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Gross III > Part II. Anatomy of foregut derivatives pg 50-59 > Flashcards

Part II. Anatomy of foregut derivatives pg 50-59 Flashcards

1
Q

The esophagus is covered by ______ superior to thoracic diaphragm (esophageal plexus) and covered by (retroperitoneal) inferior to thoracic diaphragm?

NOTE: remember histology

A
  • adventitia

- serosa

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2
Q

Where are the 4 places where esophageal constriction is seen on fluoroscopy following a barium study?

A
  • Upper Esophageal Sphincter where it is crossed by Cricopharyngeus M
  • Where it is crossed by Aortic Arch
  • Where it is crossed by L Main Bronchus
  • Lower Esophageal Sphincter where it passes through thoracic diaphragm
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3
Q

What is the clinical significance of the 4 esophageal constrictions?

A
  • Foreign bodies tend to lodge here
  • Swallowed corrosives do greatest damage here
  • Carcinoma most frequently occurs here
  • Damage resulting from endoscopic instruments most likely to occur here
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4
Q

What is the point of passage for the esophagus through the diaphragm called?

A

Esophageal hiatus

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5
Q

Where in the diaphragm does the esophagus pass through?

A

Right curs of thoracic diaphragm

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6
Q

What attaches esophagus to thoracic diaphragm at hiatus?

A

Phrenicoesophageal ligaments

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7
Q

What is the function of the Phrenicoesophageal ligaments?

A
  • Permit independent movement during respiration and swallowing - Create a seal between thoracic and abdominal cavities
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8
Q

Where is the esophagogastric junction located?

A

Left of midline at T11 (level with Xiphoid Process)

Note: esophageal hiatus is located just left of midline at T10

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9
Q

The right border of the esophagogastric junction is continuous with what?

A

lesser curvature of stomach

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10
Q

The left border of the esophagogastric junction is separated from fundus by what?

A

cardiac notch

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11
Q

What structure of the esophagus prevents gastric reflux?

A

Cardiac sphincter

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12
Q

What is the arterial supply to the esophagus?

A
  • Esophageal Branch of L Gastric A (which branches from Celiac Trunk)
  • L Inferior Phrenic A which branches from Abdominal Aorta
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13
Q

What is the venous drainage of the esophagus superiorly?

A

drains to Azygos V via Esophageal Vs

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14
Q

What is the venous drainage of the esophagus inferiorly?

A

drains to Hepatic Portal V via L Gastric V

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15
Q

What are the primary nodes for the esophagus?

A

L gastric lymph nodes

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16
Q

What are the secondary lymph nodes for the esophagus?

A

Celiac lymph nodes

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17
Q

Lymph from the esophagus, ultimately drains where?

A

Thoracic duct

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18
Q

Parasympathetic innervation to the esophagus is via ________.

A

Vagal trunks

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19
Q

Presynaptic parasympathetic neurons from the vagal trunks, supplying the esophagus, synapse in which plexi?

A

myenteric and submucosal plexuses

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20
Q

Sympathetic innervation to the esophagus is supplied by _________ from what spinal nerve roots?

A

Greater Splanchnic N (T5-T9)

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21
Q

Presynaptic sympathetic neurons supplying the esophagus will synapse in what ganglion?

A

Celiac

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22
Q

How do postsynaptic sympathetic neurons supplying the esophagus get from the celiac ganglion to the esophagus?

A

follow periarterial plexus

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23
Q

Is the stomach intraperitoneal or retroperitoneal?

A

Intraperitoneal

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24
Q

What abdominal quadrant is the stomach mostly located in?

A

Upper left abdominal quadrant

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25
Q

What is the function of the stomach?

A
  • initiate digestion
  • Blend food and digestive enzymes into chyme
  • food reservoir (can hold up to 2-3 liters of food in an adult)
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26
Q

What are the internal ridges of the stomach called and what function do they have?

A

Rugae: increase surface area for digestion

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27
Q

Where is the cardia of the stomach located?

