Abdomen: Viscera Flashcards
Innervation of peritoneum
Parietal: spinal somatic fibres: localised pain
Visceral: visceral afferents: referred pain
Greater sac and lesser sac (omental bursa)
Greater sac contains most of the abdomen
Lesser sac: posterior to stomach and liver

Omental epiploic foramen
Joins lesser sac to greater sac

Structures anterior to omental (epiploic) foramen
Portal vein
Hepatic artery proper
Bile duct

Structures posterior to epiploic foramen
inferior vena cava
Structures inferior to epiploic foraman
1st part of duodenum
Structures superior to epiploic foraman
caudate lobe of liver
Greater omentum
Greater curvature of stomach
Drapes down anterior to transverse colon, ileum and jejunum
Loops back up and joins transverse colon peritoneum

Lesser omentum
Lesser curvature of stomach to inferior liver

Mesenteries
Mesentery
Transverse mesocolon
Sigmoid mesocolon

Mesentery
The only double layered fold of peritoneum
connects jejunum and ileum to posterior wall

Structures entering through the diaphragm
Vena cava + right phrenic T8
Oesophagus + vagus T10
Aorta + thoracic duct T12
Blood supply to abdominal oesophagus
Left gastric artery
Inferior phrenic artery
Different parts of stomach
Note: cardial notch: superior angle where oesophagus enters stomach
Angular incisure: bend on lesser curvature

Arterial supply of stomach
Left gastric
Short gastric
Gastro-epiploic arcade

Parts of duodenum
Superior
Descending
Inferior
Ascending

Duodenum intra or extraperitoneal
First part: extra peritoneal
Rest: intra peritoneal
Blood supply to duodenum
Superior and inferior pancreatoduodenal arteries
Difference between the appearance of ileum and jejunum
Jejunum:
- longer vasa recta, smaller arcade
- Larger calibre.
- Darker
- less mesenteric fat
- Deeper valvulae conniventes
Ilieum:
- smaller vasa recta, more developed arcade.

Source of bleeding from a deudonal ulcer
Posterior wall
Pancreatodeudonal artery
Different positions of appendix
Retrocaecal 74%
Pelvic 21%
Postileal
Subcaecal
Paracaecal
Preileal

Identification of appendix during surgery
Caecal taenia coli converge at base of appendix and form a longitudinal muscle cover over the appendix.
Blood supply to appendix
Appendicular artery (branch of ileo-colic artery)

Colon, intra or retroperitoneal
Appendix and caecum: intra
Ascending: retro
Transverse: intra
Descending: retro
Sigmoid: intra
Rectum: (distally) retro
Arterial supply of colon
Ascending: ilio-colic and right colic (joined by marginal artery)
Transverse: middle colic
Descending: Inferior mesenteric artery (left colic)

Arterial supply of rectum
Superior rectal artery (IMA)
Middle rectal artery (internal iliac)
Inferior rectal artery (internal pudendal, from internal iliac)

Recesses around liver
Hepatorenal recess
Subphrenic recess
What space does the hepatorenal recess communicate with
Right paracolic gutter and lesser sac
Is liver intra or retroperitoneal
Intra (mostly)
Porta hepatis content
Hepatic artery
Portal vein
Common hepatic bile duct
Blood supply to liver
Right lobe: right hepatic artery
Left lobe: left hepatic artery
Quadrate lobe: Left hepatic artery (anatomically part of right)
Caudate: both hepatic arteries
Ligaments of inferior aspect of liver
Falciform ligament
Left triangular ligament
Right triangular ligament
Anterior and posterior coronary ligaments
Falciform ligament
Connects umbilicus to liver
Contains ligamentum teres (remnant of umbilical vein)
Splits into coronary and left triangular ligaments
Ligamentum venosum
Remnant of ductus venosus
Parts of gallbladder
Fundus
Body
Neck
Blood supply to gall bladder
Cystic artery (branch of right hepatc artery)
Pancreas parts
Pancreas ducts
Accessory -superior
Hepatopancreatic- inferior
Pancreatic blood supply
Head: Inferior/superior pancreatoduodenal artery
Rest: splenic artery
Biliary tree anatomy
Where does the common bile duct enter the duodenum
Posteromedial wall of the second part of the duodenum
Position of spleen (ribcage)
Ribs 9 -12
Branches of abdominal aorta

Coeliac axis branches
Left gastric
Hepatic
Splenic: branches- Pancreatic, Short Gastric, Left Gastroepiploic

Superior and inferior mesenteric artery branches

Branches of common hepatic artery
Right Gastric
Gastroduodenal
Superior Pancreaticoduodenal
Cystic (occasionally).

Branches of splenic artery
Pancreatic
Short Gastric
Left Gastroepiploic

GI venous system
IMV, Short gastric and left gastro-epiploic → splenic v
R gastroepiploic → SMV
SMV + splenic → portal v
R gastric → portal v
Renal anatomy
Outer cortex
Inner medulla: including pyramids
Papilla: apex of pyramids
Lymph drainage of kidneys
Structures in renal hilum
Anteriro to posterior
- renal vein
- renal artery
- ureter
Fascia surrounding kidneys
Gerota’s fascia
Anatomical course of ureters
Starts in renal pelvis
Descends anterior to psoas major/lateral to transverse process
Crossed by gonadal vessels anteriorly, genitofemoral n posteriorly (testicular pain with ureteric stones)
Crossed by vas (male) and uterine artery anteriorly just before entering posterolateral aspect of the bladder
Sites of constriction of ureters
Ureteropelvic junction
Crossing common iliac at pelvic brim
Entering the wall of the bladder
Blood supply to ureters
Upper 1/3: Renal artery
Middle 1/3: testicular/ovarian/common iliac
Lower 1/3: Superior vesical (internal iliac)
Lymph drainage of ureter
Upper- lateral aortic
Middle- common iliac
Lower- External and internal iliac
Adenal gland arterial supply
Superior suprarenal artery (inferior phrenic)
Middle suprarenal artery
Inferior suprarenal artery
Venous drainage of adrenal gland
Suprarenal vein
Lumbar plexus nerves
Exit in relation to psoas major:
Lateral:
- Ilioinguinal (L1)
- Iliohypogastric (L1)
- Femoral (L2,3,4)
- Lateral cutaneous nerve of thigh (L2,3)
Medial:
- obturator (L2,3,4)
- Lumbosacral trunk (L4,5)
Anterior:
- Genitofemoral (L1,2)
Ilio-hypogastric innervates
Internal oblique and transvesus abdominis
Ilio-inguinal innervates
Internal oblique
Transversus abdominis
Genitofemoral innervates
Genital branch: cremester reflex
Obturator innervates
Obturator externus
Pectineus
medial compartment
Femoral innervates
iliacus
pectineus
anterior compartment
Retroperitoneal viscera
SAD PUCKER
Suprarenal (adrenal glands)
Aorta & IVC
Duodenum (2-4th parts)
Pancreas
Ureters
Colon (descending and ascending)
Kidneys
Esophagus
Rectum
Calot’s triangle borders
Inferior edge of liver
Common bile duct
Cystic duct

Calot’s triangle content
Cystic artery
Right hepatic artery
Right branch of portal vein

Lymph drainage of rectum
Above dentate line: mesorectal node
Below dentate line: Inguinal node
Structures within gastro splenic ligament
short gastric arteries
Which structure is anterior to portal vein
Pancreatic neck

What anatomical structure controls the flow of the bile into the duodenum
Sphincter of oddi (controlled through hormonal and neural innervation)