Abdomen I, II, III, IV Flashcards
What is the peritoneum?
a serous membrane
What are the 2 layers of the peritoneum?
1 parietal
2 visceral
what is the parietal layer of the peritoneum?
lines the anterior, posterior, lateral walls of the abdomen
inferior surface of diaphragm and pelvic cavity
What is the visceral layer of the peritoneum?
leaves the body wall to surround the abdominal viscera
What is between the parietal and visceral layers?
the peritoneal cavity
filled with serous fluid
allows for free movement of viscera
What is the peritoneal cavity divided into>
greater sac and lesser sac (omental bursa)
What is the greater sac?
accounts most of the space of the peritoneal cavity
once you open peritoneum in the cadaver = greater sac
What is the lesser sac?
small space posterior to the lsser omentum, stomac, liver, inside the greater omentum.
continous to the greater though the omental epiploic foramen
stomach rotation and the growth of liver is the main reason of tis sac
How do the greater and lesser sac communicate?
through epiploic foramen or foramen of Winslow
can stick hand in between
What is the difference in the peritoneum for men and women?
men = closed cavity women = fallopian tube open into peritoneal cavity
What enters the peritoneum during development?
the gut tube
suspended from posterior abdominal wall by dorsal mesentery (double layer of pertineu,)
Where is the ventral mesentery found?
only above the umbilicus
formation of liver divides it into lesser omentum and falciform ligament
What are the four folds that the peritoneum leaves the posterior abdominal wall as?
stomach = omentum- lesser and greater omentum
small intestine= mesentary
large intestine= meso colon- mesoappendix, transverse mesocolon, sigmoid mesocolon
organ as liver or spleen= ligament- falciform ligament
What organs are completed covered by visceral peritoneum and so freely mobile?
1 stomach 2 1st part of duodenum 3 jejunum 4 ileum 5 appendix 6 transverse colon 7 sigmoid colon 8 liver 9 spleen
which organs develop to be on posterior abdominal wall (retroperitoneal)?
SAD PUCKER
suprarenal glands aorta duodenum 2nd 3rd 4th parts pancreas ureter colon kidney esophagus rectum
what is a ligament?
double layer of peritoneum connects an organ with another or anterior abdominal wall
What is mesentery?
double layer of peritneum result from the invagination of the peritoneum by the intestine
What is omentum?
double layer of peritoneum passing from the stomach and first part of duodenum to adjacent organs
decends as 2 layer anterior and bends to 2 layer posterior
greater omentum- greater curvatures of stomach
lesser omentum - lesser curvature of stomach
What are derivitives of ventral mesentary?
Falciform ligament (liver and outside) lessor omentum (stomach/liver)
What nerves supply the parietal peritoneum?
somatic nerves of overlying muscles and skin
What nerve supply the visceral peritoneum?
autonomic nerevs with underlying viscera
NO somatic innervation (cant feel pain) sympathetic innervation (sensitive to stretch, tension, ischemia)
What are the 3 parts of the gut tube and blood supply?
1 foregut - celiac trunk T12
2 midgut- superior mesenteric artery L1
3 hindgut- inferior mesenteric artery L3
What do the celiac trunk, superior mesenteric artery, inferior mesenteric artery have in common?
1 single unpaired branches of abdominal aorta
2 arise from anterior surface of abdominal aorta
3 anastomose with each other
What organs make up the foregut?
1 stomach 2 liver 3 gallbladder 4 pancrease 5 spleen 6 1st half of duodenum
What arteries make up the foregut?
celiac trunk
1 splenic
2 left gastric
3 common hepatic
What organs make up the midgut?
1 2nd half of duodenum 2 jejunum 3 ileum 4 cecum 5 ascending colon 6 2/3 transverse colon
What organs make up the hindgut?
1 left 1/3 of transverse colon
2 descneding colon
3 sigmoid colon
4 rectum
What arteries make up the midgut?
superior mesenteric:
- ileocolic
- right colic
- middle colic
What arteries make up the hindgut?
inferior mesenteric:
- left colic
- sigmoid branches
- superior rectal
What is the most dilated part of the gut tube?
stomach
What are the 2 borders with 2 omenta of the stomach?
greater and lesser
What are the 2 sacs of the stomach?
greater and lesser
What are the 2 surfaces of the stomach?
anterior and posterior
What are the 2 ends of the stomach?
cardiac and pyloric
What are the parts of the stomach?
