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ANPH 205 > The Abdomen > Flashcards

The Abdomen Flashcards

1
Q

What are the margins of the abdomen?

A

The inferior margin of the thorax to the superior margin of the pelvic bones.

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2
Q

Does the inferior margin of the abdomen have a defined border?

A

No, since the abdomen and pelvic cavity are connected.

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3
Q

Where is the abdomen in reference to the abdominopelvic cavity?

A

Superior

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4
Q

Where is the diaphragm in reference to the liver?

A

The diaphragm is located superior, posterior and anterior to the liver.

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5
Q

What area is directly inferior to the abdomen?

A

The pelvis

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6
Q

What lines the abdomen?

A

Peritoneum

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7
Q

What is peritoneum?

A

Membrane that covers viscera and abdominal wall.

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8
Q

What is the largest organ in the body?

A

The liver

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9
Q

Is the liver retroperitoneal or intraperitoneal?

A

Intraperitoneal

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10
Q

What two things cover the external surface of the liver?

A

1) The Glisson’s capsule

2) Visceral peritoneum

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11
Q

What is the size and shape of the liver?

A

Triangular shape when viewed from the anterior, size is variable.

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12
Q

What are the functions of the liver?

A

1) Metabolic activities
2) The production and secretion of bile
3) Filtration of the blood

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13
Q

What quadrant is the liver found in?

A

Primarily right upper quadrant, left lobe crosses into left upper quadrant.

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14
Q

What region/s is the liver found in?

A

Right hypochondrium and part of epigastric regions

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15
Q

In thin patients, what region may the liver be found in?

A

Left hypochondrium

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16
Q

What 3 structures are located posterior to the liver?

A

1) Aorta
2) IVC
3) Spine

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17
Q

What 3 structures are located left lateral to the liver?

A

1) Stomach
2) Spleen
3) Left Kidney

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18
Q

What 3 structures are located inferior to the liver?

A

1) Right kidney
2) Gall bladder
3) Right colon

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19
Q

Describe the diaphragmatic surface of the liver:

A
  • Dome shape (takes convex shape of diaphragm surface)

- Smooth surface

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20
Q

What surfaces of the liver are in contact with the diaphragm?

A

Superior, posterior and anterior

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21
Q

What surfaces of the liver does the peritoneal membrane cover?

A

Most of the anterior and superior surface

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22
Q

Where is the “bare area” of the liver and what does this mean?

A

The bare area is on the posterior surface of the liver, it has no peritoneum.

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23
Q

What are the boundaries of the bare area on the liver?

A
  • Coronary and triangular ligaments

- Includes a groove for the IVC

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24
Q

What divides the anterior surface of the liver?

A

The falciform ligament.

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25
Q

Describe the visceral surface of the liver?

A
  • Inferior surface
  • Oblique orientation
  • Covered with peritoneum
  • In contact with several abdominal organs that form grooves/undulations on the surface
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26
Q

In the traditional method, how was the liver divided into left and right lobes?

A

The falciform ligament visible on the anterior surface.

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27
Q

In the traditional method, what divided the quadrate and caudate lobe?

A

Ligaments

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28
Q

How many lobes in the traditional method?

A

4

Left, Right, Quadrate, Caudate

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29
Q

In the traditional method what lobes were also considered part of the right lobe?

A

The quadrate and caudate lobes.

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30
Q

What is the current method used to divide the liver?

A

The functional or segmental method

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31
Q

How many lobes in the functional method and how are they divided?

A

3 (Right, left, Caudate)

Divided by hepatic function

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32
Q

What are lobes?

A

Divisions according to anatomy

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33
Q

What are segments?

A

Divisions according to function

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34
Q

Describe the imaginary plane used to divide the liver into true right and left functional lobes?

A

A line connecting the gallbladder fossa to the IVC, it runs along the main lobar fissure as well as the middle hepatic vein.

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35
Q

How is the right lobe divided?

A

Anterior and posterior segments

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36
Q

What divides the right lobe into anterior and posterior segments?

A

The right intersegmental fissure.

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37
Q

How is the left lobe divided?

A

Medial and lateral segments

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38
Q

What divides the left lobe into medial and lateral segments?

A

The left intersegmental fissure.

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39
Q

What runs within the right intersegmental fissure.

A

The right hepatic vein and right portal vein.

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40
Q

What runs within the left intersegmental fissure?

A

The left hepatic vein, left portal vein and the ligamentum teres.

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41
Q

Where is the caudate lobe located?

A

Posterior and superior in the liver.

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42
Q

Where does the caudate lobe receive blood from?

A

Both right and left sides of liver.

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43
Q

How is the liver divided according to the couinade segmentation classification?

A

8 segments, numbered clockwise from 1-8

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44
Q

What number is the caudate lobe according to the couinaud segmentation classification?

A

1

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45
Q

How is the liver divided in the longitudinal plane in the couinaud segmentation classification?

A

Three major hepatic veins divide liver into 4 sections

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46
Q

How is the liver divided in the transverse plain according to the couinaud segmentation classification?

A

Right and left portal veins divide 4 sections into superior and inferior subsections.

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47
Q

Describe a segment of the liver from the couinade segmentation classification?

A

Each segment has a branch of the portal vein at it’s centre and a hepatic vein at its periphery.

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48
Q

Which is bigger, left or right lobe?

A

Right

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49
Q

What separates the left lobe from the right?

A

Imaginary line from gallbladder fossa to IVC

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50
Q

What structures outline the boundary between the left and right lobes?

