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Anatomy yr 1 > ABDOMEN III > Flashcards

ABDOMEN III Flashcards

1
Q

What’s the blood flow per minute to the liver?

A

1.5L per minute

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2
Q

What does percussion of the liver give?

A

Percussion gives an area of dullness compared with the resonant lung above and the abdominal contents below, as the liver is solid

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3
Q

Where does the liver develop?

A

In the ventral mesogastrium

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4
Q

Name the 4 lobes of the liver?

A

The left lobe, right lobe, caudate lobe and quadrate lobe

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5
Q

What ‘fences’ the bare area on the diaphragmatic surface of the liver?

A

Peritoneal reflections which pass from the surface of the liver to the diaphragm

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6
Q

What are the boundaries of the bare area of the diaphragmatic surface of the liver?

A

The anterior and posterior coronary ligaments

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7
Q

What do the coronary ligaments unite to form on the left and right of the superior surface?

A

The left and right triangular ligaments

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8
Q

What’s the clinical significance of the bare area of the liver?

A

It represents a site where infection can spread from the abdominal cavity to the thoracic cavity

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9
Q

What does the falciform ligament separate?

A

The left and right lobes of the liver

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10
Q

What does the falciform ligament attach the liver to?

A

The anterior abdominal wall

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11
Q

What is the thickening in the free edge of the falciform ligament?

A

The round ligament (ligamentum teres)

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12
Q

What lobe is the ligamentum teres adjacent to on the visceral surface of the liver?

A

The quadrate lobe

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13
Q

What is the ligamentum teres the remnant of?

A

The embryonic umbilical vein

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14
Q

Where is the ligamentum venosum?

A

Adjacent to the caudate lobe on the visceral surface of the liver

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15
Q

What is the ligamentum venosum a remnant of?

A

The ductus venosus of the foetal circulation

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16
Q

What does the ductus venosus do in foetuses?

A

It shunts a portion of umbilical vein blood flow directly into the inferior vena cava to allow oxygenated blood from the placenta to bypass the liver

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17
Q

What is the porta hepatis?

A

A transverse fissure that allows the passage of the portal triad into/out of the liver. It actually contains 5 structures, not 3.

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18
Q

What is the portal triad?

A

The proper hepatic artery, the hepatic portal vein and bile ducts

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19
Q

What does the portal triad run through?

A

The free edge of the lesser omentum

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20
Q

What are the 5 structures of the porta hepatis?

A 
The proper hepatic artery
The hepatic portal vein
The Common bile duct
Lymphatic vessels
A branch of the vagus nerve
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21
Q

What is Pringle’s manoeuvre?

A

A surgical manoeuvre used in certain abdominal operations, where a large atraumatic haemostat is used to clamp the hepatoduodenal ligament , interrupting the flow of blood through the hepatic artery and portal vein, helping to control bleeding from the liver

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22
Q

How many hepatic veins are there usually and where do they drain?

A

There are usually 3 hepatic veins that drain directly into the inferior vena cava from the central veins of the liver

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23
Q

What makes up the dual blood supply of the liver

A

The hepatic portal vein and hepatic arteries

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24
Q

What proportion of the livers blood supply comes via the hepatic portal vein?

A

Around 75%

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25
Q

What does the hepatic portal vein carry?

A

It carries venous blood drained from the spleen, GI tract and its associated organs

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26
Q

Why does the hepatic portal vein carry venous blood from the spleen, GI tract, pancreas and gallbladder to the liver?

A

The blood contains toxins and nutrients extracted from digestive contents so it’s taken to the liver for filtration

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27
Q

What veins unite to form the hepatic portal vein?

A

It’s formed by the merging of the superior mesenteric vein and splenic veins behind the upper edge of the head of the pancreas. It also receives blood from the inferior mesenteric, left and right gastric, and cystic veins

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28
Q

What causes portal hypertension?

