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
pancreas
accessory pancreatic duct (not always)
body: antierior to aorta
tail (only part intraperitoneal) : adjacent to hilum of spleen
neck anterior to SMA
pancreatic duct-main to major papilla
uncinate process
head: c portion to duodenum
pancreatic formation and inflammation
pancerase fomed from fusion of embryonic ducts from vental and dorsal buds
-main and accessory (accessory duct of santorini) ducts
pancreatitis
-blockage of hepatopancreatic ampulla, potential to back up of bile into panc duct
panc rupture may allow pancreatic enzymes to digest abdominal tissues
pancreatic cancer can obstruct biliary system leading to jaundice
extensive drainage of lymph )to multiple nodes_ and venous blood from the pancreas allow for rapid metastisis of cancer cells, often to liver
arterial supply of foregut
CELIAC TRUNK
3 divisions
- left gastric (1/2 art to lesser curvature)
- splenic artery (short gasrtic arteries for funsus, and panc arteries for panc, and left gastroomental artery)
- common hepatic (gastroduodenal branch (R gastroomentum) argace called superior pancreaticoduidenal)
- becomes proper heparic artery
- right and left hepatic arteries to porta hepatis
esophagus: branches off aorta directly and esophageal branches off left gastric arteries inferiorly
stomach: left and right gastric arteries anastimose
- left and right gastric also anastimose
duodenum: gastroduodenal branches
spleen:
pancreas: anastimoses of midgut (SMA) and foregut supply
- posterior superior and inferior pacreaticoduodenal arteries
System of venous drainage of foregut
IVC
superior mesentericV
Inferior mesenteric vein
splenic vein
portocaval anastimoses
- esophageal veriecs
- sticking out in the esophagus - rectal verices: hemorrhoids
- superior rectal vein drains to inferior mesenteric to portal veins
- rectal, same thing, distended veins in colon - caput medusae
- blood flows backwayrd through paraumbilical veins to superficial bands - hidden retroperitoneal verices
- lumbar veins drain to IVC, less apparent, hidden
becomes importent during portal hypertension, typically associated with cirrhosis of liver or fibrosis
so they go AROUND!
portosystemic shunts
in extreme cases, shunting from portal vein into the caval system .
reduction in portal pressure.
venous drainage
draw out venous drainage
slide 93
portal
R L gastric veins
more more
autonomic supply
periarterial plexuses
- greater splanchnic?
- celiac ganglion
both postganglionic sympathetic and preganglionic parasympathetic distrubuted by travelling with the blood vessels
lymphatic drainage
superior 2.3 stomach draines to gastric nodes which drian to celiac
lower right draines to pyloric nodes, then to celiac nodes
lower left drains to pancreaticoduodenal nodes then to celiac nodes
CELIAC TO CYSTERNA CHYLE TO THORACIC DUCT
splenic nodes drain to pacreaticosplenic nodes to celiac
duodenum: pancraeticoduodenal nodes to celiac
PANCREAS: most to pancreaticosplenic then celiac
SOME drains to pyloric, then to superior mesentaric or hepatic nodes.
Gall Bladder: cystic to hepatic to celiac
anterior live: hepatic to celiac
posterior liver (bare area)- phrenic nodes drain to posterior mediastinum -50% of lymph recieved by thoracic duct generated from the liver