A

Main lobar fissure, middle hepatic vein, galbladder to IVC

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51
Q

What lobe is found lateral to the imaginary boundary between the left and right lobes?

A

Right lobe

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52
Q

What divides the right lobe into anterior and posterior segments?

A

Right intersegmental fissure (RIF)

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53
Q

On ultrasound how is the RIF distinguished?

A

By the right hepatic vein inferiorly and the right portal vein inferiorly.

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54
Q

What is immediately left of the anterior segment of the right lobe?

A

The medial left lobe

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55
Q

What area is the left lobe found in the body?

A

Left Upper Quadrant or epigastrium

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56
Q

What divides the left lobe into medial and lateral segments?

A

The left intersegmental fissure.

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57
Q

What was the medial segment of the left lobe formally known as?

A

The quadrate lobe.

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58
Q

What is the smallest lobe in the liver?

A

Caudate

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59
Q

Where is the caudate lobe located?

A

In the superior posterior aspect of the liver.

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60
Q

What is the anterior boundary to the caudate lobe?

A

Left portal vein and ligamentum venosum

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61
Q

What is the posterior boundary of the caudate lobe?

A

The IVC

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62
Q

What is the Reidel’s lobe?

A

A normal variant of the liver where the inferior right lobe extends caudally to the iliac crests.

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63
Q

Describe what ligaments and peritoneal attachments are and what they do.

A

They are fibrous, stretchy attachments that tether organs in place (the liver to the abdominal wall).

  • They form the boundaries for the lobes and segments of the liver
  • They are great UT landmarks
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64
Q

What is the falciform ligament?

A

A peritoneal fold that runs along the anterior surface of the liver from the diaphragm to the umbilicus.

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65
Q

What does the falciform ligament connect?

A

The liver to the diaphragm and anterior abdominal wall.

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66
Q

What ligament is the falciform ligament continuous with and where?

A

The ligamentum teres on the visceral surface.

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67
Q

In the traditional method what does the falciform ligament divide?

A

The left and right lobes.

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68
Q

What spaces does the falciform ligament divide?

A

The left and right subphrenic spaces.

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69
Q

What is the ligamentum teres?

A

The remnant of the fetal left umbilical vein, it arises from the umbilicus and extends posteriorly on the inferior surface of the liver to join the ligamentum venosum.

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70
Q

What does the ligamentum teres connect?

A

Connects to the falciform ligament on the anterior inferior surface of the liver.

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71
Q

What is another name for the ligamentum teres?

A

Round ligament.

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72
Q

What does the ligamentum teres divide?

A

The Left lobe into medial and lateral segments.

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73
Q

Can the ligamentum teres be identified on UT?

A

Yes.

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74
Q

What is the ligamentum venosum?

A

It is the obliterated remnant of the ductus venosus of the fetus, it runs posteriorly from ligamentum teres at level of porta hepatis on the visceral surface of the liver.

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75
Q

What does the ligamentum venosum divide?

A

The left lateral lobe and the caudate lobe of the liver.

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76
Q

What does the ligamentum venosum attach?

A

Attaches the inferior surface of the liver to the stomach/duodenum.

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77
Q

Can the ligamentum venosum be identified on UT?

A

Yes

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78
Q

What is a fissure?

A

A groove/cleft or deep furrow in an organ that forms a natural division.

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79
Q

What does the right intersegmental fissure divide?

A

The right lobe into anterior and posterior segments.

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80
Q

What travels through the right intersegmental fissure fissure superiorly?

A

Right hepatic vein

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81
Q

What courses through the right intersegmental fissure inferiorly?

A

Right portal vein

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82
Q

What are the two other names for the main lobar fissure?

A

1) Middle intersegmental fissure

2) Interlobar fissure

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83
Q

What does the MLF divide?

A

The functional right and left lobe

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84
Q

What travels through the MLF superiorly?

A

Middle hepatic vein

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85
Q

In transverse plane, what does the MLF line up with?

A

Line from the gall bladder to the IVC

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86
Q

What does the MLF look like and where can it be found on UT?

A

In a sagittal plane the MLF can be seen as a hyperechoic line superior to the gallbladder neck extending to the right portal vein.

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87
Q

What does the left intersegmental fissure divide?

A

The medial and lateral segments of the left lobe.

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88
Q

How is the left intersegmental fissure divided?

A

Into thirds.

Cranial, middle and caudal.

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89
Q

What structure is found in the cranial portion of the left intersegmental fissure?

A

Left hepatic vein

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90
Q

What structure is found in the middle portion of the left intersegmental fissure?

A

The anterior portion of the left portal vein

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91
Q

What structure is found in the caudal portion of the left intersegmental fissure?

A

The ligamentum teres

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92
Q

Where do they hepatic veins drain blood?

A

From the liver into the IVC

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93
Q

What direction to the hepatic veins travel?

A

They course from an inferior-anterior aspect of the liver to the superior-posterior aspect and into the IVC.

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94
Q

How many hepatic veins are there?

A

Three

Right, middle and left

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95
Q

How common are accessory hepatic veins?

A

30% of the population

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96
Q

Where do the hepatic veins join the IVC?

A

Just inferior to the diaphragm

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97
Q

Where do the hepatic veins widen?

A

As they approach the IVC

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98
Q

What does the right hepatic vein drain?

A

The right lobe

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99
Q

What does the left hepatic vein drain?

A

The left lobe

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100
Q

What does the middle hepatic vein drain?

A

The medial left lobe (quadrate) and the anterior segment of right lobe.

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101
Q

What do the hepatic veins mark within couinaud’s segments?

