Sievert Embryo / Hulka Anatomy Week 1 Flashcards
1
Q
An abdominal resection is a _______ surgery
a) biliary
b) intestinal
c) gynecologic
d) gastric
A
D gastric
2
Q
A midline incision goes through the ______ and is the strongest area to close. Nerve injury is minimal.
A
linea alba
3
Q
A transverse incision goes through the __________. Nerve injury is minimal but may be weaker incision.
A
external and internal obliques, transversus and possible rectus muscles
4
Q
True/False: Laparoscopic surgery uses small incisions so there are less chances of hernias and quicker recovery
A
True
5
Q
What are three contraindications to laparascopic surgery?
A
prior abdominal surgeries, emergency, advanced pregnancy
6
Q
During laparascopic surgery, the abdomen is filled with CO2. Why is CO2 used rather than O2 and helium?
A
CO2 is not flammable, easily absorbed in body and gotten rid of through exhalation
7
Q
How is advanced pregnancy a contraindication for laparascopic surgery?
A
Can’t give too much CO2 or will cause preterm labor
8
Q
What is a hernia? (basic definition)
A
weakness in the muscle allows a organ to bulge through it. can be either developmental or acquired.
9
Q
____ of men and ___ of women will have an inguinal hernia in their lifetime
A
25, 2
10
Q
List hernias in order of most to least common: epigastric femoral inguinal umbilical ventral/incisional
A
inguinal - 75% ventral/incisional - 10% umbilical - 6% femoral - 3% epigastric - unk
11
Q
True/False: In children, inguinal hernias should not be fixed because they will normally go away
A
FALSE
Won’t go away, will get larger, possibility in incarceration/strangulation
12
Q
True/False: In adults, all hernias should be fixed
A
FALSE
watching waiting for small, asymp hernias is OK but likely will need surgery at some point
13
Q
What is the difference between an incarcerated and strangulated hernia?
A
Incarcerated - cannot be reduced because too occluded
Strangulated - blood supply cut off, risk of infarct
14
Q
Do umbilical hernias normally have to be fixed in children? adults?
A
In children, they will often close by age of 2 years. if they don’t close by then or they are symptomatic, then repair.
In adults, repair.
15
Q
True/False: All muscles of anterior abdominal wall contribute to inguinal canal
A
True
16
Q
The inguinal canal is the _______ aspect of the abdominal wall, located above the fold of the leg and is divided into right and left by the ________
A
inferior, linea alba
17
Q
True/False: Indirect hernias go through Hesselbach’s triangle
A
FALSE - direct do
18
Q
True/False: Indirect hernias go through patent processus vaginalis usually
A
TRUE
19
Q
Body folding incorporates both the gut tube and the coelom in the embryo. How many coelomic cavities are incorporated in the body cavity during folding?
A
2
20
Q
The primitive gut tube is supported btwn the linings of the 2 coelomic sacs called _____. Initially, there is a dorsal and ventral layers the entire length of the gut tube, but the ______ later deteriorates through most of the tube
A
mesenteries; ventral layer
21
Q
As folding progresses, the yolk sac gets pinched down to form a gut tube with a stalk called the ______ connecting to the remaining yolk sac.
A
vitelline duct
22
Q
From which primitive germ layer does the:
a) mucosa and glands of GI
b) surrounding connective tissue and smooth muscle
c) dorsal mesentery
develop?
A
a) mucosa and glands of GI are from endoderm
b) surrounding CT and smooth muscle comes from splanchnic mesoderm of lateral plate
c) splanchnic mesoderm of lateral plate
23
Q
What are the mesenteries? (3 features)
A
- lining of coelomic sacs from each side of the gut tube
- pathways for vessels and nerves to reach abd organs
- persist only when necessary
24
Q
True/False: Retroperitoneal structures include the aorta, vena cava, and kidneys
A
True
25
The dorsal mesentery is found throughout most of the entire length of the abd gut tube. The ventral mesentery, however, is only found in which regions?
The region of the foregut which supports the liver and gall bladder
26
What are the two component of the ventral mesentery that remain in an adult?
lesser omentum, falciform ligament
27
How does the mesentery become 4 layers when it starts out as two?
It is a two layer sac that lays on itself.
| As it pooches out, comes down on stomach and goes back to wall.
