E2B

Question 1

liver

Answer 1

located in upper part of abdominal cavity, immediately inferior to diaphragm (right hypochondriac, epigastric and left hypochondriac regions)

almost entirely under cover of ribs and costal cartilages

divided into 2 unequal lobes (right and left) by falciform ligament

Question 2

gallbladder

Answer 2

pear-shaped sac adherent to undersurface of right lobe of liver; stores and concentrates bile

Question 3

esophagus

Answer 3

connects pharynx to stomach, begins in neck and ends in abdomen, most of it is located in mediastinum

pierces diaphragm slightly to left of midline, at the level of T10, after a short course in abdomen, it becomes continuous with stomach

abdominal part of esophagus is located posterior to left lobe of liver

Question 4

stomach

Answer 4

dilated part of alimentary canal between esophagus and small intestine

located in left hypochondriac, epigastric and umbilical regions (much of it under cover of ribs and costal cartilages)

orifices: cardial (communicates with esophagus) and pyloric (communicates with duodenum)
borders: lesser curvature (right) and greater curvature (left)

Question 5

small intestine

Answer 5

begins at pyloric orifice and terminates at ileocecal junction (where small intestine joins large intestine)

parts: duodenum, jejunum and ileum

Question 6

duodenum

Answer 6

deeply placed (most of it lies posterior to peritoneal sac), located in epigastric and umbilical regions

C-shaped tube that surrounds head of pancreas, begins at pyloric orifice and terminates at duodenojejunal flexure, where it bends forward to become continuous with jejunum

4 parts: 1st (superior), 2nd (descending), 3rd (horizontal, inferior or transverse) and 4th (ascending)

Question 7

jejunum and ileum

Answer 7

together measure about 20 feet (6 meters) in length; more mobile than duodenum

jejunum begins at duodenojejunal flexure and ileum ends at ileocecal junction (where it joins large intestine)

approximately proximal two-fifths form jejunum and distal three-fifths form ileum

coils of jejunum occupy upper part of infracolic compartment of abdominal cavity

coils of ileum occupy lower part of infracolic compartment of abdominal cavity, and some extend into pelvis

Question 8

large intestine

Answer 8

most of it arches around and encloses coils of jejunum and ileum

Question 9

large intestine parts

Answer 9

cecum with vermiform appendix
 ascending colon
 transverse colon
 descending colon
 sigmoid colon
 rectum 
 anal canal

Question 10

cecum

Answer 10

blind-ended sac located in right iliac fossa, inferior to ileocecal junction

Question 11

vermiform appendix

Answer 11

small, blind-ended tube, like a worm, that originates from posteromedial aspect of cecum

Question 12

ascending colon

Answer 12

extends superiorly from ileocecal junction to inferior surface of right lobe of liver (in right hypochondriac region), where it bends to the left (right colic/hepatic flexure) to become continuous with transverse colon

Question 13

transverse colon

Answer 13

crosses abdomen from right hypochondriac region to left hypochondriac region forming a wide U-shaped curve  begins at right colic flexure  when it reaches lower end of spleen, it bends inferiorly (left colic/splenic flexure) to become continuous with descending colon

Question 14

descending colon

Answer 14

extends from left colic flexure to left iliac fossa

Question 15

sigmoid colon

Answer 15

begins in left iliac fossa and forms a loop that terminates in pelvis (level of S3), where it becomes continuous with rectum

Question 16

pancreas

Answer 16

exocrine and endocrine gland deeply located in abdomen (most of it lies posterior to peritoneal sac)

stretches across posterior abdominal wall from duodenum on the right to spleen on the left (epigastric and left hypochondriac regions)

parts: head, neck, body and tail (from right to left)

Question 17

spleen

Answer 17

largest lymphoid organ of body; located in left hypochondriac region, between stomach and diaphragm

Question 18

kidneys and ureters

Answer 18

kidneys are deeply placed organs (posterior to peritoneal sac), directly related to upper part of posterior abdominal wall, one on each side of vertebral column

each kidney gives rise to a ureter, which descends vertically on posterior abdominal wall and carries urine from kidney to urinary bladder

Question 19

suprarenal glands

Answer 19

2 endocrine glands deeply located in abdomen, one on upper pole of each kidney

Question 20

peritoneum

Answer 20

serous membrane that lines walls of abdominal and pelvic cavities and covers surface of abdominal and pelvic organs

peritoneum is more extensive than pleura and serous pericardium; it is related to many organs (not just one); it has a more complex arrangement

Question 21

peritoneal layers

Answer 21

parietal peritoneum: lines walls of abdominal and pelvic cavities

visceral peritoneum: covers abdominal and pelvic organs

Question 22

peritoneal cavity

Answer 22

potential space between parietal and visceral layers; contains small amount of serous fluid
in males it is a closed cavity
in females it communicates with outside via uterine tubes, uterus and vagina

Question 23

intraperitoneal organ

Answer 23

organ that is almost totally covered with peritoneum  ex.: stomach, jejunum, ileum, transverse colon, sigmoid colon, spleen

Question 24

retroperitoneal organ

Answer 24

organ that is located posterior to peritoneal sac (between peritoneal sac and posterior abdominal wall); organ is only covered with peritoneum anteriorly
ex.: most of duodenum and pancreas, ascending colon, descending colon, kidneys, suprarenal glands, abdominal aorta, IVC

Question 25

peritoneal ligaments

Answer 25

two-layered peritoneal fold that connects an organ (usually a solid organ) to abdominal wall or another organ
does not consist of dense fibrous connective tissue like ligaments associated with joints