1 cardia
2 fundus
3 body
4 pylorus (antrum, canal, sphincter)
What is the blood supply of the stomach?
celiac trunk
What makes up the stomach bed?
spleen
4 left
- left kidney
- left suprarenal
- left colic flexure
- left crus of diaphragm
4 transverse
- transverse colon
- transverse mesocolon
- body of pancreas
- splenic artery
What is the lesser omentum?
vental mesentery
double layer of peritoneum
extends from porta hepatis of liver to lesser curvature of stomach and 1st part of duodenum
What ligaments make up the lesser omentum?
hepatogastric and hepatoduodenal ligaments
What are the 3 structures at the free border of the lesser omentum?
1 bile duct
2 hepatic artery
3 portal vein (behind both)
What is the greater omentum?
dorsal mesentery
double layer of peritoneum hangs down from the greater curvature of stomach covering the transverse colon and other abdominal viscera
policeman of the abdomen
What ligaments make up the greater omentum?
1 gastrosplenic
2 gastrophrenic
3 gastrocolic
4 lienorenal (splenorenal)
What is the largest gland in the human body?
liver (derivitive of foregut)
What is the blood supply of the liver?
hepatic artery proper of celiac trunk
What area of the liver is not covered by peritoneum>
the bare area
between the upper and lower layers of corony ligaments
What are the five peritoneal ligaments of the liver?
1 coronary 2 falciform 3 right triangular 4 left triangular 5 lesser omentum
What are the 5 surfaces of the liver?
1 right 2 anterior 3 posterior 4 superior 5 inferior (visceral)
What are the 5 fissures of the liver?
H shaped
1 fissure for ligamentum venosum - ductus venosus
2 fissure for ligamentum teres (round lig) - oblitered umbilical vein
3 fossa of gall bladder
4 fissure for IVC
5 porta hepatis
Where does porta hepatis lie?
transveresely between quadrate and caudate lobes
How are the vessels arranged in the porta hepatis?
VAD (posterior to anterior)
portal Vein
hepatic Artery
hepatic Duct
What are the 4 lobes of the liver?
1 right
2 left
3 caudate
4 quadrate
What do the 4 lobes of the liver anatomically do?
falciform ligament, fissure for ligamentum teres and venosum = divide the liver into right anatomical lobe (contain the caudate and quadrate)
and left lobe
What do the 4 lobes of the liver functionally?
fossa of gallbladder and IVC- divide into right lobe and left functional (contain the caudate and quadrate lobe)
division based on blood supply
What is the significance of the right and left lobe division?
caudate and quadrate
right anatomical lobe contains caudate and quadrate but LEFT lobe functionally supplies their blood
What is the blood supply of the liver?
hepatic proper artery and portal vein
each divides to right and left branches
left hepatic artery and left branch of portal vein
What is the venous supply of the liver?
blood sinusoids- central veins- hepatic veins- IVC
What is the physiological breakdown of blood and oxygen supply to the liver?
hepatic artery = 25% blood and 50% oxygen
portal vein = 75% blood and 50% oxygen
What is the biliary system?
right and left hepatic ducts
common hipatic duct
gall bladder
common bile duct
What is the sphincer of oddi?
layer of circular muscle surrounding the lower end of the bile duct, pancreatic duct, and ampulla
controls the flow of bile and pancreatic secretions
What are the 3 parts of the gall bladder?
1 fundus
2 body
3 neck
drained by cystic duct
What is the fundus of the gall bladder?
meeting point between right linea semilunaris and 9th right costal cartilage
ACUTE INFLAMMATION: site of maximum tenderness
What is the body of the gall bladder?
lies in the gall bladder fossa on the inferior surface of the liver
stores bile acids
What is the neck of the gall bladder?
posteromedial wall with Hartmann’s pouch
GALL STONES common site
What is the blood supply of the foregut?
celiac trunk
the first unpaired branches of the abdominal aorta at level of T12 (very very short)
divides into 3
What are the 3 branches of the celiac trunk?
