GIT-Peritoneum, Stomach, Liver, Biliary Tract & Spleen Flashcards
What is another term to describe a single continuous membrane of simple squamous epithelium?
Mesothelium
What does the parietal peritoneum lines?
Abdominopelvic cavity
What does the visceral peritoneum lines?
Covering the organs (e.g. Bowel)
What usually stimulates the visceral peritoneum?
Stretching and chemical irritation
Where are pain from foregut, midgut andf hindgut derivatives usually experienced respectiviely?
Foregut: Epigastric region
Midgut: Umbilical region
Hindgut: Hypogastric / pubic region
The peritoneal cavity is a ________ within the layer of the peritoneum
potential space
In females, there is ____ between vagina > uterine cavity > uterine tubes: potential pathway for _____
In females, there is external communication between vagina > uterine cavity > uterine tubes: potential pathway for infection
Omentum is a ____ extension or fold of ____
Omentum is a double layered extension or fold of peritoneum
Where does the lesser omentum extend from?
Liver to the lesser curvature of the stomach
A double layered peritoneal fold
Where does the greater omentum extend from?
Greater curvature of the stomach and the transverse colon
- wraps around inflammed organ in the abdomen and protects other organs from it
What is a ligament?
A fold connecting one organ with another or one organ with any area of the body wall.
Mesentry is a ____ connecting an organ to the ____ it’s also a conduit for ____, nerves and ____ supplying viscera
Mesentry is a fold connecting an organ to the posterior abdominal wall it’s also a conduit for vessels, nerves and lympathics supplying viscera
Composed of 2 layers of peritoneum
Peritoneum is a ____, ____ serous. membrane - lines the abdominal cavity & invests the viscera
Continuous, transparent
What runs within the lesser omentum near its free edge?
Portal vein
Bile duct
Hepatic artery
PBH, same as anterior boundaries of the omental foramen (Portal Triad)
Intraperitoneal: Structures are suspended from the abdomina wall by ____
eg. most of small intestines
Mesenteries
Retroperitoneal: Structures e.g. kidneys and great vessels that lie between ____ peritoneum and ____
Retroperitoneal: Structures e.g. kidneys and great vessels that lie between parietal peritoneum and** abdominal wall**
What are some organs that became secondarily retroperitoneal?
ORgans that originally had a mesentry, but became secondarily retroperitoneal when the mesentry fused with the body wall.
Duodenem (except the first part)
Pancrease (except the tail part)
Colon (except cecum, transverse colon and sigmoid colon)
Omental foramen (Epiploic foramen) is the passage between the ____ and the ____ allowing communication between these two spaces
greater sac and lower sac
What are the boundaries of the omental foramen?
Anterior: Bile duct, hepatic artery and portal vein (portal triad)
Posterior: IVC and diaphragm
Superior: Caudate lobe of the liver
Inferior: First part of the duodenum
What is another name for the lower sac?
Omental bursa
When does the esophagus pierce through the diaphragm?
T10
Oesophagus: 10 letters
The stomach lies between the ____ and the ____ in the epigastric, umbilical and ____ regions of the abdomen
The stomach lies between the esophagus and the small intestine in the epigastric, umbilical and left hypochondriac regions of the abdomen
What are the four main regions of the stomach?
Cardia > Fundus > Body > Pylorus
What are the two orifice of the stomach?
Cardiac orifice (Gsatroesophageal junction)
Pyloric orifice
____ receives food from teh oesophagus and is mainly involved in ____ digestion
Stomach receives food from the oesophagus and is mainly involved in enzymatic digestion
Briefly describe the realation of the stomach (Anterior, Posterior and Superior)
Anterior: Left lobe of the liver and diaphragm anteriorly
Superior: Left dome of diaphragm superiorly
Posterior: Lesser sac (omental bursa) and pancreas posteriorly
Rests on the:
- Spleen
- Left kidney and adrenal
- Splenic artery
- Pancreas
- Transverse mesocolon
The interior of the stomach is lined by gastric mucosa which is thrown into mucosal folds ( ________ ) when contracted
Rugae
What does the foregut include and what is the arterial supply?
Distal 3rd of esophagus to the 2nd part of the duodenum at the entrance of the bile duct (Major duodenal papilla)
Arterial supply: Coeliac trunk
What does the midgut include and what is the arterial supply?
2nd part of the duodenum to two-thirds along transverse colon
Arterial supply: Superior mesentric artery
What does the hindgut include and what is the arterial supply?
Distal third of transverse colon to the rectum
Arterial supply: Inferior mesentric artery
What are the 3 unpaird visceral arteries and their corresponding veryebral level?
Celiac (T12)
Superior Mesentric (L1)
Inferior Mesentric (L3)
What are the 3 paired visceral arteries?
Suprarenal (L1)
Renal (L1)
Gonadal (L2)
what are the 3 paired parietal arteries?
