STRX Week 5, 6 ,7 Flashcards
Outline the lymph drainage from the liver
Anterior of diaphragm and visceral surfaces –> porta hepatis –> hepatic LN –> celiac LN –> cisterna chyli
Posterior of diaphragm and visceral surfaces –> bare area –> phrenic LN –> posterior mediastinal LN –> R lymphatic duct or thoracic duct
What vessels are direct tributaries of the portal vein?
Superior mesenteric
Splenic
Left Gastric
Right Gastric
Outline the arterial supply to the pancreas
Head:
Aorta –> Celiac trunk –> Common Hepatic a –> Gastroduodenal a –> Anterior/Posterior Superior Pancreaticoduodenal arteries
Aorta –> SMA –> Anterior/Posterior Inferior Pancreaticoduodenal arteries
Neck/Body:
Aorta –> Celiac trunk –> Splenic a –> Greater Pancreatic a
Tail:
Aorta –> Celiac trunk –> Splenic a –> Dorsal Pancreatic a
Outline lymphatic drainage of pancreas and spleen
Pancreaticosplenic LN –> Celiac LN
Name the four parts of the duodenum and any significant anatomical landmarks associated with them
Superior - only Intraperitoneal
Descending - where the major duodenal papilla is
Horizontal - sandwiched between SMA/SMV (superior) and Aorta/IVC (posterior)
Ascending - connected to diaphragm by Ligament of Trietz which is landmark to differentiate upper vs lower GI bleeds
How can you differentiate the jejunum from the ileum?
Jejunum:
Almost transparent mesenteric window
Red
Longer Straight arteries (Vasa Recta), less Loops (arcades)
Abundant plicae circulares
Ileum:
Mesentery reaches all the way down
Pink
Shorter Straights, more loops
Few plicae circulares
Peyer’s Patches
What are Lacteals?
Specialized lymphatic vessels in the intestinal villi that absorb fat
Outline the general lymphatic pathway of Chylomicrons
Lacteals –> Juxta-intestinal LN –> Mesenteric LN –> Superior Central LN –> Superior Mesenteric LN –> Intestinal Lymphatic Trunk –> Celiac LN –> Cisterna Chyli
What features of the large intestine help you tell it apart from the small intestine?
Omental appendices
Tenia coli
Haustra
Larger diameter
Outline the blood supply of the large intestine
From SMA –> Ileocolic a –> Ascending colon
SMA –> Right Colic a –> R Colic Flexure
SMA –> Middle Colic a –> Transverse Colon
IMA –> Left Colic a –> Descending Colon
IMA –> Sigmoid a –> Sigmoid Colon
IMA –> Superior Rectal a –> Rectum
From Ileocolic a –> Appendicular a –> Appendix
Explain volvulus and the complications that can arise from it
Rotation and twisting of the mobile loop of sigmoid colon and mesocolon –> acute emergency
Can result in obstruction –> obstipation (inability to pass stool) and ischemia –> necrosis
Outline the parasympathetic innervation from the abdominal viscera after the Left Colic flexure
Terminal ganglia in the wall of the organ –> periarterial plexuses –> inferior mesenteric ganglion –> superior hypogastric plexus –> Inferior hypogastric plexus –> pelvic splanchnic n –> S2-4
What is the porta hepatis?
Opening on inferior surface of the liver where the Portal Vein and Hepatic A. Proper enter the liver, and where the Common Hepatic Duct leaves the liver to reach the Gallbladder
Explain what causes the recanalization of the LIgamentum Teres and what results from it
Portal hypertension causes recanalization of the previously closed off Ligamentum Teres for an alternate blood flow into paraumbilical veins where it anastamoses
Leads to high pressure in periumbilical veins –> caput madusae
