Abdomen Week 2 (C) Flashcards
What is the pancreas?
- The pancreas is an elongated, accessory digestive gland that lies retroperitoneally, overlying and transversely crossing the bodies of the L1 and L2 vertebra (the level of the transpyloric A plane) on the posterior abdominal wall
- It lies posterior to the stomach between the duodenum on the right and the spleen on the left
- The transverse mesocolon attaches to its anterior margin
What type of organ is the pancreas?
Where is the pancreas located?
What are the functions of the liver? (2)
- an exocrine secretion (pancreatic juice from the acinar cells) that enters the duodenum through the main and accessory pancreatic ducts.
- endocrine secretions (glucagon and insulin from the pancreatic islets [of Langerhans]) that enter the blood
Pancreas
Consists of: (4)
▪ Head
▪ Neck
▪ Body
▪ Tail
What is the HEAD of the pancreas? (5)
What is the NECK of the pancreas? (3)
What is the BODY of the pancreas? (3)
What is the TAIL of the pancreas? (3)
Pancreas views:
What is the main pancreatic duct? (2)
What does the main pancreatic duct open into?
▪Main pancreatic duct may open into duodenum separately
What does the main pancreatic duct open into?
▪Main pancreatic duct may open into duodenum separately
Pancreatic ducts
Sphincters of ducts control flow of ____ and _____ juice.
bile
pancreatic
What are the accessory pancreatic ducts? (2)
What is the clinical relevance of the smooth muscle sphincters in the pancreas? (3)
What is the blood supply of the pancreas?
▪Mainly branches of splenic artery – body and tail
▪Pancreaticoduodenal arteries supply head: (2)
What is the venous drainage of the pancreas?
What is the lymphatic drainage of the pancreas?
What is the innervation of the pancreas? (3)
What is the clinical relevance of pancreatic cancer?
Where is the pancreas located?
- Soft, lobulated greyish-pink gland
- 12-15cm long and 60-100g in weight
- Location: (4)
Pancreas
* Produces:
o Exocrine secretion =
- Pancreatic juice from acinar cells
- Enters the duodenum through the main and accessory pancreatic ducts
Pancreas
* Produces:
o Endocrine secretion =
- Glucagon, insulin, somatostatin
- From the islets of Langerhans
Parts of the pancreas and their relations:
Head:
Neck:
Body:
Tail:
Parts of the pancreas and their relations:
Head:
Neck:
Body:
Tail:
Pancreatic ducts:
- Main duct (of Wirsung): (5)
Pancreatic ducts:
Sphincters: (3)
- Sphincter of the pancreatic duct around the terminal part of the pancreatic duct
- Choledochal sphincter around the termination of the bile duct
- Hepatopancreatic sphincter of Oddi around the hepatopancreatic ampulla
Pancreatic ducts:
- Accessory (minor) duct of Santorini = (4)
PANCREAS
Venous drainage =
Lymph drainage =
innervation =
PANCREAS
Venous drainage =
Lymph drainage =
innervation =
What is the arterial supply of the pancreas?
What is the arterial supply of the pancreas?
What is the applied anatomy of the pancreas?
What is the shape & colour of the spleen?
▪Ovoid, purplish ~wrap
What is the most delicate abdominal organ?
Where is the spleen located? (2)
TRUE or FALSE
The spleen is a mobile organ although it normally does not descend inferior to costal region.
TRUE
What are the surfaces of the spleen? (2)
What are the borders of the spleen? (3)
Spleen - relations:
Anteriorly:
Stomach
Spleen - relations:
Posteriorly:
Spleen - relations:
inferiorly:
Left colic flexure
Spleen - relations:
Medially:
Left kidney
▪ Connected to ______ curvature of stomach by gastrosplenic lig.
▪ Connected to left kidney by ______ lig.
greater
splenorenal
▪ Connected to ______ curvature of stomach by gastrosplenic lig.
▪ Connected to left kidney by ______ lig.
greater
splenorenal
What are the functions of the spleen? (5)
What is the spleen capable of?
What does the spleen normally contain?
Spleen - blood supply:
Coeliac trunk —>
Divides into -
Spleen - blood supply:
▪Avascular planes between __-___ splenic segments (↓ arterial anastomosis) allows for subtotal _______.
2-3
splenectomy
What is the venous drainage of the spleen? (4)
What is the lymphatic drainage of the spleen?
Spleen - innervation:
From coeliac nerve plexus
- Sympathetic
- Parasympathetic
Spleen innervation:
▪Distributed along branches of ______ artery
▪ _______ function
splenic
vasomotor
What is the clinical relevance of a splenic rupture?
What are the main features of the spleen? (3)
What is the function of the spleen? (2)
What is the location of the spleen?
What is the shape of the spleen?
Slightly curved wedge
What is the size and weight of the spleen?
What is the surface anatomy of the spleen? (3)
What are the relations of the spleen?
