Anatomy Exam 2

Front 1

superior margin of the abdominal wall

Back 1

right and left costal cartilages

Front 2

lateral margin-upper portion of the abdominal wall

Back 2

abdominal side wall

Front 3

lateral margin-lower portion of the abdominal wall

Back 3

iliac crests

Front 4

inferior margin

Back 4

inguinal ligament/symphysis pubis

Front 5

quadrants of the abdomen

Back 5

divided by the midline and the umbilicus, right and left, upper and lower

Front 6

superficial fascia of the abdomen

Back 6

fatty subQ layer, composed to two different types: Camper’s Fascia (fatty superficial layer) and Scarpa’s Fascia (membranous deeper layer)

Front 7

Camper’s fascia

Back 7

fatty superficial layer, inferior to costal margin, superior to the inguinal ligament

Front 8

Scarpa’s fascia

Back 8

membranous deep layer, continuous with the fascia lata of the lateral thigh and the superficial perineal fascia around the scrotum and penis (Cole’s fascia)

Front 9

what are the muscles that make up the abdominal wall?

Back 9

1. external oblique
2. internal oblique
3. transversus abdominus
4. rectus abdominus

Front 10

external oblique

Back 10

origin: external surface of the 5th through 12th ribs
direction: run diagonally from the rib to the pubic tubercle, like hands in a pocket
insertion: linea alba medially, pubic tubercle inferior/medially, and anterior iliac crest inferior laterally
action: flex and rotate trunk, support abdominal viscera
innervation: T7-T11 intercostal nerves, subcostal nerve and iliohypogastric nerve

Front 11

inguinal ligament

Back 11

formed from the aponeurosis of the external oblique (the inferior aspect of the external oblique), a line of fascia between the anterior iliac spine and the pubic tubercle

Front 12

superficial inguinal ring

Back 12

opening in the external oblique aponeurosis medially, considered an area of weakness, spermatic cord leaves through here covered with external spermatic fascia,

Front 13

internal oblique

Back 13

runs inferior to the external oblique
origin: anterior 2/3 of iliac crest and lateral 2/3 of inguinal ligament
direction: runs at right angles to the external oblique
insertion: inferior 3-4 ribs superiorly and linea alba medially
action: flex and rotate trunk (with the external oblique)
innervation: T7-T11 intercostal nerves, iliohypogastric, ilioinguinal and subcostal nerves

Front 14

internal oblique and the rectus sheath

Back 14

medially the internal oblique splits to enclose the rectus abdominus sheath, inferiorly the internal oblique aponeurosis forms the conjoint tendon

Front 15

transversus abdominus

Back 15

runs posterior to the internal oblique
origin: inferior 6 costal cartilages
direction: run horizontal
insertion: into the linea alba medially and the pubis (as part of the conjoint tendon)
action: supports the abdominal viscera
innervation: T7-T11 intercostal nerves, iliohypogastric, ilioinguinal and subcostal nerves

Front 16

rectus abdominus

Back 16

lies medial to the external and internal obliques and the transversus abdominus, called the strap muscle
origin: symphysis pubis and pubic crest
insertion: xiphoid process and 5th-7th costal cartilages
action: flexes trunk and tenses abdominal wall
innervation: T7-T11 intercosal nerves and subcostal nerve

Front 17

rectus sheath

Back 17

a covering over each rectus abdominus muscle, anterior leaf formed by the external oblique and part of the internal oblique aponeurosis, posterior leaf formed by the transversus abdominus and part of the internal oblique aponeurosis

Front 18

arcuate line

Back 18

half way between the umbilicus and pubic crest, below this line the posterior rectus sheath is absent around the rectus abdominus, the internal oblique and transversus abdominus portions now make up the anterior leaf

Front 19

structures housed within the rectus sheath

Back 19

superior epigastric artery-end of internal thoracic artery, branch of the subclavian artery
inferior epigastric artery-branch of external iliac artery

Front 20

linea alba

Back 20

midline that separates the two rectus abdominus muscles

Front 21

linea semilunares

Back 21

lateral border of rectus muscle

Front 22

umbilicus

Back 22

inferior to the midpoint of the linea alba

Front 23

gastroschisis or omphaloceles

Back 23

develop when the muscles do not fuse after the bowel extrudes from the abdomen during the 6-8th week of gestation

Front 24

transversalis fascia

Back 24

deep to the transversus abdominus, a transparent fasica that lines the entire abdominal wall, changes name depending on the position (diaphragmatic fascia, pelvic fascia, femoral sheath)

Front 25

peritoneum

Back 25

deep to the transversalis fascia, may have a layer of fat between the peritoneum and the transversalis fascia (extraperitoneal fat)

Front 26

innervation of the abdominal skin

Back 26

T7-T11 and subcostal nerve

Front 27

innervation of the inferior aspect of the abdominal wall

Back 27

L1 via the iliohypogastric and iliolingual nerves

Front 28

innervation of the rectus sheath

Back 28

all nerves pass between or through muscle to reach the rectus sheath, cutaneous nerves provide sensation
T6-subxiphoid
T10-umbilical area
T12/L1-suprapubic area

