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83 Cards in this Set
- Front
- Back
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Parts of the Large Intestine
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cecum, appendix, colon, rectum, anal canal
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Parts of the Colon
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ascending, descending, transverse, sigmoid; transverse & sigmoid have their own mesenteries
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Characteristics of the Colon
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tenia coli (outer longitudinal muscular coat); haustra (small pouches), epiploic appendages (sacs of fat)
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Diverticulitis
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inflammation of the diverticula, commonly found in sigmoid colon; diverticulosis = condition of having diverticula; symptoms are ab pain, chilld, fever, nausea, constipation
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Sigmoid volvulus
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twisting of sigmoid colon around its mesentery creating a colonic obstruction & may cause intestinal ischemia; symptoms are vomiting, ab pain, constipation, bloody diarrhea, hematemesis
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Megacolon [Hirschprung's disease]
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caused by the absence of enteric ganglia in the lower part of the colon; leads to dilation of colon proximal to inactive segment; congenital origin; symptoms are constipation or diarrhea, ab distention, vomiting, lack of appetite; colostomy most effective treatment
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Cecum
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blind pouch of the large intestine; lies in right iliac fossa and is usually surrounded by peritoneum but has no mesentery
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Appendix
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narrow, hollow, muscular tube w large aggregations of lymph tissue in its wall; suspended from terminal ileum by mesoappendix which contains appendicular vessels; causes spasm & distention when inflamed, resulting in pain referred to periumbilical region and moves down and to the right
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McBurney's point
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site of the base of the appendix; lateral one third of the line between the right ASIS and umbilicus; is the site of maximum tenderness in acute appendicitis
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Acute Appendicitis
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acute inflammation of the appendix, resulting from bacteria or viruses that are trapped by an obstruction of the lumen by feces
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Rectum & Anal Canal
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extend from sigmoid colon to the anus
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Liver (characteristics, functions)
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largest visceral organ, largest gland; important role in production and secretion of bile, detoxification, storage of glycogen and triglycerides, protein synthesis, production of heparin and bile pigments, storage of vitamins
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Anatomy of the liver
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surrounded by peritoneum, attached to diaphragm by coronary and falciform ligaments and the right and left triangular ligaments; has bare area on diaphragmatic surface
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Blood supply to liver & Venous drainage
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receives oxygenated blood from the hepatic artery and deoxygenated, nutrient rich blood from portal vein; venous blood is drained by hepatic veins into the IVC
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Portal Triad
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a group of the branches of the portal vein, hepatic artery and bile duct; surrounded by a connective tissue sheath, the perivascular fibrous capsule
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Right Lobe of Liver
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divided into anterior and posterior segments, each of which is subdivided into superior and inferior areas
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Left Lobe of Liver
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divided into medial and lateral segments, each of which is subdivided into superior and inferior areas; includes the medial superior (caudate lobe), medial inferior (quadrate lobe), lateral superior and lateral inferior
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Quadrate lobe
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AKA medial inferior lobe; receives blood from the left hepatic artery and drains bile into the left hepatic duct
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Caudate lobe
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AKA medial superior; receives blood from the right and left hepatic arteries and drains bile into both right and left hepatic ducts
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Fissures and ligaments of the liver
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Fissure for the round ligament, ligamentum venosum, fossa for the gallbladder, fissure for the IVC, transverse fissure (porta hepatis)
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round ligament (location)
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AKA ligamentum teres hepatis; located btw the lateral portion of the left lobe and the quadrate lobe
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ligamentum venosum (location)
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located btw the caudate lobe and the lateral portion of the left lobe
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gallbladder (location)
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between the quadrate lobe and the major part of the right lobe
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IVC (location relative to liver)
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btw the caudate lobe and the major part of the right lobe
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Porta hepatis (location)
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on visceral surface of the liver btw the quadrate and caudate lobes, lodges PORTAL VEIN, HEPATIC A, HEPATIC DUCT, hepatic nerves, lymphatic vessels
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Liver cirrhosis
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liver cells are progressively destroyed and replaced by fatty and fibrous tissue that surrounds the intrahepatic blood vessels and biliary radicles, impeding the circulation of blood through the liver; caused by alcoholism, hep B, C & D, ingestions of poisons; causes portal hypertension, esophageal varices, hemorrhoids, caput medusa, spider angioma, ascites, edema in legs, jaundice, hepatic encephalopathy, splenomegaly, hepatomegaly, coagulopathy, palmar erythema, testicular atrophy, gynecomastia, pectoral alopecia
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Liver Biopsy
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perfomed percutaneously, commonly the needle goes through the right eighth or ninth intercostal space in the right midaxillary line under ultrasound or CT guidance; patient holds breath in full expiration to reduce risk of damage to lung
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Transjugular liver biopsy
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accomplished by inserting a catheter into the right internal jugular vein and guiding it through the SVC, IVC and R hepatic vein
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Gallbladder (anatomy, characteristics)
