The Abdomen Flashcards
What are the margins of the abdomen?
The inferior margin of the thorax to the superior margin of the pelvic bones.
Does the inferior margin of the abdomen have a defined border?
No, since the abdomen and pelvic cavity are connected.
Where is the abdomen in reference to the abdominopelvic cavity?
Superior
Where is the diaphragm in reference to the liver?
The diaphragm is located superior, posterior and anterior to the liver.
What area is directly inferior to the abdomen?
The pelvis
What lines the abdomen?
Peritoneum
What is peritoneum?
Membrane that covers viscera and abdominal wall.
What is the largest organ in the body?
The liver
Is the liver retroperitoneal or intraperitoneal?
Intraperitoneal
What two things cover the external surface of the liver?
1) The Glisson’s capsule
2) Visceral peritoneum
What is the size and shape of the liver?
Triangular shape when viewed from the anterior, size is variable.
What are the functions of the liver?
1) Metabolic activities
2) The production and secretion of bile
3) Filtration of the blood
What quadrant is the liver found in?
Primarily right upper quadrant, left lobe crosses into left upper quadrant.
What region/s is the liver found in?
Right hypochondrium and part of epigastric regions
In thin patients, what region may the liver be found in?
Left hypochondrium
What 3 structures are located posterior to the liver?
1) Aorta
2) IVC
3) Spine
What 3 structures are located left lateral to the liver?
1) Stomach
2) Spleen
3) Left Kidney
What 3 structures are located inferior to the liver?
1) Right kidney
2) Gall bladder
3) Right colon
Describe the diaphragmatic surface of the liver:
- Dome shape (takes convex shape of diaphragm surface)
- Smooth surface
What surfaces of the liver are in contact with the diaphragm?
Superior, posterior and anterior
What surfaces of the liver does the peritoneal membrane cover?
Most of the anterior and superior surface
Where is the “bare area” of the liver and what does this mean?
The bare area is on the posterior surface of the liver, it has no peritoneum.
What are the boundaries of the bare area on the liver?
- Coronary and triangular ligaments
- Includes a groove for the IVC
What divides the anterior surface of the liver?
The falciform ligament.
Describe the visceral surface of the liver?
- Inferior surface
- Oblique orientation
- Covered with peritoneum
- In contact with several abdominal organs that form grooves/undulations on the surface
In the traditional method, how was the liver divided into left and right lobes?
The falciform ligament visible on the anterior surface.
In the traditional method, what divided the quadrate and caudate lobe?
Ligaments
How many lobes in the traditional method?
4
Left, Right, Quadrate, Caudate
In the traditional method what lobes were also considered part of the right lobe?
The quadrate and caudate lobes.
What is the current method used to divide the liver?
The functional or segmental method
How many lobes in the functional method and how are they divided?
3 (Right, left, Caudate)
Divided by hepatic function
What are lobes?
Divisions according to anatomy
What are segments?
Divisions according to function
Describe the imaginary plane used to divide the liver into true right and left functional lobes?
A line connecting the gallbladder fossa to the IVC, it runs along the main lobar fissure as well as the middle hepatic vein.
How is the right lobe divided?
Anterior and posterior segments
What divides the right lobe into anterior and posterior segments?
The right intersegmental fissure.
How is the left lobe divided?
Medial and lateral segments
What divides the left lobe into medial and lateral segments?
The left intersegmental fissure.
What runs within the right intersegmental fissure.
The right hepatic vein and right portal vein.
What runs within the left intersegmental fissure?
The left hepatic vein, left portal vein and the ligamentum teres.
Where is the caudate lobe located?
Posterior and superior in the liver.
Where does the caudate lobe receive blood from?
Both right and left sides of liver.
How is the liver divided according to the couinade segmentation classification?
8 segments, numbered clockwise from 1-8
What number is the caudate lobe according to the couinaud segmentation classification?
1
How is the liver divided in the longitudinal plane in the couinaud segmentation classification?
Three major hepatic veins divide liver into 4 sections
How is the liver divided in the transverse plain according to the couinaud segmentation classification?
Right and left portal veins divide 4 sections into superior and inferior subsections.
Describe a segment of the liver from the couinade segmentation classification?
Each segment has a branch of the portal vein at it’s centre and a hepatic vein at its periphery.
Which is bigger, left or right lobe?
Right
What separates the left lobe from the right?
Imaginary line from gallbladder fossa to IVC
What structures outline the boundary between the left and right lobes?
