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B3 > Sievert Embryo / Hulka Anatomy Week 1 > Flashcards

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

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2
Q

A midline incision goes through the ______ and is the strongest area to close. Nerve injury is minimal.

A

linea alba

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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

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4
Q

True/False: Laparoscopic surgery uses small incisions so there are less chances of hernias and quicker recovery

A

True

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5
Q

What are three contraindications to laparascopic surgery?

A

prior abdominal surgeries, emergency, advanced pregnancy

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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

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7
Q

How is advanced pregnancy a contraindication for laparascopic surgery?

A

Can’t give too much CO2 or will cause preterm labor

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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.

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9
Q

____ of men and ___ of women will have an inguinal hernia in their lifetime

A

25, 2

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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
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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

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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

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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

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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.

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15
Q

True/False: All muscles of anterior abdominal wall contribute to inguinal canal

A

True

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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

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17
Q

True/False: Indirect hernias go through Hesselbach’s triangle

A

FALSE - direct do

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18
Q

True/False: Indirect hernias go through patent processus vaginalis usually

A

TRUE

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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

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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

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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

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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

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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
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24
Q

True/False: Retroperitoneal structures include the aorta, vena cava, and kidneys

A

True

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25
Q

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?

A

The region of the foregut which supports the liver and gall bladder

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26
Q

What are the two component of the ventral mesentery that remain in an adult?

A

lesser omentum, falciform ligament

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27
Q

How does the mesentery become 4 layers when it starts out as two?

A

It is a two layer sac that lays on itself.

As it pooches out, comes down on stomach and goes back to wall.

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28
Q

In what area do the two separate coelomic sacs become one after the ventral mesentery disappears?

A

below the foregut

[mid-gut and hindgut in lower cross section]

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29
Q

Describe how peritonealization relates to the mesentery.

A

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

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30
Q

Name 4 organs that are secondarily retroperitoneal

A
  • pancreas
  • descending colon
  • ascending colon
  • duodenum
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31
Q

Describe the defining boundaries of the

a) foregut
b) midgut
c) hindgut

A

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

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32
Q

Describe the artery to the

a) foregut
b) midgut
c) hindgut

A

a) foregut - celiac trunk
b) midgut - superior mesenteric artery
c) hindgut - inferior mesenteric artery

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33
Q

Describe the rotation of the foregut and how this creates the greater omentum.

A

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.

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34
Q

Describe the difference between the great omentum and the lesser omentum.

A

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.

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35
Q

True/False: The liver, gallbladder and two pancreatic buds are all attached to the duodenum at the same place.

A

False - only the ventral pancreatic bud is attached to duodenum at same place as liver and gallbladder.

The dorsal pancreatic bud is separate.

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36
Q

Differential growth and rotation in the wall of the duodenum moves the opening of the bile duct around to the ______ surface

A

dorsal surface

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37
Q

What happens to the dorsal and ventral pancreatic buds during development?

A

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

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38
Q

Describe midgut rotation.

A

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.

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39
Q

When does midgut rotation begin and where does it occur?

A

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.

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40
Q

What is volvulus and why can it be dangerous?

A

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.

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41
Q

What is gatroschisis?
How common is the occurrence and in which populations is it even more common?
What is the survival rate?

A

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

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42
Q

How does intestinal damage occur from gastroschisis?

A

the herniation is lateral to the connecting stalk
not covered by amnion
amniotic fluids damages intestines
causes malabsorption due to intestinal damage

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43
Q

What is omphalocele?
How common is this defect?
What is the survival rate?

A

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

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44
Q

True/False: An omphalocele hernial sac is always covered with the epithelium of the umbilical cord, a derivative of the amnion

A

TRUE

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45
Q

Describe Meckel’s or ileal diverticulum.

A

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.

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46
Q

Describe the rule of 2 in Meckel’s diverticulum

A

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

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47
Q

Describe the pectinate line in hindgut development and its significance in terms of sensory innervation.

A

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.

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48
Q

An example of a hindgut abnormality is Hirschsprung disease or aganglionic megacolon. Describe.

A

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

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49
Q

What is an imperforate anus?

A

There is a persistent anal membrane [no anal opening]

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50
Q

What is a rectovaginal fistula or in male rectovesicle?

