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Flashcards in Abdomen II Deck (54)
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1

What is the longest part of the Gastrointestinal Tract?

Small intestine

2

Where does the small intestine extend begin and end?

It extends from the pylorus of the stomach to the ileocecal junction

3

Divisions of the small intestine

Duodenum, Jejunum and the Ileum

4

Describe the shape and location of the duodenum and the organ that it surrounds.

-It is a C-shaped tube and surrounds the head of the Pancreas.
-It is the shortest, widest, and most fixed part of the small intestine
-The duodenum and the pancreas lie at the junction between the foregut and the midgut and receive blood from the Celiac Trunk + SMA

5

What connects the duodenum to the liver (externally to these organs)?

The hepatoduodenal ligament of the lesser omentum

6

The 4 parts of the Duodenum

(1) L1- Duodenal cap- often affiliated with duodenal ulcers. Attachment for hepatoduodenal ligament. Retroperitoneal begins after the first 1-2 inches.

(2) Descending- L2- L3 Receives the major duodenal papilla (opening of the bile duct and main pancreatic duct) and the minor duodenal papilla (the opening of the accessory pancreatic duct)

(3) Inferior- L3- Crosses inferior Vena Cava and Aorta and is crossed by SMA and SMV

(4) Ascending- Ascends back up to left of L3-L2- Tethered by suspensory ligament at duodenojejunal flexure

7

Location and functioning of the Pancreas

Endocrine (insulin/glycogen) + Exocrine (digestive enzymes)

Located across the posterior abdominal wall, and extends from the duodenum to the spleen

8

The 4 parts of the Pancreas

(1) Head- lies in the C-shaped concavity of the duodenum. UNICATE is a finger like extension of the head where the SMA and SMV pass anteriorly. From here they go to supply the small intestine.

(2) Neck- lies anterior to the beginning of the portal vein where the splenic vein and SMV join to form the portal vein-- VERY IMPORTANT

(3) Body- Forms the major portion of the stomach bed. Splenic artery runs along its upper border and the splenic vein runs posterior to it.

(4) Tail- Ends in the splenorenal (lienorenal) ligament at the hilum of the spleen (touches spleen)

9

The 2 ducts of the Pancreas

(1) The main pancreatic (of Wirsung)- drains the tail, body, neck and upper part of the head. Joins the bile duct to form a short tune called Hepatopancreatic ampulla (ampulla of Vater). Opens on major duodenal papilla.

(2) The Accessory Pancreatic Duct (of Santorini)- drains the uncinate process and lower part of the head. Opens at the minor papilla.

10

What covers the Jejunum and Ileum?

Peritoneum (intraperitoneal) as they are suspended by a mesentery from the posterior abdominal wall

11

Describe the borders of the mesentery which covers the Jejunum and the Ileum

The mesentery is fan-shaped and has 2 borders:

(1) Attached border (root)- 6 inches long, crosses 3rd part of duodenum, aorta, IVC and under the right ureter and psoas major

(2) Free border- 6 meters long, encloses loops of jejunum and ileum

12

What provides the vascularization of the Jejunum/Ileum?

SMA

13

Main differences between Jejunum and Ileum

JEJUNUM:
- More vascular
- Long Vasa Recta
- A few large loops of arterial Arcades
- Large, tall, and closely packed circular folds
-Few Lymphoid nodules
-Thinner fat

ILEUM
- Less vascular
- Short vasa recta
- Many short loops of arterial Arcades
- Low and Sparse circular folds which are absent in distant parts
-Many Lymphoid nodules
-Thicker fat

14

What does the Large Intestine surround?

It surrounds the small intestine like a "picture frame"

15

Parts of the Large Intestine, and their associated peritoneal coverings (folds)

1. Cecum (retroperitoneal)
2. Appendix (mesoappendix)
3. Ascending colon (retroperitoneal)
4. Transverse colon (transverse mesocolon)
5. Descending colon (retroperitoneal)
6. Sigmoid colon (Sigmoid mesocolon)
7. Rectum (Retroperitoneal)

16

Divisions of the Colon

Ascending colon, right (hepatic) colic flexure, transverse colon, left (splenic ) colic flexure, descending colon, and sigmoid colon

17

Components of the large intestine which are fixed are within what type of covering?

Retroperitoneal

18

The parts of the large intestine which are not fixed

-Appendix
-Transverse colon
-Sigmoid colon

19

Blood supply of the large intestine

SMA + IMA

20

Small pouches filled with fat around large intestine.

Appendices epiploicaue

Feature of the Large Intestine

Aka Omental appendices

Absent in Cecum, Appendix and Rectum (CAR) [ COLIC PORTION ONLY]

21

Taeniae Coli

Feature of the Large Intestine

The outer longitudinal muscle layer is thickened to form 3 bands which are shorter than the other layers. The begin at the base of the appendix and end at the sigmoid colon.

22

Sacculations

Feature of the Large Intestine

Aka Haustra

Found between the Taeniae Coli. The colon bulges outwards forming 3 rows of pouches

23

Cecum

A blind sac in the right iliac fossa, continuous with the ascending colon. Medially receives the opening of the ileum and appendix

24

Ileocecal valve (IC)

Guards the ileal opening into the cecum. The valve has 2 lips. The opening of the appendix is 2cm below it.

25

Appendix

Blind tube rich in lymphoid tissue, suspended by mesoappendix.

26

Common positioning of appendix

Retrocecal

27

Useful landmark for appendectomies

The 3 taeniae coli meet at the base of the appendix, so this can serve as a great landmark for surgeons.

28

Acute Appendicitis

Acute inflammation of the appendix due to viral or bacterial infection. May result in thrombosis of the appendicular artery (branch of ileocolic artery) which can lead to perforation of the appendix

29

McBurney's Point

The point of maximum tenderness in acute appendicitis. Pain from the appendix enters the spinal cord through T10 segment so acute appendicitis is referred to the umbilicus region (which also shares T10).

30

Where is McBurney's point?

It lies opposite to the junction of lateral and middle thirds of a line joining the Rt. ASIS to the umbilicus. The meeting point of the median 2/3rds and the lateral 1/3rd