A

When scarring and fibrosis from cirrhosis obstruct the portal vein in the liver, causing pressure in the portal vein and its tributaries to rise

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29
Q

What does portal hypertension cause at the sites of the porto-systemic anastomoses?

A

Portal Hypertension causes enlarged varicose veins and blood flows from the portal system to the systemic system of veins

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30
Q

What are oesophageal varices?

A

Extremely dilated submucosal veins in the lower 1/3 of the oesophagus, often due to obstructed blood flow through the portal vein

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31
Q

What is splenomegaly?

A

A condition of enlargement of the spleen which can commonly be caused by portal hypertension

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32
Q

What are anorectal varices?

A

Extremely dilated submucosal vessels due to back flow in the veins of the rectum. This typically occurs due to portal hypertension, which shunts venous blood from the portal system through the Portosystemic anastomosis present at this site into the systemic venous system

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33
Q

What is caput medusa?

A

The appearance of distended and engorged superficial epigastric veins, which are seen radiating from the umbilicus across the abdomen. It’s a sign of portal hypertension

34
Q

What are gastric varices?

A

Dilated submucosal veins in the stomach, which can be a life-threatening cause of bleeding in the upper GI tract. They are most commonly found in patients with portal hypertension

35
Q

Name 5 clinical presentations that can result from portal hypertension?

A

Oesophageal, anorectal and gastric varices, splenomegaly and caput medusa

36
Q

How much bile can the gall bladder store?

A

Up to 50ml

37
Q

Where is the gall bladder?

A

Behind the tip of the right 9th costal cartilage, where the lateral margin of the rectus abdominis crosses the costal margin

38
Q

Name the 4 features of the gall bladder

A

The fundus
The body
The neck
The infundibulum (Hartmann’s pouch)

39
Q

What artery supplies the gallbladder and where does it arise?

A

The gallbladders blood supply comes from the cystic artery- a branch of the right hepatic artery

40
Q

Name 7 features of the biliary tree?

A 
The right and left hepatic ducts
The common hepatic duct
The cystic duct
The common bile duct
The hepatico-duodenal ampulla (of Vater)
The major duodenal papilla
41
Q

What is cholelithiasis?

A

The formation of gallstones

42
Q

What is cholecystectomy?

A

One of the most common surgical procedure worldwide. It’s open or laparoscopic removal of the gallbladder as treatment for gall stones

43
Q

Where do gall stones commonly collect?

A

In the infundibulum

44
Q

What happens when a gallstone blocks the bile duct?

A

A cramp-like pain in the right upper quadrant of the abdomen, known as biliary colic, can result

45
Q

What may happen if a peptic duodenal ulcer ruptures?

A

A false passage may form between the infundibulum and the superior part of the duodenum, allowing gallstones to enter the duodenum

46
Q

What is a peptic ulcer?

A

An open sore that develops on the inside lining of the stomach or the duodenum

47
Q

What causes a peptic ulcer?

A

Infection with the bacterium Helicobacter pylori and long-term use of aspirin and NSAIDs

48
Q

What are the 2 types of gall stones?

A

Cholesterol gall stones and pigment gall stones
Cholesterol gall stones are a yellow-green colour and account for around 80%. Pigment gall stones are small and dark brown. They’re made of bilirubin

49
Q

What increases risk of gallstones?

A 
Female
Fair 
Fat
Forty
Fertile
50
Q

What are the main functions of the pancreas?

A

Blood glucose regulation- Islets of Langerhans
Digestion- secretion of pancreatic juices- acinar cells
Secretes pancreatic polypeptide and VIP. Enterochromaffin cells secrete motilin, serotonin and substance P

51
Q

Is the pancreas retroperitoneal or intraperitoneal?

A

The majority of the pancreas is retroperitoneal, but the tail is intraperitoneal

52
Q

What is the tail of the pancreas closely associated with?

A

The hilum of the spleen

53
Q

What is the head of the pancreas closely associated with?

A

The duodenum

54
Q

What space separates the pancreas from the stomach?

