Organs

Question 1

LES is located approximately where the esophagus enters the stomach at the level of T11… How do you find this plane?

Answer 1

T11 doesn’t have a name, but you find the midpoint between the Linea alba and the Linea semilunaris and trace it up to the costal margin. then draw a transverse plane and that’s t11.

Question 2

How do you find T9?

Answer 2

find the Linea alba and trace up to the sternum

Question 3

ASIS bilaterally and between them is what?

Answer 3

Interspinous Plane = S2

Question 4

L1 is found where?

Answer 4

find the semilunaris and draw upwards to the costal margin. once you hit the ribs that’s L1

Question 5

Where does the Esophagus enter the stomach?

Stomach?

Pylorus

Answer 5

through the diaphragmatic hiatus at T10-T11

T11

L1

Question 6

What does the phrenicoesophageal ligament do?

Answer 6

allow independent motion of the esophagus and the diaphragm.

Question 7

What are the 3 constriction points of the esophagus?

Answer 7

Cervical: UES + Cricopharyngeus muscle

Thoracic: (2 part constriction) –> esophagus is in contact with the aorta and left main bronchus

Diaphragmatic: As it passes through the esophageal hiatus at t10. (implicated in hiatal hernias)

Question 8

What is a hiatal hernia? what are the two types?

Answer 8

abdominal structures going into the thorax

Paraesophageal: Fundus protrudes adjacent to the esophagus into the thorax (usually on the left because of the liver.

Sliding: most common. Hourglass shape. GEJ is displaced superiorly so the LES is affected. It’s the cardia that’s protruding, not the fundus.

Question 9

Why does someone with paraesophageal hernias not present with any symptoms?

Answer 9

because the GEJ is normal and they don’t have any reflux

Question 10

what is the angular incisure?

Answer 10

wehre the body of the stomach meets the pyloric portion.

Question 11

Why is the stomach a dynamic structure?

Answer 11

stomach can descend as low as the pelvis.

Question 12

What is the gastrohepatic ligament? Gastrocolic ligament?

Answer 12

connects liver with the stomach (at lesser curvature)

connects greater curvature to the colon

Question 13

What is a duodenal ulcer?

Answer 13

most like to occur at the posterior wall of the 1st part of the duodenum.

can cause a lot of hemorrhage.

Question 14

Vagotomy? 3 types?

Answer 14

surgical treatment of GERD.

Vagotomy can help prevent acid for being secreted.

Truncal - stomach and other parts of the GI

Selective gastric = only the stomach

Selective Proximal = knock out the stuff around the ulcer only

Question 15

How do you locate L3?

Answer 15

midaxillary line and look at the inferior costal margin.

Question 16

Where are the planes of the duodenum?

Answer 16

1st part = L1
2nd part = L2-L3 on the right
3rd part = anterior to L3
4th part = left of L3 vertebra - superior to about L2.

Question 17

What’s the difference between the first part of the duodenum from the rest of it?

Answer 17

first part of the first part is intraperitoneal, the rest is retroperitoneal!

Question 18

What’s so important about the hepatoduodenal ligament?

Answer 18

houses proper hepatic artery, portal vein, and bile duct.

marks the entrance to the lesser sac behind the stomach.

Question 19

What’s behind the first part of the duodenum?

Answer 19

gastroduodenal artery. if ulcers perforate this you have a life threatening injury

Question 20

What’s in the descending portion of the duodenum?

Answer 20

Major Duodenal papilla –>

the common bile duct empties bile as well as the pancreatic duct puts in pancreatic ducts.

Question 21

What happens if you have a obstruction above the major duodenal papilla?

Answer 21

vomit = will not see bile

Question 22

What’s posterior to the horizontal portion of the duodenum?

Answer 22

inferior vena cava (posterior)

superior mesenteric a/v (anterior)

Question 23

What does the suspensory muscle do?

Answer 23

also called the ligament of Treitz. Last segment of the duodenum

connects right crus of the diaphragm to the last portion of the duodenum –> pooping bright red blood or charcoal depending on if its proximal or distal to this.

Question 24

How is the jejunum and ileum attached to the posterior wall?

