ANATOMY - Abdomen p3 Flashcards
at what vertebral level is the pancreas
L1 (transpyloric)
is the pancreas intra or retroperitoneal
retroperionteal
apart from the tail = intraperitoneal
where in the abdomen is the pancreas
L hypochondrium + epigastric region
relation of stomach to pancreas
stomach is anterior the pancreas
stomach is separated from pancreas by lesser sac
relation of D1 to the pancreas
D1 is anterior to the pancreas
relation of D2 to the pancreas
D2 is lateral to the pancreas, on the right of the head
relation of transverse mesocolon to the pancreas
attaches to the anterior surface of the pancreas
relation of the common bile duct to the pancreas
CBD descends behind the head of the pancreas, opening into D2
relation of the spleen to the pancreas
spleen is located posterolaterally in relation to the pancreas
position of aorta and IVC in relation to the pancreas
posterior to the pancreas head
position of SMA/V in relation to the pancreas
SMA behind the neck of the pancreas
anterior to the uncinate process
SMV is behind neck of pancreas
position of splenic aa in relation to the pancreas
traverses the superior border of the pancreas
name of the 5 parts of the pancreas
head
neck
uncinate process
body
tail
what connects the head of the pancreas to the duodenum
connective tissue
which part of the pancreas do the SMA+V form a groove on the posterior aspect?
neck
what structure is the tail of the pancreas contained within?
splenorenal ligament (alongside splenic vessels)
route of enzyme precursors from acini cells to ampulla of Vater
acini cells clusters make up lobular serous gland which prod enzymes
cells = connected by intercalated ducts
ducts unite –> intralobular connecting duct system
–> pancreatic duct
+ CBD = Ampulla of Vater
aa supply pancreas
splenic aa branches
aa supply pancreas head
superior + inferior pancreaticoduodenal aa
superior pancreaticduodenal aa is a branch of
gastroduodenal aa
inferior pancreaticduodenal aa is a branch of
SMA
venous drainage pancreatic head
SMV branches (ultimately into portal vein)
venous drainage rest of pancreas
splenic vein
LN drainage pancreas
pancreaticosplenal LN + pyloric LN –> SM LN + coeliac LN
where is the spleen in the abdomen
ULQ under the diahpragm/ribcage
is the spleen intra or retroperitoneal
intraperitoneal
what connects the spleen to the kidney and stomach
greater omentum as the gastrosplenic and splenorenal ligaments
what is between the splenorenal and the gastrosplenic ligaments
lesser sac
what covers the spleen
a weak capsule
what are the 2 surfaces of the spleen
diaphragmatic
visceral
what are the 4 borders of the spleen
anterior
superior
posteromedial
inferior
which border of the spleen can be palpated in splenomegaly as it moves inferiorly?
superior
structure anterior to the spleen (1)
stomach
structures posterior to the spleen (3)
diaphragm
left lung
ribs 9-11
structures inferior to the spleen (1)
left colic flexure
structures medial to the spleen (2)
left kidney
tail of pancreas
aa supply spleen
splenic aa
how many branches of splenic aa to the spleen
5
significance of splenic aa branches not anastomosing in the spleen
separate vascular segments of the spleen
meaning that you can do a subtotal splenectomy in trauma cases
venous drainage of the spleen
splenic v
innervation of the spleen
coeliac plexus
LN drainage of the spleen
pancreaticsplenic LN –> coeliac LN
are kidneys intra or retroperitoneal
retroperitoneal
spinal level kidneys
T12-L3
which kidney is lower and why
right
due to presence of liver
layers of fascia/fat on kidney from deep to superficial
renal capsule
pre-renal fat
renal fascia/Gerota’s fascia
pararenal fat (posterolateral aspect of kidney only)
cortex/medulla kidney - which is outer/inner
outer cortex
inner medulla
structures anterior to the left kidney (6)
suprarenal gland
spleen
stomach
pancreas
L colic flexure
jejunum
structures posterior to the left kidney (8)
diaphragm
11/12th rib
psoas major
transversus abdominis
quadratus lumborum
subcostal nn
iliohypogastric nn
ilioinguinal nn
structures anterior to the right kidney (4)
adrenal gland
liver
duodenum
R colic flexure
structures posterior to the right kidney (8)
diaphragm
12th rib
psoas major
transversus abdominis
quadratus lumborum
subcostal nn
iliohypogastric nn
ilioinguinal nn
what is the renal aa a branch of
abdominal aorta
L vs R renal aa - which is longer
right
position of right renal aa to IVC
crosses IVC posteriorly
how does renal aa branch
renal aa –> anterior + posterior aa –> 5x segmental aa –> interlobar aa –> arcuate aa –> interlobular aa –> afferent arterioles –> capillary network –> efferent arterioles –> peritubular network + vasa recta
what are the 5 segments of the kidney
upper
apical
middle
posterior
lower
what % of people have accessory aa to the kidney
25%
do the segmental aa of the kidney anastomose?
no
what is the Avascular plane of the kidney called?
Brodels line
venous drainage of the kidneys
R+L renal vv –> IVC
relation of L renal vv to abdominal aorta
travels anterior to aa below the origin of the SMA
relation of R renal vv to IVC
posterior to IVC
LN drainage to the kidney
para-aortic LN
what is a pelvic kidney?
kidney fails to ascend, remains in pelvis at the level of the common iliac aa
what is a horseshoe kidney?