Front 29

surgical incisions

Back 29

midline incision-goes through the linea alba to minimize the amount of nerves hit
transverse incision-goes through the external and internal obliques, transversus and possibly the rectus, also minimizes the amount of nerves hit but is a weaker incision

Front 30

blood supply to the anterior abdominal wall

Back 30

1. T10-T11 intercostal arteries-encircle abdominal cavity and anastamose with superior epigastric artery
2. inferior epigastric artery-supplies majority of anterior abdominal wall
3. deep circumflex iliac artery-supplies lower abdominal wall, by inguinal ligament

Front 31

components of the inguinal canal

Back 31

all muscles of the anterior abdominal wall

Front 32

inguinal canal

Back 32

inferior aspect of the abdominal wall, above the fold of the leg, divided by the linea alba into right and left

Front 33

muscular layers of the inguinal canal

Back 33

1. external oblique-aponeurosis descends down to inferior wall forming the anterior border of the inguinal canal, inferior aspect of the external oblique is the inguinal ligament
2. internal oblique-becomes the conjoint tendon medially, some muscles become the cremaster muscle, forms the superior aspect of the inguinal canal
3. transversus-combines with the internal oblique to form the conjoint tendon, forms the superior aspect of the inguinal canal

Front 34

inguinal hernia

Back 34

checking for it is done by invaginating the skin between the scrotum and penis into the inguinal canal by going through the superficial inguinal ring, it is the most common hernia, but more common in males, can be congenital, “turn and cough”

Front 35

transversalis fascia and inguinal canal

Back 35

posterior aspect of the inguinal canal, behind the conjoint tendon

Front 36

deep inguinal ring

Back 36

a opening in the transversalis fascia in the lateral inguinal canal, is an exit point out of the abdominal cavity for the spermatic cord or round ligament

Front 37

spermatic cord

Back 37

contains vas deferens, cremaster muscle, testicular artery, and pampiniform plexus, exits abdominal cavity through the deep inguinal ring and travels down inguinal canal where it exits the inguinal canal through the superficial inguinal ring

Front 38

round ligament

Back 38

in females, exits the abdominal cavity through the deep inguinal ring and enters the inguinal canal, exits the inguinal canal through the superficial inguinal ring and attaches to the labia

Front 39

inferior epigastric artery and the inguinal canal

Back 39

crosses posterior to the inguinal canal, divides the canal into the medial and lateral parts, important in hernia surgery

Front 40

ilioinguinal nerve and the inguinal canal

Back 40

runs with the spermatic cord or round ligament (L1-L2)

Front 41

descent of the testes

Back 41

testes develop intra-abdominally in utero, testes then descend to the scrotum through the inguinal canal,

Front 42

processeus vaginalis

Back 42

communication part between the abdomen and the scrotum

Front 43

tunica vaginalis

Back 43

the processus vaginalis is obliterated and becomes the tunica vaginalis

Front 44

inguinal hernias

Back 44

two types:
1. direct-through the medial portion of the inguinal canal, medial to inferior epigastric, occurs from muscle weakness
2. indirect-through the lateral portion of the inguinal canal, usually through a patent processus vaginalis

Front 45

abdominal aorta

Back 45

continuation of the thoracic aorta, begins at the aortic hiatus as it enters the abdomen through the diaphragm at T12-L1 level, ends by dividing into 2 common iliac arteries above the pelvis at the L4-5 level

Front 46

key to blood supply in the abdomen

Back 46

collateral circulation

Front 47

phrenic branches

Back 47

first branches of the abdominal aorta, run inferior to the diaphragm, gives rise to the suprarenal arteries over the inferior surface of the diaphragm

Front 48

celiac trunk

Back 48

the first mesenteric branch of the aorta, arises at T12 level, three branches (left gastric, common hepatic, splenic)

Front 49

left gastric artery

Back 49

exits the celiac trunk to the left, courses to the right side of the stomach, blood supply to the lower esophagus (esophageal branches) and lesser curvature of the stomach

Front 50

common hepatic artery

Back 50

exits the celiac trunk to the right coursing behind the stomach to the liver, provides blood supply to the lower stomach, liver and duodenum, further branches include the right gastro-omental artery (greater curvature of the stomach), gastroduodenal artery (branches to the duodenum and pancreas) and proper hepatic artery (liver)

Front 51

splenic artery

Back 51

exits the celiac trunk to the left coursing behind the stomach, above the pancreas to the spleen, provides blood supply to the upper stomach, pancreas and spleen, further branches include the pancreatic branches along the superior portion of the pancreas, short gastric branches (greater curvature of the stomach) and left gastro-omental artery (greater curvature of the stomach)

Front 52

superior mesenteric artery

Back 52

second mesenteric branch of the abdominal aorta, arises at about the L1 vertebral level behind the pancreas

Front 53

inferior pancreaticoduodenal artery

Back 53

branch of the SMA, there are anterior and posterior versions, around C-loop of duodenum and head of pancreas, provides blood supply to the duodenum and head of pancreas

Front 54

jejunal and ileal arteries

Back 54

branches of the SMA, approximately 15-18 branches, found within the mesentery of the bowel, provide blood supply to the bowel

