Abdominal Viscera Flashcards
What organs make up the foregut?
- esophagus
- stomach
- duodenum
- liver
- gallbladder
- spleen
- pancreas
Which organs make up the midgut?
- duodenum
- jejunum
- ileum
- cecum and appendix
- ascending colon
- 2/3 of transverse colon
Which organs make up the hindgut?
- 1/3 tranverse colon
- descending colon
- sigmoid colon
- rectum and anal canal
At what vertebra level does the thoracic esophagus pierce the diaphragm?
- T10
- through the esophageal hiatus
- slightly left of midline
What does the esophagus do once it courses through the esophageal hiatus?
- Turns sharply left to enter the stomach at the cardiac orifice.
- about T11
- abdominal esophagus is 2.5 cm long
- the esophageal sphincter is physiologic, not well-defined anatomically
At which vertebral levels do structures pass through the diaphragm?
- T8 - IVC
- T10 - esophagus
- T12 - aorta
What is a “sliding” hiatal hernia?
- esophageal hiatus of diaphragm enlarges or weakens
- abdominal esophagus and parts of the stomach (cardia and sometimes fundus) herniate into the thorax
** no CT image in slides **
What is a paraesophageal hiatal hernia?
- defect in diaphragm next to the esophageal hiatus
- permits fundus of stomach to herniate (not usually the esophagus)
** has CT image in slides of it **
In which quadrants of the abdomin is the stomach located in?
- left hypochondriac region
- left epigastric region
Which plane transverses through the stomach to separate it between the left hypochondriac and epigastric regions?
transpyloric plane
What vertebral region is the left end of the stomach fixed at?
T10-11
What vertebral level is the right end of the stomach fixed at?
L1-2
What is the pyloric antrum of the stomach?
entrance to the pylorus
What is the pyloric orifice of the stomach?
entrance to the duodenum
What makes up the muscularis externa of the stomach going from superficial to deep?
- outer longitudinal layer
- middle circular layer
- inner oblique fibers
Which layer of the stomach muscularis externa is circular?
middle circular layer
What is found posterior to the stomach?
- diaphragm
- spleen (posterior and lateral)
- left suprarenal gland
- upper left kidney
- pancreas
- left colic flexure
- left transverse colon
- transverse mesocolon
What is found in relation to the anterior of the stomach?
- anterior abdominal wall
- left costal margin
- left diaphragm
- left and quadrate lobes of the liver
Is the left and quadrate lobes of the liver found on the anterior or posterior side of the stomach?
anterior relationship
Which portion of the diaphragm has an anterior relationship with the stomach?
left diaphragm
What organs is the small intestine located between?
between stomach and large intestine
How long is the duodenum?
10 inches long
What are the four parts of the duodenum?
- superior
- descending
- horizontal
- ascending
The duodenum is located approximately at which vertebral vertebra?
L1 to L4
Which ligament suspends the duodenum to the right crus of the diaphragm?
suspensory ligament of duodenum
Is the duodenum a retroperitoneal structure?
Yes - seondarily retroperitoneal
**except for some of the 1st and 4th parts**
What is the anterior portion of the duodenum covered by?
Covered anteriorly by peritoneum except where the mesocolon of the transverse colon crosses the 2nd part.
What is the first part of the duodenum surrounded by?
hepatoduodenal ligament
Where does the root of the mesentery begin?
At the duodeno-jejunal flexure.
Which vessels are found posterior and superior to the 1st part of the duodenum?
- portal vein
- hepatic artery
- bile duct
Is the head of the pancreas inferior or superior to the 1st part of the duodenum?
inferior
Where are the fundus of the gallbladder, right lobe of the liver, and transverse colon located in respect to the 2nd part of the duodenum?
anterior
Is the 2nd part of the duodenum all retroperitoneal?
YES
Where is the kidney and ureter located in respect to the 2nd part of the duodenum?
posterior
True or False:
The bile and pancreatic ducts enter into the second part of the duodenum at the major duodenal papilla.
True
Is the head of the pancreas located medially or superiorly to the 2nd part of the duodenum?
medial
What major vessels cross the anterior surface of the 3rd part of the duodenum?
superior mesenteric artery and vein; and the root of the mesentery
Where is the head of the pancreas located with respect to the 3rd part of the duodenum?
superior
Where is the jejunum located with respect to the 3rd part of the duodenum?
anterior and inferior
Is the 4th part of the duodenum covered by peritoneum?
NO
Where is the root of the mesentery and jejunum located with respect to the 4th part of the duodenum?
anterior
What muscle and major vessel is found posterior to the 4th part of the duodenum?
- left margin of aorta
- medial border of psoas muscle
What ligament holds the 4th part of the duodenum in place?
Suspensory Ligament (or muscle) of the duodenum (of Treitz).
True or False:
The suspensory ligament of the duodenum is of muscular origin, not viceral or mesenteric.
True
Which parts of the small intestine occupy most of the peritoneal cavity of the abdomen and pelvis?
jejunum and ileum
How long is the jejunum and ileum, combined?
20 feet
What holds the jejunum and ileum to the posterior wall of the abdomin?
mesentery
What is another name for the jejunum and ileum?
“free” small intestine
Compare and Contrast the jejunum and ileum.
- Length:
- jejunum -> 8-10 feet long
- ileum -> 10-12 feet long
- Portion of “free” intestine:
- jejunum -> 2/5
- ileum -> 3/5
- Vascular arcades:
- jejunum -> simple vascular arcades, long vasa recta, more vascular
- ileum -> compound vascular arcades, shorter vasa recta, less vascular
- Size:
- jejunum -> greater diameter, thicker, more plicae circularis
- ileum -> smaller diameter, thinner wall, fewer plicae circualris
What is the most common congenital anomaly of the small intestine?
