Week 10 & 11 - Abdominal Cavity, Peritoneum & Gastrointestinal Tract Flashcards
* Define parietal & visceral peritoneum and explain the functions of the peritoneum & peritoneum cavity * Draw diagrams to explain different relationships to the peritoneum (mesenteries & retroperitoneal positions) and list the structures contained within a typical mesentery * Describe the boundaries of the lesser sac and of the epiploic foramen (on Winslow) * Demarcate the course and distribution of arteries to important structures or organs derived from the foregut, midgut and hindgut
1
Q
What is the function of the liver?
A
The liver performs various functions including:
* Detoxification
* Metabolism
* Production of biochemicals necessary for digestion
2
Q
Which arteries is responsible for supplying the stomach?
A
Lesser Curvature
- Left gastric arteries
- Right gastric arteries
Greater Curvature
- Left gastro-omental arteries
- Right gastro-omental arteries
3
Q
Which artery supplies blood to the spleen?
A
Splenic artery
4
Q
What is the role of the gastroduodenal artery?
A
It supplies blood to the stomach and the duodenum.
5
Q
Which artery supplies the greater curvature of the stomach?
A
Right gastro-omental artery
6
Q
What area does the superior mesenteric artery supply?
A
It supplies the midgut.
7
Q
Name the artery that supplies the duodenum.
A
Duodenal artery
8
Q
What does the middle colic artery supply?
A
It supplies the transverse colon.
9
Q
Which artery supplies the ascending colon?
A
Right colic artery
10
Q
What artery supplies the cecum and appendix?
A
Ileocolic artery
11
Q
What is the anatomical position of the small intestine in the anterior view?
A
Located below the stomach and above the colon.
12
Q
What artery is associated with the thoracic aorta?
A
Anterior view of the thoracic aorta.
13
Q
Which artery is part of the celiac trunk?
A
Left gastric artery
14
Q
What does the inferior mesenteric artery supply?
A
It supplies the hindgut.
15
Q
What is the major vein draining the gallbladder?
A
Cystic vein
16
Q
Which vein drains directly into the hepatic portal vein?
A
Right gastric vein
17
Q
What is the function of the pancreaticoduodenal veins?
A
They drain the pancreas and duodenum.
18
Q
Which vein drains the middle colic area?
A
Middle colic vein
19
Q
What is the role of the appendicular vein?
A
It drains the appendix.
20
Q
True or False: The esophageal branch is part of the azygos venous system.
A
True
21
Q
What structure is known as the cardial notch?
A
The superior angle where the left margin of the oesophagus joins the greater curvature of the stomach
An anatomical feature of the stomach.
22
Q
Which vein drains the spleen?
A
Splenic vein
23
Q
What are the veins that drain the greater curvature of the stomach?
A
Left and right gastro-omental veins
24
Q
What does the inferior mesenteric vein drain?
A
It drains the hindgut.
25
What is the role of the superior mesenteric vein?
It drains the midgut.
26
Fill in the blank: The _______ veins drain the left colic area.
Left colic
27
What veins are associated with the jejunum and ileum?
Jejunal and ileal veins
28
Which veins drain the sigmoid colon?
Sigmoid veins
29
What is the role of the superior rectal veins?
They drain the rectum.
30
What is the origin of the celiac trunk?
Abdominal aorta (at level of aortic hiatus)
## Footnote
The celiac trunk is a major artery supplying the abdominal organs.
31
What does the coeliac trunk trifurcate into?
* Left Gastric
* Splenic
* Common hepatic arteries
32
Which organs are supplied by the celiac trunk?
* Esophagus
* Stomach
* Proximal duodenum
* Liver/biliary apparatus
* Pancreas
## Footnote
The celiac trunk is crucial for supplying blood to the upper abdominal organs.
33
What is the course of the left gastric artery?
Ascends retroperitoneally to the esophageal hiatus, then descends along lesser curvature
## Footnote
It gives rise to an esophageal branch.
34
What does the left gastric artery anastomose with?
Right gastric artery
## Footnote
This anastomosis ensures adequate blood supply to the stomach.
35
Which organs are supplied by the splenic artery?
* Body of pancreas
* Spleen
* Greater curvature and posterior stomach body
## Footnote
The splenic artery runs along the superior border of the pancreas.
36
Where does the posterior gastric artery originate?
## Footnote
Or Short Gastric arteries
From the splenic artery posterior to the stomach
## Footnote
It ascends retroperitoneally along the posterior wall of the lesser omental bursa.
37
What is the distribution area of the left gastro-omental artery?
Left portion of greater curvature of the stomach
## Footnote
It anastomoses with the right gastro-omental artery.
38
How many short gastric arteries typically arise?
4–5
## Footnote
These arteries supply the fundus of the stomach.
39
What is the origin of the hepatic artery?
Celiac trunk
## Footnote
It supplies several organs including the liver and gallbladder.
40
What does the hepatic artery bifurcate into?
Right and left hepatic arteries
## Footnote
These arteries supply the liver.
41
What is the course of the cystic artery?
- Right hepatic artery within the cystohepatic triangle (of Calot)
- Courses posterolateral to the common hepatic duct and anterior to the cystic duct towards the neck of the gallbladder
## Footnote
It supplies the gallbladder and cystic duct.
42
What does the right gastric artery anastomose with?
Left gastric artery
## Footnote
It runs along the lesser curvature of the stomach.
