Abdomen Week 2.1 Flashcards
Gall Bladder
- Piriform shaped sac lying in its fossa in the visceral surface of the liver.
- 7-10cm long.
- 3cm at its widest point.
- 30-50ml capacity.
Parts of the Gall Bladder
Fundus:
-Projects beyond inferior border of liver and related to the anterior abdominal wall. Posterior relation: transverse colon.
Body:
- Main holding region continuous with neck;
- Upper surface related to liver.
- Under surface with transverse colon and duodenum.
Neck:
- S-shaped curve.
- Continuous with cystic duct.
- Sometimes, a small pouch can project from the right wall of the neck called “Hartmann’s Pouch”.
Cystic Duct
- 3-4cm long
- Runs posteriorly, downwards to left side of the neck.
- Joins common hepatic duct to form common bile duct.
- Mucous membrane from neck to common bile duct contain 5-6 oblique projections into lumen called Spiral Folds/Valves of Reister.
Arterial Supply of Gall Bladder and Duct
Cystic artery:
- From right hepatic artery.
- Also supplies hepatic ducts and upper part of common bile duct.
- Accessory cystic artery may arise from common hepatic artery.
Venous Drainage of Gall Bladder and Duct
Cystic vein:
-Drains: Into liver directly, hepatic vein, or veins draining upper part of bile duct.
Nerves and Lymphatics of Gall Bladder
Nerves:
Coeliac Plexus (Both Sympathetic and Parasympathetic)
Lymphatics:
-Hepatic and Cystic nodes.
Applied anatomy of Gall Bladder
- Obstruction of duct system from Gall Stone formation (Cholelithiasis) leads to pain and jaundice. Could also be caused by pressure from malignant tumours (pylorus and pancreas).
- Duplicated Gall Bladder with separated or common cystic duct.
- Failure of catalysation of bile duct/ congenital atresia or stenosis.
- Separate opening of common bile duct and pancreatic duct into duodenum.
Pancreas
- Soft, lobulated, greyish-pink gland.
- 12-15cm long.
- 60-100g in weight.
- Secondarily retroperitoneal.
Location of Pancreas
- Epigastric (Head, neck, body, uncinate process) and left hypochondriac region (Tail).
- Directed nearly horizontally across posterior abdominal wall, behind stomach from duodenal concavity to hilum of spleen.
Vertebral Level:
-Bodies of L1-L2.
Functional parts of Pancreas
Exocrine acinar:
-Secretes pancreatic juices.
Endocrine (Islands of Langerhans):
-Secrete hormones, insulin, glucagon and somatostatin associated with sugar metabolism.
Parts of Pancreas
Right Extremity (Head)
-Projection from inferior part: Uncinate Process
Neck:
-Slight constriction
Body:
- Directed slightly upwards and to the left.
- Triangular in cross section.
Left extremity:
-Tail
Relations of the Pancreas (Head)
- Lodged within curve of duodenum which forms the superior, left border, and inferior relations.
- Uncinate Process projects from inferior part.
Anterior:
- Transverse colon
- Mesocolon with jejunum
- Superior mesenteric artery passes across uncinate process.
Posterior: - Inferior vena cava -Common bile duct, -Renal veins -Right crus of diaphragm -Aorta.
Relations of the Pancreas (Neck)
- Springs from right upper portion from front of head.
- About 2.5cm long.
- Posteriorly, Superior Mesenteric Vein joins Splenic Vein to form the Portal Vein
Relations of the Pancreas (Body)
Anterior Surface:
-Peritoneum; Separated from stomach by omental bursa.
Posterior Surface:
- Non-Peritoneal.
- Aorta
- Origin of Superior Mesenteric Artery
- Left Crus of Diaphragm.
- Left Suprarenal Gland.
- Left Kidney and its renal vessels.
- Splenic vein.
Inferior Surface:
- Peritoneal
- Duodenojejuneal Flexure
- Left (Splenic) Flexure
Superior border :
- Coeliac Artery
- Splenic Artery
- Hepatic Artery
Anterior border:
-Transverse colon
Inferior border:
-Superior Mesenteric vessel.
Relations of the Pancreas (Tail)
-Narrow and in contact with gastric surface of spleen within phrenicocolic or splenocolic ligament together wit splenic vessels.
