Practical 2

Question 1

Describe the innervation of parietal peritoneum

Answer 1

Somatic innervation of the abdominal wall it lines, thoracic and lumbar spinal nerves
Well localised
Pain, pressure, temperature and laceration

Question 2

Describe the innervation of visceral peritoneum

Answer 2

Poorly localised, pain referred to dermatomes
Travels with vagus nerve
Stretch and chemical irritation

Question 3

Burning and cutting would cause pain in which layers of peritoneum?

Answer 3

Burning- both

Cutting- just parietal

Question 4

What is the mesentery?

Answer 4

Double layers of peritoneum attaching the small intestine to the posterior abdominal wall

Question 5

What is the mesocolon? What happens at the transverse colon?

Answer 5

Double layer of peritoneum attaching large intestine (colon) to the posterior abdominal wall
The transverse mesocolon and the greater omentum adhere together

Question 6

Where is the attachement of the sigmoid mesocolon found?

Answer 6

At the bifurcation of the L common iliac artery

Question 7

Describe the lesser omentum

Answer 7

Peritoneal fold between visceral surface of liver and lesser curvature of the stomach, derived from ventral mesogastrium
Encloses structures en-route to the liver (biliary ducts, hepatic artery and hepatic portal vein)

Question 8

From what embryological structure is the ventral mesogastrium derived

Answer 8

Septum transversum (cranial mesenchyme)

Question 9

What is the lesser sac?

Answer 9

Pouch of the peritoneal cavity loacted posterior to the liver, lesser omentum and stomach but anterior to structures located on the posterior abdominal wall

Question 10

What is the gap where the lesser sac communicates with the greater sac called?

Answer 10

Aditus to the lesser sac

or epiploic foramen

Question 11

Describe the boundaries of the lesser sac

Answer 11

Superiorly- diaphragm
Anteriorly- liver& lesser omentum
Posteriorly- post. abdominal wall, tranverse mesocolon
Left- L margin of greater omentum, splenorenal and gastrosplenic ligaments

Question 12

What is the function of the pancreas?

Answer 12

Produces exocrine secretions-> digestion

endocrine secretions-> carbohydrate metabolism

Question 13

Name the parts of the pancreas

Answer 13

head, uncinate process, neck, body and tail

Question 14

Where does the head of the pancreas lie?

Answer 14

In the C shape of the duodenum

Question 15

What lies behind the head of the pancreas?

Answer 15

IVC, renal veins and bile duct

Question 16

Where is the uncinate process of the pancreas?

Answer 16

Projects from the lower part of the head to the left and posterior to superior mesenteric vessels

Question 17

Where is the neck of the pancreas found?

Answer 17

Anterior to the superior mesenteric vein and hepatic portal vein.

Question 18

What is the body of the pancreas in contact with?

Answer 18

Aorta (between celiac and sup. mes. a.)

the adrenal gland and the L kidney

Question 19

Describe where the splenic vein and artery lies in relation to the pancreas

Answer 19

Splenic artery lies along the superior border of the pancreas
Splenic vein lies posterior to the body of the pancreas (sometimes embedded)

Question 20

What is found anterior to the pancreas?

Answer 20

Stomach, peritoneum, transverse mesocolon

Question 21

What is found in the splenorenal ligament?

Answer 21

The tail of the pancreas and the splenic artery

Question 22

What is the hepatopancreatic ampulla?

Answer 22

Where the main pancreatic duct joins the bile duct, there is a sphincter there.

Question 23

Why can pancreatitis cause jaundice?

Answer 23

Bile duct runs through pancreas so inflammation of pancreas can obstruct bile flow into duodenum

Question 24

Describe the blood supply of the pancreas

Answer 24

Splenic artery, gastroduodenal and superior and inferior pancreaticoduodenal arteries

Question 25

Describe the venous drainage of the pancreas

Answer 25

Via the superior mesenteric vein, splenic vein and into hepatic portal vein

Question 26

Where does most of the lymph from the pancreas drain?

Answer 26

To pancreaticosplenic nodes

Question 27

What level is the neck of the pancreas found?

Answer 27

L1-> transpyloric plane

Question 28

How are the physiological lobes of the liver defined? Significance?

Answer 28

By a plane running between the gall bladder bed and the inferior vena cava Shows whether that part of liver is supplied by R or L heptic artery and hepatic portal vein and whether it is drained by R or L hepatic duct

Question 29

Where is bile formed and stored? (describe the route)

Answer 29

Bile is formed in the liver and collects in the bile canalculi, ultimately leading tot the L or R hepatic duct->common hepatic duct-> cycstic duct-> gall bladder for storage

Question 30

How does bile leave the gall bladder?

Answer 30

Walls of the gall bladder contract, bile moves along cystic duct to the common bile duct-> major duodenal papilla-> duodenum

Question 31

What happens to bile when it is being stored in the gall bladder?

Answer 31

It is concentrated by removal of water and some electrolytes

Question 32

What forms the common bile duct?

Answer 32

The cystic duct + common hepatic duct

Question 33

What colour is the bile duct in specimens? Why?

Answer 33

Green due to leakage of bile

Question 34

Where is the gall bladder found?

Answer 34

Beneath the inferior margin of the liver, beneath the R 9th costal cartilage

Question 35

Where is the bile duct found?

Answer 35

Upper part in the lesser omentum with the hepatic artery and the hepatic portal vein Lower part next to hepatic portal vein and gastroduodenal artery as they pass posterior to the 1st part of the duodenum Then passes within pancreatic tissue-> major duodenal ampulla

Question 36

How may the biliary system be imaged?

Answer 36

By ingestion of iodine, absorbed by the small intestine and carried to the liver. Concentrated in gall bladder

Question 37

Describe the blood supply and drainage of the gall bladder

Answer 37

``` Cystic artery (from hepatic artery) Venous drainage by hepatic portal vein ```

Question 38

What is Murphy's sign?

Answer 38

Breathe out then place hand over gall bladder. On inspiration the patient winces and stops inspiring

Question 39

Describe the pain from gall stones

Answer 39

Poorly localised, travels with sympathetic fibres Epigastrium, R hypochondrium, near R scapula Pain worse after eating a fatty meal (fat stimulates bile production, increased obstructive pain)

Question 40

What is the consequence of a large bile stone obstructing the bile duct

Answer 40

Not enough bile in duodenum, fat can't be properly digested, diarrhoea and pale poo