43
What areas does the gastroduodenal artery supply?
* Stomach
* Pancreas
* First part of duodenum
* Distal part of bile duct
## Footnote
It descends retroperitoneally, posterior to the gastroduodenal junction.
44
What is the distribution area of the right gastro-omental artery?
Right portion of greater curvature of stomach
## Footnote
It anastomoses with the left gastro-omental artery.
45
What does the superior pancreaticoduodenal artery supply?
* Proximal portion of duodenum
* Superior part of head of pancreas
## Footnote
It divides into anterior and posterior arteries on each side of the pancreatic head.
46
What is the origin of the inferior pancreaticoduodenal artery?
Superior mesenteric artery
## Footnote
It supplies the distal portion of the duodenum and head of pancreas.
47
Fill in the blank: The left gastro-omental artery passes between layers of the _______ to supply the stomach.
[gastrosplenic ligament]
## Footnote
It is important for the blood supply of the greater curvature of the stomach.
48
What is the left gastric vein?
A vein that drains blood from the stomach to the portal vein.
## Footnote
It is part of the venous drainage of the stomach.
49
What does the right gastric vein do?
Drains blood from the stomach to the portal vein.
## Footnote
It is involved in the venous return from the stomach.
50
What is the function of the short gastric vein?
Drains blood from the fundus of the stomach to the splenic vein.
## Footnote
It connects to the splenic vein, which is part of the portal circulation.
51
What is the portal vein?
A major vein that carries blood from the gastrointestinal tract and spleen to the liver.
## Footnote
It plays a crucial role in directing blood flow from the digestive organs to the liver for processing.
52
What is the prepyloric vein?
Vein that drains blood from the pylorus region of the stomach.
## Footnote
It is involved in the venous drainage of the pyloric area.
53
What is the pylorus?
The region of the stomach that connects to the duodenum.
## Footnote
It acts as a valve to control the passage of food into the small intestine.
54
What are pancreaticoduodenal veins?
Veins that drain the pancreas and duodenum into the portal vein.
## Footnote
They play a role in the venous drainage of the pancreas and the first part of the small intestine.
55
What is the posterior gastric vein?
A vein that drains blood from the posterior aspect of the stomach.
## Footnote
It typically drains into the splenic vein.
56
What is the left gastro-omental vein?
Vein that drains blood from the greater curvature of the stomach.
## Footnote
It connects to the splenic vein and is involved in gastric drainage.
57
What is the splenic vein?
A vein that drains blood from the spleen to the portal vein.
## Footnote
It is a significant component of the portal venous system.
58
What does the right gastro-omental vein do?
Drains blood from the greater curvature of the stomach into the superior mesenteric vein.
## Footnote
It is important for the venous return from the stomach.
59
What is the inferior mesenteric vein?
A vein that drains blood from the lower gastrointestinal tract into the splenic vein.
## Footnote
It collects blood from the descending colon, sigmoid colon, and rectum.
60
What is the superior mesenteric vein?
A vein that drains blood from the small intestine and parts of the colon into the portal vein.
## Footnote
It is vital for the venous drainage of the upper gastrointestinal tract.
61
What nerve is referred to as becoming the posterior vagal trunk?
Right vagus nerve
62
What does the left vagus nerve become?
Anterior vagal trunk
63
What type of plexus is associated with the esophagus?
Esophageal (nerve) plexus
64
Which lymph nodes are located in the celiac region?
Celiac lymph nodes
65
Which lymph nodes are specifically named for the left gastric area?
Left gastric lymph nodes
66
What are the two types of splanchnic nerves?
* Greater splanchnic
* Lesser splanchnic
67
What is the collective term for the celiac plexus and its associated ganglia?
Solar Plexus
68
What type of plexus surrounds the left gastric artery?
Superior gastric plexus
69
What are the branches of the vagus nerve that supply the stomach?
* Posterior gastric branches
* Anterior gastric branches
* Pyloric branches of vagus nerve
70
What is the anatomical location of the right dome of diaphragm?
Located above the liver
## Footnote
The right dome of the diaphragm is the superior part of the diaphragm on the right side.
71
Which organ is located under the right dome of the diaphragm?
Liver
## Footnote
The liver is a large organ responsible for various metabolic processes.
72
What is the function of the fundus of the gallbladder?
Stores bile
## Footnote
The fundus is the rounded, upper portion of the gallbladder.
73
Where is the pylorus located in relation to the stomach?
At the distal end of the stomach
## Footnote
The pylorus connects the stomach to the duodenum.
74
What is the anatomical position of the ascending colon?
Located on the right side of the abdomen
## Footnote
The ascending colon is part of the large intestine.
75
What structure is referred to as the cecum?
The beginning of the large intestine
## Footnote
The cecum is located at the junction of the small and large intestines.
76
What is the function of the small intestine?
Digestion and absorption of nutrients
## Footnote
The small intestine consists of the jejunum and ileum.
77
Fill in the blank: The _______ colon is located on the left side of the abdomen.
Descending
## Footnote
The descending colon is part of the large intestine.
78
What is the anatomical significance of the sigmoid colon?
Prepares waste for elimination
## Footnote
The sigmoid colon is the last section of the colon before the rectum.
79
What does the urinary bladder do?
Stores urine
## Footnote
It is a muscular sac that collects urine from the kidneys.
80
Which organ is located behind the stomach?
