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ANATO second semester 23-24 > block I: peritoneum & foregut > Flashcards

block I: peritoneum & foregut Flashcards

1
Q

What are the gut tube structures in the foregut and associated organs and arteries of abdominal cavity?

A
  • Esophagus
  • Stomach
  • Duodenum

Associated organs
* Liver & gallbladder
* Pancreas
* Spleenliver & gallbladder

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2
Q

WHat is the peritoneum and what organs does it connect?

A

– Is a serous membrane that forms the lining of the abdominopelvic cavity and invest the
viscera.
– Connect organs with other organs or organs
to the abdominal wall.

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3
Q

the peritoneum is divided in?

A
  • Parietal peritoneum
  • Visceral peritoneum
  • Mesentery - peritoneal cavity
  • Omentum - peritoneal cavity
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4
Q

describe parietal peritoneum and visceral peritoneum

A

parietal:
– Lines the internal surface of the abdominopelvic wall
– Sensitive to pain, pressure, heat, cold and
laceration

visceral:
– Invest the viscera
– Insensitive to touch, heat, cold and
lacerations
– Pain is poorly localized, being referred to the
dermatomes of the spinal ganglia

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5
Q

what us the peritoneal cavity?

A

– Potential space between the parietal and
visceral peritoneum

– Contains peritoneal fluid
1. lubricates the peritoneal surface2. enables the visceral to move over each other without friction

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6
Q

What is retroperitoneal and some examples

A

Structures found posterior to the cavity al
known retroperitoneal organs:

  • Duodenum (except thefirst part)
  • Pancreas (head and body)
  • Ascending colon
  • Descending colon
  • Rectum
  • Adrenal glands
  • Kidneys
  • Ureters
  • Bladder
  • Aorta
  • IVC
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7
Q

What is the mesentery and function?

A

– Double layer of peritoneum that results of the invagination of the peritoneum by an
organ
– Provides an area for neurovascular
communication between the organ and the body wall

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8
Q

identify

A
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9
Q

what is the omentum?

A

Double-layered extension of peritoneum
– Types of omentum:
* Lesser omentum
* Grater omentum

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10
Q

what is the lesser omentum and its structures

A

Connects the lesser curvature of the stomach
and the proximal part from the duodenum to
the liver

  • Contains two ligaments:
    – Hepatogastric ligament
  • Membranous portion of the lesser omentum

– Hepatoduodenal ligament
* Thickened free edge
* Contains the portal triad through the epiploic foramen

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11
Q

what is the greater omentum and its parts?

A
  • Extends from the great curvature of the
    stomach and the proximal part of the
    duodenum to the anterior surface of the
    transvers colon.
  • It has three parts:
    – Gastrosphrenic ligament
    – Gastrosplenic ligament
    – Gastrocolic ligament
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12
Q

The greater omentum is divided into:

A

– Greater sac
– Lesser sac (Omental bursa)

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13
Q

what is the epipolic foramen (omental)?

A

natural opening of greater omentum between lesser and greater sacs.

  1. it is a communication between greater and lesser sac and its boundaries are:
    * Anteriorly : hepatododenal ligament
    * Posteriorly: IVC
    * Superiorly: liver
    * Inferiorly: First part of the duodeno
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14
Q

what is the greater sac and its components?

A

– Is the main part of the peritoneal cavity
– Contains:
* Supraphenic recess
* Subhepatic recess
* Paracolic recess

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15
Q

What is the lesser sac (omental bursa) and its components?

A

– Is an irregular space that lies behind the liver, lesser omentum, stomach and upper
anterior part of the grater omentum.
– Contains:
* Superior recess
* Inferior recess
* Splenic recess

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16
Q

What is peritonitis?

A

– Inflammation of the peritoneum
– Bacterial contamination
* Caused by trauma (perforation) of the guts and gas, fecal matter and bacteria enter the peritoneal cavity

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17
Q

what are the abdominal regions?

