Goal 6 (a-b): Structure Of Stomach And Spleen Flashcards
In a Barium swallow test scan, what does dark spots in the stomach mean? Is that normal? What about a lot of dark spots in the intestinal area?
- “fundus gas shadow” and it is normal
- this is abnormal and could mean perforation
Describe the location of the LES.
- Left of midline
- at 7th left costal cartilage and T11
What is the function of LES? What does it prevent?
- sphincter is meant to relax to allow food in
- prevents GE reflux
What is Barrett’s esophagus?
- premalignant condition when esophagus tissue changed from so much acid abrasion
- esophagus supposed to be stratified squamous non keratinized
- changes to simple columnar in this disorder
What is Achalasia?
- LES fails to relax with swallowing
- no myenteric plexus (Auerbach plexus) so no motility
- dysphasia, weight loss, regurgitate
- see dilated esophagus above LES and distal stenosis at LES (bird beak on barium)
What is the function of the pyloric sphincter? Where is it located?
- prevent duodenal contents to go back, control food going out of stomach
- at L1 transpyloric plane
What is pyloric stenosis? Symptoms?
- abnormal thickening of pyloric sphincter muscles
- see projectile vomiting (NO BILE) and polyhydraminos
What is located posteriorly to the stomach?
Omental bursa
What are the structures of the bed of the stomach, from superior to inferior?
Dr. S3 Kidnapped Patients Mercilessly
- Diaphragm
- spleen, Supra renal gland, splenic artery
- left kidney
- pancreas
- transverse mesocolon
Any erosion through the stomach can damage an artery behind it that can cause massive hemorrhage. What artery is it?
Splenic artery
What area is called the “policemen of the abdomen?” Why is it special?
- GASTROCOLIC LIGAMENT
- lymphocytes and antibodies are embedded in it
- these cells move to infection area of the abdomen, fights it, and seals it to prevent further spread of infection
What are the Lesser Omentum ligaments?
- hepatoduodenal
- hepatogastric
What are the Greater Omentum ligaments?
- gastrophrenic
- gastrosplenic
- gastrocolic (largest part, like an apron)
What arteries are located along the Greater Omentum or curvature?
Right and left epiploic (gastro-omental) arteries
What arteries are located along the Lesser Omentum or curvature?
Right and left gastric arteries
Path of right and left gastric arteries from the abdominal aorta?
- AA—celiac trunk—common hepatic artery—right gastric
- AA—celiac trunk—left gastric
Path of right and left gastroepoploic arteries from the AA?
- AA—celiac trunk—common hepatic artery—gastroduodenal artery—right gastroepiploic artery
- AA—celiac trunk—splenic artery—left gastroepiploic artery
Path of short gastric arteries from abdominal aorta?
AA—celiac trunk—splenic artery—short gastric arteries
What are the main 2 veins that drain into the portal vein?
- Splenic vein
- superior mesenteric vein
What happens if any portal vein connections are blocked? What complication can this lead to? Disease of what organ can cause this?
- backflow of blood in veins (veins are valveless)
- Esophageal Strictures
- liver disease, late stage liver disease called cirrhosis specifically
What is the difference between parasympathetic and sympathetic in relation to the stomach? What areas do each innervate?
- sympathetic- T6-T9, decrease motility
- parasympathetic- anterior and posterior vagal trunks, increase motility
What is a common cause of Gastric Ulcers? What can cause this to happen? What cures it?
- Helicobacter Pylori (H. pylori)
- can spread from contaminated food, water, feces, utensils
- antibiotics
What are Gastric Ulcers? Where does it commonly happen and what artery can be hit here? What is the major complication of these ulcers?
- open lesions in mucosa of stomach-perforation
- often in lesser curvature above incisura angularis
- if in lesser curvature, left gastric artery broken
- BLEEDING
What are other symptoms of Gastric Ulcers?
