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127 Cards in this Set
- Front
- Back
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where is the most common site for a lumbar hernia?
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grynfeltt's/superior lumbar triangle
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where is the falciform ligament?
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coming of off the liver going to the round ligament of the umbilicus
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what vessel lies just deep to the anteriorcostal margin?
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musculophrenic
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GENERALLY, how will the veins of the abdomen behave?
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the will run superficially and form deep connections every which way in between
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GENERALLY, how will arteries of the abdomen behave?
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they run more centrally within the musculature and make fewer anastomoses
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what defines hesselbach's triangle?
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rectus abdominis
inferior epigastric vessels inguinal ligament |
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what important things run through Scarpa's triangle?
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Femoral VAN
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nerves of the posterior abdominal wall
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genitofemoral
femoral ilioinguinal obturator |
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if a full truncal vagotomy is performed, what undesirable ramification may result?
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dumping syndrome
(no parasympathetics and possibly not sympathetics) |
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what is a celiac block?
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it is an anesthetization of the celiac plexus to quiet the pain referred through the celiac plexus (best done on posterior approach)
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what conveys sensory fibers from the central part of the diaphragmatic peritoneum?
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the phrenic nerves
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what innervates the pelvic portion of the peritoneum?
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the obturator nerve
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does the visceral peritoneum have afferents?
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no
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what sort of sensation will the visceral peritoneum feel?
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stretching or chemical irritation
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what are the retroperitoneal organs?
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Adrenals
Kidneys Ureters |
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what are the secondarily retroperitoneal organs?
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duodenum
pancreas major portions of ascending and descending colon |
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what is the fusion fascia?
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connective tissue plane where nerves and vessels of the descending colon lie
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what are the two ligaments of the lesser omentum?
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hepatalgastric
hepatalduodenal |
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what's distinctive about a mesenteric ligament?
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it does not have connective tissue character or strength
(instead its made out of a double layer of peritoneum) |
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what creates peritoneal folds?
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obliterated fetal vesels
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describe the median umbilical fold
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from apex of bladder to umbilicus and covers the median umbilical ligaments
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whats special about the lateral umbilical folds
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they cover the inferior epigastric vessels
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what is another name for the medial inguinal fossae?
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the inguinal triangles
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what is the mesoappendix?
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is the portion of the mesentery connecting the ileum to the appendix. It may extend to the tip of the appendix. It encloses the appendicular artery and vein, as well as lymphatic vessels, nerves, and often a lymph node.
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what is the transverse mesocolon
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connects the transverse colon to the posterior wall of the abdomen.
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what is the pelvic mesocolon?
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aka the sigmoid mesocolon
anchors the sigmoid to the lower left abdominal wall |
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what are the ligaments of the liver?
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left triangular
right triangular coronary falciform ligamentum teres |
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what do the gastroepiploic arteries feed?
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aka gastro-omental aa
the stomach and the omentum |
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where does lymph from the right momentum drain>
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the sub pyloric nodes
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where does lymph from the left momentum drain?
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the splenic nodes
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what important features does the lesser momentum contain?
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portal triad
branches of the anterior vagus nerve lymph nodes R&L gastric aa |
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know gastrophrenic
gastrosplenic gastrocolic ligaments |
ligaments
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what is the "bare area"?
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the part of an organ NOT covered by peritoneum that allows the entrance or exit of neuromuscular tissue
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whats in the supra colic compartment of the peritoneal cavity?
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stomach liver spleen
(above transverse mesocolon) |
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what are the peritoneal organs?
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stomach
spleen liver |
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what important features will you find in the 2nd part of the duodenum?
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the hepatopancreatic ampulla and duodenal papilla
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what secure the 4th part of the duodenum?
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the ligament of Treitz
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what level will you find the esophageal hiatus?
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T10
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describe type 1 hiatal hernia
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GEJ goes above the diaphragm
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Describe type 2 hiatal hernia
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(pure esophageal) GEJ stays below the diaphragm and part of the stomach goes above the diaphragm
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what is the most common complication of the paraesophageal hernia?
