The Abdomen Flashcards
What cavity is located in the superior portion of the abdominopelvic cavity
Abdominal cavity
The abdominal cavity is located where in reference to the diaphragm
Inferior to the diaphragm
The abdominopelvic cavity is located where in reference to the pelvis
Superior to the pelvis
The abdominal cavity is lined with what
Peritoneum
What is the largest organ in the body
Liver
Is the liver retroperitoneal or intraperitonel
Intraperitoneal
The ——capsule covers the external surface of the liver
Glisson’s capsule
What are three functions of the liver
Metabolic activities
Production/secretion of bile
Filtration of blood
The liver occupies what quadrants in its location
RUQ and LUQ
What regions do the liver occupy in its location
Right hypochondriac and epigastic and left hypochondriac in thin patients
The diaphragm doesn’t touch the liver on what side
Inferior
What structures are posterior to the liver
IVC
Aorta
Spine
Which structures are left lateral to the liver
Spleen
Left kidney
Stomach
Which structures are inferior to the kidney
Right kidney
Gallbladder
Right colon
Which area of the liver is NOT covered in peritoneum
Bare area
Which ligament divides the anterior surface of the liver
Falciform ligament
The traditional method divided the liver into how many lobes
4 lobes
Which ligament divided the liver into right and left lobe in the traditional method
Falciform ligament
What were the four lobes called in the traditional method
Right
Left
Caudate
Quadrate
In the functional or segmental method the liver is divided into how many lobes
3lobes
Each lobe in the functional (segmental) method has its own what
Own arterial and venous blood supply and biliary drainage
The definition of lobe is
Divisions according to anatomy
The definition of segment is
Divisions according to function
What plane divides the true right and left lobes
Gallbladder fossa to IVC
Main lobar fissure
Middle hepatic vein
The right lobe is divided into what two segments
Anterior and posterior
Which structure divides the right lobe into anterior and posterior segments
Right intersegmental fissure
Which two landmark divides the right lobe into anterior and posterior segments
Right hepatic vein
Right portal vein
Which two structures run inside the right intersegmental fissure
Right hepatic vein
Right portal vein
The left lobe is divided into what two segments
Medial and lateral
What structure divides the left lobe into medial and lateral segments
Left intersegmental fissure
What landmark divides the left lobe into medial and lateral segments
Left hepatic vein
Which three structures run inside the left intersegmental fissure
Left hepatic vein
Left portal vein
Ligamentum teres
The caudate lobe receives blood from where
Receive blood from right and left side of liver
The caudate lobe is located where on the liver
Posterior and superior
What is used to further subdivided the major segments for surgical applications
Couinaud’s segmentation classification
How many segments is there in the couinaud’s segmentation classification
8
What direction are the lobes in couinaud’s numbered
Clockwise
What is the first lobe in couinaud’s segmentation classification
Caudate lobe
Is the right or left lobe larger
Right
What are three things that delineate the boundary between the right lobe and left lobe
Main lobar fissure
Middle hepatic vein
Imaginary line from gallbladder to IVC
The left medial segment of the liver was previously known as
Quadrate lobe
What is the smallest lobe on the liver
Caudate lobe
What are the boundaries that mark the caudate lobe
Left portal vein
ligamentum venosum
IVC
A normal variant that has an inferior extension of the right lobe that extends caudally to iliac crests
Reidel’s lobe
Fibrous, stretchy attachments that tether the liver to the abdominal cavity that make good ultrasound landmarks and from many boundaries for lobes and segments are
Ligaments and peritoneal attachments
A peritoneal fold that connect the liver to the diaphragm and anterior abdominal wall
Falciform ligament
Which ligament is continuous with the ligamentum teres on the visceral surface
Falciform ligament
Which ligament is a divider between right and left subphrenic spaces
Falciform ligament
Remnants of the fetal left umbilical vein
Ligamentum teres
Which ligament connects to falciform ligament on anterior, inferior surface
Ligamentum teres
Which ligament divides the left lobe into medial and lateral segments
Ligamentum teres
