Abdomen I Flashcards
What is the peritoneum?
A serous membrane w/visceral and parietal layers b/w a peritoneal cavity w/serous fluid
What does the parietal peritoneum line?
- Lines the anterior, posterior, and lateral walls of the abdomen.
- Lines the inferior surface of the diaphragm and the pelvic cavity
What does the visceral peritoneum line?
- Lines the abdominal viscera (according to their function)
- Leaves the body wall to surround these viscera
What can the peritoneal cavity be subdivided into?
- Greater sac (accounts for most of the space of the peritoneal cavity)
- Lesser sac (omental bursa)
Where is the lesser sac (AKA omental bursa)?
- It’s small space posterior to the lesser omentum, stomach, liver and inside the greater omentum
How is the lesser sac formed during development?
Stomach growth, beds, rotates + growth of liver
Once you open a cadaver for dissection, what space are you in?
The greater sac
How does the lesser sac connect to the greater sac?
- It is continuous to the greater through the Omental (epiploic) foramen, or foramen of Winslow
What enters into the peritoneal cavity in males? Females?
Males: it’s a closed space
Female: fallopian tube
During development, what suspends the gut tube to the posterior abdominal wall?
Dorsal mesentery
During development, the ventral mesentery is divided by growth of the liver into what?
Lesser omentum and falciform ligament
The small intestine (and part of the colon) evolve from which part of the gut?
Mid-gut
What is a peritoneal fold?
What is the nomenclature of each type?
They’re a double-layer of visceral peritoneum (parietal still covers everything)
- Stomach –> omentum (greater/lesser)
- Small intestine –> mesentery
- Large intestine –> meso-colon (meso-apx, transverse mesocolon, sigmoid mesocolon)
- Organ as liver or spleen –> ligament (e.g. falciform ligament)
What organs are intraperitoneal?
- Stomach
- 1st part duodenum
- Jejunum
- Ileum
- Apx
- Transverse colon
- Sigmoid colon
- Liver
- Spleen
What organs are retroperitoneal?
SAD PUCKER S: Suprarenal glands A: Aorta (+ IVC) D: Duodenum (2nd, 3rd, 4th parts) P: Pancreas U: Ureters C: Colon (ascending and descending only) K: Kidneys E: Esophagus (upper part) R: Rectum
Define ligament (in peritoneum).
A double layer of visceral peritoneum connects an organ with another or anterior abdominal wall (e.g. falciform ligament)
Define mesentery.
A double layer of visceral peritoneum resulting from the invagination of the peritoneum by the intestine
Define omentum.
A double layer of visceral peritoneum passing from the stomach and first part of the duodenum to adjacent organs.
- Greater omentum –> greater curvature of the stomach
- Lesser omentum –> lesser curvature of the stomach
What is the general nerve supply of the parietal peritoneum?
- Somatic nn. of the overlying mm. and skin (e.g. diaphragmatic peritoneum by phrenic n.)
What is the general nerve supply of the visceral peritoneum?
Autonomic nn. w/the underlying viscera
At what vertebral level is the Celiac trunk, and what does it supply?
T12
- Foregut
At what vertebral level is the superior mesenteric artery, and what does it supply?
L1
- Midgut
At what vertebral level is the inferior mesenteric artery, and what does it supply?
L3
- Hindgut
What are 3 common facts of the celiac trunk + superior/inferior mesenteric aa.?
- They are single, unpaired branches of abdominal aorta
- Arise from ant surface of abd aorta
- Branches anastomose w/eachother
Organs of the foregut?
- Stomach
- Liver
- GB
- Spleen
- Top 1/2 pancreas
- First 1/2 duodenum
Arteries supplying foregut?
Celiac trunk:
- Splenic a.
- Left gastric a.
- Common hepatic a.
Organs of the midgut?
- Bottom 1/2 pancreas
- 2nd 1/2 duodenum
- Jejunum
- Ileum
- Cecum
- Ascending colon
- Right 2/3 transverse colon
Arteries supplying midgut?
Superior mesenteric a:
- Middle colic a.
- Right colic a.
- Ileocolic a.
- Inferior pancreaticoduodenal a.
- 11-15 iliojejunal aa.
Organs of the hindgut?
- Left 1/3 transverse colon
- Descending colon
- Sigmoid colon
- Rectum
Arteries supplying hindgut?
Inferior mesenteric a:
- Left colic a.
- Sigmoid a. branches
- Superior rectal aa.
- Marginal aa. (of Drummond)–connect all the colic branches together
What does the left gastric a. run in?
What are its branches?
What does it anastomose w/?
- Lesser omentum
- Esophageal and gastric branches
- Right gastric a. (from hepatic a. proper)
Where does the splenic a. run?
What are its main branches?
- Runs along sup pancreas to give pancreatic branches
- Short gastric and left gastro-omental (AKA gastro-epiploic) aa. go to greater curvature of stomach/lesser omentum
What is the first branch of the common hepatic a.?
Gastroduodenal a.
What are the branches of the gastroduodenal a.?
- Superior pancreoduodenal a.
- Right gastro-omental a.
What does the common hepatic a. turn into?
Hepatic artery proper
What is the branch of the hepatic artery proper?
Right gastric a.
What does the hepatic artery proper turn into?
Right and left hepatic aa.
What is the branch of the right hepatic a.? Left?
Right: Cystic artery branch
Left: None
What are the 2 ends of the stomach?
