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GI I > Abdominal viscera II > Flashcards

Abdominal viscera II Flashcards

1
Q

What is the function of the spleen

A

filter RBC and platelets from circulation

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2
Q

what are the general features of the spleen

A

ovoid shaped organ
located in LUQ
protected by lower 4 ribs
peritonealized

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3
Q

what lay beneath the spleen

A

diaphragm and the costodiaphragmatic recess, ribs 9-11

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4
Q

which way does the hilum of the spleen face

A

anteromedially

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5
Q

describe the differences between the superior.anterior borders of spleen to inferioposterior

A

superior/anterior- notched and sharp

inferoposterior- smooth

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6
Q

what attaches the stomach to the spleen

A

gastrosplenic

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7
Q

what attaches spleen to kidney and post wall

A

splenorenal lig

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8
Q

what does the spleen rest inferiorly on

A

phrenicocolic ligament

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9
Q

what a supplies the spleen

A

splenic from the celiac trunk

travles through splenorenal lig to hilum

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10
Q

what is the course of the splenic vein

A

usually receives inferior mesenteric vein then merges with superior mesenteric vein to form portal vein

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11
Q

describe lymph drainage of the spleen

A

pacreaticosplenic lymph nodes–>celiac lymph nodes

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12
Q

what causes splenomegaly

A

anemias and lymphomas

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13
Q

where are accessory spleens found

A

within the gastrosplenic ligament

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14
Q

what is dangerous about splenic needle insertion

A

careful not to damage pleural cavity via the costodiaphragmatic recess relationship with the spleen

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15
Q

What are the 2 generalized functions of the pancreas

A

endocrine and exocrine

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16
Q

describe the exocrine function of the pancreas

A

secretes pancreatic enzymes into duodenum for digestion

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17
Q

describe the endocrine function on pancreas

A

secretion of pancreatic hormones into bloodstream from specialized cell sin Islets of langerhans

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18
Q

what do the cells in islets of langerhans secrete

A

glucagon and insulin

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19
Q

is the pancreas peritonealized or retroperitoneal

A

retro

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20
Q

What are the external parts of the pancreas

A 
head
uncinate process
neck
body
tail
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21
Q

where is the tail of the pancreas

A

in the splenorenal ligament

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22
Q

Where is the head of the pancreas

A

right and inferior is the duodenum
posterior is LV1LV2, IVC and renal vessels and bile duct
anterior is the pyloric region of stomach and SI

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23
Q

Where is the uncinate process of the pancreas

A

posterior to the superior mesenteric vessels

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24
Q

where is the neck of the pancreas

A

anterior is the transverse mesocolon and SI

posterior is the superior mesenteric a, and the formation of the hepatic portal vein

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25
Q

where is the body of the pancreas

A

anterior to it is the stomach

posterior is the aortam left suprarenal gland, left kidney, renal vessels

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26
Q

what is the relationship between spleen and pancreas

A

the tail of the pancreas contacts the hilum of the spleen

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27
Q

What is the path of the main pancreatic duct

A

beins in tail, travels through pancreas and merges with bile duct to form hepatopancreatic ampulla
empties into second portion of duodenum at major duodenal papilla

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28
Q

what sphincters control release of bile and pancreatic enzymes

A

sphincter of pancreatic duct
sphincter of bile duct
hepatopancreatic sphincter of Oddi

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29
Q

Where does the accessory pancreatic duct

A

travels through superior portion of head of pancreas and empties into the 2nd portion of duodenum at the minor duodenal papilla

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30
Q

What 2 main arteries supply pancreas

A

celiac and superior mesenteric

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31
Q

what are the branches of celiac that supply pancreas

A 
splenic artery gives off
dorsal pacncreatic
pancreatica magna
artery of the tail on pancreas aa
gastroduodenal gives of
anterior superior pancreaticoduodenal and posterior superior pancreaticoduodenal
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32
Q

what are the branches off superior mesenteric a that supply pancreas

A

anterior inferior pancreaticoduodenal

posterior inferior pancreaticoduodenal

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33
Q

where do vv drain from pancreas

A

hepatic portal vein

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34
Q

describe lymph drainage of pancreas

A

pancreaticosplenic nodes along splenic a

these then drain to celiac and superior mesenteric lymph nodes

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35
Q

what is a common cause on pancreatitis

A

reflux of bile through hepatopancreatic ampulaa into the main pancreatic duct
(gallstones cause this)