Which ligament extends posteriorly to join the ligamentum venosum
Ligamentum teres
Obliterated remnant of the ductus venosus of the fetus
Ligamentum venosum
Which ligament is the division between left lateral lobe and caudate lobe
Ligamentum venosum
Which ligament runs posteriorly from ligamentum teres at level of porta hepatis on visceral surface
Ligamentum venosum
What ligamentum attaches inferior surface of the liver to the stomach or duodenum
Ligamentum venosum
A groove, cleft or deep furrow in organ
Fissure
What forms a natural division in an organ
Fissure
The main lobar fissure is also called what
Middle intersegmental fissure
Interlobar fissure
What structure separates the functional right and left lobe of liver
Main lobar fissure
What structure courses through the the main lobar fissure
Middle hepatic vein
The main lobar fissure can be found where on ultrasound
From gallbladder to right portal vein
The left intersegmental is divided into thirds. What are they
Cranial -left hepatic vein superior
Middle -left portal vein middle
Caudal -ligamentum teres inferior
What drains blood from the liver and empties into IVC
Hepatic veins
Hepatic veins course from an inferior anterior aspect to what
Superior posterior to IVC
What are the three hepatic veins
Right
Middle
Left
The hepatic veins join the IVC just inferior to what structure
Diaphragm
As the hepatic veins approach the IVC they increase or decrease in diameter
Increase
The middle hepatic vein drains what parts of the middle
Medial left lobe (quadrate)
Anterior segment of right lobe
Are the walls of hepatic veins or portal veins more hyperechoic
Portal vein walls brighter
What supplies 20-30% of blood to liver
Hepatic artery
The branch from celiac axis that goes to the right it the
Common hepatic artery
The entrance/exit of the liver is called
Hilum of liver
Porta hepatis
A portal triad consists of what three things
Hepatic artery
Bile duct
Portal vein
Which artery is anterior main portal vein
Hepatic artery proper
Which artery lies medial to common bile duct
Hepatic artery proper
Which two vessels are intrahepatic
Right hepatic artery
Left hepatic artery
What supplies 70-80% of nutrient rich blood to the liver
Portal systems
Do vessels of the portal system connect directly with the IVC
NOPE
The main portal vein is formed by the union of what two vessels
Superior mesenteric vein
Splenic vein
Where is the main portal vein formed
Behind neck of pancreas (L2)
What drains the right side of the small intestine, ascending colon, transverse colon
SMV
Is the superior mesenteric vein located on right or left side of superior mesenteric artery
Right
The portal confluence is formed by what
Junction of SMV and SV
The origin of the main portal vein is what
Portal confluence
The splenic vein travels on what surface of the pancreatic body and tail
Posterior
The splenic vein courses —— to the splenic artery
Inferior
What are some structures located posterior to the splenic vein
Aorta
IVC
SMA
Renal vessels
What drains left side of bowel, descending colon, sigmoid, rectum
Inferior mesenteric vein
The inferior mesenteric vein joins which vein posterior to the body of pancreas (left of body)
Joins splenic vein
The main portal vein is formed where in relation to the pancreas
Behind neck of pancreas
The main portal vein enters the liver where
Porta hepatis
The main portal vein is posterior to what vessels
Hepatic artery proper
Biliary ducts
The main portal vein bifurcates into what
Right portal vein
Left portal vein
The main portal vein is located where in relation to duodenum
Posterior
The main portal vein is located where in relation to IVC
Anterior
The liver has a dual blood supply from what two structures
Hepatic artery - oxygen rich blood
Portal vein - full of nutrients from GI tract
Where is bile formed and how is it transported
Formed in liver cells (hepatocytes) transported by ducts
What do the biliary system do
Produce, concentrate, secrete, transport bile from liver to duodenum
What is bile used for
Digestion of fats in the diet
Where is the biliary system located in the quadrant method
RUQ
Where is the biliary system located in the regional method
Right hypochondriac , epigastric region
What does the gallbladder do with bile
Stores it
The gallbladder is located where compared to the liver
Inferior aspect of liver in a depression on the liver
Is the gallbladder retroperitoneal or intraperitoneal
Intraperitoneal
Where does the gallbladder lie in respect to the IVC and right kidney respectively