A

2cm left of midline at 6th costal cartilage (T11)

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28
Q

Where is the fundus of the stomach located?

A

under left dome of diaphragm superiorly to left 5th intercostal space

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29
Q

Where is the cardiac notch of the stomach located?

A

between esophagus and fundus

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30
Q

What is the pyloric antrum?

A

The structure in the pyloric part of the stomach that is a wide funnel-shaped extension of the body

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31
Q

What is the pyloric canal?

A

The narrower reaction in the pyloric part of the stomach that leads from the pyloric antrum to the sphincter

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32
Q

Where is the pyloric sphincter?

A

Where the stomach and duodenum meet

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33
Q

What is the function of the pyloric sphincter?

A

It is the thick circular muscle that regulates exit from stomach into duodenum

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34
Q

The concave border on right side of stomach

A

Lesser curvature

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35
Q

The convex border on left side of stomach

A

Greater curvature

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36
Q

What is the sharp indentation on the lesser curvature of the stomach at the junction of the body and the pyloric part of the stomach?

A

Angular Incisure

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37
Q

What is the primary arterial supply along lesser curvature of stomach?

A

L Gastric A branches directly from Celiac trunk

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38
Q

Very small artery that anastomoses with L Gastric A along lesser curvature?

A

R Gastric A usually branches from Proper Hepatic A

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39
Q

What arteries supply greater curvature of stomach in greater omentum

A

R Gastroepiploic A (gastro-omental) which and anastomoses with L Gastroepiploic A (gastro-omental) along greater curvature of stomach

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40
Q

Right gastroepiploic artery is a branch of _______ while left gastroepiploic artery is a branch of _______.

A
  • Right Branches from Gastroduodenal A

- Left Branches from Splenic A

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41
Q

What are the 4-5 very small arteries branching from splenic artery and supplying fundus of stomach?

A

Short gastric arteries

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42
Q

Venous drainage fo the stomach parallels the arteries supplying it and all eventually drain to where?

A

The liver

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43
Q

The left and right gastric veins drain into where?

A

Hepatic portal vein

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44
Q

Short Gastric V and L Gastroepiploic Vs drain to which vein before draining into hepatic portal vein?

A

Splenic vein

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45
Q

R Gastroepiploic V drains to which vein before draining to the hepatic portal vein?

A

Superior mesenteric vein

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46
Q

Primary lymphatic drainage on lesser curvature of the stomach is to _______.

A

Gastric nodes

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47
Q

Primary lymphatic drainage on greater curvature of the stomach is to _______.

A

Gastroepiploic nodes

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48
Q

Secondary lymphatic drainage for the stomach is to _______.

A

Celiac nodes

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49
Q

Lymphatic drainage of the stomach ultimately goes where?

A

To the thoracic duct

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50
Q

Parasympathetic innervation to the stomach is via _______.

A

Anterior/Posterior Vagal Trunks

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51
Q

Presynaptic parasympathetic neurons enter the abdomen via ______ and synapse on postsynaptic neurons in the __________ in the stomach.

A
  • esophageal hiatus

- myenteric/submucosa ganglia

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52
Q

What is the result of parasympathetic innervation to the stomach?

A
  • Increase acid secretion

- increase rate of emptying

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53
Q

Sympathetic innervation to the stomach is via ________ from what spinal nerve levels?

A

Greater splanchnic nerve (T6-T9)

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54
Q

Presynaptic sympathetic neurons that supply the stomach will synapse on postsynaptic neurons in the _______

A

Celiac ganglion

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55
Q

How do the axons of postsynaptic neurons get from the celiac ganglion to the stomach to innervate it?

A

They pass in tunica adventitia of arterial vessels to the stomach

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56
Q

Where does the duodenum begin and end?

A

It is C-shaped, begins at pylorus and ends at duodenojejunal junction (L2 level)

NOTE: it is the first, shortest, widest and most fixed region of small intestine (25cm)

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57
Q

Is the duodenum retroperitoneal or intraperitoneal?

