GB 3. General Arrangement of Abdomen Flashcards
What is the vertebral level of the Transpyloric Plane?
L1
What are the important structures associated with the Transpyloric Plane?
- Fundus of Gallbladder + Murphy’s Point
- End of Spinal Cord
- Pancreatic Body
- Origin of Superior Mesenteric Artery
- Left and Right Colic Flexure
- Hila of the Kidneys
- Spleen
(+ Pylorus of the Stomach)
(+ Formation of the Portal Vein)
Name the multiple parts of the peritoneal cavity.
- Supracolic Compartment
- Infracolic Compartment
- Paracolic Gutters
- Paravertebral Gutters
- Hepatorenal (Morison’s) Pouch = Subhepatic Space
- Subphrenic (Subdiaphragmatic)
- Lesser Sac
- Foramen of Winslow
What is Omenta?
It is doubling of the visceral peritoneum between the stomach and other organs.
There is a greater and lesser omentum and this gives rise to the greater and lesser sac.
Where is the Greater Omentum located?
It attaches the greater curvature of the stomach to the transverse colon.
It is a flap - the underside of it is attached to the transverse colon.
Where is the Lesser Omentum located?
It attaches the liver to the smaller curvature of the stomach and the first 1/2 of the duodenum
Where is the Greater Sac?
starts up at the diaphragm and extends all the way down to the pelvic cavity
it makes up most of the peritoneal cavity
Where is the Lesser Sac?
- lies behind the stomach and liver
- it is a diverticulum/recess of the of the peritoneum
What are the differences between the intraperitoneal and extraperitoneal organs?
Intraperitoneal organs are wrapped almost entirely in the visceral peritoneum and suspended in the cavity.
Extraperitoneal organs lie outside the peritoneal cavity (wrapped only one side [anterior] by the peritoneum)
What are the organs of the foregut?
- Esophagus (distal end)
- Stomach
- Duodenum (Proximal 1/2 - where bile duct enters)
- Liver
- Gall Bladder
- Pancreas
- Spleen
What is the blood supply, venous drainage and lymph drainage of the foregut?
Coeliac Trunk
Splenic Veins
Coeliac (lymph)
What are the dermatomes (nerves) that supply the foregut?
T5 - T10
What are the organs of the midgut?
- Duodenum (distal half)
- Jejunum
- Ileum
- Cecum
- Appendix
- Ascending Colon
- Hepatic Flexure of Colon
- Transverse Colon (proximal 2/3rds)
What is the blood supply, venous drainage and lymph drainage of the midgut?
Superior Mesenteric Artery
Superior Mesenteric Veins
Superior Mesenteric (lymph)
What are the dermatomes (nerves) that supply the midgut?
T9 - T11
What are the organs of the hindgut?
- Transverse Colon (distal 1/3rd)
- Splenic Flexure
- Descending Colon
- Sigmoid Colon
- Rectum
What is the blood supply, venous drainage and lymph drainage of the hindgut?
Inferior Mesenteric Artery
Inferior Mesenteric Vein
Inferior Mesenteric (lymph)
What are the dermatomes (nerves) that supply the hindgut?
L1 - L2
How is the Portal Vein formed?
- Inferior Mesenteric Vein joins up with Splenic Vein (becomes the Splenic Vein)
- Splenic vein then joins up with Superior Mesenteric Vein to become Portal Vein
- Portal Veins empties into the Inferior Vena Cava
What is the nerve supply of the parietal peritoneum?
- somatic nerves
- sensitive to localized pain
- senses pain, temperature, touch and pressure
What is the nerve supply of the visceral peritoneum?
- autonomic nerves (sympathetic and parasympathetic)
- referred pain and poorly-localized pain
- stretch + tearing sensitive
- e.g. appendicitis
What are the three different parts of the body that you may experience pain in?
- Epigastrium > Epigastric Region
- Peri-umbilical > Umbilical Region
- Suprapubic > Pubic Region
What are the organs that are affected when you have pain in the Epigastrium?
- Foregut
- Esophagus
- Stomach
- Duodenum
- Bilary Colic (Gallstones)
- Pancreas
What are the organs that are affected when you have pain in the Peri-Umbilical?
- Midgut
- Gastroenteritis
- Appendicitis/Meckels
* Meckels = congenital disorder that leads to outpouching of intestines*
What are the organs that are affected when you have pain in the Suprapubic?
- Hindgut + Pelvic Organs
- Sigmoid Colon
- Uterus, Bladder
What are the ligaments of the Greater Omentum?
