ANATOMY - Abdomen p3 Flashcards
1
Q
at what vertebral level is the pancreas
A
L1 (transpyloric)
2
Q
is the pancreas intra or retroperitoneal
A
retroperionteal
apart from the tail = intraperitoneal
3
Q
where in the abdomen is the pancreas
A
L hypochondrium + epigastric region
4
Q
relation of stomach to pancreas
A
stomach is anterior the pancreas
stomach is separated from pancreas by lesser sac
5
Q
relation of D1 to the pancreas
A
D1 is anterior to the pancreas
6
Q
relation of D2 to the pancreas
A
D2 is lateral to the pancreas, on the right of the head
7
Q
relation of transverse mesocolon to the pancreas
A
attaches to the anterior surface of the pancreas
8
Q
relation of the common bile duct to the pancreas
A
CBD descends behind the head of the pancreas, opening into D2
9
Q
relation of the spleen to the pancreas
A
spleen is located posterolaterally in relation to the pancreas
10
Q
position of aorta and IVC in relation to the pancreas
A
posterior to the pancreas head
11
Q
position of SMA/V in relation to the pancreas
A
SMA behind the neck of the pancreas
anterior to the uncinate process
SMV is behind neck of pancreas
12
Q
position of splenic aa in relation to the pancreas
A
traverses the superior border of the pancreas
13
Q
name of the 5 parts of the pancreas
A
head
neck
uncinate process
body
tail
14
Q
what connects the head of the pancreas to the duodenum
A
connective tissue
15
Q
which part of the pancreas do the SMA+V form a groove on the posterior aspect?
A
neck
16
Q
what structure is the tail of the pancreas contained within?
A
splenorenal ligament (alongside splenic vessels)
17
Q
route of enzyme precursors from acini cells to ampulla of Vater
A
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
18
Q
aa supply pancreas
A
splenic aa branches
19
Q
aa supply pancreas head
A
superior + inferior pancreaticoduodenal aa
20
Q
superior pancreaticduodenal aa is a branch of
A
gastroduodenal aa
21
Q
inferior pancreaticduodenal aa is a branch of
A
SMA
22
Q
venous drainage pancreatic head
A
SMV branches (ultimately into portal vein)
23
Q
venous drainage rest of pancreas
A
splenic vein
24
Q
LN drainage pancreas
A
pancreaticosplenal LN + pyloric LN –> SM LN + coeliac LN
25
where is the spleen in the abdomen
ULQ under the diahpragm/ribcage
26
is the spleen intra or retroperitoneal
intraperitoneal
27
what connects the spleen to the kidney and stomach
greater omentum as the gastrosplenic and splenorenal ligaments
28
what is between the splenorenal and the gastrosplenic ligaments
lesser sac
29
what covers the spleen
a weak capsule
30
what are the 2 surfaces of the spleen
diaphragmatic
visceral
31
what are the 4 borders of the spleen
anterior
superior
posteromedial
inferior
32
which border of the spleen can be palpated in splenomegaly as it moves inferiorly?
superior
33
structure anterior to the spleen (1)
stomach
34
structures posterior to the spleen (3)
diaphragm
left lung
ribs 9-11
35
structures inferior to the spleen (1)
left colic flexure
36
structures medial to the spleen (2)
left kidney
tail of pancreas
37
aa supply spleen
splenic aa
38
how many branches of splenic aa to the spleen
5
39
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
40
venous drainage of the spleen
splenic v
41
innervation of the spleen
coeliac plexus
42
LN drainage of the spleen
pancreaticsplenic LN --> coeliac LN
43
are kidneys intra or retroperitoneal
retroperitoneal
44
spinal level kidneys
T12-L3
45
which kidney is lower and why
right
due to presence of liver
46
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)
47
cortex/medulla kidney - which is outer/inner
outer cortex
inner medulla
48
structures anterior to the left kidney (6)
suprarenal gland
spleen
stomach
pancreas
L colic flexure
jejunum
49
structures posterior to the left kidney (8)
diaphragm
11/12th rib
psoas major
transversus abdominis
quadratus lumborum
subcostal nn
iliohypogastric nn
ilioinguinal nn
50
structures anterior to the right kidney (4)
adrenal gland
liver
duodenum
R colic flexure
51
structures posterior to the right kidney (8)
diaphragm
12th rib
psoas major
transversus abdominis
quadratus lumborum
subcostal nn
iliohypogastric nn
ilioinguinal nn
52
what is the renal aa a branch of
abdominal aorta
53
L vs R renal aa - which is longer
right
54
position of right renal aa to IVC
crosses IVC posteriorly
55
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
56
what are the 5 segments of the kidney
upper
apical
middle
posterior
lower
57
what % of people have accessory aa to the kidney
25%
58
do the segmental aa of the kidney anastomose?
no
59
what is the Avascular plane of the kidney called?
Brodels line
60
venous drainage of the kidneys
R+L renal vv --> IVC
61
relation of L renal vv to abdominal aorta
travels anterior to aa below the origin of the SMA
62
relation of R renal vv to IVC
posterior to IVC
63
LN drainage to the kidney
para-aortic LN
64
what is a pelvic kidney?
kidney fails to ascend, remains in pelvis at the level of the common iliac aa
65
what is a horseshoe kidney?
