Abdominal Contents: Viscera and Blood Supply

Question 1

What is the flow of bile?

Answer 1

Bile made in the liver exits each lobe via the right and left hepatic ducts –> common hepatic duct –> cystic duct –> gallbladder. When stimulated, the bile then moves back into the cystic duct –> common bile duct –> hepatopancreatic ampulla of Vater (where common bile duct and pancreatic duct meet) –> into major duodenal papilla –> hepatopancreatic sphincter or sphincter of Oddi

Question 2

What does the pancreas do? What is the flow of its duct?

Answer 2

Makes and secretes hormones and digestive enzymes; has main pancreatic duct that meets with common bile duct at hepatopancreatic ampulla of Vater and exits into duodenal papilla

Question 3

What are the branches of the abdominal aorta?

Answer 3

The celiac trunk, the superior mesenteric artery, and the inferior mesenteric artery.

Question 4

What are the branches of the celiac artery?

Answer 4

The left gastric artery, the splenic artery, and the common hepatic artery.

Question 5

What are the branches of the common hepatic artery?

Answer 5

The gastroduodenal artery, the right gastric artery, and the hepatic artery proper.

Question 6

What are the branches of the hepatic artery proper?

Answer 6

The right and left hepatic arteries and the cystic artery.

Question 7

What are the branches of the left gastric artery and what do they supply?

Answer 7

The esophageal branch that supplies the esophagus.

Question 8

What is the branch of the gastroduodenal artery and what does it supply?

Answer 8

The right gastroepiploic artery, which anastmoses with the left gastroepiploic artery and supplies the greater curvature of the stomach.

Question 9

What are the branches of the superior mesenteric artery?

Answer 9

The middle colic, the right colic, and the ileocolic artery.

Question 10

What does the ileocolic artery branch into and what does it supply?

Answer 10

The ileocolic artery branches into the colic and ileal branch. They supply the cecum. They also supply the appendix via the appendicular artery.

Question 11

The left colic, sigmoid, and superior rectal arteries are branches of which artery?

Answer 11

The inferior mesenteric artery.

Question 12

Why are portal-Systemic Anastomoses important?

Answer 12

These are the sites at which communication between the portal system and the circulatory system can communicate. So, if one system is compromised, blood can still get to the heart via the anastomoses.

Question 13

What can occur due to portal hypertension? And where do these conditions occur?

Answer 13

1. Esophageal varices - lower part of esophagus
2. Caput medusae - para-umbilical region
3. Hemorrhoids - lower part of anal canal (venous backflow to IMV and superior rectal veins)
4. Ascites - abdomen (colic veins)

Question 14

Which nerves innervate the esophagus?

Answer 14

Parasympathetic: Vagus nerve –> Esophageal plexus
Sympathetic: Splanchnic nerves

Question 15

Which nerves innervate the stomach?

Answer 15

Parasympathetic: Gastric nerves/Vagus nerve (gastric joins vagus)
Sympathetic: Celiac plexus/Sympathetic trunk (chain)

Question 16

What does the mnemonic ‘Cecelia Stopped Playing Golf Last night’ mean?

Answer 16

This refers to the innervation of the Spleen, Pancreas, Gallbladder, and Liver. They are innervated by the celiac plexus (sympathetic trunk and vagus nerve)

Question 17

What does the mnemonic ‘Superior men Think Anything like Apples Can Seem cool - but superior men are full of sh**’ mean?

Answer 17

This refers to the innervation of the first 2/3 of the Transverse colon, Ascending colon, Appendix, Cecum, Small intestine. They are innervated by the Superior mesenteric plexus.

Question 18

TEST QUESTION: What does the mnemonic ‘Inferior to the 1/3 transverse colon is the descending colon, sigmoid colon, and rectum’ mean?

Answer 18

This refers to the innervation of the distal 1/3 transverse colon, descending colon, sigmoid colon, and rectum. They are innervated by the inferior mesenteric plexus - sympathetic trunk and pelvic splanchnic nerves. *The vagus nerve no longer innervates the transverse colon, and the pelvic splanchnic nerve has taken over parasympathetic innervation.

Question 19

What is peptic ulcer disease?

Answer 19

Parietal cell –> HCl –> PUD of stomach and/or duodenum

Question 20

What can longstanding GERD cause?

Answer 20

GERD –> Barrett’s esophagus –> Esophageal carcinoma

Question 21

What is Barrett’s esophagus?

Answer 21

The digestive enzyme of the stomach come up into the esophagus, causing the simple columnar cells to change and eventually divide. The lining of the esophagus is changed.

Question 22

What is cirrhosis?

Answer 22

It is the end stage of liver disease in which the normal liver architecture is destroyed by fibrous septa.

Question 23

How can long time alcohol abuse cause liver issues or cancer?

Answer 23

1. Alchohol –> inflammatory cytokines, oxidative stress –> inflammation and fibrosis
2. Alcohol dehydrogenase –> Acetaldehyde –> Class 1 Carinogen

Question 24

What is ductular adenocarcinoma? What factors can cause it?

Answer 24

This is the most common type of pancreatic cancer. Factors such as smoking, age, BMI, and high fructose corn syrup affect it.

Question 25

What is a Whipple procedure?

Answer 25

This is the pancreaticoduodenectomy, which is the removal of the distal stomach, 1st and 2nd parts of the duodenum, head of the pancreas-common bile duct, and gallbladder

Question 26

What branches from the splenic artery?

Answer 26

The left gastroepiploic artery, which anastmoses with the right gastroepiploic artery, and supplies the greater curvature of the stomach.