Main lobar fissure, middle hepatic vein, galbladder to IVC
What lobe is found lateral to the imaginary boundary between the left and right lobes?
Right lobe
What divides the right lobe into anterior and posterior segments?
Right intersegmental fissure (RIF)
On ultrasound how is the RIF distinguished?
By the right hepatic vein inferiorly and the right portal vein inferiorly.
What is immediately left of the anterior segment of the right lobe?
The medial left lobe
What area is the left lobe found in the body?
Left Upper Quadrant or epigastrium
What divides the left lobe into medial and lateral segments?
The left intersegmental fissure.
What was the medial segment of the left lobe formally known as?
The quadrate lobe.
What is the smallest lobe in the liver?
Caudate
Where is the caudate lobe located?
In the superior posterior aspect of the liver.
What is the anterior boundary to the caudate lobe?
Left portal vein and ligamentum venosum
What is the posterior boundary of the caudate lobe?
The IVC
What is the Reidel’s lobe?
A normal variant of the liver where the inferior right lobe extends caudally to the iliac crests.
Describe what ligaments and peritoneal attachments are and what they do.
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
What is the falciform ligament?
A peritoneal fold that runs along the anterior surface of the liver from the diaphragm to the umbilicus.
What does the falciform ligament connect?
The liver to the diaphragm and anterior abdominal wall.
What ligament is the falciform ligament continuous with and where?
The ligamentum teres on the visceral surface.
In the traditional method what does the falciform ligament divide?
The left and right lobes.
What spaces does the falciform ligament divide?
The left and right subphrenic spaces.
What is the ligamentum teres?
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.
What does the ligamentum teres connect?
Connects to the falciform ligament on the anterior inferior surface of the liver.
What is another name for the ligamentum teres?
Round ligament.
What does the ligamentum teres divide?
The Left lobe into medial and lateral segments.
Can the ligamentum teres be identified on UT?
Yes.
What is the ligamentum venosum?
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.
What does the ligamentum venosum divide?
The left lateral lobe and the caudate lobe of the liver.
What does the ligamentum venosum attach?
Attaches the inferior surface of the liver to the stomach/duodenum.
Can the ligamentum venosum be identified on UT?
Yes
What is a fissure?
A groove/cleft or deep furrow in an organ that forms a natural division.
What does the right intersegmental fissure divide?
The right lobe into anterior and posterior segments.
What travels through the right intersegmental fissure fissure superiorly?
Right hepatic vein
What courses through the right intersegmental fissure inferiorly?
Right portal vein
What are the two other names for the main lobar fissure?
1) Middle intersegmental fissure
2) Interlobar fissure
What does the MLF divide?
The functional right and left lobe
What travels through the MLF superiorly?
Middle hepatic vein
In transverse plane, what does the MLF line up with?
Line from the gall bladder to the IVC
What does the MLF look like and where can it be found on UT?
In a sagittal plane the MLF can be seen as a hyperechoic line superior to the gallbladder neck extending to the right portal vein.
What does the left intersegmental fissure divide?
The medial and lateral segments of the left lobe.
How is the left intersegmental fissure divided?
Into thirds.
Cranial, middle and caudal.
What structure is found in the cranial portion of the left intersegmental fissure?
Left hepatic vein
What structure is found in the middle portion of the left intersegmental fissure?
The anterior portion of the left portal vein
What structure is found in the caudal portion of the left intersegmental fissure?
The ligamentum teres
Where do they hepatic veins drain blood?
From the liver into the IVC
What direction to the hepatic veins travel?
They course from an inferior-anterior aspect of the liver to the superior-posterior aspect and into the IVC.
How many hepatic veins are there?
Three
Right, middle and left
How common are accessory hepatic veins?
30% of the population
Where do the hepatic veins join the IVC?
Just inferior to the diaphragm
Where do the hepatic veins widen?
As they approach the IVC
What does the right hepatic vein drain?
The right lobe
What does the left hepatic vein drain?
The left lobe
What does the middle hepatic vein drain?
The medial left lobe (quadrate) and the anterior segment of right lobe.
What do the hepatic veins mark within couinaud’s segments?
The lateral boundaries
Describe the brightness of the hepatic veins?
The walls are less hyperechoic than the portal veins
Are the hepatic veins long or short axis in transverse/sagittal planes?
The hepatic veins are long axis in both sagittal and transverse planes because they travel obliquely through the liver.
How much blood does the hepatic artery supply to the liver?
20-30%
What/where does the hepatic artery branch from?
