Supracolic Compartment with Stomach, Liver and Spleen Flashcards

1
Q

[21-minute video]: the Liver

A

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2
Q

[24-minute video]: the Stomach

A

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3
Q

[1-minute video]: relations of the Stomach

A

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4
Q

Click on Answer for transverse section images of the abdomen.

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5
Q

Click on Answer to view images of the various vessels supplying this region.

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6
Q

The stomach is the widest and most distensible part of the alimentary canal between the esophagus and the duodenum. State its functions.

A
  1. Forms a reservoir of food.
  2. Mixes food with gastric secretions to form a semifluid substance called chyme.
  3. Controls the rate of delivery of chyme into the small intestine to allow proper digestion and absorption in the small intestine.
  4. Hydrochloric acid secreted by the gastric glands destroys bacteria present in the food and drink.
  5. Castle’s intrinsic factor present in the gastric juice helps in the absorption of vitamin B12 in the small intestine.
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7
Q

State the location of the stomach.

A

Situated in the upper left part of the abdomen occupying left hypochondriac, umbilical, and epigastric regions. It extends obliquely from the left hypochondriac region into the epigastric region.

Further notes:
⚚ The stomach is mostly β€œJ” shaped. Its long axis passes downward, forward, and to the right and finally backward and slightly upward. It tapers from the fundus on the left of the median plane to the narrow pylorus slightly to the right of the median plane.
⚚ Both the shape and position of the stomach vary greatly according to the build of an individual. It is:
1. High and transverse (steer-horn type) in short obese persons.
2. Low and elongated in tall and weak persons.

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8
Q

State the external features that the stomach presents.

A
  1. Two ends: Cardiac and pyloric.
  2. Two curvatures: Greater and lesser.
  3. Two surfaces: Anterior (anterosuperior) and posterior (posteroinferior).
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9
Q

State the difference between cardiac and pyloric orifices in terms of anatomical sphincters.

A

The cardiac orifice does not have an anatomical sphincter but is guarded by the physiological sphincter while the pyloric orifice has anatomical pyloric sphincter formed by the thickening of a circular coat of muscle assisted by a deep set of longitudinal fibres of the stomach.

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10
Q

Morphology of lesser curvature of stomach?

A

⚚ Concave.
⚚ Forms the shorter right border of the stomach.
⚚ The angular notch/incisura angularis on the lesser curvature indicates the junction of the body and pyloric part.
⚚ The lesser curvature provides attachment to the lesser omentum.

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11
Q

morphology of greater curvature of stomach

A

⚚ Convex.
⚚ Forms the longer left border of the stomach.
⚚ At its upper end this curvature presents a cardiac notch which separates it from the left aspect of the esophagus.
⚚ The greater curvature provides attachment to the greater omentum, gastrosplenic, and gastrophrenic ligaments.

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12
Q

Name the four parts of the stomach.

A
  1. Cardiac part (or cardia)
  2. Fundus
  3. Body
  4. Pyloric part
  5. [Diagram]
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13
Q

Why does gastric pain sometimes imitate the pain of angina pectoris?

A

Because superiorly, the fundus usually reaches the level of the left 5th intercostal space just below the nipple.

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14
Q

The pyloric part is divided into three parts. State them.

A
  1. Pyloric antrum is the proximal wide part which is separated from the pyloric canal by an inconstant sulcus, sulcus intermedius present on the greater curvature. It is about 3 inches (7.5 cm) long and leads into the pyloric canal.
  2. Pyloric canal is a distal narrow and tubular part measuring 1 inch (2.5 cm) in length. It lies on the head and neck of the pancreas.
  3. Pylorus (Greek gatekeeper) is the distal most and sphincteric region of the pyloric canal. The circular muscle fibres are markedly thickened in this region, which control the discharge of stomach contents through the pyloric orifice into the duodenum.

Note: The position of the pyloric orifice is indicated on the surface by (a) a circular sulcusβ€”pyloric constriction produced by the underlying pyloric sphincter or pylorus; and (b) the prepyloric vein of Mayo on the anterior surface of the pylorus.

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15
Q

arterial supply of stomach

A

The stomach has rich arterial supply derived from the coeliac trunk and its branches. The arteries supplying the stomach are:
1. Left gastric artery, a direct branch from the coeliac trunk.
2. Right gastric artery, a branch of the common hepatic artery.
3. Left gastroepiploic artery, a branch of the splenic artery.
4. Right gastroepiploic artery, a branch of the gastroduodenal artery.
5. Short gastric arteries (five to seven in number), branches of the splenic artery.

Note that the veins of the stomach correspond to the arteries and drain directly or indirectly into the portal vein.

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16
Q

State the location of the liver in terms of the 9 divisions of the abdomen.