Pancreas
## Footnote
The pancreas plays a crucial role in digestion and blood sugar regulation.
81
True or False: The esophagus connects the throat to the stomach.
True
## Footnote
The esophagus is a muscular tube that transports food.
82
What is the role of the right suprarenal gland?
Produces hormones like adrenaline
## Footnote
The suprarenal glands are also known as adrenal glands.
83
What organ is primarily responsible for filtering blood?
Kidney
## Footnote
The kidneys also regulate fluid balance and electrolytes.
84
Fill in the blank: The _______ is the pouch that stores bile.
Gallbladder
## Footnote
The gallbladder releases bile into the small intestine to aid digestion.
85
What is the role of the appendix?
May play a role in immune function
## Footnote
The appendix is often considered a vestigial organ.
86
Where is the rectum located?
At the end of the large intestine
## Footnote
The rectum stores feces until elimination.
87
What are the primary functions of the liver?
- Synthesis of bile
- Glycogen storage
- Clotting factor production
## Footnote
The liver plays a crucial role in digestion and metabolism.
88
What structures are in direct contact with the liver?
- Right kidney
- Right adrenal gland
- Right colic flexure
- Transverse colon
- First part of the duodenum
- Gallbladder
- Oesophagus
- Stomach
## Footnote
These structures are essential for understanding liver anatomy.
89
What is the role of the falciform ligament?
Divides the left and right lobes of the liver
## Footnote
It also contains the ligamentum teres, a remnant of the umbilical vein.
90
What does the lesser omentum connect?
Liver to the lesser curvature of the stomach and first part of the duodenum
## Footnote
It consists of the hepatoduodenal and hepatogastric ligaments.
91
What are hepatic recesses?
- Subphrenic spaces
- Subhepatic space
## Footnote
These peritoneal spaces are important for understanding liver pathology.
92
What is the dual blood supply of the liver?
Hepatic artery proper (25%) and hepatic portal vein (75%)
## Footnote
The hepatic portal vein carries partially deoxygenated blood.
93
What are the stages of alcohol-induced liver damage?
- Fatty liver
- Fibrosis
- Cirrhosis
## Footnote
These stages reflect the progression of liver disease.
94
What are common causes of jaundice?
Pre-hepatic, hepatic, post-hepatic obstructions
## Footnote
Conditions like gallstones, malignancy, and infections can lead to jaundice.
95
What are the symptoms of jaundice?
- Dark urine
- Light stools
- Yellow skin
- Itch
- Vomiting
- Anorexia
- Weight loss
- Abdominal pains
## Footnote
These symptoms indicate liver dysfunction or bile duct obstruction.
96
What imaging modalities are used for liver and biliary tree assessment?
- Ultrasound
- MRI (Magnetic Resonance Imaging)
- CT (Computed Topography)
- MRCP (Magnetic Resonance Cholangiopancreatography)
- ERCP (Endoscopic Retrograde Cholangiopancreatography)
## Footnote
Each modality has its advantages and limitations.
97
What is ascites?
Accumulation of protein-containing fluid within the abdomen
## Footnote
Often caused by portal hypertension.
98
What is colitis?
Inflammation of the inner lining of the colon
## Footnote
Causes include infection and inflammatory bowel diseases like Crohn's disease.
99
What are the complications associated with peptic ulcer disease?
- Haemorrhage
- Perforation
- Stenosis
## Footnote
These complications can arise from gastric or duodenal ulcers.
100
Fill in the blank: The __________ is a remnant of the umbilical vein.
ligamentum teres
## Footnote
It is located at the free edge of the falciform ligament.
101
True or False: The left triangular ligament attaches the right lobe of the liver to the diaphragm.
False
## Footnote
The left triangular ligament attaches the left lobe of the liver to the diaphragm.
102
What is the primary blood supply to the liver?
Hepatic artery and hepatic portal vein
## Footnote
The hepatic artery supplies oxygen-rich blood, while the portal vein supplies nutrient-rich blood from the digestive tract.
103
What are the two main types of gallstones?
- Cholesterol stones
- Pigment stones
## Footnote
Cholesterol stones make up 80% of gallstones.
104
What does the term 'biliary colic' refer to?
Pain caused by gallstones blocking the bile ducts
## Footnote
This condition can lead to cholecystitis if not treated.
105
What is the peritoneum?
A continuous membrane that lines the abdominal cavity and supports the viscera
## Footnote
It provides pathways for blood vessels and lymph to travel to and from the viscera.
106
What are the two layers of the peritoneum?
Parietal peritoneum and visceral peritoneum
## Footnote
Both layers are made of simple squamous epithelial cells.
107
What does the parietal peritoneum line?
The internal surface of the abdominopelvic wall
## Footnote
It has a somatic nerve supply for well-localized pain.
108
What type of nerve supply does the visceral peritoneum have?
Autonomic nerve supply
## Footnote
It is poorly localized and refers pain to dermatomes.
109
Which organs are classified as intraperitoneal organs?
| "Salted Spurs"
* **S**tomach
* **A**ppendix
* **L**iver
* **T**ransverse colon
* **D**uodenum (1st Part only)
* **S**mall Intestine (Jejunum, Ileum & Cecum)
* **P**ancreas (Only Tail)
* **R**ectum (Upper 1/3)
* **S**pleen
* **S**igmoid colon
| SALTD SPRSS
## Footnote
Intraperitoneal organs are covered anteriorly and posteriorly by visceral peritoneum.