- left gastric (upwards)
- splenic (left tortuous)
3 common hepatic (right)
Where does the left gastric artery run?
enters lesser omentum
branches to esophagus and stomach
ends by anastomosing with right gastric artery at lesser curve of stomach
Where does splenic artery run?
along superior border of pancreas
ends in lienorenal ligament
branch to spleen and pancreas
branch to stomach = short gastric and left gastroepiploic = both in gastrosplenic ligament
What does left gastroepiploic anastome with?
right gastroepiploic at greater curvature of stomach
What structures does common hepatic branch to?
stomach
duodenum
liver
What does the common hepatic branch?
common hepatic -> gastroduodenal, superior pancreaticoduodenal, right gastromental
hepatic proper -> right gastric
right and left hepatic -> cystic artery branch of right hepatic A to the gall bladder
where does supraduodenal atery come from?
branch of common hepatic that could come from gastroduodenal or hepatic artery proper
What is the spleen?
large lymphoid organ related to hematopoiesis
Where is the spleen?
between stomach and left kidney
connected by gastrosplenic (stomach) and lienorenal (kidney) ligaments
What are the two surfaces of the spleen?
- diaphragmatic- separates it from left lung and 9th 10th 11th ribs
- visceral - contain the hilum which transmits splenic vessels and gives attachment to gastrosplenic and lienorenal ligaments
what is the blood supply for the spleen?
celiac trunk -> splenic artery (tortuous for distension of stomach)
splenic vein -> inferior mesenteric vein IMV and unites with superior mesenteric vein SMV -> portal vein
What is the longest part of the GIT?
the small intestine
etends from pylorus of stomach to ileocecal junctionq
What makes up the small intestine?
duodenum
jejunum
ileum
What is the relationship between the duodenum and the pancreas?
duodenum is C shaped tube surrounding head of pancrease
pancreas is in the C
both are at junction between foregut and midgut (celiac trunk and SMA)
What is the duodenum?
first part of small intestine
extends from pylorus to duodenojejunal flexure
C shaped
shortest, widest, most fixed part of the small intestine
retroperitoneal except for beginning connected t iver by hepatoduodenal ligamment of lesser omentum
What are the 4 parts of the duodenum?
1st - superior = lies anterolateral to L1. 1st inch attached to greater and lesser omenta like stomach (intraperitoneal) but rest is retroperitoneal. called duodenal cap
2nd- descending= right of L2-L3. receives major duodenal papilla and minor duodenal papilla. bile and pacreatic ducts empty
3rd- inferior= horizntal anterior to L3. crossed by the SMA and SMV
4th- ascending= ascends to left of L3 and L2. ends at duodenojejunal flexure where its tethered by suspensory ligament of duodenum (ligament of Treitz)
Where are duodenum ulcers?
at the duodenal cap = 1st part of duodenum
What is the pancreas?
elongated gland with endocrine (insulin and glycogen) and exocrine function (digestive enzymes)
across the posterior abdominal wall from the duodenum to the spleen
retroperitoneal organ except tail which is in the lienorenal ligament
What are the four parts of the pancreas?
head- lies within C shaped concavity of the duodenum. SMA and SMV pass anterior to it
neck- anterior to beginning of the portal vein where splenic vein and SMV join to form portal vein
body- forms major portion of the stomach bed-splenic artery along upper border and splenic vein posterior
tail- ends in splenorenal (lienorenal) ligament at hilum of spleen
What are the 2 ducts of the pancreas?
main pancreatic duct (wirsung)
accessory pancreatic duct (santorini)
What does the main pancreatic duct drain?
the tail
body
neck
upper part of head
joins bile duct to form a short tube called hepatopancreatic ampulla
opens at 2nd part of duodenum
what does the accessory pancreatic duct drain?
uncinate process and lower part of the head
opens at minor papilla
Where does the jejunum and ileum run?
begins at duodenojejunal flexure
ends at ileocecal junction
completely covered by peritoneum
What is the shape of the jejunum and ileum?
fan shaped
2 borders
- attached border- crosses 3rd part of duodenum, aorta, IVC, right ureter, right psoas major
- free border = encloses loops of jejunum and ileum
supplied by SMA
What are the most important differences between the jejunum and ileum?
fat: jejunu, less // ileum more
color: jejunum deep red // ileum pink
vascular: jejunum more // ileum less
Lymphoid: jejunum few// ileum many
Where does the large intestine run?
extends from caecum to anal canal
surrounds small intestine
includes cecum with appendix, colon, rectum, anal canal
what is the blood supply of the large intestine?