A
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18
Q

what organs are int eh 4 quadrants of the abdominal cavity

A
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19
Q

What is the cardiac orifice, fondus and pylorus located?

A

cardiac: posterior to 7th costal cartilage, T10
fondus: posterior to the left 5th rib in the midclavicular line
pylorus: L1 to L4

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20
Q

Explain the location of the esophagus

A

*Pierces the diaphragm to the left of the median plane at the level of T10
*Abdominal part is short (~1.25 cm) and enters the stomach at its cardiac orifice
*The right border is continuous with the lesser
curvature of the stomach
*The left border is separated from the fundus
of the stomach by the cardiac notch
-physiological sphincter

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21
Q

What is the muscular arrangement of the esophagus?

A
  • ~10” long and 1” wide
  • internal circular mm and external longitudinal mm
  • 1/3 skeletal, 1/3 smooth and 1/3 both
22
Q

which nerve are are risk during an acquired hiatal hernia?

A

vagus nerve

23
Q

what is the stomach and its parts?

A

food blender 2-3 liters of chyme (30mL of milk inside a lemon (babies)

  1. outer longitudinal m layer
  2. middle circular m layer
  3. innermost oblique m layer
  4. gastric folds (rugae)
  5. fundus
  6. cardiac part & orifice
  7. body
  8. pyloris antrum
  9. pylorus & pyloric orifice (opens w intragarstric pressure)
24
Q

what are the anatomical relationships of the stomach?

A

*Covered entirely by peritoneum, except where the blood vessels run along its curvatures
*The fundus is in contact with the diaphragm
*The anterior surface is in contact with the:
* diaphragm
* left lobe of the liver
* anterior abdominal wall

The posterior surface is in contact with the:
* posterior wall of the omental bursa
* diaphragm
* spleen
* left kidney and suprarenal gland
* body and tail of pancreas
* transverse mesocolon

25
Q

describe the duodenum

A

It is the first and most fixed part
of the small intestine
*C-shaped, from pylorus, around head of pancreas, to beginning of jejunum
*Mostly 2rily retroperitoneal
*Receives the openings of the bile and pancreatic ducts (greater duodenal papilla/
hepatopancreatic ampulla)
*Internal wall has folds or plicae
*It is divided in 4 parts:
-superior or 1st part
-descending or 2nd part
-horizontal or 3rd part
-ascending or 4th part

26
Q

Duodenum is supplied by?

A

CT & SMA
-portal triad (hepatic portal vein, hepatic artery proper, common bile duct)

SMA syndrome: compression of 3rd portion of duodenum between abdominal aorta and SMA

27
Q

What is the 4th part of the duodenum?

A

ascending, The duodenojejunal flexure is supported by a fibromuscular band called the
suspensory muscle of the duodenum or
the ligament of Treitz.

One part of this ligament is attached to
the right crus of the diaphragm, the other
to connective tissue around the celiac
trunk.

28
Q

Describe the liver and its surface anatomy

A
  • The largest gland in the body (1/40th body weight)
  • Stores glycogen and produces bile
  • ~ ¼ - ½ of the lymph received by the thoracic duct comes from the liver

Surface Anatomy
* Lies mainly in the right upper quadrant
* It is hidden and protected by the thoracic cage
* It moves with respiration because it is connected to the diaphragm
* It can be palpated inferiorly along the right costal margin, particularly when the patient is asked to inspire deeply

29
Q

What is the aantomical criteria to measure the right lover lobe

A

Craniocaudal (CC) measurement of the right iver lobe (RLL) length taken in the anterior axillary region (AAR) from the uppermost right hemi-diaphragm that can be visualized in the image to the inferior tip of the right lobe, through a horizontal line as parallel as possible to the anterior liver wall is a precise and reliable measurement of the RLL.

30
Q

What are the feature of the lover?

