ABDOMINAL ORGANS

Question 1

What vessel supplies the following organs:

Transverse colon, descending colon, sigmoidal colon, rectum?

Answer 1

Inferior Mesenteric Artery (IMA)

Question 2

What vessel supplies the following organs:

Liver, esophagus, stomach, gallbladder, pancreas, spleen, 1st and 2nd parts of duodenum?

Answer 2

Celiac Trunk (arising at T12)

Question 3

What vessel supplies the following organs:

head of pancreas, jejunum, ileum, cecum, appendix, parts 2,3 & 4 of duodenum, ascending + transverse colon?

Answer 3

Superior Mesenteric Artery (SMA)

Question 4

Describe the location and significance of the gastrocolic ligament.

Answer 4

Attaches the stomach to the transverse colon within the greater omentum. This is a common surgical entry point that leads to the lesser sac (behind the stomach).

Question 5

Describe how the transverse colon is fused to the back of the greater omentum.

Answer 5

When the greater omentum was growing in the fetus, it grew so long that it folded back on itself, becoming 4 LAYERS THICK.
The transverse mesocolon (posterior to the transverse colon) also fused with the omentum.

Question 6

What two locations in the GI have overlapping blood supply from collateral vessels?

Answer 6

1. 2nd part of the duodenum (Celiac trunk + SMA)

2. Transverse colon (SMA + IMA)

Question 7

How does the esophageal hiatus function as a sphincter?

Answer 7

Whenever the diaphragm contracts during inspiration, the sphincter shuts to close the stomach. This normally reduces the risk of acid reflux.

Question 8

Describe the phrenoesophageal ligament.

Answer 8

This structure loosely attaches the esophagus to the diaphragm, enabling the esophagus to slide up and down.

Question 9

Define the two types of Hiatus hernia.

Answer 9

1. Sliding type - has the Z-line, cardiac and fundus parts of the stomach in the thorax; increasing the risk of ACID REFLUX
2. Paraesophageal type - fundus is in the thorax; no acid reflux

Question 10

What are the 3 muscle layers of the stomach? What is their significance?

Answer 10

Outer longitudinal muscle, middle circular muscle and inner oblique (circular) muscle. They serve in the churning and movement of food along the stomach. The thickening of the inner oblique at the distal end is the pyloric sphincter which can be palpated.

Question 11

Why is the fundus at a higher risk for ischemia compared to the rest of the stomach parts?

Answer 11

There are poorer anastomoses from the short gastric arteries, in the event of an occlusion of the splenic artery.

Question 12

The ______ artery supplies the lesser curvature of the stomach, whereas the ______ artery supplies most of the greater curvature. Both can anastomose with their contralateral artery.

Answer 12

Left gastric artery;

Right gastroomental artery;

Question 13

What parts to the duodenum are retroperitoneal organs?

Answer 13

The 2nd, 3rd and 4th parts of the duodenum

Question 14

What is the duodenojejumal flexure and what is it held by?

Answer 14

The duodenojejmula flexure is the sharp turn between the 4th part of the duodenum and jejunum. This is held by the Suspensory Ligament of Treitz which is attached to the diaphragm.

Question 15

Describe the arterial supply to the duodenum.

Answer 15

The gastroduodenal artery is above the duodenum. The Superior pancreaticoduodenal artery (SPAA) goes into the head of the pancreas while the IPAA anastomoses with it to provide a good collateral pathway for the pancreas and duodenum.

Question 16

The tail of the pancreas is located within the ___________ ligament located next to the ______ artery; therefore, it is a __________ organ.

Answer 16

Splenorenal ligament and splenic artery;

Peritoneal organ

Question 17

Define the ucinate process and the Ampulla of Vater.

Answer 17

The ucinate process is the hook-like appendage of the pancreas head under the SMA and SMV. The ampulla of Vater is a fusion of the major pancreatic duct and the common bile duct that heads directly into the 2nd part of the duodenum.

Question 18

What are vessels supply blood to the parts of the pancreas?

Answer 18

The SPAA and IPAA supply the ucinate process. The Splenic artery supplies the body and tail of the pancreas, located on the upper border.

Question 19

What is the significance of the Whipple Procedure?

Answer 19

A surgical procedure that removes parts of the pancreas and duodenum (in case of a tumor). The surgeon connects the stomach, pancreas and hepatic duct ALL to the jejunum. Splicing is necessary to supply enzymes and food directly into the proximal jejunum which takes over the role of the duodenum.

