10/21 Abdomen IV Flashcards
(30 cards)
name and locate the four parts of the duodenum
1st: superior, transpyloric plane
2nd: descending, alond R side of LV1/LV2/LV3
3rd: inferior, 3LV level
4th: ascending, goes up to LV2
features of 1st part of duodenum
gastroduodenal A ant to bile duct inf to quadrate lobe sup to head of pancreas peritonealized, in the hepatoduodenal ligament
features of 2nd part of duodenum
retroperitoneal post to transverse colon ant to hilum of r kidney articulates w/ head of pancreas *major duodenal papilla*
what marks the transition between foregut and midgut
major duodenal papilla, in 2nd part of duodenum
features of the 3rd part of duodenum
retroperitoneal articulates w/ head of pancreas deep to root of mesentary deep to superior mesenteric vessels ant to IVC and abdom aorta
features of 4th part of the duodenum
retroperitoneal
suspensory ligament of duodenum/ligament of treitz attaches to diagphragm, marks duodenal/jejunal jxn
clinical significance: ligament of treitz
a proximal bleed will show up in vomit
a distal bleed will show up in stool
jejunum/ileum
intraperitoneal
suspended by mesentary (root travels from LV2 to righ iliac fossa, midline cross denotes jejunum to ileum
superior mesenteric vessels
clinical significant of location of superior mesenteric a
crosses anterior to the L renal v, originates deep to the neck of the pancreas, compressable
SMA syndrome and Nutcracker syndrome
SMA syndrome
compression of 3rd part of duodenum between superior mesenteric a and aorta
nutcracker syndrome
compression of L renal v between super mesenteric a and aorta, impeding venous return from L gonadal v
(ad)renal HTN,
varicocele left testicle (or left labia majora)
improved by laying down
visible characteristic of jejunum
vasa recta, less fat
more superior
visible characteristic of jejunum
arterial arcade, no windows, lots of fat
more inferior
cecum
cont with ascending colon
ileocecal jxn, ileocecal valve
appendix hands inferiorly in mesoappendix
appendix
in its own mesoappendix
appendicular a, from ileocolic a
ClinSig: pain projects at McBurney’s point, 1/3 of the way between r ASIS and umbilicus
colon
taeniae coli (longitudinal bands) for peristalsis epiplotic appendages (fat tags)
ascending colon
goes up until R colic flexure/hepatic flexure
deep to liver
retroperitoneal
transverse colon
transition from midgut to hindgut to left of midline (2/3 of the way along the transverse colon), turns down at left colic flexure/splenic flexure
suspended by transverse mesocolon
desceding colon
retroperitoneal
things in mid/hindgut that are actually intraperitoneal
1st part of duodenum jejunum ileum appendix transverse colon
midgut general
major duodenal papilla —>—>—>2/3 transverse colon
superior mesenteric a (L1), intestinal branches within mesentary proper
hindgut general
last 1/3 of transverse colon —>—>rectum
inferior mesenteric a (L3), origin is retroperitoneal
margina A of drummond
clinical significance
major anastomoses between mid and hind gut
weak point/water shed area/L colic feature: if compromised marginal A, ischemia here first
four main branches off superior mesenteric a
ant/post inferior pancreaticoduodenal aa
middle colic
r colic
ileocolic (loops on itself)
