Anatomy - abdominal viscera Flashcards
function of the lesser sac
provides frictionless surface for expansion of the stomach
what are the narrowings of the oesophagus
- cervical narrowing (true anatomical sphincter) = upper oesophageal sphincter 2. diaphragmatic orifice 3. within the thorax made by the compression of the aortic arch and LMB arching across to the LHS
what is the epiploic/omental foarmen of Winslow
the only communication of the lesser sac to the greater sac
muscle coat of the rectum
changes from 3 discreet muscle bands of the longitudinal muscle band back to one longitudinal continuous muscle coat in the rectum
what is in the hilum of the spleen
transmits the splenic artery and vein and ymphatics and nerves
functions of the mesentry
- transmit the vessels and nerves to the IP structures - to allow for mobility and the capacity to expand
4 parts of the duodenum
- duodenal cap - vertical descending - horizontal part - ascending part
where is the spleen
in the LUQ under the left dome of the diaphragm, under ribs 9, 10 and 11
where does the oesophagus enter the stomach
the RHS of the fundus
is the duodenum intraperitoneal or retroperitoneal
all but the first inch of the duodenum is retroperioneal
what are the paired viscera and are they IP or RP
kidneys adrenals ureters all RETROPERITONEAL - located directly on the posterior abdominal wall with the aorta and the IVC
length of the jujenum and ilium
4-6 metres in length
route of the transverse intestine
begins at the right colic flexure/hepatic flexure and extends to the left colic flexure/splenic flexure
distinction between jejunum and ilium
- positioning (J=LUQ, and I=RLQ) - J is larger in diameter than I - J has a thicker wall than J - less fat in the mesentry of J compared to I - arterial arrangement in the mesentry
is the pancreas Intra or retroperitoneal
retroperitoneal
where does the sigmoid mesocolon lie
from the sigmoid colon to the posterior abdominal wall running over the division of the left common iliac artery
where does the oesophagus begin
at the level of the cricoid cartilage at the level of C6 in the neck
what is the venous supply of the cervical oesophagus
brachiocephalic systemic
what are Tenia coli
3 stripes down the large intestine composed of the 3 discreet longitudinal smooth muscle bands around the large intestine
what is the venous supply of the thoracic oesophagus
azygous systemic
what is the lymphatic drainage of the thoracic oesophagus
mediastinal nodes
composition of the jejunum and ilium (%?) and in which quandrants do they lie?
40% jejunum - LUQ 60% ilium - RLQ
types of hiatus hernia
- 95% = sliding hiatal hernia - where the stomach gets pulled up into the posterior mediastinum - 5% = paraoesophageal hiatus hernia - where the stomach slides up through the oesophageal hiatus next to the oesophagus (oesophagus is still going through the hiatus)
what does the accessory duct of the pancreas do/go?