SUbcoastal artery (L2)
Inferior phrenic (T12)
Lumbar artery (L1-L4)
Celiac trunk can be further divided into what arteries?
Supplies foregut
Common hepatic artery
Splenic artery
Gastric arteries
* Left and Right gastric arteries
* Left and Right gastro-omental arteries
* Short gastric arteries
____ run parallel to the gastric arteries in position and course. ____ are tributaries of ____ vein.
Gastric veins run parallel to the gastric arteries in position and course. Right and left gastric veins are tributaries of portal vein.
Gastric lymphatic ____ are found along the ____ and ____ curvature of the stomach.
____ nodes
____ nodes
The ____ vessels from these nodes drain into the ____ nodes then to the _____
Gastric lymphatic vessels are found along the greater and **lesser **curvature of the stomach.
**Gastric ** nodes
Gastro-omental nodes
The **efferent **vessels from these nodes drain into the celiac nodes then to the thoracic duct
The stomach receives sympathetic nerve fibres from ____ to ____ spinal segments
It stimulates ____ sphincter
The stomach receives sympathetic nerve fibres from T5 to T9 spinal segments
It stimulates pyloric sphincter
The stomach receives parasympathetic nerve fibres from the ____ and ____ nerves
It stimultes ____ movement of the stomach and secretion of ____
The stomach receives parasympathetic nerve fibres from the right and left vagus nerves
It stimultes peristalsis movement of the stomach and secretion of gastric glands (secretomotor)
____ nerve fibres (preganglionic) pass through the ____ nerves and terminates in the ____ ganglion
____ sympathetic nerves supply the stomach
Stomach is supplied by the ____ fibres which accompany the sympathetic nerve fibres and reach the ____ spinal sensory ganglia.
Visceral referred pain from gastric ulcer is reffered to the ____ region
Sympathetic nerve fibres (preganglionic) pass through the greater splanchnic nerves and terminates in the celiac ganglion
Postganglionic sympathetic nerves supply the stomach
Stomach is supplied by the sensory (pain) fibres which accompany the sympathetic nerve fibres and reach the T5-T9 spinal sensory ganglia.
Visceral referred pain from gastric ulcer is reffered to the epigastric region
Alcohol often leads to liver _____
Liver cirrhosis
What is the largest visceral organ in the body?
Liver
The liver lies primarily in the right ____ and ____ region
Right hypochondrium and epigastric region
What are the 2 surfaces of the liver and its relation?
Diaphragmatic surface of the surface is related to the inferior surface of the diaphragm and is separated by the subphrenic recess (Covered with peritoneum except the bare area)
Visceral surface: Covered by peritoneum except at the bed of gallbladder and porta hepatis
Hepatorenal recess: A peritoneal cavity on the right side between the liver and the right kidney with adrenal gland
Liver is attached to the anterior abdominal wall:
What divides the liver into right and left lobes?
Falciform ligament
Liver attached to the anterior abdominal wall by the falciform ligament
Liver is attached to the stomach:
What attaches the liver and the stomach?
Hepatogastric ligament
Liver is attached to the diaphragm:
What attaches the diaphragm and liver?
Coronary ligaments
Functions of the liver:
Secretes ____ which is released into the ____ (____ emulsifies fat)
Involved in ____, fat and ____ metabolism and stores ____
Involved in ________ of the blood by removing ____ and other foreign particles (Detoxification)
Secretes bile which is released into the duodenum (bile emulsifies fat)
Involved in carbohydrate, fat and protein metabolism and stores glycogen
Involved in filtration of the blood by removing bacteria and other foreign particles (Detoxification)
The right anatomical lobes includes the ____ lobe and ____ lobe
Quadrate lobe and Caudate lobe
What are some organs the visceral surface is related to?
Stomach
Duodenum
Gallbladder
Lesser omentum
Right colic flexure and transverse colon (Colic area)
Right kidney and adrenal gland (renal area)
Quadrate lobe and caudate lobe belongs to which function lobe of the liver?
Left functional lobe
The liver receives blood from:
____ artery (20% to 25%)-A branch of celiac trunk, that carries ____ oxygenated blood from the aorta.
____ vein (75% to 80%) that carries ____ oxygenated but ____ rich blood from the GI tract.
The liver receives blood from:
Hepatic artery (20% to 25%)-A branch of celiac trunk, that carries well oxygenated blood from the aorta.
Portal vein (75% to 80%) that carries poorly oxygenated but** nutrient** rich blood from the GI tract.
____ of the ____ and ____ divide the liver into 2 functional lobes, right and left.
Fossae of the** gallbladder** and Inferior Vena Cava divide the liver into 2 functional lobes, right and left.
What forms the portal vein?