A

Considered mostly retroperitoneal (the first 2cm are intraperitoneal)

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58
Q

What are the 4 parts of the duodenum?

A
  • superior (1st) part
  • Descending (2nd) part
  • Inferior (3rd) part
  • Ascending (4th) part
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59
Q

The superior part of the duodenum is covered anteriorly by ______ and posteriorly by ______.

A
  • parietal peritoneum

- adventitia

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60
Q

The superior part of the duodenum is attached to the liver by what structure?

A

Hepatoduodenal L (part of Lesser Omentum)

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61
Q

The superior part of the duodenum, where is ascends from the pylorus, is overlapped by what two structure?

A

Liver and gallbladder

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62
Q

The descending part of the duodenum curves around what structure?

A

Right side of head of pancreas

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63
Q

What structures are found in the descending part of the duodenum?

A
  • Major duodenal papilla

- minor duodenal papilla (although not always present)

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64
Q

What is the major duodenal papilla?

A

Internal opening of Common Bile Duct and Main Pancreatic Duct

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65
Q

What is the hepatopancreatic ampulla?

A

External union of common bile duct and main pancreatic duct

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66
Q

What is the Minor Duodenal Papilla?

A

Internal opening if Accessory Pancreatic Duct is present

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67
Q

The inferior part of the duodenum is where it begins to cross to the left. At what vertebral level does this happen?

A

L3

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68
Q

What vascular bundle passes anterior to the inferior part of the duodenum?

A

Superior Mesenteric AV

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69
Q

What structures are immediately superior to the inferior part of the duodenum?

A

Pancreatic head and Uncinate Process

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70
Q

The ascending part of the duodenum rise from and to what vertebral level?

A

from L3 vertebra to superior border of L2

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71
Q

What landmark denotes the end of the duodenum?

A

duodenojejunal junction at the point of acute angle

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72
Q

The ascending part fo the duodenum is supported by what?

A

suspensory muscle of duodenum (ligament of Trietz)

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73
Q

What happens to the acute angle of the duodenum when the suspensory muscle of duodenum (ligament of Trietz) contracts?

A

widens the angle of flexure facilitating movement through that part of the duodenum (not such a sharp angle)

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74
Q

What Artery Supplies duodenum proximal to Major Duodenal Papilla?

A

Superior Pancreaticoduodenal A from Gastroduodenal A

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75
Q

What Artery supplies the duodenum distal to Major Duodenal Papilla?

A

Inferior Pancreaticoduodenal A from Superior Mesenteric A (SMA)

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76
Q

What two arteries supplying the duodenum create an anastomosis between Celiac Trunk and SMA?

A

Superior and inferior pancreaticoduodenal arteries

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77
Q

What supplies blood from the distal esophagus to the major duodenal papilla (the embryonic foregut)?

A

Celiac trunk

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78
Q

What supplies blood from the major duodenal papilla to near the left colic flexure (embryonic midgut)?

A

Superior mesenteric artery

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79
Q

The venous drainage of the duodenum flows the arteries and drains to the __________.

A

Hepatic portal vein

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80
Q

Anteriorly, lymph from the duodenum drains to ______ and then ______.

A
  • Pancreaticoduodenal lymph nodes

- pyloric nodes

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81
Q

Posteriorly, lymph from the duodenum drains to _______.

A

Superior Mesenteric nodes

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82
Q

What are the Secondary nodes for the duodenum?

A

Celiac lymph nodes

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83
Q

Lymph from the duodenum ultimately drains where?

A

Lymphatic duct

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84
Q

Parasympathetic innervation to the duodenum is via ________.

A

Posterior Vagal Trunk

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85
Q

Sympathetic innervation to the duodenum is via ______ and ______, originating from what spinal nerve levels?

A

Greater and Lesser Splanchnic N (originating in T8-T10)

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86
Q

What is the largest gland in the body?

A

Liver

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87
Q

In what abdominal quadrant is the liver mostly located?

A

Upper right quadrant

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88
Q

What are the main functions of the liver?