28
In what area do the two separate coelomic sacs become one after the ventral mesentery disappears?
below the foregut
| [mid-gut and hindgut in lower cross section]
29
Describe how peritonealization relates to the mesentery.
most of the gut tube has a mesentery initially, but some structures lose their mesentery duringfuture development.
structures that never have a mesentery are primarily retroperitoneal
structures that lose their mesentery are secondarily retroperitoneal
30
Name 4 organs that are secondarily retroperitoneal
- pancreas
- descending colon
- ascending colon
- duodenum
31
Describe the defining boundaries of the
a) foregut
b) midgut
c) hindgut
a) foregut begins just past the opening of the bile duct and pancreatic duct in the duodenum
b) midgut includes the rest of the duodenum to the distal 1/3 of transverse colon
c) hindgut includes the distal 1/3 of the transverse colon to the proximal anal canal
32
Describe the artery to the
a) foregut
b) midgut
c) hindgut
a) foregut - celiac trunk
b) midgut - superior mesenteric artery
c) hindgut - inferior mesenteric artery
33
Describe the rotation of the foregut and how this creates the greater omentum.
The stomach undergoes a 90 degree rotation with the anterior surface turning to the right.
The greater curvature of the stomach expands.
The dorsal mesentery also needs to expand to accomomdate both growth and rotation which creates the greater omentum.
34
Describe the difference between the great omentum and the lesser omentum.
The greater omentum is a large apron-like fold of visceral peritoneum that hangs down from the stomach.
The lesser omentum hangs down from the liver to the lesser curvature of the stomach and first part of duodenum.
35
True/False: The liver, gallbladder and two pancreatic buds are all attached to the duodenum at the same place.
False - only the ventral pancreatic bud is attached to duodenum at same place as liver and gallbladder.
The dorsal pancreatic bud is separate.
36
Differential growth and rotation in the wall of the duodenum moves the opening of the bile duct around to the ______ surface
dorsal surface
37
What happens to the dorsal and ventral pancreatic buds during development?
The dorsal bud eventually merges with the duct from the ventral bud
The ventral bud therefore becomes the main one
Only a short accessory duct remains
38
Describe midgut rotation.
Prior to rotation, the midgut loop is centered on the superior mesenteric artery with the cecum, ascending, transverse, and descending colons in the caudal half of the loop.
Rotation occurs CCW from anterior surface.
Rotation is about 270 degrees around the SMA.
Results of rotation - The 4th part of the duodenum is trapped under the SMA. The colon frames the small bowel around the periphery. The cecum is put in the lower right quadrant. Descending colon on the left side.
39
When does midgut rotation begin and where does it occur?
Midgut rotation starts at about the 10th week when the midgut loops begins to enter the abdomen. The first stages occur outside of the fetus due to rapid growth of the tube relative to the fetus, but the final stages take place in the abd cavity.
40
What is volvulus and why can it be dangerous?
Any form of abnormal rotation of parts of the gut tube.
| This can be dangerous because of potential for disrupting blood supply and causing gangrene.
41
What is gatroschisis?
How common is the occurrence and in which populations is it even more common?
What is the survival rate?
Gastroschisis occurs when the lateral walls of the abdomen do not close completely and the expanding GI tract protrudes through the opening.
1:2K occurrence. More common in young mothers who used alcohol, tobacco, or NSAIDs.
It is not usually assoc with chromosomal abnormalities or other defects, so survival rate after GW35 is excellent
42
How does intestinal damage occur from gastroschisis?
the herniation is lateral to the connecting stalk
not covered by amnion
amniotic fluids damages intestines
causes malabsorption due to intestinal damage
43
What is omphalocele?
How common is this defect?
What is the survival rate?
Omphalocele - herniation of abd viscera through an enlarged umbilical ring; due to a failure of intestinal loops to return to body cavity from umbilical cord after normal herniation during W6-W10.
1/4000 births so common defect
High rate of infant mortality and numerous other severe congenital defects
44
True/False: An omphalocele hernial sac is always covered with the epithelium of the umbilical cord, a derivative of the amnion
TRUE
45
Describe Meckel's or ileal diverticulum.
Most common GI developmental abnormality
Small portion of vitelline duct persists
Therefore, diverticulum is a remnant of the yolk sac.