A

Rectovaginal fistula - The rectum connects to the vagina

Rectovesicle - rectum connects to urinary bladder in males

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51
Q

Describe the descent of the testes.

A

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.

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52
Q

The deep ring includes what two abdominal muscles

A

internal oblique

transversus abdominis

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53
Q

The top of the inguinal canal is made up of the ______ and the bottom is the ________

A

external oblique, inguinal ligament

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54
Q

True/False: Indirect hernias tend to be acquired whereas direct tend to be congenital or development

A

FALSE - the opposite is true.
direct tend to be acquired
indirect tend to be congenital or development [due to patent process vaginalis]

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55
Q

What two inner abdominal muscles make up the arching fibers associated with the weak area of the triangle? [their tendons create the conjoint tendon]

A

transversus abdominis

internal oblique

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56
Q

Where is the weak area of the triangle located?

A

medial to the deep ring

in the inguinal triangle

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57
Q

Where do femoral hernias tend to protrude? In which sex are they more common?

A

Through femoral ring below inguinal ligament

more common in women

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58
Q

How do you check for inguinal hernias in men? Women?

A

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

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59
Q

The inguinal canal extends from the ______ to the _______

A

anterior iliac crest, inguinal tubercle

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60
Q

How are indirect hernias fixed?

A

via high ligation of sac

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61
Q

How were direct hernias originally fixed? What is the current standard?

A

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

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62
Q

How are inguinal hernias fixed?

A

Open surgery is used for unilateral, first time hernia repairs, pts with prior lower abd surgery

Laparascopic for bilat or recurrent hernias

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63
Q

Fermoral hernias occur inferior to the inguinal ligament. Describe the inferior, medial, and superior borders of femoral hernias

A

Inferior border - pectineal ligament
Superior border - inguinal ligament
Medial border - lacunar ligament

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64
Q

How are femoral hernias usually repaired?

A

via mesh repair either below the inguinal ligament or above

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65
Q

Gastroschisis or omphaloceles develop when muscles do not fuse after bowel extrudes from the abdomen during gestational weeks ______

A

6-8

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66
Q

There are many theories as to the cause of abdominal wall defects. What is one that involves an umbilical artery?

A

Most likely due to obliteration of right umbilical artery which causes a wall defect

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67
Q

How was gastroschisis treated in the past versus now?

A

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.

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68
Q

The internal oblique muscle gives rise to the ______

A

cremaster muscle

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69
Q

Describe the cremasteric reflex and its afferent/efferent paths.

A

Stroking of the inner thigh –> elevation of ipsilateral testicle

Afferent path - spinal cord at L1,L2
Efferent path - genitofemoral nerve to cremaster muscle

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70
Q

An absent cremasteric reflex is highly (96%) specific for what condition?

A

testicular torsion
surgical emergency
[within 6 hours - still 90% effective in salvaging testicle]

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71
Q

What is a hydrocele?

A

liquid in the area of the tunica vaginalis

water next to the testicle basically

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72
Q

The ______ connects the liver to the peritoneum

A

falsiform

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73
Q

Name the three folds and their components

A

1) Median umbilical fold=obliterated urachus
2) Medial umbilical fold=obliterated umbilical artery
3) Lateral umbilical fold=inferior epigastric vessels

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74
Q

Describe the types of cells that are part of the
a) neurogenic
b) myogenic
components of GI neurophysiology

A

a) neurogenic - CNS, ENS

b) myogenic - interstitial cells of cajal, smooth? muscle

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75
Q

The abdominal aorta is a continuation of the _______ and begins at the ______ as it enters the abdomen through the diaphragm at the _____ vertebral level

A

thoracic aorta, aortic hiatus, T12-L1

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76
Q

How and where does the abdominal aorta end?

A

It ends by dividing into 2 common iliac arteries above the pelvis at the L4-L5 vertebral level.

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77
Q

True/False: Almost every organ in the abdominal cavity gets its blood supply from more than one place.

A

True - DUE TO COLLATERAL CIRCULATION

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78
Q

What are the seven major branches off the abdominal aorta? Which are mesenteric?

