E2C

Question 1

stomach

Answer 1

dilated part of alimentary canal located in left hypochondriac, epigastric and umbilical regions  much of it lies under cover of lower ribs and costal cartilages

functions: stores food, mixes food with gastric secretions to form semi-fluid mass (chyme), controls rate of delivery of chyme to small intestine

Question 2

stomach surfaces/borders

Answer 2

2 surfaces (walls): anterior and posterior
2 borders: lesser curvature (shorter and on the right) and greater curvature (longer and on the left)

incisura angularis (angular notch): indentation located in lower part of lesser curvature

Question 3

stomach orifices

Answer 3

cardial orifice: communicates esophagus with stomach

cardial notch: indentation located between left border of esophagus and fundus of stomach

pyloric orifice: communicates stomach with duodenum  it is surrounded by a sphincter (pyloric sphincter), formed by a thickening of circular muscle layer of stomach

Question 4

stomach parts

Answer 4

cardia (cardial part): area immediately adjacent to cardial orifice
fundus: dome-shaped, upper part of stomach; limited inferiorly by horizontal line drawn across stomach starting at cardial notch; usually is full of gas
body: extends from level of cardial notch to level of angular notch
pyloric part: distal, funnel-shaped region of stomach; extends from angular notch to pyloric orifice; its proximal, wider part is known as pyloric antrum; its distal, narrower part is known as pyloric canal

Question 5

stomach anatomical relations

Answer 5

anteriorly: anterior abdominal wall, left costal margin, diaphragm, left lobe of liver
posteriorly: lesser sac, diaphragm, spleen, upper part of left kidney, left suprarenal gland, splenic artery, pancreas, transverse mesocolon

Question 6

abdominal aorta

Answer 6

begins at the level of T12 (aortic hiatus of diaphragm) as a continuation of descending thoracic aorta  descends anterior to lumbar vertebral column, posterior to peritoneum (it is a retroperitoneal structure), and to the left of IVC; terminates at level of L4 by dividing into right and left common iliac arteries

Question 7

abdominal aorta visceral branches

Answer 7

unpaired: celiac trunk, superior mesenteric artery, inferior mesenteric artery
paired: middle suprarenal arteries, renal arteries, testicular/ovarian arteries

Question 8

abdominal aorta parietal branches

Answer 8

unpaired: median sacral artery

paired: inferior phrenic arteries, lumbar arteries (4 pairs)

Question 9

celiac trunk

Answer 9

originates from abdominal aorta at the level of T12; lies posterior to stomach and lesser sac

immediately divides into 3 branches:
left gastric artery
splenic artery
common hepatic artery

Question 10

left gastric artery

Answer 10

smallest branch of celiac trunk; passes superiorly and to the left, toward cardial region of stomach, posterior to lesser sac
gives off esophageal branches (supply lower part of esophagus) and then descends along lesser curvature of stomach
anastomoses with right gastric artery

Question 11

splenic artery

Answer 11

largest branch of celiac trunk; runs to the left along superior border of pancreas, posterior to stomach and lesser sac (it follows a wavy course); reaches hilum of spleen within splenorenal ligament

Question 12

branches of splenic artery

Answer 12

pancreatic branches: supply neck, body and tail of pancreas

left gastroepiploic artery: originates near hilum of spleen  reaches greater curvature of stomach in gastrosplenic ligament and runs along greater curvature from left to right; anastomoses with right gastroepiploic artery

short gastric arteries: originate close to hilum of spleen; reach stomach in gastrosplenic ligament and supply its fundus

terminal branches: enter spleen through its hilum

Question 13

common hepatic artery

Answer 13

runs anteriorly and to the right to reach superior aspect of 1st part of duodenum, where it divides into 2 branches: proper hepatic artery and gastroduodenal artery