Affects 2-4% of all people
Asymptomatic
There may be ulceration, bleeding or perforation in the adult however.
46
Describe the rule of 2 in Meckel's diverticulum
2% of popn
2 feet from ileocecal valve
2 inches in length
2% symptomatic
2 types of common ectopic tissue [gastric and pancreatic]
2 years is most common age of presentation
2X more common in males
47
Describe the pectinate line in hindgut development and its significance in terms of sensory innervation.
The portion of the anal canal from the rectum to the pectinate line is derived from endoderm - no sensory innervation - why you can't feel internal hemorrhoids.
The portion of the anal canal from the pectinate line to the anus is derived from the ectoderm - sensory innervation - why you can feel external hemorrhoids.
48
An example of a hindgut abnormality is Hirschsprung disease or aganglionic megacolon. Describe.
Failure of migration of neural crest cells into the developing gut tube.
Affects rectum and sigmoid colon
Results in a section of the gut tube which is lacking ganglia and unable to contract
49
What is an imperforate anus?
There is a persistent anal membrane [no anal opening]
50
What is a rectovaginal fistula or in male rectovesicle?
Rectovaginal fistula - The rectum connects to the vagina
| Rectovesicle - rectum connects to urinary bladder in males
51
Describe the descent of the testes.
The testes develop intraabdominally while the fetus is in utero [retroperitoneal]
The testes descend through the deep ring, down inguinal canal to the scrotum.
- This brings peritoneum with the testicle forming tunica vaginalis
- Communication between the abdomen and the scrotum is called the processus vaginalis. This structure obliterates after birth to become the tunica vaginalis.
52
The deep ring includes what two abdominal muscles
internal oblique
| transversus abdominis
53
The top of the inguinal canal is made up of the ______ and the bottom is the ________
external oblique, inguinal ligament
54
True/False: Indirect hernias tend to be acquired whereas direct tend to be congenital or development
FALSE - the opposite is true.
direct tend to be acquired
indirect tend to be congenital or development [due to patent process vaginalis]
55
What two inner abdominal muscles make up the arching fibers associated with the weak area of the triangle? [their tendons create the conjoint tendon]
transversus abdominis
| internal oblique
56
Where is the weak area of the triangle located?
medial to the deep ring
| in the inguinal triangle
57
Where do femoral hernias tend to protrude? In which sex are they more common?
Through femoral ring below inguinal ligament
| more common in women
58
How do you check for inguinal hernias in men? Women?
Men - invaginate skin between scrotum and penis into the inguinal canal, go through superficial inguinal ring
women - place hand over inguinal canal and have them inc abd pressure
59
The inguinal canal extends from the ______ to the _______
anterior iliac crest, inguinal tubercle
60
How are indirect hernias fixed?
via high ligation of sac
61
How were direct hernias originally fixed? What is the current standard?
Direct hernias were historically treated by bringing the muscles together with sutures but this lead to complications incl inc pain and high recurrence.
Mesh repairs were used from the 1960s to 80s
Led to inflammatory/scar rxns [now put mesh over peritoneum to protect the bowel]
Started to do laparascopic surgeries in 1990s
62
How are inguinal hernias fixed?
Open surgery is used for unilateral, first time hernia repairs, pts with prior lower abd surgery
Laparascopic for bilat or recurrent hernias
63
Fermoral hernias occur inferior to the inguinal ligament. Describe the inferior, medial, and superior borders of femoral hernias
Inferior border - pectineal ligament
Superior border - inguinal ligament
Medial border - lacunar ligament
64
How are femoral hernias usually repaired?
via mesh repair either below the inguinal ligament or above
65
Gastroschisis or omphaloceles develop when muscles do not fuse after bowel extrudes from the abdomen during gestational weeks ______
6-8
66
There are many theories as to the cause of abdominal wall defects. What is one that involves an umbilical artery?
Most likely due to obliteration of right umbilical artery which causes a wall defect
67
How was gastroschisis treated in the past versus now?
Before, would just shove organs into abdomen. However, since lungs are huge and bad cavity is very small in this infant it is better to silo the organs in a dependent position and over the course of a few days, move them in to stretch out the abdominal cavity.
68
The internal oblique muscle gives rise to the ______
cremaster muscle
69
Describe the cremasteric reflex and its afferent/efferent paths.