A 
phrenic branch
celiac trunk - mesenteric
superior mesenteric artery - mesenteric
inferior mesenteric artery - mesenteric
renal arteries
gonadal arteries
lumbar arteries
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79
Q

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 ______

A

diaphragm, adrenal, diaphragm

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80
Q

Basically, the phrenic branch gives branches to the ______ and ______

A

adrenal gland, diaphragm

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81
Q

The celiac branch is the first ____ branch of aorta and arises at approximately the ____ vertebral level.

A

mesenteric, T12

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82
Q

What are the three branches off the celiac trunk?

A

left gastric, common hepatic, splenic

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83
Q

The left gastric artery exits the celiac trunk to the ___ and courses towards the ______ of the stomach. It provides blood supply to the ______ and _____

A

left, right side, lower esophagus, lesser curvature of the stomach

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84
Q

With further branching, the left gastric artery gives off the _____

A

esophageal arteries [give off two branches to the stomach and upper stomach]

85
Q

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?

A

right, stomach;

lower stomach, liver, duodenum

86
Q

The common hepatic artery further branches to the _______ which branches to the duodenum and ______ and the ________ which provides arterial supply to the liver

A

gastroduodenal artery; duodenum and pancreas; proper hepatic artery

87
Q

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

A

left, pancreas

88
Q

The splenic artery gives off three branches. What are they?

A
  • 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
Q

The _________ is the second mesenteric branch of the abdominal aorta and arises at about the ___ vertebral level, usually directly behind the _______

A

superior mesenteric artery, L1, pancreas

90
Q

What are the five branches of the superior mesenteric artery?

A

1) inferior pancreaticoduodenal artery
2) jejunal and ileal arteries
3) ileocolic artery
4) right colic artery
5) middle colic artery

91
Q

The inferior pancreaticoduodenal arteries are _____ and ______ arteries around the C-loop of the _______ and head of ________. They provide blood supply to these two organs.

A

anterior, posterior
C-loop of the duodenum
head of pancreas

92
Q

The first branch of the superior mesenteric artery is the __________

A

inferior pancreaticoduodenal artery

93
Q

Describe collateral circulation in terms of the pancreas and duodenum.

A

Part of the pancreas and duodenum gets it blood supply from the celiac trunk, another part comes from the SMA

94
Q

The jejunal and ileal arteries give off approximately 15-18 branches and are found within the __________. They provide blood supply to the _____

A

mesentery of the bowel; small bowel [jejunem and ileum]

95
Q

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

A

true

96
Q

The ileocolic artery is the _______ branch anatomically of the SMA and is found within the _________. It provides blood supply to the ________

A

distal
mesentery of the bowel
terminal ileum and cecum

[ ileum=end of small intestine; cecum=start of colon]

97
Q

The _________ is the second colonic branch of the SMA and is found within the _________. It provides blood supply to the ______

A

right colic artery; mesentery of the bowel; right colon

98
Q

The first part of the colon is the ______

A

right colon

99
Q

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 _________

A

middle colic, mensentery of the bowel, transverse colon

100
Q

The _______ is the third mesenteric branch off the abdominal aorta and arises at approximately the ______ vertebral level, inferior to the ______

A

inferior mesenteric, L3, renal arteries

101
Q

The inferior mesenteric artery provides blood supply to what three organs?

A

1) left colon
2) sigmoid
3) part of rectum

102
Q

What are the three branches of the inferior mesenteric artery?

A

1) left colic artery
2) sigmoid branches
3) superior rectus branch

103
Q

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 _____

A

mesentery of the bowel, left colon, splenic flexure, sigmoid colon

104
Q

The sigmoid branches are the second branch off the IMA. They are found within the ______ and provide blood supply to the _______

A

mesentery of the bowel, sigmoid colon

105
Q

The superior rectal branch is the terminal branch of the IMA. It is found within the ________ and provides blood supply to the ________

A

mesentery of the bowel, superior rectum

106
Q

Describe the collateral circulation between the superior mesenteric artery and the celiac axis.

A

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
Q

Describe the areas of collateral circulation between the superior mesenteric artery and the inferior mesenteric artery

A

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
Q

Describe the areas of collateral circulation between the IMA and iliac arteries

A

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
Q

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

A

SMA, IMA, L2, three branches

110
Q

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.

