Region 3 - Abdominal Viscera Flashcards
1
Q
What organs make up the foregut?
A
Distal oesophagus Stomach Liver Spleen Proximal duodenum Part of pancreas
2
Q
What aortic branch supplies the foregut? What vertebral level is it at?
A
Coeliac axis
T12
3
Q
Where does lymph from the foregut drain?
A
Pre-aortic coeliac nodes at T12
4
Q
What is the morphology of the gastric wall from external to internal?
A
Serosa Muscularis externa: - Outer longitudinal - Middle circular - Inner oblique Submucosa Mucosa
5
Q
What is the inside of the stomach folded into when empty?
A
Rugae
6
Q
Approximately, at what level, does the oesophagus enter the stomach?
A
5th-6th ribs
7
Q
What is the approximate level of the trans-pyloric plane?
A
Rib 8/L1 level
8
Q
What is the region of the stomach that is the superior opening?
A
Cardia
9
Q
What is the dilated superior part of the stomach?
A
Fundus
10
Q
What is a feature of the lesser curvature that when drawn with a perpendicular line down from it to the greater curvature, makes up the boundary of the pyloric region?
A
Angular notch
11
Q
What is the arterial supply to the lesser curvature of the stomach? Where do these arteries originate from?
A
Left gastric artery (from coeliac axis)
Right gastric artery (from common hepatic; from coeliac axis)
12
Q
What is the arterial supply to the fundus of the stomach? Where does it originate?
A
Short gastric artery (from splenic artery; from coeliac axis)
13
Q
What is the arterial supply to the greater curvature of the stomach? Where do these originate?
A
Left gastro-omental artery (from splenic; from coeliac axis)
Right gastro-omental artery (from gastroduodenal; from common hepatic; from coeliac axis)
14
Q
Where do the left and right gastric veins drain?
A
Hepatic portal vein
15
Q
Where does the left gastro-omental vein drain to?
A
Splenic vein -> Portal vein
16
Q
Where does the right gastro-omental vein drain to?
A
Superior mesenteric vein -> Portal vein
17
Q
Where does the short gastric vein drain to?
A
Splenic vein -> Portal vein
18
Q
What is the name for the collection of lymph structures around the entrance of the stomach?
A
Cardiac ring
19
Q
What local lymph nodes drain to the coeliac nodes?
A
Gastro-omental Gastric Pyloric Pancreaticosplenic Pancreaticoduodenal
20
Q
What provides PNS innervation to the stomach?
A
Anterior and posterior vagal trunks
21
Q
What provides SNS innervation to the stomach?
A
Greater splanchnic (T5-T9) nerves via coeliac plexus
22
Q
How long is the duodenum?
A
~25cm
23
Q
What is the only part of the duodenum that is intraperitoneal?
A
1st part
24
Q
What is the name given to the folds on the inner surface of the duodenum?
A
Plicae circulares
25
What is the ampulla of Vater?
Hepatopancreatic ampulla; union of:
- Common bile duct
- Pancreatic duct
26
What is the opening of the ampulla of Vater called?
Major duodenal papilla
27
What sphincter controls the flow of bile and pancreatic fluids into the duodenum? What type of muscle is it?
Sphincter of Oddi/Hepatopancreatic sphincter
| Smooth muscle
28
Where does the duodenum lie?
Just right of midline
29
Where does the 1st part of the duodenum lie in relation to the vertebral column?
Anterolateral to L1
30
Where does the 2nd part of the duodenum lie in relation to the vertebral column?
Descends along right sides of L1-L3
31
Where does the 3rd part of the duodenum lie in relation to the vertebral column?
Crosses L3 to left side
32
Where does the 4th part of the duodenum lie in relation to the vertebral column?
Rises up to left of L2
33
Where is the duodenal-jejunal junction located?
3cm left of midline
34
What is the arterial supply of the proximal part of the duodenum?
Superior pancreaticoduodenal artery (from gastroduodenal; from common hepatic; from coeliac axis)
35
What is the arterial supply of the distal part of the duodenum?
Inferior pancreaticoduodenal artery (from superior mesenteric artery)
36
What provides SNS innervation to the duodenum?
Greater and lesser splanchnic nerves (via coeliac and superior mesenteric plexuses)
37
What provides PNS innervation to the duodenum?
Anterior and posterior vagal trunks
38
Where does pain from the duodenum go?
Epigastric region
39
What local nodes drain the proximal duodenum?