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located at junction of right ninth costal cartilage and lateral border of the rectus abdominis; on inferior liver btw right & quadrate lobes; in contact with duodenum & transverse colon; has fundus, body & neck (neck gives rise to cystic duct)
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Gallbladder (function)
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receives bile, concentrates it, stores it & releases it during digestion; contracts to expel bile as a results of stimulation by hormone cholecystokinin
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Gallbladder (blood supply)
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receives blood from cystic artery, which arises from the right hepatic artery w/in the cystohepatic triangle of Calot
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Cystohepatic triangle (of Calot)
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formed by the visceral surface of the liver superiorly, the cystic duct inferiorly, the common hepatic duct medially (Grant's Atlas, p 154)
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Gallstones (choleliths)
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formed by solidification of bile and composed chiefly of cholesterol crystals; present commonly in fat, fertile females over forty (4F); stones may lodge in the (a) fundus where they may ulcerate into transverse colon or duodenum, (b) bile duct where they obstruct bile flow leading to jaundice, (c) hepatopancreatic ampulla where they block both biliary and pancreatic duct systems
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Cholecystitis
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inflammation of the gallbladder caused by obstruction of the cystic duct by gallstones; trapped bile causes irritation and pressure build-up in the gallbladder, leading to bacterial infection and perforation and causing pain in the URQ and the epigastric region, fever, nausea & vomiting
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Cholecystectomy
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removal of gallbladder
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Pancreas (anatomy)
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lies largely in floor of lesser sac in the epigastric & hypochondriac regions; is retroperitoneal except for a small portion of its tail which lies in the lienorenal ligament; has a head that lies w/in C-shaped cavity of duodenum (love affair of the abdomen); has uncinate process which is projection of the lower part of the head to the left side behind the superior mesenteric vessels
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Pancreas blood supply
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receives blood from brances of the splenic artery and from the superior and inferior pancreaticoduodenal arteries
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Pancreas (functions)
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exocrine gland (produces digestive enzymes that help digest fats, proteins & carbs); an endocrine gland (islets of Langerhans) which secretes insulin and glucagon and somatostatin
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Main Pancreatic duct (of Wirsung)
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begins in the tail, runs to the right along entire pancreas, carries pancreatic juice containing enzymes
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hepatopancreatic ampulla (of Vater)
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formed by the union of the main pancreatic duct (of Wirsung) and the bile duct; enters the second part of the duodenum at the greater papilla
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Acessory pancreatic duct (Santorini's duct)
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begins in the lower portion of the head and drains a small portion of the head and body; empties at the lesser duodenal papilla above the greater papilla
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Pancreatitis
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inflammation of the pancreas caused by gallstones and alcohol consumption; symptoms include upper ab pain, nausea, vomiting, weight loss, fatty stools, mild jaundice, diabetes, low bp, heart failure, kidney failure
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Pancreatic cancer
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causes severe back pain, may be treated by a surgical resection called a pancreaticoduodenectomy or Whipple's procedure
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Diabetes mellitus
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char. by hyperglycemia that is caused by inadequate production of insulin (type I) or inadequate action of insulin on body tissues (type II)
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Right & Left Hepatic Ducts
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formed by union of the intrahepatic ductules from each lobe of the liver & drain bile from the corresponding halves of the liver
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Common hepatic duct
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formed by union of R & L hepatic ducts; accompanied by proper hepatic artery and portal vein
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Cystic Duct
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has spiral folds to keep it constantly open so bile can pass up into the gallbladder; joins the common hepatic duct to form the bile duct
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Common Bile Duct
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formed by union of common hepatic duct & cystic duct; located lateral to the proper hepatic artery and anterior to the portal vein in R free margin of lesser omentum; joints main pancreatic duct to form hepatopancreatic ampulla; contains sphincter of Boyden
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Hepatopancreatic duct or ampulla (of Vater)
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union of common bile duct & main pancreatic duct; enters second part of duodenum at greater papilla; contains sphincter of Oddi
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Spleen (anatomy, characteristics)
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vascular lymphatic organ lying against diaphragm and ribs 9-11 in LEFT hypochondriac region; supported by splenogastric & splenorenal ligaments; composed of white pulp & red pulp
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Spleen (function)
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hematopoietic early in life and later destroys aged RBCs in the red pulp; it filters blood, stores blood and platelets, produces lymphocytes, macrophages, antibodies in the white pulp
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Spleen (blood supply)
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supplied by the splenic artery and drained by the splenic vein
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Splenomegaly
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enlarged spleen resulting from thrombosis of the splenic vein or portal hypertension, which causes sequestering of RBCs, leading to thrombocytopenia (low platelets) and easy bruising; symptoms of fever, diarrhea, bone pain, weight loss, night sweats
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Rupture of spleen
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occurs freq by fractured ribs or blows and causes profuse bleeding; difficult to repair; splenectomy performed to prevent bleeding to death
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Celiac Trunk
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arises from front of AA (abdominal aorta) below aortic hiatus of diaphragm btw L & R crura; divides into Left Gastric, Splenic & Common Hepatic arteries
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Left Gastric Artery