A

The lateral boundaries

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102
Q

Describe the brightness of the hepatic veins?

A

The walls are less hyperechoic than the portal veins

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103
Q

Are the hepatic veins long or short axis in transverse/sagittal planes?

A

The hepatic veins are long axis in both sagittal and transverse planes because they travel obliquely through the liver.

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104
Q

How much blood does the hepatic artery supply to the liver?

A

20-30%

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105
Q

What/where does the hepatic artery branch from?

A

It is the right branch of the celiac axis, branches towards the liver.

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106
Q

What artery travels from the celiac axis to the gastroduodenal artery (GDA)?

A

Common hepatic artery

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107
Q

What direction does the common hepatic artery travel?

A

Towards the right side

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108
Q

What artery travels from gastroduodenal artery to the bifurcation of the right and left hepatic arteries?

A

Hepatic artery proper

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109
Q

What direction does the hepatic artery proper travel?

A

Courses superior and right lateral toward and into the liver.

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110
Q

What is the porta hepatis?

A

The entrance/exit of the liver

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111
Q

What enters/exits the liver via the porta hepatis?

A

Arteries, veins, ducts

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112
Q

What is another name for the porta hepatis?

A

The ‘hilum’ of the liver

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113
Q

What does the portal triad consist of?

A

1) A hepatic artery
2) A portal vein
3) A bile duct

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114
Q

What is the portal triad at the region of the porta hepatis composed of?

A

1) The hepatic artery
2) The main portal vein
3) Common Bile Duct

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115
Q

What is located anterior to the main portal vein and medial to common bile duct?

A

Hepatic artery proper

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116
Q

Are the right and left hepatic arteries intrahepatic?

A

Yes, they are within the liver.

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117
Q

What do the right and left hepatic arteries travel in unison with?

A

A billary duct and corresponding portal vein.

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118
Q

What does the right hepatic artery supply?

A

Mainly right lobe with branches to caudate

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119
Q

What does the left hepatic artery supply?

A

Mainly left lobe

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120
Q

How much nutrient rich blood does the portal system supply the liver with?

A

70-80%

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121
Q

Where does the portal system receive it’s nutrient rich blood from?

A

The gastrointestinal (GI) system

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122
Q

Is the blood from the portal system high in oxygen or low?

A

Low because it drains from gastric but nutrient dense.

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123
Q

Do vessels of the portal system connect directly to the IVC?

A

No!

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124
Q

Where does the blood from the portal veins flow?

A

Toward and within the lobes of the liver

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125
Q

What forms the main portal vein?

A

The union of the superior mesenteric vein (SMV) and the splenic vein (SV)

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126
Q

Where is the main portal vein formed?

A

Behind the neck of the pancreas at the level of L2

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127
Q

How do portal veins differ from the hepatic veins on UT?

A

The portal veins have bright vessel walls

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128
Q

What does the superior mesenteric vein drain?

A

The small intestine (right side), ascending colon and transverse colon.

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129
Q

What direction does the SMV course?

A

Superiorly

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130
Q

What vessel does the SMV meet superiorly and where?

A

The SMV meets the splenic vein at the portal confluence

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131
Q

What happens to the distal end of the SMV?

A

It terminates posterior to the pancreatic neck

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132
Q

Where is the SMV located to the SMA?

A

The SMV is located to the right side of the SMA

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133
Q

What does the splenic vein drain?

A

The spleen, other tributaries from pancreas and stomach

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134
Q

What is the portal confluence?

A

The junction of the SMV with SV.

Origin of the main portal vein.

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135
Q

How does the portal confluence appear on UT?

A

It’s a widened area seen in the transverse plane

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136
Q

Where does the splenic vein travel?

A

Travels along the posterior surface of the pancreatic body and tail.

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137
Q

Where does the splenic vein meet the SMV?

A

The SV courses from the hilum of the spleen to meet the SMV on the right side of the midline

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138
Q

What direction does the splenic vein course towards the splenic artery?

A

Inferior

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139
Q

Where does the splenic vein terminate?

A

Behind the neck of the pancreas

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140
Q

What is the splenic vein located anterior to?

A

Aorta, IVC, SMA and renal vessels

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141
Q

What does the Inferior mesenteric vein drain?

A

The left side of the small bowel, descending colon, sigmoid and rectum.

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142
Q

Where does the IMV join the splenic vein?

A

Posterior to the body of the pancreas (left of midline).

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143
Q

Is the IMV seen on UT?

A

Rarely.

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144
Q

Look at UT pictures in notes.

A

.

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145
Q

Where is the origin of the main portal vein?

A

Junction of the SMV and SV

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146
Q

Where is the main portal vein formed?

A

Behind the neck of pancreas

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147
Q

Describe the travel of the main portal vein.

A

Ascends obliquely towards the right side of the body and enters the liver at the porta hepatis

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148
Q

Where is the main portal vein in reference to the hepatic artery proper?

A

Posterior

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149
Q

Where is the main portal vein located in reference to the CBD and CHD billary ducts?

A

Posterior

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150
Q

What happens to the main portal vein at the liver hilum?

A

It bifurcates into the left and right portal veins.

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151
Q

Where is the main portal vein in reference to the duodenum?

A

Posterior

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152
Q

Where is the main portal vein located in reference to the IVC?

A

Posterior

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153
Q

What encloses the main portal vein?

A

The free edge of the lesser omentum

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154
Q

How does the right portal vein divide?

A

Divides into anterior and posterior branches within the right lobe of the liver.

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155
Q

How does the left portal vein travel?

A

Ascends anteriorly

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156
Q

How does the left portal vein divide?

