Anatomy Flashcards
What are the retroperitoneal structures?
SAD PUCKER
- Suprarenal (adrenal) adrenal
- Aorta and IVC
- Duodenum (2nd - 4th part)
- Pancreas (except tail)
- Ureters
- Colon (descending and ascending)
- Kidneys
- Esophagus (thoracic portion)
- Rectum (partially)
What does the falciform ligament connect?
Liver to anterior abdominal wall
What does the hepatoduodenal ligament connect?
Liver to duodenum
What does the hepatogastric ligament connect?
Liver to the lesser curvature of the stomach
What does the gastrocolic ligament connect?
Greater curvature and transverse colon
What does the gastrosplenic ligament connect?
Greater curvature to the spleen
What does the splenorenal ligament connect?
Spleen to left pararenal space
What ligaments are derived of the ventral mesentery?
- Falciform ligament
- Hepatoduodenal ligament
- Hepatogastric ligament
What ligaments are derived from the dorsal mesentery?
- Gastrocolic ligament
- Gastrosplenic ligament
- Splenorenal ligament
What structures are contained in the falciform ligament?
- Ligamentum teres hepatis (derivative of fetal umbilical vein)
- Patent paraumbilical veins
What is contained in the hepatoduodenal ligament?
Portal triad
- Proper hepatic artery
- Portal vein
- Common bile duct
What ligaments are contained in the lesser omentum?
- Hepatoduodenal ligament
- Hepatogastric ligament
What ligaments are contained in the greater omentum?
- Gastrocolic ligament
- Gastrosplenic ligament
What does the omental foramen connect?
The greater and lesser sacs
What ligament is held in Pringle maneuver?
Hepatoduodenal ligament (contains portal triad)
What are the borders of the omental foramen?
- Anterior: Hepatoduodenal ligament
- Posterior: the peritoneum covering the inferior vena cava
- Superior: the peritoneum covering the caudate lobe of the liver
- Inferior: the peritoneum covering the commencement of the duodenum and the hepatic artery, the latter passing forward below the foramen before ascending between the two layers of the lesser omentum.
- Left lateral: gastrosplenic ligament and splenorenal ligament
Name the layers of the gut wall from inside to out?
- Mucosa (epithelium, lamina propria, muscularis mucosa)
- Submucosa (Meissner’s plexus)
- Muscularis externa (Auerbach’s/myenteric plexus) (contains inner/circular and outer/longitudinal layer)
- Serosa
What part of the GI tract has the fatest and slowest basal electric rhythms?
Duodenum (fastest) > Ileum > Stomach (slowest)
What cells produce slow waves?
Interstitial cells of Cajal
When does an erosion become an ulcer?
Once it extends into the submucosal layer
What part of the esophagus is striated muscle and what is smooth?
- Upper 1/3 is striated
- Lower 2/3 is smooth
Describe the cells of the esophagus
Nonkeratinised stratified squamous epithelium
Histology of GI tract
First aid page 372
How many arteries supply the adrenal glands?
3
- Superior suprarenal (T12)
- Middle suprarenal (T12)
- Inferior suprarenal (L1)
What areas of the colon are ‘watershed’ areas?
- Splenic flexure (SMA and IMA)
- Rectosigmoid junction (last sigmoid arterial branch from IMA and superior rectal artery)
What is Nutcracker syndrome?
The compression of the left renal vein between the SMA and Aorta.
- Adbominal pain
- Gross hematuria (from rupture of thin-walled renal varicosities)
- Left-sided varocele
What is superior mesenteric artery syndrome?
Aorta and SMA compress transverse (3rd) portion of duodenum
- Intermittent intestinal obstruction symptoms
- Postprandial pain
- Associated with low body weight/malnutrition (low mesenteric fat)
At what vertebral level do the celiac trunk, SMA and IMA branch off?
- Celiac - T12/L1
- SMA - L1
- IMA - L3
What are the branches of the Celiac trunk?