It is the right branch of the celiac axis, branches towards the liver.
What artery travels from the celiac axis to the gastroduodenal artery (GDA)?
Common hepatic artery
What direction does the common hepatic artery travel?
Towards the right side
What artery travels from gastroduodenal artery to the bifurcation of the right and left hepatic arteries?
Hepatic artery proper
What direction does the hepatic artery proper travel?
Courses superior and right lateral toward and into the liver.
What is the porta hepatis?
The entrance/exit of the liver
What enters/exits the liver via the porta hepatis?
Arteries, veins, ducts
What is another name for the porta hepatis?
The ‘hilum’ of the liver
What does the portal triad consist of?
1) A hepatic artery
2) A portal vein
3) A bile duct
What is the portal triad at the region of the porta hepatis composed of?
1) The hepatic artery
2) The main portal vein
3) Common Bile Duct
What is located anterior to the main portal vein and medial to common bile duct?
Hepatic artery proper
Are the right and left hepatic arteries intrahepatic?
Yes, they are within the liver.
What do the right and left hepatic arteries travel in unison with?
A billary duct and corresponding portal vein.
What does the right hepatic artery supply?
Mainly right lobe with branches to caudate
What does the left hepatic artery supply?
Mainly left lobe
How much nutrient rich blood does the portal system supply the liver with?
70-80%
Where does the portal system receive it’s nutrient rich blood from?
The gastrointestinal (GI) system
Is the blood from the portal system high in oxygen or low?
Low because it drains from gastric but nutrient dense.
Do vessels of the portal system connect directly to the IVC?
No!
Where does the blood from the portal veins flow?
Toward and within the lobes of the liver
What forms the main portal vein?
The union of the superior mesenteric vein (SMV) and the splenic vein (SV)
Where is the main portal vein formed?
Behind the neck of the pancreas at the level of L2
How do portal veins differ from the hepatic veins on UT?
The portal veins have bright vessel walls
What does the superior mesenteric vein drain?
The small intestine (right side), ascending colon and transverse colon.
What direction does the SMV course?
Superiorly
What vessel does the SMV meet superiorly and where?
The SMV meets the splenic vein at the portal confluence
What happens to the distal end of the SMV?
It terminates posterior to the pancreatic neck
Where is the SMV located to the SMA?
The SMV is located to the right side of the SMA
What does the splenic vein drain?
The spleen, other tributaries from pancreas and stomach
What is the portal confluence?
The junction of the SMV with SV.
Origin of the main portal vein.
How does the portal confluence appear on UT?
It’s a widened area seen in the transverse plane
Where does the splenic vein travel?
Travels along the posterior surface of the pancreatic body and tail.
Where does the splenic vein meet the SMV?
The SV courses from the hilum of the spleen to meet the SMV on the right side of the midline
What direction does the splenic vein course towards the splenic artery?
Inferior
Where does the splenic vein terminate?
Behind the neck of the pancreas
What is the splenic vein located anterior to?
Aorta, IVC, SMA and renal vessels
What does the Inferior mesenteric vein drain?
The left side of the small bowel, descending colon, sigmoid and rectum.
Where does the IMV join the splenic vein?
Posterior to the body of the pancreas (left of midline).
Is the IMV seen on UT?
Rarely.
Look at UT pictures in notes.
.
Where is the origin of the main portal vein?
Junction of the SMV and SV
Where is the main portal vein formed?
Behind the neck of pancreas
Describe the travel of the main portal vein.
Ascends obliquely towards the right side of the body and enters the liver at the porta hepatis
Where is the main portal vein in reference to the hepatic artery proper?
Posterior
Where is the main portal vein located in reference to the CBD and CHD billary ducts?
Posterior
What happens to the main portal vein at the liver hilum?
It bifurcates into the left and right portal veins.
Where is the main portal vein in reference to the duodenum?
Posterior
Where is the main portal vein located in reference to the IVC?
Posterior
What encloses the main portal vein?
The free edge of the lesser omentum
How does the right portal vein divide?
Divides into anterior and posterior branches within the right lobe of the liver.
How does the left portal vein travel?
Ascends anteriorly
How does the left portal vein divide?
Divides into medial and lateral branches within the left lobe of the liver.
What type of blood supply does the liver have and what makes it up?
Dual
The hepatic artery and the portal vein.
20-30% from hepatic artery
70-80% from portal vein
What does the biliary system do?
Produces, concentrates, secretes and transports bile from liver to the duodenum
Where is bile formed?
