Upper Abdomen Flashcards
Most viscera in the abdominal cavity are associated with _____.
Most viscera in the abdominal cavity are associated with the celiac trunk
What are these terms associated with:
- Splanchnic
- Hepatic
- Cystic
- Pancreatic
- Splenic
- Gastric
- Colic
- Recto
- Phrenic
Splanchnic = visceral Hepatic = liver Cystic = gallbladder Pancreatic = pancreas Splenic = spleen Gastric = stomach Colic = colon Recto = rectum Phrenic = diaphragm
Parietal Peritoneum and Visceral Peritoneum are _____.
Parietal Peritoneum and Visceral Peritoneum are 2 continuous layers
How do greater omentum and lesser omentum communicate?
Through the omental foramen
Ascites
fluid (from peritoneum during herniation)
Greater omentum attaches to _____ and _____.
Greater omentum attaches to the greater curvature of the stomach and the transverse colon
Greater omentum drapes over _____ like an “apron”
small intestine
Why is the greater omentum 4 layers?
Began as 2 double layers with a sac between but they fused during development
What is the function of the greater omentum?
Protects underlying viscera from infection and inflammation. Greater omentum moves to do this which can result in adhesions.
What are adhesions of the greater omentum?
Scar tissue that inhibits motion. Came from movement for protection of viscera.
Adhesions can cause risk of pinching off digestive flow. Can be severe enough for surgery
3 ligaments of the greater omentum. What are they each derived from?
- Gastrocolic ligament (largest)
- Gastrosplenic ligament
- Gastrophrenic ligament
*all derived from dorsal mesentery
Lesser Omentum attaches to _____ & _____
Lesser omentum attaches to lesser curvature of stomach and duodenum
Two portions of lesser omentum and what are they derivatives of?
- Hepatogastric ligament - attaches liver to stomach
- Hepatoduodenal ligament - connects liver to duodenum
They are both derivatives of ventral mesenteries
Hepatogastric ligament
hepatogastric ligament connects the liver to the stomach
1 of the 2 portions of lesser omentum
Hepatoduodenal ligament
hepatoduodenal ligament attaches the liver to the duodenum
contains the portal triad (portal vein, hepatic artery, bile duct)
overlays the omental foramen
1 of the 2 portions of the lesser omentum
Mesentery Proper anchors ______
most of the small intestine to the posterior abdominal wall
How does the mesentery proper run? Along what and in what direction? How long?
mesentery proper runs diagonally from duodenojejunal junction to the ileocecal junction
It is 15-20cm in adults
Is the duodenojejunal junction retroperitoneal or intraperitoneal?
At this junction, the duodenum changes from retroperitoneal to intraperitoneal. *LOTS OF MOTION HERE.
Suspensory ligament of treitz
aka Suspensory ligament of duodenum
Marks location where duodenum goes from retroperitoneal to intraperitoneal
fibromuscular ligament descends from R. Crus of diaphragm, crosses L. Crus of diaphragm and holds distal duodenum in place
Prevents duodenojejnual junction from sagging
Mesocolon anchors _____
portions of the transverse colon to the posterior abdominal wall
Which mesentery anchors the ascending and descending colon?
None. Ascending and descending are directly attached to posterior wall
Three portions of mesocolon and what do they anchor?
- Transverse mesocolon - anchors transverse colon
- Sigmoid mesocolon - anchors sigmoid colon
- Rectal mesocolon - PARTIALLY anchors rectum
What divides the greater sac into two compartments? What are those compartments?
Transverse mesocolon divides greater sac into supracolic compartment and infracolic compartments
supracolic = stomach, liver spleen
infracolic = small intestine, asc. desc. colon, lies posterior to greater omentum, divided into R/L infracolic by small intestine
Falciform Ligament
Ventral surface of liver - divides into R/L sides. Anchors liver to diaphragm and anterior body wall.
What is the portion of falciform ligament that hangs off ventrally?
Part of the obliterated umbilical vein
Called ligamentum terest hepatis aka round ligament of the liver
What is the bare area of the liver? What is it adjacent to?
Upper posterior liver that doesn’t have visceral peritoneum, adjacent to inferior vena cava
Coronary Ligament
Reflection of visceral peritoneum around bare area of liver
Attaches liver to inferior surface of diaphragm
What are the two peritoneal pouches in recumbent position?
