ABDOMEN II Flashcards
What does the term ‘intraperitoneal’ mean?
Within or administered through the peritoneum- a thin, transparent membrane that lines the wall of the abdominal cavity
What does the term ‘retroperitoneal’ mean?
The space behind the peritoneum, with no specific delineating structures
What’s the peritoneal cavity?
The space between the parietal and visceral peritoneum
What’s contained within the peritoneal cavity?
A thin film of peritoneal fluid, which consists of water, electrolytes, leukocytes and antibodies
What are the 2 compartments of the greater sac, and what divides it into them?
The greater sac is divided into the supra colic and infra colic compartments by the transverse colon
What is the lesser omentum?
A double fold of peritoneum that attaches the liver to the lesser curvature of the stomach (hypogastric ligament) and to the first part of the duodenum (hepatoduodenal ligament). It is derived from the embryonic ventral mesogastrium
What’s the free edge of the lesser omentum between?
The porta hepatis and the duodenum
What does the free edge of the lesser omentum contain?
The hepatoduodenal ligament carries the portal triad- proper hepatic artery, the portal vein and the common bile duct. There are also lymph glands, lymph vessels and nerves, forming the hepatic hilum
What would result in clamping the lesser omentum during surgery?
A large atraumatic haemostat is used to clamp the hepatoduodenal ligament (Pringle’s manoeuvre), interrupting blood flow through the hepatic artery and the portal vein and thus helping to control bleeding from the liver
What is found posterior to the lesser omentum and through the epiploic foramen?
The lesser sac (omental bursa)
What are the borders of the epiploic foramen?
Roof- caudate process of the liver
Floor- First part of the duodenum
Posterior border- Inferior vena cava
Anterior border- Hepatoduodenal ligament in the free edge of the lesser omentum
Where does the greater omentum attach?
To the greater curvature of the stomach and the transverse colon
Why’s the greater omentum known as the abdominal policeman?
For its role in fighting intraabdominal infection
What’s the transverse mesocolon?
The mesentery associated with the transverse colon, which attaches it to the posterior abdominal wall
What does the transverse mesocolon divide the peritoneal cavity into?
Supracolic and infracolic compartments
What’s the mesentery?
A fan-shaped organ, filled with fat, which attaches the jejunum and ilium to the posterior abdominal wall. It contains the superior mesenteric artery and vein and their branches
Where is the root of the mesentery?
On the posterior abdominal wall
What’s the sigmoid mesocolon?
The mesentery associated with the sigmoid colon, the root of which forms an inverted ‘V’
What is the falciform ligament?
A double fold of peritoneum that attaches the liver to the anterior abdominal wall. It’s continuous with the visceral peritoneum surrounding the liver, and subsequently the lesser omentum.
What’s the falciform ligament derived from?
Its derived from the embryonic ventral mesogastrium
What does the free edge of the falciform ligament contain?
The ligamentum teres- a remnant of the umbilical vein
What are peritoneal recesses?
Regions where the peritoneum is reflected away from the posterior abdominal wall to form a pouch or recess
What’s the clinical importance of the left and right paracolic gutters?
The paracolic gutters provide pathways for the flow of ascitic fluid and the spread of intraperitoneal infections. Similarly, the paracolic gutters provide pathways for the spread of tumour cells that have sloughed from the ulcerated surface of a tumour and entered the peritoneal cavity
What’s the subphrenic space?
A space between the upper surface of the right lobe of the liver and below the diaphragm
What’s the hepatorenal pouch (of Morrison)?
A space between the liver and the right kidney
What is the rectovesical pouch?
A space between therectum and bladder of males
What is the uterovesical pouch?
The space between the uterus and bladder in females
What’s the rectouterine pouch (of Douglas)?
A space between the uterus and bladder in females
Where does the foregut extend from?
From the oral cavity to the major duodenal papilla of the duodenum
What does the foregut include?
The distal end of the oesophagus, the stomach and a portion of the duodenum. It also includes the lower respiratory tract, liver, gallbladder, pancreas and spleen
At what opening does the oesophagus pierce the diaphragm?
The oesophageal hiatus
At what point does the oesophagus enter the stomach?
The cardiac orifice
What is a hiatal hernia?
A protrusion of part of the stomach into the mediastinum through the oesophageal hiatus of the diaphragm
What are the 2 main types of hiatal hernia?
Sliding hiatal hernia and paraoesophageal (ROLLING) hiatal hernia
What’s a sliding hiatal hernia?
Where the abdominal part of the oesophagus, the cardia, and parts of the fundus slide superiorly through the oesophageal hiatus into the thorax, especially when the person lies down or bends over. Regurgitation of stomach contents into the oesophagus is possible
What is a paraoesophageal hiatal hernia?
The cardia remains in its normal position, but a pouch of peritoneum, often containing part of the fundus, extends through the oesophageal hiatus anterior to the oesophagus. In these cases, no regurgitation usually occurs because the cardiac orifice is in its normal position
In what region of the abdomen is the stomach found?
The left hypogastric and epigastric regions
What is the fundus normally filled with?
Air
What is the cardia?
The region where food enters the stomach from the oesophagus, which is guarded by the lower oesophageal sphincter
What’s the name of the longitudinal ridges on the internal surfaces of the body of the stomach?
Rugae
What’s the purpose of the rugae in the body of the stomach?
To allow the stomach to stretch to accommodate for large amounts of food, and to help grip and move food during digestion
What are the 3 parts of the pylorum?
The pyloric antrum, the pyloric canal and the pyloric sphincter
What does the pylorus control?
The emptying of chyme into the duodenum
What does the lesser curvature of the stomach give attachment to?
The lesser omentum
What does the greater curvature give attachment to?
The greater omentum
What is the cardiac notch?
