GI Anatomy 3 Flashcards
On which side of the liver is the caudate lobe of the liver and what is it bounded by?
1) Visible on the posterior visceral surface of the liver
2) Bounded on the left by fissure for the ligamentum venosum (remnant of sinus venosus)
3) Bounded of the right by the groove for the vena cava
On which side of the liver is the quadrate lobe visible and what is it bounded by?
1) Visible on the anterior part of the visceral surface of the liver
2) Bounded on the left by fissure for the ligamentum teres
3) Bounded on the right by the fossa for the gall bladdr
What are the segments of the biliary tree?
1) Bile canaliculi
2) Eventually drain into left and right hepatic ducts
3) Join (usually at the porta hepatis) to form the common hepatic duct
4) Joined by cystic duct to form the common bile duct
What is the relative positions of the components of the portal triad?
Portal vein closest to IVC
Bile duct and hepatic artery proper anterior
Where does the common bile duct run after it leaves the free edge of the lesser omentum?
1) Posterior to the first part of the duodenum
2) Then enfolded by the head of the pancreas
3) Unites with the pancreatic duct to form the hepatopancreatic ampulla
What is the blood supply to the gall bladder?
Cystic artery from the right hepatic artery (a branch of the hepatic artery proper)
What are the 3 parts of the gall bladder?
1) Fundus
2) Body
3) Neck
What are the peritoneal attachments of the duodenum?
First 2.5 cm is intraperitoneal
The rest is retro peritoneal
What are the 4 parts of the duodenum and where do they run from?
1) First part: Pyloric orifice of stomach to the right of the neck of the gall bladder (the right of the body of L1 vertebra)
2) Second part: Descending part: Neck of gall bladder to the lower border of L3
3) Third part: Inferior part: crosses IVC, aorta and vertebral column
4) Fourth part: Ascending part: Passes to the upper border of L2
Where does the first part of the duodenum pass relative to the bile duct, gastroduodenal artery, portal vein and IVC?
Anterior
Where does the inferior part of the duodenum pass relative to the superior mesenteric artery and vein?
Posterior
What is the blood supply to the duodenum?
1) Branches from the gastroduodenal artery (from celiac trunk)
2) Branches from the inferior pancreaticoduodenal artery (from superior mesenteric artery)
3) The first jejunal branch (from the superior mesenteric artery)
What is the peritoneal attachments of the pancreas?
Retroperitoneal
What are the parts of the pancreas?
1) Head
2) Neck
3) Body
4) Tail
Where does the uncinate process of the pancreas lie in relation to the superior mesenteric vein and artery?
Posterior to the vessels
The major duodenal papilla marks the boundary between which 2 portions of the GIT?
Foregut and midgut
What is the blood supply to the pancreas?
1) Pancreaticoduodenal arteries (from the gastroduodenal artery)
2) Pancreatic arteries (from the splenic artery)
3) Inferior pancreaticoduodenal artery (from the superior mesenteric)
Where does the stomach lie in relation to the pancreas?
Anteriorly and superiorly
What effects might you expect from carcinoma of the head of the pancreas and why?
1) Weight loss and malnourishment (few enzymes)
2) Jaundice (blockage of bile duct)
3) Vomiting (Blockage of GI tract)
4) Dark urine and pale stools (excess bilirubin in the urine and none can leave via the bile duct)
5) Diabetes (possible disruption of endocrine function)
Why is carcinoma of the pancreatic head often inoperable?
Because the cancer encases the arterial vessels and arterial reconstruction is not a feasible option
In which region of the abdomen does the spleen lie?
In the left hypochondrium
To which ribs is the spleen related?
Lies against diaphragm in the area of rib 9 to 10
What vertebral level does the spleen lie at?
L1 ie. in the transpyloric plane
How many branches does the splenic artery divide into before it enters the spleen?
4 or 5
Which branches from the splenic artery supply the stomach?
Short gastric arteries
In what is the tail of the pancreas embedded?
The hilum of the spleen
The blood vessels and the tail of the pancreas run towards the spleen in what?>
The linorenal ligament
At what vertebral level does the aorta pass behind the diaphragm?
T12
At what vertebral level does the IVC pass into abdomen?
T8
At what vertebral level does the aorta bifurcate?
L4
What is the course of the right and left renal veins?
Right renal vein passes straight into hilum of the kidney
Left renal vein passes over the abdominal aorta and into hilum of kidney
What are the positions of the abdominal aorta and the IVC relative to eachother?
The abdominal aorta lies to the left of the IVC
What are the relative positions of the renal vein, artery and renal pelvis at the hilum of the kidney?
Renal vein is most anterior
Renal artery is posterior to the renal vein
Renal pelvis is most posterior
What does the renal pelvis do and give rise to?
Collects all the urine produced by the kidneys and gives rise to the ureter
What are renal columns?
Bands of cortex which pass into the medulla
What are renal pyramids?
Sections of medulla which lie inbetween the renal columns of the cortex
How many minor calices give rise to major calices?
2/3/4 minor calices would give rise to one major calyx
How many major calices do we have that give rise to the renal pelvis?
2/3
On what surfaces of the kidneys do the suprarenal glands sit?
On the supramedial surfaces
What is perinephric fats?
Sits around the fibrous capsule of the kidney
From what does the psoas muscle originate and what does it pass towards?
