Mesenteries and Foregut Flashcards
What are the main functions of the peritoneum?
produces a peritoneal fluid, minimizes friction, resists infection by producing antibodies
what is found within a mesentery?
arteries, veins, nerves, and lymphatics supplying the organs
what is the peritoneal ligament connecting the liver to the stomach and the first part of the duodenum?
lesser omentum
what two ligaments make up the lesser omentum?
the hepatoduodenal ligament and the hepatogastric ligament
what is the peritoneal ligament attached to the greater curvature of the stomach, 1st part of the duodenum and to the transverse colon?
the greater omentum
what ligaments make up the greater omentum?
gastrocolic ligament, gastrophrenic ligament, gastrosplenic ligament
what is the opening that connects the greater and lesser sacs?
epiploic foramen
what is the inferior boundary of the epiploic foramen?
the 1st part of the duodenum
where is the stomach located?
in the right and left upper quadrants
where is the left end of the stomach fixed at?
the level of T10-T11
where is the right end of the stomach fixed at?
the level of L1
what are the parts of the stomach?
cardiac, fundus, body, and the pylorus including the pyloric sphincter
where does the greater omentum attach on the stomach?
on the inferior border/ greater curvature
where does the lesser omentum attach on the stomach?
on the superior border/ lesser curvature
where is the esophageal hiatus located?
T10
where does the esophagus enter the stomach?
at the cardiac orifice at the level of T11
what separates the esophagus from the fundus of the stomach?
the cardiac/ cardial notch
what is a protrusion of part of the stomach into the mediastinum through the esophageal hiatus of the diaphragm?
hiatal hernia
what is a para-esophageal hiatal hernia?
the cardia is in the normal position; the fundus comes out through the esophageal hiatus; no regurgitation
what is a sliding hiatal hernia?
the cardia and part of the fundus come out through the esophageal hiatus; some regurgitation
where is the spleen located?
left upper quadrant or left hypochondriac region lying parallel to left ribs 9-11 along the mid-axillary line between the stomach and diaphragm
what is the spleen attached to?
gastrosplenic and the splenorenal ligaments
what is the starting and end point of the duodenum?
it begins at the pylorus of the stomach and ends at the duodenojejunal junction (level of L2)
how many parts are there to the duodenum?
4
what is the first part of the duodenum associated with?
the hepatoduodenal ligament
what is associated with the second part (descending) of the duodenum?
it has openings for the hepatopancreatic duct (bile duct and pancreatic duct)
what are the openings for the hepatopancreatic duct?
the major and minor duodenal papilla
what is associated with the third part (horizontal) of the duodenum?
it is crossed by the superior mesenteric artery and vein
what ligament is found at the duodenojejunal junction?
suspensory ligament (ligament of Treitz)
how does the foregut get its sympathetic innervation?
from T5-T9; from greater splanchnic nerves entering from the thorax; they synapse in celiac ganglia and then are distributed via vessels
how does the foregut get parasympathetic innervation?
from anterior and posterior vagal trunks (CN 10)
where does the vagus nerve (CN 10) pierce the diaphragm?
at T10
where is the liver located?
in the right upper quadrants or epigastric and right hypochondriac regions; the left lobe is located in the left upper quadrant
what are the two surfaces of the liver?
the diaphragmatic surface and the visceral surface
what is in direct contact with the diaphragmatic surface of the liver?
the IVC
what areas of the visceral surface of the liver are not covered with peritoneum?
where the gallbladder and porta hepatis are located
What is the porta hepatis?
it is like the doorway in and out of the liver; it contains the hepatic portal vein, hepatic artery proper, nerve plexus, hepatic bile ducts, and lymphatic vessels
What causes cirrhosis of the liver?
fatty changes and fibrosis
What are the right and left lobes of the liver separated by?
falciform ligament
what lobes make up the right lobe of the liver?
quadrate and caudate lobes
what are the quadrate and caudate lobes of the right lobe of the liver separated by?
the porta hepatis
where is the caudate lobe of the right lobe of the liver found?
