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Z MD1 GI block > Anatomy - abdominal viscera > Flashcards

Anatomy - abdominal viscera Flashcards

1
Q

function of the lesser sac

A

provides frictionless surface for expansion of the stomach

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2
Q

what are the narrowings of the oesophagus

A
  1. 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
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4
Q

what is the epiploic/omental foarmen of Winslow

A

the only communication of the lesser sac to the greater sac

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5
Q

muscle coat of the rectum

A

changes from 3 discreet muscle bands of the longitudinal muscle band back to one longitudinal continuous muscle coat in the rectum

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5
Q

what is in the hilum of the spleen

A

transmits the splenic artery and vein and ymphatics and nerves

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5
Q

functions of the mesentry

A
  • transmit the vessels and nerves to the IP structures - to allow for mobility and the capacity to expand
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6
Q

4 parts of the duodenum

A
  • duodenal cap - vertical descending - horizontal part - ascending part
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7
Q

where is the spleen

A

in the LUQ under the left dome of the diaphragm, under ribs 9, 10 and 11

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8
Q

where does the oesophagus enter the stomach

A

the RHS of the fundus

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9
Q

is the duodenum intraperitoneal or retroperitoneal

A

all but the first inch of the duodenum is retroperioneal

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9
Q

what are the paired viscera and are they IP or RP

A

kidneys adrenals ureters all RETROPERITONEAL - located directly on the posterior abdominal wall with the aorta and the IVC

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10
Q

length of the jujenum and ilium

A

4-6 metres in length

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10
Q

route of the transverse intestine

A

begins at the right colic flexure/hepatic flexure and extends to the left colic flexure/splenic flexure

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11
Q

distinction between jejunum and ilium

A
  • 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
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12
Q

is the pancreas Intra or retroperitoneal

A

retroperitoneal

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12
Q

where does the sigmoid mesocolon lie

A

from the sigmoid colon to the posterior abdominal wall running over the division of the left common iliac artery

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13
Q

where does the oesophagus begin

A

at the level of the cricoid cartilage at the level of C6 in the neck

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13
Q

what is the venous supply of the cervical oesophagus

A

brachiocephalic systemic

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14
Q

what are Tenia coli

A

3 stripes down the large intestine composed of the 3 discreet longitudinal smooth muscle bands around the large intestine

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16
Q

what is the venous supply of the thoracic oesophagus

A

azygous systemic

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16
Q

what is the lymphatic drainage of the thoracic oesophagus

A

mediastinal nodes

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16
Q

composition of the jejunum and ilium (%?) and in which quandrants do they lie?

A

40% jejunum - LUQ 60% ilium - RLQ

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17
Q

types of hiatus hernia

A
  • 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)
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17
Q

what does the accessory duct of the pancreas do/go?

A

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

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17
Q

what is the gastro-colic ligament

A

part of the greater omentum that heads down and back over the intestine forming the fatty apron

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18
Q

what is special about the arteries within the mesentry connecting the jejunum and ilium to the posterior abdominal wall

A

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

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18
Q

what composes layers 1, 2 and 3 of the viscera

A

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

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19
Q

nerve supply of parietal and visceral peritoneum

A
  • 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
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20
Q

muscle covering of the large intestine

A
  • inner continuous layer of circular SM - outer coat of longitudinal SM divided into 3 discreet bands
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21
Q

what is/where is the cecum

A

pouch hanging down below the iliocecal junction in the RLQ (appendix hands off it)

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22
Q

what is the main reason for getting direct inguinal hernia

A

weak abdominal muscles

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23
Q

where is the fundus of the stomach

A

projects above the cardiac origice and sits directly under the left dome of the diaphragm

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25
Q

on which parts of the stomach are the 2 openings

A

proximal - on the proximal part of the RHS of the stomach distal - pyloric orifice at the end of the stomach

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25
Q

muscle covering of the small intestine

A

inner circular and outer longitudinal layers of SM

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26
Q

where do the structures within the hilum of the liver run

A

within the free edge of the lesser omentum

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27
Q

where is the body of the stomach

A

extends from the cardiac orifice to the angular notch

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27
Q

where are the major and minor papilla from the bile and pancreatic ducts

A

halfway down the descending duodenum on the postero-medial wall

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28
Q

where does the arterial supply of the cervical oesophagus come from

A

inferior thyroid artery

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28
Q

3 places in the GI tract where there is dual venous drainage

A

anterior abdominal wall abdominal oesophagus rectum

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29
Q

where does the Jejenum and ilium extend from/to

A

extend from the duodenal-jejunum (D-J) flexure to the ileocecal junction

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31
Q

what is a hiatus hernia

A

herniation of part of the stomach up through the oesophageal hiatus and into the posterior mediastum

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32
Q

what happens to the lesser omentum once it has reached the visceral surface of the liver

A

it splits and surrounds the liver and reflects onto the under surface of the diaphragm –> then onto the posterior wall of the abdomen

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33
Q

in which quadrant is the stomach located

A

LUQ

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34
Q

primary function of the duodenum

A

absorption of digestive products

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35
Q

if you put your finger into the epiploic foramen, what do you have around you?

