Abdominal Viscera Flashcards
0
Q
What is the esophageal hiatus?
A
The area that the thoracic esophagus pierces the diaphragm slightly left of midline
1
Q
Where does the thoracic esophagus pierce the diaphragm?
A
At T10
2
Q
At about T11, describe the esophagus
A
Turns sharply left to enter the stomach at the cardia orifice
The abdominal esophagus is about 2.5 cm
3
Q
What part of the esophagus is physiologic, but not well-defined anatomically?
A
The esophageal sphincter
4
Q
What structure passes through the diaphragm at T8?
A
Inferior vena cava
5
Q
What structure passes through the diaphragm at T12?
A
The aorta
6
Q
What are openings in the diaphragm called?
A
“hiatuses”
7
Q
Define “sliding” hiatal hernia?
A
Esophageal hiatus of diaphragm enlarges or weakens
Abdominal esophagus and parts of the stomach (cardia and sometimes fundus) herniate into the thorax
8
Q
Define paraesophageal hiatal hernia
A
A defect in diaphragm next to the esophageal hiatus
Permits fundus of stomach to herniate (not usually the esophagus)
9
Q
What is the location of the stomach?
A
Left hypocondriac and epigastric regions
Left end fixed at T10-11
Right end fixed at L1-2
10
Q
What are the parts of the external stomach?
A
Fundus Cardiac pat, cardiac orifice Body Pylorus Pyloric antrum: entrance to pylorus
11
Q
What are the parts of the internal stomach?
A
Rugae
Pylorus (pyloric sphincter)
Pyloric orifice: entrance to the duodenum
12
Q
What are the curvatures of the stomach?
A
Curvatures: Lesser and greater
Angular incisure
Pylorus
Pyloric antrum
13
Q
What are the posterior surfaces of the stomach?
A
Splenic surface Renal surface Pancreatic surface Colomesocolic surface Phrenic surface Suprarenal surface Hepatic surface
14
Q
What is posterior to the stomach?
A
Diaphragm Spleen (posterior and lateral) Left suprarenal gland Upper left kidney Pancreas Left colic flexure Left transverse colon Transverse mesocolon
15
Q
What are the anterior surfaces of the stomach?
A
Hepatic surface
Phrenic surface
Epigastric surface
16
Q
What is anterior to the stomach?
A
Anterior abdominal wall
Left costal margin
Left diaphragm
Left and quadrate lobes of the liver
17
Q
What are the muscularis externa layers of the stomach?
A
Longitudinal layer
Circular layer
Oblique layer
18
Q
Where is the small intestine located?
A
Between the stomach and the large intestine
19
Q
What is the small intestine subdivided into?
A
3 parts
Duodenum, Jejunum, Ileum
D.J ilium
20
Q
Describe general characteristics of the duodenum
A
C-shaped
10 inches long
Located approximately at L1 to L4 vertebral bodies
Starts at the pylorus of the stomach and ends at the duodenal-jeju junction
21
Q
What is the duodenum subdivided into?
A
Superior
Descending
Horizontal
Ascending
22
Q
Is the duodenum primarily or secondarily retroperitoneal?
A
Secondarily retroperitoneal except for some of the 1st and 4th parts
23
Q
What is most of the duodenum anteriorly covered by?
A
Peritoneum except where the mesocolon of the transverse colon crosses the 2nd part
24
What is the 1st part of the duodenum surrounded by?
The hepatoduodenal ligament
25
Where does the root of the mesentery begin?
Begins at the duodeno-jejunal flexure
26
What are the features of the 1st part (superior) of the duodenum
Starts at the pyloric sphincter
About 2 inches long
Held in place by the hepatoduodenal ligament
Portal vein, hepatic artery and bile duct are therefore posterior and superior to the ligament
Duodenal bulb (widened area)
Head of the pancreas is inferior to the bulb
27
Describe the features of the 2nd part (descending) of the duodenum
About 3 inches long
All retroperitoneal (2arily)
The fundus of the gall bladder, right lobe of the liver, transverse colon are all anterior
The right kidney and ureter are posterior
The head of pancreas is medial
The bile and pancreatic ducts enter into this section of the duodenum at the major duodenal papilla
28
What are the features of the 3rd part (horizontal) of the duodenum?
The superior mesenteric artery and vein and the root of the mesentery cross the anterior surface of this section
The head of the pancreas is superior
The jejunum is anterior and inferior
29
What are the features of the 4th part (ascending) of the duodenum?