- epigastric pain shortly after meals (stomach is a foregut organ so referred pain is epigastric, T6-T9, and poorly localized)
- hematemesis(bright red vomit, close to the mouth)
- dysphagia, recurrent vomiting, melena (dark red stools- since went through intestines and is now considered old blood)
What is a Vagotomy? Why is it done? What is a Truncal Vagotomy?
- surgical procedure that involves cutting a part of the vagus nerve to decrease stomach acid secretion
- done with gastric or peptic ulcers to decrease continuous damage yo the ulcer site
- truncal- commonly used for peptic ulcer, will lose vagal nerves to many organs like liver gallbladder and pancreas as well
What are Peptic Ulcers? Where are they commonly seen? What are complications of it?
- lesions of mucosa from pyloric canal and/or duodenum
- see often in posterior wall or superior part of duodenum
- complications: perforation, peritonitis, erosion of GASTRODUODENAL ARTERY (behind superior duodenum)
What is Hiatal Hernia? What the two types and their differences? What age group most commonly has these?
- part of stomach protrudes out through diaphragm and into mediastinum
- Sliding hernia- most common- part of esophagus, cardia and parts of fundus slide up through esophageal hiatus into thorax when LYING DOWN- REGURGITATION
- paraesophageal hernia- fundus extends up through esophageal hiatus, but CARDIA IN NORMAL POSTION- NO REGURGITATION
Path of lymph node drainage in relation to the stomach? (Re: lymph nodes named similarly by their location)
Gastric and gastro-omental lymph nodes—> pyloric, pancreaticosplenic, pancreaticoduodenal lymph nodes—> all end up at the CELIAC LYMPH NODES
Functions of the Spleen?
- filtration of unwanted substances from blood by phagocytosis
- make blood and make lymphocytes
Location, Axis, and Shape of Spleen? What are other features?
- location: left hyphochondrium and party epigastrium
- axis: along 10th Rib
- shape: tetrahedral, wedge
- highly vascular, purple, moves when breath, not a vital organ
Gross features of Spleen? (Re: 2, 2, 3, 2)
- 2 ends: medial, lateral
- 2 surfaces: diaphragmatic, visceral
- 3 borders: superior, intermediate, inferior
- 2 angles: anterior basal, posterior basal
Difference between the two spleen surfaces?
- diaphragmatic: smooth, touch diaphragm
- visceral: other organs press on it
Damage to the 9th, 10th, or 11th rib can damage what organ?
Rupture the spleen
What do you need to be careful of when doing a splenectomy? Why?
- PANCREAS (it’s stuck right on the hilum of the spleen)
- if cut off the tail of pancreas, will lose Islet of Langerhan cells there that help control blood sugar levels. If lose these cells, can lead to Surgery Induced Diabetes Mellitus
What are the 4 impressions of the spleen?
- gastric
- renal
- colic
- pancreatic
What are the 4 main ligaments related to the spleen?
- gastro-splenic lig: short gastric and left gastroepiploic vessels
- spleno-renal lig: have splenic vessels and tail of pancreas
- phrenico colic lig
- splenophrenic lig (pancreas tail here)
What are the different supplies of the spleen? Artery, vein, lymphatic, and never supply.
- splenic artery
- splenic vein
- pancreatico-splenic
- sympathetic plexus via celiac plexus
What is Splenomegaly?
- Large spleen
- can palpate under left costal arch
- prone to rupture
After the Spleen is removed, what organs take over it’s functions? What are they more prone to now after it’s removed?
- liver and bone marrow
- infections
What’s Kehr’s sign? What does it indicate?
-pain in left shoulder from referred pain from the spleen; why? diaphragm’s nerve supply is the phrenic nerve (C2-C5) and it supplies the shoulder too
What vessel supplies the esophagus, stomach, liver, and 1st and 2nd part of duodenum? What vertebrae level is this at? What are its branches?
- celiac trunk
- T12
- Left Hand Side (LHS): Left gastric, common Hepatic, Splenic
What vessels are in the Splenorenal ligament? And part of what organ?
- Splenic artery and vein
- tail of pancreas
What vessels are in the gastrosplenic ligament?
- short gastric arteries
- left gastroepiploic vessels