110
What does SAD PUCKER stand for in relation to extraperitoneal organs?
* S → Suprarenal gland
* A → Aorta/IVC
* D → Duodenum (prox. 2cm)
* P → Pancreas (excl. tail)
* U → Ureters
* C → Colon (ascending/descending)
* K → Kidneys
* E → (O)esophagus
* R → Rectum
## Footnote
Extraperitoneal organs are covered only anteriorly.
111
What is the function of the mesentery?
Connects intraperitoneal organs to the posterior wall
## Footnote
It is a double-layered visceral peritoneum.
112
What is the greater omentum?
A sheet of visceral peritoneum that descends from the greater curvature and proximal duodenum
## Footnote
It has 4 layers and attaches to the anterior transverse colon.
113
What is the lesser omentum?
A sheet of visceral peritoneum that attaches from the lesser curvature of the stomach and proximal duodenum to the liver
## Footnote
It has 2 layers and contains the hepatogastric and hepatoduodenal ligaments.
114
Which regions correspond to referred pain from foregut, midgut, and hindgut structures?
* Foregut structures → epigastric region
* Midgut structures → umbilicus region
* Hindgut structures → pubic region
## Footnote
This classification helps in diagnosing the source of abdominal pain.
115
What organs are classified as foregut structures?
* Oesophagus
* Stomach
* Pancreas
* Liver
* Gallbladder
* Duodenum (prox. to common bile duct)
## Footnote
These structures are involved in the early stages of digestion.
116
What organs are classified as midgut structures?
* Duodenum (distal to common bile duct) to
* Proximal 2/3 of transverse colon
## Footnote
Midgut structures are responsible for the absorption of nutrients.
117
What organs are classified as hindgut structures?
- Distal 1/3 of transverse colon to
- Anal canal
## Footnote
Hindgut structures are involved in the formation and elimination of waste.
118
What are the subdivisions of the peritoneal cavity?
* Greater sac
* Lesser sac
## Footnote
The greater sac is further divided into supracolic and infracolic compartments.
119
What does the greater sac contain?
- **Supracolic compartment**: stomach, liver, spleen
- **Infracolic compartment**: small intestine, ascending and descending colons
## Footnote
The compartments are connected by paracolic gutters.
120
What is located posterior to the stomach and lesser omentum?
The lesser sac
## Footnote
It is connected to the greater sac via the epiploic foramen.
121
What are the boundaries of the epiploic foramen?
* **Anterior**: hepatoduodenal ligament containing the portal triad
* **Posterior**: IVC and right crus of diaphragm
* **Superior**: liver
* **Inferior**: 1st part of duodenum
## Footnote
This foramen connects the greater and lesser sacs.
122
Where is the liver primarily located?
- R upper quadrant
- under right costal margin & hemidiaphragm,
- extends to left hemidiaphragm
123
What are the two surfaces of the liver?
* Diaphragmatic surface (anterosuperior)
* Visceral surface (posteroinferior)
124
What is the characteristic of the diaphragmatic surface of the liver?
- Smooth
- Convex
- NOT covered by visceral peritoneum
125
What structures does the visceral surface of the liver come into contact with?
* Abdominal part of esophagus
* Fundus of stomach
* 1st part of duodenum
* Right colic flexure & transverse colon
* Right kidney & adrenal gland
* Gallbladder
* IVC
126
What is the function of the falciform ligament?
Attaches anterior surface of liver to anterior abdominal wall at umbilicus
127
What does the coronary ligament demarcate?
Demarcates the bare area of the liver
128
What are the components of the lesser omentum?
* Hepatoduodenal ligament
* Hepatogastric ligament
129
What are the peritoneal recesses associated with the liver?
* Subphrenic
* Subhepatic
* Morison's
130
What surrounds the liver and provides structural support?
Glisson's capsule
131
What is the primary blood supply to the liver?
* Hepatic artery proper (25%)
* Hepatic portal vein (75%)
132
What is the function of the hepatic portal vein?
Carries partially deoxygenated blood and nutrients from the abdominal part of the GI tract
133
What structures are drained by the hepatic veins?
* Right hepatic vein
* Left hepatic vein
* Middle hepatic vein
134
True or False: The hepatic portal vein has valves.
False
135
What is the anatomical position of the pancreas?
Level of transpyloric plane (L1), with the tail being intraperitoneal
136
What connects the head of the pancreas to the duodenum?
Connective tissue
137
What are the two types of pancreas?
* Endocrine pancreas (islets of Langerhans)
* Exocrine pancreas (digestive enzymes)
138
What is the cause of pancreatitis represented by the acronym GET SMASHED?
* Gallstones
* Ethanol
* Trauma
* Steroids
* Mumps
* Autoimmune
* Scorpion Stings
* Hypertriglyceridemia, hypercalcemia, and hyperparathyroidism
* ERCP - Endoscopic retrograde cholangiopancreatography
* Drugs (sodium valproate, azathioprine)
139
What is the anatomical position of the spleen?
- Upper left quadrant (Left Hypochondriac)
- Below left ribs 9-11
140
What is the arterial supply to the spleen?
Splenic artery (arising from coeliac trunk)
141
What is the venous drainage of the spleen?
Splenic vein combines with superior mesenteric vein to form hepatic portal vein
142
What lymph nodes are involved in the lymphatic drainage of the spleen?