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36
Q

what can pancreatic cancer cause on bile duct

A

obstruction that leads to gallbladder enlargement, retention of bile, secondary jaundice

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37
Q

What is the function of the liver

A

metabolism of bile, lipids, carbohydrates, proteins
production of urea
detox

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38
Q

where does the left lobe of liver exten to

A

apex of heart

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39
Q

what ribs provide some protection to the liver

A

ribs 5-11

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40
Q

describe the surfaces of the liver

A

anterior and superior is smooth and convex for diaphragm

posterior and inferior is smooth and concave for the viscera

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41
Q

What is the porta hepatis

A

fissure on central portion of posterior inferior surface

entrance for hepatic aa, portal v, bile ducts lymph and nerves

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42
Q

what are located on the sides of the porta hepatis

A

sagittal fissures

43
Q

What is contatined in the sagittal fissures of the liver

A

R fissure has gall bladder(anterior) and IVC (posterior)

L fissure has ligamentum teres hepatis (anterior) and ligamentum venosum (posterior)

44
Q

What is anterior and posterior to the porta hepatis

A

anterior is the quadrate lobe

posterior is the caudate lobe

45
Q

What ligaments are assoc with the liver

A

falciform, coronary and lesser omentum has 2

46
Q

laterally the coronary ligaments fuse and form what

A

triangular ligaments

47
Q

what ligaments assist lesser omentum

A

hepatogastric

hepatoduodenal

48
Q

what is within the hepatoduodenal ligament and their relative position

A

proper hepatic a (anterior and left)
bile duct (anterior and right)
hepatic portal vein (posterior)

49
Q

What are the 2 recesses of the liver

A

subphrenic and hepatorenal

50
Q

what separates the subphrenic recess

A

falciform ligament

51
Q

what makes the subphrenic recess

A

extension of greater sac between anterior surface of liver with diaphragm

52
Q

what makes the hepatorenal recess

A

extension of greater sac between visceral surface of liver and kidney

53
Q

the anterior layer of coronary ligament binds what recess

posteiror layer?

A

anterior- subphrenic

posterior- hepatorenal

54
Q

What is the deepest part of the peritoneal cavity when a patient is supine

A

hepatorenal recess

55
Q

What is a subphrenic abscess

A

accumulation of purulent exudate in the subphrenic recess (on the right is most common)

56
Q

where do abscess and fluid drain to from subphrenic recess

A

into hepatorenal recess

57
Q

where is an incision made to drain the subphrenic recess

A

just below the 12th rib

58
Q

what separates the right and left lobe of the liver

A

falciform ligament

59
Q

what is the quadrate lobe

A

subdivision of the right lobe, anterior to the porta hepatis

60
Q

what is the caudate lobe

A

subdivision of the right lobe
posterior to the porta hepatis
caudate process extends posterior to gall bladder

61
Q

What determines a functional lobe of the liver

A

receives a primary branch of hepatic a and portal v and is drained via hepatic duct

62
Q

What are the funtional lobes of the liver

A

right lobe
left lobe
caudate lobe

63
Q

How many hepatic segments are each functional lobe divided into

A

8

64
Q

what is the smallest unit of the liver

A

liver lobule

65
Q

what is the structure of a liver lobule

A

6 hepatocytes around one central vein

66
Q

What lay at the periphery of the liver lobule

A

6 branches of portal triad
interlobular branch of hepatic portal vein
portal a
bile duct

67
Q

how does bile flow out of hepatocytes

A

within bile canaliculi to periphery to an interlobular bile duct then into right and left hepatic ducts to the common hepatic duct

68
Q

what forms the bile duct

A

when the common hepatic duct merges with the cystic duct

69
Q

Where does the bile duct travel within

A

free edge of the hepatoduodenal ligament

70
Q

what forms the hepatopancreatic ampulla

A

distal bild duct merging with main pancreatic duct

71
Q

where does the hepatopancreatic ampulla drain to

A

the minor part of the duodenum

72
Q

what is the distal sphincter of the bile duct called

A

choledochal

73
Q

What is an accessory hepatic duct and its potential risk

A

normal segmental hepatic duct outside liver

danger of being damaged during hepatic surgeries

74
Q

the bare area of the liver is in direct contact with what structure? irritation here has referred pain where?