In the liver cells and drains through the ducts
What is bile used for?
Digestion of fatty foods.
Where is the biliary system located?
Right upper quadrant, right hypochondrium, epigastric region
What is the purpose of the gall bladder?
Storage of bile
Is any bile produced in the gall bladder?
NO
What is the shape of the gallbladder?
Oblong, pear
Where is the gall bladder in reference to the peritoneum?
Intraperitoneal
Is the gall bladder attached to anything?
Peritoneum binds the neck and body of the gallbladder to the liver.
Is the gallbladder a landmark?
Yes, it is the anterior landmark dividing the left and right lobe of liver.
What does the gallbladder line up with?
The main lobar fissure
Where does the gallbladder lie in reference to the IVC?
Lateral to IVC
Where does the gallbladder lie in reference to the right kidney?
Medial to the right kidney
How is the gallbladder divided?
Neck, body and fundus
What is a good way to optimize an image of the gallbladder?
Fasting, patient will be less gassy and the gallbladder will be full of bile and easy to see.
Describe the “neck” of the gallbadder.
Narrow, superior portion of gallbladder that is fixed in place.
What part of the gall bladder does the main lobar fissure extend from?
MLB extends from neck of the gallbladder to the RPV.
What is the body of the gallbladder?
The middle portion between the neck and the fundus
What is the fundus of the gallbladder?
The mobile inferior and anterior portion of the gallbladder.
Where can the gall bladder sometimes extend?
Beyond the inferior margin of right lobe of liver
What is a phrygian cap?
A normal variant in the gallbladder where there is a fold in the fundus.
What are junctional folds?
Normal variants in the liver where there is a fold at the junction of the neck and body.
What is a hartmann pouch?
Small posterior pouch near gall bladder neck.
What is the duct system?
A pathway way of ducts collecting and transporting bile secreted by the liver to the small intestine.
How is the duct system subdivided?
Intrahepatic and extrahepatic ducts
What is the ductal network that has several branches along it’s bath called?
Biliary tree
What are intrahepatic ductules?
Very small bile ducts within the liver collecting bile secretions from liver tissue
In what direction do intrahepatic ductules get larger?
Along the biliary tree
What course do the intrahepatic ductules follow?
The course of the portal veins and hepatic arterial branches.
Are intrahepatic ductules seen on UT?
Rarely in normal conditions.
What makes up the portal triad?
1) Hepatic artery
2) Portal Vein
3) Bile duct
Where does the right hepatic duct collect bile from?
Right lobe of liver
Where foes the left hepatic duct collect bile from?
Left lobe of liver
Where do the right and left hepatic ducts join?
Roughly at the hilum (porta hepatus)
What is the RHD? LHD?
Right hepatic duct
Left hepatic duct
What is the CHD?
Common hepatic duct
Where is the common hepatic duct formed?
At the junction of left and right hepatic ducts
What does the distal segment of the CHD course alongside?
The anterior aspect of the right/main portal vein.
Where does the common hepatic duct terminate?
At the junction of the cystic duct
Is the common hepatic duct seen with UT?
Not usually
What does the cystic duct do?
Drains the gallbladder
What does the cystic duct contain?
Spiral valves of Heister
What are the spiral valves of Heister?
They are mucosal folds that provide structural support
Do the spiral valves of Heister act as “true valves” and control flow?
No, they just provide support.
What does the cystic duct merge with to form the Common Bile Duct?
The Common hepatic duct
What is the common bile duct formed by?
The union of the cystic duct and the common hepatic duct
Is the cystic duct seen by UT?
Rarely
Where does the common bile duct travel?
The CBD travels inferiorly toward the head of the pancreas to join the pancreatic duct
What does the junction between the pancreatic duct and the common bile duct form?
The ampulla of Vater
What does the ampulla of vater do?
Dumps bile into the duodenum via the sphincter of Oddi
What controls the flow of bile into the duodenum?
The sphincter of oddi
What is the difference between the ampulla of vator and the sphincter of oddi?
The ampulla of vator is the door frame (hole) into the duodenum and the sphincter of Oddi is the door.
How long is the common bile duct?
6-8 cm long
What lies posterior to the common bile duct?
The main portal vein
What lies medial to the common bile duct?
The hepatic artery proper
What does the distal common bile duct travel alongside?
The posterior aspect of the head of pancreas
What is the pancreas?
An elongated, lobuar gland
What does lobular mean?
Lumpy/bumpy
How does the pancreas lie?
