Abdominal organs and abdomen

Question 1

Name the parts of the stomach

Answer 1

-Cardia (connects stomach to oesophagus)
-Body
-Fundus
-Pylorus (connects pylorus to duodenum with pyloric sphincter)

Stomach also has a greater and lesser curvature.

Question 2

Describe the duodenum

Answer 2

-4 parts which form a c shape around the head of the pancreas
-The 2nd, 3rd and 4th parts are all retroperitoneal
-First part ascends from gastroduodenal junction
-Second part descends in curve around head of pancreas
-Third part runs transversely to the left
-4th part ascends upwards and to the left to terminate in DJ flexure

1. Superior
2. Descending
3. Inferior
4. Ascending

Question 3

Into which part of the duodenum does the CBD enter?

Answer 3

-Enters posteromedial wall of the 2nd part of the duodenum in the ampulla of vater (flow of bile is regulated by the sphicter of oddi)

Question 4

How can you tell the difference between the jejunum and ileum?

Answer 4

-Jejunum: thicker wall, greater diameter, valvulae conniventes become thicker more proximally
-jejunum: longer vasa recta, fewer arterial arcades
-Mesentery of jejunum is thinner

Question 5

How can you tell the difference between large and small bowel on an abdominal radiograph?

Answer 5

-Large bowel: haustra, only go 1/3rd of way accross bowel
-Small bowel: valvulae conniventes, go all the way accross the lumen
-Small bowel is central, large bowel peripheral

During surgery:
-Large bowel can be distinguished by appendices epiploicae and taeniae coli

Question 6

How many parts does the pancreas have?

Answer 6

-Uncinate process
-Head
-Neck
-Body
-Tail

Question 7

What are the functions of the pancreas?

Answer 7

Endocrine
-alpha cells: glucagon
-Beta cells: insulin
-Delta cells: somatostatin

Exocrine (pancreatic acini)
-Amylase
-Lipase
-Trypsinogen

Question 8

Describe the blood supply to the pancreas and the venous drainage

Answer 8

-Head:
—> superior pancreaticoduodenal (gastroduodenal)
—> inferior pancreaticoduodenal (SMA)

Body and tail
—> splenic artery

Venous drainage:
–> follows arterial supply: mesenteric veins, portal veins, splenic vein

Question 9

What are the three main divisions of the coeliac axis?

Answer 9

-Left gastric artery
-Common hepatic artery
-Splenic artery

Question 10

Describe blood supply to stomach

Answer 10

Lesser curvature
–> Left gastric (coeliac trunk)
–> Right gastric (Common hepatic

Greater curvature
–> left gastroepiploic (splenic)
–> right gastroepiploic (gastroduodenal)

Fundus and posterior:
–> short and posterior gastric arteries from splenic

Question 11

Describe the gastro-epiploic (gastro-omental) arteries

Answer 11

-Left gastro-omental artery is largest branch of splenic

-Right gastro-omental is from gastroduodenal, which is from common hepatic.
-Both give off gastric branches that supply anterior and posterior surface of stomach, and omental branches that supply greater omentum

Question 12

Which artery can bleed due to erosion by a duodenal ulcer?

Answer 12

Gastroduodenal (supplies 1st and 2nd parts duodenum)

Rarely ulcer in 3rd/4th part of duodenum could cause pancreaticoduodenal artery to bleed

Question 13

What is a meckel’s diverticulum? What complications can it cause?

Answer 13

Remnant of the vittelo-intestinal duct (connects midgut to the yolk sac)

Rule of 2s:
-2% of the population
-Twice as common in men as women
-2 inches long
-2 feet from ileocaecal valve

Complications:
–> acute inflammation (can mimic appendicitis)
–>Ulceration and bleeding (ectopic gastric mucosa)
–> perforation
–> intussusception
–> obstruction
–> littre’s hernia: hernia containing meckel’s diverticulum, found most frequently in inguinal region
–> tumours can occur in meckel’s diverticulum

Question 14

Where are the kidneys found?