A
  • Carbohydrate metabolism and storage (glycogen)
  • Plasma protein and lipoprotein synthesis and secretion
  • Bile formation and secretion
  • Drug and alcohol detoxification
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89
Q

What are the surfaces of the liver?

A
  • Diaphragmatic surface - anterosuperior and convex aspect

- visceral surface - posteroinferior and flat/concave aspect

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90
Q

What is the space that is the Anterosuperior extension of Greater Sac between liver and diaphragm?

A

Subphrenic recess

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91
Q

The subphrenic recess is separated into right and left by what structure?

A

Falciform ligament

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92
Q

What is the space that is the Inferior extension of Greater Sac between liver & R Kidney/Suprarenal gland?

A

Hepatorenal recess

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93
Q

The diaphragmatic surface of the liver is covered by _______ except posteriorly at the ________

A
  • visceral peritoneum

- bare area of the liver

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94
Q

At the bare area of the liver, the liver is in direct contact with what?

A

Thoracic diaphragm

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95
Q

The anterior and posterior peritoneal reflections from liver to thoracic diaphragm that outline bare area of liver are called what?

A

Coronary ligament

NOTE: forms a “crown” on top of the liver

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96
Q

The convergent of the anterior/posterior coronary ligament is called what?

A

Triangular ligament
Right side:
Left side: Falciform L and Lesser Omentum contributes

97
Q

The visceral surface of the liver is covered by _______ except under ________ and at ________.

A
  • visceral peritoneum

- under Gallbladder : at porta hepatis

98
Q

What is the Transverse fissure between caudate and quadrate lobes?

A

Porta hepatis

99
Q

What is the significance of the porta hepatis?

A

It is the Entry/exit for Hepatic Portal V, Proper Hepatic A, Common Hepatic duct with the liver

100
Q

The liver has 4 anatomical lobes. What are they?

A
  • left lobe
  • right lobe
  • caudate lobe
  • quadrate lobe
101
Q

What anatomical lobe of the liver is left of Falciform L, Ligamentum Teres and Ligamentum Venosum

A

Left lobe

102
Q

What anatomical lobe of the liver is right of IVC and Gall Bladder fossa?

A

Right lobe

103
Q

What anatomical lobe of the liver is between Ligamentum Venosum and IVC?

A

Caudate lobe

104
Q

What anatomical lobe of the liver is between Gall Bladder fossa and Ligamentum Teres

A

Quadrate lobe

105
Q

What is the caudate process?

A

extension of Caudate lobe of the liver connecting it to right lobe

106
Q

The liver has 2 functional lobes. What are they and what separates them?

A

Right and left separated by vertical line running through IVC and Gall Bladder fossa

107
Q

Why are the functional lobes of the liver divided the way they are?

A

Because each has its own blood supply and venous/biliary drainage

108
Q

Ligamentum teres (round ligament of the liver) is the remnant of what fetal structure?

A

Umbilical vein which Delivered oxygenated and nutrient rich blood from placenta to fetus

109
Q

Ligamentum venous is the remnant of what fetal structure?

A

Ductus venosus which allowed placental blood to largely bypass liver by shunting directly to IVC

110
Q

Where is the Ligamentum venosum located?

A

on visceral surface of the liver between caudate lobe and left lobe

111
Q

Where is Ligamentum Teres located?

A

on free edge of Falciform L

112
Q

Thick free edge of lesser omentum surrounding portal triad structures?

A

Hepatoduodenal ligament

113
Q

Thin broad sheet of lesser omentum spanning from liver to lesser curvature of stomach?

A

Hepatogastric ligament

114
Q

What supplies about 75% of blood coming to liver?

A

Hepatic portal vein

115
Q

What kind of blood is delivered to the liver via the hepatic portal vein?

A

nutrient rich, bilirubin rich, poorly oxygenated blood

116
Q

The hepatic portal vein is the confluence of what veins?

A

Superior Mesenteric V, Splenic V (Inferior Mesenteric V) Gastric vv.

