Anatomy - GI Vessels - Acht

Question 1

Where do the lesser and greater omenta attach to the stomach?

Answer 1

Lesser omentum - less curvature

Greater omentum - greater curvature

Question 2

Name of folds of stomach vs name of fold in intestine?

Answer 2

stomach = rugae

intestine = plicae circularis

Question 3

Is the small intestine retroperitoneal?

Answer 3

Most of the duodenum is, except for the first and last portion, the jejunum and ileum are both suspected by mesentary and are peritoneal organs

Question 4

What structure does the duodenum wrap around in a C?

Answer 4

The head of the pancreas. That tart!

Question 5

What part of the duodenum is common for ulcers?

Answer 5

the bulb or ampilla.

Note: the ampilla does not have plicae circulares

Question 6

What structure suspends the last part of the duodenum from the crus of the diaphragm?

Answer 6

Theligament of Treitz (Suspensory Ligament)

Question 7

Are plicae circularis more pronounced int he jejunum or ileum?

Answer 7

More pronounced in jejunum, gradually disappear by the distal ileum

Question 8

Where is the best place to find Peyer’s patches? What are they for?

Answer 8

Only find them in the ileum

For immune surveilance and response

Question 9

Name these structures

Answer 9

Question 10

Let’s say you are a GI doc doing a lower endoscopy. You want to see if you can find where the appendix is coming off of the cecum. What is another nearby structure that would help you know you’re in the right neighborhood?

Answer 10

The iliocecal valve and orifice would be good to see int he cecum, pretty near the appendix

Question 11

(Clasically) Initially appendicitis pain is located where?

Then it moves where in late stage appendicitis?

Answer 11

Initial: Pain referred to umbilicus

Later: Pain felt over McBurney’s Point (with rebound tenderness)

Question 12

Map out in your mind the large bowel:

Cecum, ascending colon, hepatic felxure, transverse, splenic flexure, descending, sigmoid, and rectum

Answer 12

Got it?

Question 13

What is ulcerative colitis?

Answer 13

Sever inflammation and ulceration of colon and rectum. Sometimes a full colectomy is required

Question 14

Name the 3 branches of the celiac trunk:

Answer 14

1. Left gastric - to lesser curvature of stomach
2. Common hepatic - heads toward the liver
3. Splenic artery

Question 15

Name branches of left gastric:

Answer 15

Esophageal branches - enter thorax and anastomose with esophageal branches from thoracic aorta

(important to understand for esophageal varices in portal hypertension)

Question 16

Branches of the common hepatic artery?

Answer 16

1. Hepatic artery proper
   
   1. right gastric (lesser curvature of stomach)
   2. left hepatic (left lobe of liver)
   3. right hepatic (right lobe of liver)
   4. cystic artery (gallbladder)
2. Gastroduodenal artery
   
   1. Supraduodenal (duodenum)
   2. superior pancreatoduodenal arteries
      
      1. right gastro-omental (greater curvature)

Question 17

Branches of the splenic artery?

Answer 17

Splenic goes right to the spleen

Branches

1. Pancreatic branches
2. Short gastric (fundus of stomach)
3. left gastro-omental (lesser curvature)

Question 18

What artery supplies the cecum?

Answer 18

ileocolic artery from the superior mesenteric artery

Question 19

Components of hepatic portal system?

Answer 19

• splenic vein drains the foregut
• recieves small veins and then the inferior mesentary vein posterior to the pancreas
• Joins with superior mesenteric vein to form the hepatic portal vein at about L2

Question 20

What is portal hypertension?

What are its clinical manifestations?

Answer 20

Portal hypertension is an increase in pressure and engorgement of vessels of the portal venous system resulting from obstruction of the portal circulation. This may occur within the liver (tumor, cirrhosis) or outside the liver by compression of the portal vein (tumor).

Clinical

Ascites : increase in pressure produces fluid in peritoneal cavity

GI bleeding (esophageal varices, rectal hemorrhoids) increased pressure engorges systemic veins where they anastomose with portal tributaries.

splenomegaly - increased pressure may enlarge the spleen

caput medusae - Engorgement of epigastric veins produces varicose veins around the umbilicus

Question 21

ID parts of the pancreas

Answer 21

Question 22

Where is the pancreas?

Answer 22

waldo!

Question 23

What terminates at the major duodenal papilla?

Answer 23

Hepatopancreatic ampulla

(both the common bile duct and pancreatic duct together)

Question 24

Within the major duodenal papilla are what sphincters?

Answer 24

Choledochal sphincter controls bile secretion into the duodenum. Pancreatic sphincter controls pancreatic secretions into the duodenum. The sphincter papillae (sphincter if Oddi) surrounds the ampulla of Vater and controls the combined opening.

Question 25

Name those arteries people:

Answer 25

howd you do?

Question 26

Name the liver lobes

Answer 26

Question 27

What makes up the portal triad?

Answer 27

Bile duct, hepatic artery, portal vein

Question 28

The bare area of the liver lacks:

Answer 28

peritoneal covering

Question 29

1.The plane dividing the functional right and left lobes of the liver can be visualized on the outside of the liver passing through the:

A.Falciform ligament and IVC
B.Falciform ligament and ligamentum venosum
C.Gall bladder fossa and hepatic portal vein
D.Gall bladder fossa and IVC
E.Gall bladder fossa and ligamentum teres

Answer 29

D. Gall bladder fossa and IVC

Remember, there is a difference between functional and anatomical division between left and right lobes

Functional = along gall bladder and IVC

Anatomical = Falciform ligament

The functional/surgical divide has more to do with distribution of bile ducts and hepatic vessels

Question 30

A 58-year-old male patient with severe jaundice was diagnosed with pancreatic cancer. Which part of the pancreas is the most likely location for the tumor?

A.Body
B.Head
C.Neck
D.Tail
E.Uncinate process

Answer 30

B - Head

Tumor growth in the pancreatic head can obstruct the bile and/or pancreatic ducts. Placement of a stent into the bile duct maintains patency. Jaundice caused because of bile pigments, bilirubin in the plasma.

Question 31

Which vessel MUST be located before proceeding with a cholecystectomy?

Answer 31

Cystic artery!

Question 32

Which of the following structures directly drains at the major duodenal papilla?

A.Cystic duct
B.Common bile duct
C.Hepatopancreatic ampulla
D.Pancreatic duct
E.R hepatic duct

Answer 32

C. Hepatopancreatic Ampulla

(others feed into it, but thats the one leading right into the papilla)