A

Divides into medial and lateral branches within the left lobe of the liver.

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157
Q

What type of blood supply does the liver have and what makes it up?

A

Dual

The hepatic artery and the portal vein.

20-30% from hepatic artery

70-80% from portal vein

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158
Q

What does the biliary system do?

A

Produces, concentrates, secretes and transports bile from liver to the duodenum

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159
Q

Where is bile formed?

A

In the liver cells and drains through the ducts

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160
Q

What is bile used for?

A

Digestion of fatty foods.

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161
Q

Where is the biliary system located?

A

Right upper quadrant, right hypochondrium, epigastric region

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162
Q

What is the purpose of the gall bladder?

A

Storage of bile

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163
Q

Is any bile produced in the gall bladder?

A

NO

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164
Q

What is the shape of the gallbladder?

A

Oblong, pear

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165
Q

Where is the gall bladder in reference to the peritoneum?

A

Intraperitoneal

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166
Q

Is the gall bladder attached to anything?

A

Peritoneum binds the neck and body of the gallbladder to the liver.

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167
Q

Is the gallbladder a landmark?

A

Yes, it is the anterior landmark dividing the left and right lobe of liver.

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168
Q

What does the gallbladder line up with?

A

The main lobar fissure

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169
Q

Where does the gallbladder lie in reference to the IVC?

A

Lateral to IVC

170
Q

Where does the gallbladder lie in reference to the right kidney?

A

Medial to the right kidney

171
Q

How is the gallbladder divided?

A

Neck, body and fundus

172
Q

What is a good way to optimize an image of the gallbladder?

A

Fasting, patient will be less gassy and the gallbladder will be full of bile and easy to see.

173
Q

Describe the “neck” of the gallbadder.

A

Narrow, superior portion of gallbladder that is fixed in place.

174
Q

What part of the gall bladder does the main lobar fissure extend from?

A

MLB extends from neck of the gallbladder to the RPV.

175
Q

What is the body of the gallbladder?

A

The middle portion between the neck and the fundus

176
Q

What is the fundus of the gallbladder?

A

The mobile inferior and anterior portion of the gallbladder.

177
Q

Where can the gall bladder sometimes extend?

A

Beyond the inferior margin of right lobe of liver

178
Q

What is a phrygian cap?

A

A normal variant in the gallbladder where there is a fold in the fundus.

179
Q

What are junctional folds?

A

Normal variants in the liver where there is a fold at the junction of the neck and body.

180
Q

What is a hartmann pouch?

A

Small posterior pouch near gall bladder neck.

181
Q

What is the duct system?

A

A pathway way of ducts collecting and transporting bile secreted by the liver to the small intestine.

182
Q

How is the duct system subdivided?

A

Intrahepatic and extrahepatic ducts

183
Q

What is the ductal network that has several branches along it’s bath called?

A

Biliary tree

184
Q

What are intrahepatic ductules?

A

Very small bile ducts within the liver collecting bile secretions from liver tissue

185
Q

In what direction do intrahepatic ductules get larger?

A

Along the biliary tree

186
Q

What course do the intrahepatic ductules follow?

A

The course of the portal veins and hepatic arterial branches.

187
Q

Are intrahepatic ductules seen on UT?

A

Rarely in normal conditions.

188
Q

What makes up the portal triad?

A

1) Hepatic artery
2) Portal Vein
3) Bile duct

189
Q

Where does the right hepatic duct collect bile from?

A

Right lobe of liver

190
Q

Where foes the left hepatic duct collect bile from?

A

Left lobe of liver

191
Q

Where do the right and left hepatic ducts join?

A

Roughly at the hilum (porta hepatus)

192
Q

What is the RHD? LHD?

A

Right hepatic duct

Left hepatic duct

193
Q

What is the CHD?

A

Common hepatic duct

194
Q

Where is the common hepatic duct formed?

A

At the junction of left and right hepatic ducts

195
Q

What does the distal segment of the CHD course alongside?

A

The anterior aspect of the right/main portal vein.

196
Q

Where does the common hepatic duct terminate?

A

At the junction of the cystic duct

197
Q

Is the common hepatic duct seen with UT?

A

Not usually

198
Q

What does the cystic duct do?

A

Drains the gallbladder

199
Q

What does the cystic duct contain?

A

Spiral valves of Heister

200
Q

What are the spiral valves of Heister?

A

They are mucosal folds that provide structural support

201
Q

Do the spiral valves of Heister act as “true valves” and control flow?

A

No, they just provide support.

202
Q

What does the cystic duct merge with to form the Common Bile Duct?

A

The Common hepatic duct

203
Q

What is the common bile duct formed by?

A

The union of the cystic duct and the common hepatic duct

204
Q

Is the cystic duct seen by UT?

A

Rarely

205
Q

Where does the common bile duct travel?

A

The CBD travels inferiorly toward the head of the pancreas to join the pancreatic duct

206
Q

What does the junction between the pancreatic duct and the common bile duct form?

A

The ampulla of Vater

207
Q

What does the ampulla of vater do?

A

Dumps bile into the duodenum via the sphincter of Oddi

208
Q

What controls the flow of bile into the duodenum?

A

The sphincter of oddi

209
Q

What is the difference between the ampulla of vator and the sphincter of oddi?

A

The ampulla of vator is the door frame (hole) into the duodenum and the sphincter of Oddi is the door.

210
Q

How long is the common bile duct?

A

6-8 cm long

211
Q

What lies posterior to the common bile duct?

A

The main portal vein

212
Q

What lies medial to the common bile duct?