117
Q

What supplies about 25% of blood coming to liver?

A

Proper hepatic artery

118
Q

What kind of blood is delivered to the liver via the proper hepatic artery?

A

highly oxygenated arterial blood

119
Q

Proper hepatic artery branches from ________.

A

Common Hepatic A (which branches from Celiac Trunk)

120
Q

What is the location of the proper hepatic artery in relation to the common bile duct and the hepatic portal vein?

A

left of Common Bile Duct and anterior to Hepatic Portal V

121
Q

Where does the proper hepatic artery split into the right and left hepatic arteries?

A

Near the porta hepatis

122
Q

Venous drainage in the liver confluences into hepatic veins which drain to _______ just inferior to the thoracic diaphragm.

A

Inferior vena cava

123
Q

Liver vascular supply functionally compartmentalizes the liver into how many segments?

A

8

124
Q

Branches of ______ and ______ supply each vascular segment of the liver. These do not anastomose with each other and are considered end vessels.

A

Hepatic portal vein : proper hepatic artery

125
Q

Branches of Hepatic V return in what relation to the vascular segments of the liver?

A

between the vascular segments

126
Q

The compartmentalization of the liver segments and their vasculature, allows for what, clinically?

A

Lobectomies after trauma or disease

127
Q

The liver produces what percentage of the lymph that passes through the thoracic duct?

A

50%

128
Q

The primary nodes for lymphatic drainage of the liver?

A

Hepatic lymph nodes

129
Q

The secondary nodes for lymphatic drainage of the liver?

A

Celiac lymph nodes

130
Q

Lymphatic drainage of the liver, gallbladder, spleen and pancreas drains to the thoracic duct via what structure?

A

Chyle cistern

131
Q

The liver is the largest effect organ innervated via what plexus?

A

Celiac

132
Q

Sympathetic innervation to the liver is via what nerve? From what spinal nerve levels?

A

Greater Splanchnic N (T6-T9)

133
Q

Presynaptic sympathetic neurons will synapse on postganglionic sympathetic neurons in the ______ to supply the liver.

A

Celiac ganglion

134
Q

What does sympathetic innervation to the liver stimulate?

A

vasoconstriction in hepatic arteries and hepatic portal V

NOTE: does not seem to affect bile formation

135
Q

Parasympathetic innervation to the liver is via what? Where do the preganglionic parasympathetic fibers synapse?

A
  • Vagal trunks

- synapse in the liver

136
Q

What does parasympathetic innervation to the liver stimulate?

A

Dilates bile duct luminal diameter

137
Q

Visceral afferents (pain) from the liver (and gallbladder) pass in splanchnic nerves (mainly right greater splanchnic nerve) back to ______ cord levels which will refer pain where?

A
  • T6-T9

- Pain refers to area between ribs 6-9 on right side

138
Q

What substance does the liver produce as part of its digestive function?

A

Bile

139
Q

What is bile?

A

a yellow-green secretion that emulsifies fat

140
Q

What is the function of the gallbladder

A

stores and concentrates bile until it is released to duodenum

141
Q

What are the components of the biliary duct system from smallest to largest?

A

Bile canaliculi (in liver) -> bile ducts(in liver) -> right and left hepatic ducts (in liver) -> common hepatic duct (from liver at porta hepatis) -> cystic duct (from gallbladder) -> common bile duct (convergence of common hepatic and cystic ducts)

142
Q

microscopic channels present between rows of hepatocytes

A

Bile canaliculli

143
Q

microscopic components of intrahepatic portal triads

A

Bile Ducts

144
Q

What forms as the convergence of intrahepatic bile ducts

A

Right and left hepatic ducts

145
Q

convergence of R/L Hepatic Ducts at porta hepatis

A

Common Hepatic Duct

146
Q

What transfers bile to/from gallbladder?

A

Cystic duct

147
Q

the convergence of Common Hepatic and Cystic Ducts

A

Common Bile Duct

148
Q

What is the path of the common bile duct?