Front 55

ileocolic artery

Back 55

most distal branch of the SMA, found within the mesentery of the bowel, provide blood supply to the terminal ileum and cecum

Front 56

right colic artery

Back 56

first colonic branch of the SMA, found within the mesentery of the bowel, provide blood supply to the right colon

Front 57

middle colic artery

Back 57

last colonic branch of the SMA, found within the mesentery of the bowel, provide blood supply to the transverse colon

Front 58

inferior mesenteric artery

Back 58

third mesenteric branch of the abdominal artery, arises at approximately L3, inferior to the renal arteries

Front 59

left colic artery

Back 59

first branch of the IMA, found within the mesentery of the bowel, provide blood supply to the left colon, from splenic fixture to the sigmoid colon

Front 60

sigmoid branches

Back 60

second branch of the IMA, found within the mesentery of the bowel, provide blood supply to the sigmoid colon

Front 61

superior rectal branch

Back 61

terminal branch of the IMA, found within the mesentery of the bowel, provide blood supply to the superior rectum

Front 62

celiac axis to SMA

Back 62

collateral circulation around the duodenum/pancreatic head
1. common hepatic artery -> gastroduodenal artery -> superior pancreaticoduodenal artery
2. SMA-inferior pancreaticoduodenal artery

Front 63

SMA to IMA

Back 63

around the splenic flexure, collateral circulation
1. SMA-middle colic artery -> marginal artery of Drummond (near bowel wall) and Arc of Riolan (more proximal)
2. IMA-left colic artery

Front 64

IMA to iliac arteries

Back 64

collateral circulation around the rectum
1. IMA-superior rectal artery
2. iliac arteries-middle and inferior rectal arteries

Front 65

mesenteric occlusive disease

Back 65

found in patients with atherosclerotic disease, occlusion of one, two, or all of the mesenteric branches of the abdominal aorta, symptoms include weight loss, pain with eating, and/or acute abdomen with ischemic/necrotic bowel

Front 66

renal arteries

Back 66

usually arise off the abdominal aorta between the SMA and IMA (L2), provide blood to the kidneys, usually single branches but may have up to three branches to the kidney

Front 67

gonadal arteries (testicular or ovarian)

Back 67

varies as either off the aorta (L2) or renal branches, arterial supply to the testicles/ovaries

Front 68

lumbar arteries

Back 68

anterior and posterior, go the lumbar spine and spinal cord, arise off the aorta at each lumbar vertebral level, blood supply to the musculature in the back and to the spinal cord

Front 69

anterior lumbar arteries

Back 69

supplies anterior and lateral abdominal wall, passes around the abdominal wall, collaterizes to inferior epigastric artery in anterior abdominal wall

Front 70

posterior lumbar arteries

Back 70

supplies spinal cord and erector spinae muscles, spinal arteries arise from the posterior lumbar arteries

Front 71

spinal arteries from the posterior lumbar arteries

Back 71

give rise to radicular arteries (at each nerve level), the largest radicular artery (Spinal Artery of Kiewicz) supplies the inferior spinal cord

Front 72

abdominal aortic aneurysm

Back 72

dilation of the abdominal aorta, usually develops below the renal arteries, but can be found at any level, risk of rupture increases when it gets larger than 5 cms

Front 73

inferior vena cava

Back 73

begins at the confluence of the common iliac veins, approximately at L5, ascends to the right of the abdominal aorta, runs posterior to the liver, through the diaphragm into the right atrium

Front 74

renal veins

Back 74

branch into the IVC from both kidneys, usually one branch, veins run anterior to renal arteries, usually at L2, runs posterior to SMA

Front 75

hepatic veins

Back 75

three branches (right, middle and left) that drain directly into the IVC along the superior aspect of the liver

Front 76

deep venous thrombosis (DVT)

Back 76

often occur in the pelvis or lower extremity veins, risk is that clot will embolize to lung becoming a pulmonary embolism (PE)
prevention-placement of Greenfield filter into IVC, usually below the renal veins

Front 77

lumbar veins

Back 77

four to five paired branches from each vertebral level, much variation in location, usually unite into the ascending lumbar vein

Front 78

right ascending lumbar veins

Back 78

becomes the azygos vein, enters thorax and central circulation

Front 79

left ascending azygos vein

Back 79

becomes the hemiazygos vein, enters thorax and central circulation

Front 80

mesenteric drainage through hepatopedal circulation

Back 80

allows venous drainage from mesentery of the bowel to be cleared by the hepatic system before systemic drainage

Front 81

inferior mesenteric vein (IMV) and hepatopedal circulation

Back 81

drains sigmoid and descending colon, unites with the splenic vein

Front 82

superior mesenteric vein (SMV) and hepatopedal circulation

Back 82

drains small bowel, right and transverse colon, unites with splenic vein and the IMV to form the portal vein

Front 83

gastric veins and hepatopedal circulation

Back 83

drains stomach and drains into the portal vein

Front 84

liver cirrhosis and esophageal/gastric varices

Back 84

cirrhosis causes scarring of the liver, leads to a decrease in hepatopedal flow and increase pressure in the venous system, this causes the venous system to distend, leading to engorged veins in esophagus, stomach, spleen and intestines (portal hypertension)