A

direct contact with diaphragm and refers to the shoulder because of phrenic n

75
Q

What 2 main vascular aa/vv supply the liver

A

proper hepatic a to 20%

hepatic portal vein 80% blood to liver

76
Q

the left saggital fissure of the liver is hat two structures? and what are they derived from?

A

ligamentum teres- round ligament from umbilical vein

ligamentum venosum- from ductus venosus

77
Q

the caudate lobe is between what 2 structures

A

IVC and the ligamentum venosum

78
Q

caudate and quadrate lobes are apart of what functional lobe

A

the left

79
Q

describe path of proper hepatic a

A

travels with portal triad and divides into left and right hepatic a at the porta hepatis

80
Q

what vessesl supplies most of oxygen to the liver parenchym

A

hepatic portal vein

81
Q

what vessels form the hepaticportal vein

A

fusion of splenic and superior mesenteric veins

82
Q

what is the portal triad

A

branch if biliary duct, branch of hepatic porta vein, branch of hepatic a

83
Q

at the porta hepatis what happens to the hepatic portal vein

A

divides into left and right branches

84
Q

an aberrant (accessory) left hepatic a is derived from what

A

left gastric a

85
Q

an aberrant(accesssory) right hepatic a comes from what

A

superior mesenteric a

86
Q

what are the 2 locations that the right hepatic a sits in relation to portal vein? then in relation to hepatic duct?

A

91% anterior to portal vein
9% posterior to portal vein
64% posterior to common hepatic duct
24% anterior to common hepatic duct

87
Q

describe the venous drainage of the liver

A

both portal vein and hepatic a feed to hepatic sinusoids–>central veins–>hepatic veins (3-4)–>IVC

88
Q

describe the lymphatic plexuses of the liver

A

superficial is deep to the capsule and drains to hepatic lymph nodes along hepatic aa, some superior go to phrenic
deep parallels the portal triad and drain to hepatic lymph nodes to the celiac nodes, some will follow IVC and drain to posterior mediastinal nodes

89
Q

What is the cystohepatic triangle of Callot? clinical relation?

A

right is cystic duct left is common hepatic duct
cystic a runs right through these structures
used in cholectomies

90
Q

What are the 3 main causes of hepatomegaly

A

increased central venous pressure that engorges liver with blood
hepatitis
metastatic carcinomas

91
Q

where are liver biosies taken

A

though 10th ICS at midaxillary line

92
Q

what is the function of the gall bladder

A

STORAGE and concentration of bile

93
Q

at what level is the fundus portion of the gall bladder

A

9th costal cartilage at MCL

94
Q

is the gall bladder peritonealized or retro

A

pertitonealized

95
Q

what is the only part of the gall bladder that makes contact with body wall? where is referred pain

A

the fundus so at the 9th ICS and MCL

96
Q

what structure drains the gall bladder?

A

cystic duct

97
Q

what does the cystic duct merge with to form

A

merges with common hepatic duct to form bile duct

98
Q

most common site for gall stone obstruction

A

hepatopancreatic ampulla

99
Q

describe vascular supply to gall bladder

A

cystic a from right hepatic a

cystic vein

100
Q

where does the cystic vein drain to

A

into liver

into portal vein

101
Q

describe lymph drainage of gall bladder

A

hepatic lymph to celiac

cystic lymph nodes to hepatic to celiac lymph

102
Q

describe referred pain of gallbladder

A

epigastric region but shift to R T8-T9 dermatomes because inflammation of parietal peritoneum
also C3C4C5 from phrenic sometimes

103
Q

what can obstruction form a gallstone at the hepaticopancreatic ampulla lead to

A

jaundice from blocking biliary system and pancreatitis from blocking release of pancreatic enzymes

104
Q

Inflammation because of gall stones can lead to what

A

adhesion of gall bladder wall to surrounding structures
can lead to ulceration and cause a cholecytoenteric fistula allowing gallstones to pass into that fused structure and cause obstruction and ileocecal junction

GI I (14 decks)

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