Foregut and Liver Flashcards
Describe foregut
Anterior part of alimentary canal
Oral cavity to 1/2 duodenum
Describe foregut blood supply
Related to celiac trunk = first unpaired branch abdominal aorta
Describe content of foregut generally
Esophagus, stomach, duodenum prox 1/2, liver, gallbladder, biliary system, pancreas, spleen
Is esophagus only in thoracic region
No
Thoracic, abdominal and cervical
Where is transition from foregut to midgut
Halfway through duodenum
Describe esophagus
Muscular tube
25cm long
Connects laryngopharynx to stomach (cricoid cartilage to diaphragm)
Name the 3 portions of esophagus
Cervical
Thoracic
Abdominal
Describe cervical eso
From inf order cricoid cartilage (c6) to jugular notch
Describe thoracic eso
From jugular notch to diaphragm
Descends anterior to thoracic vertebrae
Passes anteriorly to thoracic aorta in posterior mediastinum
Passes through diaphragm = esophageal aperture, t10
Describe abdominal eso
From diaphragm to cardia portion of stomach
Shortest part eso
Describe passages of structures through diaphragm
Ivc = pass through central tendon = t8
Esophageal hiatus = t10
Abdominal aorta = t12
Describe how esophagus enters abd cavity
Through esophageal aperture of thoracic diaphragm
Leads to cardia portion of stomach
What does eso enter with (into abd cavity)
2 vagal trunks = anterior (left vagus), and posterior (right vagus)
Rotation due to embryology
What is lower esophageal sphincter
Muscle organization
Eso contracts, so do not vomit in mouth
Describe external sphincter - les
Right crus of diaphragm
Loops around eso and forms a sling =
When inspire, constricts eso, forms an anatomical sphincter = prevent reflux
Describe internal sphincter - les
Bundle of muscle at low end of eso, where it meets stomach
Circular fibers
What is stomach
J shaped
Dilated portion gi tract
Between abd eso and duodenum
Describe location of stomach
Intraperitoneal
Describe anatomy of stomach
Divided into 4 regions = cardia, fundus, body, pyloric part
Describe cardia - stomach
Surrounds opening of eso into stomach
Describe fundus of stomach
Superior dilation on left, above cardia
Describe body of stomach
Large expansion below fundus
Large curvature
Describe pyloric part of stomach
Outflow portion of stomach, leads to 1st portion of duodenum, composed of pyloric canal and pyloric sphincter
Constricted part
Pyloric sphincter = very strong circular fibers, gate (since stomach v active = needs to be closed at end)
Name the features of the stomach
Greater curvature and lesser curvature
Describe greater curvature of stomach
Point of attachment of gastrosplenic ligament and greater omentum (floats down on top of organs )
Describe lesser curvature of stomach
Point of attachment for lesser omentum - covers liver, stomach, duo kinda
Describe hepatoduodenal ligament
Thicker portion from liver to duodenum
For structures to porta hepatis (contains important structures like biliary tree)
Describe hepatogastric ligament
Thinner portion from liver to lesser curvature stomach
What is the stomach
Distension organ, can contain up to 3 litres
Has rugae, Intra
Describe rugae
Longitudinal folds, allowing fastening
- mucosa, for expansion - stretching and increase surface area contact
Describe stomach - Intra
Peritoneum on stomach of anterior and posterior stomach
Unite to form greater omentum hanging from greater curvature
What makes up lesser omentum
Hepatoduodenal ligament
Hepatogastric ligament
Describe arterial supply stomach
From celiac trunk
Describe arteries found near lesser curvature of stomach
Left gastric artery = from celiac trunk
Right gastric artery = from hepatic proper artery
ANASTOMOSE with each other
Describe arteries found near greater curvature of stomach
Right gastro omental = from gastroduodenal artery
Left gastro omental = from splenic artery
ANASTOMose with each other
Describe arteries found near fundus of stomach
Short gastric arteries for fundus
Describe venous drainage stomach
Same system as arterial
Drains into portal venous system - gi blood to liver first = filters
Describe innervation stomach
Visceral innervation from Celiac nerves plexus
Sympathetic: vasoconstriction & inhibition of peristalsis
Parasympathetic: stimulate gastric secretion & peristalsis
What is small intestine
Longest part gi tract
6-7m long
Divided into duodenum (fore to midgut), jejunum and ileum
Describe function of si
Primary site digestion and absorption
Extends from pyloric orifice to ileocecal fold
Describe duodenum
C shaped tube
20-25cm long
Describe location of si
Around head of pancreas
Retroperitoneal= except 1st portion
Describe anatomy of si duo - Gen
4 parts of duo = 2 in foregut, 2 in midgut
D1,D2,D,3,D4
Describe D1 duo
Superior part
Is connected with hepatoduodenal ligament = part of lesser omentum
INTRA
Describe D2 duo
Descending part
Site of junction of foregut and midgut
Retro
Contains 2 papillae
Describe D3 duo
Inferior part
Superior mesenteric vessels pass over it
Describe D4 duo
Ascending part
Ends in duodenal jejunal flexure
What is minor duodenal papilla for
Entrance of accessory pancreatic duct
What is major duodenal papilla for
Entrance of bile and pancreatic ducts (hepatopancreatic duct)
Describe arterial supply of first 2 parts duo
Branches from gastroduodenal artery= superior pancreaticoduodenal artery = anterior and posterior
Describe arterial supply of last 2 parts duo
Branches from superior mesenteric artery = inferior pancreaticoduodenal = anterior and posterior
Describe venous drainage duo
Same as arterial
Drains into portal system
Describe innervation duo