Generally transverse and oblique across the midline and extends towards the spleen.
What area/level is the pancreas?
Transpyloric level
Pylorus region (epigastric)
Does the pancreas have a capsule?
No and it is difficult to distinguish on UT because of it.
Where is the pancreas in reference to the peritoneum?
Retroperitoneal except for a small part of the tail.
What types of glands does the pancreas have?
Endocrine and exocrine
How much of the pancreas is exocrine?
99%
How much of the pancreas is endocrine?
1%
What do the exocrine glands do?
The acini cells secrete enzymes to assist in digestion.
What do the endocrine glands do?
Islets of the langerhans cells secrete hormones (insulin and more) into the blood stream to regulate blood sugars
What does the duct system in the pancreas transport?
Bile and pancreatic juices to the duodenum
What location is the pancreas found in?
RUQ, LUQ, epigastric and hypochondrium regions.
Describe the shape of the pancreas?
It varies.
Can look like a boomerang, sausage, dumbell and tadpole.
What is the head of the pancreas?
Bulbous portion of pancreas
Where is the head of the pancreas located in the body?
Right of midline
What is the head of the pancreas surrounded by?
Four parts of the duodenum
Describe the lateral head edge of the pancreas?
The head is cradled by a medial curve of descending duodenum.
Describe the medial edge of the pancreas head?
It is marked by the SMV and the neck of pancreas
What vessel lies posterior to the head of the pancreas?
IVC
What vessels travel posterior to the head of pancreas?
Right renal artery and vein
What area does the gastroduodenal artery lie alongside of the pancreas?
The GDA lies along the anterolateral portion of the head of the pancreas.
What is positioned along the posteolateral aspect of the head of the pancreas?
Common Bile Duct
Where does the common bile duct meet the pancreatic duct?
At the ampulla of Vator within the central portion of the head
What is another name for the ampulla of vator?
Hepatopancreatic ampullla
What does the ampulla of vator drain?
Drains secretions towards the medial wall of the descending duodenum via the sphincter of Oddi.
What is sometimes found in the head of the pancreas?
Accessory pancreatic duct
What is an uncinate process?
A posteromedial extention of the pancreatic head
What is directly anterior to the SMV and anterior to the IVC?
Uncinate process
Describe the size of the uncinate process?
Varies
Look at diagram on PG 16 in notes.
And sketch!
What part of the pancreas lies directly anterior to the SMV near the portal confluence?
The neck
What is the most anterior aspect of the pancreas between the neck and tail?
The body
What is the most superior portion of the pancreas?
The tail
Where does the neck of the pancreas lie?
Directly posterior to pylorus of stomach
Where does the body of the pancreas lie posterior to?
- Posterior to the antrum of stomach
What 6 things does the body of the pancreas lie anterior to?
- Aorta
- SMA
- Splenic Vein
- Left renal vein
- Left renal artery
- Spine
What does the body of the pancreas lie inferior to?
The splenic artery
Which side of the SMA does the neck of the pancreas lie on?
Right side
What does the pancreas tail extend between?
The left lateral edge of spine to the hilum of spleen
Relationship between pancreatic tail and left kidney?
Tail anterior to upper/middle portion of left kidney
Relationship between pancreatic tail and stomach/transverse colon?
Tail is posterior to stomach and transverse colon.
Relationship between pancreatic tail and spine?
Tail is lateral to spine
Relationship between pancreatic tail and spleen?
Tail is medial to spleen
Relationship between pancreatic tail and splenic artery?
Splenic artery courses along superior surface of tail.
Relationship between pancreatic tail and splenic vein?
Splenic vein travels along mid-posterior surface of tail.
What is another name for the Main Pancreatic Duct?
Duct of Wirsung
How long is the main pancreatic duct?
Extends entire length of pancreas centrally (2mm in diameter)
Where does the main pancreatic duct join the common bile duct?
Head of pancreas
What forms the ampulla of vator?
The joining of the main pancreatic duct and the common bile duct
Where does the ampulla of vator drain into?
The medial wall of the duodenum via the sphincter of Oddi.
What is the sphincter of Oddi?
A flow control valve that allows bile, hormones, enzymes, to enter the duodenum and prevents gastric byproducts from refluxing into the biliary system
Can you see the main pancreatic duct on UT?
Yes, very often.
What is another name for the accessory pancreatic duct?
Duct of Santorini
What is the accessory pancreatic duct?
