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Anatomy (Lecture) > Abdominal Viscera > Flashcards

Abdominal Viscera Flashcards

1
Q

Explain the end result of the rotation of the stomach. Where are the attatchments of the dorsal and ventral mesentaries?

A

90 degree spin puts dorsal side of stomach on the left and ventral surface of the stomach on the right. Note that dorsal mesentary is linked to greater curvature and ventral mesentary is linked to lesser curvature.

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2
Q

What are the attachments of the lesser omentum? What is the pyloris?

A
  1. Lesser curvature (ventral mesentery) of the stomach (hepatogastric ligament…clear) + duodenum (hepatoduodenal ligament…thick and opaque since portal triad runs through it) to the liver.
  2. Pylosris separates stomach from duodenum
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3
Q

What attaches to the dorsal side of the stomach?

A
  1. Gastrosplenic ligament (dorsal mesentery)
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4
Q

What organ is fused to the back of the greater omentum? Why? Where are the arteries for the colon found? Where is the greater and lesser sac, relative to the stomach?

A
  1. Transverse colon. Duing development, because of rotation, mesentery had to extend itself, and the extention layed on top of transverse colon. They fuse together (epithelial cells in contact die.) Eventually, distal greater omentum fuses with transverse mesocolon (where areteries are found for the colon). Refer to slides. Greater and lesser sac is ventral and dorsal to stomach, respectively.
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5
Q

What is the gastrocolic ligament? What is significant about this ligament? What is another name for lesser sac?

A

Links distal part of stomach to transverse colon. Penetration of it leads you into lesser sac. And lesser sac = Omental Bursa

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6
Q

What lives in supracolic compartment?

A
  1. Liver, colon, spleen

2. Small intestine and ascending colon.

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7
Q

Where is the overlap between the blood supply of the celiac artery and the superior omentum? What about between the superior and inferior mesenteric artery?

A
  1. 2nd part of the duodenum

2. Transverse colon

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8
Q

How much digestion occurs in the esophagus?

A
  1. Next to none. Only works as a pathway from the mouth to the stomach
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9
Q

What is job of stomach?

A

Stomach mixes and digests

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10
Q

What is job of duedenum?

A

A LOT more digestion occurs here. Note that bile from the liver empties into it, and enzymes from the pancrease help as well.

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11
Q

What is job of jejunum and ileum?

A

Absorption

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12
Q

What is job of colon? Explain the importance of water resorption. What happens if one does not resorb enough water?

A

Absorption (resorption) of water and storage of stool. Note that disease that increase rate of food travel through gi tract would lead to watery stools since the body would not be able to absorb enough of the water. If food stays in colon too long, stool will be rock hard. Failure to reabsorb water would lead to dehydration.

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13
Q

What is the job of the right and left crura (legs) + lumbar origin + costal origin of the abdominal side of the diaphragm? What is the aortic hiatus? What is the caval hiatus for?

A
  1. They contract at central ligament to bring diaphragm down.
  2. Aortic hiatus rests between left and right crura muscles. This is where abdominal aorta passes from.
  3. Caval hiatus is a hole in the TENDON (remember, tendons do not contract, adn vena cava need not be constricted) in the diaphragm where inferior vena cava passes through.
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14
Q

How does the esophagus get through the diaphragm?

A
  1. Esophageal hiatus (within right crura), allowing the muscle to work as a sphincter between the esophagus and the stomach to prevent the HCL from entering into and irritating the esophagus.
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15
Q

What is the z line? What is the goal of the phrenoesophageal ligament?

A
  1. Junction of esophageal and gastric mucosa. Separates esophagus from stomach.
  2. The ligament attaches esophagus loosely to diaphram. Helps with sphincter action. Works in such a way that when diaphragm is not moving, it is not stuck in one spot. Note that sphincter opens when swallowing.
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16
Q

What is a sliding hiatus hernia? What is paraesophageal hiatus hernia?

A
  1. Abdominal esophagus and cardia parts of the stomach (fundus) slide up into the thorax through the right crura and sphincter of the diaphragm. You will notice regurgitation.
  2. . Only the fundus of the stomach slides up along side the esophagus into the sphincter setup. There is no regurgitation since the swallowing processes was not affected.
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17
Q

What is the benefit of have the fundus part of the stomach be higher than the entry point of the stomach?

A

Gas floats here. You could tilt to the left to bring the cardia (stomach opening) above the fundus, allowing a gas bubble to pass through

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18
Q

What is the difference, muscular wise, between the stomach and the rest of the digestive tract?

A

Stomach has 3 layers of smooth muscle, versus 2 (inner (middle, specifically for stomach) circular layer and out longitudinal layer) in the other parts. The 3rd layer for the stomach is the innermost oblique layer.

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19
Q

What makes up the thick pyloric sphincter of the stomach?

