Anatomy 4 Flashcards
What is the spleen and what is tis function?
It is a lymphoid organ connected to the blood vascular system (mobile haemo-lymphoid organ)
It acts as a filter for blood and plays an important role in the immune responses of the body
How is the spleen peritonised?
Retroperitoneal (except the hilum)
In which region of the abdomen is the spleen found in?
L hypochondium
Does the spleen move with respiration?
Yes
What ribs relate to the location of the spleen?
Ribs 9-11 of the L side
What is splenomegaly and the causes?
Abnormal enlargement of the spleen
Caused by anaemia and typhoid fever
What branch of the aorta supplies the foregut?
Celiac trunk (branches off at T12)
What are the main branches of the celiac trunk?
- L gastric aa - runs along lesser curvature of stomach
- Common hepatic artery - supplies liver and gall bladder
- Splenic artery - runs retroperitoneally along superior margins of pancreas
What branch of the aorta supplies the midgut?
Superior mesenteric artery (L1)
Describe the superior mesenteric artery
- Crossed anterior by splenic vein and neck of pancreas
- Main branches: jejunal and ileal arteries
- Other: middle colic, right colic and iliocoloic
What are omental appendices of the large intestine?
Small, fatty, peritoneal like projections
What are teniae coli of the large intestine?
Thickened bands of smooth muscle (longitudinal layer)
What branch of the aorta supplies the hindgut?
Inferior mesenteric artery (L3)
What are the branches of the inferior mesenteric artery?
Left colic, sigmoid and superior rectal artery (terminal branch)
Where does the recto-sigmoid junction occur?
Anterior to S3 vertebra
What two sphincters are found in the anal canal?
External and internal anal sphincters
What structures are palpable in a rectal examination in males?
Prostate and seminal gland
What structure are palpable in a rectal examination in females?
Cervix
In both sexes, what structures should be palpable in a rectal examination?
- Ischial spines and tuberosities
- Enlarged internal iliac lymph nodes, swelling in the ischioanal fossa
- Sacrum and coccyx
- Collections in rectovesical (males) and rectouterine fossa (female)
What are the three constrictions of the oesophagus?
- Cervical
- Thoracic
- Diaphragmatic
Describe the cervical constriction of the oesophagus
Pharyngo-oesophogeal, 15cm from incisor teeth (IT)
Describe the thoracic constriction of the oesophagus
Bronchoaortic - crossed by arch of aorta (22.5cm from it) and left main bronchus (17.5cm from IT)
Describe the diaphragmatic constriction of the oesophagus
Where is passes through the oesophageal hiatus of the diaphragm (40cm from IT)
What are three pathologies of the stomach?
- Congenital pyloric stenosis (thickening of smooth much in the pylorus)
- Carcinoma
- Gastric ulcers and vagotomy
When removing the spleen surgically what must you be careful to not damage?
Pancreatic tail
What are five functions of the spleen?
- Filters blood
- Stores RBC
- Degenerates RBC
- Phagocytosis
- Active immune response to infection
What is the pancreas and what is its function?
It is a gland that is partly exocrine and partly endocrine
It exocrine part secretes digestive pancreatic juice and the endocrine part secretes hormones
How is the pancreas related to the duodenum?
The head of the pancreas sits in the curve of the duodenum
The 1st part of duodenum in anterior to the pancreas and the 2nd part lies laterally to pancreatic head
How is the pancreas peritonised?
Retroperitoneal
What is the minor duodenal papilla?
Opening in the duodenum for the accessory pancreatic duct
What vein is formed posterior to the neck of the pancreas?
Portal vein
Into which part of the duodenum does the pancreatic duct open?
Major duodenal papilla
What are the different ligaments of the liver?
- Falciform ligament - to anterior surface
- Coronary ligament - superior liver surface to diaphragm and demarcates the bare area of liver
- Triangular ligaments (L and R) - from by union of anterior and posterior coronary ligament and L attaches L lobe to diaphragm
What is the liver?
Large gland situated int he RUQ of abdominal cavity.
What is the round ligament (continuation of the falciform ligament) a embryological remnant of?
Foetal umbilical vein
What are the lobes of the liver?
- R and L lobe
- Quadrate lobe
- Caudate (posterior to porta hepatis)
- Quadrate lobe (anterior to porta hepatis)
What is the bare area of the liver?
Area not covered by peritoneum as it is attached directly to the diaphragm
What are the 3 structures found in the porta hepatis?
- Portal vein
- Hepatic artery
- Bile duct
What fold is wrapped around these structure?
Lesser omentuum
What does the extrahepatic biliary apparatus consist of?
- R + L hepatic duct
- Common hepatic duct
- Gallbladder
- Cystic duct
- Common bile duct
What is the function of the biliary ducts?
Carry bile from the liver to gallbladder
Where is bile produced and stored?
Produced in the liver, but stored in the gallbladder
Where does bile enter the gut tube?
Through sphincter of odd and to through the major duodenal papilla
What is the function of bile?
Emulsion and absorb fats
How much bile can the gallbladder store?
Up to 50ml of bile
What is the artery of the gallbladder?
Cystic artery
Where is the cystic artery of the gallbladder found?
In the Triangle of Calot (triangle between common hepatic duct, cystic duct and visceral surface of liver)
Hoe does biliary obstruction arise?
When passage of bile int duodenum is blocked completely or partially.
Many be intrahepatic or extra hepatic (causes: gallstones, cancer of the head of pancreas)
What is Calot’s cystohepatic triangle and what is the clinical significance of it?
Triangular space formed by cystic duct, common hepatic duct and inferior surface of liver.
It contains the cystic artery.
During the removal of the gall bladder (cholecystectomy) care should be taken not to damage the structures in and round the triangle
What pathology can be caused if you cut the tail of the pancreas during splenectomy ?
Diabetes as hyperglycaemia is caused as the tail produces insulin
What are the main histological features of the pancreas?
- Islet of Langerhands
- Pure serous acini
- Small lobules surrounding by connective tissue septa
What are the main histological features of the liver?
- Cells arranged in sheets and converging towards the centra (central vein)
- At the corner of a hexagonal lobule connective tissue encloses 2-3 portal areas which contain blood vessels and ducts (portal triad)
Describe the histological features of the spleen
Spleen covered by a dense fibromuscular capsule formed by collagen and elastic fibres with scattered smooth muscle
The parenchyma is called pulp - white and red pulp.
What is the main content of WP and RP?
WP: lymphoid aggregates; mostly lymphocytes (T and B cells) and macrophages
RP: vascular and has parenchyma and lots of vascular sinuses (sinusoids - leaky capillaries)
Describe the features of biliary colic
- Colicky pain intermittent
- Pain episodes last hours
- Vomiting
- Tender on R hypochrondrium
- USS shows gall stones
- Tx: laparoscopic cholecystectomy
What is R hypochondriac pain usually caused by?
Biliary colic secondary to gall stones