drains the uncinate process and the lower part of the head and then ascends and crosses the main pancreatic duct –> penis into the duodenum at the summit of the minor duodenal papilla
what is the gastro-colic ligament
part of the greater omentum that heads down and back over the intestine forming the fatty apron
what is special about the arteries within the mesentry connecting the jejunum and ilium to the posterior abdominal wall
J - few arterial arcades and long vasa recta leading to J I - lots of arterial arcades stacked on top of each other with quite short vasa recta
what composes layers 1, 2 and 3 of the viscera
1 - paired organs 2 - ascending and descending colon, pancreas, duodenum, bile duct 3 - stomach, J and I, cecum and appendix, transverse and sigmoid colons, liver, gall bladder and spleen
nerve supply of parietal and visceral peritoneum
- parietal - supplied by somatic nerves –> irritation causes sharp, severe and localised pain - visceral 0 supplied by autonomic nerves –> sensitive only to stretch –> localised pain referred to the midline
muscle covering of the large intestine
- inner continuous layer of circular SM - outer coat of longitudinal SM divided into 3 discreet bands
what is/where is the cecum
pouch hanging down below the iliocecal junction in the RLQ (appendix hands off it)
what is the main reason for getting direct inguinal hernia
weak abdominal muscles
where is the fundus of the stomach
projects above the cardiac origice and sits directly under the left dome of the diaphragm
on which parts of the stomach are the 2 openings
proximal - on the proximal part of the RHS of the stomach distal - pyloric orifice at the end of the stomach
muscle covering of the small intestine
inner circular and outer longitudinal layers of SM
where do the structures within the hilum of the liver run
within the free edge of the lesser omentum
where is the body of the stomach
extends from the cardiac orifice to the angular notch
where are the major and minor papilla from the bile and pancreatic ducts
halfway down the descending duodenum on the postero-medial wall
where does the arterial supply of the cervical oesophagus come from
inferior thyroid artery
3 places in the GI tract where there is dual venous drainage
anterior abdominal wall abdominal oesophagus rectum
where does the Jejenum and ilium extend from/to
extend from the duodenal-jejunum (D-J) flexure to the ileocecal junction
what is a hiatus hernia
herniation of part of the stomach up through the oesophageal hiatus and into the posterior mediastum
what happens to the lesser omentum once it has reached the visceral surface of the liver
it splits and surrounds the liver and reflects onto the under surface of the diaphragm –> then onto the posterior wall of the abdomen
in which quadrant is the stomach located
LUQ
primary function of the duodenum
absorption of digestive products
if you put your finger into the epiploic foramen, what do you have around you?
above - quadrate lobe of the liver behind - IVC beneath - duodenum infront - portal trial running in the free edge of the lesser omentum
how long is the duodenal cap
2 inches - 1 inch intraperitoneal - 1 inch retroperitoneal
two mesentries of the stomach and where
- lesser omentum - from the lesser curvature of the stomach to the liver superiorly - greater omentum - from the greater curvature of the stomach to the gastro-splenic ligament
another name for the major papilla
papilla of vater
where is the duodenum positioned
forms a C shaped loop around the head of the pancreas overlaying the lumbarveretebral column
length and route of the descending duodenum
3 inches long, vertical descent, next to the head of the pancreas, next to the hilum of the R kidney, on psoas major
length and route of the ascending part of the duodenum
1 inch long runs up the left psoas (attached by fibrous tissue) and joins to the jujonem and ilium
where does the arterial supply of the thoracic oesophagus come from
the oes brs from aorta
what are the differences between the surfaces of the liver
- diaphragmatic surface = smooth and dome shaped - visceral surface - smooth and bears the impressions from the adjacent structures and bears the hilum of the liver
sizes of the liver lobes
right is larger than the left
what is the most common reason for getting an indirect inguinal hernia
incomplete closure of the processes vaginalis
what do we get arising from the primitive gut tube
all viscera except the paired organs
what causes the release of the sphincter of Oddi
entrance of fatty foods into the duodenum will cause the release of a hormone that stimulates the contraction of the gall bladder and the relaxation of the sphincter of oddi
how is the liver functionally divided
by the falciform ligament
surfaces of the spleen
- diaphragmatic surface - smooth - visceral surface - bears imprints of the structures that it lies against, where the hilum is
what is the lymphatic drainage of the cervical oesophagus
deep cervical nodes
3 main points of the spleen
- the superior margin of the spleen demarcates between the smooth diaphragmatic surface and visceral surface is always notched - hilum leads you to the tail of the pancreas - relationship of the spleen to ribs 9, 10 and 11 (tucked in underneath)