Stroking of the inner thigh --> elevation of ipsilateral testicle
Afferent path - spinal cord at L1,L2
Efferent path - genitofemoral nerve to cremaster muscle
70
An absent cremasteric reflex is highly (96%) specific for what condition?
testicular torsion
surgical emergency
[within 6 hours - still 90% effective in salvaging testicle]
71
What is a hydrocele?
liquid in the area of the tunica vaginalis
| water next to the testicle basically
72
The ______ connects the liver to the peritoneum
falsiform
73
Name the three folds and their components
1) Median umbilical fold=obliterated urachus
2) Medial umbilical fold=obliterated umbilical artery
3) Lateral umbilical fold=inferior epigastric vessels
74
Describe the types of cells that are part of the
a) neurogenic
b) myogenic
components of GI neurophysiology
a) neurogenic - CNS, ENS
| b) myogenic - interstitial cells of cajal, smooth? muscle
75
The abdominal aorta is a continuation of the _______ and begins at the ______ as it enters the abdomen through the diaphragm at the _____ vertebral level
thoracic aorta, aortic hiatus, T12-L1
76
How and where does the abdominal aorta end?
It ends by dividing into 2 common iliac arteries above the pelvis at the L4-L5 vertebral level.
77
True/False: Almost every organ in the abdominal cavity gets its blood supply from more than one place.
True - DUE TO COLLATERAL CIRCULATION
78
What are the seven major branches off the abdominal aorta? Which are mesenteric?
```
phrenic branch
celiac trunk - mesenteric
superior mesenteric artery - mesenteric
inferior mesenteric artery - mesenteric
renal arteries
gonadal arteries
lumbar arteries
```
79
The phrenic branch is the first branch off the aorta and runs inferior to the _______. it gives rise to one of the _____ arteries and blood supply to the inferior surface of the ______
diaphragm, adrenal, diaphragm
80
Basically, the phrenic branch gives branches to the ______ and ______
adrenal gland, diaphragm
81
The celiac branch is the first ____ branch of aorta and arises at approximately the ____ vertebral level.
mesenteric, T12
82
What are the three branches off the celiac trunk?
left gastric, common hepatic, splenic
83
The left gastric artery exits the celiac trunk to the ___ and courses towards the ______ of the stomach. It provides blood supply to the ______ and _____
left, right side, lower esophagus, lesser curvature of the stomach
84
With further branching, the left gastric artery gives off the _____
esophageal arteries [give off two branches to the stomach and upper stomach]
85
The common hepatic artery exits the celiac trunk to the ______ and courses behind the _______ to the liver. It provides blood supply to what three organs?
right, stomach;
| lower stomach, liver, duodenum
86
The common hepatic artery further branches to the _______ which branches to the duodenum and ______ and the ________ which provides arterial supply to the liver
gastroduodenal artery; duodenum and pancreas; proper hepatic artery
87
The splenic artery, the third branch from the celiac trunk, exits the celiac trunk from the ______ and courses behind the stomach along the top of the ______ to the spleen
left, pancreas
88
The splenic artery gives off three branches. What are they?
- pancreatic branches along superior portion of pancreas
- short gastric branches to the greater curvature of the stomach
- left gastro-omental artery to the greater curvature of the stomach
89
The _________ is the second mesenteric branch of the abdominal aorta and arises at about the ___ vertebral level, usually directly behind the _______
superior mesenteric artery, L1, pancreas
90
What are the five branches of the superior mesenteric artery?
1) inferior pancreaticoduodenal artery
2) jejunal and ileal arteries
3) ileocolic artery
4) right colic artery
5) middle colic artery
91
The inferior pancreaticoduodenal arteries are _____ and ______ arteries around the C-loop of the _______ and head of ________. They provide blood supply to these two organs.
anterior, posterior
C-loop of the duodenum
head of pancreas
92
The first branch of the superior mesenteric artery is the __________
inferior pancreaticoduodenal artery
93
Describe collateral circulation in terms of the pancreas and duodenum.
