9 spleen liver hernia Flashcards
What are the two parts of the Omentum?
Greater and Lesser Omentum.
What is the function of the Greater Omentum?
It contains milky spots for immune response, absorbs bacteria, and helps isolate contamination.
What are the three portions of the Greater Omentum?
- Bursal
- Splenic
- Veil
What is the Hepatogastric Ligament?
A portion of the Lesser Omentum that connects the liver to the stomach.
What is the Omental bursa?
A potential space between the layers of the omentum, a closed sac except for the epiploic foramen.
List three surgical conditions where the omentum is utilized.
- Post Enterectomy: omental patching
- Post Enterotomy: omental patching
- Omental pedicle grafts for skin wounds
What is the primary function of the Diaphragm?
It separates abdominal and thoracic organs and assists in ventilation.
What are the major openings in the Diaphragm?
- Aortic hiatus
- Oesophageal hiatus
- Caval foramen
What is the innervation of the Diaphragm?
Phrenic nerves arising from 5th, 6th, 7th cervical nerves.
What organ is most commonly displaced into the thoracic cavity due to traumatic diaphragmatic rupture?
Liver.
True or False: Traumatic diaphragmatic hernias can lead to lung compression.
True.
What is a Congenital Portosystemic shunt?
A vascular anomaly causing portal blood to bypass the liver.
What are the clinical pathology tests expected abnormalities for Congenital Portosystemic shunts?
- Normochromic non-regenerative anemia
- Increased ALT
- Decreased glucose, albumin, urea
What imaging modalities can be used to identify Congenital Portosystemic shunts?
- Abdominal ultrasound
- Contrast CT/CT Angiography
- Portography
Name one surgical technique used to treat Congenital Portosystemic shunts.
Gradual attenuation using Ameroid constrictor.
What is the primary blood supply to the liver?
Hepatic arteries from celiac artery and portal veins.
What is bile peritonitis?
Severe inflammation of the abdominal cavity caused by bile leakage.
What happens when bile leaks into the abdominal cavity?
It causes inflammation and can lead to necrosis and shock.
What are the causes of bile peritonitis?
- Trauma
- Gallbladder issues
- Blockages in the gallbladder ducts
What is the anatomical significance of the splenic and short gastric arteries during splenectomy?
They need to be preserved to protect the pancreatic and left gastroepiploic branches.
What is the risk if the splenic artery is ligated proximal to the pancreatic branch?
The pancreas is at risk.
Fill in the blank: The main blood drainage of the liver occurs through ___ veins.
[hepatic]
What is the purpose of splenic and short gastric ligation during a splenectomy?
To preserve the pancreatic and left gastroepiploic branches to protect supply to pancreas and stomach.
What surgical approach is used for a splenectomy?
Large midline celiotomy from xiphoid to caudal umbilicus, with moist sponges covering edges and removal of falciform.
What should be done before excising adhesions during a splenectomy?
Find and ligate any active bleeding vessels first.
What technique is used to release the head of the spleen?
Triple clamp and cut between the 2nd and 3rd clamp.
What should be avoided if the spleen is twisted during a splenectomy?
Avoid untwisting, as it can release thrombi and vasoactive compounds into circulation.
What is the role of the greater omentum during pancreatic surgery?
It needs to be opened to visualize the left limb of the pancreas.
What are the boundaries of the epiploic foramen?
Dorsally by caudal vena cava, ventrally by portal vein and hepatic artery, cranially by caudate lobe of liver, caudally by celiac artery.
What structures pass through the aortic hiatus of the diaphragm?
Aorta, azygeous, hemiazygous veins, lumbar cistern of thoracic duct.
What structures pass through the oesophageal hiatus of the diaphragm?
Oesophagus and its blood supply, dorsal and ventral vagal trunks.
What structures pass through the caval foramen of the diaphragm?
Caudal vena cava and adventitia.
What are the two main arteries that supply the colon?
- Cranial mesenteric artery (common colic artery)
- Left colic branch of caudal mesenteric artery.
What is the significance of preserving the ileocecal valve during colonic surgeries?
It decreases the chance of intractable diarrhea from SIBO.
What is the consequence of ligating individual vasa recta during distal colon resection?
Helps preserve blood supply.
What is the falciform ligament?
A fold of peritoneum that extends from umbilicus to diaphragm.
What is the embryological origin of the falciform ligament?
It originates from embryonic ventral mesentery, part of the foregut.
What are the three main ligaments that support the ovary?
- Suspensory ligament
- Proper ligament (ovarian ligament)
- Broad ligament of the uterus.
Where do the paired ovarian arteries arise from?
From the caudal aorta, caudal to renal arteries, cranial to deep circumflex iliac.
What is the drainage route for the right ovarian vein?
Drains into the caudal vena cava.
What is the drainage route for the left ovarian vein?
Enters left renal vein.