- Gastrosplenic - stomach to spleen
- Gastrocolic - stomach to colon
- Gastrophrenic - stomach to diaphragm
- Splenorenal Ligament (Lienorenal) - spleen to kidney
What is the blood supply of the Greater Omentum?
- Right Gastroepiploic Artery/Right Gastro-omental
- Left Gastroepiploic Artery/Left Gastro-omental
*note: they are branches of the coeliac trunk
What is the Foramen of Winslow and its borders?
It is a passage between the greater and lesser sac. [the entrance to the lesser sac]
Anterior - structures in free edge of lesser omentum
Posterior - inferior vena cava
Superior - caudate lobe of liver
Inferior - duodenum
What is the Supracolic Compartment (Area)?
- superior to the transverse colon
- includes stomach, liver and spleen
What is the Infracolic Compartment (Area)?
- inferior to the transverse colon
- includes small intestine, ascending + descending colon
What are the Paracolic Gutters?
- there is a right and left paracolic gutters
- they run parallel to the colon
What are the subphrenic spaces?
- there is a right and a left subphrenic space
- spaces between the diaphragm and liver
- the 2 spaces are separated by the Falciform ligament of the liver
What is the right subhepatic space (hepatorenal pouch/Morison’s pouch)?
- between the liver and the colon
What is the Hepatorenal (Morison’s) Pouch?
- between the visceral surface of the liver and your right kidney
- deepest part of the peritoneal cavity when lying supine (where fluid collects)
What lies in the free edge of the lesser omentum?
- Common Bile Duct - right
- Hepatic Artery - left
- Portal Vein - behind
What are the ligaments of the lesser omentum?
- Hepatogastric - liver to stomach
2. Hepatoduodenal - liver to duodenum
What is the mesentery?
they are peritonela folds that attach viscera to the posterior abdominal wall - they suspend organs from the posterior abdominal wall
What are the derivatives of the dorsal mesentery?
- The Mesentery (small intestine)
- Transverse Mesocolon (transverse colon)
- Sigmoid Mesocolon (sigmoid colon)
What are ligaments?
they are 2 layers of peritoneum that connects 2 organs to each other - an organ to the body of the wall + may form a part of an omentum
What are some of the main ligaments?
- Splenorenal Ligament
- Gastrophrenic Ligament
- Gastrosplenic Ligament
- Gastrocolic Ligament
- Falciform Ligament
- Round Ligament (Ligament of Teres Hepatis) hangs down from the falciform ligament on the anterior side
- this is a remnant of the Left Umbilical Vein
What are the clinical points of the abdomen? [2]
- Murphy’s Point - in TPP, on medial end of rib cage [where the gall bladder is]
- Mc Burney’s Point - 1/3 from ASIS to umbilicus [where appendix is - may be a sign of acute appendicitis]
What are the 4 relations of the spleen? Be specific!
- Gastric
- fundus of stomach - Renal
- anterior surface of left kidney - Intestinal
- splenic flexure of large instestine (colon) - Pancreatic
- tail of pancreas
What are the dimensions, weight and location of the spleen?
1x3x5 - dimension
7 - weight in ounces
9x11 - location (from rib 9 to rib 11)
What is the hepatorenal pouch? What are some other names for this?
Hepatorenal Pouch = Morison’s Pouch = Subhepatic Space
The space between the liver and the kidney
What is the space below the diaphragm and the above the kidney?
Subphrenic Space or Subdiaphragmatic Space
- there is a right and left subphrenic space as the 2 areas are separated by the Falciform ligament
What are the ligaments of the Lesser Omentum?
[1] Hepatoduodenal Ligament
[2] Hepatogastric Ligament
What are the derivatives of the dorsal mesentery?
[1] The Mesentery (for small intestine)
[2] Transverse Mesocolon (for transverse colon)
[3] Sigmoid Mesocolon (for sigmoid colon)
Where is the Ligamentum Venosum?
It is the fibrous remnant of the ductus venosus of the fetal circulation
Usually, it is attached to the left branch of the portal vein within the porta hepatis
What mesenteries is involved when the foregut organs are first being formed (embryology)?
both the ventral and dorsal mesentery (mesogastrium)
What mesenteries is involved when the foregut organs are first being formed (embryology)?
both the ventral and dorsal mesentery (mesogastrium)
What mesentery is involved when the midgut and hindgut organs are first being formed (embryology)?
ONLY the dorsal mesentery
- they are not attached to the ventral mesentery
