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Cross Sectional Anatomy > Unit 1 Exam > Flashcards

Unit 1 Exam Flashcards

1
Q

8 Segments of the Liver

Know basic

A

The three hepatic veins are the longitudinal boundaries.

The transverse plane is defined by the right and left portal pedicles.

The caudate lobe (segment I) is situated posteriorly. Segment I includes the caudate lobe.

Couinauds’s system provides the anatomic basis for hepatic surgical resections. By using this system, the radiologist may be able to precisely isolate the location of a lesion for the surgical team. The description of the liver segments is based on the portal and hepatic venous segments.

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2
Q

8 Segments of the liver

A

The caudate lobe (segment I) is situated posteriorly.

Segments II and III include the left superior and inferior lateral segments.

Segments IVa and IVb include the medial segment of the left lobe. Segments V and VI are caudal to the transverse plane.

Segmebts VII and VIII are cephalad to the transverse plane.

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3
Q

Abdominal Aorta location

A

Begins approximately 25cm above Transpyloric line or at aortic hiatus in diaphragm

Left of midline

As it descends assumes a more midline path

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4
Q

Abdominal Muscles

A

Rectus Abdominus

External Obliqu

Internal Oblique

Transverse

Psoas Major

Quadratus Lumborum

Iliacus

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5
Q

Ant. Abdominal Wall Muscles read

A

Arrangement of these muscles provide support for abd. Viscera and prevents tearing of the muscles themselves

The muscles work posturally by contracting and may flex the spine (rectus abdominis, obliques working both sides at once) or twist the spine (individual obliques or opposite internal/external obliques working together).

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6
Q

Anteriolateral wall muscles know

A

The muscles of the anterior and lateral abdominal walls include the external oblique, internal oblique, transversus, rectus abdominis, and pyramidal is(*)

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7
Q

Aortic Bifurcation where does it occur

A

Occurs approximately L4 Right and Left Common iliac arteries

Further divides at L5 and sacrum, to internal and external branches

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8
Q

Aortic Branches read

A

Celiac Axis 1-2 cm long

Divides into hepatic

splenic, LGA

Hepatic Artery directed to right and enters liver thru the Porta Hepatis

Splenic Artery directed to the left, behind stomach and anterior border to part of pancreas, enters spleen thru the hilum

LGA, smallest often arises off splenic artery, directed to left to supply cardiac region of stomach, anastomose with RGA and branch of Hepatic Artery

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9
Q

Biliary Tree

A

Biliary Ducts originate in hepatocystes

  • *function Regulates flow**
  • *Transports to intestine**

Liver secretes 1-2 liters of bile per day

Right and left hepatic ducts exit the liver… (in region of porta hepatis)

Combine to form common hepatic Duct… (approx 4mm in diameter, then descends within edge of lesser omentum

Cystic duct joins CHD….

Common bile duct… (max. diameter of 6mm)

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10
Q

Body of the pancreas

A

Posterior surface rests on anterior surface of the SMA, SA, Lt Adrenal, Lt kidney and its vessels

Seperated from Stomach by the omental bursa

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11
Q

Branches and Bifurcations

A

From superior to inferior

Celiac axis

SMA

Renal arteries

R and L gonadal

Lumbar arteries*

IMA

Bifurcation

Median Sacral Artery

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12
Q

Branches of Aorta

A

Superior Mesenteric Artery

Arises just inferior to CA

L1

Branches and anatomizes with small intestine, supplies cecum, ascending colon and transverse

LRV between SMA and Aorta

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13
Q

CAUDATE LOBE OF LIVER read

A

Situated upon the posterior surface of right

lies opposite T11-12

Bounded anteriorly and caudad by the porta

bounded posterior by IVC

Bounded on left by Lt Sagittal Fossa

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14
Q

Common bile duct

A

First part lies in rt free edge of lesser Om.
Second part is located posterior to 1st part
of duodenum
Third part lies in a groove on posterior
surface of pancreas head
End then pierces 2nd part of duodenum
Joins pancreatic duct thru ammpula of
Vater, sphincter of Oddi

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15
Q

Drainage of Blood Adominally

A

Anterior Abdominal Wall Main Venous Drainage Branches of superficial epigastric and lateral thoracic veins