SMA and IMA
What are the appendices epiploicae of the large intestine?
small pouches filled with fat
absent in Cecum, Appendix and Rectum (CAR)
What are the taeniae coli of the large intestine?
outer longitudinal muscle layer thickened to form 3 shorter bands
begin at base of appendix and end at sigmoid colon
What are the saccultations (Haustra) of the large intestine?
between the taeniae coli and the colon bulges outwards forming 3 rows of pouches
What is the cecum?
blind sac in the right iliac fossa superiorly continous with the ascending colon and medially receives the opening of the ileum and appendix
What is the ileocecal valve?
guards the ileal opening into the cecum
If obstruction of SMA the arcade will keep supplying blood
has 2 lips
opening of the appendix lies 2 cm below it
What is the appendix?
blind ending tube
rich in lymphoid tissue
suspended by mesoappendix
3 taeniae coli meet at the base of the appendix
retrocecal is common position
what is the landmark for the appendix?
taeniae coli
what is acute appendicitis?
acute inflammation of the appendix due to viral or bacterial infection
may result in thrombosis of the appendicular artery (from ileocolic artery) can lead to perforation of the appendix
right iliac fossa pain = differential diagnosis for appedix
Most have retrocecal appendix, second most common = pelvic
Rupture appendix = all contents of appendix will go over all of peritoneum
What is McBurney;s point?
point of maximum tenderness in acute appendicitis
lies opposite the junction of lateral and middle thirds of a line joining the rt ASIS to the umbilicus
line from belly button to right inferior medial 2/3 and lateral 1/3
pain enter sinal cord through T10 segment
What is Meckel’s diverticulum?
2 feet from IC valvve 2 inches long 2% population 2% symptomaitc 2 types of ectopic tissue (gastric and pancreatic) 2 years of age at clinical rsenation 2 x more common in boys
remanent from vitalion duct
gives same symptoms as acute appendicitis
What are the parasympathetics of the GIT?
+ peristalsis and - sphincters
foregut and midgut = vagus
hindgut = pelvic splanichnic nerves (paraympathetic sacral outflow S2,3,4)
- preganglionic, will relay in terminal ganglia of their organs
What are the sympathetics of the GIT?
- peristalsis and + sphincters
foregut and midgut- thoracic splanichnic nerves
- greater T5-T9 and lesser T10-T11 and least T12
hindgut- lumbar splanichnic nerves- abdominal part of sympathetic trunks
lumbar sympathics give off 3-4 lumbar splanichnic nerves
presynmaptic sympathetic
What is the arterial supply of the midgut?
superior mesenteric artery SMA
- runs downward to right iliac fossa
- jejunal and ileal branches 12-15 branch to the left
What are the branches of the SMA?
1 inferior pancreaticoduodenal- 1/2 duodenum and pancreas 2 middle colic - right 2/3 of transverse colon 3 right colic- ascending colon 4 ileocolic- cecum and appendix - anterior cecal artery - posterior secal artery - appendicular artery - ileal artery
Where do the jejunal and ileal branches run?
in the mesentery
branch and anastomose to form series of arcades that send arteries to the intestine (vasa recta)
What is the artery of the hindgut?
inferior mesentric artery IMA -unpaired branches of abdominal aorta at L3 down to LEFT iliac fossa behind 3rd part of duodenum crosses left common iliac artery becomes superior rectal artery
all three branches to the left
What are the 3 branches of the IMA?
1 left colic- left 1/3 transverse colon and upper descending colon
2 sigmoid arteries (2-3) - lower of descneding colon and sigmoid colon
3 superior rectal- sigmoid colon and rectum
What is the marginal artery?
arterial arcade along the colon
it interconnects the right , middle, left colic
What is the portal vein?
blood collected from intestinal capillary bed passes through portal vein then through liver sinusoids (2n capillary bed)
to IVC
Between 2 sets of capillaries
How does the portal vein begin and end?
as a VEIN (union of SMV and splenic vein)
ends as an ARTERY (divides into 2 branches right and left)
75% blood supply and 50% oxygen for liver
What does the portal vein drain?
blood from the GIT tract, pancreas, spleen, gallbaldder to the liver
hepatic veins -> IVC
where does the portal vein begin?
neck of pancreas by union of SMV and splenic vein
Where is portal vein?
always posterior
most posterior structure in VAD at porta hepatis
What are the major tributeries of portal vein?
superior mesenteric vein (SMV)
-veins similar to SMA branches and right gastroomental vein
splenic vein
- veins similar to splenic artery and IMV from hind gut
right and left gastric veins
cystic vein
- drain into right branch
paraumbilical veins
- drain to left branch
What are the most important sites of portal-caval systemic anastomoses?
