Anatomy Flashcards
please define retroperitoneal structure
gi structures and non gi structures that do not have a mesentery ie not in the peritoneum
list the retroperitoneal structures
upper esophagus duodenum (2-4th) all but tail of pancreas kidneys adrenals ascending and descending colon aorta IVC ureters rectum - partially
SAD PUCKER
retroperitoneal sturcutres S - suprarenals A - aorta and IVC D - duodenum (2-4th) P - all except tail U - ureters C - ascending and descending colong K - kidneys E - upper esophagus R - rectum (partially(
what happens when a retroperitoneal structure gets damaged
will see bleeding or gas accumulation in the retroperitoneal space
falciform ligament connects what to what?
anterior liver to anterio abdominal wall
hepatoduodenal connets what to what?
liver to duodenum
gastrohepatic ligament connects what to what?
liver to lesser curvature of stomach
gastrocolic ligament connects what to what?
greater curvature to transverse colon
gastrosplenic ligament connects what to what?
greater curvature to spleen
what two ligaments come off the greater curvature of the stomach
gastrocolic
gastrosplenic
what does the splenorenal ligmanet connet?
spleen to posterior abdominal wall
what structures are in the falciform ligament
ligamentum teres hepatics - fetal umbilical vein
what is the ligamentum teres hepatis
remnant of the fetal umbilical vein
what structures are in the hepatoduodenal ligmanet?
portal triad: portal vein, hepatic artery, common bile duct
what structures are in the gasrohepatic ligament
gastric arteries
what structures are in the gastrocolic ligament
gastroepiploic arteries
define: epiploic
pertaining to the omentum
what structures are in the gastrosplenic ligament
short gastrics, left gastroepiploic vessels
what structures are in the splenorenal ligament
splenic artery and vein and tail of pancreas
what is the falciform ligament a derivative of
ventral mesentery
what is the pringle maneuver
the hepatoduodenal ligament may be compressed between thumb and indx finger by placing in the omental foramen to control bleeding
what is the omental foramen
the falciform ligament -
who cares about the omental foramen
separates the greater and lesser sacs and may be used in the pringle maneuver to comples the portal triad in bleeding
what separates the greater and lesser sac on the right
gastroheparic ligament
what can be cut in surgery in order to access the lesser sav
the gastrohepatic ligament
what is part of the greater omentum
the gastrocolic ligament
what esprates the greater and lesser sac on the left
the gastrosplenic ligament
please list the borders of the greater and lesse sac
the omental foramen/hepatoduodenal ligament
gastrosplenic on left
gastrohepatic on right
see histology section for abdominal aorta branches
oopsee
what are the branches of the celiac artery;
left gastric
splenic
common hepatic
what vesels supply the stomach
left gastric - right gastric - proper hepatic
splenic - short gastrics ( in gastrosplenic ligament) and left gastroepiploic
common hepatic - gastroduodenal - right gastroepiploid - left gastroepiplice - splenic
describe how the common hepatic branches
celiac trunk - common hepatic - a) proper hepatic b) anterior superior pancreaticoduodenal c) gastroduodenal –> two brances a) posterior superior pancreaticoduodenal and b) right gastroepiploic (in the gastrocolic ligament)
where is the weakest anastomoses in the stomachs blood supplt
short gastrics ffrom splenic arteries @ fundus
where are the stong anastomese in the stomachs blood supply
left and right gastrics
right and left gastroepiploics
list vessels involved in esophageal varices
portal: left gastric
systemic: esophageal
list vessels involed in caput medusa
portal: paraumbilical
systemic: epigastric veins of anterior abdominal wall
list vessels involved in anal varices
portal: superior rectal
systemic: inferior and middle rectal
who cares about portal/systemic anastomoses
portal hypertension – esophageal varices (left gastric and esophageal veins), caput medusa (paraumbilical and epigastrics), anal varices/not internal hemorrhoids (superior rectal with inferior and middle rectal veins)
how do you treat portal hypertension
transjuular intrahepatic portosystemic shunt TIPS between the portal vein and hepatic vein – relives portal hypertension bu shunting blood to the systemic circulation by passing the lvier
what forms the pectinate line
where hindgut and ectoderm meet
derivs aove pectinate line = ?