Part of the pancreas and duodenum gets it blood supply from the celiac trunk, another part comes from the SMA
94
The jejunal and ileal arteries give off approximately 15-18 branches and are found within the __________. They provide blood supply to the _____
mesentery of the bowel; small bowel [jejunem and ileum]
95
True/False: if there was a blockage of the superior mesenteric artery, you could lose all of small intestine, right colon and part of transverse colon
true
96
The ileocolic artery is the _______ branch anatomically of the SMA and is found within the _________. It provides blood supply to the ________
distal
mesentery of the bowel
terminal ileum and cecum
[ ileum=end of small intestine; cecum=start of colon]
97
The _________ is the second colonic branch of the SMA and is found within the _________. It provides blood supply to the ______
right colic artery; mesentery of the bowel; right colon
98
The first part of the colon is the ______
right colon
99
The _______ is the first colonic branch of the superior mesenteric artery and the last part of the colon whose blood supply provided by the SMA. It is found within the ________ and provides blood supply to the _________
middle colic, mensentery of the bowel, transverse colon
100
The _______ is the third mesenteric branch off the abdominal aorta and arises at approximately the ______ vertebral level, inferior to the ______
inferior mesenteric, L3, renal arteries
101
The inferior mesenteric artery provides blood supply to what three organs?
1) left colon
2) sigmoid
3) part of rectum
102
What are the three branches of the inferior mesenteric artery?
1) left colic artery
2) sigmoid branches
3) superior rectus branch
103
The left colic artery is the first branch off the IMA. It is found within the _______ and provides blood supply to the ______ from the _____ to the _____
mesentery of the bowel, left colon, splenic flexure, sigmoid colon
104
The sigmoid branches are the second branch off the IMA. They are found within the ______ and provide blood supply to the _______
mesentery of the bowel, sigmoid colon
105
The superior rectal branch is the terminal branch of the IMA. It is found within the ________ and provides blood supply to the ________
mesentery of the bowel, superior rectum
106
Describe the collateral circulation between the superior mesenteric artery and the celiac axis.
The celiac trunk gives off the common hepatic artery which gives off the gastroduodenal artery, which gives off the superior pancreaticoduodenal arteries that connect to the inferior pancreaticoduodenal arteries of the SMA
107
Describe the areas of collateral circulation between the superior mesenteric artery and the inferior mesenteric artery
around the splenic flexure
SMA gives off middle colic artery which gives off marginal artery of drummond (near bowel wall) and arc of riolan (more proximal)
which connect to the left colic artery off the IMA
108
Describe the areas of collateral circulation between the IMA and iliac arteries
around rectum
Inferior mesenteric artery gives off superior rectal artery.
The internal iliac artery from the end of the abdominal aorta branches off into the middle and inferior rectal arteries
109
Renal arteries usually arise off the aorta between the _____ and _____ branches at approximately ____. They are the arterial supply to the kidneys and are usually single branches but may have up to ______ to each kidney
SMA, IMA, L2, three branches
110
Gonadal arteries usually branch off the aorta or less often the ________. If they branch off the aorta, it is usually at the _____ vertebral level. They are the arterial supply to the testicles and ovaries.
renal arteries, L2
111
The ______ arise off aorta at each lumbar vertebral levels. They have _____ and _____ branches that lead to the lumbar spine and spinal cord. They provide the arterial supply to the ________ and to the _______
lumbar arteries, anterior, posterior, musculature in the back, spinal cord
112
The anterior branches of the lumbar arteries supply the _________ and _______ abdominal wall. They pass around the abdominal wall and collaterize to the ________ in the anterior abdominal wall
anterior, lateral, inferior epigastric artery
113
The posterior branches of the lumbar arteries supply the ______ and ______. The _______ arise from these branches which give rise to the ______ at each nerve level
spinal cord, erector spinae muscles, spinal arteries, radicular arteries
114
What is the largest radicular artery called? What does it supply and from where does it come off?
spinal artery of adamkiewicz; inferior spinal cord; t7 and t11
115
Venous drainage of the vena cava begins at the __________ at the confluence of the ________, at approximately ____ vertebral level.
inferior vena cava, common iliac veins, L5
116
The inferior vena cava ascends to the right of the _______ and runs posterior to the _____, through diaphragm into the ________
abdominal aorta, liver, right atrium
117
Name the 4 branches off the inferior vena cava. Which are the main ones.