A

It is located in the right hypochondrium and the upper part of the epigastrium.

17
Q

Name the three fissures that divide the liver into two anatomical right and left lobes.

A

(a) fissure for the falciform ligament
(b) fissure for ligamentum terres hepatis
(c) fissure for ligamentum venosum
[Diagram]

18
Q

Name the fissure that separates the caudate and quadrate lobes of the liver.

A

porta hepatis/transverse fissure of the liver

19
Q

Name two fossae on the liver.

A

(a) fossa for the gall bladder
(b) fossa for the inferior vena cava

20
Q

Functionally, the liver is divided into eight hepatic segments. Name the ones in the:
(a) left functional lobe
(b) right functional lobe

A

(a) left functional lobe
⚚ medial superior segment [in the caudate lobe]
⚚ medial inferior segment [in the quadrate lobe]
⚚ lateral superior segment [in the anatomical left lobe]
⚚ lateral inferior segment [in the anatomical left lobe]

(b) right funcitonal lobe
⚚ anterior superior segement
⚚ anterior inferior segment
⚚ posterior superior segment
⚚ posterior inferior segment

[Diagram 1] [Diagram 2] [Diagram 3]

21
Q

List the areas of the liver not covered by peritoneum.

A

(a) Bare area of the liver
(b) Fossa for the gall bladder
(c) Groove for the inferior vena cava
(d) Groove for the ligamentum venosum
(e) Porta hepatis

22
Q

List the false/peritoneal ligaments of the liver.

A

(a) falciform ligament [connecting the liver to the undersurface of the diaphragm and the anterior abdominal wall up to the umbilicus]
(b) coronary ligament [It is a triangular fold of the peritoneum connecting the bare area of the liver to the diaphragm.]
(c) right triangular ligament
(d) left triangular ligament
(e) lesser omentum [It is the fold of peritoneum connecting the lesser curvature of the stomach and proximal 1 inch (2.5 cm) of duodenum to the visceral surface of the liver]

23
Q

List the true/vascular ligaments of the liver.

A

(a) Ligamentum terres hepatis [obliterated left umbilical vein]
(b) Ligamentum venosum [obliterated ductus venosus]

24
Q

State the anterior relations of the stomach.

A

⚚ On the right side, the anterior surface is related to the gastric impression of the left lobe of the liver, and near the pylorus to the quadrate lobe of the liver.
⚚ The left half of the anterior surface is related to the diaphram and rib cage.
⚚ The lower part of this surface is related to the anterior abdominal wall.

25
Q

State the posterior relations of the stomach.

A

⚚ Diaphragm
⚚ Spleen
⚚ Splenic artery
⚚ Splenic flexure
⚚ Left Kidney [and left adrenal gland]
⚚ Pancreas
⚚ Mesocolon

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26
Q

Name the structures that run within the hepatoduodenal ligament.

A

Portal vein, common bile duct, hepatic artery proper

27
Q

(a) What is the epiploic foramen of Winslow?
(b) What are its boundaries?

A

(a) It is a vertical slit through which the lesser sac of the peritoneum (omental bursa) communicates with the greater sac of the peritoneum. It is situated at the right free margin of the lesser omentum at the level of the T12 vertebra.

(b) Boundaries:
Anterior: Right free border of the lesser omentum containing bile duct, vertical part of the hepatic artery, and portal vein. Remember duct and artery are anterior to the vein with the duct being to the right of the artery.
Posterior: Inferior vena cava and right suprarenal gland
Superior: caudate process of the caudate lobe of the liver
Inferior: first part of the duodenum and the horizontal part of the hepatic artery

[Diagram 1] [Diagram 2] [Diagram 3]
[Diagram 4] [Diagram 5]

28
Q

List the lymph nodes that drain the stomach.

A

pancreaticosplenic nodes, right gastroepiploic nodes, pyloric nodes, right gastric nodes, hepatic nodes, left gastric nodes, coeliac nodes

29
Q

State the four relations of the visceral surface of the spleen.

A

(a) fundus of the stomach
(b) anterior surface of the left kidney
(c) left colic flexure
(d) tail of pancreas
[Diagram 1] [Diagram 2] [Diagram 3] [Diagram 4]

30
Q

Name the structures separated from the spleen by the diaphragm.

A

(a) costophrenic recess
(b) lung
(c) 9 to 11th ribs

31
Q

State the four tributaries of the splenic vein.

A

(a) short gastric veins
(b) left gastroepiploic vein
(c) pancreatic veins
(d) inferior mesenteric vein
[Diagram]

32
Q

List the structures present in the lienorenal/splenorenal ligament.

A

tail of pancreas, splenic artery, splenic vein
[Diagram]