Pancreaticoduodenal
Gastroduodenal
Pyloric
40
Where does lymph from the proximal duodenum drain to?
Pre-aortic coeliac nodes at T12
41
What local nodes drain the distal duodenum?
Pancreaticoduodenal
42
Where does lymph from the distal duodenum drain to?
Pre-aortic superior mesenteric nodes at L1
43
What separates the left and right lobes of the liver and attaches it to the anterior abdominal wall? What forms it?
Falciform ligament
| Peritoneum folds back on itself
44
What connects the left posterior part of the upper surface of the liver to the diaphragm?
Left triangular ligament
45
What connects the right posterior part of the upper surface of the liver (bare area) to the diaphragm?
Right triangular ligament
46
What does the coronary ligament form from and form into?
From falciform ligament
| To right triangular ligament
47
Where does the falciform ligament pass to?
Umbilicus
48
What does the falciform ligament contain?
Remnants of umbilical vein - Ligamentum teres
49
What structures are present at the porta hepatis, besides the portal triad?
Right and left hepatic ducts
ANS fibres
Lymph nodes
50
What structures are not present at the porta hepatis? Why?
Hepatic veins
| They are inside liver and drain directly to IVC
51
What is most of the anterior surface of the liver covered by?
Ribs
| Costal cartilages
52
What is the rough level of the gallbladder?
Level of right 9th costal cartilage
53
What structures are associated with the posterior aspect of the liver?
```
Oesophagus
Stomach
Duodenum
Right colic flexure
Right kidney
Right suprarenal gland
Gallbladder
```
54
What part of the liver is not covered in visceral peritoneum and why?
```
Bare area (right posterior)
Diaphragm
```
55
What is the blood supply to the liver?
30% from hepatic artery
| 70% from portal vein
56
What is the route of arterial and venous blood in the liver?
Travels to sinusoids -> Central vein of each lobe -> Right and left hepatic veins (~4) -> IVC
57
What fraction of the total bodily lymph does the liver produce?
1/3 to 1/2
58
Where does most lymph from the liver drain to?
Coeliac nodes
59
Where can a small amount of hepatic lymph drain to?
Posterior mediastinum (via diaphragm)
60
Where does liver pain present?
Epigastric
| Radiates to right shoulder via diaphragm
61
What organ secretes bile?
Liver
62
Where is bile stored?
Gallbladder
63
How long is the common bile duct?
~8cm
64
What makes up the common bile duct?
Common hepatic duct (right + left hepatic ducts)
| Cystic duct
65
What part of the gallbladder joins the cystic duct?
Neck
66
What stimulates the gallbladder to contract and release bile?
Fat in duodenum -> CCK release from small intestine mucosa
67
What is the purpose of bile?
Emulsifies fat
68
What is the arterial supply of the gallbladder?
Cystic artery (from right hepatic; from hepatic artery proper; from common hepatic; from coeliac axis)
69
What is the venous drainage of the gallbladder?
Cystic vein -> Portal vein
70
Where does gallbladder pain present?
Epigastric
71
What is the main component of green or yellow/white gallstones?
Cholesterol
72
What colour are pigment stones and what salts make them up?
Dark (and small)
| Bilirubin and calcium
73
Where does the head of the pancreas lie?
Concavity of duodenum
74
Where does the uncinate process of the pancreas lie?
Behind superior mesenteric vessels
75
What does the neck of the pancreas lie anterior to?
Origin of superior mesenteric artery
76
In what direction does the body of the pancreas run in?
Superolaterally
77
What does the tail of the pancreas run in and what does it contact?
Lienorenal ligament
| Hilus of spleen
78
What lies anterior to the pancreas?
Transverse colon
| Stomach
79
Where does the main duct in the pancreas run from and to?
From tail
| To ampulla of Vater
80
What is the arterial supply of the pancreas?
Dorsal pancreatic artery (from splenic)
Superior pancreaticoduodenal artery (from gastroduodenal; from common hepatic)
Inferior pancreaticoduodenal artery (from sup. mesenteric)
81
What is the venous drainage of the pancreas?
Splenic vein and sup. mesenteric vein -> Portal vein
82
Where does pancreatic lymph drain to?
Coeliac (T12) and superior mesenteric (L1) pre-aortic nodes
83
Where does the spleen lie?
Inferior to ribs 9-11 in left hypochondrium
| Posterior to stomach
84
What does the gastrosplenic ligament carry?
Short gastric vessels
| Gastro-omental vessels
85
What does the lienorenal ligament carry?