1) Renal veins - main ones
2) gonadal veins
3) hepatic veins
4) lumbar veins
118
Renal veins drain into the inferior vena cava from each kidney, usually _______. Veins run _____ to renal arteries and usually are the _____
one branch, anterior, L2 level
119
The _______ is very long and crosses under the superior mesenteric artery, under the pancreas and over the duodenum. In contrast, the ________ is longer and goes behind the vena cava
left renal VEIN, right renal ARTERY
120
The gonadal veins also come off the IVC. The ________ drains directly into the ___ renal vein and ______ drains into the IVC. These veins are usually found at the ___ level
left gonadal artery, left renal vein, right gonadal, L2
121
There are ____ branches of hepatic veins that drain directly into the IVC along the superior aspect of the _____ just below the diaphragm. What are these branches called?
three, liver
| right, middle, and left hepatic veins
122
There are ____ paired branches of lumbar veins that come off from IVC at each _____. There is much variation in their location. They usually unite into the ______
4-5, vertebral level, ascending lumbar vein
123
______ allows venous drainage from the bowel to be cleared by the hepatic system before entering systemic circulation
mesenteric drainage
124
In hepatopedal circulation, The inferior mesenteric vein drains the ______ and ______ and unites with the splenic vein
sigmoid and descending colon
125
In hepatopedal circulation, the superior mesenteric vein unites with the splenic vein to form the _____.
hepatic portal vein
126
What three structures does the superior mesenteric vein drain?
small bowel, right and transverse colon
127
Other mesenteric branches of the hepatopedal circulation include the esophageal veins that drain the _____ and the gastric veins that drain the _____ into the ______
lower esophagus, stomach, portal vein
128
What happens to hepatopedal flow to liver in cirrhosis?
Because of scarring, the hepatopedal flow to the liver decreases and this increases pressure in the venous system. The venous system distends which leads to engorged veins the esophagus, stomach, spleen and intestines (portal HTN)
129
Engorged esophageal or gastric veins due to portal HTN are called what?
varicies!
130
The _____ is the largest gland in the body and accounts for ___ of body weight
liver, 2%
131
What are the four functions of liver?
1) glycogen stores
2) produces bile
3) protein production - coagulation factors
4) filter of enteric circulation
132
What are the two surfaces of the liver?
diaphragmatic and visceral
133
Describe the diaphragmatic surface of the liver
superior, posterior, and right lateral spect that lays next to diaphragm
134
Describe the visceral surface of the liver
The visceral surface is the inferior portion that lies on the stomach, duodenum, gallbladder, lesser omentum, right colic flexure of colon
anterior surface of stomach
first and second portion of duodenum
135
What are visceral surface landmarks of the liver?
- H shaped fissures that define liver into four lobes
136
The cross-bar of each H-shaped fissure is the _____
porta hepatis
137
The porta hepatis is a _____ in the center of the inferior liver and contains what five structures.
fissure
1) portal vein
2) hepatic artery
3) common bile duct
4) lymphatics
5) hepatic nerve plexus
138
What is the bare area of the liver?
it is the posterior liver [diaphragmatic surface]
| it is the part of the liver that is in direct contact with diaphragm and IVC runs thru the bare area
139
The _______ divides the left and right lobe of the liver
falciform ligament
140
How definitive lobes does the liver have and how are they divided?
right lobe - right of falciform ligament
| left lobe - left of falciform ligament
141
True/False: Each lobe has its own arterial, venous and biliary system
True
142
There are two smaller lobes within the right lobe of the liver. What are they?
Quadrate lobe and caudate lobe
143
Where does the quadrate lobe lie?
The quadrate lobe lies between the gallbladder and falciform ligament, inferior to the porta
144
Where does the caudate lobe lie?
The caudate lobe lies between the IVC and ligamentum venosum, superior the porta
145
The falciform ligament develops from the ______ and is attached to the _______. It terminates in the ______ of the liver as the _______
umbilicus, anterior abdominal wall, bare area, coronary ligament
146
There are antepartum and postpartum versions of the falciform ligament.
