Abdominal Viscera Flashcards
1
Q
What is the length of the oesophagus?
A
25cm
2
Q
Where does the oesophagus start?
A
pharynx
(level of cricoid cartilage, C6)
3
Q
What is the significance of the oesophagogastric junction?
A
Abrupt change (z-line) where the lining of the oesophagus (stratified epithelium) ends and the gastric mucosa of the stomach begins
4
Q
What are the points of oesphageal narrowing?
A
cervical - the upper oesophageal sphincter (swallowing)
thoracic - aortic arch & LMB
abdomen - diaphragmatic orifice at T10
5
Q
What is the arterial supply to the cervical oesophagus?
A
inferior thyroid artery
6
Q
What is the arterial supply to the thoracic oesophagus?
A
oesophageal branches of the aorta
7
Q
What is the arterial supply to the abdominal oesophagus?
A
left gastric from the aorta
8
Q
What is the venous drainage of the cervical oesophagus?
A
brachiocephalic (drains into caval system/SVC)
9
Q
What is the venous supply of the thoracic oesophagus?
A
azygous (drains into caval/SVC)
10
Q
What is the venous supply of the abdominal oesophagus?
A
L gastric portal (drains into the portal venous system)
11
Q
What is the lymphatic drainage of the cervical oesophagus?
A
deep cervical LNs
12
Q
What is the lymphatic drainage of the thoracic oesophagus?
A
mediastinal LNs
13
Q
What is the lymphatic drainage of the abdominal oesophagus?
A
pre-aortic LNs
14
Q
What is a hiatus/hiatal hernia?
A
herniation of part of the stomach through the oesophageal hiatus into the posterior mediastinum
15
Q
What is the most common type of hiatus hernia?
A
sliding - 95%
oesophagus and stomach pulled up through hiatius at T10
16
Q
What is the uncommon type of hiatus hernia?
A
paraoesophageal - 5%
stomach comes up through hiatus at T10, beside the oesophagus
17
Q
What closes the superior opening of the stomach?
A
cardiac orifice/cardiac sphincter
18
Q
What clsoes the distal end of the stomach?
A
pyloric sphincter
19
Q
What is the significance of the angular notch of the stomach?
A
defines the end of the body of the stomach
20
Q
A
21
Q
The gastrosplenic ligament
A
tethers the greater curvature of the stomach to the spleen (greater omentum)
22
Q
R & L gastric arteries run in the
A
lesser curvature of the stomach
23
Q
R & L gastroepiploic arteries run in the
A
greater curvature of the stomach
24
Q
veins of the stomach drain into the
A
portal circulation
25
The length of the duodenum is
10 inches (4 parts)
26
Which parts of the duodenum are retroperitoneal?
all but the first inch
27
What is the primary function of the duodenum?
absorbtion of digestion products
28
What is the first part of the duodenum?
duodenal cap, 2 inches
(1st inch is intraperitoneal, 2nd inch is retroperitoneal)
29
the majority of peptic ulcers occur in the
duodenal cap
due to imbalance of acid secretion and mucosal defences
30
the duodenal cap sits on
the right psoas, just medial to the R kidney
31
the second part of the duodenum is
3 inches long, vertical
passes next to head of the pancreas and the hilum of the R kidney on psoas major
32
the second part of the duodenum contains the
1.5 inches/halfway down posteromedial wall
major duodenal papilla: opening of the bile & pancreatic ducts
1 inch above lies the minor duodenal papilla (accessory pancreatic duct)
33
the third part of the duodenum is
4 inches long, horizontal; retroperitoneal
crosses R psoas to L psoas over the lumbar VC, IVC, and abdo aorta
34
the fourth part of the duodenum
1 inch long, curving anteriorly into the jejunum
## Footnote
**attached by fibrous tethering to L psoas**
35
the length of the small intestine not including the duodenum is
4-6 metres
36
the duodenojejunal flexure is
where the duodenum ends and the jejunum begins
37
The jejunum comprises what percent of the small intestine?
40%
38
The ileum comprises what percent of the small intestine?
60%
39
The jejunum and ileum are in what part of the peritoneal cavity?
intraperitoneal
suspended from the posterior abdo wall by mesentery
40
Where does the jejunum end and the ileum begin?
