

What is a pancreatic pseudocyst caused by?

A
  • caused by pancreatitis or abdominal trauma
116
Q

What is a pancreatic pseudocyst?

A
  • a collection of enzyme rich fluid and blood encapsulated in the area of the pancreas
117
Q

Label this image

A
118
Q

What does the ventral bud become?

A
  • uncinate process
119
Q

What does obstructive jaundice cause?

A
  • resulting in the retention of bile pigments, enlargement of the gallbladder, and jaundice
120
Q

How does annular pancreas arise?

A
  • the two buds of the pancreas migrate in different directions
121
Q

What does cancer of the pancreatic head and neck lead to?

A
  • obstruction of the portal vein or inferior vena cava
122
Q

What is Whippleโ€™s procedure?

A
  • pancreaticoduodenectomy
  • removal of : head of pancreas, duodenum, gallbladder, bile duct
123
Q

When would Whippleโ€™s procedure be done?

A
  • cancer in head of pancreas
124
Q

Why does cancer of the head of the pancreas cause extrahepatic obstruction?

A
  • obstructs the major duodenal papilla
125
Q

How is the pancreas related to the portal vein and IVC ?

A
  • Goes anterior to both
126
Q

What is Kocherโ€™s manoeuvre?

A
  • surgical manoeuvre to expose structures in the retroperitoneum behind the duodenum and pancreas
127
Q

What is the function of the duodenum?

A
  • Responsible for the emulsification of fat
  • Also responsible for chemical digestion via enzymes produced in the pancreas
128
Q

What 3 places does the duodenum receive things from and what does it receive?

A
  • chyme from pyloric part of stomach
  • bile from liver and gallbladder via common bile duct
  • enzymes from pancreas via main and accessory pancreatic duct
129
Q

Is the duodenum retro or intraperitoneal?

A
  • the first part is intraperitoneal while the rest is retroperitoneal
130
Q

What is the first part of the duodenum enclosed by?

A
  • hepatoduodenal ligament
131
Q

What are the vertebral levels of the retroperitoneal part of the duodenum?

A
  • L1-L3
132
Q

Where do the greater and lesser omenta arise from?

A
  • arise from the upper and lower surfaces of the proximal portion of the superior part of the duodenum
133
Q

What is the vertebral level of the first part of the duodenum?

A
  • L1
134
Q

What are the 2 names for the first part of the duodenum?

A
  • duodenal cap
  • ampulla
135
Q

What artery runs behind the first part of the duodenum?

A
  • gastroduodenal artery
136
Q

What 3 structures run posteriorly to the superior part of the duodenum?

A
  • common bile duct, hepatic portal vein and gastroduodenal artery
137
Q

Where are peptic ulcers most likely to occur?

A
  • first part of duodenum
138
Q

What structure can be damaged if a peptic ulcer ruptures?

A
  • If a peptic ulcer ruptures through the mucosa of the first part of the duodenum, the gastroduodenal artery can rupture
139
Q

What 2 structures are inferior to the first part of the duodenum?

A
  • head and neck of pancreas
140
Q

What structure is medial to the first part of the duodenum?

A
  • pylorus
141
Q

What 2 structures are superior to the first part of the duodenum?

A
  • epiploic foramen
  • neck of gallbladder
142
Q

What 5 structures are posterior to the first part of the duodenum?

A
  • lesser sac
  • bile duct
  • hepatic portal vein
  • gastroduodenal artery
  • IVC
143
Q

What 3 structures are anterior to the first part of the duodenum?

A
  • gallbladder
  • quadrate lobe of the liver
  • peritoneum
144
Q

What is the radiological significance of the duodenal cap?

A
  • can be seen as a bright spot in the duodenum
145
Q

What is the vertebral level of the second part of the duodenum?

A
  • L2/ L3
146
Q

What is the second part of the duodenum lined with and what is their function?

A
  • lined with circular folds called plicae circulares which increase the surface area
147
Q

What 3 structures are medial to the second part of the duodenum?

A
  • bile duct
  • pancreatic duct
  • head of pancreas
148
Q

What structure is inferior to the second part of the duodenum?

A
  • inferior duodenum
149
Q

What 4 structures are posterior to the second part of the duodenum?

A
  • hilum of right kidney
  • renal vessels
  • right ureter
  • psoas major
150
Q

What 5 structures are anterior to the second part of the duodenum?

A
  • right lobe of the liver
  • fundus of gallbladder
  • transverse colon
  • transverse mesocolon
  • coils of small intestine
151
Q

What is found in the medial part of the second part of the duodenum?

