Abdominal Mesentaries and Vasculatures Flashcards
What structures do the foregut include?
the stomach, the first half of the duodenum, liver, gall bladder and pancreas
what structures do the midgut include?
the second half of the duodenum, jejunum, ileum, cecum, ascending colon and transverse colon
the hindgut which includes which three structures?
the descending and sigmoid colons and the rectum
what supplies the foregut?
the celiac trunk
what supplies the midgut?
the superior mesenteric artery
what supplies the hindgut?
inferior mesenteric artery
what is it called when there are two layers of serous membrane which enclose blood vessels, lymphatics and nerves traveling beteween the gut tube and body walls?
mesentary
the ventral mesentary of the foregut is called?
the ventral mesogastrium
what connects the stomach/duodenum to the liver
lesser omentum
what connects the liver to the ventral body wall
falciform ligament
what attaches, anchors and supports the gut tube to the posterior wall?
dorsal mesentery
what attaches the liver and gut tubes to the anterior wall
ventral mesentery
What are the two ventral mesentery derivatives?
the lesser omentum
falciform ligament
the lesser omentum has. two ligements, what are they? what do they connect?
hepatogastric ligament
- connects the liver to the superior (lesser) curvature of the stomach
hepatoduodenal ligament
-connects the liver to the duodenum
-contains vessels and structures associated with the liver
the falciform ligament does what? what does it contain?
anchors liver to the anterior abdominal wall
the falciform ligament
contains the obliterated umbilical vein- the round ligament of the liver
What are the four dorsal mesentery derivatives?
greater omentum
mesentery proper
transverse mesocolon
sigmoid mesocolon
the greater omentum connects what? how many layers does it have?
the greater omentum connects the inferior (greater) curvature of the stomach to the transverse colon
-it has 4 layers of visceral peritoneum because it folds back on its self.
the mesentery proper is associated with what? what does it enclose? how many layers does it have?
associated with the small intestine.
it encloses fat, vessels, lymphatics and nerves to the small intestine
2 layers
what mesentery is associated with the transverse and sigmoid parts of the colon
transverse and sigmoid mesocolon
why don’t the ascending and descending colon not have a mesentery
they became secondarily retroperitoneal as their dorsal mesenteries fused with the parietal peritoneum
The spleen develops within and subdivides?
the dorsal mesentery
what structures are in the right upper quadrant of the abdomen?
gallbladder, liver, duodenum
what structures are in the left upper quadrant of the abdomen
stomach and spleen
what structure is in the right lower lower quadrant
appendix
what structures are in the left lower quadrant?
sigmoid colon
the stomach to the 1st half of the duodenum is the
foregut
the 2nd half of the duodenum to the transverse colon is the
midgut
descending colon to the anus is the
hindgut
what are the three large unpaired branches of the abdominal aorta that supply the gut tube?
The celiac trunk
superior mesenteric artery
inferior mesenteric artery
what are the three branches from the celiac trunk?
the common hepatic artery
left gastric artery
splenic arteries
The common hepatic branches to what side? what does it branch into? what does it supply?
the common hepatic artery branches to the right and bifurcates in to the proper hepatic artery and duodenal
the proper hepatic goes to the liver
gastroduodenal goes to the stomach and duodenum
the proper hepatic artery branches into? what does it supply?
the left and right hepatic arteries that supply the left and right lobes of the liver
what is a variable branch of the common hepatic artery? why is it variable
right gastric artery
variable because it can branch off the common hepatic or the proper hepatic artery
what is a branch of the right hepatic artery before it enters the hilum of the liver?
cystic artery
where does the right gastric artery travel along therefore supplying this area?
it travels along the lesser (superior) curvature of the stomach
The gastroduodenal artery bifurcates into? what do they supply
the right gastroepiploic artery which supplies the right side inferior (greater) curvature of the stomach
and the superior pancreaticoduodenal artery that supply the pancreas and duodenum
the left gastric artery will travel along what? therefore supplying?
what is it a branch of?
travels along the left side of the superior (lesser) curvature of the stomach
this is a branch of the left celiac trunk
the left and right gastric artery will anastomose along?
the lesser curvature of the stomach
the right gastoepiploic artery is a branch of? what does it supply
the gastroduodenal artery
the right side of the greater curvature of the stomach
the superior pancreaticoduodenal artery is a branch of? what does it supply?
branch of the gastroduodenal artery and it supplies the pancreas and the duodenum
the splenic artery travels? what does it look like?
posterior to the stomach along the superior surface of the pancreas to reach the spleen
looks like a pigs tail
What branches of the splenic artery
- branches to the fundus of the stomach
- branches to the pancreas
- left gastroepiploic artery to the greater (inferior) curvature of the stomach
the greater (inferior) curvature of the stomach is supplied by?