Not covered by peritoneum
The root of the mesentery and jejunum are anterior
The left margin of the aorta and medial border of the psoas muscle are posterior
Held in place by suspensory ligament (or muscle) of the duodenum (of Treitz)
The suspensory ligament anchors the section to the right crus of the diaphragm
30
What are the general features of the jejunum and ileum?
Occupy most of the peritoneal cavity of the abdomen and pelvis
Coiled and about 20 feet long
The jejunum begins at duodenal-jejunal junction and the ileum ends at the ileo-cecal valve
---This part of the small intestine is very mobile and is held to posterior wall by THE mesentery
31
What frames the jejunum and ileum?
Large intestines
32
What parts are called the "free" small intestine?
Jejunum and ileum
33
What are the characteristics of the jejunum?
8-10 feet long
2/5 of the free small intestine
Compared to the ileum, the jejunum has:
Long vasa recta; simple vascular arcades; more vascular
More plicae circularis; greater diameter; thicker
34
What are the characteristics of the ileum?
10-12 feet long
3/5 of the free small intestine
Compared to the jejunum the ileum has:
Has compound vascular arcades; shorter vasa recta; less vascular
Smaller diameter, thinner wall, fewer plicae circularis
35
What is meckel's (ileal) diverticulum?
```
A possible feature of the ileum
Most common congenital anomaly of the small intestine
Occurs in about 2% of the population
About 2 feet from the ileocecal junction
Average is 2 inches long
Remnant of vitelline duct
clinically difficult to distinguish from appendicitis
May contain other types of tissue
```
**Almost like an extra appendix
36
What is the jejunum and ileum supported by?
THE mesentery
37
Describe THE mesentery in relation with the jejunum and ileum
15 cm long at the root
| Attaches the jejunum and ileum to the posterior body wall
38
What does THE mesentery cross?
```
LV1-2
3 part of duodenum
aorta
IVC
right ureter
right gonadal vessels
right psoas major
ends at right S.I. joint
```
39
Describe THE mesentery
2 layers of peritoneum with nerves, lymph nodes, and vessels
fat, arteries and veins running between the layers
6 to 7 inches long at it's root and 20 feet long at it's intestinal border
40
What are the regions of the large intestine?
```
Cecum and vermiform appendix
Ascending colon (AC)
Right colic flexure (RCF)
Transverse colon
Left colic flexure (LCF)
Descending colon
Sigmoid colon
Rectum and anal canal are in the pelvis
```
41
What are the general characteristics of the large intestine?
Highly mobile and location of its parts is variable
| Functions: fecal formation, transport and evacuation, water absorption and mucus secretion
42
What are 3 bands of longitudinal muscles on the outside of the colon called?
Taenia coli
43
Where do taenia coli converge?
At the root of the appendix
44
What do taenia coli produce?
Haustrae (sacculations) that slow the movement of feces
45
What are tags of fat on the large intestine?
Appendices epiploicae
46
What are structures of the cecum?
No epiploic appendages: blind "pouch" inferior to ileocecal orifice
Iliocolic valve: 2 folds that are not a true sphincter
ileal papilla: cone-like projection of the ileum into the cecum
The opening for the appendix is inferior to the ileal papilla
47
What is the vermiform appendix?
Structure attached to the postero-medial part of the cecum
Located at the junction of 3 taenia coli
9-10 cm long and supported by a mesoappendix
Position variable
48
Describe the ascending colon
Right colic flexure (hepatic flexure)
Secondarily retroperitoneal (usually)
Except the lowest part
49
Describe the transverse colon
Left colic flexure (splenic flexure)
| Intraperitoneal (transverse mesocolon)
50
Describe the descending colon
Secondarily retroperitoneal
51
Describe the sigmoid colon
Intraperitoneal (sigmoid mesocolon )
52
What is the size, shape and location of the spleen?
Left hypochondriac region
Parallels left ribs 9, 10, and 11
Midaxillary line, between stomach and diaphragm
About the size of a hand
Normally not palpable below the costal margin
53
What is the spleen covered by?
Peritoneum
54
The peritoneum that covers the spleen develops where?
In the dorsal mesentery from the mesoderm
55
What are the mesenteries of the spleen?
Gastrosplenic ligament and splenorenal ligament
56
Where is the diaphragm in reference to the spleen
Posterior
57
The stomach, left colic flexure and tail of the pancreas are (anterior/superior/inferior/posterior) to the spleen?
