Abdominal organs and celiac trunk week 1

Question 1

What 2 layers are the peritoneum divided into? (just list)

Answer 1

parietal layer (paries=wall)

visceral layer (viscus=organ)

Question 2

Where is the parietal peritoneum?

What organs does it cover?

What type of innervation does it receive? (somatic or visceral)

What nerves innervate the parietal peritoneum?

Answer 2

The Parietal (paries = wall) layer lines the body wall and covers the retroperitoneal organs on one surface. Parietal peritoneum is very sensitive to somatic pain and is innervated by the lower intercostal nerves and the ilioinguinal and the iliohypogastric nerves of the lumbar plexus.

Question 3

What does the visceral peritoneum enclose?

Answer 3

The Visceral (viscus = organ) layer encloses the surfaces of the intraperitoneal organs.

Question 4

peritionitis

Answer 4

Inflammation of the parietal peritoneum (peritonitis) results in sharp pain that is localized over the area.

Question 5

What are mesenteries?

What are the functions of mesenteries?

The following are important remnants of mesenteries in the abdomen. Define what they attach to:

lesser omentum

greater omentum

What are ligaments?

Answer 5

Mesenteries (meso = middle; enteron = intestine) are double-layered peritoneal membranes that suspend parts of the GI tract from the body wall. This allows the parts of the GI tract to move around as needed. The mesenteries are used as a route for vessels, nerves, and lymphatics to reach the GI tract.
Some important remnants of mesenteries in the abdomen are:
The lesser omentum - attach the liver to the lesser curvature of the stomach and the duodenum.
The greater omentum - attaches to the greater curvature of the stomach and the transverse colon.

Ligaments - reflections of mesenteries between organs or the body wall that are named according to their attachments.

Question 6

Question 7

Where is extraperitoneal fascia located? What does it enclose?

Answer 7

Extraperitoneal fascia - deep to the transversalis fascia (lines the abdominal cavity.)

Question 8

The ______ plus the ______ equals the lesser omentum.

The lesser omentum connects the _______ to the _____.

The epiploic foramen of Winslow connects the _____ to the _______.

Answer 8

1. The hepatogastric ligament plus hepatoduodenal ligament equals lesser omentum.
2. The lesser omentum connects the liver (porta hepatis portion) to the lesser curvature of the stomach and the first part of the duodenum.
3. The epiploic foramen of Winslow connects the lesser sac to the greater sac .

Question 9

The abdominal viscera are lined by _____.

How do organs in the abdominal cavity receive blood supply?

Answer 9

• The abdominal viscera are lined by peritoneum.
• Some organs (e.g. ascending and descending colon) never grow into the cavity and are pressed against the body wall in their retroperitoneal position.
• Other organs like the pancreas become secondarily retroperitoneal.
• All of the structures receive their blood supply from vessels that pass through folds of peritoneum.

Question 10

The abdominal cavity is lined by peritoneum and is subdivided into ______ and _____ ______.

Answer 10

The abdominal cavity is lined by peritoneum and subdivided into the greater and lesser sacs.

Question 11

What are the anterior and posterior borders of the lesser sac?

Answer 11

Peritoneal cavity
• During development the peritoneal cavity is subdivided into the greater and lesser sacs.
• The lesser sac is bordered by the posterior abdominal wall (posteriorly) and the gastrocolic ligament, stomach and lesser omentum (anteriorly).
• The two sacs communicate through the epiploic foramen of Winslow.

Question 12

When placing your finger through the epiploic foramen of Winslow, you are connecting the greater and lesser sacs. What lies anterior, posterior, superior, and inferior the this foramen?

Answer 12

You should know these important relationships within the foramen of Winslow:
• Anterior - Hepatoduodenal ligament and the hepatic portal vein
• Posterior - Inferior vena cava
• Superior - Caudate lobe of the liver
• Inferior - First part of the duodenum

Question 13

List the intraperitoneal, secondarily retroperitoneal, and retroperitoneal organs of the abodminal cavity.

Answer 13

Question 14

A sliding hiatal hernia occurs when the cardia of the stomach herniates through the esophageal hiatus of the diaphragm. What is a neurological consequence of this?

Answer 14

This can damage the vagal trunks as they pass through the hiatus.

Question 15

Question 17

What are the 2 surfaces of the liver?

What kind of peritoneum surrounds the liver?

Answer 17

• The liver has 2 surfaces: a superior (diaphragmatic) and an inferior (visceral) surface.
• It is protected by the rib cage and positioned in the right aspect of the abdominal cavity.
• The liver is surrounded by visceral peritoneum.

Question 18

Name 3 reflections of visceral peritoneum on the liver and where they lie.

Answer 18

Reflections of visceral peritoneum of the liver.
• falciform ligament - between the diaphragmatic surface of the liver and the diaphragm.
• The coronary ligament is the reflection point from the liver and has right and left triangular ligaments.
• The lesser omentum – extends between the visceral surface of the liver (hepatogastric ligament) and the first part of the duodenum (hepatoduodenal ligament.)

Question 19

What are the lobes of the liver?

What lobes are anatomically part of one side of the liver but functionally part of the other side of the liver?

Answer 19

2 lobes unequal size (right and left). The quadrate and caudate lobes are anatomically part of the right lobe but functionally part of the left.

Question 20

What structures are seen on the inferior surface of the liver? (5)

What structures are the caudate and quadrate lobes associated with?