the right and left gastroepiploic arteries
esophageal branches of the left gastric artery supply?
the abdominal portion of the esophagus
the left gastroepiploic artery travels along? what does it supply
greater (inferior) curvature of the stomach
what is the second of the three unpaired vessels to the gut from the aorta
Superior mesenteric artery
what does the superior mesenteric artery supply when it branches to the left?
the small intestine
what does the superior mesenteric artery supply when it branches to the right
the colon
the first branch of the SMA on the right is? what does it immediately branch into? what does it supply?
inferior pancreaticoduodenal artery immediately branches into the anterior and posterior inferior pancreaticoduodenal arteries
-these ascend and supply the pancreas and duodenum
what is the second branch of the SMA? What does it supply
middle colic artery
supplies the transverse colon
what is the third branch of the SMA? what does it supply?
right colic artery
supplies the ascending colon
what it the fourth branch of the SMA? where does it go and what does it supply?
the ileocolic artery
travels to the ileocecal junction
supplies the last porstion of the ileum, the cecum and the initial portion of the ascending colon and the appendix
the marginal artery is?
the route of anastomosis between the superior and inferior mesenteric arteries
Coming off of the SMA on the left is? what do they supply?
intestinal arteries
travel through the mesentery proper to supply small intestine
intestinal arteries from? what is the purpose
they form multiple interconnections called arcades and allow for multiple routes of blood to get to the small intestine
branches to the intestine from the arcades are called?
vasa recta (straight arteries)
occlusion of a straight artery will often result in?
necrosis of the portion of the intestine that it supplies
structures supplied entirely or in part by the celiac trunk and its branches
esophagus, stomach, duodenum, pancreas,
spleen
structures supplied entirely or in party by the superior mesenteric artery and its branches
duodenum, jejunum, ileum, ascending colon, transverse colon, pancreas
The third unpaired artery from the abdominal aorta to the intestine
Inferior mesenteric artery
what is the 1st branch of the inferior mesenteric artery? what does it supply?
left colic artery
this supplies the descending colon
what is the 2nd branch of the inferior mesenteric artery? what does it supply?
sigmoid branches
this supply to the sigmoid colon
what is the 3rd and last branch of the the inferior mesenteric artery? what does it supply
the superior rectal artery
it is the major blood supply to the rectum
supplies the superior aspect of the rectum
the rectum receives blood supply from three arteries. What are they?
Superior, middle and inferior rectal.
structures supply entirely or in part by the inferior mesenteric arteries and its branches
descending colon, sigmoid colon, superior rectum
the middle rectal artery and the inferior rectal artery are branches of? what does that supply?
the internal iliac artery
supplies organs in the pelvis
what supplies the head of the pancreas?
the pancreaticoduodenal branches of the celiac and superior mesenteric arteries supply the head of the pancreas
what supplies the neck, body and tail of the pancreas
branches that arise from the splenic as it runs along the superior surface of the gland during its course to the hilum of the spleen
branches involved int eh anastomosis between the celiac trunk and the SMA?
the anterior and posterior superior pancreaticoduodenal
and the anterior posterior inferior pancreaticoduodenal
branches involved in the anastomosis between the superior and inferior mesenteric arteries? what does this result in?
middle, right and left colic arteries
the result is a continuous loop along the entire inner margin of the colon called the marginal artery
the attachment of this ligament marks the boundary between the right and left lobe
falciform ligament
the quadrate and caudate lobes are bounded by
the gallbladder and the right ligament of the liver
the caudate lobe is adjacent to the inferior vena cava
What forms the portal triad
common bile duct, hepatic portal vein and proper hepatic artery
the triad enters the liver at the?
porta hepatis (hilum of the liver)
the round ligament is located where? what is it a remnant of?
located at the free edge of the falciform ligament
-remnant of the umbilical vein and fetal circulation
pathway of fetal circulatoin
umbilical vein- IVC- right atrium- foramen ovale- left atrium - left ventricl- aorta
the right and left hepatic ducts fuse at the porta hepatis to form?
the common hepatic duct
the common hepatic duct merges with the cystic duct to form?
the common bile duct
where does the common bile duct empty? what does it empty with?
into the duodenum
with the main pancreatic duct
muscular valve controlling bile and pancreatic fluid into 2nd part of duodenum
hepatopancreatic sphincter (sphincter of oddi)
what is the purpose of the gall bladder?
