Lecture 12 DA

Question 1

What can be found at the iliocaecal junction?

Answer 1

The iliocaecal opening is found. Inferiorly is the caecuma and appendix. Above is the ascending colon.

Question 2

What are the names of the 6 regions of the colon?

Answer 2

It begins with the ascending colon. Inferior to it is the caecum and appendix. The ascending colon becomes the transverse colon at the hepatic flexure. The transverse colon becomes the descending colon at the splenic flexure. Descending colon becomes the sigmoidal colon as it enters the pelvis. It becomes the rectum past the rectosigmoidal junction.

Question 3

What direction are the muscles of the colon? What are the outer muscles called?

Answer 3

The inner muscles are circular, while the outermost are longitudinal. The outermost form 3 distinct bands called tenia coli.

Question 4

What are haustra, and how are they formed?

Answer 4

They are pouch-like structures on the colon, caused by the tenia coli.

Question 5

What are the fat pads hanging off the haustra called?

Answer 5

Epiploic appendices.

Question 6

What direction does the verbiform appendix have? What is its histology?

Answer 6

The appendix is found at the merge of the three tenia coli bands. The appendix extends downwards into the pelvis, called pelvic appendix. In some people, it may extend upward instead, called retrocaecal appendix. It has mostly lymph nodes.

Question 7

What happens to the colon at the hepatic flexure?

Answer 7

It goes from ascending to transverse colon.

Question 8

What happens at the splenic flexure?

Answer 8

It goes from transverse to descending colon.

Question 9

What is the caecum?

Answer 9

Blind ending pouch, below the iliocaecal junction.

Question 10

What happen to tenia coli at the rectosigmoidal junction?

Answer 10

They fan out to become a continuous muscle.

Question 11

Where is the liver found?

Answer 11

It fills the upper right quadrant, above the right costal margin.

Question 12

What are the surfaces of the liver?

Answer 12

It has a smooth diaphragmatic surface, and an impressioned visceral surface.

Question 13

What is the falciform ligament?

Answer 13

It connects the left and right liver. The right lobe is bigger.

Question 14

Which lobe of the liver is bigger?

Answer 14

Right.

Question 15

What does the falciform ligament attach the liver to?

Answer 15

To the anterior abdominal wall.

Question 16

What is found at the base of the falciform ligament?

Answer 16

The ligamentum teres hepatis, which once had a vascular bundle for foetal (gosh darnit jimmeh), originating from the umbilicus.

Question 17

Describe the lobes found on the visceral surface of the liver.

Answer 17

Rather than being split up-down for 2 lobes, itthe visceral surface is split by a H, for 4 lobes. There is still a left and right, but the upper quadrant within the H is known as the caudate lobe, while the lower quadrant is known as quadrate lobe.

Question 18

Categorise the liver by lobes, in terms of functionality.

Answer 18

Functional left liver = caudate + quadrate + left lobe.

Functional right liver = right lobe + gall bladder.

Question 19

Where is the gall bladder found relative to the liver?

Answer 19

It is found on the liver’s quadrate lobe. Its duct is found on the right.

Question 20

Where does the liver drain?

Answer 20

Direct to the IVC.

Question 21

Describe the vessels of the liver.

Answer 21

On the left, the proper hepatic artery is found, splits into the left and right hepatic artery.
It is followed by the common hepatic duct.
Behind both of these is the portal vein, which supplies blood from the gastrointestinal circulation to the liver (ie. products of digestion). It does NOT drain the liver.

Question 22

What is the porta hepatis?

Answer 22

Hilum of the liver.

Question 23

What is found at the porta hepatis?

Answer 23

The proper hepatic artery, it hasn’t branched yet, but does so when it enters the liver. It is found on the left.
Followed by common cystic duct,
Behind both, the portal vein.

Question 24

Where is the IVC relative to the liver?

Answer 24

It is embedded within the liver superiorly, between the caudate and left lobes. The hepatic vein drains direct to the IVC.

Question 25

What connects the lesser curvature of the stomach to the liver?

Answer 25

The lesser omentum.

Question 26

What connects the greater curvature of the stomach to the transverse colon?

Answer 26

The greater omentum.

Question 27

How does the cystic duct reach the duodenum?

Answer 27

The duodenum leaves the mesentery, and as it does, a space is found. The cystic duct travels down this space, and the portal vein travels up. A double folded mesentery connects it to the liver.

Question 28

Describe the regions of the gall bladder.

Answer 28

Fundus - inferiorly

Neck - Superiorly, becomes the spiral cystic duct

Question 29

Describe the cystic duct system.

Answer 29

The left and right hepatic duct merge to become the common hepatic duct. The spiral and common hepatic duct merge to form the common cystic duct.
The common cystic duct tucks behind the first part of the duodenum and enters the second part. This occurs at a C-shaped junction. Pancreatic duct enters here too.

Question 30

What is the major duodenal papilla?

Answer 30

It is where the common cystic and pancreatic duct enter the duodenum. It has a complex sphincter, which releases after a fatty meal. Otherwise, it remains closed, and fluid backtracks and concentrates in the gall pladder.

Question 31

Is the gall bladder completely enclosed by the liver?

Answer 31

No, the fundus dips below the liver slightly, at the right lobe.

Question 32

Describe the regions of the pancreas from medial to lateral.

Answer 32

Medial
Head
Neck
Body
Tail
Lateral

Question 33

Where is the head of the pancreas found?

Answer 33

The head is found at the C-shaped junction of the duodenum, which curves around the head.

Question 34

What is the unsinate process? Why is it important?

Answer 34

It is a projection off the head of the pancreas, and is a landmark for the sueprior mesentery artery.

Question 35

Where is the neck and body of the pancreas found? What do they overlie?

Answer 35

They both overlie the inferior stomach. The neck also overlies the superior mesentery vessels.
The body is found superior to the duodeno-jejunal flexure.

Question 36

Where is the tail of the pancreas found?

Answer 36

It is found directly medial to the hilum of the spleen.

Question 37

What shape is the spleen? What happens to it with age?

Answer 37

It is fist sized and oval shaped. It atrophies with age.

Question 38

The spleen has a smooth and visceral surface. Describe the visceral surface.

Answer 38

Inferiorly, it has a colic surface, found by the colic flexure.
The superior margin is notched, on the lateral side (due to ribs).

Question 39

Where is the hilum of the spleen found?

Answer 39

It is superior to he colic surface.

Question 40

The spleen is extremely vascular. What is the clinical significance of this?

Answer 40

It is directly related to ribs 9, 10 and 11, with the 12th inferiorly. Breaking any of these ribs poses the risk of puncturing the spleen and suffering from severe internal haemorrhage (muh freedom).