Originates from the lateral surfaces of the lumbar vertebrae
Runs towards the lower limb
Which muscle sits within the iliac fossa?
The iliacus
The iliacus muscle and psoas muscle unite to form what? Where does this pass and what is its role?
Iliacus muscle joins with the psoas muscle to form the iliopsoas muscle, the joint tendon from these 2 muscles passes to the femur, this muscle is an important flexur of the thigh
What is the quadratus lumborum muscle and where does it originate from and pass to?
Quadrangular shaped muscle on the posterior abdominal wall, superior to the iliacus muscle
Originates from the 12th rib and passes inferiorly towards the iliac crest
What are the 3 nerves which run on the posterior abdominal wall on which the kidney sits? What are there relative positions, what kind of nerves are they and what do they supply?
1) Most superiorly = Subcostal nerve (T12)
2) Inferior to that = Ileohypogastric nerve (L1)
3) Inferior to that = ileoinguinal nerve (L1)
Both the ileohypogastric and ileoinguinal branch from L1
All 3 are somatic nerves and supply the body wall, motor to the muscles of anterior lateral aspects of body wall and sensory from the skin
At what point does the ureter pass into the pelvis?
At the bifurcation of the common iliacs into internal and external iliacs
What muscle does the ureter pass along as it courses from the renal pelvis to the pelvis?
The psoas muscle
What 3 paired bones make up the pelvic bone and where do they join?
1) Ilium
2) Pubis
3) Ischium
Join at the acetabulum
Also have the sacrum bone
As the falciform ligament runs towards the liver, what lies on the posterior surface of the liver and what is it a remnant of?
The ligamentum venosum
Remnants of the ductus venosus in the embryo which was to bypass the liver in the embryo as blood had already been detoxified by the mother
What are the ‘peritoneal attachments’ of the inferior mesenteric artery?
Runs retroperitoneally
What arteries branch off the inferior mesenteric?
1) Left colic (runs up towards splenic flexure)
2) Sigmoidal
3) Superior rectal
What are the relative positions of the inferior mesenteric vein and artery?
The inferior mesenteric vein lies to the left of the inferior mesenteric artery
What parts of the GIT does the inferior mesenteric vein receive blood from?
1) Rectum
2) Sigmoid colon
3) Splenic flexure
What does the inferior mesenteric vein drain into?
The splenic vein
Where do the hepatic duct and the cystic duct unit to form the common bile duct?
Some way along the free edge of the lesser omentum
The greater omentum runs from where to where?
The greater curvature of the stomach to the transverse colon
At what vertebral level does the oesophagus enter the abdomen?
T10
What are the 5 parts of the stomach?
1) Cardia - opening of oesophagus into stomach = cardiac orifice
2) Fundus
3) Body
4) Antrum (or pyloric antrum)
5) Pylorus
The left and right gastric arteries come off where?
Left gastric - direct branch of celiac trunk
Right gastric - off the common hepatic artery
The left and right gastro-omental arteries come off where?
Left gastro-omental - off the splenic artery
Right gastro-omental - off the gastroduodenal artery (off common hepatic artery)
What are the relative positions of the superior mesenteric artery and vein?
Left = superior mesenteric artery Right = superior mesenteric vein
What are the 2 features of the blood vessels running towards the jejunum and ilium?
1) Arterial arcades
2) Vasa vecta - straight arteries that run from the arterial arcades to the SI
Where do veins from the jejunum and ileum run?
Parallel to arteries and return digested food to superior mesenteric vein which ultimately unites with the splenic vein to form the portal vein
What 3 vessels come off the superior mesenteric to supply the colon?
1) Middle colic - runs up and through the transverse mesocolon to supply the transverse colon
2) Right colic - Runs across abdomen and heads to ascending colon and hepatic flexure
3) Ileocolic - gives off branches to the distal ileum and the cecum, the appendix also receives a branch from the ileocolic artery
What does the conjoint tendon insert into?
The pelvic bone
What is the peritoneal cavity?
Space between the parietal and visceral peritoneum
What are the ovaries covered in?
Peritoneum
The liver develops within what structure?
The ventral mesentery
what is the gastrocolic ligament made up of?
The greater omentum and the transverse mesocolon
Where does the external oblique muscle extend from and what does it attach to?
The lower 8 ribs
Attaches to the iliac crest and forms the inguinal ligament which runs from the ASIS to the pubic tubercle
Where does the internal oblique extend from superiorly, posteriorly and inferiorly?
Superiorly, costal margin
Posteriorly the thoracolumbar fascia
Inferiorly the iliac crest and lateral 2/3 of the inguinal ligament
Where does the tranverse abdominis extend from superiorly, posteriorly and inferiorly?
Superiorly - the costal margin
Posteriorly - the thoracolumbar fascia
Inferiorly - Iliac crest and the lateral 1/3 of the inguinal ligament
What nerves supply the muscles of the anterior abdominal wall?
Anterior rami of the intercostal nerves - T7-T12
Also have contributions from the iliohypogastric and ilioinguinal nerves (L1) which run posterior to the kidney
Why, when the spleen enlarges, does it not travel inferiorly but travels anteriorly and diagonally?
Because the phrenicocolic ligament prevents it from enlarging inferiorly
What are the peritoneal arrangements of the ascending and descending colon?
Secondarily retroperitoneal
