G20 21 Anatomy of Foregut I & II Flashcards
Foregut/midgut/hindgut
forgutL blood inntervation and lympth to stomach, liver, GB, spleen panc, first 1/5 of duodenum
- celiac trunk
- sympathetics: celiac ganglion
- parasympathetics: vagus (10)
- lymphatics: celiac nodes
midgut: blood innervation and lymph to duodenum, jejunum, ileum, cecum, asc and 2/3 transverse colon
- superior mesenteric artery
- sympathetics: sup mesenteric ganglion
- parasympathetics: Vagus (10)
- lymphatics: superior mesenteric nodes
hindgut: blood innervation and lymph to remaining transverse colondesc, sigmoid colon and rectum
- sympathetics: multiple
- parasumpathetics: pelvic splanchnic
- lymphatics: inf mesenteric nodes
foregut arterial supply
celiac trunk
trifurcation to splenic and common hepatic and left gastric
Hiatal Herniation 2 types
sliding hiatal herniationL abdominal esophagus, fundus slide thorugh diaphragm into thorax when person lies or bends over. Regurgitation bc right crus of diaphragm can no longer clamp the esophagus closed
MORE COMMON
paraesophageal hiatal hernia
-herniation of fundus -regurg less common bc the cardiat orifice in normal position
LESS COMMON
sections of stomach
cardiac orifice
rugae
pyloric antrum
pyloric canal
pyloric sphincter
pyloric orifice
L1L2 trans pyloric plane
L1/L2
pylorus of stomach
fundus of GB
end of SC
body of panc
origin of the superior mesenteric artery
term of superior mesenteric vein at portal vein
hilum of kidney (L)
upper pole of kidney (R)
root of transverse mesocolon
first part of duodenum
hilum of spleen
gastric ulcer
open lesion of of the mucosa: 90% by pylori helicobacter
-can hemmorage
duodenal or peptic ulcers
ulcerations result in spilling of duodenal contents into the peritoneal cavity leading to PERITONITIS
-Liver panc or GB can be damaged by duodenal ulceration.
gastroduodenal arterial hemorrhage can lead to vomitting bright red blood.
-bleeding occurs proximal to hepatopancreatic duct (bile and panc juices would make it brown)
Spleen location and function
impressions/ligaments
9th-11th ribs
-posterior to midaxillary line
filters blood, removes redundant RBC’s and pathogens, largest lympoid organ
tail of pancreas, posterior wall of stomach, and left kidney
covered by peritoneum except at hilum
- fibrous capsul (different from peritoneum)
- splenic pulp (HIGHLY VASCULARIZED)
- gastrosplenic ligament and splenorenal ligament
- renal impression, gastric impression, colic impression (smooth at diaphragmatic surface)
accessory spleen and splenomegaly
due to embryogical dev, and surrounding tissue 10% have them, tiny spleens. If you have to remove the spleen in splenic anemia. You need to look for this if you are trying to remove the spleen.
giant spleen : granulocytic, leukemia, hemolytic and granulocytic anemias- hypertension
Liver location/surfaces/spaces around it and fxn
Spaces: subphrenic recess (separated Rand L by falciform ligament (reound lig of liver). (obliterated umbilical vein)
coronary ligaments, left and right triangular ligaments
BARE area: direct contact with diaphragm (posterior NOT superior)
Right ant: stomach
superior duodenum, lesser omentum , GB, Right colic flexure, right tranverse colon, right kidney and suprarenal galnd
4 lobes?: Right Left and
right looking at the inferior side: Caudate Lobes and quadrate lobe
pora hepatis
where vessels enter the liver
-proper hepatic artery, common hepatic duct, common bile duct, portal vein, cystic duct,
cannot see nerves and lympatics
Liver Lobes
functional segments: 8 individual functional segments: based on bile ducts and hepatic vessels
liver blood flow
sinusoid- central vein- sublobular vein, right left and middle hebatic vein- to IVC
portal vein (hepatic artery and portal vein will eventually anastimose)
bile goes opposite direction
Gall Bladder
visceral surface of the liver
anterior and superior to 1st and 2nd parts of the duodenum.
bile produced in the liver and stored and concentrated in GB
fundus, body, neck, cystic duct Commong bile duct
moving superior to liver: commmon bile duct(posterior to duodenum) - commone hepatic duct- rigng and left hepatic ducts
pacreatic duct and bile duct arrive at hepatopancreatic ampulla of Vater (duodenal papilla) (second part of duodenum)
-controlled by sphincter of oddi
(minor panc duct accessory from panc)
sphincters:
- sphincter of bile duct
- sphincter of panc duct (INCONSTANT)
- sphincter of hepatopancreatic ampula)
arteries to GB highly variable-
- cystic atery (supplies GB) (TRIANGLE OF CALOT???)
- right and left hepatic arteries
- both come crom the common hepatic artery to hepatic artery proper
Cholecystitis and Gallstones
Gallstones: concretion of cholesterol crystals
-problematic if trapped in distap HP ampulla (narrowest part), cystic or hepatic ducts
Cholecystitis: inflammation and enlargement of galbladder due to bile accumulation
-bile back up into blood-> post hepatic jaundice (bilirubin backup into blood)
FISTULA?? LARGE stones directly to duodenum
Cholescystectomy: removal of Gall bladder