Anterior:
Posterior:
Inferior:
Medial:
Relations of the spleen
Hilum: (2)
o Tail of pancreas
o Splenic vessels, nerves and nodes
What are the surfaces and borders of the spleen? (3)
What are the ligaments of the spleen? (3)
Spleen:
Arterial supply =
Venous drainage =
Lymphatic drainage =
Innervation =
Spleen:
Arterial supply =
Venous drainage =
Lymphatic drainage =
Innervation =
What is the combined length of the jejunum and ileum?
6-7m
What are the features of the jejunum? (5)
What are the features of the ileum? (5)
What are the differences between the jejunum and ileum? (9)
What is the mesentery? (2)
▪ Fan-shaped fold of peritoneum
▪ Attaches jejunum & ileum to posterior abdominal wall
What does the mesentery contain? (4)
▪ Mesenteric root runs obliquely from _________ (left of L2) to ileocolic junction (right sacroiliac joint)
duodenojejunal
What is the arterial supply of the jejunum and ileum? (4)
What is the venous drainage of the jejunum and ileum? (3)
What is the lymphatic drainage of the jejunum and ileum? (5)
Jejunum and ileum
▪ Superior mesenteric nerve plexus →
periarterial plexus
Jejunum and ileum
▪ Sympathetic: (3)
Jejunum and ileum
▪ Parasympathetic: (2)
Jejunum and Ileum:
▪ Sensory (visceral afferent)
▪ Insensitive to most ____ stimuli stretch
▪ Sensitive to ____
pain
distention
Jejunum and Ileum:
▪ Sensory (visceral afferent)
▪ Insensitive to most ____ stimuli stretch
▪ Sensitive to ____
pain
distention
Small intestine
- Extent:
- Parts:
- Extent: pylorus to ileocecal valve
- Parts: duodenum, jejunum and ileum
- Jejunum and ileum
Small Intestine
o are __-___m long
o Diminish in diameter ______ termination
o Are completely _______
6-7
towards
intraperitoneal
- Jejunum: proximal ____ after duodenum from duodenojejunal flexure
- Ileum: distal ____ to ileocecal junction
2/5
3/5
- Jejunum: proximal ____ after duodenum from duodenojejunal flexure
- Ileum: distal ____ to ileocecal junction
2/5
3/5
What are the locations of the jejunum and ileum?
What are the locations of the jejunum and ileum?
Distinguishing characteristics of jejunum and ileum in the living body: (9)
Mesentery of the small intestine:
* Extent: (2)
Mesentery of the small intestine:
Contents: (4)
Small intestine
Blood supply:
Venous drainage:
Lymph drainage:
Innervation:
What are the functions of the large intestine? (3)
What does the large intestine consist of? (5)
What does the large intestine consist of? (5)
▪Large intestine can be distinguished from small intestine by: (2)
▪Large intestine can be distinguished from small intestine by: (2)
What are the teniae coli? (3)
What are the 3 bands of the large intestine? (3)
Large intestine
▪ Merge at _______ junction into a continuous longitudinal layer around rectum
rectosigmoid
What are the haustra?
▪ Haustra – sacculations of wall of colon between teniae (teniae shorter)
What is the caecum? (2)
▪Blind intestinal pouch continuous with ascending colon (1st part)
▪ ≈7.5 cm in length & breadth
Where is the caecum located? (3)
Caecum:
▪No _______ (may be displaced from iliac fossa), but commonly bound to lateral abdominal wall by caecal folds of peritoneum
mesentery
What is the ileo-caecal valve? (4)
What is the Vermiform? (2)
▪Blind intestinal diverticulum (6-10cm long)
▪Contains masses of lymphoid tissue
Where does the appendix arise from?
▪Arises from posteromedial aspect of caecum inferior to ileocaecal junction
Appendix
▪ Mesoappendix attaches to caecum & ______ appendix
▪ Position is variable, but usually _______
proximal
retrocaecal
What is the clinical relevance of appendicitis?
What are the parts of the colon? (4)
▪ Ascending
▪ Transverse
▪ Descending
▪ Sigmoid
What are the parts of the colon? (4)
▪ Ascending
▪ Transverse
▪ Descending
▪ Sigmoid
▪ ______ around small intestine
Arch
What are the features of the ascending colon? (7)
What are the features of the transverse colon? (5)
What are the features of the descending colon? (6)
What are the features of the sigmoid colon? (7)
What is the rectum and anal canal? (5)
What is the clinical relevance of the ileostomy and colostomy?
Colon - arterial supply
▪ SMA → ileocolic a. (caecum) → ……
▪ SMA→ileocolic & right colic a. →…….
▪ SMA → middle colic a. (mainly), Right & left colic a. (minor via marginal a.) →……
Colon - arterial supply
▪ IMA →
▪ IMA → left colic a. (descending colon) & sigmoid a. (sigmoid colon)
Colon - arterial supply
▪ _______ along colic margin
forming continuous arterial
channel – marginal a.