Question 14

proper hepatic artery

Answer 14

ascends between 2 layers of lesser omentum (hepatoduodenal ligament) toward hilum of liver (porta hepatis); divides into right and left branches that enter liver through porta hepatis; right branch usually gives off cystic artery (supplies gallbladder)

within lesser omentum, proper hepatic artery lies anterior to portal vein and to the left of common bile duct

Question 15

right gastric artery

Answer 15

usually originates from proper hepatic artery; descends to pyloric end of stomach; runs to the left along lesser curvature of stomach; anastomoses with left gastric artery

Question 16

gastroduodenal artery

Answer 16

descends posterior to 1st part of duodenum; it gives off right gastroepiploic and superior pancreaticoduodenal arteries

Question 17

right gastroepiploic artery

Answer 17

runs along greater curvature of stomach from right to left; anastomoses with left gastroepiploic artery

Question 18

superior pancreaticoduodenal arteries

anterior and posterior

Answer 18

supply duodenum and head of pancreas; anastomose with inferior pancreaticoduodenal arteries (branches of superior mesenteric artery)

Question 19

stomach blood supply

Answer 19

arteries:
left gastric artery (branch of celiac trunk)
right gastric artery (branch of proper hepatic artery)
left gastroepiploic artery (branch of splenic artery)
right gastroepiploic artery (branch of gastroduodenal artery)
short gastric arteries (branches of splenic artery)

all arteries are accompanied by veins of same name  all venous blood from stomach drains (directly or indirectly) into portal vein

Question 20

liver

Answer 20

located in upper part of abdominal cavity, just beneath diaphragm, in right hypochondriac, epigastric and left hypochondriac regions; most of it lies under cover of lower ribs and costal cartilages

Question 21

liver surfaces

Answer 21

diaphragmatic and visceral surfaces are separated anteriorly by a sharp border (inferior border of liver): no clear demarcation between them posteriorly

Question 22

diaphragmatic surface

Answer 22

convex, smooth, molded to undersurface of diaphragm

Question 23

visceral surface

Answer 23

faces inferiorly, posteriorly and to the left: molded to adjacent organs (gallbladder, esophagus, stomach, duodenum, right kidney, right suprarenal gland, right colic flexure); visceral surfaces “H”

Question 24

cross bar of H

Answer 24

porta hepatis (hilum of liver): contains right and left hepatic ducts (collect bile produced by liver), branches of proper hepatic artery and portal vein (supply blood to liver), autonomic nerves and hepatic lymph nodes and vessels

Question 25

right limb of H (right sagittal fissure)

Answer 25

formed anteriorly by fossa for gallbladder and posteriorly by groove for IVC

Question 26

left limb of H (left sagittal fissure)

Answer 26

formed anteriorly by fissure for round ligament of liver (ligamentum teres hepatis) and posteriorly by fissure for ligamentum venosum

Question 27

liver embryology

Answer 27

during intrauterine life, umbilical vein carries oxygenated blood from placenta  umbilical vein joins portal vein  a large proportion of this blood bypasses liver and goes directly into IVC via ductus venosus

at birth, umbilical vein and ductus venosus close and become fibrous cords  umbilical vein becomes round ligament of liver and ductus venosus becomes ligamentum venosum

Question 28

quadrate lobe of liver

Answer 28

part of liver located anterior to porta hepatis, between fossa for gallbladder (right) and fissure for round ligament (left)

Question 29

caudate lobe of liver

Answer 29

part of liver located posterior to porta hepatis, between groove for IVC (right) and fissure for ligamentum venosum (left)

Question 30

liver peritoneal ligaments

Answer 30

falciform
coronary
R/L triangular
lesser omentum

Question 31

falciform ligament

Answer 31

two-layered peritoneal fold that connects diaphragmatic surface of liver to anterior abdominal wall (above umbilicus); its liver attachment forms boundary between right and left lobes; has an inferior, free margin that contains round ligament of liver; posteriorly its 2 layers separate and become superior layer of coronary ligament

