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SHB Exam 2 > Abdomen II > Flashcards

Abdomen II Flashcards

1
Q

At what vertebral level does the superior mesenteric a. (SMA) arise from the aorta?
Which side of the body do the aa. branch?

A
  • L1

- Right (all branch to right except jejunal and ileal branches, 12-15)

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2
Q

What are the branches of the SMA?

A
  1. Inferior pancreaticoduodenal a.
  2. Middle colic a.
  3. Right colic a.
  4. Ileocolic a.
  5. Jejunal and ileal branches
    (6. Marginal a. of Drummond)
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3
Q

What does the inferior pancreaticoduodenal a. (of SMA) supply?

A

1/2 duodenum and pancreas

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4
Q

What does the middle colic a. (of SMA) supply?

A

Right 2/3 of transverse colon

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5
Q

What does the right colic a. (of SMA) supply?

A

Ascending colon

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6
Q

What does the ileocolic a. (of SMA) supply?

A

Cecum (ileal branch) and apx (*appendicular branch)

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7
Q

What do the jejunal and ileal branches of the SMA turn into?

A
  • Run to the mesentery
  • Branch and anastomose to form series of arcades
  • Arcades send straight aa. to the intestines
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8
Q

What is the name for the straight aa. that the arcades of the jejunal and ileal branches of the SMA supply?

A

Vasa recta

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9
Q

What part of the gut is the SMA? IMA?

A

SMA: midgut
IMA: hindgut

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10
Q

At what vertebral level does the inferior mesenteric a. (IMA) arise from the aorta?
Which side of the body do the aa. branch?

A
  • L3

- Left (arises from 3rd part of duodenum)

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11
Q

What are the branches of the IMA?

A
  1. Left colic a.
  2. Sigmoid aa. (2-3)
  3. Superior rectal a.
    (4. Marginal a. of Drummond)
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12
Q

What does the left colic a. (of IMA) supply?

A

Left 1/3 transverse colon and upper part of descending colon

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13
Q

What do the sigmoid aa. (of IMA) supply?

A

Lower portion of descending colon + sigmoid colon

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14
Q

What does the superior rectal a. (of IMA) supply?

A

Sigmoid colon + rectum

- it’s a direct continuation of the IMA

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15
Q

What are the marginal a. of Drummond?

A

Arteriole arcade along the colon, interconnecting the right, middle, and left colic aa.

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16
Q

What are the 2 arteriole anastomoses of the colon?

A
  1. Pacreaticoduodenal (b/w SMA and celiac trunk)

2. Marginal a. (b/w SMA and IMA)

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17
Q

What lies in the “C” of the duodenum?

A

Head of pancreas

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18
Q

Where do duodenum and pancreas sit?

A

At junction b/w foregut and midgut

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19
Q

What is the area b/w the duodenum and jejunum called?

A

Duodenojejunal flexure

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20
Q

What’s unique about the duodenum?

A

Shortest, widest, most fixed part of small intestine.

- Retroperitoneal (except for 1st part)

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21
Q

At what vertebral level does the 1st part of the duodenum sit?
What is this part’s nickname?
What condition can occur here?

A
  • L1 (anterolateral)
  • Duodenal cap
  • Duodenal ulcers
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22
Q

At what vertebral level does the 2nd part of the duodenum sit?
What is important about this part?

A
  • L2/L3 (right)
  • Receives major duodenal papilla (opening of bile duct and main pancreatic duct)
  • Receives minor duodenal papilla (opening of accessory pancreatic duct)
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23
Q

At what vertebral level does the 3rd part of the duodenum sit?
What vessels cross it?

A
  • L3 (horizontal)

- SMA and SMV (itself crosses IVC and aorta)

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24
Q

At what vertebral level does the 4th part of the duodenum sit?
Besides the jejunum, what attaches to it?

A
  • L3 to L2 (ascends left)

- Suspensory ligament of duodenum (ligament of Treitz)

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25
Q

What are the 4 parts of the pancreas?

A

Head, neck, body, tail

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26
Q

Which part of the pancreas contains the uncinate process?

A

Head

SMA and SMV pass anterior to head

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27
Q

What occurs at the neck of the pancreas?

A

Splenic v. and SMV join to form portal v.

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28
Q

What runs posterior to the body of the pancreas?

A

Splenic v. (splenic a. runs on sup. border)

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29
Q

What is attached to the tail of the pancreas?

A

Splenorenal (lienorenal) ligament

30
Q

Which part of the pancreas is in the peritoneum?

A

First part, the rest if retroperitoneal

31
Q

What are the names of the 2 ducts of the pancreas?

A
  • Main pancreatic duct (of Wirsung)

- Accessory pancreatic duct (of Santorini)

32
Q

What does the main pancreatic duct drain?

What does the accessory pancreatic duct drain?

A
  • All of pancreas except uncinate process and lower head.

- Uncinate process and lower head

33
Q

The main pancreatic duct joins the CBD to form the _________________.

A

Hepatopancreatic ampulla (of Vater)

34
Q

Where does the hepatopancreatic ampulla open into?

What about the minor?

A
  • Major duodenal papilla (at 2nd part of duodenum)

- Minor papilla, 2cm superior/proximal

35
Q

Where does the distal ileum end?

A

Ileocecal junction

36
Q

Describe the shape of the mesentary of the jejunum and ileum?