A

renal arteries, L2

111
Q

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 _______

A

lumbar arteries, anterior, posterior, musculature in the back, spinal cord

112
Q

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

A

anterior, lateral, inferior epigastric artery

113
Q

The posterior branches of the lumbar arteries supply the ______ and ______. The _______ arise from these branches which give rise to the ______ at each nerve level

A

spinal cord, erector spinae muscles, spinal arteries, radicular arteries

114
Q

What is the largest radicular artery called? What does it supply and from where does it come off?

A

spinal artery of adamkiewicz; inferior spinal cord; t7 and t11

115
Q

Venous drainage of the vena cava begins at the __________ at the confluence of the ________, at approximately ____ vertebral level.

A

inferior vena cava, common iliac veins, L5

116
Q

The inferior vena cava ascends to the right of the _______ and runs posterior to the _____, through diaphragm into the ________

A

abdominal aorta, liver, right atrium

117
Q

Name the 4 branches off the inferior vena cava. Which are the main ones.

A

1) Renal veins - main ones
2) gonadal veins
3) hepatic veins
4) lumbar veins

118
Q

Renal veins drain into the inferior vena cava from each kidney, usually _______. Veins run _____ to renal arteries and usually are the _____

A

one branch, anterior, L2 level

119
Q

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

A

left renal VEIN, right renal ARTERY

120
Q

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

A

left gonadal artery, left renal vein, right gonadal, L2

121
Q

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?

A

three, liver

right, middle, and left hepatic veins

122
Q

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 ______

A

4-5, vertebral level, ascending lumbar vein

123
Q

______ allows venous drainage from the bowel to be cleared by the hepatic system before entering systemic circulation

A

mesenteric drainage

124
Q

In hepatopedal circulation, The inferior mesenteric vein drains the ______ and ______ and unites with the splenic vein

A

sigmoid and descending colon

125
Q

In hepatopedal circulation, the superior mesenteric vein unites with the splenic vein to form the _____.

A

hepatic portal vein

126
Q

What three structures does the superior mesenteric vein drain?

A

small bowel, right and transverse colon

127
Q

Other mesenteric branches of the hepatopedal circulation include the esophageal veins that drain the _____ and the gastric veins that drain the _____ into the ______

A

lower esophagus, stomach, portal vein

128
Q

What happens to hepatopedal flow to liver in cirrhosis?

A

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
Q

Engorged esophageal or gastric veins due to portal HTN are called what?

A

varicies!

130
Q

The _____ is the largest gland in the body and accounts for ___ of body weight

A

liver, 2%

131
Q

What are the four functions of liver?

A

1) glycogen stores
2) produces bile
3) protein production - coagulation factors
4) filter of enteric circulation

132
Q

What are the two surfaces of the liver?

A

diaphragmatic and visceral

133
Q

Describe the diaphragmatic surface of the liver

A

superior, posterior, and right lateral spect that lays next to diaphragm

134
Q

Describe the visceral surface of the liver

A

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
Q

What are visceral surface landmarks of the liver?

A
  • H shaped fissures that define liver into four lobes
136
Q

The cross-bar of each H-shaped fissure is the _____

A

porta hepatis

137
Q

The porta hepatis is a _____ in the center of the inferior liver and contains what five structures.

A

fissure

1) portal vein
2) hepatic artery
3) common bile duct
4) lymphatics
5) hepatic nerve plexus

138
Q

What is the bare area of the liver?

A

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
Q

The _______ divides the left and right lobe of the liver

A

falciform ligament

140
Q

How definitive lobes does the liver have and how are they divided?

A

right lobe - right of falciform ligament

left lobe - left of falciform ligament

141
Q

True/False: Each lobe has its own arterial, venous and biliary system

A

True

142
Q

There are two smaller lobes within the right lobe of the liver. What are they?

A

Quadrate lobe and caudate lobe

143
Q

Where does the quadrate lobe lie?

A

The quadrate lobe lies between the gallbladder and falciform ligament, inferior to the porta

144
Q

Where does the caudate lobe lie?

A

The caudate lobe lies between the IVC and ligamentum venosum, superior the porta

145
Q

The falciform ligament develops from the ______ and is attached to the _______. It terminates in the ______ of the liver as the _______

A

umbilicus, anterior abdominal wall, bare area, coronary ligament

146
Q

There are antepartum and postpartum versions of the falciform ligament.

A

The antepartum contains the umbilical vein.