in between the falciform ligament and the IVC
where is the quadrate lobe of the right lobe of the liver found?
between the gallbladder and the falciform ligament
What is the bare area of the liver?
the area of the liver that is in direct contact with the diaphragm and is not covered by visceral peritoneum
What are the coronary ligaments of the liver?
it surrounds the bare area of the liver
What is the falciform ligament caused by?
ligamentum teres hepatis or the round ligament
What brings oxygenated blood into the liver?
hepatic artery
What brings deoxygenated blood into the liver?
the hepatic portal vein
What is the portal triad made up of?
the hepatic artery, the portal vein, and the bile duct
What surrounds the portal triad?
the hepatoduodenal ligament
What is the pringle maneuver used for?
it is used when the gallbladder is taken out and the arteries that were running to the gallbladder need to be clamped; done by pinching the portal triad/ hepatoduodenal ligament
where is the pancreas located?
at the level of L1-L2 vertebra
what is anterior to the pancreas?
the lesser sac
what is to the right of the pancreas?
the 2nd part of the duodenum
what is to the left of the pancreas?
the spleen
what is inferior to the pancreas?
the 3rd part of the duodenum
where does the head of the pancreas lie?
in the curvature of the duodenum
where does the neck of the pancreas lie?
it overlies the superior mesenteric artery
where is the tail of the pancreas located?
within the splenorenal ligament; its tip is adjacent to hilum of spleen
where is the uncinate process of the pancreas?
it is adjacent to the head; it is superior to the third part of the duodenum
what is the function of the gallbladder?
it stores and releases bile
what are the three main parts of the gallbladder?
the fundus, body, and neck
what connects the neck of the gallbladder to the common hepatic duct?
the cystic duct
what is the arterial supply of the gallbladder?
the cystic artery
what innervates the gallbladder?
nerves from the celiac plexus
how many hepatic ducts are there?
2- a right and left hepatic duct
what happens when the right and left hepatic ducts come together?
they form the common hepatic duct
what happens when the common hepatic duct and the cystic duct come together?
they form the bile duct
where does the main pancreatic duct begin?
in the tail of the pancreas and it courses to the head
what does the main pancreatic duct contain?
the sphincter of the main pancreatic duct
what is the purpose of the sphincter of the main pancreatic duct?
it prevents bile from entering the pancreas
what happens when the main pancreatic duct and the common bile duct join together?
it forms the hepatopancreatic ampulla (of Vater)
what is the hepatopancreatic ampulla associated with?
the heaptopancreatic sphincter and the major dueodenal papilla
what are gallstones composed of?
cholesterol crystals
what does blockage of the hepatopancreatic ampulla by gallstones block?
both the common bile duct and the main pancreatic duct
what happens when there is blockage of the hepatopancreatic ampulla?
bile backs up into the pancreas, which causes pancreatitis
There are three main branches off of the celiac trunk. What are they?
common hepatic artery, the splenic artery, and the left gastric artery
what are the three main branches off of the common hepatic artery?
gastroduodenal artery, right gastric artery, and hepatic artery proper
what branches off of the gastroduodenal artery?
right gastro-omental artery, the superior pancreaticoduodenal artery, and the supraduodenal artery
what branches off the hepatic artery proper?
the right and left hepatic artery and the cystic artery
what branches off the splenic artery?
short gastric arteries, left gastro-omental artery, and pancreatic branches (dorsal pancreatic and great pancreatic artery
what branches off the left gastric artery?
the esophageal branch
what is anastamosed on the greater curvature of the stomach?
the right gastro-omental artery and the left gastro-omental artery
what is anastamosed on the lesser curvature of the stomach?
the right gastric artery and the left gastric artery
what arises within the cystohepatic triangle of Calot?
the cystic artery
what are the borders of the cystohepatic triagnle of Calot?
the cystic duct, the common hepatic duct, and the visceral surface of the liver
what parts of the duodenum are considered retroperitoneal?
2nd-4th parts
what is the ligamentum teres hepatis/ round ligament of the liver a remnant of?
left umbilical vein
