Mesenteries And Abdominal Foregut Flashcards
What is the parietal peritoneum?
Lines the inner surface of the abdominal wall
What is the visceral peritoneum?
Covers many of the abdominal organs
True or false: the parietal and visceral peritoneum are continuous with one another
True
What are the functions of the peritoneum?
Produce peritoneal fluid which lubricates the peritoneum
Minimize friction between abdominal organs
Resists infection by producing Abs, mobilizing leukocytes nad localizing infection
What is a mesentery?
A double layered peritoneal membrane that attaches intraperitoneal organs to the abdominal wall
Contains arteries, veins, nerves and lymph supplying these organs
Contains a variable amount of fat
What is a peritoneal ligament?
Regional mesenteries connecting one organ with another or connecting an organ to the abdominal wall
Most are named but he organs they connect
What are the peritoneal ligaments?
Gastrophrenic, gastrosplenic, gastrohepatic (hepatogastric), hepatoduodenal, gastrocolic, transverse mesocolic, phrenocolic, splenorenal
What is the lesser omentum?
Peritoneal ligament connecting the liver to the stomach and 1st part of duodenum
Consists of two parts: hepatoduodenal and hepatogastric ligament
What is the greater omentum?
Peritoneal ligament attached to greater curvature of the stomach, 1st part of duodenum and to the transverse colon
Includes the gastrocolic, gastrophrenic and gastrosplenic ligaments
Elongated so it drapes over the anterior surface of the intestines
What is the epiploic foramen?
Opening connecting the greater and lesser sac
What is the anterior boundary of the epiploic foramen?
Hepatoduodenal ligament
What is the inferior boundary of the epiploic foramen?
1st part of duodenum
What is the superior boundary of the epiploic of foramen?
peritoneal reflection from liver to IVC
What is the posterior boundary of the epiploic foramen?
Peritoneum covering inferior vena cava
Where is the stomach located?
Right and left upper quadrants
Left end fixed at level of T10-11
Right end fixed at the level of L1
What are the 4 parts of the stomach?
Cardiac, fundus, body, pylorus, including pyloric sphincter
What is the greater curvature of the stomach?
Inferior border and site of greater omentum attachment
What is the lesser curvature of the stomach?
Superior border and where the lesser omentum attaches
Where is the esophageal hiatus of the stomach located?
At the level of T10
Esophagus enters the stomach at the cardiac orifice at level of T11
What separates the esophagus from the fundus of the stomach?
Cardiac/cardial notch
What is a hiatal hernia?
Protrusion of part of the stomach into the mediastinum through the esophageal hiatus of the diaphragm
What is a para-esophageal hiatal hernia?
Less common
Cardia in normal position
Fundus through esophageal hiatus
No regurgitation (cardia in normal position)
What is a sliding hiatal hernia?
More common
Cardia and part of fundus through esophageal hiatus
Some regurgitation (cardia superior to diaphragm)
Where is the spleen located?
LUQ or left hypochondriac region lying parallel to left ribs 9-11 along the mid axillary line between stomach and diaphragm
Describe the spleen
Intraperitoneal organ
Attached to both the gastrosplenic and splenorenal ligaments
Describe the duodenum
Begins at pylorus and ends at duodenojejunal junction (level of L2)
Consists of 4 parts
Describe the 1st part of the duodenum
Superior duodenum
Intraperitoneal
Travels superior and to the right
Associated with the hepatoduodenal ligament
Describe the 2nd part of the duodenum
Descending
Retroperitoneal organ
Openings of the hepatopancreatic duct (bile duct and pancreatic duct) - major and minor duodenal papilla
Describe the 3rd part of the duodenum
Horizontal part
Retroperitoneal
Crossed by superior mesenteric artery and vein
Describe the 4th part of the duodenum
Ascending part
Retroperitoneal
Joins with jejunum
Suspensory ligament at the duodenojejunal junction (ligament of Treitz)
Describe the sympathetic innervating the foregut
Sympathetics from T5-9
From greater splanchnic nerves entering from thorax
Synapse in celiac ganglia and then distributed via vessels
Describe the parasympathetics innervating the foregut
From anterior and posterior vagal trunks - pierces diaphragm at T10 (CN 10)
Branches directly to organs with others entering celiac plexus and distributed via vessels
Where is the liver located?
URQ or epigastric and right hypochondriac regions
Left lobe located in left upper quadrant
What is the diaphragmatic surface of the liver?
Conforms to concavity of the diaphragm
Covered by peritoneum except where it is in direct contact with the diaphragm
IVC in direct contact with this surface
What is the visceral surface of the liver?
