GI Organs Flashcards
RUQ organs
right lobe of liver gallbladder pylorus of stomach parts 1-3 of duodenum head of pancreas right suprarenal gland right kidney right colic (hepatic) flexure superior part of ascending colon right half of transverse colon
LUQ organs
left lobe of liver spleen stomach jejunum and proximal ileum body and tail of pancreas left kidney left suprarenal gland left colic (splenic) flexure left half of transverse colon superior part of descending colon
RLQ organs
cecum appendix most of ileum inferior part of ascending colon right ovary right uterine tube abdominal part of right ureter abdominal part of right spermatic cord uterus (if enlarged) urinary bladder (if very full)
LLQ organs
sigmoid colon inferior part of descending colon left ovary left uterine tube abdominal part of left ureter abdominal part of left spermatic cord uterus (if enlarged) urinary bladder (if very full)
Xiphisternal plane
Rib 7 projects posteriorly to T9
Transpyloric plane
Rib 9 projects posteriorly to L1
Subcostal plane
Rib 10 projects posteriorly to L3
Supracristal plane
Projects posteriorly to L4
Transtubercular plane
Widest part of hips, projects posteriorly to L5
Interspinous plane
At ASIS, projects posteriorly to S2
Esophagus
Passes thru right crus of the diaphragm at T10
Enters cardial orifice of the stomach at T11
Attached to diaphragm via phrenico-esophageal ligament
fits into a groove on the posterior liver
Esophageal constrictions
Cervical: upper sphincter and cricopharyngeus muscle
Thoracic: esophagus in contact with aorta and left main bronchus
Diaphragmatic: as it passes thru the esophageal hiatus at T10, implicated in hiatal hernias (sliding and para-esophageal)
Hiatal hernias
Abdominal structure enters thorax, usually on the left side
Paraesophageal: normal gastro-esophageal junction, fundus protrudes into thorax, less chances of GERD
Sliding: most common, GEJ displaced superiorly, cardia protrudes, “hourglass” stomach presentation
What lies posteriorly to the stomach?
diaphragm, spleen, left upper kidney and suprarenal gland, pancreas, omental bursa (lesser sac) - stomach forms most of its anterior wall
What lies anteriorly to the stomach?
diaphragm, left lobe of liver, anterior abdominal wall
What lies inferolaterally to the stomach?
transverse colon
Gastrohepatic ligament
connects lesser curvature to the liver, contains gastric vessels
Gastrocolic ligament
connects greater curvature to the transverse colon, contains gastropipolic vessels and part of greater omentum
Duodenal ulcer complications
hemorrhage from gastroduodenal artery for posterior ulcers in first part of duodemun
ulcer in first part of duodenum can also cause adhesions with gallbladder or liver
anterior ulcer can perforate into peritoneal space
pancrease may be affected
Gastric ulcer complications
lesser curvature ulcer can cause hemorrhage from left gastric a
Ligament of Treitz
suspensory muscle of duodenum, connects the third and fourth parts of the duodenum
Jejunum characteristics
long vasa recta, a few large arcade loops, large tall and closely paked circular folds, very few peyers patches
Ileum characteristics
short vasa recta, many short arcade loops, low and sparce circular folds, many peyers patches
Meckel diverticulum
most common congenital anomaly of GI tract
true diverticulum, persistent vitelline/omphalomesenteric duct, can contain ectopic gastric or pancreatic tissue
rule of 2’s: 2x more likely in males, 2 inches long, 2 ft from ileocecal valve, 2% of population, presents in first 2 years of life if symptomatic, 2 types of epithelia may be present
Intussesception
telescoping of proximal bowel segment into distal segment
common at ileocecal junction, mostly children
target sign on ultrasound
idiopathic vs. Meckel (kids) vs. tumor (adults)
Which organs are retroperitoneal?
Suprarenal gland Aorta/IVC Duodenum (2nd and 3rd part) Pancreas (except tail) Ureters Colon (ascending and descending) Kidneys Esophagus Rectum
Sigmoid colon
runs from iliac fossa to S3
teniae coli terminate at the recto-sigmoid junction
long mesentery: sigmoid mesocolon
most common site of volvulus in the elderly
Volvulus
rotation of loop of bowel can cause constipation, ischemia and necrosis midgut volvulus more common in infants sigmoid volvulus more common in elderly coffee bean sign on XR
Liver
largest abdominal organ
occupies most of RUQ and can extend as fast as left anterior axillary line
top of liver is at xiphistenal plane
follows subcostal line
will move inferiorly on inspiration, aids is palpation
What separates the right and left lobes of the liver?
falciform ligament, connects liver to the anterior abdominal wall
What are teh 2 accessory lobes of the right anatomic lobe?
quadrate love, part of left hemi-liver
caudate lobe, is functionally separate
Round ligament (teres) of liver
Remnant of umbilical vein
Hepatoduodenal ligament
contains the proper hepatic artery, bile duct and the portal vein
anterior boundary of epiploic foramen
What are the functional lobes of the liver?
left medial segment, left anterior segment, left lateral segment, right posterior medial, right posterior lateral, right anterior medial, right anterior lateral segment, posterior (caudate) segment
separated into R/L based on primary division of portal triad, EXCEPT caudate lobe which receives vessles from both portal bundles
Cantlie line is imagined from the fundus of gallbladder superiorly to the diaphragm
NOTE: the left medial division is part of right functional lobe
Gallbladder
blind diverticulum located between 4th and 5th segments of liver
has fundus, neck and body
attached to common bile duct via cystic duct
common bile duct meets with pancreatic duct to empty into ampulla of Vater in the 2nd part of duodenum
Cholelithiasis
gall stones
50% are asymptomatic
gallstones obstructing the cystic duct can cause cholecystitis (3 F’s: female, forty, fertile, overweight)
Murphy’s sign: palpate RUQ, ask pt to inhale, sudden halt to inspiration d/t pain is a positive sign
Choledocolithiasis
caused by an obstruction of the common bile duct
Gallstone ileus
caused by an obstruction of the ileocecal junction
Spleen
largest lymphatic organ, vulnerable to blunt trauma, LUQ
splenorenal ligament contains the splenic artery
gastrosplenic ligament contains short gastric arteries
Relationships to spleen
stomach is anterior
diaphragm, ribs 9-11 are posterior
loeft colic flexure is inferior
left kidney is medial