- Hepatorenal pouch
2. Rectovesical pouch / rectouterine pouch
Are the rectouterine/retovesical and hepatorenal pouches separate?
No.
Pathological fluids can accumulate here and spread to one another
Hepatorenal pouch is bounded by ______
Hepatorenal pouch is pounded by the liver, right kidney, colon, duodenum
Which side is the hepatorenal pouch on? Why?
Hepatorenal pouch is on the right side of the body.
Liver is on right side, weighs down so pouch is lower.
Left side includes spleen - in the way of pouch
Rectovesical pouch is between _____. Male or female?
Rectum and bladder.
Male.
What is the rectovesical pouch called in females? Why?
Uterine splits rectovesical pouch into two compartments.
Rectouterine and vesicouterine pouch.
In females, what is the lowest point in recumbent position in pelvic cavity?
Rectouterine pouch.
Basic function of the liver
Liver detoxifies products and produces bile
Basic function of the gallbladder
Gallbladder stores bile for emulsification of bile
Basic function of pancreas
Pancreas produces enzymes for digestion
Basic function of spleen
Spleen produces lymphocytes and filters blood
Lobes of liver
Anterior surface: right and left lobes
Posterior surface: caudate and quadrate lobes
Quadrate lobe vs. Caudate lobe
Posterior lobes of liver.
Quadrate lobe is inferior and adjacent to gallbladder
Cuadate lobe is superior and adjacent to the inferior vena cava
Diaphragm vs visceral surface of liver
Diaphragm surface: smooth and dome shaped along diaphragm
Visceral surface: mostly posterior, includes fossae for each viscera in contact
Where is the portal hepatis?
On liver
Entrance for the portal triad
If you can view the portal hepatis posteriorly, what has been cut out?
The hepatoduodenal ligament has been removed if you can see the portal hepatis from posterior view
Which can hold more bile - liver or gallbladder? What do these structures do because of this relationship?
Liver produces much more bile than gallbladder can hold.
So gallbladder must concentrate the bile 10-20fold
What are the parts of the gallbladder and where are they?
Fundbus of gallbladder - hangs on inferior aspect of liver
Also has body and neck of gallbladder and duct system
Follow bile path from liver to gallbladder
Right and left lobes of liver
to right and left hepatic ducts
to common hepatic duct
to cystic duct (connected to gallbladder)
Follow bile path from gallbladder to duodenum
Cystic duct and common hepatic duct join at COMMON BILE DUCT
common bile duct joins with main pancreatic duct
both common bile duct and main pancreatic duct drain into MAJOR DUODENAL PAPILLA
Where is the major duodenal papilla?
on the descending portion of the duodenom
Why is the major duodenal papilla important?
It is the site where the common bile duct and main pancreatic duct drain into the duodenum
It is the last structure of the foregut before midgut begins
What is the location of the pancreas in relation to the stomach and duodenum?
Pancreas is posterior to stomach and posterior to most of duodenom
What is the location of the pancreas in relation to the spleen?
Tail of the pancreas is pointed towards the hilum of the spleen (on the left)
The head and the uncinate process of the pancreas sit in the ______.
C-shaped curve of the duodenom (on the right)
What is draining from the pancreas?
Digestive enzymes (exocrine)
What is the drainage system for the pancreas?
- Main pancreatic duct or
2. Accessory pancreatic duct
Pathway for main pancreatic duct
enters duodenum (with common bile duct) at major duodenal papilla
Pathway for accessory pancreatic duct
May enter duodenum as well
~2cm above major papilla at the minor duodenal papilla
What is the physical relationship between major and minor duodenal papilla?
Minor duodenal papillae is ~2cm OVER major duodenal papillae
Diaphragm vs visceral surface of spleen
Diaphragmatic surface: smooth along ribs 9-11
Visceral surface: many fossae/depressions, contacts stomach, left kidney, pancreas and colon
Gastrosplenic ligament
connects spleen to greater curvature of stomach
Splenorenal ligament
connects spleen to left kidney, contains splenic vessels
Hilum of the spleen
No visceral peritoneum
point of entry for splenic vessels
Tail of pancreas reaches hilucm of spleen occasionally