Pancreaticosplenic nodes and coeliac nodes
143
Fill in the blank: The gallbladder is _____ to the liver.
Inferior
144
What is the main duct system of the pancreas?
Main pancreatic duct runs the length of the pancreas and joins with the common bile duct
145
What is the function of cholecystokinin in relation to the gallbladder?
Mediates contraction of gallbladder and secretion of bile
146
What anatomical structures are connected by the gastrosplenic ligament?
Spleen to greater curvature of stomach
147
What is the role of the sphincter of Oddi?
Regulates the flow of bile and pancreatic juice into the duodenum
148
What is the anatomical position of the oesophagus?
C6-T11
149
Where does the abdominal oesophagus terminate?
At the cardiac orifice of the stomach at T11
150
Which structures are anterior to the abdominal oesophagus?
* Left vagus nerve
* Posterior surface of the heart
151
Which structures are posterior to the abdominal oesophagus?
* Right vagus nerve
* Left crus of diaphragm
152
What are the layers of the abdominal oesophagus from outer to inner?
* Serosa
* Muscle (inferior 1/3 is smooth muscle)
* Submucosa
* Mucosa (NKSSE)
153
What are the arterial supplies to the abdominal oesophagus?
* Left gastric artery
* Left inferior phrenic artery
154
What is the venous drainage of the abdominal oesophagus?
* **Left gastric vein** to portal circulation
* **Azygos vein** to systemic circulation
* **Porto-systemic anastomosis**
155
Where do the lymphatics of the abdominal oesophagus drain?
**Left gastric** nodes to **Celiac lymph** nodes
156
What nerves supply the abdominal oesophagus?
* Anterior & posterior gastric from parasympathetic vagal trunks
* Sympathetic branches from the thoracic sympathetic trunk
157
What are the two openings of the stomach?
* Cardiac opening
* Pyloric opening
158
What is the lesser curvature of the stomach?
Medial surface from cardiac orifice to pylorus
159
What is the greater curvature of the stomach?
Lateral border from cardiac orifice to pyloric antrum
160
What are the divisions of the stomach?
* Cardia
* Fundus
* Body
* Pylorus (divided into pyloric antrum, pyloric canal, pyloric sphincter)
161
What is the function of the inferior oesophageal sphincter?
- Allows food to pass through the cardiac orifice
- Prevents the reflux of gastric contents back into the oesophagus
162
What is the anatomical sphincter that controls the exit of chyme?
Pyloric sphincter
163
What are the blood supplies to the stomach's lesser curvature?
* Right gastric artery
* Left gastric artery
164
What arteries supply the greater curvature of the stomach?
* Short gastric arteries
* Right gastro-omental artery
* Left gastro-omental artery
165
What is the nerve supply for the stomach?
The stomach receives innervation from the autonomic nervous system:
- **Parasympathetic nerve** supply arises from the **anterior and posterior vagal trunks**, derived from the vagus nerve.
- **Sympathetic nerve** supply arises from the **T6-T9 spinal cord segments** and passes to the **coeliac plexus** via the **greater splanchnic nerve**. It also carries some pain transmitting fibres.
166
What is the anatomical location of the first part of the duodenum (D1)?
- Superior to L1
- Ascends from pylorus
- Intraperitoneal for first 3cm
167
What structures are anterior to D1?
* Quadrate lobe of the liver
* Gallbladder
168
What are the characteristics of the jejunum compared to the ileum?
- **Jejunum**: red, wider, thicker, larger plicae circulares, fewer lymphoid nodules
- **Ileum**: pink, thinner, smaller plicae circulares, Peyer patches present
169
What is the blood supply to the cecum?
* Anterior & posterior cecal arteries from ileocolic artery
* Appendicular artery from ileocolic
170
What is the base location of the appendix?
1/3 way up the line joining ASIS & umbilicus (McBurney's point)
171
What is the main blood supply for the ascending colon?
- Ileocolic
- Right colic
## Footnote
Branches of SMA
172
What nerve supplies the sigmoid colon?
- Parasympathetic innervation via the pelvic splanchnic nerves
- Sympathetic innervation via the lumbar splanchnic nerves.
173
What is the peritoneal covering of the rectum?
- Covers anterior and lateral surfaces of the first 1/3,
- only anterior surface of middle rectum,
- none on lower 1/3
174
What are the main nerves supplying the rectum?
**Autonomic**
- Sympathetic - **lumbar splanchnic** nerves and **superior and inferior hypogastric plexuses**
- Parasympathetic - **S2-4 via the pelvic splanchnic nerves and inferior hypogastric plexuses**
**Sensory**
- parasympathetic fibers retrogradely to the **S2–S4 spinal sensory ganglia**.
175
What are the anatomical relations of the rectum posteriorly?
The rectum is in contact with:
- the sacrum and coccyx;
- piriformis, coccygeus, and levator ani muscles;
- sacral plexus;
- and sympathetic trunks.
176
What is the continuation of the inferior mesenteric artery that supplies the rectum?
Superior rectal artery
177
What part of the rectum is dilated to form the rectal ampulla?
Lower part of the rectum
178
Fill in the blank: The _______ covers the anterior and lateral surfaces of the first one-third of the rectum.
Peritoneum
179
What arteries supply the muscular coat of the rectum?
Middle rectal artery
180
True or False: The lower third of the rectum is covered by peritoneum.