A

The hepatic artery proper

213
Q

What does the distal common bile duct travel alongside?

A

The posterior aspect of the head of pancreas

214
Q

What is the pancreas?

A

An elongated, lobuar gland

215
Q

What does lobular mean?

A

Lumpy/bumpy

216
Q

How does the pancreas lie?

A

Generally transverse and oblique across the midline and extends towards the spleen.

217
Q

What area/level is the pancreas?

A

Transpyloric level

Pylorus region (epigastric)

218
Q

Does the pancreas have a capsule?

A

No and it is difficult to distinguish on UT because of it.

219
Q

Where is the pancreas in reference to the peritoneum?

A

Retroperitoneal except for a small part of the tail.

220
Q

What types of glands does the pancreas have?

A

Endocrine and exocrine

221
Q

How much of the pancreas is exocrine?

A

99%

222
Q

How much of the pancreas is endocrine?

A

1%

223
Q

What do the exocrine glands do?

A

The acini cells secrete enzymes to assist in digestion.

224
Q

What do the endocrine glands do?

A

Islets of the langerhans cells secrete hormones (insulin and more) into the blood stream to regulate blood sugars

225
Q

What does the duct system in the pancreas transport?

A

Bile and pancreatic juices to the duodenum

226
Q

What location is the pancreas found in?

A

RUQ, LUQ, epigastric and hypochondrium regions.

227
Q

Describe the shape of the pancreas?

A

It varies.

Can look like a boomerang, sausage, dumbell and tadpole.

228
Q

What is the head of the pancreas?

A

Bulbous portion of pancreas

229
Q

Where is the head of the pancreas located in the body?

A

Right of midline

230
Q

What is the head of the pancreas surrounded by?

A

Four parts of the duodenum

231
Q

Describe the lateral head edge of the pancreas?

A

The head is cradled by a medial curve of descending duodenum.

232
Q

Describe the medial edge of the pancreas head?

A

It is marked by the SMV and the neck of pancreas

233
Q

What vessel lies posterior to the head of the pancreas?

A

IVC

234
Q

What vessels travel posterior to the head of pancreas?

A

Right renal artery and vein

235
Q

What area does the gastroduodenal artery lie alongside of the pancreas?

A

The GDA lies along the anterolateral portion of the head of the pancreas.

236
Q

What is positioned along the posteolateral aspect of the head of the pancreas?

A

Common Bile Duct

237
Q

Where does the common bile duct meet the pancreatic duct?

A

At the ampulla of Vator within the central portion of the head

238
Q

What is another name for the ampulla of vator?

A

Hepatopancreatic ampullla

239
Q

What does the ampulla of vator drain?

A

Drains secretions towards the medial wall of the descending duodenum via the sphincter of Oddi.

240
Q

What is sometimes found in the head of the pancreas?

A

Accessory pancreatic duct

241
Q

What is an uncinate process?

A

A posteromedial extention of the pancreatic head

242
Q

What is directly anterior to the SMV and anterior to the IVC?

A

Uncinate process

243
Q

Describe the size of the uncinate process?

A

Varies

244
Q

Look at diagram on PG 16 in notes.

A

And sketch!

245
Q

What part of the pancreas lies directly anterior to the SMV near the portal confluence?

A

The neck

246
Q

What is the most anterior aspect of the pancreas between the neck and tail?

A

The body

247
Q

What is the most superior portion of the pancreas?

A

The tail

248
Q

Where does the neck of the pancreas lie?

A

Directly posterior to pylorus of stomach

249
Q

Where does the body of the pancreas lie posterior to?

A
  • Posterior to the antrum of stomach
250
Q

What 6 things does the body of the pancreas lie anterior to?

A
  • Aorta
  • SMA
  • Splenic Vein
  • Left renal vein
  • Left renal artery
  • Spine
251
Q

What does the body of the pancreas lie inferior to?

A

The splenic artery

252
Q

Which side of the SMA does the neck of the pancreas lie on?

A

Right side

253
Q

What does the pancreas tail extend between?

A

The left lateral edge of spine to the hilum of spleen

254
Q

Relationship between pancreatic tail and left kidney?

A

Tail anterior to upper/middle portion of left kidney

255
Q

Relationship between pancreatic tail and stomach/transverse colon?

A

Tail is posterior to stomach and transverse colon.

256
Q

Relationship between pancreatic tail and spine?

A

Tail is lateral to spine

257
Q

Relationship between pancreatic tail and spleen?

A

Tail is medial to spleen

258
Q

Relationship between pancreatic tail and splenic artery?

A

Splenic artery courses along superior surface of tail.

259
Q

Relationship between pancreatic tail and splenic vein?

A

Splenic vein travels along mid-posterior surface of tail.

260
Q

What is another name for the Main Pancreatic Duct?

A

Duct of Wirsung

261
Q

How long is the main pancreatic duct?

A

Extends entire length of pancreas centrally (2mm in diameter)

262
Q

Where does the main pancreatic duct join the common bile duct?

A

Head of pancreas

263
Q

What forms the ampulla of vator?

A

The joining of the main pancreatic duct and the common bile duct

264
Q

Where does the ampulla of vator drain into?

A

The medial wall of the duodenum via the sphincter of Oddi.

265
Q

What is the sphincter of Oddi?

A

A flow control valve that allows bile, hormones, enzymes, to enter the duodenum and prevents gastric byproducts from refluxing into the biliary system

266
Q

Can you see the main pancreatic duct on UT?

A

Yes, very often.

267
Q

What is another name for the accessory pancreatic duct?