The postpartum version contains the ligamentum teres (remnant)

147
Q

The liver is divided into right and left lobes by the __________

A

falciform ligament

148
Q

The coronary ligament begins at the ____ aspect of the liver where the falciform ligament terminates. It surrounds the ______ of the liver

A

superior, bare area

149
Q

The coronary ligament divides the bare area into the ________ surrounded by the ________ and _______ surrounded by the ________

A

left lateral aspect [left triangular ligament]

right lateral aspect [right triangular ligament]

150
Q

The ________ begins at the left triangular ligament and terminates in the _______. This is part of the __________.

A

hepatogastric ligament, lesser curvature of the stomach, lesser omentum

151
Q

The hepatogastric ligament contains the ______ arteries, veins and lymphatics

A

gastric

152
Q

The hepatoduodenal ligament begins along the _____ and terminates along the C loop of the ______. It is part of the ______ and contains the peripancreatic lymphatics

A

caudate lobe, duodenum, lesser omentum

153
Q

The lesser omentum contains the ______ and ______ ligaments. The portal triade runs along the freee dge of the lesser omentum and contains which three structures?

A

hepatogastric, hepatoduodenal

portal vein, common bile duct, proper hepatic artery

154
Q

What are the two blood supplies to the liver?

A 
hepatic artery (30%)
portal vein (70%)
155
Q

As reviewed earlier, the common hepatic artery is a branch off the celiac trunk. It gives off gastroduodenal and _______ branches and becomes the ________

A

right gastroepiploic, proper hepatic artery

156
Q

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 ______

A

right hepatic artery

left hepatic artery

157
Q

What variations are seen in the proper hepatic arteries branches and why are they important?

A

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
Q

The portal vein, formed by the confluence of the superior mesenteric vein and splenic vein, runs posterior the the _______ and _______. It divides into _________ and ______

A

bile duct, proper hepatic artery,
right portal vein
left portal vein

159
Q

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?

A

right - drains right lobe
middle - drains caudate lobe
left - drains left lobe

160
Q

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

A

caudate, quadrate, right

161
Q

When an entire liver is replaced, the surgeon will take the entire ________ so that multiple posterior branches are not sacrified

A

inferior vena cava

162
Q

Describe the lymphatic drainage of the liver

A

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
Q

The liver produces bile which drains through the _________. Small _____ bile ducts coalesce to form larger ducts

A

biliary system, intralobular

164
Q

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 _______

A

common hepatic duct, cystic duct, common bile duct

165
Q

Basically, the common bile duct is formed once the _______ joins the _______

A

cystic duct, common hepatic duct

166
Q

The common bile duct travels down the _______ into the head of the pancreas where it joins the ______

A

porta hepatis, pancreatic duct

167
Q

The common bile and pancreatic ducts drain into the second portion of the duodenum through the ________

A

sphincter of oddi

168
Q

Gallstones can exit the gallbladder through the cystic duct and block the common bile duct in a condition known as ________

A

choledocholithiasis

169
Q

Describe the symptoms of choledocholithiasis

A

pain, jaundice, nausea, vomiting

170
Q

What kind of scope can be used to evaluate choledocholithiasis

A

endoscopic retrograde cholangiopancreatogram (ERCP)

171
Q

The gallbladder is a pear-shaped organ attached to the _____ lobe of the liver. It stores bile. When does it drain this bile

A

right

drains when stomach stimulates gallbladder to empty via CCK

172
Q

WHat are the four portions of the gallbladder?

A

fundus (wide end)
body (main)
neck (narrow, tapered)
cystic duct (cont w/ neck, drains into common hepatic duct)

173
Q

True/False: the cystic duct position can vary considerably so care has to be taken to prevent injuries

A

true

relation to cystic artery, common bile duct, and right hepatic artery may change

174
Q

The ________ arises from the right hepatic artery and supplies the gallbladder. THere are multiple variations in position in relation to the _____ duct

A

cystic artery, cystic

175
Q

Venous drainage from the gallbladder drains into the ________ or ______

A

portal vein, liver directly

176
Q

Lymphatic drainage from the gallbladder occurs via the _________ which is found at the confluence of the _____ and ________.