concentrate and stores up to 50ml of bile
what causes the the sphincter of oddi to relax
when fatty foods enter the duodenum
what happens to bile when the sphincter of oddi is closed?
bile produced by the liver fills the biliary ducts and then backfills into the gall blader
what is the triangle of Calot formed by?
the cystic artery, the cystic duct and the common hepatic duct
why is the the triangle of calot clinically important?
it is important to find this region to dissect and find the cystic artery during a cholecystectomy because the cystic duct and cystic artery must both be ligated and removed along with the gall bladder
a gallstone which blocks the common bile duct will block?
will block bile from the liver and gall bladder
the portal triad is located within and protected by
the hepatoduodenal ligament of the lesser omentum
the common bile duct is always positioned
on the right in the triad
the proper hepatic artery is always positioned?
to the left in the triad
the hepatic portal vein is always positioned?
posteriorly to the two other structures in the triad
two major veins drain blood from the abdominopelvic cavity
the inferior vena cava and hepatic portal vein
structures that drain into the portal system?
gut tube (through the superior rectum) accessory digestive organs ( pancreas, gallbladder, liver) spleen
the portal system first drains into the (blank) and then drains into the (blank)
liver
inferior vena cava
organs that are peritoneal or secondarily retroperitoneal drain through the?
portal system
organs that are primarily retroperitoneal (kidneys, gonads, inferior rectum) drain into the?
inferior vena cava
what three veins come together and the hepatic portal vein
splenic, superior mesenteric and inferior mesenteric
vein carrying partially de-oxygenated nutrient rich blood to the liver
hepatic portal vein
the hepatic portal vein drains all portions of the digestive tract that
are responsible for absorption of nutrients
nutrient rich oxygen poor veins flows into?
the liver sinusoidal (capillary bed)
what happens at the liver sinusoidal capillary bed?
oxygen poor blood in the hepatic portal vein mixes with oxygen rich blood from the hepatic artery
where does the mixed blood of the liver go?
through the hepatic veins into the inferior vena cava
which veins normally feed into the hepatic portal system?
left gastric vein splenic vein superior rectal vein inferior mesenteric vein superior mesenteric vein
What is it called when the liver is unable to process the amount of blood coming to it, causing a back up of blood?
portal hypertension
due to increased portal system pressure, blood will follow?
the path of least resistance and flow into the caval system via portosystemic anastomoses
what are the three portosystemic anastomeses
anorectal, esophageal, paraumbilical
blood redirected from superior rectal vein to inferior and middle rectal veins causes?
anorectal varicies by overwhelming venous capillary beds and the middle and inferior rectal veins
anorectal varices cause
hemorrhoids
if there is a back up of blood in the portal system (distal esophagus) it will overwhelm the the proximal esophagus (azygos system/cava) causing?
esophageal varices
ruptured esophageal varices are what? why?
emergent because blood is swallowed and goes undetected
first sign of massive acute hemorrhage of esophageal varices?
black, tarry stool
back up of blood within the portal system is going to back up into the paraumbilical vein and travel more subQ to skin
caput medusae
procedure that reduces the amount amount of pressure in portal system
TIPS
transjusgular intrahepatic portosystemic shunt
How does TIPS work
put a shunt down between the hepatic portal vein and the inferior vena cava so that the liver doesn’t have to process all the blood coming in from the portal system
what are the two types of fat in the human body?
brown fat and white fat
What distinguishes brown fat from white fat histologically?
brown fat has more mitochondria in it which makes it darker in color while white fat is primarily filled with large vacuole of lipid
what is the majority of the fat we see in the body?
white fat
brown fat is higher in what population? What location in health adults? what fibers does it contain?
brown fat is higher in the infant population
in health adults it is in the neck, shoulders, mediastinal and paraspinal regions
it is innervated by postganglionic sympathetic fibers
White fat can be divided into which two categories
subQ fat and visceral fat
viseral fat functions as?
an endocrine organ and releases hormones that have been linked to the development of insulin resistance
The peritoneal cavity is divided into what two regions?
the greater and lesser sacs
if a gastric ulcer perforates the posterior aspect of the stomach?
the infection will spread into the lesser sac
what could allow an infection to spread from the greater sac to the lesser sac?
epiploic foramen
the transverse colon subdivides the greater sac into?
a supracolic compartment and infracolic compartment
what does the supracolic compartment contain?
stomach, liver, and spleen
what does the infracolic compartment contain?
small intestine and ascending and descending colon
what are paracolic gutters?
depressions located along the lateral borders of the ascending and descending colons
infections in the pelvis tend to occur on the right side because?
of appendicitis and duodenal ulcers
in the erect position subphrenic spaces?
spread easily into the pelvis