- Left gastric (esophageal branches from this)
- Splenic (gives off short gastric and left gastroepiploic)
- Common hepatic
What are the branches of the common hepatic artery?
Proper hepatic
- R hepatic
- Left hepatic
- Cystic
Right gastric
Gastroduodenal
- Ant Sup pancreaticoduodenal
- Post Sup pancreaticoduodenal
- Right gastroepiploic
What veins are joined in caput medusae?
- Paraumbilical (portal)
- Small epigastric (systemic)
What can be used to treat portal hypertension?
- Transjugular Intrahepatic Portosystemic Shunt (TIPS)
- May cause build up of ammonia -> encephalopathy
What veins come together to form anorectal varices?
- Superior rectal vein (portal)
- Middle and inferior rectal veins (systemic)
What cancers do you get above the pectinate line?
Adenocarcinoma
What type of hemorrhoids are painful and why?
External hemorrhoids (if thrombosed) as they receive somatic innervation from the inferior rectal branch of the pudendal nerve
What cancers do you get below the pectinate line?
Squamous cell carcinoma
Where does the inferior rectal artery arise from?
Internal pudendal artery
Where are anal fissures loacted?
Posterior midline (poorly perfused) - Below pectinate line
Where does the lymph above the pectinate line drain to?
Internal iliac lymph node
Where does the lymph below the pectinate line drain to?
Superficial inguinal lymph node
What is the functional unit of the liver (the lobule) made up of?
- Hexagonal
- Each corner contains a portal triad
- In the centre is a central vein (which drains into the hepatic vein)
- Sinusoids ( which carry fluid from th portal triad to the central vein
What is the function of Kupffer cells?
- Specialised macrophages
- Clear bacteria
- Clear damaged or senescent RBCs
What cells are responsible for hepatic fibrosis?
- Hepatic stellate (Ito) cells in the space of Disse
What do hepatic stellate cells store?
Vitamin A
What zone is affected by yellow fever?
Zone II (intermediate zone)
What effects Zone I (periportal zone) ?
- Viral hepatitis
- Ingested toxins (cocaine)
What affects zone III (pericentral/centrilobular) zone?
- Ischaemia
- Ethanol, CCl4, halothane, rifampin, acetaminophen)
Where is the enzyme cytochrome P-450 mostly found?
Zone III
Cancer of the head of the pancreas has what sign?
Courvoisier sign (painless jaundice and enlarged gallbladder)
What are the bordes of the femoral triangle?
- Superiorly (base): Inguinal ligament
- Lateral: Sartorius major
- Medial: Adductor longus
What does the femoral sheath contain?
Femoral artery, vein and lymph (does not contain femoral nerve, this lies laterally)
What is contained in the femoral canal (ring)?
deep inguinal lymph nodes
What are the differences between indirect and direct inguinal hernias in terms of there relation to epigastric vessels?
- Indirect inguinal hernias occur lateral to inferior epigastric vessels
- Direct inguinal hernias occur medialy to inferior epigastric vessels
What type of hernia only passes through the superficial inguinal ring (and thru Hesselbach’s triangle)?
Direct inguinal hernia
- Indirect hernias pass through both deep and superficial inguina rings
How many layers of spermatic fascia are covered by an indirect inguinal hernia?
- All 3
What are the 3 layers of spermatic fascia?
Internal spermatic fascia
- from transversalis fascia
Cremasteric muscle and fasica
- from internal oblique
External spermatic fascia
- External oblique
Anatomy of groin
Page 379
In a paraesophageal hiatal hernia what protrudes through to the thorax?
The fundus
- The gastroesophageal junction is usually intact
What is an indirect inguinal hernia caused by?
A failure of the tunica vaginalis to close (may form a hydrocele)
What type of hernia is more common in females and more likely to cause strangulation?
Femoral hernia
Where is a femoral hernia located?
- Below and lateral to pubic tubercle
- Through femoral canal
What is Zollinger-Ellison syndrome caused bY?
Gastrinoma
- G cells produce too much gastrin
- Resulting in too much H+ secretion
