Anatomy Overview 2 Flashcards
Name the 4 sections of the abdomen and the two lines seperating them?
Right upper quadrant R. lower Quadrant L. Upper quadrant L. Lower Quadrant - Transumbilical line - Medial Line?
Note the 9 sections of the abdomen and what gut section they belong to
Foregut : R. Hypochondrium - Epigastrium - L. Hypochondrium
Midgut: R. Lumbar - Periumbilical - L Lumbar
Hindgut: R. Iliac Fossa - Hypogastrium - L Iliac Fossa
What are the 3 constrictions of the oesophagus?
Cervical (Pharyngoesophageal)
Thoracic (Broncho-Aortic) - Where its crossed by the aortic arch & L main bronchus
Diaphragmatic - Where it passes through the oesophageal hiatus
What controls discharge of stomach contents into the duodenum?
Pyloric Sphincter
What is the stomach bed?
The structures on which the stomach rests:
Diaphragm - Spleen - Left Kidney - Adrenal gland - splenic artery - Pancreas - Transverse mesocolon - Colon
What is the transverse mesocolon?
A broad fold of peritoneum connecting the transverse colon to the wall.
See? Its transverse colon + Meso for mesentery
What are the major sections/landmarks of the stomach?
Cardia - Where oesophagus becomes stomach
Cardial Notch - Notch above cardia
Fundus - Superior section above cardia
Body - Bulk of stomach from cardia down to pylorus
Pyloric antrum & Pyloric canal
Pyloric sphincter
Greater & LEsser curvature
Name & explain one major developmental pathology of the stomach
Congenital pyloric stenosis (aka hypertrophic pyloric stenosis)
Thickening of smooth muscle in the pylorus leads to stenosis of the sphincter
What are the important ligaments of the liver?
Falciform Ligament - between lobes
Round ligament - Found on the free edge of the falciform ligament (inferiorly) & left over from the umbilical vein
What is the bare area of the liver?
A mostly posterior area of liver uncovered by peritoneum
How do the ribs relate to the liver?
The liver lies deep to ribs 7-11 on the left side
Where is the gastric area of the lvier?
inferior surface of the left lobe
Where is the colic area of the liver?
to the right of the gall bladder fossa and in front of the renal area
Where is the renal area of the liver?
Right of gall bladder fossa
Behind colic area
Where is the duodenal impression?
medial to the renal impression, between it and the neck of the gall bladder
Where is the caudate lobe of the liver?
On the postero-superior surface of hte right lobe.
Between the IVC - ligamentum venosum.
What is the portal triad?
three structures entering the liver above the colic area medial/superior to the gall bladder
- Hepatic Artery
- Portal Vein
- Bile Duct (actually leaving)
What is the function of gall bladder/bile ducts?
To store/concentrate up to 50ml of bile from the liver then transport it to the duodenum
What is the cystic artery and where does it lie?
The artery supplying the gall bladder.
During removal it must be clamped, misclamping can lead to killing the liver.
Its found in the triangle of calot
Qhat is the triangle of calot?
A triangle containing the cystic artery of the gall bladder, its formed by:
- Common hepatic duct (drain bile from liver)
- Cystic Duct (gall bladder -> Bile duct)
- Visceral surface of the liver
What are the risk factors of biliary colic and what is it?
Biliary colic is sudden pain due to a gallstone blocking the bile duct.
Four Fs:
Fat - Female - Fertile - Forty
What is the pancreas?
An accessory digestive gland
Is the pancreas exocrine or endocrine?
Both!
Exocrine - Pancreatic Juice
Endocrine - Insulin & Glucagon
Is the pancreas retro or intraperitoneal?
Retroperitoneal
At what level is the pancreas found?
L1/L2 on the transpyloric plane
What are the sections of the pancreas?
Head Neck Body Tail
How the pancreas relate tot he portal vein?
The portal vein is found behind the neck of the pancreas
What is the spleen and where is it found?
A mobile haemo-lymphoid organs found in the left hypochondrium behind left ribs 9-11
Is the spleen intra or retorperitoneal?
Intraperitoneal
What is the most common pathology of the spleen?
Splenomegaly due to many causes such as anaemia or typhoid fever
Explain the arterial supply of the foregut:
Abdominal Aorta -> Celiac Trunk (T12) ->:
- > Left Gastric Artery
- > Hepatic Artery
- > Splenic Artery
What structures are found in the foregut?
Oesophagus Stomach Liver Gall Bladder Pancreas Spleen 1st half of duodenum
What structures are found in the midgut?