what is/where is THE mesentry
large fan shaped, double layered fold of peritoneum that connects the J and I to the posterior abdominal wall running obliquely from the DK flexure, crossing the 3rd part of the duodenum, across the aorta and IVC and R ureter onto psoas and ending at the iliocecal junction
main function of the large intestine
absorption of water and important ions from the faeces
functions of the portal vein and hepatic artery
portal vein - carries all the products of absorption hepatic artery - carries oxygenated blood into the liver
where are the hepatic veins
come straight out of the substance of the liver on the posterior surface and straight into the IVC (can never see them) - nothing to do with the liver
what is the gastro-lienal ligament
middle part of the greater omentum that envelops the spleen before heading to the posterior abdominal wall
how long is the abdominal oesophagus
1.5cm
what is the anatomical point for the contact between the fundus and the anterior abdominal wall
where the R costal margin meets the lateral R border of rectus abdominus
what is the lymphatic drainage of the abdominal oesophagus
pre-aortic nodes
where do the R and L gastric arteries lie
along the lesser curvature of the stomach
how did we get secondarily retroperitoneal viscera
some organs during development came to lie against the posterior abdominal wall and then their mesentry got reabsorbed
what is after the descending colon and what is its route
the sigmoid colon - often hangs down into the pelvis –> eventually becomes midline and straightens out as the rectum
where does the transverse mesocolon lie
from the hepatic flexure, running almost transversely across the posterior abdominal wall, over the 2nd part of the duodenum and then the head and body of the pancreas, ending at the splenic flexure
what is the ligamentum teres
it is the obliterated umbilical vein
what is the venous supply of the abdominal oesophagus
Left gastric portal overlaps systemic
how does bile enter the gall bladder
enters it by being backed up from the sphincter of Oddi when digestion is not occuring
where does the large intestine extend from/to
extends from the cecum in the right iliac fossa to the anal canal
where is the liver situated
in the RUQ –> pushes up the R dome of the diaphragm and pushes down on the R kidney
are the jejunum and ilium intra or retroperitoneal
intraperitoneal - have a mesentry that connects them to the posterior abdominal wall
length of oesophagus
25cm tube
route of the ascending intestine
ascends from the cecum up the RHS as far as the liver and ends at the right colic flexure
why cant you normally feel the liver
because it is normally tucked in under the costal margin
where does the greater omentum extend to
drapes down over the front of the abdominal viscera - draping inferiorly down over the transverse colon and the coils of the I and J, then it turns inferiorly and then posteriorly to head back to the posterior abdominal wall
how can you distinguish the ileocecal junction
mucosa covering a thick smooth muscle sphincter
direction of the duodenal cap
direct continuation from the pyloric canal heading upwards and backwards towards the posterior abdominal wall to become retroperitoneal.o the right kidney Comes to lie on the right psoas muscle just medial t
what lies within the porta hepatis (hilum of the liver) and what are their positioning
posteriorly - portal vein infront and to the left - proper hepatic artery infront and to the right - hepatic ducts nerves and lymphatics
venous drainage of the rectum and anal canal
overlap between portal and caval drainage - top –> portal system - botton –> caval system
function of oesophagus
conducts the food from the pharynx to the stomach by peristalsis
supply and drainage of the liver
supply: portal vein (75%) and hepatic artery (25%) drainage: 3 main hepatic veins
how long is the duodenum
10 inches long
at what vertebral level does the oesophagus pass through the diaphragm
T10 slightly left of the midline
length and route of the horizontal part of the duodenum
retroperitoneal - back to the posterior abdominal wall, running from right psoas to left psoas, crossing over the abdominal aorta and lumbar-vertebral column at L3
where do the R and L gastroepiploic arteries lie
along the greater curvature of the stomach
route of the descending colon
down the LHS of the abdominal cavity extending from the splenic flexure to the sigmoid colon
main function of the pyloric sphincter
allows slow exposure of the stomach contents to the intestines
prominence of the rugae of the stomach as you move inferiorly
there is an increase in rugae as you get closer to the pylorus
common features to all of the large intestine
- position - around the margins of the abdomen - muscle coat - fat tags
where does the arterial supply of the abdominal oesophagus come from
left gastric artery from the aorta
what does the appendix contain
numerous lymphoid nodules
what is the gastro-phrenic ligament
part of the greater omentum that goes straight up to the undersurface of the diaphragm
where is the ligamentum teres
it runs between the left lobe and the quadrate lobe of the liver
how long is the appendix
7-10cm (but highly variable)
what stops all of us having inguinal hernias?