A normal variant, it is a secondary duct draining the upper anterior portion of the pancreatic head
Where does the accessory pancreatic duct enter the duodenum?
The medial aspect of the descending duodenum approximately 2cm proximal to the ampulla vater.
Is the accessory pancreatic duct seen on UT?
Rarely
Two functions of the urinary system?
1) Maintains chemical balance
2) Excretes liquid waste products
What substances does the urinary system maintain the chemical balance of?
1) Water
2) Electrolytes
What does changing the chemical balance of water and electrolytes effect?
Changes the blood pressure regulation and the pH balance
What structures are included in the urinary system?
Kidneys, ureters, bladder and urethra
How do the kidneys lie in the abdomen and at what level?
Obliquely
T12 to L4 level
Which kidney is higher in the abdomen? Why?
The left
The liver forces the right one down further.
How long is an adult kidney?
9-12 cm
Where are the kidneys in reference to the peritoneum?
Retroperitoneal
What are the psoas muscles?
Two bands of muscle that run on either side of the spine.
What is the lumborum?
Right and left muscle sitting posterior to the right and left kidney
What are the kidneys lateral to?
Spine, aorta and IVC
Where do the kidneys lie in reference to the psoas muscle?
Anterolateral
Where do the kidneys lie in reference to the lumborum muscle?
Anterior
Which pole of the kidney lies more posterior?
The upper
Kidneys are tipped back into the body
Which pole of the kidneys lies more medial?
The upper pole
The upper poles lean in towards eachother “talking”
Why do we get patients to past for kidney exams?
Lots of bowel surrounding kidneys in order to see them there can’t be a lot of gas.
Structures anterior to RIGHT kidney?
Liver
Ascending colon
Transverse colon
Duodenum
Small bowel
Right adrenal gland
Stuctures anterior to left kidney?
Stomach
Descending colon
Transverse colon
Body and tail of pancreas
Small bowel
Left adrenal gland
What is the renal parenchyma?
Outer portion of the kidney between the renal capsule and the base of the pyramids
What does the renal parenchyma include?
The outer cortex and the inner medulla
What is the renal cortex?
Located between the renal capsule and medulla
Contains functional units (nephron)
What are the renal columns?
Cortex that extends between renal pyramids into medulla
What is another name for the columns?
Columns of Bertin
What is another name for medulla?
Medullary pyramids
What are the medulla?
Located between cortex and renal sinus
How do pyramids appear on UT?
Triangular shape
Hypoechoic
8-18 of them
Wide base towards cortex
Apex (tip) towards sinus
What is the cental/medial aspect of the kindey?
The renal sinus
What does the renal sinus include?
Minor calyx
Major calyx
Renal pelvis
Vessels
How does the renal sinus appear on UT? Why?
Hyperechoic, packed with fat.
Describe the minor calyx.
8-18 (same # as pyramids)
They receive the apex of the renal pyramids
Describe the major calyx
2-3
Receive urine from minor calyx
What is the renal pelvis?
The flared upper portion of the ureter, it is posterior to the renal vessels.
Which is more anterior, renal vein or renal artery?
The renal vein is anterior to the renal artery.
Look at UT pictures of kidney
.
What are the 4 coverings of the kidney from inner to outer?
1) Renal capsule
2) Perirenal fat
3) Renal fascia
4) Pararenal fat
What’s another name for the renal fascia?
Gerota’s fascia
What does the renal fascia/gerota’s fascia do??
Keeps kidney in place.
What is the normal variant of the kidney where there is a localized bulge on the lateral boarder of the left kidney?
(Spelling!!)
Dromedary Hump
What is the normal variant of the kidney that often indents the renal sinus and occurs in varying degree?
(Spelling!)
Hypertrophied Column of Bertin
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!)
Parenchymal Junctional Defect
What is the normal kidney variant where the lower poles of the kidneys are fused together? (Congenital)
(Spelling!)
Horseshoe kidney
What is the normal kidney variant where a kidney is located outside of the renal fossa?
Ectopic Kidney
Look at handout of variant kidney images
.
What are the ureters?
Paired muscular tubes that convey urine from the kidneys to the urinary bladder
What direction do the ureters travel?
Inferiorly through the retroperitoneum
What do the ureters extend between?
From the renal hilum to the posterior portion of the bladder at trigone.
How do the ureters change in size?
They decrease in diameter as they course towards the bladder.
What area is the lower half of the ureters located in?
The pelvis
Where are the ureters in reference to the internal iliac artery?
Anterior
Where are the ureters in reference to the ovary in females?
