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GI II > Anatomy of liver, pancreas, and small intestine > Flashcards

Anatomy of liver, pancreas, and small intestine Flashcards

1
Q

What branch does the SMA give off that supplies the pancreas?

A

The inferior pancreaticoduodenal arteries.

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2
Q

What are the three branches of the SMA that supply the midgut?

A

The middle colic artery, the right colic artery, and the ileocolic artery.

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3
Q

What does the middle colic artery supply?

A

The proximal half of the transverse colon (runs along its margin).

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4
Q

What does the right colic artery supply?

A

The ascending colon.

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5
Q

What does the iliocolic artery supply?

A

The ileocolic junction (ileum and cecum) as well as the appendix.

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6
Q

What do the branched of the SMA to the distal duodenum, jejunum, and ilium form?

A

They form “arcades” that are protected from twisting and compression of the small intestines.

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7
Q

What is the marginal artery of the colon (artery of Drummond)?

A

It runs along the inner border of the colon and is the anastomotic link between all the branches that supply the colon.

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8
Q

What part of the duodenum is compressed in superior mesenteric artery syndrome?

A

The third part of the duodenum (horizontal/inferior) is compressed in SMA syndrome.

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9
Q

What do the veins supplying the head of the pancreas drain into?

A

The superior mesenteric vein which drains into the portal vein.

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10
Q

What do the veins supplying the body and tail of the pancreas drain into?

A

The splenic vein which drains into the portal vein.

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11
Q

What does the gallbladder drain into?

A

The cystic duct.

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12
Q

What does the cystic duct merge with?

A

The common hepatic duct which forms the common bile duct.

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13
Q

What does the common bile duct merge with?

A

The pancreatic duct which forms the dilation called the hepato-pancreatic ampulla (ampulla of Vater).

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14
Q

What is clinically relevant about the hepato-pancreatic ampulla (ampulla of Vater)?

A

It is the most likely site for gallstones to lodge due to the sphincter of Oddi at its distal end.

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15
Q

What are the two major lobes of the liver?

A

The right and left lobes, which are separated by the falciform ligament.

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16
Q

What is the area of the liver located on the superior/diaphragmatic surface?

A

The bare area of the liver.

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17
Q

What are the two minor lobes of the liver located on the posterior aspect of the right lobe?

A

The caudate lobe and the quadrate lobe.

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18
Q

What is the caudate lobe closest to?

A

The IVC.

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19
Q

What is the quadrate lobe closest to?

A

The gallbladder.

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20
Q

What are the other ligaments of note for the liver aside from the falciform and lesser omentum (hepatoduodenal and hepatogastric)?

A

The right and left triangular ligaments which are continuous with the coronary ligament. They all serve to anchor the liver to the diaphragm (located on the superior surface along the bare area of the liver).

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21
Q

What comprises the portal triad traveling within the hepatoduodenal ligament?

A

The proper heaptic artery, the portal vein, and the common bile duct.

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22
Q

What connects the portal vein to the central hepatic vein?

A

Hepatic sinusoids in the liver parenchyma.

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23
Q

What comprises the esophageal portal-systemic anastomoses?

A

The left gastric vein (right off the splenic vein) and the esophageal veins.

24
Q

What comprises the rectal portal-systemic anastomoses?

A

The superior rectal vein (drains into the inferior mesenteric vein which drains into the splenic vein) and the middle/inferior rectal veins which come from the internal iliac vein.

25
Q

What will enlarged rectal portal-systemic anastomoses present as?

A

Hemorrhoids.

26
Q

Where can portal-systemic anstomoses potentially develop?

A

Wherever a tissue becomes secondarily retroperitoneal (AC/DC Party Down).

27
Q

What are the paraumbilical veins?

A

Small veins surrounding the ligamentum teres hepatis.

28
Q

What do the paraumbilical veins anastomose with?

A

The small epigastric veins of the anterior abdominal wall.

29
Q

What is the portal-systemic anastomoses between the paraumbilical and small epigastric veins called?

A

A caput medusae.

