Abdominal Viscera Flashcards
What is a sliding hiatal hernia?
- esophageal hiatus of diaphragm enlarges or weakens
- abdominal esophagus and parts of the stomach (cardia and fundus) herniated into thorax
What is a paraesophagegal hiatal hernia?
- defect in diaphragm next to the esophageal hiatus
- permits fundus of the stomach to herniate (not usually the esophagus)
Where is the stomach?
- left hypochondriac and epigastric regions
- left end fixed at T10-11
- right end fixed at L1-2
What are the different parts of the stomach?
- fundus
- cardiac part, cardiac orifice
- body
- pylorus
- pyloric antrum
What are the surfaces of the stomach?
- rugae
- pylorus(pyloric sphincter)
- pyloric orifice -> entrance to duodenum
What organs are posterior to the stomach?
- diaphragm
- spleen
- left suprarenal gland
- upper left kidney
- pancreas
- left colic flexure
- left transverse colon
- transverse mesocolon
What structures are anterior to the stomach?
- anterior abdominal wall
- left costal margin
- left diaphragm
- left and quadrate lobes
What are the three subdivisions of the small intestine?
- duodenum
- jejunum
- ileum
What are some general features of the duodenum?
-C shaped
-10in long
-located at L1 to L4 vertebral bodies
-subdivided into 4 parts
+superior
+descending
+horizontal
+ascending
What ligaments and mesenteries is the duodenum covered by?
- covered anteriorly by peritoneum except where the mesocolon of the transverse colon crosses and 2nd part
- the 1st part is surrounded by the hepatoduodenal ligament
- the root of the mesentery begins at the duodeno-jejunal flexure
What are the features of the superior duodenum?
- starts at pyloric sphincter
- 2in long
- held in place by the hepatoduodenal ligament
- portal veins, hepatic artery, and bile duct and post. And sup to this part
- duodenal bulb
- head of pancreas is inf to this part
What are the features of the descending duodenum?
- 3in long
- all retroperitoneal
- the fundus of the gallbladder, right lobe of the liver, transverse colon are all anterior
- right kidney and ureter are posterior
- head of pancreas is medial
- bile and pancreatic ducts enter into the second part of the duodenum at the major duodenal papilla
What are some features of the horizontal duodenum?
- their sup mesenteric artery and vein and the root of the mesentery cross the anterior surface
- head of pancreas is superior
- jejunum is anterior and inferior
What are the features of the ascending duodenum?
- not covered by peritoneum
- root of mesentery and jejunum
- left margin of the aorta and medial border of the psoas muscle are posterior
- held in place by the suspensory ligament of the duodenum (of Treitz)
- anchors to the right crus of the diaphragm
What are some general features of the jejunum and ileum?
- occupy most of the peritoneal cavity of the abdomen and pelvis
- coiled and about 20ft long
- begins at duodenal-jejunum junction and ileum ends at ileo-decal valve
- very mobile and held to the posterior wall by the mesentery
- framed by the large intestine
What are some features of the jejunum?
- simple vascular arcades, long vasa recta, more vascular
- greater diameter, thicker, more plicae circularis
What are some anatomical features of ileum?
- 3/5 of the SI
- has compound arcades, shorter vasa recta, is less vascular
- smaller diameter, thinner wall
- fewer plicae circularis
What is Meckel’s diverticulum?
Most common congenital anomaly of the SI
- occurs in about 2% of the population
- 2ft from ileo-cecal junction
- remnant of vitelline duct
- clinically difficult to distinguish from appendicitis
- may contain other tissue types
What does the mesentery attach the jejunum and ileum to?
The posterior body wall
What does the mesentery cross???
- L1-2
- 3rd part of duodenum
- aorta
- IVC
- right ureter
- right gonadal vessels
- right psoas major
- ends at right SI joint
What are the features of mesentery on the jejunum and ileum?
- made up of 2 layers of peritoneum with nerves, lymph nodes, vessels, fat, arteries, and veins running between them
- 6-7in long at it’s root and 20ft long at its intestinal border
What are the regions in the large intestine?
