abdominal contents Flashcards
What are the factors which contribute to preventing reflux in the LES?
the sphincteric muscles of the lower esophageal sphincter
the fibres of the right crus
a mucosal flap produced by the muscularis mucosae
the differences between the intrathoracic and abdominal pressures.
what vertebral level is the trans pyloric plane?
L1
in a highly selective vagotomy which nerves are cut?
the branches to the fundus and the body leaving the antrum.
which direction are the innermost fibers of the stomach running?
oblique,
then curcular then longditudinal like the rest of the GIT
which artery of the bowel could be damaged during partial gastrectomy ?
the middle colic as can be damaged as you free the greater omentum from the transverse meso colon.
an accessory hepatic artery can arrise from which common atomach artery?
the left gastric , and can sometimes be the sole supply for the left hepatic.
what are the 4 segments of the duodenum called?
D1: superior
D2: descending
D3: horizontal
D4: ascending
how long is the duodenum?
25cm
what forms the lower most boundary to the lesser sac?
the D1
the second part of the duodenum passes which part of which kidney?
the hilum of the right kidney
how many cm from the pylorus is the duodenal papilla
10cm
which part of the duodenum is has its inferior border sitting on the IMA ?
D3
the SMA courses over it here too
what is directly posterior to the fourth part of the duodenum?
the sympathetic chain
how can you tell the difference between the dupdenum adn the jujunum?
the jujunum has a mesentry
which nervous pathway ususally transmits pain impulses from organs such as the stomach and other viscera?
the sympathetic pathways afferent
small intestinal pain is usually felt in which region of the abdomen and why?
the umbilical area
due to the sympathetic supply from the T9 and T10 lateral horn cells.
what is the location of the appendix in relation to the caecum?
on the posterior medial wall above its lower end. At te cinvergence of the three taeniae coli
the caecum lies upon which structures?
the iliacus, the psoas muscle and the femoral nerve , the lower end lies on the pelvic brim .
how big is the appendix usually?
6 - 9 cm
how far below the ileocaecal valve is the opening to the appendix
2cm
what is the surface marking of mcBurneys point? and what does it correspond with?
1/3 of the way between the ASIS and the umbilicus , the base of the appendix
what direction do the muscle fibres face in the appendix?
all longditudinal
the meso appendix is a continuation of what?
the prolongation of he left (inferior) layer of the mesentry of the terminal ileum.
is the appendicular artery an end artery?
yes
what is lining the posterior parts of the ascending and descending colons?
nothing they both have bare areas which are devoid of peritoneum.
where is the hepatic flexure in relation to the righ kidney?
lateral surface of the inferior pole of the right kindney
in what locations are the tinea coli found in the ascending and descending colon?
anteriorly , posterior laterally and posterior medially
in what location on the trasverse colon are the tineae coli found?
posterior, anterior superior and anterior inferior
what is the area of distinction when sigmoid colon becomes rectum?
when there is no mesentry that is rectum
where is hindgut pain felt?
in the hypogastric region. due to forming lower than T10
what are the anatomical and vacular borders of the right hemicolectomy?
the terminal ileum and the proximal transverse colon.
ligation of the right and ileocolic vessels
what are the anatomical borders and vascular ligation of a transverse colectomy?
the right and left colic flexures and the transverse mesocolon and greater omentum and
vessels: middle colic.
what are the anatomical border adn vessels ligated in a left hemicolectomy?
the left side fo the transverse colon to part of the sigmoid colon
ligation of the left colic and sigmoid vessels.
+/- IMA if needed.
in a posterior duedenal ulcer rupture, which artery is involved and causes haemorrhage?
the gastroduodenal artery
where is the gastroduodenal vein located?
THERE IS NO GASTRODUODENAL VEIN
what organs in the body are 25 cm long?
the duedenum the esophagus ureter descending colon Superficial Femoral Artery
what are the 4 narrowings of the esophagus and how many cm from the incisor are they?
crichopharyngeus: sphince=ter: 15cm
Aorta: 22cm
left main brinchus: 27 cm
diaphragm: 38cm
what is the lymphatic drainage of the esophagus
upper 1/3
middle 1/3
lower 1/3
the deep posterior cervical lymph nodes
posterior mediastinum nodes
left gastric nodes
what vertebral level does the throacic duct cross over to the left?
T5
the thoracic duct drains all of thebody except?
the right side of the face, right arm and right thorax.
Injury to the thoracic duct above and below T5 will give what sided chylothorax?
Above T5: left sided chylothorax
below T5: right sided chylothorax
which part of the esophagus has a serosa?
THERE IS NO SEROSA IN THE ESOPHAGUS
what 6 structures are anterior to the esophagus in the chest?
2 arteries : aortic arch and the right pulmonary artery
2 airways: the trachea and the left main bronchus
2 muscles: left artium and the diaphragm
what is on the left lateral side of the esophagus?
one artery: aorta descending
one vein; left subclavian
one nerve: the left recurrent laryngeal
one lymph: the thoracic duct at T5
what is on the right lateral side of the esophagus?
the azygous vein
What are the posterior relations of the esophagus?
the vertebral colulm with intercostal arteries the aorta the thoracic duct crosses behind at T5 diaphragm left mediastinal pleura azygous vein
how many cm from the incisors does the esophagus start?
18cm
ends at 43 cm
is the transverse colon in front or below the stomach?
in front
at the trans pyloric plane , which costal cartilage is interescted?
the tips of the 9th costal cartilages
which ribs cover the spleen
9 through 11
what are the thee notches on the spleen?
the gastric, colic and renal
what are the three ligaments fusing to the spleen?
the gastrosplenic, leinorenal, and leinocolic.
how many ml of blood does the liver recieve a min ?