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a gastric volvulus
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what leads to a type 1 volvulus?
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abnormal laxity in the gastrosplenic, gastrodupodenal, gastrophrenic, and gastrohepatic ligaments
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describe an organoaxial volvulus
How does it present? |
stomach rotates around longitudinal axis
with postprandial chest pain |
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What is a common complication of the organoaxial volvulus?
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strangulation and necrosis
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describe mesentericoaxial volvulus
How does it present? |
rotates along the bisection of the greater and lesser curvature
No chronic symptoms |
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where does the body of the pancreas lie?
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over the aorta and L2
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where does the tail of the pancreas pass?
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between layers of the splenorenal lig.
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what are the ducts of the pancreas?
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Main: duct of Wirsung
Minor: Duct of Santorini |
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where does the duct of wirsung going the Common Bile Duct?
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at the hepatopancreatic ampulla
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How much, and what is the function of red pulp in the spleen?
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75% and it has a phagocytic function
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how much and what is the function of white pulp in the spleen?
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25% and has an immunological function
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What might you find near the splenic hilum?
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an accessory spleen! It's fully functional and can also be found in the peritoneal folds, in the tail of the pancreas, or the gastrosplenic ligament
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what section is the caudate lobe associated with?
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1
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what section is the quadrate lobe associated with?
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4
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what structures are associated with cantlies line?
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the IVC and the gall bladder, defines right and left lobes
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where is arterial blood to the liver first distributed?
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intrahepatic bile ducts
(slide 26) |
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how common is a replaced right hepatic artery and where does it come from?
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18-22% and arises from the SMA
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How common is a replaced left hepatic artery and where does it come from?
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12-15% and the left gastric artery
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how common is a completely replaced common hepatic artery and where does it come from?
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1-2% and the SMA
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name the hepatic veins
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right middle left
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what segments does the RHV drain?
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5 6 7 8
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what segments does the MHV drain>
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4 5 8, forms a common trunk with LHV before entering the IVC
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what segments does the LHV drain?
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2 and 3
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what are the nodes around the celiac trunk?
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inferior phrenic
paracardiac rt. gastric gastroduodenal |
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what is the portal hepatis?
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it is the combination of the portal vein, the hepatic artery and the CBD in the hepatoduodenal ligament
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what will the pringle maneuver accomplish?
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the pringle maneuver is pinching off the portal hepatis to stop blood flow into the liver
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where will you find an infundibulum?
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between the body and the neck of the gall bladder
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what is the blood supply to the gall bladder
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the cystic artery with probable contribution from retro and supra duodenal
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what is the venous drainage of the gall bladder
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usually many small venous drains
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what defines the triangle of calot? why is this clinically relevant?
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the cystic duct, the CHD, and the liver margin.
this is how you locate the cystic A |
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describe the hepatopancreatic ampulla
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its where the pancreatic duct and the CBD combine (in the pancreas) and enter the duodenum.
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what are the named parts of the CBD
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supraduodenal
retroduodenal pancreatic intramural |
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what are the muscles called that control the inlet to the papilla of vater (hypatopancreatic ampulla)?
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the sphincter of Oddi
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what is a cholangiogram?
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it is an x-ray image of the gallbladder. Useful for imaging gall stones
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what is NOTES?
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Natural Orifice Transluminal Endoscopic Surgery
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What is LESS
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Lapro Endoscopic Single Site Surgery
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what is gastroschisis?
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almost always to the right, this defect protrudes guts through the abdominal wall with no peritoneum protection (so bathed in peritoneal fluid)
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what is omphalocele?
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bowels and visera protruding through the umbilical ring, covered by peritoneum
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what is malrotation?
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abnormal rotation and fixation around the SMA resulting in obstruction and vascular occulsion
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describe ventral and umbilical hernias
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hernias coming through the umbilicus
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describe spigelian hernias
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a hernia at the semi lunar line, below the arcuate line
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a direct hernia is...
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a hernia in hesselbach's triangle
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an indirect hernia is...
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a hernia outside hesselbachs triangle
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what is diastasis recti?
