Abdomen 1 - Stomach, Duodenum & Pancreas (Anatomy & NV)

Question 1

Where is the stomach located? What type of peritoneal organ is it?

Answer 1

upper left quadrant (epigastric region)
intraperitoneal

Question 3

peritoneal attachments of the stomach?

Answer 3

1. intraperitoneal (fully suspended in mesentery)
2. greater omentum - from greater curvature to posterior abdominal wall
3. lesser omentum (hepatogastric ligament) - from liver to lesser curvature

Question 4

anatomical regions of the stomach

Answer 4

fundus
cardia
body
pylorus - antrum, canal, sphincter

Question 5

what is the fundus of the stomach?

Answer 5

dome-shaped
air-filled upper part above the cardiac notch; contacts left diaphragm

Question 6

what is the cardia of the stomach?

Answer 6

region around oesophageal opening; entry point of food into the stomach

Question 7

what is the body of the stomach? what is the function of the rugae in the stomach?

Answer 7

main central part - primary site of digestion

rugae = allows stomach to expand; directs chyme toward pylorus

Question 8

what type of sphincter is the pyloric sphincter?

Answer 8

anatomical - (thickened circular muscle); controls gastric emptying into duodenum

Question 9

what mesenteries attach to the stomach?

Answer 9

lesser omentum (hepatogastric & hepatoduodenal ligaments) attaches to lesser curvature

greater omentum (gastrocolic, gastrophrenic & gastrosplenic ligaments) - attach to greater curvature; contain gastro-omental vessels

Question 10

name the layers of the stomach wall (innermost to outermost)

Answer 10

1. mucosa (with gastric glands)
2. submucosa
3. muscularis propria: inner oblique, middle circular, outer longitudinal
4. serosa (visceral peritoneum)

Question 11

what is the Z-line between the stomach & oesophageal mucosa? clinical significance?

Answer 11

junction between oesophageal and gastric mucosa (squamous → columnar epithelium)

with repeated gastric reflux - normal stratified squamous epithelium of the oesophageal mucosa is replaced my metastatic columnar epithelial cells - metaplastic change can be a precursor to oesophageal cancer

Question 12

how might the pyloric sphincter malfunction? effects?

Answer 12

pyloric stenosis
- overactive/obstructed sphincter
- caused by peptic ulcer
- leads to delayed gastric emptying & vomiting

pyloric insufficiency
- weak sphincter
- affects gastric emptying into duodenum

Question 13

what structure on the stomach marks the commencement of the pyloric antrum?

Answer 13

incisura angularis (notch of lesser curvature)

Question 14

What arteries supply the lesser curvature of the stomach?

Answer 14

1. left gastric artery (from coeliac trunk)
2. right gastric artery (from proper hepatic/common hepatic)

Question 15

What arteries supply the greater curvature of the stomach?

Answer 15

1. left gastro-omental (from splenic artery)
2. right gastro-omental (from gastroduodenal → common hepatic)

Question 16

what arteries supplies the fundus of the stomach?

Answer 16

short gastric arteries (from splenic artery)

Question 17

What is the significance of anastomoses in stomach arteries?

Answer 17

provide collateral circulation – especially on curvatures
- anastomoses between left & right gastric arteries (on border of lesser curvature)
- anastomoses between left & right gastro-omental arteries (on greater curvature)

Question 18

how is the stomach drained venously?

Answer 18

1. left & right gastric veins - to hepatic portal vein
2. gastro-omental veins - to splenic/SMV veins - to portal vein
3. short gastric veins - to splenic vein

Question 19

what is the parasympathetic supply of stomach? role?

Answer 19

vagus nerve
- increases secretion & motility
- relaxes sphincters
- synapses in stomach wall

Question 20

What is the sympathetic supply of the stomach?

Answer 20

greater splanchnic nerve (T5–T9) - coeliac plexus
- vasoconstriction, decreased secretion & motility
- contracts pyloric sphincter

Question 21

What causes referred pain from the stomach?

Answer 21

visceral afferents travel with sympathetic fibres to T5–T9 spinal cord levels - causes referred epigastric pain with signals from different dermatomes converging at one point

Question 22

What structures are at risk with perforated ulcers in the duodenum?

Answer 22

• gastroduodenal artery - risk of erosion & haemorrhage
• hepatic portal vein
• bile duct

Question 23

what are omenta?

Answer 23

double-layered folds of peritoneum connecting the stomach to other abdominal organs; include the greater and lesser omentum

Question 24

what is the lesser omentum?

Answer 24

double-layered peritoneal fold connecting the lesser curvature of the stomach and proximal duodenum to the liver

consists of two ligaments:
- hepatogastric (liver to lesser curvature of stomach)
- hepatoduodenal (liver to duodenum)

Question 25

What does the lesser omentum separate?

Answer 25

separates the greater sac from the lesser sac (omental bursa)

Question 26

which structures are found within the hepatoduodenal ligament?

