Anatomy - GI Vessels - Acht Flashcards
Where do the lesser and greater omenta attach to the stomach?
Lesser omentum - less curvature
Greater omentum - greater curvature
Name of folds of stomach vs name of fold in intestine?
stomach = rugae
intestine = plicae circularis
Is the small intestine retroperitoneal?
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
What structure does the duodenum wrap around in a C?
The head of the pancreas. That tart!
What part of the duodenum is common for ulcers?
the bulb or ampilla.
Note: the ampilla does not have plicae circulares
What structure suspends the last part of the duodenum from the crus of the diaphragm?
Theligament of Treitz (Suspensory Ligament)
Are plicae circularis more pronounced int he jejunum or ileum?
More pronounced in jejunum, gradually disappear by the distal ileum
Where is the best place to find Peyer’s patches? What are they for?
Only find them in the ileum
For immune surveilance and response
Name these structures
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?
The iliocecal valve and orifice would be good to see int he cecum, pretty near the appendix
(Clasically) Initially appendicitis pain is located where?
Then it moves where in late stage appendicitis?
Initial: Pain referred to umbilicus
Later: Pain felt over McBurney’s Point (with rebound tenderness)
Map out in your mind the large bowel:
Cecum, ascending colon, hepatic felxure, transverse, splenic flexure, descending, sigmoid, and rectum
Got it?
What is ulcerative colitis?
Sever inflammation and ulceration of colon and rectum. Sometimes a full colectomy is required
Name the 3 branches of the celiac trunk:
- Left gastric - to lesser curvature of stomach
- Common hepatic - heads toward the liver
- Splenic artery
Name branches of left gastric:
Esophageal branches - enter thorax and anastomose with esophageal branches from thoracic aorta
(important to understand for esophageal varices in portal hypertension)
Branches of the common hepatic artery?
- Hepatic artery proper
- right gastric (lesser curvature of stomach)
- left hepatic (left lobe of liver)
- right hepatic (right lobe of liver)
- cystic artery (gallbladder)
- Gastroduodenal artery
- Supraduodenal (duodenum)
- superior pancreatoduodenal arteries
- right gastro-omental (greater curvature)
Branches of the splenic artery?
Splenic goes right to the spleen
Branches
- Pancreatic branches
- Short gastric (fundus of stomach)
- left gastro-omental (lesser curvature)
What artery supplies the cecum?
ileocolic artery from the superior mesenteric artery
Components of hepatic portal system?
- 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
What is portal hypertension?
What are its clinical manifestations?
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
ID parts of the pancreas
Where is the pancreas?
waldo!
What terminates at the major duodenal papilla?
Hepatopancreatic ampulla
(both the common bile duct and pancreatic duct together)
Within the major duodenal papilla are what sphincters?
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.
Name those arteries people:
howd you do?
Name the liver lobes
What makes up the portal triad?
Bile duct, hepatic artery, portal vein
The bare area of the liver lacks:
peritoneal covering
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
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
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
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.
Which vessel MUST be located before proceeding with a cholecystectomy?
Cystic artery!
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
C. Hepatopancreatic Ampulla
(others feed into it, but thats the one leading right into the papilla)