Posterior Abdominal Wall oLumbar Veins oAzygos veins

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16
Q

Gall bladder Normal Anatomy

A

Lies of undersurface of right lobe of Liver

Lies anterior to Right Kidney

Extends from MLF to anterior free margin of the liver

Lateral to MPV

Medial to liver dome
Superior to Hepatic Flexure of Colon

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17
Q

External Oblique Muscles

A

The opposite of the internal obliques, they course downward and inward, largest and strongest abdominal muscles. They are on the surface and begin at ribs 5 to 12 and connect to the linea semilunaris.

start superior and course medial

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18
Q

External Olbique

A

Outermost layer of lateral muscles

Orignate at ribs and extend downward/medially

Terminates in a broad aponeurosis

Aponeurosis inserts on

Linea alba

Iliac crest

Pubic tubercle

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19
Q

Four Fossae

Where is it exactly?

A

1.IVC FOSSA (Right Sagittal fossa)

  1. Portal Fossa
  2. Left Sagittal Fossa

4.Gallbladder Fossa

Fossae of the RUQ/LIVER

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20
Q

Four muscles make up the anterior 5 lateral wall:

A

Rectus abdominis

External oblique

Internal oblique

Transverse abdominis

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21
Q

Gallbladder function

A

Storage and concentration of Bile

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22
Q

Gallbladder Size

Location

A

Size 8-9 cm 2-4cm in diameter -walls less than 3mm • Shape- Pear shaped Oblong

Location RUQ

Under surface of Liver

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23
Q

Greater Omentum

A

Attached to greater curvature of stomach and hangs down like an apron in space between sm. intestine and abd. wall Folded back on itself and attached to inferior border of the colon

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24
Q

Greater Sac

A

Primary compartment of peritoneal cavity Extends across anterior abdomen and from diaphragm to pelvis

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25
Q

Head of the pancreas

A

Broad , flattened

Right extremity

Lies in C of duodenum

Small Uncinate process projects inferiorly and medially

Rests on IVC and LRV

SMV anterior to uncinate proces

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26
Q

How many Quadrants are they?

Name them?

Whats in each quadrant?

A

There are 4 quadrants

Right Upper Quadrant ,Left upper Quadrant

Right Lower Quadrant, Right Lower Quadrant

Right upper quadrant – liver, part of ascending colon and transverse colon, part of duodenum, right kidney.

Left upper quadrant – stomach, part of duodenum, transverse and descending colon, spleen, left kidney,

Right lower quadrant – cecum and appendix, part of ascending colon, small intestines, female gonad, part of bladder

Left lower quadrant – part of descending colon, sigmoid colon, small intestines, female gonad, part of bladder

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27
Q

How many regions are they?

Name the regions

Whats in each quadrant?

A

There are 9 Regions

  1. Right hypochondriac region
  2. Epigastric region
  3. Left hypochondriac region
  4. Right Lumbar region
  5. Umbilical region
  6. Left lumbar region
  7. Right Illiac region
  8. Hypogastric region
  9. Left Illiac Region
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28
Q

If liver resection is needed for removal of tumor what do we need to know?

A

it is important to know the tumor(s) location in relation to the hepatic vessels

Liver resections must follow the hepatic veins to preserve venous outflow and the portal veins and hepatic arteries to provide vascular inflow. Furthermore, bile ducts must be preserved to provide biliary outflow.

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29
Q

Illiacus muscle read

A

Large triangular sheet of muscle

Located in the iliac fossa on the medial side of wings the ilium

Located in false pelvis not abdomen

Close realtinship to Psoas inferior to Psoas major

Can be referred to as iliopsoas when assoc with psoas

Extends the length of the iliac fossa. The psoas muscle passes through the iliac fossa medial to the iliacus.

The psoas and iliacus muscles merge as they extend into the true pelvis. The iliopsoas muscle takes on a more anterior location caudally to lie along the lateral pelvic side wall.

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30
Q

Inferior Vena Cava

A

Originate anterior to L5 by joining of common Iliacs veins

Receives tributaries as it ascends

Goes posterior to Liver

Enters chest thru Caval hiatus (T8)

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31
Q

Inferior Vena Cava Fossa read

A

Short depression of posterior surface between caudate lobe and bare area of the liver.

