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Flashcards in accessory organs of digestion Deck (52):
1

spleen

lymph organ, filters RBCs and platlets
LUQ
protected by lower 4 ribs, but very frequently ruptured
peritonealized

2

anatomical relationships of spleen

anterior- stomach
posterior- diaphragm
inferior- left colic flexure

3

external features of spleen

usually 12cm long, 7cm wide, weighs 7 ounces
hilum faces anteriomedially, receives blood vessels
borders:
superior and anterior notched and sharp
inferoposterior- smooth

4

ligaments associated w/spleen

gastrosplenic
splenorenal (spleen to posterior body wall)
rests inferiorly on phrenicocolic ligament

5

lymph of spleen

pancreaticosplenic nodes -> celiac nodes

6

pancreas exocrine function

secretion of pancreatic enzymes into duodenum for digestion

7

pancreas endocrine function

secretion of pancreatic hormones (insulin and glucagon) into bloodstream from islets of langerhans

8

pancreas

secondarily retroperitoneal

9

external features of pancreas

head- lies w/in concavity of duodenum
ucinate process
neck- passes anterior to superior mesenteric vessels
body- continuous from neck to tail
tail- lies w/in splenorenal ligament

10

anatomical relationships head of pancreas

anterior- pyloric region of stomach, small intestines
posterior- LV1,2, IVC, renal vessels, bile duct
right and inferior- duodenum

11

anatomical relationships uncinate process of pancreas

anterior- superior mesenteric vessels

12

anatomical relationships neck of pancreas

anterior- transcerse mesocolon, small intestine
posterior- SMA, formation of hepatic portal v

13

anatomical relationships body of pancreas

anterior- stomach
posterior- aorta, left suprarenal gland, left kidney, renal vessels

14

anatomical relationships tail of pancreas

contacts hilum of spleen

15

main pancreatic duct

begins in tail, travels thru inferior portion of body and head
merges w/bile duct to form hepatopancreatic ampulla
empties into second portion of duodenum at major duodenal papilla
release controlled by sphincters (of pancreatic duct, of bile duct, and hepatopancreatic duct of oddi)

16

accessory pancreatic duct of santorini

travels through superior portion of head of panceas
empties into 2nd portion of duodenum at minor duodenal papilla

17

lymph of pancreas

II splenic a -> pancreaticospenic nodes -> celiac and superior mesenteric nodes

18

liver functions

metabolism of bile, lipids, carbs, proteins
produce urea
detox

19

surfaces of liver

diaphragmatic- (ant/sup) smooth and convex
visceral (post/inf) concave

20

porta hepatis

fissure on central portion of visceral surface
entrance of hepatic aa, portal v, hepatic bile ducts, lymphatics, nn
anterior to this is the quadrate lobe
posterior to this is the caudate lobe

21

sagittal fissues

on L and R of porta hepatis
R- contains gallbladder (ant) and IVC (post)
L- contains ligamentum teres hepatis (ant) ligamentum venosum (post)

22

ligaments associated w/liver

falciform
coronary
lesser omentum

22

ligaments associated w/liver

falciform
coronary
lesser omentum

23

coronary ligaments

anterior and posterior layers not opposed medially, creating bare area of liver
laterally anterior and posterior layers fuse to form triangular ligaments

23

coronary ligaments

anterior and posterior layers not opposed medially, creating bare area of liver
laterally anterior and posterior layers fuse to form triangular ligaments

24

hepatoduodenal ligament

contains portal triad:
-proper hepatic a (ant and left)
-bile duct (ant and right)
- heptatic portal v (post)

24

hepatoduodenal ligament

contains portal triad:
-proper hepatic a (ant and left)
-bile duct (ant and right)
- heptatic portal v (post)

25

subphrenic recess

extensions of greater sac btwn ant surface of liver and diaphragm
bounded deeply by ant layer of coronary lig
seperated into Land R by falciform lig

25

subphrenic recess

extensions of greater sac btwn ant surface of liver and diaphragm
bounded deeply by ant layer of coronary lig
seperated into Land R by falciform lig

26

hepatorenal recess

extension of greater sac btwn visceral surface of liver and kidney
bounded deeply by post layer of coronary lig
deepest part of peritoneal cavity when patient supine

26

hepatorenal recess

extension of greater sac btwn visceral surface of liver and kidney
bounded deeply b

27

subphrenic abcess

accumulation of purulent exudate in subphrenic recess (usually on R)
often drain to hepatorenal recess, especially if patient supine
drained w/incision just inferior to 12th rib

28

anatomical lobes of liver

right- separated form L by falciform
left
quadrate- subdivision of R, lies btwn anterior limbs of 'H'
caudate- subdivision of R, lies bwn posterior limbs of "H"
caudate process extends posterior to gall bladder

29

functional lobes of liver

each receives primary primary brr of hepatic a, portal v and drained via hepatic duct
right
left (includes quadrate)
caudate
further divided into 8 hepatic segeme tns

30

abbarrant R hepatic a

typically arises from SMA

31

biliary ducts

bile canaliculi -> interlobular biliary ducts -> L and R hepatic ducts -> common hepatic duct -> exit @ porta hepatis -> merges w/cystic duct = bile duct

32

bile duct

travels w/ free edge of hepatoduodenal ligament -> merges w/main pancreatic duct = hepatopancreatic ampulla -> 2nd portion of duodenum
distally has sphincter (choledochal)

33

accessory hepatic duct

normal segemental hepatic duct that joins mail billiary sytem outside liver
danger of being damages during hepatic surgeries

34

liver biopsy

thru 10TH ICS at MAL

35

abbarrant R hepatic a

typically arises from SMA

36

right hepatic a

91% anterior to portal v
64% passes post to common hepatic duct

37

lymphatic drainage of liver

superficial plexus- deep to liver capsule, to hepatic nodes, some superior drainage to phrenic nodes
deep plexus- parallel portal triad -> hepatic nodes-> celiac nodes, some deep follow IVC to post mediastinal nodes

38

elevation of central pressure

can be transmitted to liver causing it to engorge w/blood, painful, maybe cause of runner stitch

39

liver biopsy

thru 10TH ICS at MAL

40

gall bladder

maximum capacity 50ml
lies w/in fossa of the gallbladder on the visceral surface of liver
its fundus lies apporximately at the 9th costal cartilage at MCL
peritonealized

41

external gallbladder

fundus- distal, expanded portion lying deep to anterior body wall
body- main portion, contacting liver and 1st portion of dudenum
neck- narrow s-shaped portion leading to cystic duct

42

cystic duct

attached to neck of gallbladder
merges w/common hepatic duct to form bile duct
mucosa of gallbladder neck forms spiral fold which maintains patency of proximal portion of cystic duct
cytohepatic triange is formed by common hepatic duct, cystic duct, and visceral surface of liver

43

lymph of gallbladder

cystic -> hepatic nodes -> celiac nodes

45

cholecystectomy

surgical removal of gallbladder
cystic a must be clamped and ligated
cystohepatic triangle structures must be localized

46

variations of biliary ducts

low vs high union of cystic and common hepatic ducts
accessory hepatic ducts

47

cholelithiasis

gallstones
more common in women
50% asymptomatic
often cause obstruction at hepatopancreatic ampulla

49

pain from gallbladder

initially referred to epigastric region
often shifts to the right T8,9 dermatomes due to inflammation of parietal peritoneum
MCL 9TH ICS right
can also refer to C3-5 due to sensory innervation of phrenic