The antepartum contains the umbilical vein.
| The postpartum version contains the ligamentum teres (remnant)
147
The liver is divided into right and left lobes by the __________
falciform ligament
148
The coronary ligament begins at the ____ aspect of the liver where the falciform ligament terminates. It surrounds the ______ of the liver
superior, bare area
149
The coronary ligament divides the bare area into the ________ surrounded by the ________ and _______ surrounded by the ________
left lateral aspect [left triangular ligament]
| right lateral aspect [right triangular ligament]
150
The ________ begins at the left triangular ligament and terminates in the _______. This is part of the __________.
hepatogastric ligament, lesser curvature of the stomach, lesser omentum
151
The hepatogastric ligament contains the ______ arteries, veins and lymphatics
gastric
152
The hepatoduodenal ligament begins along the _____ and terminates along the C loop of the ______. It is part of the ______ and contains the peripancreatic lymphatics
caudate lobe, duodenum, lesser omentum
153
The lesser omentum contains the ______ and ______ ligaments. The portal triade runs along the freee dge of the lesser omentum and contains which three structures?
hepatogastric, hepatoduodenal
portal vein, common bile duct, proper hepatic artery
154
What are the two blood supplies to the liver?
```
hepatic artery (30%)
portal vein (70%)
```
155
As reviewed earlier, the common hepatic artery is a branch off the celiac trunk. It gives off gastroduodenal and _______ branches and becomes the ________
right gastroepiploic, proper hepatic artery
156
The proper hepatic artery ascends along the free edge of the lesser omentum as part of the portal triad and divides in the the _______ and ______
right hepatic artery
| left hepatic artery
157
What variations are seen in the proper hepatic arteries branches and why are they important?
Approximately 10% of left hepatic arteries arise from left gastric artery instead of proper hepatic
Approximately 1-2% of right hepatic arteries will arise from superior mesenteric artery
It is important because can cause damage during surgery if there is a variation
158
The portal vein, formed by the confluence of the superior mesenteric vein and splenic vein, runs posterior the the _______ and _______. It divides into _________ and ______
bile duct, proper hepatic artery,
right portal vein
left portal vein
159
There are three hepatic veins located on the superior aspect of the liver that drain into the IVC. What are they and what portion of the liver do they drain?
right - drains right lobe
middle - drains caudate lobe
left - drains left lobe
160
There are two hepatic veins that are located on the posterior aspect of the liver that drain into the IVC. These include 6-18 branches that drain the ______, ________ and _____ lobes
caudate, quadrate, right
161
When an entire liver is replaced, the surgeon will take the entire ________ so that multiple posterior branches are not sacrified
inferior vena cava
162
Describe the lymphatic drainage of the liver
The superior and anterior portions drain into PARASTERNAL LYMPH NODES.
The inferior portions drain into HEPATIC LYMPH NODES in the porta hepatis and GASTRIC LYMPH NODES in the lesser omentum
163
The liver produces bile which drains through the _________. Small _____ bile ducts coalesce to form larger ducts
biliary system, intralobular
164
The right and left hepatic ducts form the ________. Approximately 3-5 cm down, the ______ from the gallbladder also drains into this structure. Afterward, it becomes becomes the _______
common hepatic duct, cystic duct, common bile duct
165
Basically, the common bile duct is formed once the _______ joins the _______
cystic duct, common hepatic duct
166
The common bile duct travels down the _______ into the head of the pancreas where it joins the ______
porta hepatis, pancreatic duct
167
The common bile and pancreatic ducts drain into the second portion of the duodenum through the ________
sphincter of oddi
168
Gallstones can exit the gallbladder through the cystic duct and block the common bile duct in a condition known as ________
choledocholithiasis
169
Describe the symptoms of choledocholithiasis
pain, jaundice, nausea, vomiting
170
What kind of scope can be used to evaluate choledocholithiasis
endoscopic retrograde cholangiopancreatogram (ERCP)
171
The gallbladder is a pear-shaped organ attached to the _____ lobe of the liver. It stores bile. When does it drain this bile
right
| drains when stomach stimulates gallbladder to empty via CCK
172
WHat are the four portions of the gallbladder?
fundus (wide end)
body (main)
neck (narrow, tapered)
cystic duct (cont w/ neck, drains into common hepatic duct)
173
True/False: the cystic duct position can vary considerably so care has to be taken to prevent injuries
true
relation to cystic artery, common bile duct, and right hepatic artery may change
174
The ________ arises from the right hepatic artery and supplies the gallbladder. THere are multiple variations in position in relation to the _____ duct
cystic artery, cystic
175
Venous drainage from the gallbladder drains into the ________ or ______
portal vein, liver directly
176
Lymphatic drainage from the gallbladder occurs via the _________ which is found at the confluence of the _____ and ________.
cystic lymph node; cystic duct and common hepatic duct
177
The cystic lymph node ultimately drains into the _____ and _____ lymph nodes
hepatic, celiac
178
What is biliary colic and how is it treated?
