Anatomy Block 2 Week 3

Front 1

Define Mesentery

Back 1

A double layer of peritoneum through which nerves, vessels and lymphatics travel to/from organs. The mesentery anchors jejunum and ileum to posterior body wall.

Front 2

The small intestines are located in what space?

Back 2

The peritoneal cavity

Front 3

NAme

Back 3

A. Mesentery
B. Peritoneal Cavity
C. Peritoneum, parietal layer
D. Peritoneum, visceral layer
E. Intraperitoneal organ

Front 4

What is peritoneal ligament composed of?

Back 4

Two layers of peritoneum anchoring an organ to the body wall or to another organ (not bone)

Front 5

Define intraperitoneal organs

Back 5

Organs covered in peritoneum and suspended from body wall by mesentery. An example would be a piece of intestine.

Front 6

Define retroperitoneal

Back 6

Organs/structures the develop and always remain posterior to the peritoneal sac (kidneys, aorta, IVC)

Front 7

Define secondarily retroperitoneal

Back 7

Organs that develop intraperitoneally but become compressed against the body wall and appear to be retroperitoneal. These organs are separated from the body wall by a bloodless plane.

Front 8

Prof said we need to know intraparitoneal, retroperitoneal and secondarily retroperitoneal. Define them

Back 8

Got it?

Front 9

When lying supine, what are the two lowest portions of the peritoneal cavity where the most fluid will accumulate?

Back 9

1. Hepatorenal recess/pouch (AKA Morrison's Pouch).
2. Rectovesicle/rectouterin pouch (Pouch of Douglas)

Front 10

Where are the paracolic gutters?

Back 10

The are next to the ascending and descending colons.

Front 11

What tissue structure splits the body into right and left halves?

Back 11

The dorsal mesentary.

Front 12

How do you get into the lesser sac? What is it also known as?

Back 12

Put fingers deep to duodenum and anterior to pancreas. AKA Foramen of Winslow

Front 13

What is the name of the foregut artery? What structures does it send blood to?

Back 13

Celiac sends blood to the liver, stomach, spleen, and gall bladder.

Front 14

What does the spleen do?

Back 14

It stores and recycles blood.

Front 15

Which parts of the duodenum are intra- or retroperitoneal?

Back 15

The 1st and 4th part are intraperitoneal. The 2nd and 3rd part are retroperitoneal.

Front 16

What defines the boundries between the foregut and midgut?

Back 16

Defined by arteries that supply them. The foregut is supplied by the celiac artery (which is composed of the 1st and 2nd parts of duodenum). The midgut is supplied by the superior mesenteric artery (which is composed of 3rd and 4th part of duodenum)

Front 17

What ligament supports the 4th part of the duodenum?

Back 17

It's a suspensory ligament called the Ligament of Trietz that connects the diaphragm to the fourth part of the duodenum.

Front 18

What ligament supports the 4th part of the duodenum?

Back 18

It's a suspensory ligament called the Ligament of Trietz that connects the diaphragm to the fourth part of the duodenum.

Front 19

Name em

Back 19

A. Right Hepatic Ducts
B. Left Hepatic Ducts
C. Cystic Duct
D. Common Bile Duct

Front 20

What three structures make up the Portal Triad?

Back 20

1. Common Bile Duct
2. Portal Vein
3. Proper Hepatic Artery

Front 21

Name the five parts of the pancreas

Back 21

1. Head
2. Uncinate Process
3. Neck
4. Body,
5. Tail

Front 22

What are the four lobes of the liver?

Back 22

1. Caudate lobe
2. Quadrate lobe
3. Left Lobe
4. Right lobe

Front 23

Can you draw the celiac trunk vasculature? See back side

Back 23

Front 24

The lesser omentum is composed of two ligaments - what are they?

Back 24

Hepatodueodenal and hepatogastric ligament.

Front 25

By placing your finger and pinching off the structures in the foremen of Winslow, what can you control?

Back 25

1. Common Bile Duct
2. Hepatic Portal Vein
3. Proper Hepatic Artery

Front 26

What structure separates the common hepatic artery from the proper hepatic artery? (In lecture, he said, "If you were in an exam and... how would you figure this out?)

Back 26

The gastroduodenal artery (see N284 or 9/19 1p at 1:18:30)

Front 27

As the R gastric artery runs along the lesser curvature of the stomach, which artery does it anastomose with?

Back 27

The L gastric artery.

Front 28

Lecture Q: If the L gastric artery was blocked right at the aorta, how is it possible that the esophagus could still receive blood? Trace the arteries.

Back 28

Celiac trunk --> common hepatic artery --> proper hepatic a --> right gastric a --> up around to esophageal a.

Front 29

For your own benefit, how does blood reach the R gastro-omentum?