- cecum and veriform appendix
- ascending colon
- right colic flexure
- transverse colon
- left colic flexure
- descending colon
- sigmoid colon
- rectum and anal canal
What are the general characteristics of the large intestine/
-highly mobile
-functions: fecal formation, transport and evacuation, water absorption and mucus secretion
-Taenia coli are 3 bands of longitudinal muscle on the outside of the colon
+converge at root of appendix
+produce haustrae that slow the movement of feces
-appendices epiplicae
+tags of fat
+characteristic of the large intestine
What is the cecum?
- no epiploic appendages
- blind pouch inferior to ileocecal orifice
- ileocolic valve is 2 folds that are not a true sphincter
- ideal papilla is a cone-like projection of the ileum into the cecum
- opening for the appendix is inferior to the ideal papilla
Describe the vermiform appendix.
-usually attached to the posteri-medial part of the cecum
-located at the junction of the 3 Taenia coli
-supported by mesoappendix
Position variable
What is the size, shape, and location of the spleen?
- left hypochondriac region
- parallels left ribs 9, 10, 11
- mid axillary line, between stomach and diaphragm
- about the size of a hand
- normally not palpable below the costal margin
Peritoneal relationships with spleen.
-develops in dorsal mesentery from mesoderm
+gastrosplenic ligament
+splenorenal ligament
What other organs does the spleen relate with?
- diaphragm is posterior
- stomach, left colic flexure and tail of the pancreas are anterior to the spleen
- left kidney and phrenicocolic ligament are inferior to the spleen
What are some general features of the pancreas?
- secondarily retroperitoneal
- located L1-L2
- parts: head, body, neck, tail
What relationships with other organs does the pancreas have?
- superior mesenteric artery and vein are posterior to the neck
- splenic veins and artery run horizontally superior to or posterior to the body
- tail against spleen
- inferior vena cava and aorta are posterior to the body
- stomach is anterior to spleen
- duodenum is superior, right and inferior to head
- transverse colon is anterior ad inferior
Main or major pancreatic duct joins the _________ duct and enter the _______ part of the duodenum through a common ______________ ampulla.
- bile
- 2nd
- heptopancreatic
- forms the major duodenal papilla
- accessory pancreatic duct enters the duodenum at the superior minor duodenal papilla
What quadrant(s) is the liver located?
-most in right upper and left lobe is located in the left upper quadrant
What are the lobes of the liver?
- left lobe
- right lobe
- caudate lobe
- quadrate lobe
What ligament separates the right left lobes?
-falciform ligament -> double layer of peritoneum that connects liver to anterior wall
What is the diaphragmatic surface of the liver?
-smooth, fits con cavity of diaphragm
-peritoneum attaches the liver to the anterior body wall and the peritoneum splits to enclose a bare area of the liver
+area where IVC is posterior to liver and hepatic vein drains
What is found in the visceral surface of the liver?
-ligamentum venosum \+old ductus venosus \+used to connect the umbilical vein with the inferior vena cava -ligamentum teres \+edge of falciform \+obliterated umbilical vein -hepatic fossa for gallbladder -lobes of liver -porta hepatis \+a transverse fissure between caudate and quadrate lobes \+transmits portal triad
What is the portal triad?
- hepatic artery
- portal vein
- Bile duct
Where does gallbladder and biliary tract lie?
-lies in hepatic fossa
-fundus
+lowest, widest part
+contacts anterior abdominal wall at the midclavicular line, 9th or 10th costal cartilage
+usually located on the transpyloric line
What are the parts of the gallbladder?
- fundus
- body
- neck
What the extra hepatic bile passages?
-rt hepatic duct
-left hepatic duct
+together form the common hepatic duct
-cystic duct
-bile duct
What is the bile duct formed from?
Cystic and common hepatic ducts
Where is the esophageal hiatus? What does it enter next?
- T10, slightly. Left of midline (passes through diaphragm at T8, T10, T12)
- turns sharp left to enter stomach cardiac orifice, T11 (about 2.5cm)
- esophageal sphincter is physiologic not defined anatomically