False
181
What is the venous drainage of the superior rectal vein?
Drains into IMV
## Footnote
Tributary of portal circulation
182
What is the nerve supply of the rectum?
Sympathetic & parasympathetic nerves from inferior hypogastric plexuses
183
What supplies blood to the mucous membrane of the rectum?
Superior rectal artery
184
What anatomical structure does the lower third of the rectum relate to in males?
- Posterior surface of the bladder
- Termination of the vas deferens
- Seminal vesicles
- Prostate
185
Fill in the blank: The middle rectal veins drain into the _______.
Internal iliac
186
What creates an anorectal portal-systemic anastomosis?
Middle rectal veins and inferior rectal veins
187
What is the lymph drainage of the upper rectum?
**Pararectal** nodes to **inferior mesenteric** nodes
188
What is the relationship of the upper two thirds of the rectum in females?
Related to the sigmoid colon and coils of ileum in the rectouterine pouch
189
What is the main function of the sympathetic and parasympathetic nerves supplying the rectum?
Sensitive only to stretch
## Footnote
**Sympathetic**:
- During a "fight or flight" response, sympathetic stimulation would lead to a reduction in bowel motility and a tightening of the internal anal sphincter.
**Parasympathetic**:
- Parasympathetic stimulation, which occurs during "rest and digest" states, leads to increased rectal motility and relaxation of the internal anal sphincter, allowing for defecation.
190
What are the three teniae coli of the sigmoid colon responsible for?
Allow longitudinal fibers to form a broad band on anterior and posterior surfaces of rectum
191
What does the inferior rectal artery anastomose with at the anorectal junction?
Middle rectal artery
192
What anatomical structure does the lower third of the rectum relate to in females?
Posterior surface of the vagina
193
Where is the liver located?
R upper quadrant, under right costal margin & hemidiaphragm, extends to left hemidiaphragm
194
What are the two surfaces of the liver?
* Diaphragmatic surface
* Visceral surface
195
Describe the diaphragmatic surface of the liver.
- Anterosuperior,
- smooth,
- convex,
- posterior aspect NOT covered by visceral peritoneum
196
What structures does the visceral surface of the liver contact?
* Abdominal part of esophagus
* Fundus of stomach
* 1st part of duodenum
* Right colic flexure & transverse colon
* Right kidney & adrenal gland
* Lesser omentum
* Gallbladder
* IVC
197
What is the falciform ligament?
Attaches anterior surface of liver to anterior abdominal wall (umbilicus), free edge contains ligamentum teres
198
What does the coronary ligament do?
- Connects superior liver to inferior diaphragm,
- demarcates bare area of liver
199
What forms the triangular ligament of the liver?
Union of anterior & posterior layers of coronary ligament at apex, attached to left lobe
200
What is the lesser omentum?
- Attaches liver to lesser curvature of stomach & 1st part of duodenum,
- consists of hepatoduodenal and hepatogastric ligaments
201
What are the recesses of the liver?
* Subphrenic
* Subhepatic
* Morison's pouch
202
What is Glisson's capsule?
Fibrous layer covering the liver
203
What are the two lobes of the liver?
* Smaller left lobe
* Larger right lobe
204
What are the accessory lobes of the liver?
* Caudate lobe
* Quadrate lobe
205
Where is the porta hepatis located?
Posteroinferior surface between caudate & quadrate lobes
206
What is the portal triad in the liver?
- Hepatic Artery
- Portal Vein
- Bile Duct
207
What is the function of the hepatic artery?
Supplies non-parenchymal structures with arterial blood, divides into left & right terminal branches
208
What is the function of the hepatic portal vein?
Supplies liver with partially deoxygenated blood, carries nutrients from small intestines
209
Where does venous drainage from the liver go?
Central veins → hepatic veins → IVC
210
What is the hepatic plexus?
- Nerve supply to the liver,
- enters porta hepatis,
- sympathetic from coeliac plexus,
- parasympathetic from Vagus nerve
211
How does lymphatic drainage of the liver occur?
* **Anterior surface**: Hepatic lymph nodes → Coeliac lymph nodes → cisterna chyli
* **Posterior surface**: Phrenic nodes & posterior mediastinal nodes → Right lymphatic & thoracic ducts
212
What anatomical relations surround the gallbladder?
* Anterior & superior: Inferior border of liver, anterior abdominal wall
* Posterior: Transverse colon, 1st & 2nd duodenum
* Inferior: Biliary tree, rest of duodenum
213
What are the main parts of the gallbladder?
* Fundus
* Body
* Infundibulum
* Neck
214
What is Hartmann's pouch?
Mucosal fold in the neck of the gallbladder, common location for gallstones
215
Describe the biliary tree.
- Hepatocytes →
- canaliculi & intralobular ducts & collecting ducts →
- hepatic ducts →
- common hepatic duct
216
What is the function of the common bile duct?
Descends and joins with the main pancreatic duct at the hepatopancreatic ampulla, regulated by the sphincter of Oddi
217
What is the anatomical position of the pancreas?
Level of transpyloric plane (L1)
## Footnote
Tail is retroperitoneal
218
What are the anatomical relations of the pancreas?
- **Stomach**: Anterior
- **Duodenum**: Outlines head
- **Transverse mesocolon**: Attaches anterior surface
- **Common bile duct**: Descends posterior to head
- **Spleen**: Posteriorly & laterally
219
What are the parts of the pancreas?