A

above - quadrate lobe of the liver behind - IVC beneath - duodenum infront - portal trial running in the free edge of the lesser omentum

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36
Q

how long is the duodenal cap

A

2 inches - 1 inch intraperitoneal - 1 inch retroperitoneal

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37
Q

two mesentries of the stomach and where

A
  • 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
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38
Q

another name for the major papilla

A

papilla of vater

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40
Q

where is the duodenum positioned

A

forms a C shaped loop around the head of the pancreas overlaying the lumbarveretebral column

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41
Q

length and route of the descending duodenum

A

3 inches long, vertical descent, next to the head of the pancreas, next to the hilum of the R kidney, on psoas major

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43
Q

length and route of the ascending part of the duodenum

A

1 inch long runs up the left psoas (attached by fibrous tissue) and joins to the jujonem and ilium

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44
Q

where does the arterial supply of the thoracic oesophagus come from

A

the oes brs from aorta

44
Q

what are the differences between the surfaces of the liver

A
  • diaphragmatic surface = smooth and dome shaped - visceral surface - smooth and bears the impressions from the adjacent structures and bears the hilum of the liver
45
Q

sizes of the liver lobes

A

right is larger than the left

45
Q

what is the most common reason for getting an indirect inguinal hernia

A

incomplete closure of the processes vaginalis

46
Q

what do we get arising from the primitive gut tube

A

all viscera except the paired organs

47
Q

what causes the release of the sphincter of Oddi

A

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

48
Q

how is the liver functionally divided

A

by the falciform ligament

49
Q

surfaces of the spleen

A
  • diaphragmatic surface - smooth - visceral surface - bears imprints of the structures that it lies against, where the hilum is
50
Q

what is the lymphatic drainage of the cervical oesophagus

A

deep cervical nodes

51
Q

3 main points of the spleen

A
  • 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)
52
Q

what is/where is THE mesentry

A

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

53
Q

main function of the large intestine

A

absorption of water and important ions from the faeces

54
Q

functions of the portal vein and hepatic artery

A

portal vein - carries all the products of absorption hepatic artery - carries oxygenated blood into the liver

54
Q

where are the hepatic veins

A

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

54
Q

what is the gastro-lienal ligament

A

middle part of the greater omentum that envelops the spleen before heading to the posterior abdominal wall

55
Q

how long is the abdominal oesophagus

A

1.5cm

56
Q

what is the anatomical point for the contact between the fundus and the anterior abdominal wall

A

where the R costal margin meets the lateral R border of rectus abdominus

57
Q

what is the lymphatic drainage of the abdominal oesophagus

A

pre-aortic nodes

58
Q

where do the R and L gastric arteries lie

A

along the lesser curvature of the stomach

59
Q

how did we get secondarily retroperitoneal viscera

A

some organs during development came to lie against the posterior abdominal wall and then their mesentry got reabsorbed

60
Q

what is after the descending colon and what is its route

A

the sigmoid colon - often hangs down into the pelvis –> eventually becomes midline and straightens out as the rectum

61
Q

where does the transverse mesocolon lie

A

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

62
Q

what is the ligamentum teres

A

it is the obliterated umbilical vein

63
Q

what is the venous supply of the abdominal oesophagus

A

Left gastric portal overlaps systemic

63
Q

how does bile enter the gall bladder

A

enters it by being backed up from the sphincter of Oddi when digestion is not occuring

65
Q

where does the large intestine extend from/to

A

extends from the cecum in the right iliac fossa to the anal canal

67
Q

where is the liver situated

A

in the RUQ –> pushes up the R dome of the diaphragm and pushes down on the R kidney

68
Q

are the jejunum and ilium intra or retroperitoneal

A

intraperitoneal - have a mesentry that connects them to the posterior abdominal wall

69
Q

length of oesophagus

A

25cm tube

71
Q

route of the ascending intestine

A

ascends from the cecum up the RHS as far as the liver and ends at the right colic flexure