**there is no clear demarcation; there are structural differences**
* jejunum occupies the LUQ
* iluem lies in the RUQ
* jejunum is larger in diamaeter with a thicker wall (more numberous mucosal folds)
* more absorption occurs here
* **there is less fat in the mesentery of the jejunum than the ileum**
* where there is more fat, you cannot see the vessels as well (ileum)
* if you can clearly see vessels it is more likely jejunum
* the **jejunal** vasculature comprises few arterial arcades and **long vasa recta**
* the **ileal** vasculature there are many arcades (stacked on each other) and **short vasa recta**
41
the ileum ends at the
ileocecal junction/valve
sphincter that controls passage of ileal contents into the large intestine
42
The length of the large intestine is
1.5 metres long
43
The function of the large intestine is
absorption of water and important ions from faeces
44
The muscular structure of the small intestine is
inner circular smooth muscle
outer longitudinal smooth muscle coat (continuous)
45
What is the muscular structure of the large intestine?
continuous layer of inner circular smooth muscle
outer coat of longitudinal smooth muscle divided into three discrete bands
called **tenia coli**
46
The tenia coli gather the large intestine into
haustra/sacculations
47
What are epiploic appendices?
fat tags that hang off the colon/large intestine
48
The cecum sits
below the ileocecal junction, the origin of the appendix
49
The length of the appendix is usually
7-10cm
50
The appendix contains
numerous lymphoid nodules
51
The appendix attaches to
the inferior aspect of the cecum where the 3 tenia coli meet
52
In ~1/5 people, the appendix lies
dipping down into the pelvis, across the pelvic brim (iliac vessels)
53
Most commonly, the appendix lies
retrocecal, ~65% of people
tucked under the posterior cecum
54
What distinguishes the rectum from the sigmoid colon (and the rest of the large intestine)?
re-develops a single longitudinal muscle coat (like the small intestine) as the sigmoid colon goes midline and straightens out to become the rectum
55
The liver receives venous drainage from
the gastrointestinal tract and its derivatives (products of digestion)
via the **portal venous system**
56
What are the major functions of the liver?
* receives venous drainage from GIT and derivatives (products of digestion and absorption)
* storage of energy sources
* glycogen, fat, protein, vitamins
* production of cellular fuels
* glucose, keto acids, fatty acids
* production of plasma proteins and clotting factors
* metabolism of toxins and drugs
* modification of hormones
* production of bile acids
* excretion of bilirubin
* storage of iron and many vitamins
57
The falciform ligament
divides the anterior diaphragmatic surface of the liver into a small L lobe and a large R lobe
it is a peritioneal reflection off the anterior abdominal wall
contains in the free edge the obliterated umbilical vein (**ligamentum teres**) from the placenta to the foetal liver hilum in utero
58
What runs in the free inferior edge of the falciform ligament?
ligamentum teres (obliterated umbilical vein)
59
60
Physiologically, the left lobe of the liver comprises
functional left lobe
caudate lobe (posterior)
quadrate lobe (anterior)
61
What runs in the groove between the R lobe and the quadrate lobe of the liver?
gallbladder
62
What runs in the groove between the R lobe and the caudate lobe of the liver?
IVC
63
What runs in the groove between the L lobe and the quadrate lobe of the liver?
Ligamentum teres in the inferior edge of the falciform ligament
64
What runs in the groove between the L lobe and the caudate lobe of the liver?
ligamentum venosum (foetal ductus venosus)
65
What is the ligamentum venosum?
foetal ductus venosus
connected the umbilical vein (ligamentum teres) to the IVC through the fissures on the visceral surface of the liver
66
The hilum of the liver is called the
porta hepatis
67
What structures are transmitted through the porta hepatis?
posteriorly - portal vein
anteriorly - L: proper hepatic artery & R: R & L hepatic ducts (join cystic duct to form common bile duct)
**not seen: hepatic nerve plexus and hepatic lymphatics**
68
What is the direction of each structure passing through the porta hepatis?
portal vein **ENTERS** bringing portal venous drainage from the GIT
hepatic artery **ENTERS** bringing O2'd blood to the liver
**hepatic ducts EXIT** bringing bile down to the ducts/major duodenal papilla
69
The lesser omentum tethers
the lesser curvature of the stomach to the under surface of the liver in the region of the hilum
the free edge (where the duodenum becomes retroperitoneal) is where the porta hepatis structures run (hepatic ducts, hepatic artery, and portal vein)
70
What is the vascular input to the liver?
hepatic artery: R & L terminal branches to each functional half
portal vein: R & L terminal branches to each functional half
**vein sits behind artery**
**artery to L of ducts**
71
What is the venous drainage of the liver?
