Abdomen Anatomy Flashcards
What is the surface anatomy of the gallbladder?
Tip of 9th CC to the lateral rectus sheath margin in MCL (transpyloric plane - L1 marked by midway between jugular notch & pubis symphysis)
Why would patients with gallbladder pain get shoulder tip pain?
Irritation of diaphragm (C3-5 phrenic nerve) which refers to the corresponding dermatomal distribution (C4) of the supraclavicular nerve suppling the shoulder
What is the surface anatomy of the spleen?
Between 9th-11th rib in space of traube (lower edge of left lung, anterior spleen, left costal margin & inferior left liver lobe)
What might be injured in splenectomy?
Tail of pancreas
Ensure to preserve duodenum
What is the splenic blood supply?
Splenic artery: from coeliac trunk, passes left above pancreas, goes behind stomach seperated from it by lesser sac into the lienorenal (splenorenal) ligament) giving terminal branches inside splenic hilum
Also supplies pancreas & stomach
What are the parts of the duodenum? Where does ampulla of vater open into and what structures open here?
1 (superior)
2 (descending) - ampulla of vater opens here on posteromedial wall and drains the pancreatic duct & common bile duct
3 (inferior)
4 (ascending)
What are the vascular relations of the 1st part of the duodenum?
Gastroduodenal artery
Portal vein
IVC
What is the main artery supplying the liver and stomach? What are its branches?
Coeliac trunk (Left Hand Side):
Left gastric
Hepatic (common): right gastric, gastroduodenal, hepatic proper (gives off R/L) & occasionally cystic
Splenic: pancreatic, short gastric & left gastroepiploic
So hepatic artery supplies both & runs in free border of lesser omentum to porta hepatis
What is the venous drainage of the liver?
Hepatic veins to IVC
What ligament attaches liver to diaphragm?
Triangular
Coronary
Falciform (mostly to anterior abdominal wall)
How far does left lobe of liver extend?
MCL on L
What divides right and left lobe of the liver?
Falciform ligament anteriorly & fissure for ligamentum teres/venosum posteriorly
OR a line passing from IVC to GB fossa
What are the boundaries of the quadrate lobe?
Under surface of right lobe
Bounded by anterior liver margin, the porta (behind), GB fossa (right) and umbilical vein fossa (left)
What are the lobes of the liver?
Right
Left
Quadrate (anterior)
Caudate (posterior)
Caudate & quadrate anatomically part of right lobe but functionally part of left as they receive blood supply from left hepatic artery/portal vein & drain bile to left hepatic duct
Where does the oesophagus begin and end? What is its arterial/venous/lymph supply?
Starts & lower cricoid cartilage (C6) and is goes through the oesophageal hiatus (right crus) when it reaches 40cm
Arterial, venous and lymph is altered depending on level:
Upper 1/3rd - inferior thyroid a/v then deep cervical LNs
Middle 1/3rd - aortic branches (a), azygous (v) & mediastinal LNs
Lower 1/3rd - left gastric a/v then gastric LNs
What are the major structures at the transpyloric plane?
Gallbladder
1st part of duodenum
Stomach pylorus
Root of transverse mesocolon + hepatic flexure of colon
How is the pancreas formed?
From ventral bud from hepatic diverticulum -> lower head & uncinate process
From dorsal bud from dorsal duodenum –> upper head, neck, body & tail
What is the anatomy of the renal vessels?
Come off abdominal aorta @ L1-2 (middle suprarenals come off @ L1) immediately distal to SMA origin (R is longer & cross IVC posteriorly) -> anterior (75%) and posterior (25%) divisions -> segmental arteries (line of Brodel is posterior avascular plane for surgeries)
The renal veins drain directly into IVC (L is longer and travels anterior to abdominal aorta below SMA origin whereas R is posterior to IVC)
Where is minor duodenal papilla and what opens into it?
2nd part 2cm proximal to major duodenal papilla
Accessory pancreatic duct of Santorini opens here