Answer 26

portal triad: - proper hepatic artery (oxygenated blood to liver) - portal vein (nutrient-rich deoxygenated blood to liver) - common bile duct (bile to duodenum) lymphatic vessels and autonomic nerves

Question 27

What is the free edge of the lesser omentum?

Answer 27

hepatoduodenal ligament – forms the anterior boundary of the epiploic (omental) foramen epiploic foramen is an opening posterior to the hepatoduodenal ligament that connects the greater and lesser sacs

Question 28

main functions of the lesser omentum? clinical significance?

Answer 28

- connects stomach/duodenum to liver - conveys neurovascular structures (portal triad) - allows communication between sacs via epiploic foramen clinical: - route for spread of infection (peritonitis) - ascites (fluid accumulation) between sacs - potential metastatic pathway

Question 29

what is the Pringles manoevure?

Answer 29

surgical clamping of the hepatoduodenal ligament to temporarily occlude hepatic artery & portal vein → controls liver bleeding

Question 30

what three arteries does the coeliac trunk (which supplies the foregut) trifurcate into?

Answer 30

left gastric artery splenic artery common hepatic artery

Question 31

What is the duodenum and where is it located?

Answer 31

- first part of the small intestine; ~25 cm long - begins at pylorus (L1) & ends at duodenojejunal flexure (L2) - wraps around the head of the pancreas

Question 32

Which parts of the duodenum are retroperitoneal?

Answer 32

2nd, 3rd, and 4th parts are retroperitoneal 1st part is partly intraperitoneal

Question 33

Which embryological regions contribute to the duodenum?

Answer 33

foregut - 1st and 2nd (proximal) parts midgut - 2nd (distal), 3rd, and 4th parts transition at the major duodenal papilla

Question 34

What is the arterial blood supply of the duodenum?

Answer 34

1 & 2nd parts = superior pancreaticoduodenal artery (coeliac trunk > common hepatic artery > gastroduodenal) 3rd & 4th = inferior pancreaticoduoodenal artery (from SMA) arteries anastomose around the head of the pancreas - form an arterial arcade

Question 35

How is the duodenum drained venously?

Answer 35

into the hepatic portal vein via the superior mesenteric and splenic veins

Question 36

duodenum - sympathetic & parasympathetic innervation?

Answer 36

sympathetic: - greater splanchnic nerve (T5-9) via coeliac ganglion FOR 1ST & 2ND parts - lesser splanchnic nerves (T10-11) via superior mesenteric ganglion for 3RD & 4TH parts parasympathetic: - vagus nerve (CN X) — increases motility and secretion

Question 37

Why is the posterior 1st part of the duodenum clinically significant?

Answer 37

ulcers can erode the gastroduodenal artery = massive haemorrhage

Question 38

What is the major duodenal papilla?

Answer 38

opening for common bile duct & main pancreatic duct into the 2nd part of duodenum (foregut–midgut junction)

Question 39

What is the minor duodenal papilla?

Answer 39

opening of the accessory pancreatic duct (if present)

Question 40

what does the suspensory muscle of duodenum at the duodenojejunal flexure mark?

Answer 40

marks transition from duodenum to jejunum (around L2)

Question 41

Where is the pancreas located?

Answer 41

- retroperitoneal organ in the upper abdomen (L1–L2) - extends from the duodenum (right) to the spleen (left) - posterior to the stomach

Question 42

What are the 5 anatomical parts of the pancreas?

Answer 42

head uncinate process neck body tail

Question 43

Which arteries supply the pancreas?

Answer 43

head & uncinate process: - superior pancreaticoduodenal artery (coeliac trunk > common hepatic > gastroduodenal > superior PD) - inferior pancreaticoduodenal artery (from SMA) form anastomoses; pancreaticoduodenal arcades = collateral flow between coeliac trunk and SMA body & tail: - pancreatic branches (coeliac trunk > splenic artery > pancreatic branches)

Question 44

how does the pancreas drain venously?

Answer 44

pancreatic veins > splenic vein & superior mesenteric vein > hepatic portal vein

Question 45

key features & related structures to different parts of the pancreas

Answer 45

body lies anterior to the splenic artery, with the splenic vein running along its superior margin. It is located to the left of the superior mesenteric artery (SMA) and vein (SMV). neck passes anterior to the SMA and portal vein. It is at this point that the splenic vein and SMV unite to form the hepatic portal vein. head is the expanded part nestled in the C-curve of the duodenum. It lies posterior to the SMA & SMV, and the portal vein begins behind it. uncinate process - hook-like projection from the inferior part of the head, it wraps posteriorly around the SMA, forming a key anatomical relationship

Question 46

Describe the pathway and function of the main pancreatic duct.

