Flashcards in Abdomen 2 Deck (65):
What is the largest gland in the human body?
What is the blood supply t the foregut?
What structure extends from the pylorus of the stomach to the ileocecal junction?
What are the three components of the small intestine?
What is the shortest, widest, and most fixed part of the small intestine that extends from the pylorus to the duodenojejunal flexure?
The duodenum is retroperitoneal. TRUE OR FALSE
the first part of the duodenum is INTRA-peritoneal
- the remaining parts are retroperitoneal
What connects the first part of the duodenum to the liver ?
of the lesser momentum
What are the lumbar vertebrae levels of the 4 parts of the duodenum?
1st = L1 (duodenal cap--> can have ulcers here)
2nd = L2-L3
3rd = L3
4th = L3-L2
Which part of the duodenum receives the major duodenal papilla (bile duct & main pancreatic duct) & the minor duodenal papilla (accessory pancreatic duct)? Which lumbar vertebrae does it lie at?
What artery & vein cross the 3rd part of the duodenum? Where is the Portal Vein?
SMV & SMA
- NECK of the pancreas (behind it)
The suspensory ligament of the duodenum (ligament of Treitz) tethers which part of the duodenum?
4th = Ascending (L3-2)
The whole pancreas is RETROPERITONEAl. True or False?
- TAIL lies in the lienorenal ligament
The SMA & SMV cross which organ (& what part of this organ)
HEAD of the PANCREAS
At which part of the pancreas do the splenic & SMV join together to form the PORTAL vein?
What are the two ducts of the pancreas? What parts of the pancreas do they drain?
1. Main Pancreatic (of wirsung) Duct
- drain tail, neck and upper head
2. Accessory Pancreatic Duct (of santorini)
- drain uncinate process
What two structures join together to form the AMPULLA of VATER? At what organ is this located?
Bile Duct & Pancreatic duct (Hepatopancreatic Ampulla)
- 2nd part of DUODENUM
Where do the duodenum & jejunum begin & end?
BEGIN = duodenojejunal flexure
END = ILEOCECAL JUNCTION
What artery supplies the Duodenum & Jejunum?
What are 4 major differences between the JEJUNUM & ILEUM?
1. Jejunum = less fatty
3. Greater vascularity
4. LONG Vasa Recta
5. A few large ARACADE loops
1. more fatty
3. less vascularity
4. short VASA RECTA
5. many SHORT Arcade Loops
What are the 4 components of the large intestine?
1. Cecum w/ Appendix
4. Anal Canal
What parts of the colon are retroperitoneal?
ASCENDING & DESCENDING
Is appendix retroperitoneal or intraperitoneal?
- along w/ transverse colon, and sigmoid colon
What arteries supply the large intestine?
SMA & IMA
The appendices epiploicase (mental bursae) are small pouches filled with fat that are usually found on all aspects of the LARGE INTESTINE except:
What longitudinal muscle layer forms 3 bands? Where do they begin and end?
- base of appendix to sigmoid colon
What is found in between the tania coli bulging outward to form 3 rows of pouches in the LARGE intestine?
Haustra --> Sacculations
What valve guards the ideal opening into the cecum? What is found 2 inches below this valve?
What suspends the Appendix?
MESO - APPENDIX
- appendix is rich in lymphoid tissue
What can be a useful landmark in surgery to find the appendix?
3 bands of the Tania Coli
What may Appendicitis cause that leads to perforation of the appendix?
Thrombosis of the APPENDICULAR Artery
Where is McBurney's point found? What is the source of this pain?
junction of the lateral and middle 1/3s of a line joining the RIGHT ASIS (anterior Superior Iliac Spine) and the UMBILICUS
- pain from Appendicitis
Where is pain usually felt at during Appendicitis?
T10 dermatome = UMBILICUS
What is the syndrome that often gets confused with Appendicitis?
Syndrome of 2's:
1. 2 feet from IV valve
2. 2 in long
3. 2% of population
4. 2% symptomatic
5. 2 types ectopic tissue
6. 2 years of age
7. 2 times more common in boys
Parasympathetic stimulation of the GIT causes an increase in peristalsis and a decrease in sphincter function.
What nerves provide the parasympathetic innervation for the FOREGUT& MIDGUT? The hindgut?
2. Pelvic Splanchnics S2- S4
(parasympathetic pre-ganglionic fibers)
What nerves provide the sympathetic innervation for the FOREGUT& MIDGUT? The hindgut?
