GIT-Peritoneum, Stomach, Liver, Biliary Tract & Spleen

Question 1

What is another term to describe a single continuous membrane of simple squamous epithelium?

Answer 1

Mesothelium

Question 2

What does the parietal peritoneum lines?

Answer 2

Abdominopelvic cavity

Question 3

What does the visceral peritoneum lines?

Answer 3

Covering the organs (e.g. Bowel)

Question 4

What usually stimulates the visceral peritoneum?

Answer 4

Stretching and chemical irritation

Question 5

Where are pain from foregut, midgut andf hindgut derivatives usually experienced respectiviely?

Answer 5

Foregut: Epigastric region
Midgut: Umbilical region
Hindgut: Hypogastric / pubic region

Question 6

The peritoneal cavity is a ________ within the layer of the peritoneum

Answer 6

potential space

Question 7

In females, there is ____ between vagina > uterine cavity > uterine tubes: potential pathway for _____

Answer 7

In females, there is external communication between vagina > uterine cavity > uterine tubes: potential pathway for infection

Question 8

Omentum is a ____ extension or fold of ____

Answer 8

Omentum is a double layered extension or fold of peritoneum

Question 9

Where does the lesser omentum extend from?

Answer 9

Liver to the lesser curvature of the stomach

A double layered peritoneal fold

Question 10

Where does the greater omentum extend from?

Answer 10

Greater curvature of the stomach and the transverse colon

• wraps around inflammed organ in the abdomen and protects other organs from it

Question 11

What is a ligament?

Answer 11

A fold connecting one organ with another or one organ with any area of the body wall.

Question 12

Mesentry is a ____ connecting an organ to the ____ it’s also a conduit for ____, nerves and ____ supplying viscera

Answer 12

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

Question 13

Peritoneum is a ____, ____ serous. membrane - lines the abdominal cavity & invests the viscera

Answer 13

Continuous, transparent

Question 14

What runs within the lesser omentum near its free edge?

Answer 14

Portal vein
Bile duct
Hepatic artery

PBH, same as anterior boundaries of the omental foramen (Portal Triad)

Question 15

Intraperitoneal: Structures are suspended from the abdomina wall by ____

eg. most of small intestines

Answer 15

Mesenteries

Question 16

Retroperitoneal: Structures e.g. kidneys and great vessels that lie between ____ peritoneum and ____

Answer 16

Retroperitoneal: Structures e.g. kidneys and great vessels that lie between parietal peritoneum and** abdominal wall**

Question 17

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.

Answer 17

Duodenem (except the first part)
Pancrease (except the tail part)
Colon (except cecum, transverse colon and sigmoid colon)

Question 18

Omental foramen (Epiploic foramen) is the passage between the ____ and the ____ allowing communication between these two spaces

Answer 18

greater sac and lower sac

Question 19

What are the boundaries of the omental foramen?

Answer 19

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

Question 20

What is another name for the lower sac?

Answer 20

Omental bursa

Question 21

When does the esophagus pierce through the diaphragm?

Answer 21

T10

Oesophagus: 10 letters

Question 22

The stomach lies between the ____ and the ____ in the epigastric, umbilical and ____ regions of the abdomen

Answer 22

The stomach lies between the esophagus and the small intestine in the epigastric, umbilical and left hypochondriac regions of the abdomen

Question 23

What are the four main regions of the stomach?

Answer 23

Cardia > Fundus > Body > Pylorus

Question 24

What are the two orifice of the stomach?

Answer 24

Cardiac orifice (Gsatroesophageal junction)
Pyloric orifice

Question 25

____ receives food from teh oesophagus and is mainly involved in ____ digestion

Answer 25

**Stomach** receives food from the oesophagus and is mainly involved in **enzymatic** digestion

Question 26

Briefly describe the realation of the stomach (Anterior, Posterior and Superior)

Answer 26

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

Question 27

The interior of the stomach is lined by gastric mucosa which is thrown into mucosal folds ( ________ ) when contracted

Answer 27

Rugae

Question 28

What does the foregut include and what is the arterial supply?

Answer 28

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

Question 29

What does the midgut include and what is the arterial supply?

Answer 29

2nd part of the duodenum to two-thirds along transverse colon Arterial supply: Superior mesentric artery

Question 30

What does the hindgut include and what is the arterial supply?

Answer 30

Distal third of transverse colon to the rectum Arterial supply: Inferior mesentric artery

Question 31

What are the 3 unpaird visceral arteries and their corresponding veryebral level?

Answer 31

Celiac (T12) Superior Mesentric (L1) Inferior Mesentric (L3)

Question 32

What are the 3 paired visceral arteries?

Answer 32

Suprarenal (L1) Renal (L1) Gonadal (L2)

Question 33

what are the 3 paired parietal arteries?

Answer 33

SUbcoastal artery (L2) Inferior phrenic (T12) Lumbar artery (L1-L4)

Question 34

Celiac trunk can be further divided into what arteries? ## Footnote Supplies foregut

Answer 34

Common hepatic artery Splenic artery Gastric arteries * Left and Right gastric arteries * Left and Right gastro-omental arteries * Short gastric arteries

Question 35

____ run parallel to the gastric arteries in position and course. ____ are tributaries of ____ vein.

Answer 35

**Gastric veins** run parallel to the gastric arteries in position and course. **Right and left gastric veins** are tributaries of **portal** vein.