Gallstones lodge in the neck or cystic duct leading to a colicky pain in the RUQ.
Treatment is via cholecystectomy, usually laparascopic
179
Describe the exocrine and endocrine functions of the pancreas
Exocrine=external excretions pancreatic enzymes into duodenum through pancreatic duct
ENdocrine=internal secretions of insulin and glucagon into blood directly
180
The pancreas lies in the ______ behind the stomach in the _______ over the spine.
retroperitoneum, lesser sac
181
How does the duodenum run in relation to the pancreas?
The duodenum runs along the right and inferior portions of the pancreas
182
Where does the pancreas end?
In the hilum of the spleen in the LUQ
183
The _______ of the pancreas lies within the C loop of the duodenum. Posteriorly, it lays on the ____ and ______
head
IVC
right renal vessels
184
The _______ comes down from the porta hepatis and enters the head of the pancreas. It joins with the ________ and exits into the duodenum
common bile duct, pancreatic duct
185
True/False: The common bile duct and the pancreatic duct always form a short common channel before entering the second portion of the duodenum
false, sometimes don't form a channel
| sometimes the channel is long and includes the "sphincter of ampulla"
186
The head of the pancreas contains the _______ which lies inferior to the superior mesenteric vessels and rests against the aorta
uncinate process
187
The ______ of the pancreas is continuous with the head at approximately where the ________ cross the pancreas
neck, superior mesenteric vessels
188
The _____ of the pancreas is continuous with the neck and is the portion of the pancreas to the left of the _____ that extends superiorly. It has an anterior, posterior and inferior surface
body, aorta
189
The ____ of the pancreas is continuous with the body and crosses through the ____ with the splenic vessels. It terminates in the hilum of the _____
tail, ilenorenal ligament, spleen
190
The pancreas develops as two separate buds. The dorsal bud becomes the ____ and the ventral bud becomes the ______ which later fuse to form the pancreatic gland
main, uncinate process
191
The main pancreatic duct begins in the ____ of the pancreas within the dorsal pancreatic duct.
tail
192
The proximal pancreatic duct is formed by the ________ [ventral pancreatic duct]
uncinate process [part of the head]
193
The proximal part of the dorsal pancreatic duct in the head of the pancreas is the __________
accessory pancreatic duct
194
The main pancreatic duct joints with the common bile duct to form the _________
hepatopancreatic ampulla (ampulla of vater)
195
The Whipple procedure is used to treat pancreatic cancer and involves cutting the ______ and _____
pancreas, duodenum
196
True/False: The accessory pancreatic duct is always connected to the main pancreatic duct
False, 90%
can be a separate duct that drains into the duodenum
197
Pancreatic cancer usually develops in the _____ of the pancreas and presents with back pain, jaundice, and weight loss
head
198
Symptoms of pancreatic cancer often occur when what gets blocked?
common bile duct
199
What are the three sources of pancreatic blood supply?
superior pancreaticoduodenal arteries (head)
inferior pancreaticoduodenal arteries (head)
dorsal pancreatic artery (neck, body, tail)
200
Describe the venous drainage of the pancreas
Most of pancreas drains into the splenic vein
201
What are the three lymph nodes that drain the pancreas?
pancreaticosplenic [along superior aspect]
pyloric [along head]
celiac [along draining veins]
202
The ________ is the largest lymph tissue in the body
spleen
203
What are the functions of the spleen?
filter old RBC's
| clear antigens
204
Describe where the spleen is located
left upper abdomen
against diaphragm
behind stomach
205
What are the 2 attachments of the spleen?
1) gastrolienal ligament - attachment to stomach
| 2) lieorenal ligament - attachment to left kidney
206
The spleen is divided into an ______ and _____ pole which are divided by the _____
superior, inferior, hilum
207
The splenic artery runs along the _____ aspect of the pancreas to enter the splenic hilum then divides into 3-5 branches
superior
208
The ______ is formed by smaller veins draining the splenic parenchyma and also runs along the superior aspect of the pancreas
splenic vein