A

Duct of Santorini

268
Q

What is the accessory pancreatic duct?

A

A normal variant, it is a secondary duct draining the upper anterior portion of the pancreatic head

269
Q

Where does the accessory pancreatic duct enter the duodenum?

A

The medial aspect of the descending duodenum approximately 2cm proximal to the ampulla vater.

270
Q

Is the accessory pancreatic duct seen on UT?

A

Rarely

271
Q

Two functions of the urinary system?

A

1) Maintains chemical balance

2) Excretes liquid waste products

272
Q

What substances does the urinary system maintain the chemical balance of?

A

1) Water

2) Electrolytes

273
Q

What does changing the chemical balance of water and electrolytes effect?

A

Changes the blood pressure regulation and the pH balance

274
Q

What structures are included in the urinary system?

A

Kidneys, ureters, bladder and urethra

275
Q

How do the kidneys lie in the abdomen and at what level?

A

Obliquely

T12 to L4 level

276
Q

Which kidney is higher in the abdomen? Why?

A

The left

The liver forces the right one down further.

277
Q

How long is an adult kidney?

A

9-12 cm

278
Q

Where are the kidneys in reference to the peritoneum?

A

Retroperitoneal

279
Q

What are the psoas muscles?

A

Two bands of muscle that run on either side of the spine.

280
Q

What is the lumborum?

A

Right and left muscle sitting posterior to the right and left kidney

281
Q

What are the kidneys lateral to?

A

Spine, aorta and IVC

282
Q

Where do the kidneys lie in reference to the psoas muscle?

A

Anterolateral

283
Q

Where do the kidneys lie in reference to the lumborum muscle?

A

Anterior

284
Q

Which pole of the kidney lies more posterior?

A

The upper

Kidneys are tipped back into the body

285
Q

Which pole of the kidneys lies more medial?

A

The upper pole

The upper poles lean in towards eachother “talking”

286
Q

Why do we get patients to past for kidney exams?

A

Lots of bowel surrounding kidneys in order to see them there can’t be a lot of gas.

287
Q

Structures anterior to RIGHT kidney?

A

Liver

Ascending colon

Transverse colon

Duodenum

Small bowel

Right adrenal gland

288
Q

Stuctures anterior to left kidney?

A

Stomach

Descending colon

Transverse colon

Body and tail of pancreas

Small bowel

Left adrenal gland

289
Q

What is the renal parenchyma?

A

Outer portion of the kidney between the renal capsule and the base of the pyramids

290
Q

What does the renal parenchyma include?

A

The outer cortex and the inner medulla

291
Q

What is the renal cortex?

A

Located between the renal capsule and medulla

Contains functional units (nephron)

292
Q

What are the renal columns?

A

Cortex that extends between renal pyramids into medulla

293
Q

What is another name for the columns?

A

Columns of Bertin

294
Q

What is another name for medulla?

A

Medullary pyramids

295
Q

What are the medulla?

A

Located between cortex and renal sinus

296
Q

How do pyramids appear on UT?

A

Triangular shape

Hypoechoic

8-18 of them

Wide base towards cortex

Apex (tip) towards sinus

297
Q

What is the cental/medial aspect of the kindey?

A

The renal sinus

298
Q

What does the renal sinus include?

A

Minor calyx

Major calyx

Renal pelvis

Vessels

299
Q

How does the renal sinus appear on UT? Why?

A

Hyperechoic, packed with fat.

300
Q

Describe the minor calyx.

A

8-18 (same # as pyramids)

They receive the apex of the renal pyramids

301
Q

Describe the major calyx

A

2-3

Receive urine from minor calyx

302
Q

What is the renal pelvis?

A

The flared upper portion of the ureter, it is posterior to the renal vessels.

303
Q

Which is more anterior, renal vein or renal artery?

A

The renal vein is anterior to the renal artery.

304
Q

Look at UT pictures of kidney

A

.

305
Q

What are the 4 coverings of the kidney from inner to outer?

A

1) Renal capsule
2) Perirenal fat
3) Renal fascia
4) Pararenal fat

306
Q

What’s another name for the renal fascia?

A

Gerota’s fascia

307
Q

What does the renal fascia/gerota’s fascia do??

A

Keeps kidney in place.

308
Q

What is the normal variant of the kidney where there is a localized bulge on the lateral boarder of the left kidney?
(Spelling!!)

A

Dromedary Hump

309
Q

What is the normal variant of the kidney that often indents the renal sinus and occurs in varying degree?
(Spelling!)

A

Hypertrophied Column of Bertin

310
Q

What is the normal kidney variant where there is a defect located at the junction of upper and middle third of the kidney? (More often in right)
(Spelling!)

A

Parenchymal Junctional Defect

311
Q

What is the normal kidney variant where the lower poles of the kidneys are fused together? (Congenital)

(Spelling!)

A

Horseshoe kidney

312
Q

What is the normal kidney variant where a kidney is located outside of the renal fossa?

A

Ectopic Kidney

313
Q

Look at handout of variant kidney images

A

.

314
Q

What are the ureters?

A

Paired muscular tubes that convey urine from the kidneys to the urinary bladder

315
Q

What direction do the ureters travel?

A

Inferiorly through the retroperitoneum

316
Q

What do the ureters extend between?

A

From the renal hilum to the posterior portion of the bladder at trigone.

317
Q

How do the ureters change in size?

A

They decrease in diameter as they course towards the bladder.

318
Q

What area is the lower half of the ureters located in?

A

The pelvis

319
Q

Where are the ureters in reference to the internal iliac artery?