Separated from the porta by the caudate lobe

Holds the IVC

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32
Q

Internal Oblique

A

Extends opposite to External

Upward and medially

Fibers runs perpendicular to external

Extends from the iliac crest to inferior borders of the ribs

Sandwiched in the middle between the external obliques and the transversus abdominis, the internal obliques begin from the side of the hip crest and the inguinal ligament, and connect with the linea semilunaris

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33
Q

Intraperitoneal Organ: Liver

A

The surface of the liver in enclosed by peritoneum except the “Bare Area”, which is the posterior surface that comes in contact with the Diaphragm.  Bare area is bordered by Coronary Ligaments (peritoneal reflections)

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34
Q

Kidney a Retroperitoneal space

A

• Kidneys

Kidneys lie in the retroperitoneum in the paravertebral gutters of the posterior abdominal wall. Some refer to the as the lying in the flanks.

Retroperitoneal organs

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35
Q

Kidney Anatomy read

A

HILUM

Slit located medially in kidney

Right at level of L1

Left at the level of L1/L2

Structures pass to and from kidney thru this

Pelvis most anteriorly and renal vein posteriorly with the artery lying between. Lymph and nerves also enter at the hilum

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36
Q

Kidney Lies

A

They lie obliquely with the upper poles more medial/posterior than the lower poles.

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37
Q

Kidney parts

A

Two main portions PARENCHYMA- Outer portion SINUS- Inner Portion

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38
Q

KIDNEY SIZE

A

Size • Length- 9-12cm

Wide 5-6cm

A/P 3.5cm

Extend the length of approximately 3 and a half vertebrae.

Usually at level of T12-L4

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39
Q

Kidneys

A

The kidneys are essentially regulatory organs which maintain the volume and composition of body fluid by filtration of the blood and selective reabsorption or secretion of filtered solutes

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40
Q

Kidneys

A

The kidneys are essentially regulatory organs which maintain the volume and composition of body fluid by filtration of the blood and selective reabsorption or secretion of filtered solutes

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41
Q

know the bilirary metabolism

A

see lecture

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42
Q

LEFT LOBE Read

A

Contains medial and lateral segments

Medial segment often referred to as the quadrate lobe

Smaller and flatter than right

situated in epigastrium and Lt Hypochondria

Upper surface convex and molded onto diaphragm

Under surface presents the gastric impression and omental tuberosity

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43
Q

Left Sagittal Fossa know

sepates what?

A

Fossa of the RQU/LIVER

Separates right /left lobes

Holds the falciform ligament

Porta joins at rightangle and divides in 2 parts

Holds the falciform ligament

Falciform liagment telescopes into ligament of terres inferiorly

Recanilization of Umb vein would occur in this fossa

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44
Q

Lesser Omentunm

A

Slings the lesser curvature of stomach to the undersurface of the liver

Gastrosplenic omentum ligament connects stomach to spleen

45
Q

Lesser Sac

A

Extensive peritoneal pouch located behind the lesser omentum and stomach

Extends upward to diaphragm and inferior between the layers of the greater omentum

46
Q

Ligamentum teres

A

(LT, arrows) appears as a bright echogenic focus in the left lobe of the liver on a transverse image.

47
Q

List the functions of the liver

A
  1. Formation of Bile
  2. Activity of Reticulo-Endothelial Tissues
  3. Metabolism of Carbs, Lipids, Proteins for preparation and excretion.
  4. Storage Depot
  5. Blood Reservoir
  6. Heat Production
  7. Detoxification
  8. Lymph Production
48
Q

Name the liver lobes

A

Left lobe, Right lobe, Caudate lobe, Quadrate lobe

49
Q

LOCATION OF Kidneys

A

Kidneys lie in the retroperitoneum in the paravertebral gutters of the posterior abdominal wall. Some refer to the as the lying in the flanks. • Retroperitoneal organs

50
Q

Location of the liver

A

The liver occupies most of the Rt. Hypochondrium, the epigastrium, and extends into the left hypogastrium. May extend to the Left Mamillary line.

The Liver is an Intraperitoneal Organ

51
Q

Main Lobar Fissure

A

Main lobar fissure (MLF) extends between the long axis neck of the gallbladder (GB) and the main portal vein (PV) on the longitudinal image. B, Falciform ligament extends from the umbilicus to the diaphragm in a longitudinal plane.