Meckel’s (ileal) diverticulum
** in the ileum **
Where does Mecke’s (ileal) diverticulum typically occur?
- About 2 feet from the ileo-cecal junction.
- Occurs in 2% of population
- Average about 2 inches long
- Rmenant of the vitelline duct
- Clinically difficult to distinguish from appendicitis
- May contain other types of tissue
How long is the mesentery at the root?
15 cm (6-7 inches)
What does the mesentery attach to the posterior abdominal wall?
jejunum and ileum
What does the mesentery cross?
- L 1-2
- 3rd part of duodenum
- aorta
- IVC
- right ureter
- right gonadal vessels
- right psoas major
- ends at right S.I. joint
What runs in between the mesentery (2 layers of peritoneum)?
- nerves
- lymph nodes and vessels
- fat
- arteries
- veins
How long is the mesentery at it’s intestinal border?
20 feet
Where is the rectum and anal canal located?
in the pelvis
Is the large intestine highly mobile?
yes
What are the functions of the large intestine?
- fecal formation
- transport
- evacuation
- water absorption
- mucus secretion
What are taenia coli?
3 bands of longitudinal muscle on the outside of the colon.
- they converge at root of appendix
- they produce haustrae (sacculations) that slow the movement of feces
What are appendices spiploicae (epiploic appendages)?
- tags of fat
- characteristic of the large intestine
Does the cecum have epiploic appendages?
no
Is the iliocolic valve a true sphincter?
NO - 2 folds that are not a true sphincter.
What is the ileal papilla?
a cone-like projection of the ileum into the cecum
Where is the opening for the appendix located in relation to the ileal papilla?
inferior
Which parts of the colon are secondarily retroperitoneal?
- ascending colon
- descending colon
Which parts of the colon are intraperitoneal?
- transverse colon (transverse mesocolon)
- sigmoid colon (sigmoid mesocolon)
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
What are the peritoneal relationships of the spleen?
- covered by peritoneum
- develops in the dorsal mesentery from mesoderm
- gastrosplenic ligament
- splenorenal ligament
What are the relation of the spleen with other organs of the abdominal cavity?
- diaphragm is posterior
- stomach, left colic flexure and tail of pancreas are anterior to the spleen
Does the spleen have a diaphragmatic surface?
yes - smooth against diaphragm
Where are the left kidney and phrenicocolic ligament in relation to the spleen?
inferior to spleen
What impressions are found on the visceral surface of the spleen?
- colic
- gastric
- renal
Which two ligaments are found in the hilum of the spleen?
- gastrosplenic
- splenorenal
Is the pancreas seondarily or primarily retroperitoneal?
Secondarily Retroperitoneal
Is some of the tail of the pancreas located in the splenorenal ligament?
yes
Is the tail of the pancreas anterior or posterior to the hilus of the spleen?
anterior
What are the relationships of the pancreas to other organs in the abdominal cavity?
- superior mesenteric artery and vein are posterior to the neck
- splenic vein and artery run horizontally superior to or posterior to the body
- the tail is against the spleen
- inferior vena cava and aorta are posterior to the body
- stomach is anterior to the spleen
- duodenum is superior, right and inferior to the head
- transverse colon lies anterior and inferior to the pancreas
What joins the bile duct at the hepatopancreatic ampulla?
main or major pancreatic duct
Where does the accessory pancreatic duct enter the duodenum?
more superior minor duodenal papilla
Where does the main pancreatic duct and bile duct empty into the 2nd part of the duodenum?
major duodenal papilla
Where is most of the liver located?
right upper quadrant
Where is the smaller left lobe of the liver located?
left upper quadrant
What are the 4 lobes of the liver?
- right lobe
- left lobe
- quadrate lobe
- caudate lobe
What is the falciform ligament?
Is a double layer of peritoneum that connects liver to the anterior wall.
What connects the liver to the anterior abdominal wall?
Falciform ligament - which is a double layer of peritoneum.
What does the peritoneum that attaches the liver to the anterior body wall split to enclose?
“bare area” of the liver
What does the bare area include?
Area where IVC is posterior to liver and hepatic veins drain into it.
Which ligament borders the left and anterior side of the caudate lobe?
ligamentum venosum
Which ligament boarders the left side of the quadrate lobe?
ligamentum teres (round ligament)
- in the edge of the falciform
- obliterated umbilical vein
What is the porta hepatis?
- transverse fissure between caudate and quadrate lobes
- transmits the portal triad
- hepatic artery (proper)
- portal vein
- bile duct
Which ligament is the obliterated umbilical vein?
ligamentum teres
Which ligament is the “old” ductus venosus?
- ligamentum venosum
- used to connect the umbilical vein with the inferior vena cava
What did the ductus venosus connect before it became the ligamentum venosum?
umbilical vein with inferior vena cava
What are the peritoneal attachments of the liver?
- falciform ligament with ligamentum teres
- lesser omentum with hepatoduodenal and hepatogastric ligaments
Where does the gall bladder and biliary tract lie?
hepatic fossa
Where does the gallbladder contact the anterior abdominal wall at?
Midclavicular line - 9th or 10th costal cartilage.
Is the gallbladder typically located on the transpyloric line?
Yes
What forms the bile duct and where does it course?
- Bile Duct: formed from 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.
