GI Anatomy 4 Flashcards
What is the normal arrangement of the blood supply to the gall bladder?
Cystic artery from the right hepatic artery (branch of hepatic artery proper)
What is the blood supply to the pancreas?
1) Have an anterior and posterior superior pancreaticodudoenal artery, both from the gastroduodenal (from the common hepatic artery)
2) Have an anterior and posterior inferior pancreaticoduodenal artery which come straight off the superior mesenteric artery
3) Have a dorsal pancreatic artery (which comes off the splenic artery)
4) Have a great pancreatic artery (which comes off the splenic lateral to the dorsal pancreatic artery)
NB. The superior and inferior pancreaticoduodenal arteries anastamoses as do the dorsal and great pancreatic arteries
Why does a carcinoma of the head of the pancreas metastasise early?
Because the lymph nodes of the pancreas cant drain to the lymph nodes they normally would - these have become inaccessible
So the lymph drains to the liver via the portal vein - so cancer metastasises to the liver early
Which kidney lies at a higher level?
Left kidney (due to the liver on the right)
What is perinephric and paranephric fat?
Perinephric fat = completely surrounds the kidney, extraperitoneal fat immediately outside the renal capsule
Paranephric fat = accumulates posterior and posteriolateral to each kidney behind a layer of fascia
On which ribs do the left and right kidneys lie?
Left = 11 and 12 Right = 12
Which organs lie in contact with the anterior surface of the left kidney?
Suprarenal gland Intraperitoneal stomach and spleen Retroperitoneal pancreas Splenic flexure and beginning of descending colon Intraperitoneal jejunum
Which organs lie in contact with the anterior surface of the right kidney?>
Suprarenal gland Liver Descending part of duodenum Hepatic flexure Intraperitoneal small intestine
What are the posterior relations of each kidney?
Psoas major, Quadratus lumborum, Transversus abdominis
Which structures unite to form the ureteric pelvis?
2 or 3 major calices
On average at what vertebral level is the renal artery given off?
L2
What is the renal sinus?
Main cavity of the kidney, expansion behind the hilum containing the renal pelvis, calices and major renal vessels
What is the lymphatic drainage of the kidney?
To the lateral aortic (lumbar) nodes around the origin of the renal artery
What is an accessory renal artery?
Arises from the lateral aspect of the abdominal aorta either above or below the primary renal arteries
What is the clinical importance of the arrangement of the renal arteries?
Left renal vein crosses the midline anterior to the abdominal aorta and posterior to the superior mesenteric artery and can therefore be compressed in an aneurysm of either
What is the difference between the shapes of the 2 suprarenal glands?
Right = shaped like a pyramid Left = semilunar shape and larger
How many arteries supply each suprarenal gland and what are they?
3
1) Superior suprarenal arteries (from the inferior phrenic arteries)
2) Middle suprarenal arteries (from the abdominal aorta)
3) Inferior suprarenal arteries (from the renal arteries)
Why do the adrenal glands have such a rich blood supply?
Secrete endocrine hormones
What is the venous drainage of the suprarenal glands?
Right suprarenal vein - into the IVC
Left suprarenal vein - into the left renal vein (because of the crossing over the abdominal aorta)
What is the endothelial lining of the ureter?
Transitional epithelium
The bifurcation of the common iliac arteries lies over what joint?
The sacro-iliac joint
What is the course of the ureters?
From the renal pelvis runs down onto the psoas muscle, leaves the psoas at the bifurcation of the common iliacs (over the sacro-iliac joint)
Passes into the pelvis where it turns anteriorly and medially to enter the bladder
What structures cross the ureters just before they enter the bladder in males and females?
Males - ductus deferans
Females - Uterine arteries
What is the blood supply to the ureters?
Upper end = renal arteries
Middle = branches from aorta, gonadal arteries and common iliacs
In the pelvic cavity = Branches of internal iliacs
What is the innervation of the ureters and what dermatomes is pain referred to?
Innervation through renal, aortic, superior and inferior hypogastric plexuses by nerves that follow blood vessels.
