Liver, Spleen, Pancreas, Kidneys, Adrenals, and Post. Abdominal Wall

Question 1

What is the blood supply, venous drainage of the liver, spleen, and the pancreas?

Answer 1

Blood Supply:

• Liver: left hepatic a, right hepatic a (celiac trunk)
• Pancreas: superior pancreaticoduodenal a (celiac trunk) and inferior pancreaticoduodenal a (SMA), pancreatic branch of the splenic a (celiac a)
• Spleen: splenic a (celiac trunk)

Venous Drainage:

• Liver: L/R hepatic vein
• spleen: splenic vein
• pancreas: superior mesenteric vein, splenic vein, and the hepatic portal vein

Question 2

What are the parts of the pancreas and their blood supply?

Answer 2

Superior Head: superior pancreaticoduodenal a (gastroduodenal a)

Inferior Head: inferior pancreaticoduodenal a (SMA)

Body and Tail: Pancreatic branches of the splenic artery

Question 3

Discuss the function of the ampulla of Vader?

Answer 3

Ampulla of Vader is how the bile (used in food digestion) enters the duodenum

Location: at the junction of the pancreas, common bile duct, and the duodenum

Question 4

Function and components of the hepatic portal system?

Answer 4

The hepatic portal system is the drainage of blood to the liver from the GI tract for metabolization avant d’aller au IVC

Question 5

Veins that form the hepatic portal vein and the veins that form the hepatic portal system.

Answer 5

The hepatic portal vein:
-Splenic vein + Superior mesenteric vein = hepatic portal vein

Hepatic Portal System: 
-Splenic Vein and its tributaries 
-Inferior mesenteric vein and its tributaries 
-Superior mesenteric veins and its tributaries 
-liver
IVC 
-hepatic portal vein 
-right and left hepatic vein

Question 6

What are the components of the porta hepatis?

Answer 6

Porta hepatis is the hilium of the liver

IN:

1. hepatic portal vein
2. proper hepatic artery

OUT:
3. common hepatic duct (not the common bile duct, and you know why)

Question 7

Describe the lobes/ligaments of the liver?

Answer 7

Anterior:

1. Right Lobe
2. Left Lobe

Inferior:

3. Caudate Lobe (IVC)
4. Quadrate Lobe (Gall Bladder)

Ligaments:

1. Coronary Ligaments
2. R/L triangular ligaments
3. Falciform Ligament
4. Round Ligament

Question 8

What is the difference between the falciform ligament and the round ligament?

Answer 8

Falciform ligament is in between the right and left lobe while the round ligament is what the falciform ligament turns into after is passes through the right and left lobe

Question 9

Explain the biliary duct system

Answer 9

left and right hepatic duct –> common hepatic duct
common hepatic duct + cystic duct –> common bile duct
common bile duct + pancreatic duct –>Ampulla of Vader –> duodenum

Question 10

Describe and identify the following structures: cortex, medulla, papilla, minor/major calyx, renal pelvis, ureter

Answer 10

Look at an image and you should know the general flow of things

Question 11

Flow of urine in the kidney vs. the flow of blood in the kidney

Answer 11

1. Urine flows out, while blood flows in.

Flow of urine: medullary pyramid–> papilla–> minor calyx –> major calyx –> renal pelvis –> ureter –> bladder

Flow of Blood:
Renal artery (off of the aorta
Renal vein
-left goes under the SMA

Question 12

Differentiate between the cortex/medulla of the adrenal gland, and the hormones produced in each.

Answer 12

Cortex: outer layer of the adrenal gland, and is divided into three layers (GFR):

1. Zona Glomerulosa: minerocorticoids (aldosterone)
2. Zona Fasciculata: corticoids (cortisol)
3. Zona Reticularis: androgens (testoterone)

Medulla: only has one layer
1. Catecholamines (NE or Epi)

Question 13

Describe what a tumor in each of the layers of the adrenal gland would present as:

Answer 13

Zona Glomerulosa: increased BP
Zona Fasiculata: Increased stress response
Zona Reticularis: Increase in male presenting symptoms
Catecholamines: Increase in sympathetic tone

Question 14

Describe the openings of the diaphragm and what passes through each.

Answer 14

I 8 10 Eggs AT 12

I: Caval Opening

• IVC
• Level of T8

Esophageal Opening:

• Esophagus AND Vagus N.
• Level of T10
• right by the esophogeal hiatus

Aortic Opening:

• aorta and thoracic duct
• level of T12

Question 15

Major branches of the abdominal aorta (I suggest drawing this)

Answer 15

inferior phrenic –> celiac trunk –> middle adrenal –> SMA –> renal a. –> gonadal a –L> IMA –> common iliac/middle sacral

and then you have the lumbar arteries that are distributed kind of throughout the aorta

Question 16

Major tributaries of the IVC (be sure to distinguish between right and left)

Answer 16

IVC is located more on the right so, which causes the left side to be a lot more different

Right:

• right adrenal vein
• renal vein
• right gonadal
• lumbar veins

Left:

• left renal vein
• left external illiac

Question 17

Describe the muscles of the posterior abdominal wall

Answer 17

1. Quadratus Lumburus
   - iliac crest –> 12th rib
   - function:
   
   • unilateral: lateral flexion of the vertebral column
   • bilateral: rib depression
2. Psoas Major
   - T12–> lesser trochanter of the femur
   - flexes the hip
3. Illiacus
   - iliac fossa –> lesser trochanter of the femur
   - flexes the hip
4. Psoas Minor
   - superficial to psoas major

Question 18

What is the major hip flexor?

Answer 18

iliopsoas = iliacus + psoas major

Question 19

What are the nerves of the posterior abdominal wall? in order!

Answer 19

1. subcostal nerve
2. iliohypogastic
3. ilioinguinal n
4. Lateral cutaneous nerve of the thigh
5. femoral nerve
6. genitofemoral nerve (and its genitobranch and femoral branch)
7. obturator nerve

Question 20

reference structures for the nerves?

Answer 20

iliohypogastric: across QL and transverse abdominis
ilioinguinal: more inferior and travels along the iliac crest
lat. cutaneous of thigh n.: travels lat to the femoral nerve
Femoral nerve: huge
genitofemoral n: pierces psoas major
Obturator n: travels medially to the psoas major m.