IVC - lateral
Right kidney - medial
What are the three parts of the gallbladder
Neck
Body
Fundus
The portion of the gallbladder between the neck and fundus is called
Body
Narrowed, tapered, superior portion of the gallbladder is which part
Neck
The main lobar fissure extends superiorly from this part of the gall bladder
Neck
The inferior and anterior portion of the gallbladder is the
Fundus
The fixed part of the gallbladder is the
Neck
The mobile part of the liver is what
Fundus
A fold in the gallbladder’s fundus is called what (smurfs hat)
Phrygian cap
A fold at the junction of the neck and body in the gallbladder is called what
Junctional fold
A small posterior pouch near the gallbladder’s neck is called what
Hartmann pouch
The duct system is divided into what two types of ducts
Intrahepatic
Extrahepatic
Do branches get smaller or bigger along the biliary tree
Larger
What are the very small ducts within the liver collecting bile secretions that follow the course of portal veins and hepatic arterial branches
Intrahepatic ductules
Where do the right and left hepatic ducts roughly join together
About level of liver hilum
The common hepatic duct is formed by what
Junction of right and left hepatic ducts
The common bile duct courses in which aspect in respect to the right and main portal veins
Anterior
What does the cystic duct drain
Gallbladder
The spiral valves of heister are found in which duct
Cystic duct
The cystic duct merges with what to form the common bile duct
Common hepatic duct
The common bile duct is formed from what two vessels forming
Common hepatic duct
Cystic duct
The common bile duct travels —— towards the head of the pancreas to join which duct
Inferiorly to join the pancreatic duct
The junction of the pancreatic duct and common bile duct form what
Ampulla of vater
The ampulla of vater dumps into the duodenum via what
Sphincter of oddi
What does the sphincter of oddi do
Controls the flow of bile into the duodenum
The common bile duct is about how long
6-8 cm
The common bile duct lies where in regards to the main portal vein and hepatic artery proper respectively
Anterior
Lateral
The common bile duct travels along or within which aspect of the head of the pancreas
Posterior
An elongated, lobular gland
Pancreas
The pancreas usually lies at what level
Transpyloric level
Does the pancreas have a capsule
Nope
Is the pancreas retroperitoneal or intraperitoneal
Retroperitoneal except part of tail
What percent of the pancreas is endocrine and exocrine
Endocrine - 1%
Exocrine - 99%
The exocrine gland in the pancreas secretes what
Acini cells secrete enzymes that help in digestion
The endocrine glands secrete what
Islets of langerhans cells secrete hormones to regulate blood sugars
Which system transports bile and pancreatic juices to the duodenum
Duct system
In the quadrant method what spaces does the pancreas occupy
RUQ
LUQ
In the regional method which areas does the pancreas occupy
Right hypochondriac
Epigastric
Part of pancreas that is bulbous and located out of midline
Head
Part of pancreas surrounded by four parts of duodenum
Head
The IVC lies where in relation to the head of the pancreas
Posterior
The right renal vein and artery travel what in relation to the pancreatic head
Posterior
Gastroduodenal lies along what portion of the head
Anterolateral
Common bile duct is positioned where along the head of the pancreas head
Posterolateral
A posteromedial extension of the pancreatic head
Uncinate process
Uncinate process is directly —— to the SMV and —— to the IVC
Posterior
Anterior
What are the parts of the pancreas
Head
Neck
Body
Tail
What part of the pancreas is located directly anterior to the SMV
Neck
Which part of the pancreas is directly posterior to the pylorus of stomach
Neck
Most anterior aspect of pancreas between neck and tail
Body
Which part of pancreas lies posterior to antrum of stomach
Body
Which part of pancreas lies anterior to aorta, SMA, splenic vein, left renal vein and artery, spine
Body
Which part of pancreas lies inferior to splenic artery
Body
Most superior portion of pancreas
Tail
Which part of pancreas extends from left lateral edge of spine to hilum of spleen
Tail
Which part of pancreas is anterior is left kidney
Tail
Which part of pancreas is posterior to stomach and transverse colon
Tail
Which part of pancreas is lateral to spine
Tail
Which part of pancreas is medial to spleen
Tail
What courses along superior surface of tail of pancreas
Splenic artery