Visceral afferents return to T11-L2 so pain is referred to these dermatomes
What are the 3 narrowest parts of the ureter where obstruction can commonly occur?
1) Uteropelvic junction (where renal pelvis becomes ureter)
2) Pelvic inlet (where ureters cross the pelvic brim)
3) Uterovesical junction (where the ureters enter the wall of the bladder)
Between which vertebral levels does the abdominal aorta extend?
Lower level T12 - Lower level L4
From the top to the bottom which veins come off the IVC?
1) Hepatic veins
2) Right suprarenal (left suprarenal drains into left renal)
3) Left and right renal
4) Right gonadal (left gonadal drains into left renal)
5) IVC splits into right and left common iliac veins
6) Median sacral drains into the left common iliac vein
7) Common iliac veins then split into internal and external iliac veins
From the top to the bottom what branches come off the abdominal aorta?
1) Right and left inferior phrenic arteries
2) Coeliac trunk
3) Superior mesenteric
4) Right and left middle suprarenal
5) Right and left renal
6) Left and right gonadal arteries
7) Series of left and right lumbar arteries
8) Inferior mesenteric
9) Median sacral artery comes off where the abdominal aorta splits into the left and right common iliacs
What is the peritoneum arrangement over the pelvic organs?
Peritoneum drapes over the superior surfaces of the pelvic organs that project upwards into the lower abdomen
This draping creates peritoneal pouches
What are the peritoneal pouches in males and females?
Males = rectovesical pouch (between bladder and rectum) Females = rectouterine and vesicouterine pouches
What is the significance of the rectouterine (pouch of douglas) in females?
Lowest portion of abdominal cavity, can collect free fluid and pus
Where does the bladder and the apex of the bladder lie in the pelvic cavity?
Lies directly posterior to the pubic symphysis, apex lies superior to pubic symphysis
What is the function of rugae in the bladder wall, in which region aren’t they present and why?
Allow the bladder to distend
Not in the trigone, this region needs no contracting fibres, it needs to remain relaxed otherwise urine wont be able to escape
What are the 3 parts of the uterus?
1) Cervix - extends into upper portion of vagina
2) Body
3) Fundus
What is the shape of the cervix and what is the internal and external os?
Donut shaped
External opening into vagina = external os
Internal opening into body of uterus = internal os
What is the cervical fornyx?
Gutter surrounding the cervix in the upper vagina 4 parts 1) Anterior fornyx 2) Posterior fornyx 3) Lateral fornices
What is the clinical significance of the posterior fornyx?
Lies close to recto uterine pouch - transvaginal approach can be used to drain pus from the rectouterine pouch
What is the broad ligament?
Extension of the peritoneum which drapes laterally either side of the uterus - has important structures running through it
What structures run through the broad ligament?
Superior margin broad ligament = uterine tube
3 ligaments within the broad ligament
1) Ovarian ligament (between ovary and uterus)
2) Round ligament of uterus (thickening of broad ligament extends from lateral surface of the uterus through the broad ligament destined from the anterior abdominal wall)
3) Suspensory ligament (continuation of ovarian ligament, from ovary to lateral pelvic wall - contains the ovarian artery and vein)
What is the structure of the uterine tube?
1) Dilated distal end with finger like projections called fimbriae
2) Dilation by fimbriae = infundibulum
3) Then have ampulla of uterine tube
4) Then as tube tapers away towards uterus have the ischthmus
What lies posterior to the prostate in the male?
Vas deferans and seminal vesicle
What is the function of the vas deferens?
takes sperm from the testes through prostate to enter prostatic urethra
What do the seminal vesicle and ductus deferans unite to form?
Ejaculatory duct
What is the function of the seminal vesicles?
Produce semen
At what vertebral level does the rectum begin?
S3
Where does the rectum end?
At the ano rectal junction at the level of the plevic floor
What are rectal folds/valves and what is their function?
Rectum is not a straight tube, running into tube have rectal folds/valves - 2 rectal folds on left, 1 on right
Shelf like structures which prevent faeces from just passing out the rectum