* Uncinate process
* Head
* Neck
* Body
* Tail
220
What forms the hepatic portal vein?
Union of:
- superior mesenteric vein (nutrients)
- splenic vein (products of RBC breakdown)
221
What are examples of porto-systemic anastomoses?
* Inferior esophagus
* Anal canal
* Peri-umbilical region
* Posterior aspect of liver
222
What is the uncinate process of the pancreas?
Lower part of the head of the pancreas
223
How is the head of the pancreas connected to the duodenum?
By connective tissue
224
Where is the neck of the pancreas located?
Behind the head and body of the pancreas
225
What is the anatomical position of the tail of the pancreas?
Close proximity to the hilum of the spleen; contained within the splenorenal ligament with the splenic vessels
226
What is the only intraperitoneal part of the pancreas?
Tail of the pancreas
227
What are the two main components of the duct system of the pancreas?
* Endocrine pancreas (islets of Langerhans)
* Exocrine pancreas (lobulated serous gland)
228
What hormones are produced by the endocrine pancreas?
* Insulin
* Glucagon
229
What is the role of acini in the pancreas?
Clusters of cells that produce digestive enzyme precursors
230
What is the main pancreatic duct's function?
Drains digestive enzymes into the duodenum
231
What does the accessory pancreatic duct drain into?
Minor duodenal papilla
232
What structure does the pancreatic duct join with before entering the duodenum?
Common bile duct
233
What is the vasculature supplying the pancreas?
- Pancreatic branches of splenic artery (Splenic artery)
- Superior pancreaticoduodenal arteries (Gastroduodenal artery)
- Inferior pancreaticoduodenal arteries (SMA)
234
What veins drain the pancreas?
* Pancreatic veins
* Superior mesenteric branches of hepatic portal vein
235
What lymph nodes are involved in the lymphatic drainage of the pancreas?
Pancreaticosplenal and pyloric nodes
236
Which nerve fibers supply the pancreas?
Sympathetic and parasympathetic vagal nerve fibers
237
What mnemonic is used to remember the causes of pancreatitis?
GET SMASHED
238
What does each letter in the mnemonic GET SMASHED stand for?
* G ⇒ Gallstones
* E ⇒ Ethanol
* T ⇒ Trauma
* S ⇒ Steroids
* M ⇒ Mumps
* A ⇒ Autoimmune
* S ⇒ Scorpion Stings
* H ⇒ Hypertriglyceridemia, hypercalcaemia, and hyperparathyroidism
* E ⇒ ERCP
* D ⇒ Drugs (sodium valproate, azathioprine)
239
What are common presentations of pancreatitis?
* Epigastric pain (radiating to back)
* Nausea
* Vomiting
* Diarrhoea
240
In which quadrant of the abdomen is the spleen located?
Upper left quadrant
241
What connects the spleen to the stomach?
Gastrosplenic ligament
242
What is the anatomical shape of the spleen?
Oval shaped
243
What is the function of the weak capsule of the spleen?
Allows the spleen to expand in size
244
What arteries supply the spleen?
* Splenic artery (arising from coeliac trunk)
* Five branches that do not anastomose
245
What is the venous drainage of the spleen?
Splenic vein
## Footnote
Combines with the superior mesenteric vein to form the hepatic portal vein
246
What innervates the spleen?
Coeliac plexus
247
What are the layers of the abdominal oesophagus from outer to inner?
* Serosa
* Muscle (inferior 1/3 smooth muscle)
* Submucosa
* Mucosa (NKSSE)
248
What is the arterial supply of the abdominal oesophagus?
* Left gastric artery
* Left inferior phrenic artery
249
What are the two main openings of the stomach?
* Cardiac opening
* Pyloric opening
250
What are the divisions of the stomach?
* Cardia
* Fundus
* Body
* Pylorus
251
What anatomical structure demarcates the transpyloric plane?
Pyloric sphincter
252
What does the pyloric sphincter control?
Exit of chyme from the stomach
253
What is the function of the suspensory ligament of the duodenum?
Widening of the duodenojejunal flexure to aid movement of contents
254
What anatomical relations are associated with the first part of the duodenum (D1)?
* **Anteriorly**: Quadrate lobe of the liver and gallbladder
* **Posteriorly**: Lesser sac, gastroduodenal artery, bile duct, portal vein, inferior vena cava
* **Superiorly**: Entrance to lesser sac
* **Inferiorly**: Head of pancreas
255
What anatomical relations are associated with the second part of the duodenum (D2)?
* **Anteriorly**: Fundus of gallbladder, right lobe of liver, transverse colon, coils of small intestine
* **Posteriorly**: Hilum of right kidney and right ureter
* **Medially**: Head of pancreas, bile duct, and main pancreatic duct
256
What anatomical relations are associated with the third part of the duodenum (D3)?
* **Anteriorly**: Root of the mesentery and coils of jejunum
* **Posteriorly**: Right ureter, right psoas muscle, inferior vena cava, and aorta
257
What anatomical relations are associated with the fourth part of the duodenum (D4)?
* **Anteriorly**: Beginning of the root of mesentery and coils of jejunum
* **Posteriorly**: Left margin of the aorta and medial border of left psoas muscle
258
What is the role of contraction in the duodenum?
Widening of flexure to aid movement of contents
259
What structures are located anteriorly to the duodenum?