- anterior and posterior walls are muscle so when we cough - contract - deep and superficial rings are not aligned - contraction of abdominal walls also closes roof and floor of the inguinal ring
what are the secondarily retroperioneal viscera
ascending and descending volon duodenum pancreas bile duct
what is the mesocolon
the mesentry connecting the large intestine to the posterior abdominal wall
what is the difference between a bilateral indirect inguinal hernia and a bilateral direct inguinal hernia
indirect inguinal hernia - the protrusion of abdominal contents in the inguinal/groin region direct inguinal hernia - protrusion of abdominal contents forward into the inguinal canal through an area of weakness in its posterior wall (hasnt traversed the inguinal canal)
2 curvatures of the stomach
lesser and greater curvatures
where is bile stored and concentrated
gall bladder
most common placement of the tip of the appendix
retrocecal - tucked in under the cecum (have to lift up the ascending colon to see it
what is the course taken by bile
secreted by liver cells into a duct system that gets progressively larger and eventually forms the R and L hepatic ducts (one from each functional half of the liver) at the hilum of the liver –> eventually fuse together to from the common hepatic duct - this is then joined by the cystic duct after a short course in the free edge of the lesser omentum –> common bile duct
where is the pyloric antrum of the stomach
underneath the body, narrowing down to the last part of the stomach to the pyloric sphincter
where is the ligamentum venosum
runs between the left lobe and the caudate lobe
describe the sphincter at the major papilla
sphincter envelopes both the terminal outflow tract at the major duodenal papilla and also the last part of the pancreatic duct and common bile ducts separately
course of the common bile duct
3 parts of its course - rest of the free edge of the lesser omentum - slips behind the first part of the duodenum - slips behind the head of the pancreas in the groove between the vertical part of the duodenum and the head of the pancreas –> major papilla, halfway down the 2nd part of the duodenum on the posteromedial wall
what is the omenta
the double layers of peritoneum that pass from the stomachand the first part of the duodenum to other viscera
position of the pancreas
- head surrounded by the C shape of the duodenum - lies deep to the pylorus - body lies above the DJ flexure - tail takes us right across the vertebral column and abdominal aorta and IVC and terminates at the hilum of the spleen - back to the posterior abdominal wall
mesentry of the primitive gut tube
had both dorsal and ventral mesentry (means that every organ was initially intraperioneal)
what are the other two “lobes” of the liver other than the R and L
quadrate (rectangular, close to inferior margin) and caudate lobes
length of large intestine
1.5 metres
describe the main duct of the pancreas
begins at the tail and runs the length of the organ collecting all of the exocrine secretions –> opens into the duodenum in conjunction with the common bile duct into the major duodenal papilla
what are haustra
gathered appearance of the large intestine caused by the tenia coli
functions of the liver
- receives venus drainage of the GI tract and metabolises those products - storage of energy sources - production of cellular fuels, plasma proteins and clotting factors - metabolism of toxins and drugs - modification of hormones - production of bile acids - excretion of bilirubin - storage
what is the Z line
the abrupt change of epithelium between the stratified squamous epithelium of the oesophagus and the gastric mucosa lining the stomach
another name for the sphincter at the major papilla
sphincter of Oddi
definition of intra and retroperitoneal
intra - structures that are surrounded by visceral peritoneum retro - structures that are situated behind the peritoneal cavity against the posterior abdominal wall with only a layer of peritoneum covering their anterior surface
what is special about the base of the appendix
it has a fixed point of attachment to the cecum where the 3 tenia coli meet on the posteromedial inferior aspect of the cecum
where is the lesser sac/omental bursa
behind the stomach and liver
where is the gall bladder
lies on the visceral surface of the liver in the groove between the R and quadrate lobes
3 parts of the greater omentum
gastro-colic ligament gastro-lienal ligament gastro-phrenic ligament
