Abdomen Flashcards
Contents of Transpyloric plane
The transpyloric plane is the midpoint between jugular notch and pubic symphysis
it’s contents include
- Pylorus of stomach
- Fundus of the gallbladder
- Front on the pancreas
- superior mesenteric artery
- splenic vein behind the pancreas
- Hilum of the kidneys
Contents of Transpyloric plane
The transpyloric plane is the midpoint between jugular notch and pubic symphysis
it’s contents include
- Pylorus of stomach
- Fundus of the gallbladder
- Front on the pancreas
- superior mesenteric artery
- splenic vein behind the pancreas
- Hilum of the kidneys
Falciform Ligament is an anterior abdominal peritoneal structure contain
The ligamentum teres ( obliterated portion of the L) umbilical vein)
Borders of the lesser sac and it’s function
- provides a slippery surface for the mobility of the posterior surface of the liver
ant surface: stomach and lesser omentum
Left border: hilum of the spleen
Right border: epiploic foramen
Roof: peritoneum of the caudate lobe of the liver
Floor: Transverse mesocolon
What are the sites of origin of the greater omentum
The greater curvature of the stomach
The lesser omentum covers..
The connection between the liver and lesser curvature of the stomach.
- originates from the R) side of the abdominal esophagus to D1 of the duodenum
- originates at the liver from fissure of ligamentum venosum and porta hepatis
this forms epiploic foramen where, portal triad exists
- portal vein(back)
- hepatic artery(front and left)
- common bile duct(front and right)
Border of the epiploic foramen consists of:
Upper boundary: Caudate lobe of liver
Lower boundary
How are the Peritoneal Compartments separated
There are 3 supracolic spaces and they each have their own subspace
- Supracolic
i. Right upper
ii. Right Lower
iii. Left upper
iv. Left Lower
They are separated by the Transverse Mesocolon
- Infracolic
i. Right/ Upper
ii. Left/ Lower
Pelvic
How is the Infracolic Section of Peritoneum Separated
It is separated via the root of the mesentery which is a 40 degree angle from L-> R
- Starts at the left of the duodojejunal junction and crosses the 3rd part of the duodenum where SMA enters it’s mesentary
What is the Right/Upper infracolic compartment and it’s borders
- Triangular area of peritoneum of the posterior abdominal wall
Apex: Lies in the ileocecal junction
Right side: Ascending colon
Left side: the mesentary of small intestine
Base: attachment of transverse mesocolon
Floor of the triangle consists
- Right kidney
- in the left the duodenum can also be felt
What is the Left/Lower Infracolic Ligament and it’s borders
- It is a quadrilateral shaped space
borders
Sup border: Attachment of the transverse mesocolon between dudodojejunal flexture and the splenic flexure
ascending duodenum lies in this space
lateral end of upper border lies the inferior pole of the L) kidney
floor: IVC and abdominal aorta
at the lower end of infracolic compartment is the sigmoid mesocolonh is A-shaped and the two limbs diverge from each other at the bifurcation of the common iliac vessels,
what is the embryological form of the ligamentum teres
the umbilical vein
in embryology, The liver grows downwards @ the anterior abdominal wall and engulfs….
the ligamentum teres
during embryology, the dorsal stomach rotates into becoming the …. curvature
greater curvature
during embryology, the dorsal stomach rotates into becoming the …. curvature
greater curvature
ORIGIN of the Coeliac Plexus
@ the level of T12 between the crura and the median arcuate ligament. It is flanked by the pre-aortic lymph nodes and surrounded by the sympathetic nerves. It will then devide above the superior border of the pancreas, behind the peritoneum of the lesser sac
Splenic artery will pass through
it runs across the left crus and left psoas to the hilum of the Ieft kidney, where it runs forward in the lienorenal /ligament to the hilum of the spleen.
it gives off 3 branches
i. Arteries to the pancreas
ii. short gastric arteries
iii. left gastroepiploic artery
The common hepatic artery supplies
initially in it’s course it goes downwards and backwards until the lower part of the duodenum and turns upwards into the lesser sac forming the portal triad.
It branches off and gives off the
i. The right gastric
ii. Gastroduodenal–> gastroepiploic
iii. Superior pancreaticoduodenal from branch of gastroduodenal and has posterior and anterior branches and anastomosis with Inferior pancreaticoduodenal branches.
The portal vein has tribituaries from….
i. Left gastric veins
ii. Right gastric veins
iii. right gastroepiploic vein
iv. left gastroepiploic veins
v. Confluence of the superior mesenteric vein and Splenic vein
Where and what is a meckel’s diverticulum
it is at the apex of the physiological hernia during embryology, this is at the vitellointestinal duct at the ileum.
What level is the branch of superior mesenteric artery, it’s course and it’s branches
it’s origin is at the level of L1
It is directed steeply downwards behind the splenic vein @ the head of the pancreas, next to the superior mesenteric vein. passing in front of the L) renal vein and in between the uncinate process, and finally on the third part of the duodenum.
the branches include
i. The inferior pancreaticoduodenal arteries–> ant. and post.
ii. Jejunal branch
iii. Ileal branch
iv. Ileocolic artery- has posterior and anterior branches that communicate
v. right colic artery- ascending and descending branches
vi. middle colic artery
What level is the branch of the inferior mesenteric artery, it’s course and branches
occurs at the level of L3
runs obliquely down the pelvic brim crosses the bifurcation of the iliac arteries at the SI joint
branches
i. sup. rectal artery
ii left colic artery-> ascending and descending branch
iii. sigmoid arteries
What are the lymphatic vessels that lie in front of the aorta
i. Coeliac
ii. Superior mesenteric
iii. Inferior mesenteric
they travel upwards, they are the last in a series of lymph node filters between the guy and cisterna chylii.