A

*Receives venous blood returning from the GI
tract through portal vein
*Its smooth surfaces are in contact with the
diaphragm and the anterior abdominal wall
*It is attached to the anterior abdominal wall
through the falciform ligament
*It is attached to the diaphragm through the
coronary and triangular ligaments
*It has a bare area in direct contact with the diaphragm

31
Q

What is the subprenic recess and hepatorenal recess (morrison’s punch)?

A

Subphrenic recess
* divided by falciform ligament in right
and left

Hepatorenal recess a.k.a “Morrison’s
pouch”
* the right one is continuous with the
right subphrenic recess

32
Q

features of visceral surface of liver

A

*It has an H-shaped group of fissures and fossae:
* Porta hepatis:
portal vein
hepatic artery
hepatic ducts
* Ligamentum teres (round ligament of liver) & ligamentum venosum (remnant of the fetal ductus venosus)
* Fossae for gallbladder and inferior vena cava
*The visceral surface is covered with peritoneum except at the gallbladder and
porta hepatis

33
Q

edges inferiorly of liver:

A
  • superior rightportion of anteriorstomach
  • superior part ofduodenum
  • lesser omentum
  • gallbladder
  • right colic flexure
34
Q

What are the lobes of the liver

A

*Right lobe - demarcated by fossa
of gallbladder and inferior vena cava
*Left lobe - demarcated by
fissures for ligamentum teres and
ligamentum venosum
*Caudate lobe - between fissure
for ligamentum venosum and
fossa for inferior vena cava
*Quadrate lobe - between fissure
for ligamentum teres and fossa for
gallbladder

35
Q

how is the blood flow of liver?

A

portal vein - hepatic vein - IVC

70% from vein (nutrients) and 30% from artery (O2)

36
Q

Describe the gallbladder and bile ducts

A

*The gallbladder is a bluish-green pear-shaped sac lying along the right edge of the quadrate lobe of the liver
*It concentrates the bile secreted by the liver and stores it
*It is divided in a fundus, a body and a neck
*It lies superoanterior to the descending part of the duodenum and part of the transverse colon
*Its main duct is the cystic duct
*The cystic duct joins with the common hepatic duct (formed by the junction of the left and right hepatic ducts) to form the common bile duct
*The common bile duct joins with the pancreatic duct to form the hepatopancratic ampulla, which opens into the duodenum at the major duodenal papilla
(Papilla is the point of entrance)

37
Q

What are the ducts of the gallbladder?

A

Right and left hepatic duct
common hepatic duct
cystic duct
common bile duct
(main) pancreatic duct

hepatopancreatic ampulla (ampulla of Vater)
major duodenal papilla
(gallstones may lodge in the hepatopancreatic ampulla)

38
Q

Describe gallstones and clinical correlations

A
  1. Gallstone- a concretion of cholesterol crystals
  2. More common in females than males
  3. 50% of persons are asymptomatic
  4. Clinically relevant when they produce mechanical injury to the gallbladder or obstruction of the biliary tract
  5. A large gallstone may not be able to pass through the cystic duct but may develop adhesions with adjacent viscera
  6. Cholecystoenteric fistula; ulceration of tissue boundaries between (most commonly) the gallbladder and superior part of the duodenum and transverse colon
  7. Gallstone ileus; a gallstone may become trapped at the ileocecal valve; this is the junction between the ileum and the cecum
  8. Gas from the digestive tract can enter the gallbladder
39
Q

Describe the pancreas

A

*Elongated digestive gland located across the transpyloric plane; 2rily retroperitoneal
*It is divided in a head, neck, body and tail
*Head: located within the curve of the duodenum. rests on the inferior vena and the common bile duct
*Neck: adjacent to the pylorus. anterior to the superior mesenteric vessels
*Body: extends slightly superiorly as it extends to the left across the aorta, posterior to the omental bursa, its superior border trailing the splenic vein
*Tail: narrow left end, in contact with hilum of
spleen

40
Q

Which are the pancreatic ducts?