Front 85

function of the stomach

Back 85

storage of food during intake and provides reservoir for food for mixing with digestive enzymes, it is a distendible organ up to 2-3 L

Front 86

aspiration of the stomach

Back 86

stomach can hold liquid/air for long periods of time, esp. during illness and trauma, patients may vomit and aspirate large volumes especially when trying to intubate for airway management

Front 87

divisions of the stomach

Back 87

beings at the gastro-esophageal junction, then the fundus, then the body, then the antrum, then the pylorus

Front 88

gastro-esophageal junction

Back 88

cardiac orifice, below the diaphragm

Front 89

fundus

Back 89

superior portion of the stomach above the orifice
body
between the fundus and antrum, from the cardiac orifice to the Vein of Mayo, lower 1/3 of stomach

Front 90

antrum

Back 90

acid producing portion of the stomach, from vein of Mayo to pyloric canal

Front 91

pylorus

Back 91

canal and sphincter, end of the stomach, thickened circular muscle that control gastric emptying

Front 92

hiatal hernia

Back 92

herniation of the fundus and/or fundus through the esophageal hiatus, may increase gastro-esophageal reflux because of disruption of gastro-esophageal junction

Front 93

peptic ulcer disease (PUD)

Back 93

use H2 blockers to alleviate, before H2 blockers needed surgery to stop bleeding and perforation (antrectomy (removing antrum) and vagotomy (removing vagus nerves), vagotomy may lead to problems with gastric emptying

Front 94

pyloring stenosis

Back 94

hypertrophy of the pyloric muscle that causes a gastric outlet obstruction, in infants 2-8 weeks old, boys more frequent, treatment is a pylorotomy (cutting of the muscle to open the pyloric canal)

Front 95

position of the stomach

Back 95

sits in the upper abdomen, left liver lobe covers the upper stomach, fundus of the stomach sits next to the diaphragm and spleen, greater omentum attaches along the greater curvature, pancreas sits behind the stomach, area behind the stomach is the lesser sac

Front 96

pancreatic pseudocyst

Back 96

a complication of pancreatitis, treatment includes draining it into the stomach (cystgastrostomy)

Front 97

arterial supply of the stomach

Back 97

provided by all three branches of the celiac axis

Front 98

left gastric artery and the stomach

Back 98

enters the stomach along the lesser curvature in hepatogastric ligament (mesentery along the lesser curvature), supplies the upper stomach and lower esophagus

Front 99

right gastric artery and the stomach

Back 99

branch of the common hepatic artery, enters the stomach along the lesser curvature in hepatogastric ligament, supplies the antrum and pylorus

Front 100

right gastro-omental artery and the stomach

Back 100

branch of the gastroduodenal artery, enters the stomach along the greater curvature of the stomach, supplies the greater curvature from antrum to mid body of stomach

Front 101

short gastic arteries and the stomach

Back 101

branches of the splenic artery, enters the stomach along the greater curvature at the fundus and upper body in the gastrolienal ligament, supplies the greater curvature from the fundus to the upper body of stomach

Front 102

left gastro-omental artery and the stomach

Back 102

branch of the splenic artery, runs inferior to the short gastric arteries, enters the stomach along the greater curvature at the fundus and upper body in the gastrolineal ligament, anastomoses with the right gastro-omental, supplies the greater curvature from fundus to upper body of the stomach

Front 103

venous drainage of the stomach

Back 103

parallels the supply of the stomach, veins coalesce and drain into the portal vein which drains into the liver
1. right and left gastric veins drain into the portal vein
2. right gastro-omental vein drains into the SMV
3. left gastro-omental vein drains into the splenic vein

Front 104

lymphatic drainage of the stomach

Back 104

1. left gastric lymph nodes (along left gastric artery)
2. gastro-omentla lymph nodes (along the greater curvature)
3. pyloric lymph nodes anterior surface of the pancreas (near the pylorus)
4. pancreaticolienal lymph nodes (along splenic artery, superior aspect of pancres)
5. right gastric lymph nodes (along right gastric artery)

Front 105

where do lymph nodes in the stomach drain?

Back 105

drain into the celiac axis lymph nodes

Front 106

gastric lymphoma

Back 106

lymphoma that develops in the stomach wall, involves multiple lymph nodes

Front 107

innervation of the stomach

Back 107

left and right branches of the vagus nerve (CN X), provides motor to stomach and stimulation for acid release (specifically the antrum)

Front 108

left vagus nerve and the stomach

Back 108

left vagus nerve becomes the anterior vagus nerve at the stomach, enters along the lesser curvature and branches to the anterior stomach, liver and duodenum

Front 109

right vagus nerve and the stomach

Back 109

becomes the posterior vagus nerve at the stomach, enters the lesser curvature and branches to the posterior stomach

Front 110

liver

Back 110

largest gland in the body, accounts for 2% of the body weight

Front 111

functions of the liver

Back 111

1. glycogen storage
2. produces bile
3. protein production (coagulation factors)
4. filter of enteric circulation