A

fan-shaped

37
Q

Name the borders of the jejunum and ileum. How long are they?

A
  • Attached border AKA root (6 inches)

- Free border (6 meters)

38
Q

What generally supplies the jejunum and ileum?

39
Q

How are the aa. different b/w the jejunum and ileum?

A
  • J is red, I is pinker
  • J is thicker/heavier, I is lighter
  • J has more vascularity
  • J has longer vasa recta
  • J has a few large loops, I has a many short loops
  • I has more fat in mesentery
  • I has many more lymph nodules
40
Q

What are the main parts included in the colon?

A

Ascending colon, right (hepatic) colic flexure, transverse colon, left (splenic) colic flexure, descending colon, sigmoid colon

41
Q

Which parts of the colon are in the peritoneum?

A
  • cecum
  • apx
  • tranverse colon
  • sigmoid colon
42
Q

What aa. generally supply the colon?

A

SMA and IMA

43
Q

What are appendices epiploicae (omental appendices?

Where are they found?

A
  • Small pouches filled with fat

- Ascending, transverse, descending, and sigmoid colons

44
Q

What is the taeniae coli?

Where are they found?

A
  • Outer m. layer, longitudinal, thickened to form 3 bands

- Spans from base of apx to sigmoid colon

45
Q

What are sacculations (haustra)?

A

Small pouches

46
Q

What/where is the cecum?

A

A blind sac in the right iliac fossa, superiorly continuous with the ascending colon and medially receives the opening of ileum and apx

47
Q

What valve guards entrance into cecum?

A

Ileocecal (IC) valve

48
Q

What is the apx?

A

Blind-ending tube, rich in lymph tissue, suspended by meso-apx.
- 3 tenia coli meet at the base (useful for surg)

49
Q

What are the 2 most common positions of the apx?

A
  • Retro-cecal (~65%)

- Pelvic (~32%)

50
Q

What nerve level supplies the apx?

A

T10, so could have referred pain to navel

51
Q

What is acute appendicitis?

A

Acute inflammation of the apx due to viral or bacterial infection.
- Infection of apx may result in thrombosis of appendicular a. (branch of ileocolic a.) which can lead to perforation

52
Q

What/where is McBurney’s pt?

A
  • Pt of max tenderness

- Find it by making like b/w navel and ASIS, go 2/3s down towards lateral side

53
Q

What is Meckel’s Diverticulum?

A 
Gives same picture as acute appendicitis.
Syndrome of 2's
- 2 ft from IC valve
- 2 inches long
- 2% of pop.
- 2% are symptomatic
- 2 types of ectopic tissue (gastric and pancreatic)
- 2 y/o at clinical presentation
- 2x more common in boys
54
Q

Where is the hepatic portal vein situated?

A
  • B/w 2 cap beds!

- Intestinal cap bed, then thru liver sinusoids (then reaches IVC)

55
Q

What vv. unite to form the portal v?

Where does this occur?

A
  • SMV and splenic v. (splenic v. receives IMV)

- Neck of pancreas

56
Q

What does the hepatic v. become as it reaches porta hepatis?

A

An artery!

57
Q

From post to ant, what is the vessel arrangement at the porta hepatis?

A

VAD
Post - portal Vein
Right - hepatic Artery
Left - hepatic Duct

58
Q

What are the tributaries of the hepatic portal v? (don’t need to know all this)

A
  1. SMV
  2. Splenic v. (which receives IMV)
  3. Right and left gastric veins
  4. Cystic v.
  5. Paraumbilical veins
    (There is no a celiac v. or gastroduodenal v)
59
Q

What structures allow the portal venous system to anastomose w/the systemic venous circulation?

A

Portosystemic anastomosis

60
Q

What are the 3 most important sites of the portal-caval anastomoses?

A

Remember: esophagus, belly button, rectum

  1. Left gastric v and the esophageal v of the azygos system [inferior end of esophagus]
  2. Paraumbilical vv and radicals of the superficial epigastric vv [peri-umbilical]
  3. Superior rectal v w/the middle and inferior rectal vv [inferior end of rectum]
61
Q

What is cirrhosis of the liver?

A
  • Progressive liver fibrosis

- Fibrosis disrupts portal blood flow, leading to portal HTN and varices (dilated, engorged veins)

62
Q

What is a sx of esophageal varices?

A

Hematemesis (due to bleeding at lower part of esophagus)

63
Q

What is a sx of rectal varices?

A

Hemorrhoids, rectal bleeding (due to bleeding at lower part of rectum)

64
Q

What is a sx of caput medusae?

A

Venous engorgement radiating from umbilicus

65
Q

What is the vertebral origin of the greater splanchic n?

66
Q

What is the vertebral origin of the lesser splanchic n?

67
Q

What is the vertebral origin of the least splanchic n?

68
Q

What supplies parasymp innervation to the foregut and midgut?
Hindgut?

A
  • Vagus n.

- Pelvic splnachnic nn. (S2-S4)

69
Q

What supplies symp innervation to the hindgut?

A

Lumbar splanchnic nn. (L1, L2)

70
Q

What is the sympathetic affect on peristalsis and the sphincter?

A
  • Inhibits peristalsis
  • Contracts sphincter
    (parsymp is opposite)

SHB Exam 2 (17 decks)

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