Lecture 3 - Abdominal Viscera and Collateral Circulation Flashcards
Gastrocolic ligament
Connects the stomach to the transverse colon. Great window into the lesser sac if you incise here.
Know all branches of celiac trunk, sup. mesenteric, and inf. mesenteric.
On sheet
Marginal Artery of Drummond
- vasa recta
Each of the colics as well as the sigmoid arteries divides into a proximal and distal portion. They then anastomose at what is called marginal arteries. From there, they give off small end arteries called vasa recta.
Branches of IVC
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- Inf Phrenic, Hepatic, Renal, Gonadal, Lumbar, Common Iliac
Branches of Portal Vein
- Left gastric
- Splenic - inf. mesenteric comes off of it.
- Sup. mesenteric - superior rectal comes off of it.
Supracolic vs. infracolic
Depends on whether you are above or below the transverse colon. They are two compartments of the greater sac. Based on the pictures in the lecture, I believe that the greater sac is both above the greater omentum as well as beneath the greater omentum below the lesser sac
Portacaval anastemosis
1) Between superior rectal (portal) and middle and inferior rectal (caval). Internal hemorrhoids.
2) Between esophageal branch of left gastric (portal) and esophageal (caval). Esophageal varices.
3) Between Paraumbilcal (portal) and epigastric (caval). Caput Madussae.
Procedures used to avoid esophageal varices
1) portacaval shunt
2) splenorenal shunt
TIPS procedure
Connect portal and hepatic through the liver.
Lymphatic drainage
lymph nodes are preaortic and paraaortic. They drain into the Cysterna Chylae and then from there the thoracic duct.
3 openings in the diaphragm
1) Caval Hiatus - lets the IVC through
2) Esophageal Hiatus - lets the esophagus in
3) Aortic Hiatus - Lets the aorta in
2 types of hiatus hernias1
1) sliding - everything slides upwards. Fundus, abdominal esophagus, cardia. Will have symptoms of regurgitation.
2) Nonsliding - Only fundus slides up. No real symptoms
3 layers of smooth muscle in the stomach
Outer longitudinal
Middle circular
Inner oblique
Arterial supply to the stomach
R and L gastric
R and L gastro-omental
Short Gastric AA
Suspensory Ligament of Treitz
Supports the duodenojejunal junction.
What is the name of the flexure between the duodenum and jejunum?
Duodenojejunal flexure
Arterial supply to the duodenum
Gastroduodenal artery
superior pancreaticoduodinal
inferior pancreaticoduodenal
superior mesenteric
Pancreatic ducts
Major duct and minor duct
The common biliary duct also is in this area and at the point that it meets up with the major duct is called the hepatopancreatic ampula
Blood supply to pancreas
Superior pancreatiduodenal
Inferior pacreaticoduodenal
Splenic artery
Whipple procedure
used when you have to remove the head of the pancreas. You have to remove the ties between the duodenum ad the jejunum and stomach. Then you need to split the blood supply of the arteries going to the duodenum. Remove the head of the pancreas from the neck. Then reanastomose the bile duct. Reanastomose the stomach to the jejunum.
Portal Triad
Common Bile Duct
Proper Hepatic Artery
Portal Vein
Blood supply to liver and gall bladder
cystic artery, right and left hepatic artery.
Hepatocystic triangle
Cystic artery runs through here.
Boundaries are cystic duct, common hepatic duct, and the liver
Differences between jejunum and ileum
Jejunum is more vascuularized, larger vasa recta, less fat in mesentery, larger, deeper red