The angle between the oesophagus and the fundus of the stomach
What is the incisor angularis?
A small notch on the lesser curvature of the stomach, near the pyloric end, which marks where the body ends and pylorus begins
Is the duodenum intraperitoneal or retroperitoneal?
The first part is intraperitoneal, while the rest is retroperitoneal
What is the duodenal cap?
The very first part (2cm) of the duodenum which is slightly dilated
What is the first part of the duodenum?
D1 is the superior part of the duodenum, which begins as a continuation of the duodenal end of the pylorus and ends at the superior duodenal flexure
What is the second part of the duodenum?
This starts at the superior duodenal flexure, passes inferiorly to the lower border of L3, then turns medially into the inferior duodenal flexure
What’s another name for the major duodenal papilla?
The ampulla of Vater
What enters the descending duodenum through the major duodenal papilla?
The pancreatic duct and the common bile duct
What’s the minor duodenal papilla the entrance for?
The accessory pancreatic duct
Where does the junction between the embryological foregut and midgut lie?
Just inferior to the major duodenal papilla
What is the 3rd part of the duodenum?
D3 starts at the inferior duodenal flexure, passes transversely left to cross the vertebral column
What vessels run superior to the third part of the duodenum?
The superior mesenteric artery and vein
What is the 4th part of the duodenum?
D4, the ascending part, passes superiorly, either anterior to, or to the left of, the aorta, until it reaches the inferior border of the pancreas. Then it curves anteriorly and terminates at the duodenojejunal flexure to become the duodenum
What surrounds the duodenojejunal flexure?
The ligament of Treitz- a peritoneal fold containing muscle fibres
What’s the arterial supply to the duodenal cap?
The right gastric and right epiploic arteries
What’s the arterial supply to D1, bar the duodenal cap, and the proximal half of D2?
The superior pancreaticoduodenal artery (a branch of the gastroduodenal artery)
What’s the arterial supply to between mid-D2 and the ligament of Treitz?
The inferior pancreaticduodenal artery (a branch of the SMA)
Where do most (95%) inflammatory erosions of the duodenal wall (duodenal ulcers) occur?
In the posterior wall of the superior part of the duodenum
From what trunk does vascular supply to the stomach arise?
The coeliac trunk
Why does vascular supply to the stomach arise from the coeliac trunk?
The stomach is developed from the embryological foregut
What thoracic vertebral level is the coeliac trunk?
T12
What are the 3 arteries from the coeliac trunk?
The common hepatic artery, the left gastric artery and the splenic artery
Where does the proper hepatic artery bifurcate and what into?
The proper hepatic artery bifurcates into the left and right hepatic arteries at or before the porta hepatis
What triangle does the right hepatic artery pass into?
The right hepatic artery passes superiorly and turns right, crossing behind the common hepatic duct to enter Calot’s triangle
What segments of the liver does the left hepatic artery supply?
Segments I, II and III
What does the left hepatic artery usually give off?
A middle hepatic artery branch that runs towards the right side of the umbilical fissure
What branch does the right hepatic artery give off in Calot’s triangle?
The cystic artery
What is the cystic artery the main blood supply to?
The gall bladder
What is the right gastric artery?
A non-hepatic branch of (usually) the proper hepatic artery, that supplies the pylorus and lesser curvature of the stomach. Can be a branch of the common hepatic artery or even the SMA in some cases
Where does the common hepatic artery become the proper hepatic artery?
After it gives off the gastroduodenal artery
What does the gastroduodenal artery supply?
The pylorus, proximal duodenum, and the head of the pancreas
What is the gastroduodenal artery one of the major sources of, and why?
It’s one of the most important sources of upper gastrointestinal bleeding due to its proximity to the anterior wall of the proximal duodenum
What does the gastroduodenal artery give off behind the first part of the duodenum?
The supra duodenal artery
What does the gastroduodenal artery bifurcate into?
The right gastroepiploic artery and the superior pancreaticduodenal artery
Where does the left gastroepiploic artery arise from?
The splenic artery
What are the branches of the splenic artery?
The left gastroepiploic artery, the short gastric arteries and the pancreatic branches, which include the dorsal pancreatic artery, the transverse pancreatic artery and the greater pancreatic artery
What do the pancreatic branches of the splenic artery supply?
The neck, body and tail of the pancreas
What do the short gastric arteries supply?
The cardiac and fundal regions of the stomach
Where do the short gastric arteries arise?
Before the splenic artery reaches the splenic hilum
What ligament do the short gastric arteries run in?
The gastrosplenic ligament
What forms the splenic vein?
The splenic tributaries emerging at the splenic hilum in the splenorenal ligament at the tip of the tail of the pancreas
Where does the splenic vein run?
In the splenorenal ligament close to the splenic artery
Where does the splenic form the portal vein?
Behind the neck of the pancreas where it confluences with the superior mesenteric artery
What’s the lymphatic drainage of the stomach?
Gastric nodes along the lesser curvature and gastroepiploic nodes along the greater curvature
What’s the lymphatic drainage from the superior portion of the duodenum?
Gastroduodenal nodes
What supplies the stomachs sympathetic innervation?
The greater splanchnic nerves (T5-T9)
What supplies the stomachs parasympathetic innervation?
The left and right vagus nerves (anterior and posterior vagal trunks)
What are the medial, inferior and superior borders of Calot’s triangle?
The medial border is the common hepatic duct.
The inferior border is the cystic duct.
The superior border is the inferior anterior border of the liver
Why is Calot’s triangle important to laparoscopic cholecystectomy?
In the procedure, the surgeon carefully dissects the triangle and identifies its contents and borders. This allows the surgeon to take any anatomical variation into account and permits safe ligation and division of the cystic duct and cystic artery