52
Q

Mesentary

A

Two layered fold of peritoneum Attaches part of intestines to posterior abd wall and includes mesentery of small intesine, transvers mesocolon and sigmoid mesocolon

53
Q

Mesenteric

A

SMA

SV and Body of pancreas are anterior to SMA

Inferior Mesenteric Arteries

Inferior to SMA

Arises off ventral surface (L3)

Curves to left to supply distal transverse colon and descending, sigmoid and rectur

54
Q

Name the land marks

A

Lateral Margins (costal margins)

Midline (aligns with the spine)

Xyphoid  Superior landmark of abd cavity

Umbilicus Seperates Abd/Pelvis

S-Pubis Inferior landmark

55
Q

Name the planes and views

A

Anterior, posterior,superior, inferiror, Medial, lateral, proximal, distal.

56
Q

Neck and Body

A

Posterior surface rests on anterior surface of the SMA, SA, Lt Adrenal, Lt kidney and its vessels  Seperated from Stomach by the omental bursa

57
Q

Nephron

A

Functional unit of the kidney

Consists of glomerulus, convuoluted tubules responsible for filtration of urine

58
Q

Normal Anatomy of the liver

Weight and Length Which Rib

A

Right lobes exceeds the left by a 6:1 ratio

Weight: 1400 to 1600g

Length: us. 15-17 cm

Lower border at costal cartilage of 8-9 rib

Each Lobule is 1 X 2 mm

59
Q

OMENTUM

A

Two-layered peritoneum that attaches the stomach to another viscus organ

Broken into Greater Omentum Lesser Omentum

60
Q

Paired Visceral Branches

A

Suprarenal (L1)

Renal (L2)

Gonadal (inf L2)

Four pairs of Lumbar

Post/lateral surface L1-L4

61
Q

Pancreas

A

Lies deep in the epigastrium

Retroperitoneal

Anterior to the prevertebral vessels

Tranverse Oblique Plane

62
Q

Parenchymal cortex in the Kidney

A

Cortex- outer extensions referred to as the columns of Bertin

This separates the medulla into individual pyramids makes up one third of functional subunit (nephron

63
Q

PARENCHYMA in the kidney

A

Parenchyma made up of an outer and inner component

64
Q

Parietal and Visceral Layer

A

Parietal Portion that lines the abdominal wall Does not cover the organs Visceral Covers organs

65
Q

Parts of Gall bladder

A

NECK- Lies most posterior ,Lies towards Porta

BODY Largest portion

FUNDUS, ies lateral, caudal and anterior to neck Often extends just inferior to liver edge

66
Q

Peritoneal cavity?

A

Serous membrane Lines the abdominal cavity Covers the peritoneal organs Formed by a single layer of cells MESOTHELIUM

Divided into two layers Parietal Visceral

Potential space between the parietal and visceral layers..

Cavity that contains small amount of lubrication Serous fluid lubricates with serous fluid and helps organs move on one another without friction

67
Q

Peritoneal Relations

A

Only covered with Peritoneum on it’s anterior surface

Extends from duodenum to splenic hilum

Divided into 3 parts

68
Q

Porta Fossa

A

Short deep fissure extending transversely across under surface of left lobe

Separates quadrate lobe in front (anteriorly) from caudate behind

Transmits PV( portal vein), HA (hepatic artey), BD(Bile ducts) , nerves, Lymphatic

69
Q

Portal Venous System

A

Blood from digestive system travels to liver thru Portal system of veins, prior to entering IVC to return to heart

Blood from SMV joined by splenic vein enter liver as MPV

IMV, usually empties into SV prior to Portal Confluence

70
Q

Portal Venous System

A

?