Question 32

coronary ligament

Answer 32

consists of superior and inferior layers, which lie at some distance from each other; between them there is an area of liver devoid of peritoneum that is in direct contact with diaphragm; bare area of liver

Question 33

right and left triangular ligaments

Answer 33

right and left ends of coronary ligament, where its superior and inferior layers join each other

Question 34

lesser omentum

Answer 34

two-layered peritoneal fold that connects visceral surface of liver (porta hepatis and fissure for ligamentum venosum) to lesser curvature of stomach and 1st part of duodenum

Question 35

liver blood ciruclation

Answer 35

30% from proper hepatic artery, 70% from portal vein

artery and vein divide into progressively smaller branches; eventually arterial and venous blood mix in liver capillaries (sinusoids); blood is collected afterward by hepatic veins

hepatic veins join forming progressively larger veins; eventually 3 large hepatic veins are formed (right, intermediate [middle] and left) which drain into IVC

Question 36

extra hepatic biliary ducts

Answer 36

bile produced by hepatocytes is collected by small bile ducts within liver; these ducts join to form progressively larger ducts

eventually, 2 large ducts are formed (right and left hepatic ducts), which exit liver via porta hepatis; after a short course, right and left hepatic ducts join to form common hepatic duct

Question 37

common hepatic duct

Answer 37

common hepatic duct descends within hepatoduodenal ligament and is joined by cystic duct (from gallbladder) to form common bile duct

Question 38

common bile duct

Answer 38

lies first within hepatoduodenal ligament, then it passes posterior to 1st part of duodenum, and more inferiorly it lies posterior to head of pancreas (or embedded in it)

usually joined by main pancreatic duct; they form a short dilated chamber embedded in duodenal wall (hepatopancreatic ampulla or ampulla of Vater), which opens into 2nd part of duodenum by an orifice on the tip of a small mucosal elevation (major duodenal papilla)

Question 39

hepatopancreatic ampulla

Answer 39

surrounded by a sphincter (sphincter of hepatopancreatic ampulla or sphincter of Oddi)

Question 40

gallbladder parts

Answer 40

fundus: anterior, rounded end which projects below inferior border of liver  it is in contact with anterior abdominal wall at level of tip of right 9th costal cartilage
body: middle part of gallbladder (between fundus and neck); contacts visceral surface of liver (superiorly) and transverse colon and duodenum (inferiorly)
neck: narrow, tapering end, opposite the fundus and directed toward porta hepatis  usually makes and S-shaped bend and becomes continuous with cystic duct

Question 41

spleen

Answer 41

largest lymphoid organ of the body; located in left hypochondriac region, between stomach and diaphragm, entirely sheltered by lower ribs (9th to 11th); lacerations of spleen are commonly caused by fractured ribs

Question 42

spleen functions

Answer 42

elimination of old and/or damaged blood cells

filters antigens from blood and contributes to immune response against such antigens

Question 43

spleen surfaces

Answer 43

diaphragmatic: smooth and convex, faces posterolaterally, related to diaphragm
visceral: irregular and concave, faces anteromedially, related to stomach, left kidney, left colic flexure and tail of pancreas, also contains hilum of spleen

Question 44

spleen borders

Answer 44

borders: superior (usually notched) and inferior
poles: anterior and posterior
long axis of spleen lies along 10th rib
normal spleen cannot be palpated in the adult (anterior pole reaches normally as far forward as midaxillary line)

Question 45

spleen ligaments

Answer 45

intraperitoneal organ: its hilum is connected to stomach and left kidney by gastrosplenic and splenorenal ligaments, respectively

splenorenal ligament contains splenic artery and vein and tail of pancreas

gastrosplenic ligament contains short gastric arteries and veins and left gastroepiploic artery and vein

Question 46

spleen blood supply

Answer 46

splenic artery (branch of celiac trunk)
venous drainage: splenic vein, begins at hilum of spleen and runs to the right, inferior to splenic artery, and posterior to pancreas; drains into portal vein