Abdomen part 2 Flashcards
What artery does the superior epigastric artery come off?
Internal thoracic artery
Which nerves do the thoracoabdominal nerves come off?
7-11 intercostal nerves
What is the course of the iliohypogastric nerve?
Arises from L1, posterior abdominal wall, then upper border of psoas muscle, then runs obliquely to anterior abdominal wall
What is the function of the iliohypogastric (L1) nerve?
Sensory and motor supply to the abdominal muscles
Where is the arcuate line?
Midway between the pubic symphysis and the umbilicus
The umbilicus is located at which vertebral level?
L3/4
Where does the rectus sheath end?
At the arcuate line
What is the median umbilical ligament a remnant of?
allantois
What is the medial umbilical ligament a remnant of?
Umbilical artery
What is the ligamentum teres a remnant of?
Left umbilical vein
What does the right umbilical vein become?
Nothing - it disintegrates
Which ligament does the ligamentum teres sit in?
Falciform Ligament
What are the attachments of the greater omentum?
Greater curve of the stomach, transverse colon
What are the attachments of the lesser omentum?
Lesser curve of the stomach, liver
Where is the small bowel attached to the abdominal wall?
Obliquely across the posterior wall from duodenajejunal flexure on the left to the right sacroiliac joint
What are the four main branches of the superior mesenteric artery?
Jejunal and ileal arteries, ileocolic artery, right colic, middle colic artery
What does the ileocolic artery supply?
Distal portion of the ilium to 1/3 of the way up the ascending colon
What does the right colic artery supply?
The middle of the ascending colon
What does the middle colic artery supply?
The transverse and some of the ascending colon
What is the difference in blood supply between the jejunum and ileum?
J: longer vasa recta, fewer arcades
I: short vasa recta, many arcades on top of each other
What is the hepatic portal vein formed from?
The joining of the superior mesenteric vein and the splenic vein
At what level does the SMA come off the aorta?
L1
At what level does the IMA come off the aorta?
L3
What are the branches of the Inferior mesenteric artery?
left colic, sigmoidal, superior rectal, marginal artery
What does the left colic artery supply?
some of transverse and descending colon
What is the marginal artery of the IMA?
The artery from the left colic that runs alongside and supplies the splenic flexure of the colon and anastamoses with the middle colic
What does the inferior mesenteric vein drain into?
Splenic vein
What are the four parts of the duodenum?
Superior (L1), descending (L2), inferior (L3), ascending (L2)
Where do the common bile duct and pancreatic duct enter the duodenum?
In the 2nd (descending) portion, at the major duodenal papilla
What is the minor duodenal papilla?
The opening of the accessory pancreatic duct into the duodenum
Which part of the duodenum is intraperitoneal?
The first part (superior)
Is the duodenum retroperitoneal?
Yes, except the first part
Is the small bowel retro or intra peritoneal?
jejunum and ileum are intra (have mesentery), first part of the duodenum is intra, the other 3 parts are retro
What are peyer’s patches?
lymphatic nodules
Where are peyer’s patches found?
In the terminal ileum
How do the plicae circulares change throughout the small bowel?
J: complete circles, more of them
I: Less, not as deep, incomplete circles
What are taenia coli?
Three separate longitudinal muscles that lie on the outside of the colon?
Where do the taenia coli converge?
At the appendix
What artery does the appendicular artery come off?
Ileocaecal artery
What features distinguish the large intestine?
taenia coli, haustral folds, epiploic appendages
What are the five parts of the stomach?
Cardia, fundus, body, antrum, pylorus
What are the three branches of the coeliac trunk?
Left gastric, splenic, common hepatic
What arteries come off the left gastric?
Oesophageal branches
What arteries come off the splenic artery?
short gastric, splenic branches, left gastroepiploic, posterior gastric, pancreatic branches
What arteries come off the common hepatic?
Right gastric, gastroduodenal (duodenal, superior pancreatoduodenal), hepatic artery proper
What arteries come off the hepatic artery proper?
L and R hepatic (cystic artery comes of R hepatic)
What are the three muscle layers of the stomach?
Longitudinal, circular, oblique
What are the folds of the stomach called?
Rugae
What are the two internal parts of the spleen?
Red pulp and white pulp
What are the five parts of the pancreas?
uncinate process, head, neck, body, tail
Where does the blood supply to the pancreas come from?
splenic artery, gastroduodenal artery
What is the sphincter of Oddi?