Front 112

diaphragmatic surface of the liver

Back 112

superior, posterior and right lateral aspect that lay on the diaphragm

Front 113

bare area of the liver

Back 113

portion of the diaphragmatic surface of the liver, in the posterior liver, liver is in direct contact with the diaphragm, IVC runs through here

Front 114

visceral surface of the liver

Back 114

inferior portion of the liver, lies on the anterior surface of the stomach, first and second portion of the duodenum, gallbladder, lesser omentum, right colic flexure of colon (hepatic flexure, where ascending colon becomes the transverse colon)

Front 115

visceral surface landmarks

Back 115

H-shaped fissures that define the liver into 4 lobes, the crossbar of the H is the porta hepatis

Front 116

porta hepatis

Back 116

fissure in the center of the inferior liver, contains the portal vein, hepatic artery, common bile duct, lymphatics and hepatic nerve plexus

Front 117

right lobe of the liver

Back 117

to the right of the falciform ligament, has its own arterial, venous, and bilary system, has two smaller lobes within it (quadrate and caudate lobe)

Front 118

left lobe of the liver

Back 118

to the left of the falciform ligament, has its own arterial, venous, and bilary system

Front 119

quadrate lobe of the liver

Back 119

lies between the gallbladder and the falciform ligament inferior to the porta hepatis

Front 120

caudate lobe

Back 120

lies between the inferior vena cava and the falciform ligament/ligamentum venosum

Front 121

falciform ligament

Back 121

develops from the umbilicus and attached to anterior abdominal wall, terminates in the bare area as the coronary ligament, divides the liver into left and right lobes, antepartum (contains the umbilical vein), postpartum (umbilical vein becomes the ligamentum teres)

Front 122

cirrhosis of the liver

Back 122

can increase venous pressure in the abdomen, back pressure can lead to the ligamentum teres to become patent again, can see “caput medusa” (prominent periumbilical vein due to portal hypertension

Front 123

coronary ligament

Back 123

begins at the superior aspect of liver where the falciform ligament terminates, surrounds the bare area, left lateral aspect is the left triangular ligament while the right lateral aspect makes the right triangular ligament

Front 124

hepatogastric ligament

Back 124

begins at the left triangular ligament and terminates in the lesser curvature of the stomach, part of the lesser omentum, contains the left and right gastric arteries and veins, gastric lymphatics

Front 125

hepatoduodenal ligament

Back 125

begins along the caudate lobe and terminates along the C loop of the duodenum, part of the lesser omentum, contains the peripancreatic lymphatics

Front 126

lesser omentum

Back 126

includes the hepatogastric and hepatodudoenal ligaments, portal tirad runs along the free edge of the lesser omentum

Front 127

portal triad

Back 127

1. portal vein
2. common bile duct
3. proper hepatic artery

Front 128

blood supply of the liver

Back 128

is considered to have a double blood supply
1. hepatic artery provides approximately 30% of blood supply
2. portal vein provides approximately 70% of blood supply

Front 129

common hepatic artery

Back 129

branch of the celiac trunk, passes to the right of the stomach and along first portion of the duodenum, gives off gastroduodenal and right gastroepiploic branches and becomes proper hepatic artery

Front 130

proper hepatic artery

Back 130

part of the portal triad, divides into right and left hepatic arteries

Front 131

variations in the proper hepatic artery

Back 131

approx. 10% of left hepatic arteries will arise off left gastric artery (replaced left hepatic), and approx. 1-2% of right hepatic arteries will arise off the superior mesenteric artery (replaced right hepatic)

Front 132

portal vein

Back 132

part of the portal triad, formed by the confluence of the SMV and IMV and the splenic vein, runs posterior to the bile duct and proper hepatic artery, divides into right and left portal veins

Front 133

hepatopedal flow

Back 133

all venous drainage from bowel is cleared by the liver, carcinomas from the bowel can spread to liver, manifested by metastatic lesions in liver through hematogenous spread

Front 134

superior hepatic veins

Back 134

located at superior aspect of liver, three superior hepatic veins drain into IVC, right, middle (drains caudate lobe) and left

Front 135

inferior hepatic veins

Back 135

located along posterior aspect of liver, drain into the IVC, 6 to 18 branches that drain the caudate, quadrate and right lobe

Front 136

liver transplants

Back 136

replace the entire liver for cirrhosis due to alcoholism and hepatitis, when replacing the liver, surgeon will the IVC to save the multiple posterior branches

Front 137

lymphatic drainage of the liver

Back 137

superior and anterior portions drain to parasternal lymph nodes, inferior portions drain to hepatic lymph nodes in the porta hepatis and gastric lymph nodes in the lesser momentum

Front 138

bilary system

Back 138

bile is made by the liver and drains through the bilary system, small intralobular bile ducts coalesce to form larger ducts

Front 139

right and left hepatic ducts

Back 139

drain bile from the right and left lobes, form the common hepatic duct at the superior aspect of the porta hepatis

Front 140

common hepatic duct

Back 140

after forming by the right and left hepatic ducts, travel approx. 3-5 cm where the cystic duct from the gallbladder drains into the common hepatic duct