Covered with peritoneum except where gallbladder and porta hepatis are located
Transmits porta hepatis
What is the porta hepatis?
Transverse fissure on visceral surface
Contains hepatic portal vein, hepatic artery proper, nerve plexus, hepatic bile ducts, and lymph vessels
What is cirrhosis?
Alcoholic cirrhosis is the most common type
Hepatomegaly and hobnail appearance of liver surface
Resulting from fatty changes and fibrosis
Describe the right lobe of the liver
Larger than left
Includes quadrate and caudate lobes which are separated by the porta hepatis
Where is the caudate lobe located?
Between IVC and falciform ligament
Where is the quadrate lobe located?
Between gallbladder and falciform ligament
What separates the left lobe of the liver from the right?
The falciform ligament
What is the bare area of the liver?
In direct contact with the diaphragm
What are the coronary ligaments of the liver?
Reflection of visceral peritoneum from liver to the respiratory diaphragm
Surrounds bare area of liver
What is the falciform ligament?
Fold of peritoneum caused by ligamentum teres hepatis/round ligament of liver (remnant of left umbilical vein)
What are the ligaments of the liver?
Coronary, right and left triangular and falciform ligaments
What is the dual blood supply of the hepatic portal?
Hepatic artery carrying oxygenated blood from common hepatic artery to liver
Hepatic portal vein carrying venous blood from stomach, intestines, spleen and gallbladder
What is the portal triad?
Hepatic artery, portal vein and bile duct
What is the Pringle maneuver?
Pinching of the hepatoduodenal ligament containing the hepatic A to cut off blood supply to the gallbladder after its removal
At what level is the pancreas located?
Level of L1-2
What is located anteriorly to the pancreas?
Lesser sac (omental bursa) and stomach
What is posterior to the pancreas?
Aorta, IVC, splenic vein, common bile duct, right crus of diaphragm, left kidney and vessels, left suprarenal gland, superior mesenteric a/v
What is located to the right of the pancreas?
Duodenum (2nd part)
What is located left of the pancreas?
The spleen
What is inferior to the pancreas?
3rd part of duodenum
Where is the head of the pancreas located?
Lies in curvature of the duodenum
Describe the neck of the pancreas
Indistinct
Joins head to body
Overlies superior mesenteric artery
Where is the tail of the pancreas located?
Within the splenorenal ligaments
It’s tip is adjacent to the hilum of the spleen
What is the uncinate process of the pancreas?
Adjacent to the head
Superior to third part of the duodenum
Describe the gallbladder
Stores and releases bile
Attached to liver by CT in liver fossa
Three main parts: body, fundus and neck
What is the cystic duct?
Connects neck of gallbladder to common hepatic duct
What is the blood supply and innervation of the gallbladder?
Supplied by cystic A (usually off right hepatic A but varies)
Nerves from celiac plexus
What are gallstones?
Clinical condition known as cholelithiasis
Composed of cholesterol crystals
Can be lodged in several structures such as the cystic duct, hepatic duct, or the hepatopancreatic ampulla
Blockage of the hepatopancreatic ampulla blocks both common bile duct and main pancreatic duct
Results in bile backing up into pancreas causing pancreatitis
What are the hepatic ducts?
From right and left hepatic lobes
What is the common hepatic duct?
Combined hepatic ducts
What is the bile duct?
Combined cystic and common hepatic duct
What is the main pancreatic duct?
Begins in tail and courses to the head
Usually joined by accessory duct in the head
Contains the sphincter of the main pancreatic duct which prevents bile from entering the pancreas
Joins common bile duct
What is the accessory pancreatic duct?
May have a separate opening in the duodenum at the minor duodenal papilla
What is the hepatopancreatic ampulla of Vater?
Formed by union of common bile duct and main pancreatic duct
Associated with sphincter of Oddi (hepatopancreatic sphincter) and major duodenal papilla
What are the branches of the celiac trunk?
Common hepatic artery, splenic artery and left gastric A
What are the branches of the common hepatic artery?
Gastroduodenal artery, right gastric and hepatic artery proper
What are the branches of the gastroduodenal artery?
Right gastro-omental (gastroepiploic) artery
Superior pancreaticoduodenal artery
Supraduodenal artery
What are the branches of hepatic artery proper?
Right and left hepatic A
Cystic A
What are the branches of the splenic A?
Short gastric arteries
Left gastro-omental (gastroepiploic) artery
Pancreatic branches: dorsal pancreatic and great pancreatic artery
What are the branches of the left gastric A?
Esophageal branch
What is the cystohepatic triangle of Calot?
Cystic artery arises within it
Borders: cystic duct, common hepatic duct and visceral surface of the liver