A

Anterior

320
Q

Where are the ureters in reference to the ovary in females?

A

Posterior to ovary

321
Q

How do the ureters enter the bladder?

A

At an oblique angle on the posterior lateral surface

322
Q

What can cause obstruction of ureter and consequently affect the respective kidney in females?

A

Pelvic pathology

323
Q

What are the two ureteral junctions?

A

1) UPJ (Ureteropelvic Junction)

2) UVJ (Ureterovesicular Junction)

324
Q

What is the ureteropelvic junction?

A

Junction of the renal pelvis and ureter

325
Q

What is the ureterovesicular junction?

A

Junction between the lower ureters and bladder

326
Q

What is the bladder?

A

A hollow, symmetrical muscular organ that is a reservoir for urine.

327
Q

What are the four layers of the bladder from inner to outer?

A

1) mucosa
2) Submucosa
3) Muscularis
4) Serosa

328
Q

Is the bladder fixed? If so, where?

A

It is relatively mobile and therefore varies in shape but it is fixed at the inferior neck (base).

329
Q

Where is the bladder located?

A

Posterior to symphysis pubis and anterior to the uterus and vagina

330
Q

What area of the bladder is covered in peritoneum?

A

Superior surface

331
Q

What forms potential spaces in the pelvis?

A

Peritoneal reflections

332
Q

What is the apex of the bladder?

A

Superior portion covered in peritoneum

333
Q

What is the base of the bladder?

A

Inferior portion that is fixed

334
Q

What is the Trigone of the bladder?

A

Triangular area in the base accommodating the bladder inlets and outlet.

335
Q

What are the bladder inlets?

A

The ureterovescular junctions (UVJ’s) and the urethra

336
Q

What is the urethra?

A

Muscular tube that transports urine out of the bladder (out of the body).

337
Q

How long is the female urethra?

A

4 cm long

338
Q

How long is the male urethra?

A

Approx 15-20 cm

339
Q

Where is the female urethra located?

A

Directly posterior to the pubic symphysis

340
Q

What is the direction of the female urethra?

A

Runs obliquely inferiorly and anteriorly

341
Q

What is the path of the male urethra?

A

Prostate –> urogenital diaphragm –> penis

342
Q

Describe the adrenal glands

A

Bilateral, pyramid shaped “caps” on the superior pole of kidneys sitting slightly medial to the kidney

343
Q

Where are the adrenal glands in reference to the peritoneum?

A

Retroperitoneal

344
Q

Describe the structure of the adrenal glands

A

1) Capsule (outer surface)
2) Cortex
3) Medulla (innermost portion)

345
Q

Describe the location of the right adrenal gland?

A

Posterior and lateral to IVC

Posterior and medial to right liver

346
Q

Describe the location of the left adrenal gland?

A

Posterior to pancreatic tail, splenic vessels and stomach.

Lateral to aorta

347
Q

Can you see adrenal gland on UT?

A

Not in adults, only in babies unless a cyst or mass occurs.

348
Q

Where is the spleen in reference to the peritoneum?

A

Intraperitoneal

349
Q

What are the functions of the spleen?

4

A

Part of body’s defence system.

Produces lymphocytes, phagocytes, plasma cells and antibodies.

Filters out old Redblood cells and platelets

Blood reservoir

350
Q

Do you need a spleen to live?

A

No, not essential to life

351
Q

How does the spleen appear on UT?

A

Homogenous parenchyma

Smooth surfaces

Hilum

352
Q

What is the word for the formation of new red blood cells?

Spelling!

A

Hematopoiesis

353
Q

Describe the size and shape of the spleen.

A

Variable on body size

Crescent or inverted comma.

Same size as left kidney

354
Q

What is the length of the spleen in sag and transverse?

A

Sag - 12-13 cm

Trans - 7-8cm

355
Q

What area is the spleen located in?

A

LUQ, left hypochondrium

356
Q

Describe the splenic hilum

A

Structures enter/exit on the central visceral surface, no peritoneal covering at hilum.

357
Q

What structures enter/exit at the splenic hilum?

A

Splenic artery, splenic vein, lymph vessels and nerves

358
Q

What is a common splenic variant? Describe.

A

Accessory spleens or splenule

10% of population has them

Often found at splenic hilum

1 cm or smaller

May be multiple

Can be ectopic (brain, scrotum etc.)

359
Q

Where is the GI tract located?

A

All quadrants and all regions. (Mouth to anus)

360
Q

What are 2 other names for the gastrointestinal tract?

A

1) Digestive system

2) alimentary tract

361
Q

What is the function of the GI tract?

A

Break down food, distribute and absorb nutrients and dispose of waste.

362
Q

What are the 4 GI layers?

A

1) Mucosa
2) Submucosa
3) Muscularis
4) Serosa

363
Q

How does the GI lining appear on UT?

A

Like a target.

All 4 layers have a different echogenicity.

364
Q

Describe the salivary glands?

A

Located in mouth

Release enzymes that lubricate mouth and initiate food breakdown

365
Q

Describe the course of the esophagus.

A

Extends from mouth, courses through thorax just anterior to the thoracic spine and pierces the diaphragm at T10 where it enters the abdominal cavity (stomach)

366
Q

Where is the esophagus in relation to the aorta?

A

Located anterior and left of aorta.

367
Q

What is the terminal end of the esophagus called?

A

GE junction

Gastroesophageal junction

368
Q

What is the GE junction?

A

“Door to stomach”

Allows food to enter stomach and prevents reflux into esophagus.