A

Passes through Hepatoduodenal L and descends posterior to duodenum

149
Q

The common hepatic bile duct joins with ________ to form _________ and open in the posterior duodenal wall at _______.

A
  • Main Pancreatic Duct
  • Hepatopancreatic Ampulla
  • Major Duodenal Papilla
150
Q

What is present at the distal end of the common bile duct to regulate the release of bile from the gallbladder?

A

Sphincter of common bile duct

151
Q

Where is the gallbladder located?

A

In the gallbladder fossa on visceral surface of liver and sits on the superior part of the duodenum

152
Q

The shallow fossa at the junction of the right and left functional lobes of the liver?

A

Gallbladder fossa

153
Q

What is the bile storage capacity of the gallbladder?

A

50 mL

154
Q

The wide blunt end of the gallbladder that projects from anterioinferior border of the liver?

A

Fundus

155
Q

The fundus of the gallbladder contacts the anterior body wall just below the tip of what costal cartilage?

A

Right 9th

156
Q

The part of the gallbladder that is adjacent to visceral surface of the liver, transverse colon and duodenum

A

Body

157
Q

The narrow, tapered region of the gallbladder near the porta hepatis?

A

Neck

158
Q

What is the spiral valve?

A

The mucosa in the cystic duct that spirals to form a valve that is responsive to constriction of sphincter at distal end of common bile duct

159
Q

What supplies blood to the gallbladder?

A

Cystic artery (descending aorta -> celiac trunk -> proper hepatic artery -> right hepatic artery -> cystic artery)

160
Q

Venous drainage of the gallbladder is through cystic veins which either drain to ______ or _______.

A

Right hepatic vein : directly to the liver

161
Q

The primary nodes for lympathic drainage of the gallbladder?

A

Cystic and hepatic lymph nodes

162
Q

The secondary nodes for lympathic drainage of the gallbladder?

A

Celiac lymph nodes

163
Q

Lymphatic drainage of the gallbladder drains to the thoracic duct via what structure?

A

Chyle cistern

164
Q

The gallbladder is innervated via what plexus?

A

Celiac

165
Q

Parasympathetic innervation to the gallbladder is via what?

A

Vagal trunks

166
Q

Parasympathetic innervation of the gallbladder stimulates what?

A

Contraction of gallbladder and relaxation of sphincters at ampulla

167
Q

The hormone produced by the duodenum in response to a fatty meal that stimulates contraction of gallbladder and relaxation of sphincters at ampulla

A

cholecystokinin (CCK)

168
Q

Sympathetic innervation to the gallbladder is via what nerve? What spinal nerve levels contribute to innervation?

A

Greater Splanchnic N (T6-T9)

169
Q

Sympathetic innervation of the gallbladder stimulates what?

A

Relaxation of gallbladder and contraction of sphincters at ampulla

170
Q

The largest lymphatic organ in the body

A

The spleen

171
Q

Is the spleen intraperitoneal or retroperitoneal?

A

Intraperitoneal

172
Q

What abdominal quadrant is the spleen in?

A

Upper left

173
Q

What rib level is the spleen located at?

A

9-11

174
Q

The spleen is surround entirely by ________ except at the ________.

A
  • Visceral peritoneum

- hilum

175
Q

What structures surround the spleen and where in relation to it?

A
  • Stomach is anterior
  • thoracic diaphragm is posterior
  • L kidney and pancreas are medial
  • L colic flexure is inferior
176
Q

The rounded convex surface of the spleen is adjacent to what structure?

A

Thoracic diaphragm

177
Q

Describe the anterior superior borders of the spleen?

A

Sharper and notched

178
Q

Describe the posterior and inferior border of the spleen?

A

Rounded and smooth

179
Q

What is the primary function of the spleen?

A

Filter blood (both physically and immunologically)

180
Q

Is the spleen a vital organ?

A

No

181
Q

How does the spleen respond to dynamic blood flow?