hindgut
derivs below pectinate line =?
ectoderm
innervation above vrs below pectinate line
above - visceral - not painful
below - somatic - painful
what diseases are associated with location ABOVE pectinate line
internal hemorrhoids - not painful
adenocarcinoma
what diseases are associated with locale BELOW the pectinate line?
external hemorrhoids - painful
squamous cell carcinoma
anal fissures
describe arterial supply above and below pectinate line
above: inferior mesenteric –> superior rectal artery
below: internal iliac – internal pudenal – inferior rectal artery
describe venous supply above and below pectinate line
above: superior rectal vein – inferior mesenteric vein – portal system
below: inferior rectal vein – internal pudendal vein – internal iliac vein – common iliac vein – IVC
list innevation permitting pain for external hemmorhoids
inferior rectal branch of pudendal nerve; pain if thrombosed
list lymphatic drainage for above and below pectinate line
above: internal iliac lymph nodes
below: superficial inguinal lymph nodes
describe an anal fissure
below pectinate line, ectoderm
tear in the anal mucosa below the pectinate line. pain while pooping, blood on the toilet paper, located posteriorly since this area is poorly perfused
Ps!
what part of the hepatocyte is apical side
near bile
what part of hepatocyte is basal side
faces sinusoids
where is zone one?
periportal zone
where is zone tow?
inbtween portal and central vein
where is zone three?
pericentral vein/centrilobular
where does yellow fever strike?
zone two - intermediate
where do Hep viruses strike?
zone 1; periportal - close to blood supply
where do ingested toxins strike? like cocaine
zone 1; periporal - close to blood supply
where does OH hepatitis occur?
zone 3; pericentral vein/centrilobular; near P450 system
where does metabolic injury occur in liver?
zone 3; pericentral vein/centrilobular; near P450 system
what portion of liver is first affected by iscahemia
zone 3: pericentral vein/centrilobular; near P450 system
list the ducts that come together by the time the common bile duct reaches the duodenum
left and right hepatic ducts
cystic duct
main pancreatic duct (from ventral bud) @ ampulla of vader
what happens when gallstones reach confluence of the common bile and pancreatic ucts
at the ampullan of vater - blocks giving a DOUBLE DUCT SIGN ie cholangitis and pancreatitis
what is a double duct sign
gall stone at the ampulla of vater blocking the common bile duct and main pancreatic duct – cholangitis and pancreatitis
painless jaundice
tumor in the head of the pancrease causing obstruction fo common bile duct alone
list the structures found in the femoral triangle
LATERAL - NAVEL - MEDIAL
lateral - nerve, artery, vein, empty space, lymph - medial
borders of the femoral triangle please
inguinal ligament - superiorly
sartorisu - laterally
adductor longus - medially
what is in the femoral triangle
femoral nav
lateral: nerve, artery vein: medial
what is the femoral sheath
fascial tube 3-4 cm below the infuilnal ligament
what is in the femoral sheath
femora vein, arter and canal (deep infulinal lymph nodes ) but not the gemoral nerve
where are the deep infuinal lymph nodes located?
in the femoral sheath
what is in the femoral triangle but not the femoral sheath?
the femoral nerve. sheath only has femoral artery, vein and deep inguinal lymph nodes.
list the layers from external to internal laterally inguinal cnal sstyle
inguinal ligament – aponeurosis of external obluiqeu muscle – internal oblique muscel – transversu sabdominis muscle – transversalis fascia – extrapeironeal tissue - vessels and ligaments – parietal pertoneum
what makes up the conjoined tendon
transversalis muscle and internal oblique come together near midline and this is fascia that covers it
list the layers of the spermatic cord from external to internal
external spermatic fascia/external oblique
cremasteric muscle and fascia/internal oblique
internal spermatic fascia/transversalis fascia
what si the medial umbilical ligament from
umbilical arter
what is the median umbilical ligament from
allantois/urachus