Answer 20

Structures seen on the inferior surface of the liver.
• ligamentum teres and the ligamentum venosum
• porta hepatis
• fossa for the gallbladder
• quadrate lobe, and the caudate lobe.

GQ: quadrate lobe is associated with the gallbladder

caudate lobe is associated with the IVC

Question 21

What is the portal triad? Where is it located? What is contained within it?

How do hepatic veins drain the liver?

Answer 21

The portal triad is located in the hepatoduodenal ligament at the right free border of the lesser omentum and contains:
• Arterial supply from the hepatic artery.
• Porta hepatis, which receives venous blood from the portal vein.
• Common bile duct which collects bile produced by the liver.

Hepatic veins drain the liver by collecting blood from the liver sinusoids and returning it to the inferior vena cava.

Question 22

What structure does the liver share a common embryological origin with that is still maintained in the adult? What is this part of the liver called?

Answer 22

The liver and diaphragm share a common embryologic origin and part of that relationship is maintained in the adult. Thus, the liver has a “bare area” where it is attached to and in direct contact with the diaphragm.

Question 23

Explain the anatomy of the peritoneum and a reflection of the peritoneum in the bare area of the liver.

Answer 23

Bare area of the liver.
• The bare area of the liver has a boundary where the parietal peritoneum reflects onto the liver thus becoming visceral peritoneum.
• This reflection is called the coronary ligament (connect liver to diaphragm and define the bare area of the liver). The extreme margins of the coronary ligament are composed of the right and left triangular ligaments of the liver (where coronary ligaments come together laterally).

Question 24

summary of peritoneal reflections associated with the liver

Question 25

Answer 25

Question 26

In what quadrant is the spleen located? What ribs is it deep to?

What 3 things is the visceral surface of the spleen in contact with?

How do the splenic artery and vein reach the hilus of the spleen?

The fracture of what bones may cause a lacerated spleen?

Answer 26

The spleen is a peritoneal organ in the upper left quadrant that is deep to the left 9th, 10th, and 11th ribs. The visceral surface of the spleen is in contact with the left colic flexure, stomach, and left kidney. The splenic artery and vein reach the hilus of the spleen by traversing the splenorenal ligament. The spleen may be lacerated with a fracture of the 9th, 10th, or 11th rib on the left side.

Question 27

What organ is the pancreas deep to? What plane is it level with?

What are the 4 parts of the pancreas? (just list)

Answer 27

Location – horizontal; deep to the stomach; at the level of the transpyloric plane.

head (with uncinate process), neck, body, and tail

Question 28

What anatomical structures are the 4 parts of the pancreas associated with?

Answer 28

• Head - within the C-shaped area of the duodenum; traversed by the common bile duct. Has an uncinate process.
• Neck - posterior to the neck is the hepatic portal vein and superior mesenteric vessels..
• Body - anterior to the aorta and the left kidney. The splenic artery and vein pass posterior/superior border of the body of the pancreas.
• Tail - enters the splenorenal ligament to reach the hilum of the spleen.

Question 29

What vessels have the potential to be compressed with pancreatitis?

Answer 29

Hepatic portal vein and superior mesenteric vessels bc they lie posterior to the neck of the pancreas.

Question 30

What is the course of the main pancreatic duct? What duct does it join with? What is the name of the joined ducts?

Answer 30

The main pancreatic duct courses through the pancreas to reach the head of the pancreas, where it joins with the common bile duct to form the hepatopancreatic ampulla.

Question 31

Explain the arterial supply to the pancreas.

Answer 31

Anastomoses between the celiac trunk and superior mesenteric artery are a key feature of the arterial supply to the pancreas.

• head - superior and inferior pancreaticoduodenal branches of the gastroduodenal and superior mesenteric arteries.
• neck, body, and tail - from the splenic artery.

Question 32

What is the shape of the duodenum? How many parts of the duodenum are there? Which portions are intraperitoneal and which are retroperitoneal?

Answer 32

C-shaped, has 4 parts and is located retroperitoneal except for the 1st and 2nd parts.

Question 33

What structures are associated with the 4 parts of the duodenum? In what direction does each part of the duodenum go? (horizontal, asecnding, etc)

Answer 33

• Part 1 - the gastroduodenal artery and the common bile duct descend posterior to the first part.
• Part 2 - (descending) receives the common bile duct and main pancreatic duct at the hepatopancreatic ampulla (of Vater). Smooth muscle in the wall of the duodenal papilla is known as the sphincter of Oddi.
• Part 3 - horizontal, retroperitoneal, anterior to the aorta, deep to the superior mesenteric art. and vn.
• Part 4 – ascending and connects to the jejunum at the suspensory ligament of Treitz (contains muscle fibers from the right crus of the diaphragm.)

Question 34

Question 35

What are the 3 main branches of the celiac trunk?

Name all aa of the branches of the celiac trunk and what they supply.

Answer 35

Question 36

What are important anatomoses of branches of the celiac trunk?

Answer 36

Important anastomoses:
• Right Gastric anastomosis with Left Gastric.
• Gastrodudoneal Branch – duodenal branches and superior pancreaticoduodenal branches (anterior and posterior; i.e. the pancreas is an endocrine/digestive organ and needs a lot of blood.)
• Proper Hepatic Branch – left and right hepatic branches); cystic artery (gallbladder; usually a branch of the right hepatic.)

Question 37

Where are 2 places that ulcerations and bleeding can occur?

Answer 37

Posterior stomach and splenic artery

Gastroduodenal artery and 1st part of the duodenum