2 kidneys fuse
become stuck under IMA
still drained by 2 ureters
66
PS horseshoe kidney
asymptomatic unless obstructed
67
are the adrenal glands intra or retroperitoneal
retroperitoneal
68
which fascia encloses the kidneys and adrenal glands?
renal fascia
69
what separates the kidneys from the adrenal glands?
peri-renal fat
70
structures anterior to right adrenal (2)
IVC
R lobe of the liver
71
structures posterior to right adrenal (1)
R crus diaphragm
72
structures anterior to the Left adrenal (3)
stomach
pancreas
spleen
73
structures posterior to the left adrenal (1)
L crus diaphragm
74
layers of the adrenal gland from superficial to deep
capsule
zona glomerulosa
zona fasciculata
zona reticularis
medulla
75
embryological origin cortex
embryonic mesoderm
76
embryological origin medulla
ectodermal neural crest cells
77
colour of adrenal cortex vs medulla
cortex = yellowish
medulla = brown
78
what does the zona glomerulosa produce/secrete
mineralcorticoids e.g. aldosterone
79
what does the zona fasciculata producte/secrete
corticosteroids e.g cortisol
80
what does the zona reticularis produce/secrete
androgens e/g/ DHES
81
what cells does the medulla comprise of and what do they secrete
chromaffin cells
catecholamines
82
superior adrenal aa is a branch of
inferior phrenic aa
83
middle adrenal aa is a branch of
abdominal aorta
84
inferior adrenal aa is a branch of
renal aa
85
vv drainage adrenals
L + R adrenal aa
L --> renal aa --> IVC
R --> IVC
86
innervation adrenals
coeliac plexus + greater splanchnic nn
87
LN drainage adrenals
lumbar LN
88
level coeliac trunk arises from abdominal aorta
T12
89
3 major branches of the coeliac trunk
L gastric aa
Splenic aa
common hepatic aa
90
branches of the L gastric a a
oesophageal branches
91
what does the L gastric aa ananstomose with and where
R gastric aa on the lesser curvature of the stomach
92
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
93
l gastroepiploic aa supplies
greater curvature stomach
94
short gastrics supply
fundus stomach
95
pancreatic branches of splenic aa supply
body and tail of pancreas
96
what are the 2 terminal branches of the common hepatic aa
proper hepatic aa
gastroduodenal aa
97
what are the 3 branches of the proper hepatic aa
R gastric aa
R/L hepatic aa
cystic aa (branch of R hepatic aa )
98
R gastric aa supplies
pylorus + lesser curvature stomach
99
R + L gastric aa supply
R + L lobes liver
100
cystic aa supplies
GB
101
what are the 2 branches of the gastroduodenal aa
R gastroepiploic aa
superior pancreaticoduodenal aa
102
R gastroepiplpoic aa supplies
greater curvature sstomach
greater omentum
103
superior pancreaticoduodenal aa supplies
head of pancreas
104
what comprises the pancreaticoduodenal arcade
superior and inferior pancreaticoduodenal aa
surround head of pancreas
105
what is coeliac trunk compression syndrome
median arcuate ligament sometimes lies anterior to the coeliac trunk --> compression --> ischaemia, pain
T
106
Tx coeliac trunk compression syndrome
surgical divison of median arcuate ligament
107
structures anterior to the SMA (3)
pyloric part of stomach
splenic vv
neck of pancreas
108
structures posterior to the SMA (3)
left renal vein
uncinate process pancreas
inferior part of the duodenum
109
major branches of the SMA (5)
inferior pancreaticoduodenal aa
middle colic aa
ileal/jejunal aa
r colic aa
ileocolic aa
110
what spinal level does the IMA arise from the AA
L3
111
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
112
is the IMA intra or retroperitoneal?
retroperitoneal
113
what are the 3 major branches of the IMA
L colic aa
sigmoid aa
superior rectal aa
114
what are the 2 anastomoeses involving the IMA
marginal aa of Drummond
Arc of Riolan (betw L colic branch IMA + middle colic branch SMA)
115
what are the 2 venous drainage systems of the abdomen
portal vein
systemic vein
116
location of IVC
posterior abdominal wall, anterior to the vertebral column, to the right of abdo aorta
117
what veins unite to form the IVC and at what level
common iliac veins
L5
118
what does the IVC drain into
RA
119
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
120
what is the major vessel of the portal venous system?
portal vein
121
which veins unite to form the portal vein and where
SMV + splenic vv
L2 posterior to the neck of the pancreas
122
tributaries of the portal vein (3)
R + L gastric vv
cystic vv
para-umbilical vv
123
tributaries of the splenic vv (4)
short gastric vv
L gastro-omental vv
pancreatic vv
inferior mesenteric vv
124
which vv drain into the inferior mesenteric vv (3)
superior rectal
sigmoid
L colic vv
125
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
126
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
127
def portal HTN
>20mmHg