2 kidneys fuse
become stuck under IMA
still drained by 2 ureters
PS horseshoe kidney
asymptomatic unless obstructed
are the adrenal glands intra or retroperitoneal
retroperitoneal
which fascia encloses the kidneys and adrenal glands?
renal fascia
what separates the kidneys from the adrenal glands?
peri-renal fat
structures anterior to right adrenal (2)
IVC
R lobe of the liver
structures posterior to right adrenal (1)
R crus diaphragm
structures anterior to the Left adrenal (3)
stomach
pancreas
spleen
structures posterior to the left adrenal (1)
L crus diaphragm
layers of the adrenal gland from superficial to deep
capsule
zona glomerulosa
zona fasciculata
zona reticularis
medulla
embryological origin cortex
embryonic mesoderm
embryological origin medulla
ectodermal neural crest cells
colour of adrenal cortex vs medulla
cortex = yellowish
medulla = brown
what does the zona glomerulosa produce/secrete
mineralcorticoids e.g. aldosterone
what does the zona fasciculata producte/secrete
corticosteroids e.g cortisol
what does the zona reticularis produce/secrete
androgens e/g/ DHES
what cells does the medulla comprise of and what do they secrete
chromaffin cells
catecholamines
superior adrenal aa is a branch of
inferior phrenic aa
middle adrenal aa is a branch of
abdominal aorta
inferior adrenal aa is a branch of
renal aa
vv drainage adrenals
L + R adrenal aa
L –> renal aa –> IVC
R –> IVC
innervation adrenals
coeliac plexus + greater splanchnic nn
LN drainage adrenals
lumbar LN
level coeliac trunk arises from abdominal aorta
T12
3 major branches of the coeliac trunk
L gastric aa
Splenic aa
common hepatic aa
branches of the L gastric a a
oesophageal branches
what does the L gastric aa ananstomose with and where
R gastric aa on the lesser curvature of the stomach
what are the 3 branches of the splenic aa (apart from the 5 terminal branches to the spleen)
L gastroepiploic aa
short gastrics
pancreatic branches
l gastroepiploic aa supplies
greater curvature stomach
short gastrics supply
fundus stomach
pancreatic branches of splenic aa supply
body and tail of pancreas
what are the 2 terminal branches of the common hepatic aa
proper hepatic aa
gastroduodenal aa
what are the 3 branches of the proper hepatic aa
R gastric aa
R/L hepatic aa
cystic aa (branch of R hepatic aa )
R gastric aa supplies
pylorus + lesser curvature stomach
R + L gastric aa supply
R + L lobes liver
cystic aa supplies
GB
what are the 2 branches of the gastroduodenal aa
R gastroepiploic aa
superior pancreaticoduodenal aa
R gastroepiplpoic aa supplies
greater curvature sstomach
greater omentum
superior pancreaticoduodenal aa supplies
head of pancreas
what comprises the pancreaticoduodenal arcade
superior and inferior pancreaticoduodenal aa
surround head of pancreas
what is coeliac trunk compression syndrome
median arcuate ligament sometimes lies anterior to the coeliac trunk –> compression –> ischaemia, pain
T
Tx coeliac trunk compression syndrome
surgical divison of median arcuate ligament
structures anterior to the SMA (3)
pyloric part of stomach
splenic vv
neck of pancreas
structures posterior to the SMA (3)
left renal vein
uncinate process pancreas
inferior part of the duodenum
major branches of the SMA (5)
inferior pancreaticoduodenal aa
middle colic aa
ileal/jejunal aa
r colic aa
ileocolic aa
what spinal level does the IMA arise from the AA
L3
pathway of IMA
arises at L3
near inferior border duodenum
3-4cm above where aorta bifurcates into common iliac
initially descends anterior to the AA, then moves left
is the IMA intra or retroperitoneal?
retroperitoneal
what are the 3 major branches of the IMA
L colic aa
sigmoid aa
superior rectal aa
what are the 2 anastomoeses involving the IMA
marginal aa of Drummond
Arc of Riolan (betw L colic branch IMA + middle colic branch SMA)
what are the 2 venous drainage systems of the abdomen
portal vein
systemic vein
location of IVC
posterior abdominal wall, anterior to the vertebral column, to the right of abdo aorta
what veins unite to form the IVC and at what level
common iliac veins
L5
what does the IVC drain into
RA
what are the tributaries of the IVC (7)
common iliac vv
lumbar bb
renal vv
R testicular/ovarian vv
R suprarenal vv
inferior phrenic vv
hepatic vv
what is the major vessel of the portal venous system?
portal vein
which veins unite to form the portal vein and where
SMV + splenic vv
L2 posterior to the neck of the pancreas
tributaries of the portal vein (3)
R + L gastric vv
cystic vv
para-umbilical vv
tributaries of the splenic vv (4)
short gastric vv
L gastro-omental vv
pancreatic vv
inferior mesenteric vv
which vv drain into the inferior mesenteric vv (3)
superior rectal
sigmoid
L colic vv
which vv drain into the SMV? (7)
R gastro-omental vv
anterior/posterior inferior pancreaticoduodenal vv
jejunal vv
ileal vv
ileocolic vv
R colic vv
mid colic vv
what are the 4 main porto-systemic anastomoses points?
oesophageal (oesophageal branch L gastric + oesophageal tributaries to azygous)
rectal (superior rectal vv + inferior rectal vv)
retroperitoneal vv - (portal tributaries of mesenteric vv + retroperitoneal vv)
paraumbilical vv - betw portal vv liver + vv anterior abdominal wall
def portal HTN
> 20mmHg