Splenic vessels
| Tail of pancrease
86
Where is the midgut?
From halfway along duodenum to 2/3 of transverse colon
87
How long is the jejunum and ileum?
~6m
| Proximal 2/5 is jejunum
88
Which is paler; Jejunum or Ileum?
Ileum
89
The walls of which is thicker with more plicae circularis; Jejunum or Ileum?
Jejunum
90
The bore of which is wider; Jejunum or Ileum?
Jejunum
91
Which has more mesenteric vessel branches from 3-4 arcades; Jejunum or Ileum??
Ileum
92
In which does most of the adipose tissue lie near the root of the mesentery; Jejunum or Ileum?
Jejunum
93
Which has numerous Peyer's patches; Jejunum or Ileum??
Ileum
94
Apart from ileal branches, what supplies the lower ileum?
Ileocolic artery
95
Where does pain from the jejunum and ileum present?
Umbilical region
96
What are haustra?
Sacculations of the colonic wall
97
What is the name for the fatty tags on the large intestine?
Appendices epiplociae
98
What are the longitudinal muscles on the large intestine and how many bands are there?
Teniae coli
| 3 bands
99
What is the arterial supply to the caecum?
Caecal arteries (from ileocolic; from superior mesenteric)
100
Where does the tip of the appendix often lie?
Retroperitoneal
101
Where is the appendix (surface anatomy)?
Right iliac region
| 1/3 of the way along line from ASIS to umbilicus
102
What is the arterial supply to the appendix?
Appendicular artery (terminal branch of ileocolic; from superior mesenteric)
103
What is the venous drainage of the appendix?
Posterior caecal vein
104
How long is the ascending colon?
~15cm
105
What muscles is the ascending colon related to?
Iliacus
| Qudratus lumborum
106
What nerves is the ascending colon related to?
Ilioinguinal and iliohypogastric nerves
107
What is the arterial supply of the ascending colon?
Ileocolic and right colic arteries (from superior mesenteric)
108
How long is the transverse colon?
~38cm
109
What does the transverse colon hang from?
Transverse mesocolon
110
What hangs the left colic flexure from the diaphragm?
Phrenicocolic ligament
111
What is the arterial supply to the transverse colon?
Proximal 2/3rds:
- Middle colic artery (from superior mesenteric)
Distal 1/3rd:
- Left colic artery (from inferior mesenteric)
Both anastomose by the marginal artery of Drummond (in transverse mesocolon)
112
What is the nerve supply to the transverse colon?
```
Superior mesenteric plexus:
- SNS from chain
- PNS from vagus (prox. 2/3rds)
Inferior mesenteric plexus:
- SNS from chain
- PNS from pelvic splanchnic (S2-S4) nn. to distal 1/3rd
```
113
How long is the descending colon?
~25cm
114
What nerves is the descending colon related to?
Femoral
Iliohypogastric
Ilioinguinal
115
What muscles is the descending colon related to?
Psoas
| Quadratus lumborum
116
What is the arterial supply to the descending colon?
Left colic and sigmoid arteries (from inferior mesenteric)
117
What is the nerve supply to the descending colon?
SNS from inferior mesenteric plexus
| PNS from pelvic splanchnic nerves
118
How long is the sigmoid colon?
~25-38cm
119
Where does the sigmoid colon run?
From pelvic brim (in front of left external iliac artery)
| To 3rd sacral vertebra
120
What attaches the sigmoid colon to the posterior pelvic wall?
Pelvic mesocolon
121
What is the arterial supply of the sigmoid colon?
Sigmoid artery (from inferior mesenteric)
122
What is the innervation of the sigmoid colon?
Inferior hypogastric plexus
- SNS from sacral splanchnic nerves
- PNS from pelvic splanchnic nerves
123
How long is the rectum?
~13cm
124
Where does the rectum run?
From 3rd sacral vertebra
| To 2cm anterior to tip of coccyx
125
What is the arterial supply to the rectum?
Superior rectal artery (from inf. mesenteric)
Middle rectal artery (from internal iliac)
Inferior rectal artery (from internal pudendal)
126
What is the venous drainage of the rectum?
Superior 1/3rd:
- Superior rectal vein into portal system via inferior mesenteric vein
Inferior 2/3rds:
- Middle and inferior rectal veins
- Drain to internal iliac and internal pudendal
127
Where does lymph from the rectum drain?
Upper:
- Inferior mesenteric (L3) pre-aortic nodes
Lower:
- Internal iliac nodes
128
What are primary retroperitoneal structures?