Question 26

falciform ligament

Answer 26

peritoneal fold that connects liver to anterior abdominal wall (above umbilicus)

Question 27

coronary ligament

Answer 27

peritoneal fold that connects liver to diaphragm

Question 28

splenorenal ligament

Answer 28

peritoneal fold that connects spleen to left kidney

Question 29

gastrosplenic ligament

Answer 29

peritoneal fold that connects spleen to stomach

Question 30

peritoneal folds

Answer 30

omentum (greater and lesser)

Question 31

lesser omentum

Answer 31

two-layered peritoneal fold that connects lesser curvature of stomach and 1st part of duodenum to visceral (inferior) surface of liver

has 2 parts: hepatogastric and hepatoduodenal ligaments

hepatogastric ligament is thin

hepatoduodenal ligament forms right margin of lesser omentum and is thick because it contains ducts, blood vessels, lymph vessels and nerves traveling to and from liver

Question 32

greater omentum

Answer 32

hangs down from greater curvature of stomach, like an “apron”, in front of loops of jejunum and ileum

contains a variable amount of fat; consists of 4 peritoneal layers

2 anterior layers descend from greater curvature of stomach, fold back on themselves and ascend (becoming 2 posterior layers) to attach to transverse colon; space between 2 anterior and 2 posterior layers is obliterated

Question 33

mesentery

Answer 33

two-layered peritoneal fold that connects intestines to posterior abdominal wall

allows blood vessels, lymph vessels and nerves to reach intestines from posterior abdominal wall

Question 34

parts of intestines that have mesentery are more mobile and are intraperitoneal

Answer 34

mesentery of small intestine (or just simply “the mesentery”): connects loops of jejunum and ileum to posterior abdominal wall

transverse mesocolon (mesentery of transverse colon): connects transverse colon to posterior abdominal wall

sigmoid mesocolon (mesentery of sigmoid colon): connects sigmoid colon to posterior abdominal and pelvic walls

Question 35

more on peritoneal folds

Answer 35

mesenteries have a root: posterior border of mesentery attached to posterior abdominal wall

early in development, all parts of digestive tract are intraperitoneal and have a mesentery

with further development, some parts of digestive tract adhere to posterior abdominal wall, loose their mesentery and become retroperitoneal (more fixed in position); they are known as secondary retroperitoneal organs (ex.: most of duodenum, most of pancreas, ascending colon, descending colon)

Question 36

omental bursa (lesser sac)

Answer 36

part of peritoneal cavity located posterior to lesser omentum and stomach

on the left it is closed by spleen, gastrosplenic ligament and splenorenal ligament

on the right it communicates with greater sac (remaining of peritoneal cavity) via omental (epiploic) foramen (a.k.a. opening of lesser sac, foramen of Winslow)

Question 37

superior recess

Answer 37

upward extension of omental bursa, located between liver and diaphragm

Question 38

inferior recess

Answer 38

downward extension of omental bursa between 2 anterior and 2 posterior layers of greater omentum (usually very short due to adherence of anterior and posterior layers of greater omentum)

Question 39

omental (epiploic) foramen
opening of lesser sac
foramen of Winslow

Answer 39

anteriorly: right, free border of lesser omentum (hepatoduodenal ligament), within which are structures traveling to and from liver; 3 main structures: portal vein, proper hepatic artery and common bile duct
posteriorly: inferior vena cava
superiorly: caudate lobe of liver
inferiorly: 1st part of duodenum

Question 40

1 median umbilical fold

Answer 40

formed by peritoneum that covers median umbilical ligament (fibrous cord that extends from apex of urinary bladder to umbilicus)

it is a remnant of allantois of embryo (when lumen of allantois obliterates in the embryo, it is called urachus; in the adult it is known as median umbilical ligament)

Question 41

2 medial umbilical folds

Answer 41

formed by peritoneum that covers medial umbilical ligaments

fibrous cords that represent distal, obliterated parts of umbilical arteries

Question 42

2 lateral umbilical folds

Answer 42

formed by peritoneum that covers inferior epigastric vessels

Question 43

supracolic compartment

Answer 43

located above transverse colon and its mesentery; contains stomach, liver, gallbladder, spleen

Question 44

infracolic compartment

Answer 44

located below transverse colon and its mesentery; contains most of the small and large intestines; divided into right and left infracolic spaces by mesentery of small intestine

Question 45

paracolic gutters

Answer 45

grooves between lateral aspects of ascending and descending colon and abdominal wall that allow free communication between supracolic and infracolic compartments

Question 46

peritoneal nerve supply

Answer 46

pain can be elicited by mechanical, chemical or thermal stimulation of parietal peritoneum, but usually only by stretching visceral peritoneum (ex.: over-distension of a hollow organ)

pain originating from parietal peritoneum is usually more intense and well localized

pain originating from visceral peritoneum is usually dull and poorly localized (referred pain)

Question 47

parietal peritoneum innervation

Answer 47

peritoneum that covers central part of undersurface of diaphragm is innervated by phrenic nerves (pain referred to shoulder)

peritoneum that covers peripheral part of undersurface of diaphragm is innervated by lower 5 intercostal nerves and subcostal nerve

remaining of parietal peritoneum is innervated by lower 5 intercostal nerves, subcostal nerve and iliohypogastric and ilioinguinal nerves

Question 48

visceral peritoneum innervation

Answer 48

visceral sensory fibers that travel with sympathetic and parasympathetic fibers that supply organs