A sphincter that surrounds the bile duct and pancreatic duct but keep both separate
What is the Ampulla of Vater?
The major duodenal papilla, opening of common bile duct and pancreatic duct into the duodenum
Which gonadal vein drains straight into the IVC?
Right gonadal vein
What does the coronal ligament of the liver do?
attaches the liver to the diaphragm, right kidney and adrenal gland
What does the falciform ligament do?
Anchors the liver to the anterior abdominal wall and diaphragm
What are the four lobes of the liver?
Right, left, caudate and quadrate
What is the ligamentum venosum?
The remnant of the ductus venosum
What did the ductus venosum do?
Shunt blood from the left portal vein to the left hepatic vein, bypassing hepatic circulation
What is the porta hepatis?
The part of the liver where all the vessels enter
What is in the portal triad?
Portal vein, hepatic artery, bile duct (lymphatics, branch of vagus)
What is the blood supply to the liver?
25% hepatic arteries
75% portal vein
What is the cystic duct?
The duct from the gallbladder to the common bile duct
What joins to form the common hepatic duct?
The left and right hepatic duct
What joins to form the common bile duct?
The common hepatic duct and the cystic duct
How would you describe the internal appearance of the gallbladder?
Honeycomb
What are the valves in the cystic duct called?
Spiral valves
Where do the three main hepatic veins drain into?
(right, middle, left) into IVC
What are the main filtration cells of the liver called?
Kupffer cells
What are the small veins and bile ducts called in the portal triad?
Sinusoids
Bile canaliculi
What is the casing around the kidney called?
The renal capsule
Where do the kidneys sit in relation to vertebrae?
T12-L3 Right kidney is lower due to liver
At what vertebral level do the renal arteries leave the aorta?
L1-L2. Right kidney is lower
Where do the gonadal arteries come off?
Left comes of the left renal artery, right comes off the aorta. sometimes both off aorta or other way round.
What are the parts of the kidney?
Renal medulla and cortex. Medulla is made of minor and major calyces. renal pelvis, renal columns
What are renal columns?
The pieces of tissue in between the renal pyramids
What is a renal lobe?
The renal pyramid and its corresponding arteries
What are the arteries that supply the renal pyramid?
interlobular arteries and arcuate arteries that loop over the pyramids
What level is the sub-costal plane?
L3, 10th costal margin
What structures are at the transpyloric plane?
gallbladder, pancreas, pylorus, duodenal-jejunal flexure, spleen hilum, kidney hilum, L1
What level is the transpyloric plane?
L1
What vertebral level is the xiphoid process?
T7
What is the innervation to the external oblique muscles?
T7-T12 intercostal nerves
What is the innervation to internal oblique and transversus abdominis?
T7-T12 intercostal nerves, some innervation from iliohypogastric and ilioinguinal
Where does the inferior epigastric artery arise from?
The external iliac artery
Where is the pyramidalis muscle?
At the inferior pole of the abdominal linea alba. From pubic tubercle to linea alba
Which organs are secondary retroperitoneal (had a mesentery but lost it during development)?
Duodenum, pancreas, ascending and descending colon
What are the divisions of the renal artery?
Segmental artery - lobular - interlobular - arcuate
What is the parasympathetic innervation to the hindgut?
S3-S4 pelvic splanchnic
What is the sympathetic innervation to the hindgut?
L1-L2 lumbar splanchnic nerve
What is the arterial supply to the adrenal glands?
Superior adrenal arteries- from inferior phrenic artery,
Middle adrenal arteries - from aorta,
Inferior adrenal arteries -from renal arteries
What are the boundaries of the epiploic foramen?
Anteriorly: (in the free edge of the lesser omentum): Bile duct to the right, portal vein behind and hepatic artery to the left.
Posteriorly: Inferior vena cava
Inferiorly: 1st part of the duodenum
Superiorly: Caudate process of the liver
What are the borders of hesselbach’s triangle?
Inferior: inguinal ligament
Lateral: Inferior epigastric vessels
Medial: Lateral border of rectus sheath
What is the path of the thoracic duct?
The thoracic duct lies posterior to the oesophagus and passes to the left at the level of the Angle of Louis. It enters the thorax at T12 together with the aorta.
At what level do the common iliac veins form the IVC?
L5
At what level does the portal vein begin?
L1
The quadrate lobe is functionally part of which lobe of the liver?
The left
What are the first arteries to come off the abdominal aorta?
Inferior phrenic arteries
What artery is the inferior rectal artery a branch of?
The internal pudendal artery