Front 141

common bile duct

Back 141

formed after the cystic duct joins the common hepatic duct, travels down the porta hepatis into the head of the pancreas, joins the pancreatic duct, drains into the second portion of the duodenum through the sphincter of Oddi

Front 142

common bile duct stone

Back 142

gallstones from in the gallbladder, stones can exit the gallbladder through the cystic duct and block the common bile duct (choledocholithiasis), can cause pain, jaundice, nausea, vomiting, evaluated by ERCP (endoscopic retrograde cholangiopncreatorgram

Front 143

gallbladder

Back 143

pear shaped organ attached to the right lobe of the liver, stores bile and drains when the stomach stimulates gallbladder to empty, through CCK (cholecystekinase)

Front 144

portions of the gallbladder

Back 144

1. fundus-wide end of gallbladder
2. body-main portion of gallbladder
3. neck-narrow, tapered portion of gallbladder
4. cystic duct-continuous with neck, drains into common hepatic duct

Front 145

cystic duct

Back 145

position can vary considerably, relation to cystic artery, common bile duct and right hepatic artery can lead to injuries if care is not taken

Front 146

cystic artery

Back 146

arises from the right hepatic artery, multiple variations in position in relation to cystic duct

Front 147

venous drainage of the gallbladder

Back 147

drains into the portal vein or liver direcetly

Front 148

lymphatic drainage of the gallbladder

Back 148

cystic lymph node (Node of Cliquot) found at confluence of cystic and common hepatic duct, drains ultimately into hepatic and celiac lymph nodes

Front 149

bilary colic

Back 149

gallstones form in the gallbladder, can lodge in the neck or cystic duct leading to colicky pain in the right upper quadrant, treatment is a cholecystectomy, usually laparoscopic

Front 150

functions of pancreas

Back 150

act as a both an exocrine and endocrine gland, external excretion of pancreatic enzymes into the duodenum through the pancreatic duct, internal secretions of insulin and glucagon into blood directly

Front 151

pancreatic position

Back 151

pancreas lies in the retroperitoneum, behind the stomach in the lesser sac, over the spine, the duodenum runs along the right portion and inferior portion, the tail of the pancreas ends in the hilum of the spleen in the left upper quadrant

Front 152

pancreatic trauma

Back 152

can occur with seat belt injuries, back injuries and handlebar injuries, gland often transected over the spine, treatment can include removal of distal pancreas

Front 153

head of pancreas

Back 153

within the C loop of the duodenum, posteriorly, the head lays on the IVC and right renal vessels

Front 154

common bile duct anatomy

Back 154

comes down from porta hepatis and enters the head of pancreas, joins with the pancreatic duct and exits into the duodenum

Front 155

uncinate process of the pancreas

Back 155

part of the head of the pancreas, lies inferior to the superior mesenteric vessels and rests against the aorta posteriorly

Front 156

neck of the pancreas

Back 156

continuous with the head of the pancreas, approx. where the superior mesenteric vessels cross the pancreas

Front 157

body of the pancreas

Back 157

continuous with the neck of the pancreas, portion of pancreas to left of aorta and extends superiorly, has an anterior, posterior, and inferior surface

Front 158

tail of the pancrease

Back 158

continuous with the body of the pancreas, crosses through the lienorenal ligament with the splenic vessels, terminates in the hilum of the spleen

Front 159

embryology of the pancreas

Back 159

pancreas develops as two separate buds, the buds fuse to form the pancreas
1. dorsal bud-becomes main gland
2. ventral bud-forms uncinate process

Front 160

formation of the pancreatic duct

Back 160

main pancreatic duct begins in the tail of the pancreas, formed within the dorsal pancreatic bud, proximally, the uncinate process forms the proximal pancreatic duct, main duct becomes Y shaped at the uncinate process, proximal part of the dorsal pancreatic duct is the accessory pancreatic duct, much variation in formation is found in the pancreatic gland

Front 161

main pancreatic duct

Back 161

joins with the common bile duct to form the hepatopancreatic ampulla (ampulla of vater), drains into the duodenum through the choledochal sphincter (Sphincter of Oddi)

Front 162

accessory pancreatic duct

Back 162

usually is connected to the main pancreatic duct (90%), can be a separate duct which drains into the duodenum through the minor duodenal papilla

Front 163

pancreatic cancer

Back 163

usually develops in the head of the pancreas, presents with back pain, jaundice and weight loss, symptoms often occur with the blockage of the common bile duct where it traverses the pancreas

Front 164

pancreatic blood supply

Back 164

three sources of blood supply:
1. common hepatic artery -> gastroduodenal artery -> superior pancreaticoduodenal arteries
2. superior mesenteric artery -> inferior pancreaticoduodenal arteries
3. splenic artery > dorsal pancreatic artery

Front 165

superior pancreaticoduodenal (PD) arteries

Back 165

supplies head of the pancreas and C loop of duodenum

Front 166

inferior PD arteries

Back 166

supplies the head of the pancreas

Front 167

dorsal pancreatic artery

Back 167

supplies the neck, body and tail of pancreas

Front 168

venous drainage of the pancreas

Back 168

most of the pancreas drains into the splenic vein

Front 169

draining lymph nodes of the pancreas

Back 169

1. pancreaticosplenic-along superior aspect
2. pyloric-along the head of the pancreas
3. celiac-along draining veins