1 left gastric vein and the esophgeal vein of the azygos venous system
2 superior rectal vein and middle and inferior rectal veins
3 paraumbilical veins and radicles of the superficial epigastric veins
What is liver cirrhosis?
progressive liver fibrosis
disrupts the portal blood flow leading to portal hypertension
- esophageal varices- hematemesis (puke blood)
- rectal varices - hemorrhoids (ass bleeding)
- caput medusae- varicose veins from umbilicus (medusa snake shit on your bellybutton)
What are the layers of the posterior abdominal wall?
from posterior to anterior
1 bony layer 2 msucles 3 fascia 4 viceral layer 5 partial periotoneal layer
What is in the bony layer of the posterior abdominal wall?
iliac bone (iliac fossa, crest) lumbar vertebrae last 2 ribs
What is in the muscle layer of the PAW?
psoas major
psoas minor
iliacus
quadratus lumborum
fascia with same names
What is in the visceral layer of the PAW?
kidneys ureters suprarenal glands abdominal aorta IVC (retroperiotoneal structures)
Where is the lumbar plexus?
formed inside the psoas major
branches related to PAW muscles
Iliacus
origin: superior 2/3 iliac fossa, ala of sacrum, anterior sacroiliac ligaments
insertion: lesser trochanter of femur and shaft inferior to it and to psoas ajor tendon
innervation: femoral nerve
action: flexes hip and stabilizes hip join, acts with psoas major
Psoas major
origin transverse proesses of lumbar vertebrae, sides of bodies of T12-T5 vertebrae, interveming intevetrebral discs
insertion lesser trochanter of femur
innervation ventral rami of first four lumbar nerves
action acting superiorly with iliacus, flexes hip, acting inferiorly flexes vertebral column laterally, used to balance trunk in sitting position, actuing inferiorly with iliacus flexes trunk
Psoas minor
origin vertebral margins of T12-L1 vertebrae, corresponding intervertebral disc
insertion pectinlea line, iliopectineal eminence
innervation ventral rami of first lumbar nerve
action flexes pelvis on vertebral column
Qudratus lumborum
origin medial half o inferior border of 12th rib , tips of lumbar transverse processes
insertion iliolumbar ligament, inernal lip of iliac crest
innervation ventral rami of T12 and first four lumbar nerves
action extends and laterally flexes vertevral column, fixes 12th rib during inspiration
What is the diaphragm?
chief muscle of respiration
fibromuscular partition between thorax and abdomen (umbrella)
right and left copula (right higher b/c liver)
central tendon = insertion of diaphragm
supplied by phrenic nerve C3 4 5
What is the origin of the diaphragm?
1 sternal part = xiphoid process 2 costal part = lower 6 costal cartilages 3 vertebral (lumbar) part - 2 crura and 5 ligaments
What are the lumbar parts of the diaphragm?
1 right crus
- larger, longer, stronger than left and arsies from bodies of upper 3 lumbar vertebrae
- some fibers run up to form the esophageal hiatus by encirculing esophagus
- others run down to form suspensory legament of duodenum
2 left crus
- arsies from bodies of upper 2 lumbar vertebrae
3 median arcuate ligament
- unites crura across aorta- forms aortic hiatus
4 medial arcuate ligament
- tendinous arch across upper part of psoas major
5 lateral arcuate ligament
-tendinous arch across the quadratus lumborum
What forms the esophageal hiatus?
right crus
What forms the suspensory ligament of duodenum?
right crus
What forms the aortic hiatus?
median arcuate ligamemt
What arch crosses the psoas major?
medial arcuate ligament
What arch crosses the quadratus lumborum?
lateral arcuate ligament
What are the openings of the diaphragm?
I 8 (ate) 10 Eggs At 12 (noon)
caval hiatus - IVC T8
esophageal hiatus- esophagus T10
Aortic hiatus- aorta (thoracic duct, azygos vein, greater splamicmic nerve) T 12
Where is the lumbar plexus?
nerve plexus L1, 2, 3, 4
formed inside the psoas major
What are the branches of the lumbar plexus?