Develop posterior to peritoneum and stay that way
129
What are the primary retroperitoneal structures?
Kidneys and ureters (and associated vessels/nerves)
Suprarenal glands (and associated vessels/nerves)
Aorta
IVC
130
What are secondary retroperitoneal structures?
Become covered in peritoneum by end of development
131
What are the secondary retroperitoneal structures?
Most of duodenum
Pancreas
Ascending and descending colon
Upper 2/3rds rectum
132
What are the dimensions of a kidney?
~10-12cm long
| ~6-8cm wide
133
What is the rough vertebral level of a kidney?
L1 (right is usually lower due to liver)
134
What structures lie anterior to the right kidney?
Suprarenal gland
Liver
2nd part of duodenum
Right colic flexure
135
What structures lie posterior to the right kidney?
```
Diaphragm
Rib 12
Psoas
Quadratus lumborum
Transversus abdominis
Subcostal nerve
```
136
What structures lie anterior to the left kidney?
```
Suprarenal gland
Spleen
Stomach
Pancreas
Left colic flexure
Jejunum
```
137
What structures lie posterior to the left kidney?
```
Diaphragm
Ribs 11 and 12
Psoas
Quadratus lumborum
Transversus abdominis
Subcostal nerve
```
138
What is present at the renal hila?
Renal vein
Branches of renal arteries
(Lymph and sympathetic fibres)
139
What renal artery variants are common?
Supernumerary renal arteries
| Polar arteries
140
What parts of the filtration system are in the renal cortex?
Glomeruli
141
What parts of the filtration system are in the renal medullary pyramids?
Loop of Henle
| Collecting ducts
142
What part of the kidney is the part where the medullary pyramids empty into the minor calyces?
Renal papillae
143
Where does the right renal artery lie in relation to the IVC?
Posterior
144
What do the segmental branches of the renal arteries branch into within the kidney?
Lobar
Interlobar
Arcuate
Afferent glomerular arterioles
145
Where do the renal veins drain?
IVC
146
Where does renal lymph drain?
Lateral para-aortic nodes around renal arteries at L1
147
What is the nerve supply to the kidney?
From renal sympathetic plexus
| Afferent fibres to T10-T12
148
What structures does the left renal vein pass behind?
Splenic vein
| Body of pancreas
149
What veins drain to the left renal vein?
Left gonadal vein
| Left suprarenal veins
150
What structure does the right renal vein pass behind?
Descending duodenum (2nd part)
151
What muscle do the ureters run on the surface of?
Psoas muscle
152
What bifurcation does the ureter cross?
Common iliac (anterior to sacro-iliac joint)
153
What pelvic structure does the ureter move towards?
Ischial spine
154
What surface of the bladder does the ureter enter via and at what structure?
Inferior surface
| Trigone
155
What propels urine through the ureter?
Contractions of ureter wall
| Glomerular filtration pressure
156
Where are the ureteric constrictions?
Ureteropelvic junction
Pelvic brim (common iliac bifurcation)
Ureterovesical junction
157
What is the arterial supply to the ureter?
Renal arteries
Gonadal arteries
Superior vesical arteries
158
Where does lymph from the ureters drain?
Lateral para-aortic nodes (L1)
| Iliac nodes
159
Where does the innervation to the ureters arise?
Renal, gonadal and hypogastric plexuses
160
What spinal levels do afferent fibres from the ureters enter?
L1 and L2
161
What colour is the suprarenal cortex?
Yello
162
What does the suprarenal cortex produce and what do these control?
```
Corticoids:
- Fluid
- Electrolytes
Glucocorticoids:
- Carbohydrates
- Fats
- Proteins
```
163
What colour is the suprarenal medulla?
Brown
164
What does the suprarenal medulla produce?
Adrenaline and noradrenaline
165
What is the arterial supply to the suprarenal glands?
Suprarenal branches of:
- Inferior phrenic arteries
- Aorta
- Renal arteries
166
What is the venous drainage of the suprarenal glands?
Single vein on each side:
- Right suprarenal vein to IVC
- Left suprarenal vein to renal vein
167
What shape is the right adrenal gland and where does it lie?
Pyramidal
| Behind right lobe of liver
168
What shape is the left adrenal gland and where does it lie?
```
Crescenteric
Behind:
- Pancreas
- Stomach
- Lesser sac
```
169
What is the nerve supply to the suprarenal glands?
Preganglionic SNS from (greater) splanchnic nerves (usually ending in medulla)