Back 29

Celiac T --> common hepatic --> Gastroduodenal --> R gastro-epiploic

Front 30

The gastroduodenal artery splits into (3 arteries):
(BTW - N283/4 is worth reviewing over and over again)

Back 30

1. R gastro-omentum
2. Supraduodenal a.
3. superior pancreaticoduodenal (ant & post)

Front 31

Where is the division for the midgut/hind gut? All of the small intestine is in the..?

Back 31

The first 2/3 of colon is the midgut and the later 1/3 is the hind gut (this is established primarily by vascular supply). The small intestine is in the mid gut.

Front 32

What structures make up the mid gut?

Back 32

Parts 3&4 of the duodenum, jejunum, and ilium.

Front 33

What artery supplies the small intestines (sp Jejunum and Ileum)? What about the large intestines?

Back 33

Sm = Superior Mesenteric Artery
Lg = Inferior mesenteric artery

Front 34

In lecture, Hoagland mentioned three major aa coming off of the superior mesenteric. What are they and what do the supply? (And what's the fourth general ones?)

Back 34

1. Inferior pancreaticoduodenal a - it supplies the duodenum and pancreas (it's the "watershed" a that divides the midgut from the hindgut)
2. Middle Colic - it serves the "middle" of the transverse colon
3. Iliocolic - serve the iliocolic region including the appendicular region that serves the appendix.
The general ones include the jejunal and ileal (intestinal) arteries.

Front 35

What is the major artery that serves the Hindgut?

Back 35

The Inferior Mesenteric Artery (the distal 3rd of the transverse colon)

Front 36

What are the three major aa coming off of the inferior mesenteric a?

Back 36

1. Left colic a
2. Sigmoid branches
3. Superior rectal artery

Front 37

Name em

Back 37

1. Superior mesenteric a
2. Middle colic a
3. Inferior pancreaticoduodenal a
4. Iliocolic a

Front 38

Name em

Back 38

A. Left Colic
B. Superior Rectal
C. Sigmoid Branches
D. Inferior mesenteric artery

Front 39

Where do the glomeruli, the functional unit of the kidney, reside?

Back 39

The cortex

Front 40

Name

Back 40

1. Renal pelvis
2. major calyces
3. minor calyces
4. renal capsule
5. ureter
6. cortex
7. medulla (pyramids)
8. renal papilla
9. renal column (of Bertin)

Front 41

What is almost always directly superior to the L renal v?

Back 41

Superior mesenteric a

Front 42

The adrenal gland on the left is called (1)? The adrenal gland on the right is called (2)?

Back 42

1. Left lunar adrenal gland
2. R pyramid adrenal gland

Front 43

Name

Back 43

1. L testicular (ovarian) a & v
2. R testicular (ovarian) a & v
3. L renal a and v
4. superior mesenteric
5. R superior suprarenal a
6. R middle suprarenal a
7. R inferior suprarenal a
8. R suprarenal v
9. R and L inferior phrenic a
10. L inferior phrenic v

Front 44

The R testicular v drains into the ? The L testicular v drains into the ? This difference can sometimes cause what? Why?

Back 44

R = IVC; L = L renal v. The L renal v has a lower flow rate and this can cause pressure that leads to an engorged testicle - aka a Varicocele - a hemrhoidalization of Left testicle

Front 45

AS in lecture, "If I were to shoot you, where would the bullet go through?"...in regard to the renal vessels?

Back 45

Renal v, Renal a, then ureter.

Front 46

Note: the ureter is a muscular tube capable of peristalses. What muscle does it run along? What vessels does it run behind? What vessels does it run anterior to?

Back 46

Runs along psoas major muscle. Runs behind testicular vessels. It runs anterior to the iliac vessels.

Front 47

Describe origin, insertion and under what ligament the psoas major muscle runs. Its action and innervation.

Back 47

Origin is T12-L5; Insertion is lesser trochanter of femur; Runs under inguinal ligament; It flexes the hip; Innervation is lumbar plexus (L1 book) L2, 3, & 4.

Front 48

Describe origin, insertion and under what ligament does the psoas minor muscle run

Back 48

Origin is T12 to L1; Inserts at pectineal line; runs under inguinal ligament; has no action (really); and about 50% actually have one

Front 49

Iliacus muscle originates from; inserts where and with; action is; nerve supply is

Back 49

Originates from the iliac crest/fossa; inserts with psoas major muscle at lesser troachanter of femur; action is to flex the hip; nerve supply is L1 to L3; action flexes hip

Front 50

Quadradus lumborum originates? Inserts; Its action; nerve supply

Back 50

Originates at iliac crest and iliolumbar ligament, inserts at the 12th rib; helps bend trunk, nerve supply is from lumbar plexus (subcostal n (T12) and L1-4)

Front 51

name

Back 51

1. Inferior phrenic
2. Celiac trunk
3. Middle adrenal a
4. SMA
5. Ovarian (testicular aa)
6. Four pairs of lumbar aa
7. Renal aa
8. IMA
9. Internal Iliac
10. Common Iliac
11. External iliac
12. Median sacral