A

Expands and contracts somewhat dynamically

182
Q

What structure spans from the spleen to the greater curvature of the stomach?

A

Gastrosplenic ligament

183
Q

What arteries are located in the gastrosplenic ligament?

A

Short Gastric A and L Gastroepiploic A

184
Q

What structure spans from spleen to posterior wall near L kidney?

A

Splenorenal ligament

185
Q

What vascular bundle is located in the splenorenal ligament?

A

Splenic AV

186
Q

What is the arterial supply to the spleen?

A

Splenic artery (largest branch of celiac trunk)

187
Q

The splenic artery is a tortuous artery that passes along the superior border of the ________.

A

Pancreas

188
Q

The splenic artery, which is in the splenorenal ligament, splits into about 5 branches near what landmark?

A

Splenic hilum

189
Q

The convergence of several venous tributaries at the splenic hilum?

A

Splenic vein

190
Q

The splenic vein is joined by ________ and then passes posteriorly to the ________.

A
  • Inferior mesenteric vein

- pancreas

191
Q

After the plenum vein and the inferior mesenteric vein join, they are subsequently joined by ________ to form the hepatic portal vein.

A

Superior mesenteric vein

192
Q

What are the primary nodes fro lymphatic drainage of the spleen?

A

Pancreaticosplenic lymph nodes

193
Q

What are the secondary node for lymphatic drainage of the spleen?

A

Celiac or superior mesenteric lymph nodes

194
Q

The spleen is innervated by what plexus?

A

Celiac plexus

195
Q

Sympathetic innervation of the spleen is via what? Which vertebral levels contribute to it?

A

Greater Splanchnic N (T6-T8)

196
Q

Preganglionic sympathetic neurons supplying the spleen will synapse on postganglionic sympathetic neurons where?

A

Celiac ganglion

197
Q

Sympathetic innervation of the spleen stimulates what?

A

Vasomotor and stimulate splenic contraction

198
Q

Parasympathetic innervation to the spleen stimulates what?

A

HAHA…trick question!!

There is no apparent parasympathetic innervation to the spleen

199
Q

Is the pancreas intraperitoneal or retroperitoneal?

A

Retroperitoneal

200
Q

The pancreas is located posterior to the stomach at what vertebral level?

A

L1-L2

201
Q

What organ is to the right of the pancreas? To the left?

A

duodenum on right and spleen on left

202
Q

The pancreas has both endocrine and exocrine functions. What is it;s exocrine function?

A

digestive enzyme secretion and delivery to duodenum

203
Q

The pancreas has both endocrine and exocrine functions. What is it’s endocrine function?

A

insulin/glucagon secretion and delivery to blood

204
Q

What part of the pancreas is surrounded by the C-shaped duodenum?

A

The head of the pancreas

205
Q

The head of the pancreas is located to the right of what artery?

A

Superior mesenteric artery

206
Q

What part of the pancreas is located anterior to IVC, R Renal AV and L Renal V?

A

The head of the pancreas

207
Q

The inferomedial extension of pancreatic head posterior to superior mesenteric artery?

A

Uncinate process

208
Q

What structure courses through the posterosuperior portion of the head of the pancreas?

A

Common bile duct

209
Q

The short segment of the pancreas that is located anterior to the superior mesenteric artery and vein.

A

Neck of the pancreas

210
Q

Where in relation to the pancreas, do the Superior Mesenteric V and Splenic V merge to form Hepatic Portal V?

A

posterior to neck of the pancreas

211
Q

What is the elongated left side of the pancreas that is located to the left of the superior mesenteric artery?

A

Body of the pancreas

212
Q

The body of the pancreas is located transversely anterior to what arterial structure and at what vertebral level?

A

Abdominal Aorta and L2

213
Q

The body of the pancreas is covered anteriorly by ________, posteriorly by _________.

A
  • parietal peritoneum

- adventitia

214
Q

What part of the pancreas is located anterior to L Kidney and close to hilum of spleen?

A

Tail of the pancreas

215
Q

How does the main pancreatic duct course through the pancreas?