Visceral innervation from Celiac nerves plexus
Sympathetic: vasoconstriction & inhibition of peristalsis
Parasympathetic: stimulate gastric secretion & peristalsis
What is function of pancreas
Lobulated gland
Vital organ
Exocrine = digestive enzymes
Endocrine = hormones, like insulin and glucagon
What is location of pancreas
Posterior to stomach
From duo to spleen on left
Retroperitoneal = head, neck, and body, EXCEPT TAIL
Describe anatomy of pancreas - parts
Head, uncinate process, neck, body and tail
Describe head of pancreas
Lies within c shaped duo
Describe uncinate process of pancreas
Projection of head
Posterior to superior mesenteric vessels
Describe neck of pancreas
Anterior and superior to superior mesenteric vessels
Describe body of pancreas
Elongated part from neck to tail
Describe tail of pancreas
Into splenorenal ligament
Intra = needs to be mobile
Describe duct system pancreas
Exocrine
Consists of main pancreatic duct - wirsung
And accessory duct = santorini
Describe main pancreatic duct
Traverse its length
Join common bile duct at hepatopancreatic ampulla (bulge, biliary tree and main due to major pap)
Drain into duodenum at major duodenal papilla
Describe accessory duct of pancreas
Drain through minor duodenal papilla
Connected to main pancreatic duct too
Describe arterial supply of pancreas
Divided into 2 sections
Several regions with many alternate paths
What supplies uncinate process, head and neck of pancreas
From gastroduodenal = ant and post superior pancreaticoduodenal arteries (celiac trunk)
From superior mesentery = ant and post inferior pancreaticoduodenal arteries
Describe what supplies neck, body and tail of pancreas
Pancreatic branches from splenic a
Describe function of liver
1500grams
2nd largest organ of whole body
Filtrates nutrients and detoxifies substances from GI
Produces bile and stores vitamins and minerals
Describe location of liver
Intraperitoneal
Suspended under diaphragm
Surrounds ivc (also drains into it)
Describe impressions of liver
From surrounding organs
Renal - right kidney
Gastric - stomach on left lobe
Colic - hepatic flexure of colon on right
(Esophageal, gastric, renal, colic)
Describe visceral surface and diaphragmatic surface of liver
Diaphragmatic surface = superior moulded to diaphragm
Visceral surface = inferior moulded to abdominal viscera
Describe suspensory system liver
Liver covered by peritoneum
Intra
Needs to suspended - heavy organ
What is bare area
No peritoneum covering = direct contact with diaphragm here- creates vacuum, helps suspend and stick liver to diaphragm
Describe suspension of liver = superiorly
Peritoneum reflects into coronary ligaments = ant coronary and post coronary
Join to form triangular ligaments - where they meet on each side = right triangular and left triangular
Describe suspension of liver = anteriorly
Attached to abd wall = falciform ligament, extends into ligament teres (end, hangs down)
Describe suspension of liver = posteriorly
Lesser omentum (heaptoduodenal ligament) - encloses portal triad
Describe anatomy of liver
Divided into 4 lobes = right, left, caudate, quadrate
Caudate and quadrate from right lobe
Describe right and left lobes of liver
Divided by left Sagittarius fissure = featuring ligamentum teres anteriorly and ligamentum venosum posteriorly
Right = larger
Describe quadrate lobe of liver
Anterior on visceral surface
Between ligamentum teres and fossa of gallbladder
Separated from caudate by hilum
Describe caudate lobe liver
Posterior on visceral surface
Between ligamentum venosum and ivc
Describe location of porta hepatis
Visceral surface between caudate and quadrate
Describe content of porta hepatis
Right - left hepatic ducts (biliary system)
Hepatic arteries (blood supply)
Portal vein (venous drainage)
What is porta hepatis contained in
Hepatoduodenal ligament = part of lesser omentum
What is portal triad
Bile duct, portal vein, hepatic proper artery
Describe arterial supply liver
Celiac trunk gives =
Left gastric a
Splenic a
Common hepatic a —> proper hepatic a —> right and left hepatic a
Describe venous drainage liver
Hepatic veins draining into ivc
What is extrahepatic biliary system
Duct system for bile secreted by liver
Connects with gallbladder and empties into 2nd portion duo
Describe whole of extrahepatic biliary system
Right and left hepatic duct, combines into 1 common hepatic duct (in hepatoduodenal ligament)
Joins cystic duct (from gallbladder) = forms bile duct
Empties with main pancreatic duct through major duodenal papilla
Describe gallbladder
Pear shaped sac lying on visceral surface between quadrate and right lobes
Describe gall bladder function
Store bile from liver and concentrate it to release it through extrahepatic biliary duct system
Describe gallbladder anatomy
Neck = continuity with cystic duct, constricted
Body = enlargement projected over first part duo
Fundus = protruded from inferior border liver
Describe blood supply to gallbladder
Cystic a from right hepatic a
What is spleen
Lymphoid gland that filters blood
Part of vascular system
Describe location spleen
Left hypochondriac recon - behind stomach
Inferior to left dome of diaphragm
Posterior to stomach
Anterior to ribs 9-10-11
Describe anatomy spleen
Notched on ant border
Helium on medial surface (entry of vessels)
Visceral impression = renal, gastric, colic
Is spleen Intra or retro
Intra
Connected to greater curvature stomach by gastrosplenic ligament
Connected to left kidney by splenorenal ligament (contains splenic vessels)
Describe arterial supply spleen
Splenic artery from celiac trunk
