Lecture 12 RH Flashcards
Where does the ileum end? What does it contain?
ileum ends at iliocecal junction which contains the iliocecal valve covering a smooth muscle sphincter.
What structure does the large intestine form below the iliocaecal junction?
the caecum
What are the parts of the large intestine?
Cecum
Ascending colon
Transverse colon
Descending colong
S-shaped sigmoid colon
Rectum
How many layers of muscle does the large intestine contain?
2 muscular layers:
Inner circular
Outer longitudinal (continuous throughout the jejunum, ileum, and large intestine)
How long is the large intestine?
1.5 meters
What are the tenia coli?
3 discrete longitudinal muscle bands in the large intestine. They are visible from the outside.
Why does the large intestine have a segmented appearance?
longitudinal muscle stripes are shorter than the mucosal tube inside them and that causes formation of haustrations of the mucosa.
What are epiploic appendages?
fat tags on the large intestine
What is the length of the cecum?
Cecum is variable in length between 3 and 4 inches long.
What is important about the appendix histologically?
appendix contains lots of lymphoid nodules histologically.
Where is the appendix located?
Everyone has an appendix at exactly the position where the tenea coli meet at the bottom of the cecum.
What are the variations in the tip of the appendix?
Tip of the appendix:
hanging down into pelvis (known as a pelvic appendix) 25%
Appendix tucked onto the side of the large ascending colon. (Known as a retrocaecal appendix) 65% of cases
What are the kinds of flexures that are present in the large intestine?
Right colic flexure or Hepatic flexure. (transition from ascending to transverse colon)
Left colic flexure or splenic flexure (transion from transverse colon to descending colon
Where is the viscus located?
Right upper quadrant.
How many surfaces does the liver have and what is their name/location?
Liver has 2 surfaces:
A smooth diaphragmatic surface
Visceral surface
Why is the visceral surface not so smooth?
visceral surface bares (it’s bears you idiot) impressions from adjacent viscera
What is the demarkation of the anterior and posterior surface of the liver? (where is the boundary between them?)
The inferior margin of the liver. It is tucked in to the right upper quadrant.
What is the job of the falciform ligament?
The falciform ligament connects the anterior part of the liver to the anterior abdominal wall.
What is the ligamentum teres of the liver?
Round ligamentum teres is a remnant of the umbilical vein from times of development.
What lobes is the liver divided into ateriorly?
Large right lobe
Small left lobe
What lobes is the liver divided into posteriorly?
caudate lobe superiorly
quadrate lobe inferiorly
What delineates the left and right lobes of the liver functionally?
Hepatic veins
gallbladder
What is the functional left lobe of the liver?
caudate lobe
quadrate lobe
left lobe
Where is IVC located relative to the liver?
IVC is embedded into the visceral surface of the liver.
What is the ligamentum teres and where does it attach? What is it called in the liver?
ligamentum teres is a cord that is remnant of the vein during development. For this reason it continues through the liver and then connects to IVC. When it reaches the liver’s porta hepatis it is called the ligamentum venosum
What is the hilum of the liver called?
porta hepatis
What structures can be found in the hilum of the liver?
nerves
arteries (proper hepatic artery divides into right and left hepatic arteries 1 for each functional half of the liver) On the left of the hilum
veins (portal vein also splits in half) behind the artery to the left and the duct to the right.
lymphatics
hepatic ducts (right and left from functional halves) on the right of the hilum
Where do the veins of the liver go?
venous drainage of the liver comes from the IVC. The portal veins penetrate IVC.
What structure does the helpatic duct go through to reach the duodenum?
lesser omentum ends at the duodenum. At that location the structures entering and exiting the porta hepatis is embedded in the free edge of the lesser omentum. This free edge connects the hilum to the duodenum.
Where does the gall bladder sit on the liver?
Gall bladder sits in a groove on the undersurface of the liver.
What are the parts of the gall bladder (including the ducts)?
fundus (blind end)
body
Neck
These structures are continuous and form the cystic duct and then the common hepatic duct and finally the common bile duct.
What part of the duodenum does the common bile duct connect to? How does it get there?
It gets there by running behind the first part of the duodenum and then through the space between the pancreas and the duodenum and it inserts into the second part of the major duodenal papilla along with the pancreas.
How does bile release get regulated before and after a meal?
sphincter of the hepatopancreatic ampulla is closed most of the time. It opens in response to fatty food.
How does bile get stored in the gall bladder?
The closed sphincter (hepatopancreatic ampulla) causes build up of bile which falls into the gall bladder and gets stored and concentrated.
How can gallstones be diagnosed?
fundus of gall bladder tips below the inferior margin of the liver. Gallstones can be palpated between right costal margin and right border of rectus abdominus after breathing in.
Where is the pancreas located relative to other viscera of the abdominal wall?
head is within C-shaped duodenum.
uncinate process is wedge shaped from the head and connects to superior mesenteric vessels.
Neck overlies superior mesenteric vessels. Pyloris of stomach is superior to it.
duodenal jejunal flexure corresponds to the body of the pancreas.
Tail of the pancreas is right next to the hilum of the spleen.
Is the pancreas intra or retro peritoneal?
retroperitoneal
What is the function of the main pancreatic duct?
main pancreatic duct runs through the pancreas and opens into the duodenum. It joins the common bile duct at the major duodenal papilla. It collects the secretions of the pancreas and directs them to the duodenum.
How is the secretion of pancreatic “stuff” regulated?
terminal portion of common bile duct and pancreatic duct has a common complex sphincter.
What is the function of the minor duodenal papilla?
accessory pancreatic duct is usually present and drains the lower part of the pancreas into the minor duodenal papilla.
How big is the spleen?
Spleen is approximately fist sized but this decreases with age.
What are the surfaces that the spleen has?
Visceral surface
Diaphragmatic surface
What surface separates the diaphragmatic and the visceral surface of the spleen?
Visceral and diaphragmatic surface are separated by the notched margin.
What structures does the splenic hilum contain?
Splenic artery which follows the body and tail of the pancreas towards the spleen.
Splenic vein
*spleen is very vascular
Where is the spleen located relative to other structures?
spleen lies below the diaphragm in left upper quadrant.
right above the left colic flexure.
Directly under ribs 9, 10, 11.
What is the clinical significance of the spleen’s location?
fracture of 9, 10, and 11 can cause a tear in the spleen followed by a hemorrhage .