1 subcostal nerve T12
2 iliohypogastric nerve L1
3 ilioinguinal nerve L1
All run in front of quadratus lumborum
pierce transverse abdominal muscle
run between it and internal oblique muscle
What structure do iliohypogastric nerve and ilioinguinal nerve pierce?
internal oblique to run between it and external oblique
What nerve accompanies the spermatic cord (or round ligament in uterus)?
ilioinguinal nerve
travels through inguinal canal and emerges through superficial inguinal ring
Where is genitofemoral nerve?
L1 and L2
emerges on front of psoas muscle and descends on its anterior surface
genital branch enters inguinal canal and deep inguinal ring to spermatic cord
femoral branch supplies skin of femoral triangle
Where is lateral femoral cutaneous nerve?
L2,3
runs in front of iliacus
comes from lateral side of psoas muscle
Where is femoral nerve?
L2,3,4
emerges from lateral border of psoas major and descends int the groove between the psoas and iliacus
enters femoral triangle
where is obturator nerve?
L2,3,4
descends along the medial border of the psoas muscle
runs forward on lateral wall of pelvis to thigh
Where is the kidney?
Retroperitoneal organ on PAW opposite T12 to L3 vertebrae
right kieny lower than left becuase of liver
right kidney related to rib 12
left kidney related to ribs 11 and 12
hilum on medial border
What goes through hilum of kidney?
anterior to posterior
VAP
renal Vein, renal Artery, Pelvis of ureter
What is the strucuture of the kidney?
1 cortex- outer part and renal columns
2 medulla- inner party with pyramids and renal papilla apex
3 minor calyces - receive urine and emopy to major calyces
What are the functional and anatomic units of the kidney?
nephrons
what is the flow of urine in the kidney?
1 urine received by minor calyces
2 empty to major calyces
3 empty to renal pelvis of ureter
What is the blood supply of the kidney?
renal arteries from abdominal aorta near L2
RIGHT renal is LONGER and passes posterior to IVC
gives inferior suprarenal artery before hilum then divides into 5 segemntal artries
Where do the left and right renal veins open?
directky into IVC
What is special about the left renal vein?
longer than right
passes anterior to aorta before orgin of SMA
receives 3 veins
1 left suprarenal vein
2 left gonadal vein
3 may give rise to inferior hemiazygos vein
What is the ureter?
retroperitoneal muscular tube that begins with renal pelvis
extends from kidney to urinary bladder
What are sites of constriction of ureter?
kidney stomes (renal calculi)
1 uretero-pelvic junction = joins renal pelvis
2 pelvic inlet = crosses pelvic brim over distal end of common iliac artery
3 ureterovesicular junction = enters wall of urinary bladder (narrowester point)
What is the suprarenal gland?
retroperitoneal organ on the superomedial pole of the kidney
pyramidal on the the right and semilunar on the left
What does the suprarenal gland produce?
3 steroids in cortex
medulla secrets epinephrine and norepinephrine
What is the blood supply of the suprarenal gland?
1 superior suprarenal artery from the inferior phrenic artery
2 middle suprarenal artery from abdominal aorta
3 inferior suprarenal artery from the renal artery
drained via suprarenal vein - IVC on the RIGHT and LEFT renal vein on the left
Where does the abdominal aorta bifurcate?
becomes left and right common iliac arteries anterior to L4
What are the single branches of the abdominal aorta?
Celiac
SMA
IMA
all to gut tube
median sacral artery- fromback of aorta to sacrum for rectum and anal canal
What are the paired branches of the abdominal aorta?
inferior phrenic (diaphragm) middle suprarenal and renal (kidney) gonadal lumbar arteries common iliac arteries (terminal branches)
Where is the IVC?
right side of L5 union of two common iliac veins below bifurfactoin of aorta longer than abdominal aorta to right of aorta
What does the IVC recieve?
right gonadal and right suprarenal veins
(left side drained by left renal vein)
right and left renal veins 3rd and 4th lumbar veins inferior phrenic veins hepatic veins azygos vein (back of IVC at L2)
Where does the left renal vein run?
posterior to the superior mesenteric artery and anterior to the abdominal aorta
What is the cisterna chyli?
dialated lymphatic sac at the end of the thoracic duct
just right and posterior to aorta
formed by intestinal and lumbar lymph trunks
gives throacic duct
Where does the thoracic duct drain?
between left subclavian and internal jugular vein
Where is it common to get reflux?
Very easy to get reflux if weak lower esophageal end
What does the portal vein not have?
Celiac trunk but NO celiac vein NO gastroduodenum
Diameter of portal = huge compared to any other vein in body- second after inferior vena cava