Posterior to ovary
How do the ureters enter the bladder?
At an oblique angle on the posterior lateral surface
What can cause obstruction of ureter and consequently affect the respective kidney in females?
Pelvic pathology
What are the two ureteral junctions?
1) UPJ (Ureteropelvic Junction)
2) UVJ (Ureterovesicular Junction)
What is the ureteropelvic junction?
Junction of the renal pelvis and ureter
What is the ureterovesicular junction?
Junction between the lower ureters and bladder
What is the bladder?
A hollow, symmetrical muscular organ that is a reservoir for urine.
What are the four layers of the bladder from inner to outer?
1) mucosa
2) Submucosa
3) Muscularis
4) Serosa
Is the bladder fixed? If so, where?
It is relatively mobile and therefore varies in shape but it is fixed at the inferior neck (base).
Where is the bladder located?
Posterior to symphysis pubis and anterior to the uterus and vagina
What area of the bladder is covered in peritoneum?
Superior surface
What forms potential spaces in the pelvis?
Peritoneal reflections
What is the apex of the bladder?
Superior portion covered in peritoneum
What is the base of the bladder?
Inferior portion that is fixed
What is the Trigone of the bladder?
Triangular area in the base accommodating the bladder inlets and outlet.
What are the bladder inlets?
The ureterovescular junctions (UVJ’s) and the urethra
What is the urethra?
Muscular tube that transports urine out of the bladder (out of the body).
How long is the female urethra?
4 cm long
How long is the male urethra?
Approx 15-20 cm
Where is the female urethra located?
Directly posterior to the pubic symphysis
What is the direction of the female urethra?
Runs obliquely inferiorly and anteriorly
What is the path of the male urethra?
Prostate –> urogenital diaphragm –> penis
Describe the adrenal glands
Bilateral, pyramid shaped “caps” on the superior pole of kidneys sitting slightly medial to the kidney
Where are the adrenal glands in reference to the peritoneum?
Retroperitoneal
Describe the structure of the adrenal glands
1) Capsule (outer surface)
2) Cortex
3) Medulla (innermost portion)
Describe the location of the right adrenal gland?
Posterior and lateral to IVC
Posterior and medial to right liver
Describe the location of the left adrenal gland?
Posterior to pancreatic tail, splenic vessels and stomach.
Lateral to aorta
Can you see adrenal gland on UT?
Not in adults, only in babies unless a cyst or mass occurs.
Where is the spleen in reference to the peritoneum?
Intraperitoneal
What are the functions of the spleen?
4
Part of body’s defence system.
Produces lymphocytes, phagocytes, plasma cells and antibodies.
Filters out old Redblood cells and platelets
Blood reservoir
Do you need a spleen to live?
No, not essential to life
How does the spleen appear on UT?
Homogenous parenchyma
Smooth surfaces
Hilum
What is the word for the formation of new red blood cells?
Spelling!
Hematopoiesis
Describe the size and shape of the spleen.
Variable on body size
Crescent or inverted comma.
Same size as left kidney
What is the length of the spleen in sag and transverse?
Sag - 12-13 cm
Trans - 7-8cm
What area is the spleen located in?
LUQ, left hypochondrium
Describe the splenic hilum
Structures enter/exit on the central visceral surface, no peritoneal covering at hilum.
What structures enter/exit at the splenic hilum?
Splenic artery, splenic vein, lymph vessels and nerves
What is a common splenic variant? Describe.
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.)
Where is the GI tract located?
All quadrants and all regions. (Mouth to anus)
What are 2 other names for the gastrointestinal tract?
1) Digestive system
2) alimentary tract
What is the function of the GI tract?
Break down food, distribute and absorb nutrients and dispose of waste.
What are the 4 GI layers?
1) Mucosa
2) Submucosa
3) Muscularis
4) Serosa
How does the GI lining appear on UT?
Like a target.
All 4 layers have a different echogenicity.
Describe the salivary glands?
Located in mouth
Release enzymes that lubricate mouth and initiate food breakdown
Describe the course of the esophagus.
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)
Where is the esophagus in relation to the aorta?
Located anterior and left of aorta.
What is the terminal end of the esophagus called?
GE junction
Gastroesophageal junction
What is the GE junction?
“Door to stomach”
Allows food to enter stomach and prevents reflux into esophagus.
Where is the GE junction in reference to the diaphragm?
Inferior
Where is the GE junction in reference to the aorta?
Anterior and slightly left
Where is the GE junction in reference to the left lobe of liver?