Front 170

spleen

Back 170

largest lymph tissue in the body

Front 171

functions of the spleen

Back 171

filter the blood of old red cells and clear antigens

Front 172

overwhelming post splenectomy sepsis

Back 172

patients who have a splenectomy are at increased risk of having an overwhelming infection because of lack of antigen filter, can occur up to 42 years after splenectomy

Front 173

spleen anatomy

Back 173

located in the left upper abdomen, against the diaphragm, behind the stomach, attaches to the stomach via the gastrolienal ligament and attaches to the left kidney via the lienorenal ligament

Front 174

spleen poles

Back 174

divided into superior and inferior poles, divided by the hilum of the spleen (central portion where blood vessels enter and exit)

Front 175

splenic artery

Back 175

branch of the celiac trunk, runs along the superior aspect of the pancreas to enter the splenic hilum, divides into 3-5 branches in the hilum to supply the spleen, all arteries are end arteries, no collateral circulation

Front 176

splenic vein

Back 176

formed by smaller veins draining the splenic parenchyma, runs along the superior aspect of the pancreas, unites with the superior mesenteric vein to form the portal vein

Front 177

sickle cell disease

Back 177

red cells “sickle” and will filter out in the spleen, these will clog the end arteries and lead to infarction, sickle cell patients will have autosplenectomy increasing the risk of infection

Front 178

splenic trauma

Back 178

spleen can be injured in any trauma, most common intra-abdominal organ to be injured, treatment may be non-operative or require repair or removal of spleen

Front 179

duodenum

Back 179

first portion of small intestine, begins after pylorus of the stomach, ends at the ligament of Trietz (the beginning of the jejunum) shortest portion of the small bowel

Front 180

duodenum position

Back 180

except for the first 2-3 cm, is a completely retroperitoneal structure

Front 181

first portion/division of the duodenum

Back 181

is the intraperitoneal portion (AKA duodenal bulb), in continuity with the pylorus, approx. 2-3 cm in length, the common bile duct, gastroduodenal artery and IVC run posterior to this portion

Front 182

duodenal ulcer disease

Back 182

ulcers can develop in the duodenal bulb due to increased acidity entering the bulb from the stomach, can perforate or bleed, perforations are often anterior (intraperitoneal) while bleeding often is from the gastroduodenal artery requiring ligation

Front 183

second portion of the duodenum

Back 183

referred to as the C loop, continuous with the first portion, where the duodenum becomes retroperitoneal, approx. 8-10 cm in length, where the pancreatic and common bile duct drain into the duodenum through the ampulla of Vater

Front 184

third portion of the duodenum

Back 184

referred to as the horizontal portion, in continuity with the second portion, ends wehre the superior mesenteric vessels cross, approx. 5-8 cm in length, where the duodenum proceeds horizontally over the spine from right to left

Front 185

fourth portion of the duodenum

Back 185

referred to as the ascending portion, in continuity with the third portion, begins to the left of the superior mesenteric vessels, ends at the ligament of Trietz, approx. 2-3 cm in length, duodenum proceeds superiorly to the left side of abdomen and acute turn where it becomes the jejunum

Front 186

blood supply to the duodenum

Back 186

superior pancreaticoduodenal artery from the gastroduodenal artery, inferior pancreaticoduodenal artery from the superior mesenteric artery

Front 187

venous drainage from duodenum

Back 187

most venous drainage is into the superior mesenteric vein, entering the portal system

Front 188

lymphatic drainage of duodenum

Back 188

drain primarily into pancreaticoduodenal lymph nodes, ultimately draining into the celiac lymph nodes

Front 189

malrotation

Back 189

the intestine exits the fetus at 7-8 weeks development and then returns in a rotated position, present with bilious vomiting to septic secondary to mid gut volvulus

Front 190

jejunum and ileum

Back 190

second and third portions of the small intestine, begins at the ligament of Trietz, ends at the ileocecal valve, no obvious demarcation where jejunum becomes ileum, both total approx. 6-7 meters (first 2/5ths thought to be jejunum)

Front 191

external differences between the jejunum and ileum

Back 191

1. jejunum is usually thicker and more muscular
2. jejunum is the more proximal portion so resides in the upper abdomen
3. ileum is more distal so resides in the pelvis and lower abdomen

Front 192

internal differences between the jejunum and ileum

Back 192

circular folds (plicae circulares) in the mucous membrane are large and well developed in the jejunum, provides more absorptive surface

Front 193

mesentery and the jejunum and ileum

Back 193

mesentery suspends the two and carries blood vessels and lymphatics, root of mesentery emanates from superior mesenteric vessels and fans out with the bowel along the edge of the mesentery

Front 194

blood supply of the small intestine

Back 194

entire blood supply to jejunum and ileum comes from the superior mesenteric artery, SMA provides 15-18 branches to jejunum and ileum, arteries unite to form arterial arcades, from the arterial arcades, vasa recta arise, vasa recta then enter bowel on the mesenteric border

Front 195

venous drainage of the small intestine

Back 195

drains into the superior mesenteric vein, veins and venules follow arterial supply