The union of superior mesenteric vein and splenic vein
The portal-systemic anastomoses (PSA) are where veins draining into the ____ vein and the ____ communicate.
The portal-systemic anastomoses are where veins draining into the portal vein and the IVC communicate.
Portal vein may become dilated if ____ blood flow through the liver is ____ in ____ disease
Portal vein may become dilated if portal blood flow through the liver is** obstructed** in liver disease
Where are some important sites of the portal-systemic anastomoses?
A: Lower Oesophagus
B: Rectum
C: Umbilicus
D: Posterior abdominal wall
Haemorrhage is often seen in which 2 PSA?
Lower Esophagus
Rectum
Liver or portal obstruction causes these veins to dilate widely, possibly leading to severe venous haemorrhage from esophagus or rectum
____ liver cirrhosis caused by destruction of ____ leads to ____. Cirrhosis may be treated by ____ the ____ and ____ systems.
Alcoholic liver cirrhosis caused by destruction of hepatocytes leads to portal hypertension. Cirrhosis may be treated by anastomosing the portal and systemic venous systems.
Briefly describe the PSA relations at the lower esophagus
Portal systemic anastomoses
Systemic: Esophageal vein
Portal: Left gastric vein
Briefly describe the PSA relations at the rectum
Systemic: Inferior rectal vein
Portal: Superior rectal vein
Briefly describe the PSA relations at the umbilicus
Systemic: Epigastric vein
Portal: Paraumbilical vein
Briefly describe the PSA relations at the posterior abdominal wall
Systemic: Retroperitoneal vein
Portal: Visceral vein
Where does the gall bladder lie?
Its a pear-shaped sac lying on the visceral surface of the right lobe of the liver
Gallbladder:
Receives, ____ and stores ____
Has 3 parts: ____, body and ____
____ duct connects the ____ to the ____
Supplied by the ____ artery, a branch of the ____ hepatic artery
Innervated by the sympathetic (from ____ plexus), parasympathetic (vagus) and ____ phrenic nerves (sensory)
Gallbladder:
Receives, concentrates and stores bile
Has 3 parts: fundus, body and neck
Cystic duct connects the** neck **to the common bile duct
Supplied by the cystic artery, a branch of the **right ** hepatic artery
Innervated by the sympathetic (from **celiac **plexus), parasympathetic (vagus) and right phrenic nerves (sensory)
Where is bile produced / secreted?
In the liver by hepatocytes
Biliary system:
____ bile secreted by the hepatocytes in the liver to the ____
Right and left hepatic ducts unite to form the ____ which joins the ____ to form the ____
Bile duct lies in front of the ____, and on the right side of the ____ artery in the free margin of the _____
Transfers bile secreted by the hepatocytes in the liver to the duodenum
Right and left hepatic ducts unite to form the common hepatic duct which joins the **cystic duct **to form the bile duct
Bile duct lies in front of the portal vein, and on the right side of the hepatic artery in the free margin of the lesser omentum
Bile duct joins with main ____ duct and they open into the ampulla of ____ in the ____ wall
The ampulla of ____ opens into the ____ through major ____
Bile duct joins with main pancreatic duct and they open into the ampulla of vater in the duodenal wall
The ampulla of vater opens into the duodenum through major duodenal papilla
Ampulla surrounded by a circular muscles whch functions as sphincter of the bile duct
What arteries supplies the bile duct?
Proximal: Cystic artery
Middle part: Right hepatic artery
Duodenal: Posterior superior pancreatico duodenal and gastroduodenal arteries
When there is a gall bladder disease such as inflammation of the gallbladder with resulting swelling, the phrenic nerves get irritated. Where is the pain usually felt?
- Local pain in the right hypochondriac region
- A dull pain in the right shoulder and neck (referred pain)
Spleen:
____ covered with the ____ except its ____ which is in contact with the ____ of the pancreas
Related to the
- Stomach anteriorly
- 9 to 11 ribs and left part of the ____ posteriorly
- Left colic flexure ____
- ____ medially
-____ of pancreas
Connected to the
- ____ curvature of the stomach by the ____ ligament
- ____ kidney by the ____ ligament
**Completely **covered with the peritoneum except its hilium which is in contact with the tail of the pancreas
Related to the
- Stomach anteriorly
- 9 to 11 ribs and left part of the diaphragm posteriorly
- Left colic flexure inferiorly
- Left kidney medially
- Tail of pancreas
Connected to the
- Greater curvature of the stomach by the gastrosplenic ligament
- Left kidney by the Splenorenal ligament
Briefly describe the blood, venous flow and innervation of the spleen
Receives blood from the splenic artery
Drained by the splenic vein
Innervated by the nerves from the celiac plexus
What organ may rupture leading to severe intraperitoneal haemorrhage if there is a fracture of the 9 to 11th ribs or a sudden increase in intra-abdominal pressure?
Spleen