Posterior
What is chyme?
The liquidy breakdown of food that moves through the intestines.
Where is the stomach located?
Between the esophagus and the duodenum
Where is the stomach located in reference to the peritoneum?
Intraperitoneal
What are rugae? Function?
Internal folds of stomach that increase surface area to increase absorption.
What is the cardia?
Entrance to the stomach on superior medial aspect of organ
What is the fundus of the stomach?
Rounded portion above the GE junction
What is the body of the stomach?
Major portion of stomach, between fundal and pyloric region.
What is the pylorus?
Lower section of stomach between the body and duodenum
How is the pylorus divided?
2 Parts:
Antrum
Canal
Describe the antrum of the stomach?
Wider portion, near midline of body.
What level of the body is the antrum and canal located at?
L1-L2
Describe the stomach canal
Narrow portion between antrum and duodenum
Posterior to liver
Slightly right of midline
What part of the stomach is anterior to the pancreatic body?
Antrum of the pylorus
What part of the stomach is anterior to the pancreatic neck?
Pylorus canal
What part of the stomach communicates with the 1st part of the duodenum?
Pylorus canal
Describe the greater curvature of the stomach
Marks the left border of the organ
Describe the lesser curvature of the stomach
Marks the right border of the organ
What does the lesser curvature of the stomach extend between?
Cardiac orifice and the pyloric orifice
What is the site of attachment of the lesser omentum to the liver?
The lesser curvature of the stomach
How long is the small intestine?
6-7 meters
Where is the small intestine found?
RLQ and LLQ
What are the three parts of the small intestine?
1) Duodenum
2) Jejunum
3) Ileum
What is the shortest portion of the small intestine?
Duodenum
Describe the duodenum?
Found in epigastric region
Connects to pylorus and pyloric sphincter
Has 4 parts
What are the 4 parts of the duodenum?
1) Superior (bulb) 1st
2) Descending 2nd
3) Tranverse 3rd
4) ascending 4th
Where is the duodenum located in reference to the peritoneum?
The superior (1st) section of the duodenum is Intraperitoneal, the other three sections are retroperitoneal
Where is the superior duodenum located?
Intraperitoneal
Anterior to the pancreatic head
Posterior to gall bladder fundus
Where is the descending duodenum located?
Retroperitoneal
(Vertical portion)
Right lateral to pancreatic head
Posterior to transverse colon
Where is the transverse duodenum located?
Retroperitoneal
Anterior to aorta and IVC
Inferior to pancreatic head
Where is the ascending duodenum located?
Retroperitoneal
Inferior and medial to pancreatic head
Anterior to aorta
What is the jejunum?
Tightly coiled tube mainly located in the umbilical region.
Where is the jejunum located in reference to the peritoneum?
Intraperitoneal
What is the ileum?
The final and longest portion of small bowel
Where does the ileum terminate?
At the ileocecal junction
What is the ileocecal junction?
Junction of the ileum and cecum (ascending colon)
What is the large intestine?
Frames small bowel
Large diameter
Has haustra and multiple divisions
What are haustra?
Puckered sacs along the length of colon
What are the divisions of the large intestine?
1) cecum
2) colon
3) sigmoid
4) rectum
5) anus
What is the cecum?
Pouch like portion at origin of ascending colon
Located in RLQ
RT iliac region
What extends from the inferior portion of the cecum?
Appendix
What is the appendix?
6-10 cm long blind tube that courses inferior and medial.
No function.
What are the 4 sections of the colon?
1) Ascending
2) Transverse
3) Descending
4) Sigmoid
Describe the ascending colon.
Superior path along right flank.
Retroperitoneal
Hepatic flexure
Bends 90 degrees to connect to transverse
Describe the transverse colon
Travels horizontally along midline
Extends from hepatic flexure to splenic flexure
Intraperitoneal
What is the hepatic flexure?
90 degree turn connecting ascending colon and transverse colon beside the liver
What is the splenic flexure?
90 degree turn connecting the transverse colon and descending colon beside the spleen
Describe the descending colon
Starts at splenic flexure and travels inferiorly along left flank.
Retroperitoneal
Whish is more superior the hepatic flexure or the splenic flexure?
Splenic because the liver forces the hepatic downwards
Describe the sigmoid colon
S-shaped terminal end of colond
Left inguinal and supraphrenic region
Describe the location of the rectum?
Located in the true pelvis (pubic region)
Posterior to the bladder and uterus in females.