Front 196

lymphatic drainage of small intestine

Back 196

lacteals are lymphatics in the intestinal villi, lacteals drain into a lymph vessel plexus in the mesentery, plexus drains into mesenteric lymph nodes, three levels of mesenteric lymph nodes:
1. next to intestine
2. along arterial arcades
3. along SMA

Front 197

innervation of the small intestine

Back 197

derived from the vagus (parasympathetic, motility) and splanchnic nerves, sympathetic from superior mesenteric ganglion (T9-T10), pain is mediated through the thoracic segments not the vagus

Front 198

Meckel’s diverticulum

Back 198

embryologically, omphalomesenteric duct drains intestinal contents from distal small bowel through umbilicus in the womb, the diverticulus is a 3-6 cm long pouch found in the ileum within 50 cm of the ileocecal valve, may have fibrous cord connecting to umbilicus

Front 199

large intestine

Back 199

begins at the ileocecal valve, at the cecum, ends at the anus, approx. 1.5 meters long

Front 200

functions of large intestine

Back 200

absorb water from feces and storage of feces

Front 201

features of the small intestine

Back 201

1. teniae coli-three longitudinal muscle bands that run along the entire colon
2. haustra coli-permanent sacculations between teniae involving the circular muscle
3. appendices epiploicae-fatty appendages that are attached to the teniae

Front 202

cecum

Back 202

begins at ileocecal valve, is first portion of ascending (right) colon, sac like structure, blood supplied by the ileocolic artery (branch of the SMA)

Front 203

vermiform appendix

Back 203

vestigial portion of GI tract, unknown function but it does have some lymphoid tissue, begins at confluence of teniae coli, at base of cecum, blood supplied by the ileocolic artery

Front 204

ascending colon

Back 204

begins at cecum, ends at the hepatic or right flexure, approx. 12-20 cm long, lies retroperitoneally, along right side of abdomen, blood supplied by the right colic artery

Front 205

transverse colon

Back 205

begins at the hepatic or right flexure, ends at the splenic or left flexure, approx. 30-50 cm long, lies intraperitoneally, draped across abdomen from right to left side of abdomen, blood supplied by middle colic artery (branch of the SMA)

Front 206

descending colon

Back 206

begins splenic or left flexure, ends at the brim of pelvis, becomes sigmoid colon, approx. 15-20 cm long, lies retroperitoneally, along left side of abdomen, blood supplied by left colic artery, branch of the IMA

Front 207

sigmoid colon

Back 207

begins pelvic brim (S-shaped loop), ends at the sacral promontory, becomes rectum, approx. 15-80 cm long, lies intraperitoneally, in the left lower quadrant, blood supplied by the sigmoid arteries (2 or 3) branch of the IMA

Front 208

diverticuli

Back 208

outpouchings of mucosa between teniae coli in colon, can occur anywhere in the colon but most commonly in the sigmoid colon, complications include infection (diverticulitis) or bleeding (diverticular hemorrhage)

Front 209

rectum

Back 209

begins at the sacral promontory, ends at the anus, approx. 12-15 cm long, lies retroperitoneally, in the pelvis, blood supplied by the superior rectal artery (branch of IMA) and middle and inferior rectal arteries (branches of internal iliacs)

Front 210

differences in the rectum

Back 210

there are internal folds, transverse rectal folds, are continuations of teniae, aids in supporting the feces, rectum functions to store feces before defecating, since the rectum goes through the pelvic floor, there are no diverticuli

Front 211

lymphatic drainage of cecum

Back 211

periappendiceal LN -> superior mesenteric LN

Front 212

lymphatic drainage of ascending colon

Back 212

paracolic LN -> superior mesenteric LN

Front 213

lymphatic drainage of transverse colon

Back 213

superior mesenteric LN

Front 214

lymphatic drainage of descending colon

Back 214

inferior mesenteric LN

Front 215

lymphatic drainage of sigmoid colon

Back 215

inferior mesenteric LN

Front 216

lymphatic drainage of rectum

Back 216

superior portion-pararectal LN -> inferior mesenteric LN
inferior portion-internal iliac LN

Front 217

inervation of colon

Back 217

supplied by SMA (superior mesenteric plexus) and IMA (inferior mesenteric plexus)

Front 218

innervation of rectum

Back 218

middle rectal plexus -> from inferior hypogastric plexus

Front 219

anus

Back 219

terminal portion of GI tranct, approx. 2.5-5 cm in length, begins at the puborectalis muscle, surrounded by internal and external sphincters, internal anal sphincter is involuntary, external anal sphincter is voluntary

Front 220

innervation of anus

Back 220

external anal sphincter, inferior rectal nerve

Front 221

anus internal anatomy

Back 221

superior portion-mucosa similar to rectum, has folds called anal columns
inferior portion-anal columns end in anal valves
superior and inferior portions separated by pectinate line

Front 222

blood supply to the anus

Back 222

superior rectal artery supplies the superior part of the canal
inferior rectal arteries supply inferior part of the canal

Front 223

anal pathology

Back 223

perirectal/perianal abscesses
hemorrhoids: internal (superior rectal vein), external (inferior rectal vein)