1. Greater (T7-T9)
Least Splanchnics (T12)
2. Lumbar Splanchnics to the HINDGUT
What are the 4 main branches of the SMA? Is it the artery of the foregut, midgut, or hindgut?
1. Inferior Pancreaticoduodenal
2. Right Colic
3. Middle Colic
-Ileal (anastomoses w/ end of SMA)
Celiac Trunk, SMA, and IMA are found at what vertebral levels?
T12, L1, L3
Which artery (SMA or IMA) runs downward to the RIGHT iliac fossa?
All branches of the SMA are to the right except:
- run in mesentery and form arcades, which send straight arteries to intestine (VASA RECTA)
Which two arteries of the SMA form the VASA RECTA?
Jejunal & Ileal Branches
Which part of the duodenum does the IMA arise at? What does the IMA end as?
1. 2rd part of duodenum
2. SUPERIOR RECTAL ARTERY
What are the branches of the IMA? Are all the branches left or right?
all branches LEFT*
1. Left Colic
3. Superior Rectal Artery
What artery connects the right colic, middle colic, and left colic?
MARGINAL ARTERY of DRUMMOND
What vein ends as an artery?
Hepatic Portal Vein
What structures does the portal vein pass before reaching the IVC?
1. Intestinal Capillary bed
2. Liver Sinusoids (capillary bed)
PORTAL VEIN IS BETWEEN TWO SETS OF CAPILLARY BEDS
Portal vein is a union of what two veins?
Splenic & SMV
What structure provides the liver with 75% of its blood and 50% of its oxygen?
Where do the SMV and splicing vein meet?
NECK of the pancreas
V --> Hepatic Portal Vein is POSTERIOR
Artery & Duct are anterior
What are the 3 important Portosystemic Anastomosis?
1. Left Gastric & Esophageal Vein (Azygos)
2. Superior Rectal & Middle & Inferior Rectal Veins
3. Paraumbilical Veins & radicles of the superficial Epigastric Veins
What is Liver Cirrhosis, it can lead to what three events?
Cirrhosis = fibrosis of the liver
1. Esophogeal Varices - Hematemesis (vomit blood)
2. Rectal Varices - Hemorrhoids (bleeding per rectum)
3. Caput Medusae - varicose veins from the umbilicus
What part of the pancreas marks the location of the SMA & SMV (lateral to SMA)?
--> head of pancreas
What are the two main tributaries of the portal vein? What part of the pancreas do they join at?
SMV + Splenic Vein
- join at the NECK
What two arteries supply the small intestine?
SMA & Celiac Trunk
The jejunum and ileum are suspended by ______
- attached = 1st 6 inches
free = 6feet
What are the 3 main features of the large intestine?
1. Taeni COli
3. Appendices Epiploicae (omental appendices)
What two veins are not included in the Portal Vein?
Celiac & Gastroduodenal
What vein drains all the tributaries of SMA, SMV, Celiac trunk...etc
What occurs during cirrhosis of the liver?
FIBROUS TISSUE surrounds the Hepatic Sinusoids
-PRESSURE INSIDE PORTAL VEIN INCREASES = Portal Hypertension
A-20- year old man with a ruptured appendix is sent to the ER for surgery. To cut off the blood supply to the appendix. A surgeon should ligate which of the following arteries?
A) Right colic artery
B) Ileocolic artery
C) Middle colic artery
D) Inferior mesenteric artery
E) Left colic artery
- Appendicular branches off of this
A 54-year- old man with a long history of alcohol abuse presents to the ER with rapidly increasing abdominal distention most likely resulting from an alteration in portal systemic flow. Which of the following characteristics is associated with the portal vein or portal venous system ?
A) Lower blood pressure than in the IVC.
B) Least risk of venous varices because of portal hypertension.
C) Distension of portal vein because of its numerous valves.
D) Less blood flow than in the hepatic artery.
E) Esophageal varices & hemorrhoids caused by portal hypertension.
E) Esophogeal Varices & hemorrhoids caused by portal hypertension
Omental appendices ( appendices epiploica) and Taenia coli are located on which of the following structures?
C) Ascending colon
E) Anal canal
C) Ascending colon
The sympathetic fibers in the nerves to the jejunum and ileum originate in which of the following spinal cord segments ?