A

*Main (wirsung)- joins with bile duct to
form hepatopancreatic ampulla
*Accessory (santorini)- usually connected
to the main duct. In some
cases, it is a separate duct that
opens into the duodenum at
the minor duodenal papilla

41
Q

explain the pancreas secretions

A

*Exocrine - pancreatic juice
*Endocrine - glugacon and insulin

42
Q

What is obstructive pancreatitis?

A

Billiary stones, duodenal ulcers,
periampullary tumors are common agents
causing obstruction of pancreatic duct.
Obstruction leads to retained
pancreaticobiliary secretions, ductal
hypertension and produce inflammation
(i.e.pancreatitis).
Backup of bile pigments leads to jaundice
commonly seen in obstructive pancreatitis.
When due to biliary stones, management is
via endoscopic removal of obstructive
gallstones. Once pancreatitis resolves,
gallbladder is removed (cholecystectomy) to
prevent recurrence of obstructive
pancreatitis.

43
Q

explain pancreatic cancer

A

It often compresses and obstructs the bile duct and/or hepatopancreatic ampulla. This is
known as Ductular adenocarcinoma. This results in retention of bile pigments, enlargement of
the gallbladder, and Obstructive jaundice, which is the yellow staining of most body
tissues/membranes including the skin.

It produces severe pain in the back (body wall) and may also cause Hepatic portal or Inferior
vena caval obstruction.

44
Q

Describe the spleen

A

The largest of the lymphatic organs;
*Is hidden and protected by the thoracic cage
*Normally, it does not extend inferior to the
left costal margin; thus it is not palpable

45
Q

Feature of the spleen:

A

*Large, soft vascular lymphatic organ
*Intraperitoneal
*In contact with the posterior wall of the stomach (gastrosplenic ligament) and
lateral and superior edge of left kidney (splenorenal ligament)
*The splenic artery is the largest of the celiac trunk.

46
Q

What is splenomegaly?

A

enlargement of the spleen,
can be produced by several clinical
conditions such as:
1. Chronic hypertension
2. Granulocytic leukemia; high leukocyte
and white blood cell count
3. Hemolytic or Granulocytic Anemias;
red or white blood cells are destroyed
at rates higher than usual

47
Q

What are the paired aortic branches and unpaired?

A

paired aortic:
* inferior phrenic aa.
* suprarenal aa.
* renal aa.
* gonadal aa.
* lumbar aa.

*Unpaired aortic branches:
* celiac trunk
* superior mesenteric a.
* inferior mesenteric a.
* median sacral a.

48
Q

What does the SMA supply?

A

midgut:
Duodenum (distal half of 2nd part, 3rd and 4th parts)
Jejunum,
Ileum,
Cecum,
Appendix, Ascending colon
Hepatic flexure of colon.
Transverse colon (proximal two-thirds)

49
Q

What does IMA supply?

A

hindgut:
Transverse colon (distal one-third)
Left colic (splenic) flexure
Descending colon
Sigmoid colon
Rectum

50
Q

SMA and branches:

A

*Inferior pancreaticoduodenal arteries
*anterior
*posterior

*Jejunal and Ileal arteries

*Ileocolic artery
*ileal branch
*colic branch
*appendicular artery
-posterior cecal artery

*Right colic artery
*Middle colic artery

51
Q

Abranches of IMA?

A

*Left colic artery
*ascending branch
*descending branch

*Sigmoid arteries
*Superior Rectal artery
*right branch
*left branch

  • Observe the Marginal Artery (of
    Drummond) formed by anastomosing
    loops between SMA and IMA.
52
Q

Where do fluids accumulate of eprson is supine?

A

hepatorenal
recess and in the
rectovesical (male) or
rectouterine (female)
pouches

ANATO second semester 23-24 (4 decks)

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