The beginning of the root of the mesentery and coils of jejunum
260
Which structures are found posteriorly to the duodenum?
- Left margin of the aorta
- Medial border of the left psoas muscle
261
What is the arterial supply to the upper half of the duodenum?
Superior pancreaticoduodenal artery (celiac trunk)
262
What artery supplies the lower half of the duodenum?
Inferior pancreaticoduodenal artery (SMA)
263
What is the venous drainage of the superior pancreaticoduodenal vein?
Portal vein
264
What nodes are involved in lymph drainage of the upper duodenum?
Pancreaticoduodenal nodes -> pyloric nodes -> celiac nodes
265
What nerves supply the duodenum?
- Sympathetic innervation is carried by nerves of the coeliac plexus
- Parasympathetic innervation by the vagus nerve (cranial nerve X).
266
Where is the cecum located?
Between ileum and ascending colon
267
What is the function of the ileocecal valve?
Prevents reflux from cecum into ileum
268
What anatomical structures are found anteriorly to the cecum?
- Coils of the small intestine
- Part of the greater omentum
- Anterior abdominal wall
269
What creates cecum recesses?
Presence of peritoneal folds
270
What is the blood supply to the cecum?
Anterior and posterior cecal arteries from the Ileocolic artery
271
What is the base of the appendix located in relation to the ASIS and umbilicus?
1/3 way up the line joining ASIS and umbilicus (McBurney's point)
272
What is the most common position of the appendix?
Retrocecal
273
What is the nerve supply to the appendix?
Sympathetic and parasympathetic (vagus) nerves from superior mesenteric plexus
274
What is the primary blood supply to the ascending colon?
Ileocolic and right colic branches of SMA
275
What is the function of the transverse mesocolon?
Suspends transverse colon via anterior border of pancreas
276
What is the blood supply to the transverse colon?
- Middle colic artery from SMA for proximal 2/3
- Left & right colic arteries for distal 1/3
277
What is the relationship of the descending colon posteriorly?
- Lateral border of the left kidney
- Quadratus lumborum
- Iliac crest
- Left psoas
278
What arteries supply the sigmoid colon?
Sigmoid arteries from IMA
279
What is the anatomical position of the rectum?
Located in the pelvic cavity, posterior to the sigmoid colon
280
What is the relationship of the sigmoid colon to the ileum?
Related to the lower coils of the terminal part of the ileum
281
What is the blood supply of the sigmoid colon?
IMA ⇒ sigmoid arteries ⇒ ascending & descending branches
282
What veins drain the sigmoid colon?
Sigmoid veins ⇒ IMV
283
What nerves supply the sigmoid colon?
Sympathetic, parasympathetic and sensory supply via nerves from the inferior mesenteric plexus:
- Parasympathetic innervation via the pelvic splanchnic nerves
- Sympathetic innervation via the lumbar splanchnic nerves.
284
Where does lymph drainage from the sigmoid colon go?
Paracolic & Intermediate colic nodes ⇒ Inferior mesenteric nodes
285
What anatomical structure does the rectum continue with?
Anal canal
286
What is the anatomical position of the rectum?
S3 ⇒ tip of coccyx & piercing the pelvic diaphragm
287
What dilated structure forms the lower part of the rectum?
Rectal ampulla
288
What surfaces does the peritoneum cover in the rectum?
- Covers ant. & lat. surfaces of 1st 1/3 of rectum
- Only ant. surface of middle rectum
- None on lower 1/3
289
What are the layers of the muscular coat of the rectum?
- Outer longitudinal
- Inner circular layers of smooth muscle
290
What allows longitudinal fibres to form a broad band on the rectum?
3 teniae coli of sigmoid colon
291
What is the posterior anatomical relation of the rectum?
In contact with:
- Sacrum
- Coccyx
- Piriformis
- Coccygeus
- Levator ani muscles
- Sacral plexus
- Sympathetic trunks
292
What anatomical structures are anterior to the upper two thirds of the rectum in males?
Sigmoid colon and coils of ileum in the rectovesical pouch
293
What anatomical structures are anterior to the lower third of the rectum in males?
- Posterior surface of the bladder
- Termination of the vas deferens
- Seminal vesicles
- Prostate
294
What anatomical structures are anterior to the upper two thirds of the rectum in females?
Sigmoid colon and coils of ileum in the rectouterine pouch (pouch of Douglas)
295
What anatomical structures are anterior to the lower third of the rectum in females?
Posterior surface of the vagina
296
What is the arterial supply of the rectum?
- Superior rectal artery (continuation of IMA),
- Middle rectal artery (branch of internal iliac artery),
- Inferior rectal artery (internal pudendal artery)
297
What does the superior rectal artery supply?
Mucous membrane
298
What is the venous drainage of the rectum?
- Superior rectal vein drains into IMV
- Middle rectal veins drain into internal iliac
- Inferior rectal veins drain into internal pudendal veins
299
What type of anastomosis do the middle and inferior rectal veins create?
Anorectal portal-systemic anastomosis
300
What is the nerve supply to the rectum?
Sympathetic & parasympathetic nerves from inferior hypogastric plexuses; sensitive only to stretch
301
Where does lymph from the upper rectum drain?
Pararectal nodes ⇒ inferior mesenteric nodes
302
Where does lymph from the lower rectum drain?
Follows middle rectal artery to internal iliac nodes