A

Made of the middle circular smooth muscle layer of the stomach. Stays closed during stomach churning.

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20
Q

Describe blood supply of the stomach

A

Right and left gastric artery run in lesser curvature of stomach and anastamose.
Right and left gastroomental arteries anastomose on the greater curvature of the stomach.
Fundus of stomach is supplied by branches of splenic arteries called Short Gastric arteries. They do not anastamose, so relatively poorest area of circulation on the stomach. Fundus is most susceptible to ischemia. (pancreatic tumor or some kind of obstruction to the splenic artery would wreck the fundus…)

21
Q

What are the 4 main parts to the duodenum? Which parts are secondary retroperitoneum? Where does the jejunum start?

A

1st part horizontal, 2nd part (bilde duct drains here) downward, 3rd part horizontal in opposite direction, 4th part vertical.
2nd, 3rd, and 4th are secondary retroperitoneal. Note that jejunum is peritoneal again. When is loses the mesentary, it becomes jejunum, at the duodenojejunal flexure.

22
Q

What is the job of the suspensary ligament (of Treitz)?

A

Holds of duodenojejunal flexure

23
Q

What is the job of the gastroduodenal artery? What

A

It branchs off of an artery coming from the celiac artery. Foods the 1st part of duodenum and branches again to feed head of pancrease. This branch = Superior pancreaticoduodenal artery

24
Q

How does superior mesenteric artery feed the pancrease?

A

It provides an inferior pancreaticoduodenal artery, which feeds inferior head of the pancrease. Note that this anastemoses with superior pancreaticoduodenal artery.

25
Q

What is significant about the arteries at the head of the pancrease?

A

They branch off and feed. Meaning, if you need to remover the head of the pancrease, you most also remove the duodenum, because it will have zero chance of surviving.

26
Q

Which parts of the pancrease are secondarily retroperitoneal? Where does the tail sit?

A
  1. Head, neck, and body

2. Tail sits at splenorenal ligament and touches the spleen. Stays in the mesentery, so it is periotoneal.

27
Q

What is the uncinate process?

A

Hook component at head of the pancrease. Hooks itself under superior mesentaric artery and vein.

28
Q

Describe the presence of the ducts on the pancrease. What is the hepatopancreatic ampulla (of Vater)

A

Came about from the joining of the two parts of the pancrease. Minor Pancreatic Duct (of Santorinin) from dorsal pancrease bud and Major Pancreatic Duct (of Wirsung) from ventral pancrease bud. The hepatopancreatic ampulla of Vater is where the Common Bile Duct and fused pancreatic ducts link together before entering into the duodenum.

29
Q

Describe blood supply to the pancrease

A

Body and tail get blood from splenic artery (runs on upper border of pancrease. Splenic vein runs posterior to the pancrease). Note that the head of the pancrease still gets its blood supply from the superior and inferior pancreaticoduodenal arteries.

30
Q

What is a pancreaticoduodenectomy (Whipple Procedure?)

A

Created because if you remover the head of the pancreas, you must also remove the duodenum because they share same blood supply. The procedure creates a pathway to get from the stomach to the jejunum. Ultimately, you connect the stomach, pancrease, and bile duct to the jejunum.

31
Q

What is the point of the falciform ligament? What is the coronary ligament? How do you get the liver to descend for palpation? Where is the liver directly in contact with the diaphragm?

A

Connected liver to ventral body wall. It is a remnant of ventral mesentery. Note that liver sits under diaphragm. Coronary ligament makes contact between the head of the liver and the underneath of the diaphragm. Note that the diaphram has parietal peritonieal. To descend liver, take a deep breath, which contracts the diaphragm and pushes down on the liver. Liver directly contacts diaphragm at bare area (which is also where the hepatic veins leave the liver to enter inferior vena cava).

32
Q

What are the lobes of the liver? What is the functional right lobe?

A
  1. use the falciform ligament as a divider into left and right (larger) lobes.
  2. Functional left lobe (left lobe + caudate and quadrate lobes of the liver). Functional left lover is whatever is left on the right side.
33
Q

What is the porta hepatis?

A

It’s the portal vein, proper hepatic artery, and common hepatic duct splitting into a right left to feed their respective liver lobes. Feeds functional, not anatomical, lobes.

34
Q

Where does common bile duct carry bile from? What carries bile out of the gallbladder? What is the name of the duct that result from the fusion of these ducts? What happens if gall bladder is blocked off?

A
  1. Both right and left lobe of the Liver
  2. Cystic duct carries bile out the gallbladder.
  3. Common bile duct. It opens when you eat a meal and the smooth muscle of the gall bladder contracts and allows the bile to flow into the duodenum. If you cut off gall bladder, it will keep squeezing when hungry, leading to stomach pain since it is unable to remove the occlusion. If occlusion proceeds to common bile duct, bile from liver seeps into bloodstream. (results in JAUNDICE). You will not get jaundice from blockage of cycstic duct.
35
Q

What is the blood supply to the liver? What artery goes to the gallbladder?