369
Q

Where is the GE junction in reference to the diaphragm?

A

Inferior

370
Q

Where is the GE junction in reference to the aorta?

A

Anterior and slightly left

371
Q

Where is the GE junction in reference to the left lobe of liver?

A

Posterior

372
Q

What is chyme?

A

The liquidy breakdown of food that moves through the intestines.

373
Q

Where is the stomach located?

A

Between the esophagus and the duodenum

374
Q

Where is the stomach located in reference to the peritoneum?

A

Intraperitoneal

375
Q

What are rugae? Function?

A

Internal folds of stomach that increase surface area to increase absorption.

376
Q

What is the cardia?

A

Entrance to the stomach on superior medial aspect of organ

377
Q

What is the fundus of the stomach?

A

Rounded portion above the GE junction

378
Q

What is the body of the stomach?

A

Major portion of stomach, between fundal and pyloric region.

379
Q

What is the pylorus?

A

Lower section of stomach between the body and duodenum

380
Q

How is the pylorus divided?

A

2 Parts:

Antrum

Canal

381
Q

Describe the antrum of the stomach?

A

Wider portion, near midline of body.

382
Q

What level of the body is the antrum and canal located at?

A

L1-L2

383
Q

Describe the stomach canal

A

Narrow portion between antrum and duodenum

Posterior to liver

Slightly right of midline

384
Q

What part of the stomach is anterior to the pancreatic body?

A

Antrum of the pylorus

385
Q

What part of the stomach is anterior to the pancreatic neck?

A

Pylorus canal

386
Q

What part of the stomach communicates with the 1st part of the duodenum?

A

Pylorus canal

387
Q

Describe the greater curvature of the stomach

A

Marks the left border of the organ

388
Q

Describe the lesser curvature of the stomach

A

Marks the right border of the organ

389
Q

What does the lesser curvature of the stomach extend between?

A

Cardiac orifice and the pyloric orifice

390
Q

What is the site of attachment of the lesser omentum to the liver?

A

The lesser curvature of the stomach

391
Q

How long is the small intestine?

A

6-7 meters

392
Q

Where is the small intestine found?

A

RLQ and LLQ

393
Q

What are the three parts of the small intestine?

A

1) Duodenum
2) Jejunum
3) Ileum

394
Q

What is the shortest portion of the small intestine?

A

Duodenum

395
Q

Describe the duodenum?

A

Found in epigastric region

Connects to pylorus and pyloric sphincter

Has 4 parts

396
Q

What are the 4 parts of the duodenum?

A

1) Superior (bulb) 1st
2) Descending 2nd
3) Tranverse 3rd
4) ascending 4th

397
Q

Where is the duodenum located in reference to the peritoneum?

A

The superior (1st) section of the duodenum is Intraperitoneal, the other three sections are retroperitoneal

398
Q

Where is the superior duodenum located?

A

Intraperitoneal

Anterior to the pancreatic head

Posterior to gall bladder fundus

399
Q

Where is the descending duodenum located?

A

Retroperitoneal

(Vertical portion)

Right lateral to pancreatic head

Posterior to transverse colon

400
Q

Where is the transverse duodenum located?

A

Retroperitoneal

Anterior to aorta and IVC

Inferior to pancreatic head

401
Q

Where is the ascending duodenum located?

A

Retroperitoneal

Inferior and medial to pancreatic head

Anterior to aorta

402
Q

What is the jejunum?

A

Tightly coiled tube mainly located in the umbilical region.

403
Q

Where is the jejunum located in reference to the peritoneum?

A

Intraperitoneal

404
Q

What is the ileum?

A

The final and longest portion of small bowel

405
Q

Where does the ileum terminate?

A

At the ileocecal junction

406
Q

What is the ileocecal junction?

A

Junction of the ileum and cecum (ascending colon)

407
Q

What is the large intestine?

A

Frames small bowel

Large diameter

Has haustra and multiple divisions

408
Q

What are haustra?

A

Puckered sacs along the length of colon

409
Q

What are the divisions of the large intestine?

A

1) cecum
2) colon
3) sigmoid
4) rectum
5) anus

410
Q

What is the cecum?

A

Pouch like portion at origin of ascending colon

Located in RLQ

RT iliac region

411
Q

What extends from the inferior portion of the cecum?

A

Appendix

412
Q

What is the appendix?

A

6-10 cm long blind tube that courses inferior and medial.

No function.

413
Q

What are the 4 sections of the colon?

A

1) Ascending
2) Transverse
3) Descending
4) Sigmoid

414
Q

Describe the ascending colon.

A

Superior path along right flank.

Retroperitoneal

Hepatic flexure

Bends 90 degrees to connect to transverse

415
Q

Describe the transverse colon

A

Travels horizontally along midline

Extends from hepatic flexure to splenic flexure

Intraperitoneal

416
Q

What is the hepatic flexure?

A

90 degree turn connecting ascending colon and transverse colon beside the liver

417
Q

What is the splenic flexure?

A

90 degree turn connecting the transverse colon and descending colon beside the spleen

418
Q

Describe the descending colon

A

Starts at splenic flexure and travels inferiorly along left flank.

Retroperitoneal

419
Q

Whish is more superior the hepatic flexure or the splenic flexure?

A

Splenic because the liver forces the hepatic downwards

420
Q

Describe the sigmoid colon

A

S-shaped terminal end of colond

Left inguinal and supraphrenic region

421
Q

Describe the location of the rectum?

A

Located in the true pelvis (pubic region)

Posterior to the bladder and uterus in females.

ANPH 205 (6 decks)

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