Question 36

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 _____

Answer 36

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**

Question 37

The stomach receives sympathetic nerve fibres from ____ to ____ spinal segments It stimulates ____ sphincter

Answer 37

The stomach receives sympathetic nerve fibres from **T5 to T9** spinal segments It stimulates **pyloric sphincter**

Question 38

The stomach receives parasympathetic nerve fibres from the ____ and ____ nerves It stimultes ____ movement of the stomach and secretion of ____

Answer 38

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)

Question 39

____ 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

Answer 39

**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

Question 40

Alcohol often leads to liver _____

Answer 40

Liver cirrhosis

Question 41

What is the largest visceral organ in the body?

Answer 41

Liver

Question 42

The liver lies primarily in the right ____ and ____ region

Answer 42

Right hypochondrium and epigastric region

Question 43

What are the 2 surfaces of the liver and its relation?

Answer 43

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

Question 44

# Liver is attached to the anterior abdominal wall: What divides the liver into right and left lobes?

Answer 44

Falciform ligament ## Footnote Liver attached to the anterior abdominal wall by the falciform ligament

Question 45

# Liver is attached to the stomach: What attaches the liver and the stomach?

Answer 45

Hepatogastric ligament

Question 46

# Liver is attached to the diaphragm: What attaches the diaphragm and liver?

Answer 46

Coronary ligaments

Question 47

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)

Answer 47

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)

Question 48

The right anatomical lobes includes the ____ lobe and ____ lobe

Answer 48

Quadrate lobe and Caudate lobe

Question 49

What are some organs the visceral surface is related to?

Answer 49

Stomach Duodenum Gallbladder Lesser omentum Right colic flexure and transverse colon (Colic area) Right kidney and adrenal gland (renal area)

Question 50

Quadrate lobe and caudate lobe belongs to which function lobe of the liver?

Answer 50

Left functional lobe

Question 51

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.

Answer 51

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.

Question 51

____ of the ____ and ____ divide the liver into 2 functional lobes, right and left.

Answer 51

**Fossae** of the** gallbladder** and **Inferior Vena Cava** divide the liver into 2 functional lobes, right and left.

Question 52

What forms the portal vein?

Answer 52

The union of superior mesenteric vein and splenic vein

Question 53

The portal-systemic anastomoses (PSA) are where veins draining into the ____ vein and the ____ communicate.

Answer 53

The portal-systemic anastomoses are where veins draining into the **portal vein** and the **IVC** communicate.

Question 54

Portal vein may become dilated if ____ blood flow through the liver is ____ in ____ disease

Answer 54

Portal vein may become dilated if **portal** blood flow through the liver is** obstructed** in **liver** disease

Question 55

Where are some important sites of the portal-systemic anastomoses?

Answer 55

A: Lower Oesophagus B: Rectum C: Umbilicus D: Posterior abdominal wall

Question 56

Haemorrhage is often seen in which 2 PSA?

Answer 56

Lower Esophagus Rectum ## Footnote Liver or portal obstruction causes these veins to dilate widely, possibly leading to severe venous haemorrhage from esophagus or rectum

Question 57

____ liver cirrhosis caused by destruction of ____ leads to ____. Cirrhosis may be treated by ____ the ____ and ____ systems.

Answer 57

**Alcoholic** liver cirrhosis caused by destruction of **hepatocytes** leads to **portal hypertension**. Cirrhosis may be treated by **anastomosing** the **portal** and **systemic venous systems.**

Question 58

Briefly describe the PSA relations at the lower esophagus ## Footnote Portal systemic anastomoses

Answer 58

Systemic: Esophageal vein Portal: Left gastric vein

Question 59

Briefly describe the PSA relations at the rectum

Answer 59

Systemic: Inferior rectal vein Portal: Superior rectal vein

Question 60

Briefly describe the PSA relations at the umbilicus

Answer 60

Systemic: Epigastric vein Portal: Paraumbilical vein

Question 61

Briefly describe the PSA relations at the posterior abdominal wall

Answer 61

Systemic: Retroperitoneal vein Portal: Visceral vein

Question 62

Where does the gall bladder lie?

Answer 62

Its a pear-shaped sac lying on the visceral surface of the right lobe of the liver

Question 63

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)

Answer 63

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)

Question 64

Where is bile produced / secreted?

Answer 64

In the liver by hepatocytes

Question 65

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 _____

Answer 65

**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**

Question 66

Bile duct joins with main ____ duct and they open into the ampulla of ____ in the ____ wall The ampulla of ____ opens into the ____ through major ____

Answer 66

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** ## Footnote Ampulla surrounded by a circular muscles whch functions as sphincter of the bile duct

Question 67

What arteries supplies the bile duct?

Answer 67

Proximal: Cystic artery Middle part: Right hepatic artery Duodenal: Posterior superior pancreatico duodenal and gastroduodenal arteries

Question 68

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?

Answer 68

- Local pain in the right hypochondriac region - A dull pain in the right shoulder and neck (referred pain)

Question 69

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

Answer 69

**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** Splenorena**l ligament

Question 70

Briefly describe the blood, venous flow and innervation of the spleen

Answer 70

Receives blood from the splenic artery Drained by the splenic vein Innervated by the nerves from the celiac plexus

Question 71

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?

Answer 71

Spleen