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smallest branch of celiac trunk, gives rise to esophageal and hepatic branches; runs along lesser curvature w/in the lesser omentum to anastomose w/ Right Gastric Artery
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Splenic artery
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largest branch of celiac trunk; runs along superior border of pancreas and enters lienorenal ligament; gives rise to: Dorsal Pancreatic Artery, Short Gastric Arteries, Left Gastroepiploic artery
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Left Gastroepiploic Artery
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runs along greater curvature of the stomach
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Common Hepatic Artery
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runs along upper border of the pancreas and divides into: Proper Hepatic Artery, Gastroduodenal Artery (possibly the Right Gastric Artery)
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Proper Hepatic Artery
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from Common Hepatic, divides into R & L hepatic arteries; R gives rise to cystic artery; gives rise to Right Gastric Artery
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Right Gastric Artery
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arises from Proper Hepatic Artery or Common Hepatic; runs to pylorus and then along lesser curvature of stomach to anastomose w/ Left Gastric Artery
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Gastroduodenal Artery
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from Common Hepatic; descends behind first part of duodenum, divides into two major branches: Right Gastroepiploic artery & Superior Pancreaticoduodenal artery
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Right Gastroepiploic
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from Gastroduodenal from Common Hepatic; runs along greater curvature of stomach
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Superior Pancreaticoduodenal Artery
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passes between the duodenum and the head of the pancreas and further divides into anterior-superior and posterior-superior pancreaticoduodenal arteries
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Pringle's maneuver
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temporary cross-clamping of the hepatoduodenal ligament containing portal triads at the foramen of Winslow for control of hepatic bleeding during liver surgery
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Superior Mesenteric Artery
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arises from aorta behind the neck of the pancreas; descends across uncinate process & third part of duodenum, enters the root of the mesentery behind the transverse colon to run to the right iliac fossa; gives rise to: Inferior Pancreaticoduodenal artery, Middle Colic Artery, Right Colic Artery, Ileocolic artery, Intestinal Arteries
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Inferior Pancreaticoduodenal Artery
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divides into anterior-inferior & posterior inferior arteries which anastomose w/ corresponding superior branches
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Middle Colic Artery
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enters transverse mesocolon and divides into right branch that anastomoses w/ right colic artery & left branch which anastomoses w/ ascending branch of left colic artery; form the marginal artery along large intestine
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Right Colic Artery
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divides into ascending and descending branches, distributing to the ascending colon
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Ileocolic artery
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divides into ascending colic (anastomoses w/ right colic), anterior and posterior cecal arteries, appendicular artery & ileal branches
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Intestinal Arteries
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12-15 in number, supply jejunum & ileum
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Inferior Mesenteric Artery
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distributes to the descending and sigmoid colons and upper portions of rectum; gives rise to: Left Colic Artery, Sigmoid Arteries, Superior Rectal Artery (terminating artery)
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Portal Vein
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drains ab part of gut, spleen, pancreas, gallbladder; formed by union of splenic vein and superior mesenteric vein posterior to neck of pancreas; receives left gastric vein
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Superior Mesenteric Vein
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accompanies Sup. Mes. Artery on its right side in the root of the mesentery, crosses third part of duodenum and uncinate process of pancreas; joins splenic vein forming portal vein
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Splenic Vein
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formed by union of tributaries from the spleen; receives short gastric, left gastroepiploic, pancreatic veins
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Inferior Mesenteric Vein
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formed by union of superior rectal and sigmoid veins; receives left colic vein and usually drains splenic vein
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Left gastric Vein
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drains into portal vein; has esophageal tributaries that anastomose w/ esophageal veins of azygos system at lower part of the esophagus
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Paraumbilical Veins
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found in the FALCIFORM LIGAMENT and are virtually closed; dilate in portal hypertension
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Important Portal-Caval Anastomoses
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left gastric vein & esophageal of azygos system; superior rectal vein & middle and inferior rectal veins; paraumbilical veins & radicles of epigastric (superficial & inferior) veins; retroperitoneal veins draining the colon & twigs of the renal, suprarenal & gonadal veins
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Hepatic Veins
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consist of right, middle, left hepatic veins that lie in intersegmental planes and converge on IVC; no valves
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Budd-Chiari or Chiari Syndrome
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occlusion of the hepatic veins and results in high pressure in the veins, causing hepatomegaly, upper RQ pain, ascites, mild jaundice and eventually portal hypertension and liver failure; treated by balloon angioplasty or surgical bypass of the clotted hepatic vein into vena cava
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Portal Hypertension
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results from thrombosis of the portal vein or liver cirrhosis, forming esophageal varices, caput medusae, hemorrhoids; can be treated by splenorenal shunt, end-to-side portacaval shunt, mesocaval shunt, transjugular intrahepatic portosystemic shunt
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Superior Mesenteric Artery Obstruction
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caused by thrombus, an embolus, atherosclerosis, an aortic aneurysm, a tumor in the uncinate process of the pancreas, compression by the third part of the duodenum or surgical scar tissue; leads to small and large intestinal ischemia, resulting in necrosis of all or part of the involved segment; symps are ab pain, nausea, vomiting, diarrhea, electrolyte imbalance
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