A

Celiac artery, which has a main Common Hepatic Artery, but also further branches off the celiac artery to give off proper hepatic artery, which produces right and left hepatic arteries. Cystic artery, coming off of right hepatic artery goods to the gallbladder.

36
Q

What is the hepatocystic triangle (of Calot)

A

Cysitc artery passes through it to get to the gall badder. It is bounded by cystic duct, right hepatic duct, and liver

37
Q

Spleen is located

A

Between stomach and left kidney. Note that spleen lies against 9, 10, and 11th ribs on the left side. It is entirely covered by the rib cage (normally…unless splenomegaly). Also note that damage to these ribs could rupture spleen.

38
Q

What are the four parts of the small intestine? What is the blood supply to the small intestine? Keep in mind that it is in the midgut…How do the blood vessels get to destination?

A

Duodenum, Jejunum (first 2/5), Ileum (last 3/5). Blood supply = superior mesenteric artery (gives off intestinal arteries to jejunum and ileum. They run through mesentery.)

39
Q

What is the difference between arcards and vasa recta?

A

Arcades come off in in or two tiers in the proximal jejunum and this becomes more elaborate in tier quantity as you get to distal ileum. Arcades branch off until they reach vasa recta. Vasa recta get shorter as you reach distal jejunum. ALSO: more anastamosis in arcades than in vasa recta, so tissue in this gut region is more likely to become ischemic if occluded.

40
Q

Difference between jejunum and ilium

A

Jejunum has way more vascularity (food digests and absorbs more proximal than distal in the intestie, so it makes sense.) Also, Less fat in mesentery of jejunum (easier to see through) than in ileum. Jejunum is redder. Gut tube diameter is larger in jejunum than in ileum. Jejunum has thicker wall (more folds, more surface area for more absorption). WAY LESS nodes in jejunum than in ileum.

41
Q

Where is jejunum and where is ileum in the gut? Why?

A

Jejunym - upper left quadrant, ileum = lower right quadrant. Cause: rotation. There is usually more bowel in the left and right side, not the center, because the vertebral column takes too much space Note that jejunum looks feathery on x ray because of all the folds.

42
Q

What enters the cecum (first part of the colon/large intestine), and what closes it off? What comes off of the cecum?

A
  1. Ileum, closed off by ileocecal valve. The appendix comes off of the cecum!
43
Q

What is the name of the turn between the ascending colon and the transverse colon? What about between the transverse and descending colon? Remember that ascending and descending colon are secondary peritoneal. When does the sigmoid colon start? What starts when you reach the rectorsigmoid junction?

A
  1. Hepatic flexure/right colic flexure
  2. Splenic flexure/left colic flexure
  3. Sigmoid colon starts when the descending colon regains a mesentery
  4. Lose mesentary again since you are now retroperitoneal. starts the rectum.
44
Q

What exists on colon and not the small intestine? What are haustra? What are omental appendicis?

A
  1. Teniae coli (strip of smooth muscle). 3, 1 for ever 120 degrees.
  2. Teniae coli is shorter than length of the colon, causing it to bunch up. These folds are the haustra. Also only found in colon.
  3. layers of fat inbetween viscseral peritoeum and wall of colon (inside visceral peritoneum). Also only in colon, not intestine. Omental appendicies
45
Q

What continuous outer layer surrounds the appendix? What mesentary surrounds the appendix, and what artery runs in it? What position of the appendix is the most common?

A
  1. Teniae coli. Use this to locate the appendix,
  2. Appendix surrounded by mesoappendix, which holds appendicular artery
  3. Retrocecal position is the most common.
46
Q

What arteries supply proximal colon?

A
  1. Superior mesenteric artery (which branches into middle colic artery for transverse colon, right colic artery for ascending colon, and ileocolic artery for ileum and ceum). Appendicular artery is a branch of ileocolic.
47
Q

What arteries supply distal colon?

A

They are supplied by inferior mesenteric artery which gives off left colic artery for descending colon, sigmoid artery for sigmoid colon, adnt eh inferior mesenteric artery changes name to superior rectal artery when it reaches rectum.

48
Q

What is special about branching of the inferior and superior mesenteric arteries?

A

They all branch superiorly and inferiorly to create a marginal artery which lines the entire colon. The ultimate final pathway to the colon is still vasa recta, which is still prone to ischemia.

49
Q

What is something to note about transverse colon?

A

Longer transverse colon dips down more. You can recognize which side the patient is lying down by locating the black area (gas) which tells you that the patient is lying down in the opposite side of it. Also note that hepatic flexure should always be lower than the splenic flexure because the liver is in the way. If splenic flexure was at the same level, or lower: splenomegaly.

Anatomy (Lecture) (32 decks)

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