Initially, they lie in the follicles in the mucous membrane through the muscle wall of the gut ot nearby nodes.
- juxtaintestinal nodes in the mesentary of the small intestine or paracolic nodes for the large intestine.
- the second group lie along the main blood vessels of the supply and finally to the pre-aortic roots as above
What is the collective nerve supply of the GIT called and it’s plexus. What systems do these nerves recieve
that are collectively called the enteric plexus they consists of:-
- Myenteric plexus(of Auerbach)- in the muscle layers
- Submuous plexus(of Meissner)- in the submucosa
they receive
i. post-ganglionic sympathetic (inhibatory)
ii. pre-ganglionic parasympathetic fibres(excitory)
What is the arteries that supply the stomach?
The coeliac plexus supplies the blood supply of the stomach; the stomach is supplied by the left and right gastric arteries(usually a branch of the gastroduodenal or the hepatic artery) this supplies the lesser curvature
The left and right gastroepiploic arteries
left gastroepiploic a branch of the gastroduodenal arteries
right gastroepiploic artery is a branch of the splenic artery
What is the arteries that supply the stomach?
The coeliac plexus supplies the blood supply of the stomach; the stomach is supplied by the left and right gastric arteries(usually a branch of the gastroduodenal or the hepatic artery) this supplies the lesser curvature
The left and right gastroepiploic arteries
left gastroepiploic a branch of the gastroduodenal arteries
right gastroepiploic artery is a branch of the splenic artery
What are the lymphatic drainage of the stomach
there are:
i. Left gastric nodes–> splenic nodes–> pancreatic nodes
ii. Right gastric nodes
iii. The rest reach nodes along the gastroepiploic vessels of the greater curvature and in the pyloric region
Nervous supply of the stomach consists of
Sympathetic fibres provide vasomotor and pain and run with the various arterious branch to the stomach
The vagus nerve provides the parasympathetic innervation and this controls the secretions and motiliy.
- The Anterior vagal trunk( lies in the right margin)–> runs downs the lesser omentum to the lesser curvature towards the left gastric artery giving a branch to the anterior surface of the stomach, a hepatic branch which also givens a branch to the pyloric antrum
- The posterior vagi trunk(rarely double) lies in loose connective tissue to the right oesophageal margin but not in contact; it also runs in the lesser omentum BEHIND the anterior trunk. It provides a branch to the coeliac ganglion
What cells of the stomach produce acid and gastrin
The parietal cells produce acid secreting and is in the body of the stomach
the G cells producing gastrin are precent in the pylorus
What cells of the stomach produce acid and gastrin
The parietal cells produce acid secreting and is in the body of the stomach
the G cells producing gastrin are precent in the pylorus
What are the relative positions of the duodenum to the pancreas and in the transpyloric plane
The duodenum makes a C shaped loop around the pancreas, D1 lies above the pancreas @ L1, D2 and the right side of the pancreas @ L2, D3 on L3, and D4 on the Left of L2
Relative to the transpyloric plane; D1 runs to the right upwards and and backward to the pylorus, the duodenal cap convexity is where the neck of the gallbladder lies. the next 3cm passes backwards and upwards to the right crus of the diaphragm & the R) psoas muscle. It’s post, syrface us bare of peritoneum and to the R) of the epiploic foramen. It touches the head of the pancreas, where the inferior surface of the right lobe of the liver lies.
D2, curves downwards over the hilum of the R) kidney. and crossed by the transverse mesocolon, thus the upper half lies in the supracolic comparment to the left of the hepatorenal pouch and the L) to the inf. poles of the R) kidney. it lies alongisde the head of the pancreas. D2 receives the hepatopancreatic ampula at the major duodenal papilla at the posterior-medial wall. it is guarded by a semilunar flap. above it is the accessory pancreatic duct.
D3 curves forwards, from R) paravetebral gutter over R) psoas muscle and IVC and aorta, around origin of IMA. its upper border hugs the lower border of the pancreas.lies in btoh right and left infracolic compartments and is in line with the jejunum.
D4 lies in the L) of aorta. and psoas muscle. and L) lumbar sympathetic trunk, reaching the lower border of the pancrease. it is covered by the peritoneal floor of the L) infracolic compartment and jejunum, and then leaves peritoneum to form duodenojejunal flexure.
What separates the duodenum and jejunum and it’s significance
The duodenum is retroperitoneum and the jejunum is within a mesentary, it is fixed to the L) psoas via fibrous tissue & further supported by suspensory muscle of the duodenum/ligament of Trentz(From the R) crus of the diaphgram in front of the aorta and the renal vessels but behind the pancreas.
What are the numerous folds of the small intestine called
plicae circulares/ valvulae conniventes