Anterior
58
The left kidney and phrenicocolic ligament are _______ to the spleen
Inferior
59
The diaphragmatic surface of the spleen is _____
Against the diaphragm and smooth
60
The visceral surface of the spleen has impression made by what?
Colic, gastric and renal
61
The hilum of the spleen is on what surface?
The visceral surface
62
What does the hilum of the spleen have?
Gastrosplenic and spleorenal ligaments (houses vessels going into the spleen)
63
The pancreas is primarily or secondarily retroperitoneal?
2arily
64
Where is the pancreas located?
About L1 and L2
65
What are the parts of the pancreas?
Head, body, neck, and tail
66
Describe the head of the pancreas
Has uncinate process
| and is in the duodenal curve
67
Describe the body of the pancreas
Triangular cross-section
68
Describe the neck of the pancreas
Constricted part between head and body
69
Describe the tail of the pancreas
Some of the tail is located in the splenorenal ligament
| Anterior to the hilus of the spleen
70
What are posterior to the neck of the pancreas?
Superior mesenteric artery and vein
71
What runs horizontally superior to or posterior to the body of the pancreas?
Splenic vein and artery
72
What is the tail of the pancreas against?
The spleen
73
What is anterior to the spleen?
The stomach
74
What is posterior to the body of the pancreas?
Inferior vena cava and aorta
75
What is superior, right and inferior to the head of the pancreas?
The duodenum
76
What lies anterior and inferior to the pancreas?
Transverse colon
77
The main or major pancreatic duct joins the bile duct and they enter the 2nd part of the duodenum together through what?
Common hepatopancreatic ampulla
78
What forms the major duodenal papilla?
Hepatopancreatic ampulla
79
The accessory pancreatic duct (if present) enters the duodenum where?
At the more superior minor duodenal papilla
80
Where is most of the liver located?
Right upper quadrant
81
Where is the smaller left lobe of the liver located?
In the left upper quadrant
82
What are the lobes of the liver?
Left lobe
Right lobe
Caudate lobe
Quadrate lobe
83
What double layer of peritoneum that connects liver to the anterior wall?
The falciform ligament
84
Describe the diaphragmatic surface of the liver
Smooth, fits concavity of diaphragm
85
What is the "bare area" of the liver?
between the two layers of the coronary ligament lies the bare area of the liver, and is attached to the diaphragm by areolar tissue.
Peritoneum that attaches the liver to the anterior body wall and the peritoneum splits to enclose a "bare area"
86
What does the bare area include?
The area where the IVC is posterior to the liver and the hepatic veins drain into it
87
What structure is between the caudate and left lobe of the liver?
Ligamentum venosum
88
What structure can be found between the quadrate and the left lobe of the liver?
Ligamentum teres h.
89
What fossa is found between the quadrate and right lobe of the liver?
Hepatic fossa for gall bladder
90
What surface features are found on the visceral posterior surface of the liver?
Porta hepatis
Ligamentum teres
Ligamentum venosum
Hepatic fossa for gall bladder
91
Describe the porta hepatis of the liver
A transverse fissure between caudate and quadrate lobes that transmits the portal triad
92
What is the portal triad?
Hepatic artery (proper)
Portal vein
Bile duct
93
describe the ligamentum teres
It is in the edge of the falciform and is the obliterated umbilical vein
94
Describe the ligamentum venosum
It is the "old" ductus venosus
| It was used to connect the umbilical vein with the inferior vena cava
95
What are peritoneal attachments of the liver?
Falciform ligament with ligamentum teres
| Lesser omentum with hepatoduodenal and hepatogastric ligaments
96
Where does the gall bladder lie?
In the hepatic fossa
97
What is the fundus of the gallbladder
The lowest, widest part
Contacts anterior abdominal wall at the midclavicular line, 9th or 10th costal cartilage
Usually located on the transpyloric line
98
What are the parts of the gall bladder?
Fundus, body and neck
99
What are the extrahepatic bile passages?
Right hepatic duct (R)
| Left hepatic duct (L)
100
What do the extrahepatic bile passages form together?
The common hepatic duct
101
What is the structure between the common hepatic duct and the gall bladder?
Cystic duct
102
What is the common bile duct?
Formed from the cystic and common hepatic ducts
Runs in the edge of the lesser omentum (hepatoduodenal ligament)
Goes posterior and inferior to the 1st part of the duodenum, posterior to the head of the pancreas, enters the 2nd part of the duodenum with the pancreatic duct
