Feb2 M3-Anatomy Lecture 4 Flashcards
spleen 1x3x5x7x9x11 rule
- size is 1x3x5 inches
- weight is 7 oz
- position is between 9th and 11th rib
name of abd region where spleen is + anterior and posterior structure
left hypochondriac region
A: splenic flexure of the colon
P: diaphragm
relationship of organs and mesentery near spleen in primitive embryonic stage
anterior to posterior: liver, stomach, spleen, aorta. all peritoneal
relationships of organs near the spleen in adults and how lesser sac is formed
intraperitoneal: spleen goes to the left. stomach a bit anterior. liver to the right. tail of pancreas
retroperitoneal: pancreas (head and neck), aorta, ..
ligament connecting the spleen to the back wall (of abd wall)
splenorenal (or lienorenal) ligament: between kidney and pancreas
ligament connecting spleen at the front
gastrosplenic ligament
ventral mesentary connecting the liver to the umbilicus
falciform ligament
2 surfaces of the spleen + 3 impressions
diaphragmatic surface (outer) visceral surface (inner): renal impression, colic impression and gastric impression
ligament that supports the spleen but that doesn’t connect to it
phrenicocolic ligament (between diaphragm and colon)
2 ligaments that support the spleen: components and composition
lienorenal and gastrosplenic (contain vessels and CT)
splenic artery vs splenic vein
splenic a.: curly, sup border of pancreas
splenic v: straight. middle back of pancreas
3 veins forming portal vein
splenic vein, SMV, IMV
splenomegaly def and causes
enlargement of the spleen. back pressure from portal htn or spleen working too hard (hemolytic anemia) or infiltration from leukemia or lymphoma
4 functions of the spleen
- storage of RBCs
- destruction of worn-out RBCs
- Removal of foreign material from the blood
- Production of mononuclear leukocytes
organs that take over the spleen when it’s removed
liver and bone marrow
pancreas head relations + special portion
is in curve of D2. posterior: IVC and bile duct
anterior: SMA and SMV
uncinate process: elongation to the left
common bile duct is junction of what
cystic duct from gallbladder and common hepatic duct in the liver
where common bile duct and main pancreatic duct join and name of region where they’re joined before entering D2
in head of the pancreas hepatopancreatic ampulla (ampulla of Vater)
name of sphincter and name of opening where hepatopancreatic ampulla opens in D2
sphincter of Oddi
major duodenal papilla
sphincter of Oddi (or sphincter of ampulla) composition
muscular valve
in people with extra pancreatic duct, name of the duct + name of opening
- accessory pancreatic duct (or duct of Santorini)
- minor duodenal papilla
blood supply to the pancreas (each part)
head: ant and post superior PD a. + ant and post inferior PD a.
neck: dorsal pancreatic a
body and tail: splenic a. and transverse pancreatic a.
2 surfaces of the liver and what covers them
diaphragmatic = top, visceral peritoneum on it
visceral surface = bottom, visceral peritoneum on it
bare area intra or retroperitoneal + what defines it
retroperitoneal. area in back of liver not covered with perit. bc greater sac stopped on one side and lesser sac stopped on other side
falciform ligament function
attaches the liver to the anterior body wall
ligamentum teres hepatis: meaning in english, what it comes from and where it is
round ligament of the liver. remnant of fetal umbilical veins. hangs down falciform ligament
what traverses the bare area and what surrounds it
traversed by IVC and esophagus
surrounded by coronary ligament
coronary ligament of the liver def
parts of the peritoneal reflections that hold the liver to the inferior surface of the diaphragm
3 ligaments in the liver extending from the coronary ligament
- right triangular ligament
- left triangular ligament
- falciform ligament
if lift the liver at the front and flip it upwards to see the visceral surface, what forms the H shape
right arm: gallbladder (top) and IVC (bottom) but reversed IRL
left arm: ligamentum teres (top) and ligamentum venosum bottom but reversed IRL
4 lobes of the liver surrounding the H shape
right lobe, left lobe, quadrate lobe (top) and caudate lobe (bottom) but reversed IRL
trick for remembering caudal vs quadrate lobe
Caudate is near inferior vena Cava (two Cs)
porta hepatis def
middle of H shape: hepatic ducts and branches of portal vein and hepatic artery
ligamentum venosus origin
ductus venosus shunting portion of left umb vein blood directly to IVC (to allow O2 blood from placenta to bypass liver)