72
Q

why cant you normally feel the liver

A

because it is normally tucked in under the costal margin

73
Q

where does the greater omentum extend to

A

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

74
Q

how can you distinguish the ileocecal junction

A

mucosa covering a thick smooth muscle sphincter

76
Q

direction of the duodenal cap

A

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

78
Q

what lies within the porta hepatis (hilum of the liver) and what are their positioning

A

posteriorly - portal vein infront and to the left - proper hepatic artery infront and to the right - hepatic ducts nerves and lymphatics

79
Q

venous drainage of the rectum and anal canal

A

overlap between portal and caval drainage - top –> portal system - botton –> caval system

80
Q

function of oesophagus

A

conducts the food from the pharynx to the stomach by peristalsis

81
Q

supply and drainage of the liver

A

supply: portal vein (75%) and hepatic artery (25%) drainage: 3 main hepatic veins

82
Q

how long is the duodenum

A

10 inches long

83
Q

at what vertebral level does the oesophagus pass through the diaphragm

A

T10 slightly left of the midline

83
Q

length and route of the horizontal part of the duodenum

A

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

84
Q

where do the R and L gastroepiploic arteries lie

A

along the greater curvature of the stomach

85
Q

route of the descending colon

A

down the LHS of the abdominal cavity extending from the splenic flexure to the sigmoid colon

87
Q

main function of the pyloric sphincter

A

allows slow exposure of the stomach contents to the intestines

89
Q

prominence of the rugae of the stomach as you move inferiorly

A

there is an increase in rugae as you get closer to the pylorus

91
Q

common features to all of the large intestine

A
  • position - around the margins of the abdomen - muscle coat - fat tags
92
Q

where does the arterial supply of the abdominal oesophagus come from

A

left gastric artery from the aorta

92
Q

what does the appendix contain

A

numerous lymphoid nodules

93
Q

what is the gastro-phrenic ligament

A

part of the greater omentum that goes straight up to the undersurface of the diaphragm

95
Q

where is the ligamentum teres

A

it runs between the left lobe and the quadrate lobe of the liver

97
Q

how long is the appendix

A

7-10cm (but highly variable)

98
Q

what stops all of us having inguinal hernias?

A
  • 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
99
Q

what are the secondarily retroperioneal viscera

A

ascending and descending volon duodenum pancreas bile duct

100
Q

what is the mesocolon

A

the mesentry connecting the large intestine to the posterior abdominal wall

101
Q

what is the difference between a bilateral indirect inguinal hernia and a bilateral direct inguinal hernia

A

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)

102
Q

2 curvatures of the stomach

A

lesser and greater curvatures

103
Q

where is bile stored and concentrated

A

gall bladder

104
Q

most common placement of the tip of the appendix

A

retrocecal - tucked in under the cecum (have to lift up the ascending colon to see it

106
Q

what is the course taken by bile

A

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

107
Q

where is the pyloric antrum of the stomach

A

underneath the body, narrowing down to the last part of the stomach to the pyloric sphincter

108
Q

where is the ligamentum venosum

A

runs between the left lobe and the caudate lobe

109
Q

describe the sphincter at the major papilla

A

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

111
Q

course of the common bile duct

A

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

112
Q

what is the omenta

A

the double layers of peritoneum that pass from the stomachand the first part of the duodenum to other viscera

114
Q

position of the pancreas

A
  • 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
115
Q

mesentry of the primitive gut tube

A

had both dorsal and ventral mesentry (means that every organ was initially intraperioneal)

116
Q

what are the other two “lobes” of the liver other than the R and L

A

quadrate (rectangular, close to inferior margin) and caudate lobes

118
Q

length of large intestine

A

1.5 metres

119
Q

describe the main duct of the pancreas

A

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

120
Q

what are haustra

A

gathered appearance of the large intestine caused by the tenia coli

121
Q

functions of the liver

A
  • 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
122
Q

what is the Z line

A

the abrupt change of epithelium between the stratified squamous epithelium of the oesophagus and the gastric mucosa lining the stomach

123
Q

another name for the sphincter at the major papilla

A

sphincter of Oddi

125
Q

definition of intra and retroperitoneal

A

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

126
Q

what is special about the base of the appendix

A

it has a fixed point of attachment to the cecum where the 3 tenia coli meet on the posteromedial inferior aspect of the cecum

127
Q

where is the lesser sac/omental bursa

A

behind the stomach and liver

128
Q

where is the gall bladder

A

lies on the visceral surface of the liver in the groove between the R and quadrate lobes

129
Q

3 parts of the greater omentum

A

gastro-colic ligament gastro-lienal ligament gastro-phrenic ligament

Z MD1 GI block (18 decks)

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