Abdomen #2 (starting w/ portal vein; lecture 30B) Flashcards
List the tributaries of the splenic vein (4; and secondary tributaries if applicable)
- Mnemonic: LIPS*
1. ) Inferior mesenteric vein (IMV) and its tributaries:
a. ) Left colic
b. ) Sigmoid
c. ) Superior rectal
2. ) Pancreatic veins
3. ) Left gastroepiploic vein
4. ) Short gastric veins - approx. p.250 Moore
Where does the SMV meet the splenic vein? What do they form?
Posterior to the neck of the pancreas to form the portal vein.
-p.252 Moore
List the tributaries of the SMV
- ) Inferior pancreaticoduodenal vein
- ) Right gastroepiploic vein
- ) Right colic vein
- ) Ileocolic vein
- ) Jejunal veins
- ) Ileal veins
What are the three most important/clinically relevant portosystemic anastomoses, where do they occur, and what is their relevant pathology (e.g. esophageal varices)?
Know clinical significance and anastomosing veins!
1.) Lower esophagus
Portal: Oesophageal branches of left gastric veins
Systemic: Azygous veins
–> Esophageal varoces: Torrential bleeding from the mouth
2.) Upper anal canal
Portal: Superior rectal vein
Systemic: Middle/inferior rectal veins
–> If these veins become engorged, you get HEMORRHOIDS
3.) Umbilical
Portal: Veins of ligamentum teres
Systemic: Superior/inferior epigastric veins
–> “Caput medusae” (p.280 Moore): Engorged dilated veins radiating around belly button can be caused by cirrhosis of the liver in alcoholics.
-p.280 Moore
Where do the portosystemic anastomoses occur (6)?
*Mnemonic: BLUURP* Lower esophagus Upper anal canal Umbilical Bare area of liver Patent ductus venosus (rare) Retroperitoneal
When can a portal vein become blocked?
Cirrhosis of the liver (from alcohol)
- ) Where does the common bile duct open to?
2. ) Where is it in relation to the first part of the duodenum on its way to the second?
- ) Medial side of the second part of the duodenum
2. ) Posterior to the first part of the duodenum <– Know this, according to Dr. Rich!
What is the blood supply for the gallbladder?
The CYSTIC ARTERY which is a branch of the RIGHT HEPATIC ARTERY.
What is Calot’s Triangle? Borders?
Lateral: Inferior border of the liver
Medial: Cystic duct
Superior: Cystic artery
Where does the gallbladder receive innervation from? i.e. sensory, parasympathetic, sympathetic.
Sensory from RIGHT PHRENIC NERVE
Sympathetic: Celiac plexus
Parasympathetic: Vagus
What lymph node becomes enlarged when there is inflammation of the gallbladder?
Mascagni’s/Lund’s lymph node
When performing surgery around Calot’s Triangle (e.g. laproscopic cholecystectomy), what structures should be secured first in order to avoid injury?
Cystic duct and common hepatic duct
-19:00 Lecture 30B
The tail of the pancreas lies inside of what structure?
Lienorenal (literally, “Spleen Kidney”) ligament
Where does the spleen lie in relation to the ribs?
Ribs # 9, 10, and 11. Thus, rib injuries can injure the spleen.
What structures form the cystohepatic triangle?
Cystic duct, common hepatic duct, and the liver margin.
-19:16, Lecture 30B
What provides sensory innervation for the gallbladder?
Right phrenic nerve
What are the main risk factors for developing gall stones (4)?
The four F’s
Fat, female, forty, fertile
- ) Describe the location of the pancreas?
2. ) Where does it refer pain to?
- ) Retroperitoneally and transversely across the posterior abdominal wall.
- ) To the back
What structure(s) is/are at risk when surgically removing the spleen?
The lienorenal ligament (attaches the hilum of the spleen to the kidney) and/or tail of the pancreas that lies within it
What lies behind the neck of the pancreas in situ?
Portal vein (where the SMV and splenic vein unite to form the portal vein).
What is a possible consequence of cancer in the head of the spleen?
It compresses the common bile duct and prevents bile from entering the second part of the duodenum and bile subsequently enters the bloodstream. THIS CAUSES JAUNDICE.
Which blood vessels does the head of the pancreas lie over?
IVC, left and right renal veins, and right renal artery.
What is the uncinate process?
A projection from the inferior part of the head of the pancreas that extends TO THE LEFT (it is at the bottom of the head after it forms a “C”).
Where does the neck of the pancreas lie in relation to the pylorus and superior mesenteric vessels?
It overlies the superior mesenteric vessels and is ADJACENT to the pylorus.