A

From tail to head

216
Q

The main pancreatic duct merges with the common bile duct to form what?

A

Hepatopancreatic Ampulla

217
Q

What are present at the distal ends of the common bile duct, main pancreatic duct and hepatopancreatic ampulla?

A

Sphincters to regulate flow of bile & pancreatic juice into duodenum (and duodenal reflux)

218
Q

The accessory pancreatic duct usually communicates with the major pancreatic duct, but when it does not, which is larger?

A

The accessory pancreatic duct which means that it carries more of the pancreatic juice in this scenario

219
Q

What is the arterial supply to the tail of the pancreas?

A

Pancreatic arteries which are up to 10 small branches along length of Splenic A

220
Q

What is the arterial supply to the superior aspect of the head of the pancreas?

A

Anterior/Posterior Superior Pancreaticoduodenal As which branch from Gastroduodenal A (indirectly from Celiac Trunk)

221
Q

What is the arterial supply to the inferior aspect of the head of the pancreas?

A

Anterior/Posterior Inferior Pancreaticoduodenal As which branch from Superior Mesenteric A

222
Q

Venous drainage of the pancreas is via ________.

A

Pancreatic veins

223
Q

The pancreatic veins drain primarily to _____ and less so to _______ but ultimately , venous flows to ______.

A
  • Splenic vein
  • superior mesenteric vein
  • hepatic portal vein
224
Q

The primary nodes for lymphatic drainage of the pancreas are what?

A

Pancreaticosplenic nodes alone the splenic artery

225
Q

Secondary nodes for lymphatic drainage of the pancreas are what?

A

Celiac, superior mesenteric and hepatic nodes

226
Q

Sympathetic innervation to the pancreas is via what nerves? What spinal cord levels contribute?

A

Greater & Lesser Splanchnic N (T6-T10)

227
Q

Preganglionic sympathetic neurons that supply the pancreas will synapse in one of two ganglia. What are they?

A

Celiac and Superior Mesenteric ganglia

228
Q

What is the action of sympathetic innervation to the pancreas?

A

vasoconstriction and inhibition of pancreatic secretions

229
Q

Pancreatic pain refers to what cord segments and their corresponding dermatomes?

A

(T6-10)

NOTE: Pain may also refer to the back between T10 and L2 vertebrae

230
Q

Parasympathetic innervation to the pancreas is via what?

A

Vagal trunks and Celiac and Superior Mesenteric plexuses

231
Q

What is the action of parasympathetic stimulation to the pancreas?

A

Increased pancreatic secretions

NOTE: pancreatic secretions are primarily stimulated by hormones

232
Q

What are the three main branches of the celiac trunk?

A
  • left gastric artery, left side of lesser curvature of the stomach
  • splenic artery, spleen
  • common hepatic artery
233
Q

The left gastric artery is a branch off of the celiac trunk. It has one branch. What is it and what does it innervate?

A

Esophageal branch, inferior esophagus

234
Q

The splenic artery has three branches. What are they and what do they supply?

A
  • Pancreatic arteries, pancreas
  • Short Gastric Artery, fundus of stomach
  • L Gastroepiploic Artery, left side of greater curvature of stomach
235
Q

The common hepatic artery has two branches. What are they and what do they supply?

A
  • Proper Hepatic A, liver

- Gastroduodenal A, stomach, duodenum, pancreas

236
Q

The proper hepatic artery has 3 branches. What are they and what do they supply?

A
  • R Gastric A, right side of lesser curvature of stomach
  • R Hepatic A, right functional lobe of liver
  • L Hepatic A, left functional lobe of liver
237
Q

What is the branch off of the right hepatic artery and what does it supply?

A

Cystic A - gallbladder

238
Q

The gastroscope also artery has 2 branches. What are they and what do they supply?

A
  • Superior Pancreaticoduodenal A, pancreas and duodenum

- R Gastroepiploic A, right side of greater curvature of stomach

Gross III (20 decks)

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