Rest of duodenum, Jejunum & Ileum Cecum Appendix Asc. Colon 1st 2/3rds of the Transverse Colon
Where do the bile and pancreatic ducts join the gut tube?
At the duodenum
What is the most fixed part of the gut tube?
The duodenum
How do we tell between the jejunum and ileum
Jejunum has:
- Longer vasa recta with less loops of arterial arcades in its mesentery.
- Also less fat in the mesenter
- Greater Vasculature
- Thicker & heavier than the ileum
Explain the arterial supply of the midgut?
Abdominal Aorta (L1) -> Superior Mesenteric Artery ->:
- > Jejunal & Ileal arteries
- > Middle Colic
- > Right Colic
- > Ileocolic
What branches of the superior mesenteric artery supply what structures?
Jejunal & Ileal arteries = duh
Ileocolic = Last part of ileum, cecum and appendix
Right Colic = Asc. Colon
Middle Colic = Transverse Colon
What structures are in the hindgut?
- Last 3rd of transverse colon
- Desc. Colon
- Sigmoid Colon
- Rectum
- Upper part of anal canal
- Also forms the epithelium of the urinary bladder and urethra
Explain the blood supply of the hindgut:
Abdominal Aorta (L3) -> Inferior Mesenteric Artery ->:
- Left Colic artery (Desc. Colon)
- Sigmoid artery(Sigmoid Colon)
- Superior Rectal artery(rectum)
How do we differentiate large from small intestine?
The large intestine has:
- Omental Appedices. Small fatty peritoneal-like projections
- Haustra/Saculations. Gives it the balloon animal appearance
- Tenia Coli. Thick bands of smooth muscle that can be seen running up the middle of it
What is the appendix?
A blind intestinal diverticulum with masses of lymphatic tissue
Most often behind the cecum (retocecal)
What is macburneys point?
The points of maximum tenderness in appendicitis
What is the rectum and where does it join tot he sigmoid colon?
The pelvic section of the gut tube
Sigmoid colon becomes rectum anterior to the S3 vertebral body
What sphincters are found in the anal canal?
The external & internal sphincters
What can be felt on a rectal exam?
Men - Prostate & seminal gland
Women - Cervix
Both: - ISchial spines/Tuberosities - Enlarged internal iliac lymph nodes Sacrum & Coccyx - Collections in the rectovesical (men) & retrouterine (women) fossa.
Is innervation of abdominal organs somatic or autonomic?
Entirely Autonomic
What is the parasympathetic supply of the abdominal organs?
Vagus Nerve (cranial X) Pelvic Splanchnic Nerves (S2,S3,S4
What is the sympathetic supply of the abdominal organs?
The Thoracic splanchnic nerves:
- Greater (T5-T9)
- Lesser (T10-T11)
- Least (T12)
Explain the venous drainage of the abdominal GI tract:
Inf. Mesenteric -> Splenic Vein
Then Splenic vein, Gastric veins & superior mesenteric vein all form into the portal vein.
The portal vein drains into the liver
The liver drains into the hepatic vein then into the IVC
What are porto-systemic anastomoses?
Where the portal system communicates with the systemic venous system
Give 4 examples of porto-systemic anastomoses?
Gastroesophogeal Junction:
- esophogeal veins drain into either the azygos (systemic) or left gastric (portal)
Anorectal junction:
- Rectal veins drain into the IVC (systemic) or IMV (portal)
Para-Umbilical:
- para-umbilical veins (portal) anastomose with superficial epigastric veins (systemic)
Colic:
- Twigs of colic veins (portal) anastomose with retroperitoneal veins (systemic)
What happens if theres a portal obstruction?
Venous enlargements occur around the porto-systemic anastomoses.
- Gastroesophogeal varices
- Haemorrhoids or Piles (anorectal junction)
- Caput Medusae (umbiiical)
What lymphatic vessel takes the bulk of lymph from abdominal walls and structures?
The thoracic Duct
What are the 3 groups of lumbar lymphatic nodes?
Pre-Aortic:
- Includes celiac, sup mesenteric & inf mesenteric
- ‘Drains the organs supplied by the anterior aortic branches
Lateral Aortic:
- Drains organs supplied by lateral aortic branches
Retro Aortic
- You get the idea
Most gut organs are drained by groups of nodes from the pre-aortic lumbar nodes. Which group drains which structures?
Celiac group = foregut structures
Superior Mesenteric = Midgut Structures
Inferior Mesenteric = Hindgut Structures