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separation of the rectus abdomens muscle pillars
IS NOT a hernia because the aponeurosis is intact |
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how is pyloric stenosis treated?
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by making a small incision in the puloris and allows for the pyloric sphincter to expand
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peptic ulcers account for what % of epigastric abdominal pain?
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90% !!
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what are the majority of peptic ulcers caused by?
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H. Pylori infection or NSAIDs
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if a patient has pain 2-3 hours after a meal they might have which kind of ulcer?
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duodenal
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if a patient has pain while eating they may have which kind of ulcer?
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gastric
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There are 5 types of gastric ulcers. type 2 and 3 are...
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acid hypersecretion
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which gastric ulcer tile is NSAID induced?
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5
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whats the difference between stenosis and atresia?
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stenosis: narrowing
atresia: total blockage |
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when performing a laproscopy, what should you first identify?
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the cysticD and CBD
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if a patient has gall stones blocking the hypoduondenal ampulla and into the CBD, they likely have what pathology?
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gall stone pancreatitis
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what is gallstone ileus?
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happens when erosions of the gallbladder allow gall stones to pass into the duodenum, stomach or colon.
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what is Meckel's diverticulum?
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It is a vestigial remnant of the omphalomesenteric duct (also called the vitelline duct or yolk stalk)
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what is the MOST PREVALENT congentical abnormality of the GI tract!
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meckels diverticulum
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where is a Meckels diverticulum found
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usually found in the ileum within 100 cm of the ileoceval valve
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what is the most common presentation of a mockers diverticulum in children? in adults?
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bleeding
intestinal obstruction |
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what are two common sites of GI volvuli?
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Cecum & sigmiod
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when resecting the colon, what should a surgeon be cognizant to remove as well?
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the associated arteries.
ex: if there is cancer at cecum, what arteries should also go? |
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what is glisson's sheath (aka glissons capsule)
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it covers the A,D,PV bundles in the liver
(grays pg 1169) |
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where will you find MOST of the jejunum?
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in the LUQ
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where will you find MOST of the Ileum?
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In the RLQ
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what constitutes the majority of the small intestine (jejunum or ileum?)
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ileum 60%, jéjunum 40%
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where will you find peyer's patches and what are they?
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peyers patches are in the ileum and they are aggregated lymphoid follicles
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where will you find long vasa recta?
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in the jejunum
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where will you find short vasa recta
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ileum
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which "side" do the short branches of the vasa recta serve?
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mesenteric side
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which "side" do the long branches of the vasa recta serve?
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antimesenteric
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has a larger circumference, thicker wall, less fatty mesentery, longer vasa recta
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jejunum
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has smaller circumference, thinner wall, more fatty mesentery, and shorter vasa recta AND lymphoid follicles
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ileum
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what are taeniae?
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they are the longitudinal muscle fibers, concentrated around the colon to form three longitudinal bands
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what part of the large intestine has no mesentery?
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the cecum
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which part of the bowel is most vulnerable to perforation?
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the cecum
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what is the most common site of volvulus in the colon?
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the sigmoid
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is the mesentery of the sigmoind long or short?
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long
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where is the rectum located?
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between the sigmoind and the anus
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where do the taenia spread to form the smooth muscle of the rectum?
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the rectosigmoid junction
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what holds poop until defacation?
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the rectal ampulla (or is it the rectal papilla? ;) )
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where will you find the duct of luscka?
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in the gall bladder between the GB and liver
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how will the cloaca divide?
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anterior and posterior, bladder and rectum, respectively
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what creates the pectinate line?
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division between the hind gut and the protodeum (which have separate vascular and nervous supply)
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what does the white line demarcate?
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where epithelium changes from columnar to stratified squamous.
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what vein drains the rectum
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the inferior mesenteric v
(with contribution from the middle rectal v) |
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what is an imperforate anus?
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its the abnormal development of the urorecta; septum resulting in incomplete separation of the cloaca
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where do the right and left gastroepiploic vessels run?
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between the two layers of of the anterior fold of the GO
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