Answer 24

via mesentary

Question 25

Difference between the following for jejunum and ileum: vasa recta arcades Fat in mesentary Circular folds Lymphoid Nodules

Answer 25

long, short few long loops, many short loops Less, More Large tall closely packed, low and sparse few, many

Question 26

What is Meckel Diverticulum? Rule of 2's? lead point for what?

Answer 26

you have ectopic gastric / pancreatic tissue producing acid, you can erode and cause the bleeding seen in a patient. ``` 2x more likely in males 2 inches long 2 feet from ileocecal valve 2% of population common in first 2 years of life 2 types of epithelia ``` most common lead point to intussusception

Question 27

What is Intussusception? where is it common? what will you see on ultrasound?

Answer 27

proximal bowel segment is teloscoping the distal segment common at ileocecal junction. ultrasound = Target sign

Question 28

Where is the ileocecal junction located? What about the lower edge of the ascending colon?

Answer 28

L5. Widest portion on the hips and draw a transverse line. S2 (interspinous)

Question 29

What parts of the large intestine are retroperitoneal?

Answer 29

descending and ascending colon

Question 30

What is the longitudinal band of muscle on the large intestine? what's on each side of it?

Answer 30

Tenieae Coli Omental Appendices or Epicloic appendices

Question 31

Where do you find the appendix?

Answer 31

1/3 of the way between right ASIS and umbilicus (McBurney's point)

Question 32

Where do the teniae coli terminate?

Answer 32

sigmoid colon

Question 33

What is volvulus?

Answer 33

common at sigmoid colon for elderly. midgut for kids "coffee bean" sign on X-ray intestine rotates on itself leading to necrosis

Question 34

Where is the top of the liver located at in most individuals?

Answer 34

xiphisternal plane (T9)

Question 35

How do you do a liver biopsy?

Answer 35

find rib 10, go superiorly and have them exhale and hold it so it goes up and you don't collapse a lung. then you do the biopsy.

Question 36

For anatomic lobes of the liver, how are the right and left lobes separated? what are the two extra lobes?

Answer 36

falciform ligament, which connects the liver to the anterior abdominal wall. Quadrate (part of left hemi-liver) + Caudate (functionally separate)

Question 37

What are the different ligaments of the liver?

Answer 37

Falciform ligament Round ligament (remnant of the umbilical vein) Ligamentum Venosum (ex ductus venosus -> accept oxygen rich blood from the liver and shunt it) hepatoduodenal ligament (has those 3 structures --> hepatic artery, bile duct, portal vein..

Question 38

Pringle maneuver?

Answer 38

if someone is bleeding and you don't know why, if you do this maneuver and it stops, you know it's coming from the proper hepatic artery and vein.

Question 39

Why if you remove a portion of the functional liver it doesn't affect the whole organ?

Answer 39

each one has it's own portion of the hepatic artery, vein, bile duct.

Question 40

Why is the caudate called the 3rd liver?

Answer 40

receives vessels from both portal bundles.

Question 41

What separates the right and left FUNCTIONAL lobes? what #'s are associated with right liver? left liver?

Answer 41

imaginary Cantlie line. (tip of gallbladder to the diaphragm) 5,6,7,8 1,2,3,4

Question 42

what segments are the gallbladder found near on the liver?

Answer 42

4+5

Question 43

Pathway of bile?

Answer 43

Gallbladder --> cystic duct --> common bile duct --> meet with pancreatic duct and dump into the ampulla of vater (hepatopancreatic ampulla) in the 2nd part of the duodenum

Question 44

what's the deal with obstructions and the gallbladder?

Answer 44

whatever's above it will have the infection

Question 45

Cholelithiasis? 4 f's? what's the sign to do for this? what is choledocolithiasis?

Answer 45

gallstone. murphy's sign Female, Forty, Fertile, Fat obstruction of the common bile duct

Question 46

What is gallstone ileus?

Answer 46

gallstone can inflame the gallbladder and cause adhesions, perforate, travel to ileocecal junction, and obstruct it because it's the narrowest point of the Small intestine.

Question 47

Where is the spleen located? what's good to know about it? what are the two ligaments? why are they important?

Answer 47

9th-11 ribs are posterior to it. it's vulnerable to blunt trauma splenorenal ligament --> houses splenic artery gastrosplenic ligament --> houses short gastric arteries (he's doing this for his research project)