30
Q

Why is portal hypertension problematic?

A

The portal-systemic anastomoses are not designed to handle lots of blood flow. When there is portal hypertension i.e. blocked hepatic sinusoids it can lead to enlargement of the anastomoses.

31
Q

What are the two sets of liver lymph nodes?

A

One set drains the surface structures and the other drains the body of the liver.

32
Q

What lymph nodes will drain the surface structures of the liver?

A

They will drain up into the IVC nodes and into the parasternal lymph nodes.

33
Q

What is another lymphatic drainage of the superficial liver?

A

The pericarial nodes and the mediastinal nodes.

34
Q

What is the last lymphatic drainage of the surface structures of the liver?

A

The lateral diaphragmatic nodes to the posterior thoracic wall. Some will short circuit and go to the cardiac nodes and into the thoracic duct.

35
Q

Where will most liver cancers be found?

A

In the deep lymph nodes.

36
Q

What is the deep lymphatic drainage of the liver?

A

The hepatic hilar LN, the hepatic artery LN, and the celiac LN.

37
Q

What are the para-aortic nodes that are at the terminal end of the hepatic lymphatic node chain?

A

The celiac LN. The celiac LN are also terminal LN due to draining into the cisterna chyli.

38
Q

What are the surface features of the colon?

A

The tenia coli, which are three muscular bands around the three parts of the colon.

39
Q

What is found around two of the parts of the tenia coli?

A

Characteristic fat pads called omental fat pads or epiploic fat pads.

40
Q

What happens as you follow the tenia coli down the length of the ascending colon?

A

All three tenia coli converge on the appendix (way to identify the appendix).

41
Q

What do the tenia coli separate the colon into?

A

They bunch thge colon into saccules called haustra.

42
Q

What it the cecum?

A

The part of the ascending colon with a blind end (the ileum joins the colon superior to the cecum).

43
Q

What comes off of the cecum?

A

The appendix.

44
Q

What is Mcburney’s point?

A

A location on the abdominal wall used to locate the appendix.

45
Q

Where is Mcburney’s point located?

A

1/3 the way from ASIS to the umbilicus.

46
Q

What is another way to locate the appendix?

A

Make a line across the ileum where it joints the semilunar line and rectus abdominis.

47
Q

What structure is inflamed to produce rebound tenderness during appendicitis?

A

The appendix rests upon the parietal peritoneum of the psoas major. As such, there will be somatic pain in this peritoneum causing rebound tenderness (plus patients with appendicitis will find relief with flexing the hip).

48
Q

What is a Meckel’s /Ileal diverticulum?

A

When the vitelline duct (remnant of the yolk sac) persists.

49
Q

What will a Meckel’s/ileal diverticulum sometimes contain?

A

Ectopic gastric or pancreatic muscosa. Ectopic gastric mucosa can cause ulcers in the the surrounding area.

50
Q

How can ectopic gastric mucosa be diagnosed?

A

Radioactive pertechnetate will accumulate in ectopic gastric mucosa due to the presence of the Na/I symporter.

51
Q

What are the main branches of the inferior mesenteric artery?

A

The left colic artery, sigmoid arteries, and superior rectal artery.

52
Q

What does the left colic artery supply?

A

The left colic arterysupplies the distal half of the transverse colon and the entire descending colon.

53
Q

What does the left colic artery form an anastomoses with?

A

The middle colic artery.

54
Q

What will the venous drainage of the IMA region drain into?

A

Like the rest of the gut, venous drainage to the hindgut travels to the liver via the portal circulation. The veins will go to the posterior body wall and pass behind the ascending duodenum to join the splenic vein into the portal system.

55
Q

What is the first capillary bed that an intestinal metastatic cancer cell encounter if it enters the venous drainage?

A

The portal vein to the hepatic sinusoids to the liver and into the systemic circulation.

56
Q

What is the first capillary bed that an intestinal metastatic cancer cell encounter if it enters the lymphatic drainage?

A

The thoracic duct to the lungs.

GI II (7 decks)

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