Answer 14

-Vertebral level T12-L3
-Hilum is at L1 (transpyloric plane)
-Right kidney is normally around 1 inch lower than the left
-Kidneys are retroperitoneal structures surrounded by perinephric fat and gerota’s fascia

Question 15

What are the relations of the kidney>

Answer 15

Posterior:
–> diaphragm
–> psoas major, quadratus lumborum, transversus abdominis
–> 12th rib (11th left side)
–> nerves top to bottom: subcostal (T12), iliohypogastric and ilioinguinal (L1)

Anteiror:

Both
–> Suprarenal gland
–> colic flexure
–> small intestine (jejunum left, duodenum right)

Left:
–> Spleen
–> Stomach
–> Pancreas

Right:
–> Liver

Question 16

Where do the suprarenal glands lie:

Answer 16

antero-superiorly to kidney, in separate compartment of encompassing gerota’s fascia

Question 17

What are the layers of the adrenal gland?

Answer 17

Each adrenal gland has a medulla surrounded by outer cortex. Medulla secretes adrenaline and noradrenaline

Cortex is divided into 3 layers (GFR from superficial to deep)

-Zona glomerulosa (produces mineralocorticoid: aldosterone)
-Zona fasciculata: produces mineralocorticoid (cortisol)
-Zona reticularis (produces androgens)

Question 18

What organs are palpable in the normal abdomen

Answer 18

-Aorta
-Upper pole of right kidney in some individuals

-Liver and spleen can be felt in pathology

Question 19

Name surface markings of:
1. the neck of the pancreas
2. The liver
3. The gallbladder
4. The spleen

Answer 19

1. L1 transpyloric plane
2. Runs superiorly along the nipple line to the left 5th intercostal space mid-clavicular line, inferiorly along right 10th rib
3. 9th costal cartilage, mid clavicular line
4. Lies behind 9th, 10th and 11th rib. Susceptible to blunt chest wall and abdominal trauma

Question 20

Identify the branches of the aorta

Answer 20

Anterior branches
-Coeliac axis (T12)
-SMA (L1)
-IMA (L3)

Lateral/posterior branches:
-T12: inferior phrenic, middle suprarenal
-L1-2: renal arteries
-L1-L4: lumbar arteries
-L2: gonadal arteries
-L4: divides into common iliacs, median sacral given off

Question 21

Surface markings of abdominal aorta

Answer 21

-Enters abdomen at T12 through diagphragm
-Runs in retroperitoneal space
-Bifurcates at L4 into common iliacs, gives off median sacral

Question 22

What is this investigation?

Answer 22

Ct aortogram. It is a form of digital subtraction angiography

Question 23

What branch is this?

Answer 23

Splenic artery

Question 24

What artery is this?

Answer 24

SMA

Question 25

What lies anterior to the aorta at L1?

Answer 25

-SMA
-Neck of pancreas

Question 26

What are the structures at the transpyloric plance?

Answer 26

Midline:
-Conus or termination of spinal cord
-Aorta
-SMA
-Neck of pancreas
-SMA
-Pylorus

Lateral
-Kidney hila
-renal vein
HIlum of spleen
-first part of duodenum
-Origin of portal vein
-DJ flexure
-Fundus of gallbladder, 9th costal cartilage

Question 27

What is the foramen of wilmslow

Answer 27

-Communication between greater and lesser peritoneal sac
-Lesser sac lies posterior to the stomach medially, greater sac laterally

Boundaries:
–> Anterior: free edge of lesser omentum
–> Superior: Caudate lobe of liver
–> Inferior: 1st part of duodenum
–. posteiror; IVC

Question 28

What is pringle’s maneuver?

Answer 28

-Compression of portal vein and hepatic artery in free edge of lesser omentum during laparotomy to avoid haemorrhage from the liver

Question 29

What are the functions of the spleen?

Answer 29

-Filtration of encapsulated organisms and blood cells
-Immunological function (production of antibodies)
-Storage of platelets
-Haematopoiesis in the foetus

Question 30

Which organs may be damaged during a splenectomy?

Answer 30

-Splenic flexure of colon
-Diaphragm
-Tail of pancreas (in relation to hilum of the spleen
-Left kidney

Question 31

Describe the attachments of the spleen and what lies within them

Answer 31

-Spleen is attached to greater curvature of stomach by gastrosplenic ligament, in which the short gastric and left gastro-epiploic vessels lie. The lienorenal ligament attaches it to the left kidney (containing the splenic vessels and the tail of the pancreas)

Question 32

Where do porto-systemic anastomoses occur?

Answer 32

-Rectum
-Oesophagus
-Periumbilical region
-Bare area of the liver
-Retroperitoneum