(juxtacolic a.
Anastomose
Colon - venous drainage
▪ Caecum & appendix→
Ileocolic v.→SMV→portal v.
Colon - venous drainage
▪ Ascending colon→
Ileocolic & right colic veins→SMV→ portal v.
Colon - venous drainage
▪ Transverse colon→
▪Transverse colon→Middle colic v.→SMV→portal v.
Colon - venous drainage
▪Descending & sigmoid colon →
▪Descending & sigmoid colon →Left colic v. & sigmoid v.→ IMV→splenic v.→portal v.
Colon - lymphatic drainage
▪Caecum & appendix →
Colon - lymphatic drainage
▪ Ascending colon→
Colon - lymphatic drainage
▪ Transverse colon→
Colon - lymphatic drainage
▪ Descending & sigmoid colon→
Colon - innervation
▪ Caecum, appendix, ascending & transverse colon:
▪ Sympathetic & parasympathetic in superior
mesenteric plexus via ______ ________.
periarterial plexuses
Colon - innervation
▪ Caecum, appendix, ascending & transverse colon:
▪ Sympathetic –
▪ Sympathetic – Abdominopelvic splanchnic nerves (T8-T12)
Colon - innervation
▪ Caecum, appendix, ascending & transverse colon:
▪ Parasympathetic –
▪ Parasympathetic – vagus (posterior trunk)
Colon - innervation
▪ Descending & sigmoid colon:
▪ Sympathetic & parasympathetic fibers aborad to _____ ______ follow separate routes
splenic flexure
Colon - innervation
▪ Descending & sigmoid colon:
Sympathetic:
Colon - innervation
▪ Descending & sigmoid colon:
Large Intestine
* Parts: (3)
Large intestine:
- Omental appendices: (2)
Large intestine:
- Omental appendices: (2)
Large intestine:
- Taenia coli:
o Longitudinal muscle fibres arranged in 3 bands from base of appendix: (3)
Large intestine
- Haustra/sacculations:
o Caused by taenia coli being shorter than the other coats
Surface anatomy:
* Ascending colon:
o upward through right lumbar region, lateral to right MCL.
Surface anatomy:
* Right colic flexure:
o in upper right angle of intersection of subcostal line & right MCL.
Surface anatomy:
* Transverse Colon: (3)
Surface anatomy:
* Transverse Colon: (3)
Surface anatomy:
* Descending colon:
o courses down through left lumbar region lateral to left MCL as far as iliac crest
Surface anatomy:
* Left colic flexure:
o in upper left angle of intersection between left MCL & transpyloric lines.
Surface anatomy:
* Sigmoid Colon:
o line is from end of descending colon to left MCL at level of ASIS
What is the caecum? (3)
- Dilated pouch
- Continuous superiorly as ascending colon
- Extends caudally below ileocecal valve
Caecum
Location: (4)
What is the * Ileocecal valve? (2)
What is the * Ileocecal valve? (2)
What is the Vermiform appendix? (6)
What are the variable positions of the vermiform appendices? (4)
o Retrocecal-most common
o Subcecal
o Pre-ilealorretro-ileal
Vermiform appendix:
- The 3 _____ _____ converge on the base of the appendix
o Easy guide to it in surgery
taeniae coli
Vermiform appendix:
* Surface marking:
Applied anatomy: appendicitis (3)
Referred pain:
- region around _______ (T10 spinal nerve)
umbilicus
Ascending colon:
Extent -
Location -
- Narrower than caecum
- Extent: Ileocecal orifice to right colic (hepatic) flexure
- Location: right lumbar and right hypochondriac regions.
- Peritoneum covers anterior and lateral surfaces
Transverse colon: (5)
Extent:
Transverse colon: (5)
Extent:
Descending colon: (2)
Extent:
- Extent: from left colic flexure to end in the sigmoid colon at pelvic inlet
- Covered by peritoneum on the anterior and lateral surfaces
Sigmoid colon: (3)
Sigmoid colon: (3)
Blood supply to large intestine:
Superior mesenteric:
Inferior mesenteric:
BRANCH:
DISTRIBUTION:
Large intestine:
Venous drainage =
- Superior and inferior mesenteric vv.
Innervation large intestine:
- Midgut derivatives:
o Coeliac and superior mesenteric plexuses
Innervation large intestine:
- Hindgut derivatives: (2)
o Lumbar part of sympathetic trunk
o Superior hypogastric plexuses
Lymphatics:
Caecum and appendix:
ileocolic LN
Lymphatics:
Ascending colon:
epiploic and paracolic LN
Lymphatics:
Transverse colon:
middle colic LN
Lymphatics:
Descending and sigmoid colon:
intermediate colic LN
Lymphatics:
Descending and sigmoid colon:
intermediate colic LN
What is the applied anatomy of the colon?
- Colonoscopy -
- Volvulus -