A

The triangular space in which the gastrohepatic ligament is found

55
Q

What forms the gastrohepatic ligament?

A

The left lateral extension of the peritoneal layers of the greater omentum

56
Q

What does the gastrosplenic ligament connect?

A

It connects the greater curvature of the stomach with the splenic hilum

57
Q

What is the uncinate process?

A

The formed prolongation of the angle of junction of the lower and left lateral borders in the head of the pancreas

58
Q

What is annular pancreas?

A

A congenital defect whereby the uncinate pancreas splits and encircles the pancreas

59
Q

Where do the superior mesenteric artery and vein run in relation to the uncinate process?

A

Anterior to the uncinate process

60
Q

What vessels run posterior to the neck of the pancreas?

A

The superior mesenteric artery, superior mesenteric vein and the portal vein

61
Q

What attaches to the anterior surface of the body of the pancreas?

A

The transverse mesocolon

62
Q

What compartment of the peritoneal cavity does the pancreas lie in?

A

Both the supra-colic and infra-colic compartments due to its attachment to the transverse mesocolon

63
Q

What ligament does the tail of the pancreas run in?

A

The spleno-renal ligament

64
Q

What is a pancreatic pseudocyst?

A

A collection of enzyme rich fluid and blood encapsulated in the area of the pancreas, often caused by pancreatitis or abdominal trauma

65
Q

What accounts for most cases of extra-hepatic obstruction of the biliary system?

A

Cancer involving the head of the pancreas

66
Q

What does extra-hepatic obstruction of the biliary system cause?

A

Obstructive jaundice, resulting in the retention of pigments, enlargement of the gall bladder and jaundice

67
Q

What may cancer of the neck and body of the pancreas cause?

A

Obstruction of the portal vein or inferior vena cava

68
Q

What is a Whipple’s procedure?

A

An operation to remove the head of the pancreas, the duodenum, the gall bladder and the bile duct to treat tumours and other disorders of the pancreas, duodenum and bile duct. It’s most often used to treat pancreatic cancer confined to the head of the pancreas. The remaining organs are then reconnected

69
Q

What is Kocher’s manoeuvre?

A

A surgical manoeuvre to expose structures in the retroperitoneum behind the duodenum and pancreas to control haemorrhage from the IVC or aorta, or to facilitate removal of a pancreatic tumour

70
Q

Is the spleen intraperitoneal or retroperitoneal?

A

Intraperitoneal

71
Q

What is the spleen derived from and where does it develop?

A

The embryological foregut

Within the dorsal mesogastrium

72
Q

What connects the spleen to the stomach?

A

The gastrosplenic ligament

73
Q

What connects the spleen to the kidney?

A

The splenorenal ligament

74
Q

What ribs is the spleen behind?

A

The left 9th, 10th and 11th ribs

75
Q

What do 1,3,5,7,9,11 mean in the context of the spleen?

A

Its dimensions are 1” x 3” x 5”, it weighs 7 oz and it lays behind ribs 9-11

76
Q

Where does the splenic artery arise?

A

The coeliac trunk

77
Q

What does the splenic artery run superior to to enter the spleen at the hilum?

A

The body of the pancreas

78
Q

What categorises a splenic artery aneurysm?

A

A dilation of the splenic artery that exceeds a diameter of 1cm. SAA rupture is associated with relatively high mortality

79
Q

What drains blood from the spleen?

A

The splenic vein, which also receives blood from the inferior mesenteric vein

80
Q

Where does the splenic vein form the hepatic portal vein?

A

Where it unites with the superior mesenteric vein posterior to the neck of the pancreas

81
Q

Where would you begin palpitation for splenomegaly?

A

The patient should be supine and with knees flexed. The examiner should begin well below the left costal margin and feel considerately firmly for the splenic edge by pushing down, then cephalad, then releasing.

82
Q

How much bigger would the spleen have to be to extend below the costal margin?

A

It would have to have doubled in size

Anatomy yr 1 (20 decks)

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