Question 20

Define the falciform and coronary ligaments of the liver.

Answer 20

The falciform ligament is the attached visceral peritoneum that separates the liver lobes anteriorly. The coronary ligament is a reflection of the parietal peritoneum of the diaphragm to the visceral peritoneum of the liver.

Question 21

On the posterior liver, what divisions make up the anatomical right lobe? What of the functional left lobe?

Answer 21

Anatomical right lobe = right lobe + quadrate + caudate lobes;
Functional left lobe = left lobe + quadrate + caudate lobes

Question 22

On the back of the liver, the ______ ______ emerge from the bare area of the liver. The ____ _____ is a region where the portal triad “functionally” splits to supply the right and left lobes.

Answer 22

Hepatic veins;

Porta hepatis

Question 23

Describe the function of the gallbladder and what can occur if its contents are too concentrated.

Answer 23

The gallbladder stores and concentrates bile. If it becomes too concentrated, gallstones precipitate and can block the cystic duct which leads to post-prandial (after meal) pain in the right upper quadrant. Aka “colic pain” whenever the gallbladder contracts.

Question 24

Describe the pathway of bile from the gallbladder and liver to the duodenum.

Answer 24

The liver sends bile into the right and left hepatic ducts into the common hepatic duct which merges with the cystic duct (from the gallbladder). This new common bile duct later merges with the pancreatic duct to form the Ampulla of Vater that is released into the 2nd part of the duodenum.

Question 25

What 3 structures make up the border of Calot’s triangle.

Answer 25

The cystic duct, right hepatic duct and liver make up the borders. This location is used to find the cystic artery within it.

Question 26

Fracture of the either the 9th, 10th or 11th ribs should be a concern for what? What might someone have if his or her spleen can be felt below the costal margin upon palpation?

Answer 26

Rupture of the spleen that might cause a hemorrhage. The person could bleed to death since the febrile spleen is located underneath those ribs. Splenomegaly could be present in someone with a spleen that can be felt below the ribs.

Question 27

Describe the arterial supply of the small intestine.

Answer 27

The SMA supplies arteries that runs through the mesentery in specialized systems. The arcades are LONG arches that anastomose to connect one intestinal artery to the next. The vasa recta are shorter, distal branches that connect to the GI wall.

Question 28

If this mesenteric artery (__________) were occluded it would lead to ischemia in a region of small intestine. If the _______ were occluded this would not be an issue since they anastomose.

Answer 28

Vasa recta;

Arcades

Question 29

Compared to the jejunum, the ileum has ___ vascularization, ____ vasa recta, ______ short loops, _____ fat in the mesentery and _____ lymphoid nodules.

Answer 29

Less vascularization,
Shorter vasa recta,
Many short loops,
MORE FAT in mesentery,
More lymphoid nodules

Question 30

Why is the abdominal aorta best heard and palpated directly above the umbilical cord instead of a slightly to the left?

Answer 30

Since there is not much space between the vertebrae and anterior wall at the MIDLINE, the aorta can be heard and felt (in case of an aneurysm).

Question 31

Define haustra and teniae coli.

Answer 31

Haustra are evaginations of the colon wall that are LONGER than teniae coli (when unfolded). Teniae coli are 3 non-continuous strips of longitudinal muscle along the surface of the colon. “Haustra are like curtains on a curtain rod (teniae coli)”.

Question 32

The most common position of the appendix is the ________ position.

Answer 32

Retrocecal position located behind the cecum.

Question 33

Appendicitis presents in various ways depending on the _____ and _____ of the appendix. It is felt as a sharp, localized pain if it contacts the ________. It’s felt as general pain in the abdomen if it has _________. It may be felt as pelvic pain in the LRQ if it touches the ________.

Answer 33

Length and position of the appendix;
Parietal peritoneum;
No contact;
Bladder or lower pelvic organ

Question 34

Describe where the marginal artery originates and its location.

Answer 34

The marginal artery is made up of anastomoses of colic arteries. It is found near but not on the colon and branches off vasa recta that supplies the colon.

Question 35

What sign can be seen on an X-ray that indicates splenomegaly?

Answer 35

If the splenic flexure is LOWER than the hepatic flexure, this might indicate an enlarged spleen. Abnormal finding in addition to a palpable spleen that is below the costal margin.