Cardiac and pyloric ends
What are the 2 surfaces of the stomach?
Ant and post
What are the chambers of the stomach?
- Cardia (under esophagus)
- Fundus (most sup)
- Body
- Pylorus
What are rugae?
Folds that allow for dilation of the stomach
What a. supplies the stomach?
Celiac trunk
What is the stomach bed?
What are in it?
- Group of structures related posteriorly to the stomach, separated from it by lesser sac
- Spleen + 4 left + 4 transverse
- 4 left: left kidney, left suprarenal gland, left colic flexure, left crus of diaphragm
- 4 transverse: transverse colon, transverse mesocolon, body of pancreas, splenic a.
What/where is the lesser omentum?
What type of fold is the lesser omentum?
- Double layer of peritoneum, extends from porta hepatis of liver to lesser curvature of stomach and 1st part of duodenum
- Ventral mesentery
What ligaments make up the lesser omentum?
- Hepatogastric ligament
- Hepatoduodenal ligament
What 3 structures are at the free border of the lesser omentum?
- Bile/hepatic duct (right)
- Hepatic a. (left)
- Portal v. (posterior)
What/where is the greater omentum?
What type of fold is the greater omentum?
- Double layer of peritoneum, hangs down from greater curvature of stomach, covering the transverse colon and other abdominal viscera
- Dorsal mesentery
What ligaments make up the greater omentum?
- Gastrosplenic ligament
- Gastrophrenic ligament
- Gastrocolic ligament
- Splenorenal/Lienorenal ligament
Why is the greater omentum considered the policeman of the abdomen?
Surrounds an infection in the area to keep it from spreading
Directionally, how does the stomach rotate during development?
90 degrees clockwise
If you lift the stomach, what do you take w/you in the greater omentum?
Transverse colon
What is the largest gland in the human body?
Liver
All of the liver is w/in the peritoneum except the ____________.
Bare area (b/w upper & lower areas of coronary ligaments)
What are the 5 peritoneal folds (ligaments) of the liver?
- Falciform ligament
- Coronary ligament
- /4. Right and left triangular ligaments
- Lesser omentum
Besides the lesser omentum, what do the ligaments of the liver attach it to?
Diaphragm and abdominal wall
What is the falciform ligament a remnant of?
Ventral mesentery artery
What are the 5 surfaces of the liver?
Which contact the diaphragm?
- Right, sup, inf (visceral), ant, post
- Sup, ant, post
What is the porta hepatis?
Basically the hilum to the liver
What are the 5 H-shaped fissures of the liver?
Lateral superior: Fissure for IVC
Lateral inferior: Fossa of GB
Middle: Porta hepatis
Medial superior: Fissure for ligamentum venosum (ductus venosus)
Medial inferior: Fissure for round ligament AKA ligamentum teres (obliterated umbilical v.)
What lobes are on either side of the porta hepatis?
Caudate lobe (superior) and quadrate lobe (inferior)
What is the arrangement of vessels of the porta hepatis, post to ant?
VAD
- portal Vein
- hepatic Artery
- hepatic Duct
What are the 4 lobes of the liver?
Right (containing caudate & quadrate) and left
What vessels supply the liver?
- Hepatic a. proper
- Portal vein
(each branch into left and right)
What vessels supply the caudate and quadrate lobes, specifically?
- Left hepatic a.
- Left branch of portal v.
Explain the general venous drainage of the liver
Blood sinusoids -> central veins -> hepatic veins -> IVC
What % of blood does the hepatic a. proper and portal v. supply to the liver?
What % of O2?
- Hepatic a: 25% blood
- Portal v: 75% blood
- O2 split 50%/50%
*Explain the flow of the biliary system, or “Tree”
- Right and left hepatic ducts fork together to form common hepatic duct.
- GB comes into common hepatic duct via its cystic duct
- Post to duodenum, common hepatic duct becomes CBD
- Main pancreatic duct forks in with CBD to become hepatopancreatic ampulla (ampulla of Vater) at 2nd part of duodenum
*What controls the bile and pancreatic secretions from the distal bile duct, pancreatic duct, and ampulla?
Sphincter of Oddi
there’s also a sphincter of pancreatic duct and sphincter of bile duct.
What are the 3 parts of the GB (inf to sup)?
Fundus, body, neck
Where would you find the fundus of the GB? Why would you want to find this part of the GB?
- 9th costocartilage at the linea semilunaris
- Maximum tenderness here w/cholecystitis
Where is Hartmann’s pouch? Why is it important?
- Posteromedial wall of neck of GB
- Common site of gallstones
What does the left gastro-omental a. anastomose with?
Right gastro-omental a. (rt. gastro-epiploic a)
Where is the spleen located?
Wedged b/w stomach and left kidney, (connected by gastrosplenic ligament and lienorenal ligament respectively)
What are the 2 surfaces of the spleen?
- Diaphragmatic (separates it from left lung and ribs 9/10/11)
- Visceral (contains hilum)
What is Murphy’s sign?
Put your hand on RUQ, ask pt to breath. If hurts, positive for cholecystitis
What is the venous drainage of the spleen?
Splenic v. receives inf mesenteric v., unites w/sup mesenteric v., gives portal v.
What is the arteriole supply to the spleen?
Splenic a. of celiac trunk
Where would you go to find the epiploic foramen (foramen of Winslow)?
Just below the neck of the GB, b/w liver and duodenum