A
  • Medially you can find the opening of the hepatopancreatic ampulla through the major duodenal papilla and superior to it is the minor duodenal papilla
152
Q

What is the blood supply of everything above the major duodenal papilla supplied by?

A
  • celiac trunk
153
Q

What is the blood supply of everything below the major duodenal papilla?

A
  • superior mesenteric artery
154
Q

Where is the most common site for diverticula?

A
  • second part of duodenum
155
Q

What is the relationship of the transverse mesocolon to 2nd part of duodenum?

A
  • transverse mesocolon is anterior to the 2nd part of duodenum
156
Q

What vertebral level is the third part of the duodenum?

A
  • L3
157
Q

What 3 structures pass anteriorly to the 3rd part of the duodenum?

A
  • SMA/SMV
  • coils of small intestine
  • root of mesentery
158
Q

What 4 structures pass posteriorly to the 3rd part of the duodenum?

A
  • right psoas major
  • IVC
  • aorta
  • right ureter
159
Q

What structure is medial to the 3rd part of the duodenum?

A
  • 4th part of duodenum
160
Q

What structure passes inferiorly to the 3rd part of the duodenum?

A
  • coils of the ileum
161
Q

What 3 structures are superior to the 3rd part of the duodenum?

A
  • head of pancreas
  • uncinate process of pancreas
  • SMA/SMV
162
Q

What is the vertebral level of the 4th part of the duodenum?

A
  • L1
163
Q

Where does the 4th part of the duodenum join the jejunum?

A
  • duodenojejunal flexure
164
Q

What is the suspensory muscle of the duodenum?

A
  • Ligament of Treitz
165
Q

What 2 structures are anterior to the 4th part of the duodenum?

A
  • root of mesentery
  • coils of jejunum
166
Q

What are the 2 posterior structures to the 4th part of the jejunum?

A
  • left psoas major
  • left margin of aorta
167
Q

What are the 2 medial structures to the 4th part of the duodenum?

A
  • SMA/SMV
  • uncinate process of pancreas
168
Q

What is found inferiorly and superiorly to the 4th part of the duodenum?

A
  • inferior : coils of jejunum
  • superior : body of pancreas
169
Q

What is the blood supply to the duodenum?

A
  • proximal segment of the duodenum is supplied by the gastroduodenal artery and its branches which include the superior pancreaticoduodenal artery.
  • The distal segment of the duodenum is supplied by the superior mesenteric artery and the inferior pancreaticoduodenal artery
170
Q

Label this image

A
171
Q

Where do the lymphatic nodes of the duodenum drain?

A
  • Above the major duodenal papilla they will travel to the hepatic lymph nodes which drain into the celiac nodes
  • The inferior pancreaticoduodenal nodes drain to the superior mesenteric nodes
172
Q

Where do the lymphatics of the duodenum go?

A
  • follow arteries superiroly from superior pancreaticoduodenal to celiac nodes
  • follow arteries inferiorly from pancreaticoduodenal to superior mesenteric nodes
173
Q

Where is the spleen found?

A
  • left upper quadrant/left hypochondrium
174
Q

What are the dimensions of the spleen?

A
  • 1โ€x 3โ€x 5โ€, weighs 7oz and situated between 9th - 11th ribs
175
Q

What is the function of the spleen?

A
  • white cell proliferation
  • immune surveillance
  • filters and stores RBC and platelets
  • recycles iron and Hb
176
Q

How can the spleen be injured?

A
  • penetrating wounds of the thorax
177
Q

How is the spleen connected to the stomach?

A
  • stomach by the gastrosplenic ligament
178
Q

How is the spleen connected to the kidney?

A
  • splenorenal ligament
179
Q

Where does the spleen develop within in embryological development?

A
  • dorsal mesogastrium
180
Q

Where is the splenic notch found?

A
  • antero-inferior border
181
Q

Is the spleen retro or intraperitoneal?

A
  • intraperitoneal
182
Q

Where does the splenic artery arise from?

A
  • from the coeliac trunk
183
Q

Where does the splenic artery pass?

A
  • superior to the body of the pancreas to enter the spleen at the hilum.
184
Q

What 2 veins unite to form the hepatic portal vein?

A
  • splenic vein unites with the superior mesenteric vein, to form the hepatic portal vein.
185
Q

Label this image

A
186
Q

Label this image

A
187
Q

Where would you begin palpation for an enlarged spleen (splenomegaly)?

A
  • right iliac fossa

๐˜พ๐™ก๐™ž๐™ฃ๐™ž๐™˜๐™–๐™ก ๐˜ผ๐™ฃ๐™–๐™ฉ๐™ค๐™ข๐™ฎ (20 decks)

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