71
Q

Posterior Abdominal Wall Muscles

A

Psoas major muscle

Lateral to lumbar region of Vertebra

Fibers begin on Transverse processes, borders and lumbar intervertebral discs
Pass along the pelvic brim

Enter the thigh to insert at lesser trichinae of femur

72
Q

Posterior View of Liver

A

Posterior view of the diaphragmatic surface of the liver. The caudate lobe is located on the posterosuperior surface of the right lobe, opposite the tenth and eleventh thoracic vertebrae

73
Q

Potal Vein

A

Portal Vein Confluence Main Portal Vein Right Portal Vein Left Portal Vein Posterior to BD and HA Anterior to caudate lobe Surrounded by Connective tissue

74
Q

Pre Vertebral Vessels

A

Arteries arising from aorta

Veins draining into IVC

Portal Venous System Combo Bring blood to Liver

75
Q

PSOAS MAJOR MUSCLE

A

The psoas muscle extends from the mediastinum to the thigh

Major are more posterior than minor

Major are more superior than minor

Origins at the transverse processes and vertebral bodies of T12-L5 and insertions at the lesser trochanter of the femur.

76
Q

Quadrate lobe read

A

Obsolete term for medial aspect of left lobe

situated on the under surface of left lobe

Boudned anteriorly by the anterior margin of liver/ posteriorly by ports; right by GB fosse, and on left by Lt sagittal fossa.

Oblong in shape

77
Q

Quadratus Lumborum Muscle

A

This muscle originates from the iliolumbar ligament, the adjacent iliac crest, and the superior borders of the transverse process of L3 and L4 and inserts into the marg

Appears lateral and posterior to psoas muscle on transverse section

78
Q

Rectus Abdominis

A

On contraction, its lateral margin forms a palpable curved surface, termed the linea semilunaris,

Starting from the linea alba and working out, we first come to the rectus abdominis. [Shown in the image above with black vertical arrows. This is the left side of the body.] Starting from the pubic bone, these muscles connect with the fifth, sixth and seventh ribs and xiphoid process.

79
Q

Rectus Abdominis

A

This extends from the ninth costal cartilage to the pubic tubercle. The anterior surface of the rectus muscle is crossed by three tendinous intersections,

These are firmly attached to the anterior wall of the rectus sheath.

80
Q

Rectus Abdominis

A

Lie lateral to the linea alba

Extends the length of the abdominal wall

Xyphoid to SP

Enclosed by a sheath

Sheath formed by aponeuroses

81
Q

Rectus Abdominis

A

The rectus abdominis muscle rises from the front of the symphysis pubis and the pubic crest.

82
Q

Rectus Abdominis/ Pyramidal

A

The pyramidalis muscle arises by its base from the anterior surface of the pubis and inserts into the linea alba. It lies anterior to the lower part of the rectus abdominis muscle.

More pelvic than abdominal

83
Q

Rectus Abdominis

A

They are divided into compartments by strips of tendon that creates what body builders inaccurately call a “six pack”, as there are 8 or possible 10 segments, or 4 to 5 pairs. These pairs can, if trained to do so, contract individually.

84
Q

Relational anatomy

A

Anteriorly •

Right kidney

liver

second portion of the duodenus

ascending colon

small intestinal loops

Left kidney

stomach

pancreas and its vessels

spleen

splenic flexure

jejunal loops

85
Q

Relational anatomy

A

•Superiorly •Adrenal gland more medial on right

86
Q

Renal Medulla

A

Broken into pyramids by the Columns of Bertin, the apices of the pyramids are called papillae and jut into the calyces.

Pyramids radiate from sinus to outer portion of kidney

Striated area contain Loops of Henle and collecting tubules

Function as the proximal collecting system

87
Q

Renal pyramids

A

The base of each pyramid starts at the corticomedullary border The apex ends in the renal papilla which merges to form the renal pelvis and then on to form the Uterer

88
Q

Renal Sinus

A

Inner portion of kidney tissue Arises from the apices of the pyramids as cup-shaped minor calyces Each kidney has 7-14 MINOR CALYCES Each kidney has 2-3 MAHOR CALCYES

Sinus- Contains, major and minor calyces, vessels, nerves, lymphatic’s, proximal pelvis, and is surrounded by fat

Variation of interfaces cause this portion to look highly echogenic
All tissues that transport sound well, small structures beyond resolution when not dilated

89
Q

RENAL VEINS

A

Renal Veins

they drain directly into the IVC

Left renal vein has a longer course than the right and must pass anterior to the aorta to reach the IVC. Left also receives the Inferior phrenis, adrenal and gonadal veins of that side.