anatomical vs functional separation of the left and right lobes of the liver
anatomical: -separated at falciform ligament and lig teres hepatis
- functional: separated at gallbladder and IVC
functional segments of the liver: what separates them
hepatic veins cut between the segments vertically. and vein cutting liver in 2 horizontally
functional segments of liver in right lobe ( right of IVC)
top row: 7-8
bottom row: 6-5
functional segments of liver in left lobe (left of IVC)
1 in the back
top row: 4a and 2
bottom row: 4b and 3
3 parts of gallbladder + where it empties
fundus, body and neck. empties in cystic duct at bottom
visible portion of cystic duct on radiology + function
spiral valve. helps keep the duct open
gallbladder function
stores bile produced by the liver that backs up in GB when sphincter of Oddi is shut
portal triad and their relations
- portal vein in the back
- front left: proper hepatic artery
- front right: bile duct
the portal triad is found in which structure
hepatoduodenal ligament
what branches lead to forming the bile duct (common bile duct)
- right and left hepatic ducts form common hepatic duct
- common hepatic duct (left) + cystic duct (right) join to make common bile duct
names of the 3 hepatic veins
right hepatic vein, middle HV and left HV
name of veins that do the same thing as azygos and hemiazygos but below subcostal vein (T12)
ascending lumbar veins give 4 lumbar veins on each side of the IVC that enter the IVC
location of the 4 lumbar veins (superior and inferior limits)
superiorly, lumbar vein 1 at level of renal vein
inferiorly, lumbar vein 4 before IVC divides in right and left common iliac v.
lumbar veins in abdomen are equivalent to what in thorax
intercostal veins
4 portocaval anastomoses (locations)
- esophageal
- paraumbilical
- rectal
- retroperitoneal
esophageal portocaval anastomosis
venous blood can go to portal system or to azygos vein
paraumbilical portocaval anastomosis
at the superficial abdomen level near ligamentum teres + on body wall, blood may go to portal system or superior epigastric vein
rectal portocaval anastomosis (no exam Q on that in GI)
middle and inferior rectum drain in caval system not portal like superior rectum
retroperitoneal portocaval anastomosis
ascending and descending colon are retroperitoneal and blood goes to IVC
how esophageal portocaval anastomosis may manifest clinically
can get esophageal varices and spit blood if they rupture bc buildup from portocaval htn
how paraumbilical portocaval anastomosis may manifest clinically
from portal htn, can get backup of venous blood in umbilical region
type of innervation on front (abd) wall
somatic
splanchnic nerve 3 divisions and spinal origins + what nervous system
SS.
greater splanchnic: T5-T9
lesser splanchnic: T10-T11
least splanchnic: T12
how SS nerves get to organs in abdomen
follow blood vessels (initially aorta)
how SS postganglionic nerves get to stomach, intestine + colon and also lower GI
to stomach: follow celiac trunk
to intestine and colon: follow SMA
to lower GI tract: follow IMA
name of 3 MAIN ganglia the SS system synapses on in the GI tract
celiac ganglion
superior mesenteric ganglion
inferior mesenteric ganglion
how PSS pregang fibers get to their organs
follow vagus nerve
where are the ganglia for the PSS system in GI tract + can they be located
can’t be seen bc synapses occur in the organs
PSS innervation below intestines and why
through pelvic splanchnic nerves (S2 to S4) bc vagus doesn’t get below intestines
SS innervation below intestines and origin
sacral splanchnic nerves (L5, S1, S2, S3) from SS chain
GI PSS innervation (2 components) + how fibers get to organs
- vagus nerve (esophagus to proximal 2 thirds of transverse)
- pelvic splanchnic nerve (distal third of transverse until rectum)
- pre-gangl fibers use vessels to get to organs
GI organ with no PSS innervation
spleen
SS innervation, nerves and corresponding ganglia + how fibers get to organs
- thoracic splanchnic (greater to celiac gang., lesser and least to aorticorenal gangl)
- lumbar splanchnic nerves (L1-2) to sup and inf mesenteric glanglia.
- POST gangl fibers use vessels to get to organs
lumbar splanchnic nerves spinal origin
L1-L2
PSS innervation to the stomach and analogy to esophagus
posterior vagal trunk (was right vagus n. in thorax) and anterior vagal trunk (was left vagus n. in thorax)
stomach orientation compared to esophagus
rotated 90 degrees to the right compared to esophagus