1.5L
what is the embryonic derivative of the liver?
ventral mesogastrium
the surface markings of the right side of the liver go over which ribs?
7-11
where is the bare area located in relation to the inferior vena cava on the liver?
lateral to the IVC
which lobe of the liver is inthe lesser sac?
caudate
the borders of the bare area of the liver are made out of which 2 ligaments?
the coronary ligament (above) and the tirangular ligement (Below)
in the portal triad which is most anterior and which is most posterior?
anterior: duct
middle: artery
posterior: vein (portal)
what are the 4 lobes of the liver called?
left, right, quadrate and caudate (above)
what devided the left and right hepatic lobes?
the line of the porat hepatis and the gallbadder
which lobe of the liver lies between the gall bladder and the fissure for the ligamentum teres ?
the quadrate lobe
When looking at the hepatic artery and portal vein first divisions in the liver what shape do each of them take?
The hepatic artery division looks like a “T”
the portal vein looks like a “Y”
are the right and left hepatic arteries end arteries?
yes, for the right and left lobes infarction can occur due to them being end arteries
however there is a capillary bed on the bare area where the phrenic artery can cupply some collateral.
which part of the liver does the arterial blood and the portal blood mix ?
in the sinusoids
the central veins and then
hepatic veins then IVC
where does lymph from the liver and gallbladder drain into?
nodes in the porta hepatis. -> retro pyloric -> coeliac nodes
describe the path of bile production
hepatic sinusoids in hapatocytes goes into canaliculi , bile ductules, hepatic ducts.
the fundus of the gall bladder touches the peritoneum in which location?
at the tip of the light 9th costal catilage at the lateral border of the right rectus sheath
where does the cytic artery enter the gall bladder?
the neck then branches out over the viscus
what are the borders of calots triangle?
liver above
cystic duct to the left and
common hepatic duct to the right
the cystic artery will be in the middle there
what are some annonolous places which the cystic artery can come out of?
main trunk of hepatic artery
from the left hepatic
gastroduodenal
and may pass in front of the cystic or bile ducts.
where in the gall bladder are the musus secreting glands found?
in the neck of the gallbladder
behind the duodenum the bile duct passess in what relation to the gastroduodenal artery and portal vein ?
the bile duct passes laterally (to the right of these two structures)
which vagal trunk innervates the gall bladder?
hapatic branch of anterior or left vagal trunk
gall bladder pain can be felt over which spinal cord segmetn distribution?
T7 to T9
but some fibres can relay on C3-5 via phrenic nerve and give pain in the right shoulder region.
when peeling the duodenum forward to expose its uderside what strutures lie underneath which need to be careful not to damage?
the IVU, ureter and gonadal vessels.
how long is the pancreas?
15cm
the neck and body of the pancreas are in line with which lumbar vertebrae ?
L1 - the trans pyloric plane
the left and right renal veins join the IVC at which vertebral level and in what relation to the pancreas?
L2
posterior to the pancreatic head.
which part of the pancreas crosses the aorta ?
the body
which part of the pancreas touches the hilum of the spleen and through which ligment?
the tail of the pancreas
through the leinorenal ligment
the splenic artery and vein also go through here
which duct drains the uncinate process and the head of the pancreas?
the accessory pancreatic duct, which somes out of its own accessory pancreatic duct which opens into the minor duodenal papilla whichis 2cm proximal to the major papilla.
the lymph drainage of the three areas of the pancreas?
the body and tail follow the splenic artery adn are retropancreatic
the head is the superior mesenteric preaortic
and the superior part of the head into the coeliac groups.
sympathetic afferents from the pancreas are located in an area which means that pain is felt over which dermatomal distribution?
T6 - T10
the pancreas is derivative of which embyronic plate at which part of the GIT
the endoderm at the junction of the fore and mid gut
the two buds grow into the dorsal (accessory)and ventral (main pancreatitic duct) mesogastrium then the duodenum rotates and goes into the retroperitoneum
how big does the spleen need to be in order to palpate it below the left costal margin.
at least twise as big.
if a spleen were to enlarge int he abdomen would it be above or below the splenic flexure fo colon>
In front
what embryonic derivative is the spleen?
mesoderm
what are the 4 borders of the epiploic foramen?
upper: liver
anterior: lesser omentum
lower: D1
Posterior: ICV
how many cm of bowel do you need to have in order to prevent short bowel syndrome?
50- 100cm
the greater and lesser omentums originate on which side of the esophagus respectively?
the lesseromentum is on the left and down the lesser curvature and
the greater omentum attaches on the right and goes down the greater curvature.
the uncinate process of the pancreas is anterior or posterior to the SMA
the tip goes posterior to it
this islets of langerhand are mainly found in which part of the pancreas?
hainly the head
in the islets of langerhans what is produced by A cells, B cells and delta cells?
Alpha cells: glucagon
Beta cells: Insulin
Delta: somatostatin
the scattered islets of langerhans in the pancreas take up the stain more or less H+E staining?
they are paler, less staining
the venous cushions in the anus occupy which positions on a clockface?
3, 7 and 11 O’Clock
the rectum starts at which verterbral level?
S3
which artery supplies the lower rectum below the level of the levator ani?
the inferior rectal artery , goes in then runs upward to supply all three layers of the rectum and anastomose with the other two artereis
the lymph drainage of the rectum goes in three directions what are they?
the superiror part to the inferior mesenteric artery area, upwards to the pre aortic nodes.
the middle part on the side wall of the pelvis along the middle rectal artery.
the most inferior part to the hollow of the sacrum along the median sacral artery
what is the nerve supply tot he rectum?
the hypogastric plexis and th ecoeliac plexus
PNS from S2- 3 by pelvic splanchnic which are motor to rectal muscle
pain is on PNS and sns