A

cystic lymph node; cystic duct and common hepatic duct

177
Q

The cystic lymph node ultimately drains into the _____ and _____ lymph nodes

A

hepatic, celiac

178
Q

What is biliary colic and how is it treated?

A

Gallstones lodge in the neck or cystic duct leading to a colicky pain in the RUQ.

Treatment is via cholecystectomy, usually laparascopic

179
Q

Describe the exocrine and endocrine functions of the pancreas

A

Exocrine=external excretions pancreatic enzymes into duodenum through pancreatic duct
ENdocrine=internal secretions of insulin and glucagon into blood directly

180
Q

The pancreas lies in the ______ behind the stomach in the _______ over the spine.

A

retroperitoneum, lesser sac

181
Q

How does the duodenum run in relation to the pancreas?

A

The duodenum runs along the right and inferior portions of the pancreas

182
Q

Where does the pancreas end?

A

In the hilum of the spleen in the LUQ

183
Q

The _______ of the pancreas lies within the C loop of the duodenum. Posteriorly, it lays on the ____ and ______

A

head
IVC
right renal vessels

184
Q

The _______ comes down from the porta hepatis and enters the head of the pancreas. It joins with the ________ and exits into the duodenum

A

common bile duct, pancreatic duct

185
Q

True/False: The common bile duct and the pancreatic duct always form a short common channel before entering the second portion of the duodenum

A

false, sometimes don’t form a channel

sometimes the channel is long and includes the “sphincter of ampulla”

186
Q

The head of the pancreas contains the _______ which lies inferior to the superior mesenteric vessels and rests against the aorta

A

uncinate process

187
Q

The ______ of the pancreas is continuous with the head at approximately where the ________ cross the pancreas

A

neck, superior mesenteric vessels

188
Q

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

A

body, aorta

189
Q

The ____ of the pancreas is continuous with the body and crosses through the ____ with the splenic vessels. It terminates in the hilum of the _____

A

tail, ilenorenal ligament, spleen

190
Q

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

A

main, uncinate process

191
Q

The main pancreatic duct begins in the ____ of the pancreas within the dorsal pancreatic duct.

A

tail

192
Q

The proximal pancreatic duct is formed by the ________ [ventral pancreatic duct]

A

uncinate process [part of the head]

193
Q

The proximal part of the dorsal pancreatic duct in the head of the pancreas is the __________

A

accessory pancreatic duct

194
Q

The main pancreatic duct joints with the common bile duct to form the _________

A

hepatopancreatic ampulla (ampulla of vater)

195
Q

The Whipple procedure is used to treat pancreatic cancer and involves cutting the ______ and _____

A

pancreas, duodenum

196
Q

True/False: The accessory pancreatic duct is always connected to the main pancreatic duct

A

False, 90%

can be a separate duct that drains into the duodenum

197
Q

Pancreatic cancer usually develops in the _____ of the pancreas and presents with back pain, jaundice, and weight loss

A

head

198
Q

Symptoms of pancreatic cancer often occur when what gets blocked?

A

common bile duct

199
Q

What are the three sources of pancreatic blood supply?

A

superior pancreaticoduodenal arteries (head)
inferior pancreaticoduodenal arteries (head)
dorsal pancreatic artery (neck, body, tail)

200
Q

Describe the venous drainage of the pancreas

A

Most of pancreas drains into the splenic vein

201
Q

What are the three lymph nodes that drain the pancreas?

A

pancreaticosplenic [along superior aspect]
pyloric [along head]
celiac [along draining veins]

202
Q

The ________ is the largest lymph tissue in the body

A

spleen

203
Q

What are the functions of the spleen?

A

filter old RBC’s

clear antigens

204
Q

Describe where the spleen is located

A

left upper abdomen
against diaphragm
behind stomach

205
Q

What are the 2 attachments of the spleen?

A

1) gastrolienal ligament - attachment to stomach

2) lieorenal ligament - attachment to left kidney

206
Q

The spleen is divided into an ______ and _____ pole which are divided by the _____

A

superior, inferior, hilum

207
Q

The splenic artery runs along the _____ aspect of the pancreas to enter the splenic hilum then divides into 3-5 branches

A

superior

208
Q

The ______ is formed by smaller veins draining the splenic parenchyma and also runs along the superior aspect of the pancreas

A

splenic vein

B3 (7 decks)

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