90
Q

Retroperitoneal Spaces

A

Anterior Pararenal space Vs Gerota’s fascia and post peritoneum Asc and Descending colon also in this area

Posterior Pararenal Space vs. post renal fascia and PAW muscles only fat and vessels in this

91
Q

Retroperiotneal area

A

Perirenal Space directly around the kidney enclosed by renal fascia Kidneys, adrenals, lymph nodes, vessels and perirenal fat iin this area

92
Q

Right renal artery

A

has a longer course and is more inferior than the left.

RRA passes posterior to the IVC

Each renal artery divides into trhee branches

one posterior, anterior/upper

anterior lower which passes anterior to renal pelvis

They then further branch and subdivide into segmental, interlobar, arcuate and interlobular arteries.

93
Q

SACS

A

Greater and Lesser Sac Division of peritoneal cavity

94
Q

See Pictures of the pancreas

A

cross sectional

95
Q

Splenic vein and Artery in the pancreas

A

Splenic Artery runs anterior to the body and tail of the pancreas

Originates superiorly as a branch of the celiac axis (aorta)

Splenic Vein runs posterior to the body and tail of the pancreas

Originates superiorly at splenic hilum

96
Q

Superior Cross section

A

Read abt it in the lecture

97
Q

Surrounding anatomy in the kidney

A

Posteriorly

Upper third of kidney diaphragm and 12th rib and the costodiaphragmatic recess of the pleura

Lower third of the kidney medial to lateralpsoas, quadratus lumborum and transverses abdominis muscles

98
Q

Tail of the pancreas

A

Left extremity of pancreas

Close proximity to splenic hilum

Most superior and posterior portion of pancreas

99
Q

Tail of the Pancreas

A

Left extremity of pancreas

Close proximity to splenic hilum

Most superior and posterior portion of pancreas

100
Q

The hapatic veins

How Many are they?

A

The hepatic veins are divided into three components: right, middle, and left. They all drain into the inferior vena cava at the level of the diaphragm.

101
Q

The head of the pacreas lies where

A

on the duodenum

102
Q

Transversus

A

The deepest muscles of the abdominal muscles, the transversus abdominis go horizontally from front to back.

103
Q

Transversus Abdominis

A

Innermost of the three flat muscles

Fibers pass in a horizontal direction

104
Q

Vascular Anatomy for Liver

whats Oxygenated and Deoxigenated

A

Receives nutrients from HA and PV from both

PV is 80% saturated and supplies 50-60% of oxygen requirements for hepatocytes

PV and HA both have echodense walls Collegen connective sheaths cause reflections.

Portal Vein walls are thicker only in that region in the liver

HV walls less echodense (thiner)

PV run in horizontal plane (oblique) intralobar path

HV vary in calliper with location and breathing

HV run more longitudinally between segments

Portal Vein Bring oxygenated to the liver

Hepatic arteries does not bring oxygenated so its deoxygenated blood in the liver ONLY IN THE LIVER Thought out, they normally are oxygenated but not in the liver.

105
Q

RETROPERITONEUM

A

Space posterior to Peritoneal cavity

Contains the following:

Kidneys

*Uterus Ureters

*Duodenum

Adrenals

Prostate

Pancreas

*COLON

Great Vessels Bladder

106
Q

Vessels

A

Main Artery Supply Abdominal Wall mainly supplied by Internal thoracic arteries Parietal branches of Abdominal Aorta

Main Artery Supply Posterior Abdominal Wall Lumbar arteries Direct tributaries of Aorta

107
Q

What surrounds the liver?

A

Rt. Kidney lies inferior and posterior

Great vessels lie Posteriorly

Portal Triad enters medially

Pancreas lies inferior and posterior

Left lobe of liver can serve as a window to image the pancreas

108
Q

Whats is the Couinaud’s hepatic segments?

A

divide the liver into 8 segments.

Each segment is independent because it has its own vascular inflow, vascular outflow, and biliary outflow…all of which are necessary to the proper functioning of the liver

109
Q

Where is the Fossa in the liver

A

Short linear depression

located on posterior surface between caudate lobe and bare area of liver

Separates Quadrate lobe in front from caudate lobe behind

Separated from portal by caudate

Cross Sectional Anatomy (5 decks)

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