Answer 46

Runs from the tail through the body, neck, and head. Joins the bile duct to form the hepatopancreatic ampulla (ampulla of Vater). Drains into the major duodenal papilla, controlled by the Sphincter of Oddi. Delivers pancreatic juice + bile into the descending duodenum.

Question 47

What is the accessory pancreatic duct and what is its role?

Answer 47

An additional duct found in most individuals. Opens into the minor duodenal papilla, located ~1cm above the major papilla. Only carries pancreatic juice (no bile). Clinical note: Can serve as a backup drainage route if the main duct is blocked.

Question 48

How is secretion into the duodenum regulated?

Answer 48

Through the Sphincter of Oddi, a smooth muscle sphincter that controls flow from the hepatopancreatic ampulla into the major duodenal papilla.

Question 50

What’s the most common site of pancreatic adenocarcinoma?

Answer 50

head of pancreas - may compress common bile duct & lead to painless jaundice

Question 51

main pancreatic duct & accessory pancreatic duct - functions?

Answer 51

main pancreatic duct: - drains exocrine secretions into 2nd part of duodenum via major duodenal papilla (with common bile duct) accessory pancreatic duct: - drains superior portion of head into minor duodenal papilla (may be absent)

Question 52

where do the lymph nodes of the duodenum drain?

Answer 52

into cisterna chyli > thoracic duct

Question 53

what is the epiploic foramen? boundaries (SI/AP)?

Answer 53

epiploic foramen = connects greater sac and lesser sac (omental bursa) boundaries: - A = hepatoduodenal ligament (contains portal triad) - P = IVC and right crus of diaphragm - S = Caudate lobe of liver - I = 1st part of duodenum

Question 54

what is the duodenal cap? clinical significance?

Answer 54

first part (proximal 2 cm) of the duodenum – smooth-walled, intraperitoneal segment before it becomes retroperitoneal and gains circular folds common site for peptic ulcers - ulcers can erode posteriorly into gastroduodenal artery

Question 55

The short gastric arteries arise from which of the following? A. Common hepatic artery B. Splenic artery C. Left gastric artery D. Right gastroepiploic artery

Answer 55

B. Splenic artery

Question 56

The 1st part of the duodenum is intraperitoneal and is a common site for what? A. Crohn’s disease B. Peptic ulcers C. Appendicitis D. Gallstones

Answer 56

B. Peptic ulcers

Question 57

Which structure lies posterior to the first part of the duodenum and is at risk in posterior ulcers? A. Splenic artery B. Common bile duct C. Gastroduodenal artery D. Portal vein

Answer 57

C. Gastroduodenal artery

Question 58

Blood supply to the 3rd and 4th parts of the duodenum comes from which artery? A. Right gastric B. Inferior pancreaticoduodenal C. Superior pancreaticoduodenal D. Splenic

Answer 58

B. Inferior pancreaticoduodenal (arises from SMA)

Question 59

The body and tail of the pancreas are mainly supplied by branches of which artery? A. Gastroduodenal artery B. Superior mesenteric artery C. Splenic artery D. Common hepatic artery

Answer 59

C. Splenic artery - gives off pancreatic branches

Question 60

Which structure forms the anterior boundary of the epiploic foramen? A. IVC B. Hepatoduodenal ligament C. Caudate lobe D. First part of duodenum

Answer 60

B. Hepatoduodenal ligament

Question 61

A surgeon clamps the hepatoduodenal ligament. Name this manoeuvre. What is this for?

Answer 61

Pringle’s manoeuvre - temporarily occlude hepatic artery & portal vein to control bleeding

Question 62

What are the two layers of the peritoneum and how do they differ?

Answer 62

parietal peritoneum: Lines cavity walls; somatic innervation → localized pain visceral peritoneum: Covers organs; visceral innervation → referred pain

Question 63

What is the peritoneal cavity and what does it contain?

Answer 63

potential space between parietal and visceral peritoneum - contains serous fluid produced by mesothelium - allows frictionless organ movement

Question 64

Which structure forms the posterior boundary of the epiploic foramen? A. Hepatic artery B. IVC C. Caudate lobe of liver D. Bile duct

Answer 64

B. IVC

Question 65

Which of the following is not a content of the greater omentum? A. Fat B. Portal vein C. Immune cells D. Lymphatic vessels

Answer 65

B. Portal vein (in lesser omentum; hepatoduodenal ligament)

Question 66

The mesentery carrying the superior mesenteric vessels is: A. Transverse mesocolon B. Sigmoid mesocolon C. The mesentery (of SI) D. Hepatoduodenal ligament

Answer 66

C. The mesentery (of SI)

Question 67

Which of the following is true regarding the lesser sac? A. Anterior boundary is the kidney B. Contains portal triad C. Posterior to the stomach D. Cannot communicate with greater sac

Answer 67

C. Posterior to the stomach

Question 68

A tagged mesentery connecting transverse colon – name it + contents

Answer 68

Transverse mesocolon – contains middle colic vessels (branch of SMA)