~3 (variable) hepatic veins that drain into the IVC
## Footnote
**emerge from posterior surface of the liver where they enter the IVC
not seen**
72
What is the path of bile from the liver?
* enters duct system that gets progressively larger (biliary channels)
* eventually form the **R and L hepatic ducts** (one from each functional half)
* this occurs at the hilum of the liver
* R & L hepatic ducts join to form the **common hepatic duct**
* the common hepatic duct exits the hilum and joins the **cystic duct**
* forms the **common bile duct** that descends in the rest of the free edge of the lesser omentum
* travels behind the first part of the duodenum and the head of the pancreas
* enters the **major duodenal papilla**
73
What is the path of the common hepatic duct?
* runs from hilum of liver (R & L hepatic ducts) in free edge of lesser omentum
* joined by the **cystic duct** **of the gallbladder**
* together they form the **common bile duct**
74
What is the path of the common bile duct?
* first part is through the rest of the free edge of the lesser omentum
* second part slips behind the first part of the duodenum (duodenal cap)
* third part slips behind the head of the pancreas in the groove between it and the 2nd part of the duodenum
* empties into the major duodenal papilla
* sits halfway down the posteromedial wall of the 2nd part of the duodenum
75
What is the common name for the major duodenal papilla?
papilla of Vater
76
What ducts drain into the major duodenal papilla?
common bile & pancreatic
77
What is the function of the sphincter of Oddi?
complex sphincter that (separately) closes off:
* the last part of the common bile duct
* the last part of the pancreatic duct
* the common duct that opens into the major duodenal papilla
**closed during digestion**
* this causes bile to back up the common bile duct
* goes into the gallbladder where it is stored and concentrated
**stimulated to open by hormones in response to a fatty meal**
78
The gallbladder lies
on the visceral surface of the liver between the R lobe and the quadrate lobe
the fundus projects beyond the inferior margin of the liver and contacts the anterior abdominal wall
79
80
What is the significance of where the fundus of the gallbladder contacts the anterior abdominal wall?
this is where the R costal margin meaets the R linea semilunaris (R border of rectus abdominis/lateral border of R rectus)
81
cholecystitis
inflammation of the gallbladder
point of tenderness where the R costal margin meets the R rectus abdominis/linea semilunaris
82
What is the exocrine function of the pancreas?
produces enzymes for the digestion of protein, starches, and fat, and bicarbonate to neutralize acidic gastric contents, into the pancreatic duct
83
What is the endocrine function of the pancreas?
releases insulin, glucagon, and somatostatins into the bloodstream
84
85
The pancreas sits in what part of the peritoneal cavity?
retroperitoneal
86
The tail of the pancreas leads to
the hilum of the spleen
87
What is the uncinate process?
prolongation of the head of the pancreas
lies posterior to the superior mesenteric vessels
**drained by the accesory duct that drains into the minor duodenal papilla (1 inch proximal to the major duodenal papilla)**
88
What is the course of the pancreas?
* head sits in C-shape of duodenum
* neck lies deep to the pylorus
* the body lies above the DJ flexure
* tail terminates at the hilum of the spleen
89
What is the position of the pancreas?
* retroperitoneal (back to posterior abdominal wall)
* head sits to the R of the lumbar VC
* tail sits to the L of the lumbar VC
* body crosses over the lumbar VC, IVC, and aorta
90
What is the course of the main duct of the pancreas?
* begins at the tail
* runs the length of the neck, body, and head
* collecting exocrine secretions
* opens into the duodenum w/common bile duct at the major duodenal papilla
* accessory duct drains the head and the uncinate process
* crosses over the main pancreatic duct
* drains into the duodenum 1 inch proximal to the major duodenal papilla at the minor duodenal papilla
91
What is the structure of the spleen?
* ~size of clenched fist (wide variation)
* oval shaped mass of lymphoid tissue
* in the LUQ
* tucked up under the L dome of the diaphragm
* highly vasculature
* risk of rupture with trauma (very thin capsule), rib fractures
* smooth diaphragmatic surface, visceral surface w/visceral imprints and hilum (splenic artery and vein, + nerves and lymphatics not seen)
* line of demarcation is always notched on the superior/anterior margin
92
What ribs lie close to the spleen?
9, 10, and 11
(axis lies along the shaft of the 10th rib)
