Describe Abdominal Viscera Flashcards

Question

Discuss the hepatic artery

Answer 1

Pass retroperitoneally to reach hepatoduodenal ligament; passing between layers of the pora hepatis; birfucates into right and left hepatic arteries Supplies the liver, gallbladder, biliary ducts, stomach, duodenum, pancreuas and respective lobes of liver Branches - Right gastric: runs along the lesser curvature of the stomach to anastomose with the left gastric - right and left hepatic arteries - gastroduodenal

Answer 2

Descends retroperitoneally, posterior to gastroduodenal junction Suppleis stomach pancreas and first part of duodenum Branches: - Right gastro-omental: right portion of greater curvature of the stomach - superior pancreaticodudenal: proximal portion of duodenum and superior part of head of pancreas

Answer 3

Parrallel the arteries in position and course The right and left gastric drain into the portal vein Short gastric and left gastroomental veins drain into the splenic vein which joins the SMV to form the portal vein The right gastro-omental drain into the SMV

Answer 4

Lymphatic accompany the arteries along the lesser and greater curves where the gastric and gastro-omental lymph nodes are located Lymph from the superior two thirds of the stomach drains along the right and left gastric vessels to the gastric lymph nodes; Lymph from the right 2/3rd of the inferior third drain along the right gastro-omental vessels to the pyloric lymph nodes Lymph from the left on third of the greater curvature drains along the short gastric and splenic vessels to the pancreaticoduodenal lymph nodes

Answer 5

Anterior and posterior vagal trunks and their branches which enter the abdomen through the oesophageal hiatus The anterior vagal trunk derived mainly from the left vagal nerve usually enters the abdomen as a single branch that lies on the anterior surface of the oesophagus. It runs toward the lesser curvature of the stomach where it give off hepatic and duodenal branches. The larger posterior vagal trunk is derived from the right vagal nerve. Supplies the anterior and posterior surfaces of the stomach. Gives off a ceoliac branch which runs to the celiac plexus and then continues along the lesser curvature given rise to posterior gastric branches The sympathetic is through th t6-t9 through the greater splanchnic nerve

Answer 6

First and shortest part of the small intestine (25cm) is also the widest and most fixed. C-shaped course around the pancreas Begins at the pyloris and ends in the duodenojejunal junction at the level of L2. This junction normally forms an acute angle the duodenojejunal flexure . Fixed by peritoneum to structures on the posterior abdominal wall and is considered to be partially retroperitoneal. Divisible into four parts 1: superior part: short (approximately 5cm) and lies anterolateral to the body of the L1 Vertebra 2: descebing part longer (7-10) and descends along the L1-l3 vertebrae 3: Horizontal (6-8) cross the l3 4: ascending part (5c) and beings at the left of the l3 and raises superiorly as far as the superior border of the l2 vertebra The first 2cm of the superior part of the duodenum immediately distal to the pyloris has a mesentery and is mobile. This free part is called the ampulla. The rest have no mesentery and a immobile as they are retroperitoneal

Answer 7

Overlapped by the liver and gallbladder. Has the hepatoduodenal ligament Relations: - Anterior: peritoneum, gallbladder, quadrate lobe of the liver - Posterior: bile duct, gastroduodenal artery, portal vein, IVC - Superior: neck of gallbladder - Inferior: neck of pancreuas:

Answer 8

Recieves the hepatopancreatic ampulla which opens on an eminences called the major duodenal papilla Relations Anterior: transverse colon, transverse mesocolon, colis of small intestine Posterior: hilum of right kidney, renal vessels, ureter, psoas major Medial: head of pancreas, pancreatic duct bile duct

Answer 9

Anterior: SMA, SMV, coils of small intestine Posterior: right psoas major, IVC, Aorta, right ureter Superior: head and uncinated process of pancrease. Superior mesenteric vessels

Answer 10

Anterior: beginning of root of mesentery, Colis of jejunum Posterior: left psoas major, left margin of aorta Medial: head of pancreas Superior: body of pancreas

Answer 11

Superior pancreaticoduodenal arteries gastroduodenal artery of the common hepatic Inferior pancreaticoduodenal artery of the SMA supplies duodenum distal to the entry of the bile duct Veins follow the arteries and drain into the portal system.

Answer 12

The second part of the small intestine the jejunum at the duodenojejunal flexure where the alimentary tract resumes an intraperitoneal course. The ilieum the third portion ends at the ileocaeacl junction. Together the ilieum and jejunum are 6-7 m long , jejunum(2/5) and ilieum 3/5th the length. Jejunum lies in the left upper quadrant Ilieum lies in the right lower quadrant Specialiased lymphatic vessels in the intestinal villi that absorb fat called lacteals. They empty their milk like fluid into the lymphatic plexuses in the walls of the jejunum and lieum. Within the mesentery the lymph nodes pass sequentially through three groups of lymph nodes 1) Juxtu-intestinal lymph nodes 2) Mesenteric lymph nodes 3) Superior central nodes These drain into the ileocolic lymph nodes

Answer 13

Site where water is absorbed from the indigestible residues of the liquid chyme converting it into semisolid stool Can be differentiated from the small intestine by 1: omental appendices, small, fatty omentum like projections 2: three teni coli (thicekend bands of smooth muscle representing most of the longitudinal coat) - mesocoli: to which the transverse and simoid mesocolons attach - omental to which the omental appendices attach - free tow which neither mesocolons nor omental appendices attach The tenia coli begin at the appendix as as the thick longitudinal layer of the appendix and then split into three merging again at the rectosigmoid junction

Answer 14

First part of the large intestine It is a blind intestinal pouch approximately 7.5cm in both length and breath Lies with 2.5cm of the inguinal ligament Nil mesentery but freely moveable Terminal ilieum enters the caecum obliquely and partly invaginates into it. This manner of entrance produce ileocolic lips at the ileal orifice which form the ileal papilla. These meet laterally to form the frenula which when the caecum contracts tight to prevent reflux

Answer 15

Blind intestinal diverticulum (6-10cm) that contains masses of lymphoid tisseus. It arises from the posteriormedial aspect of the caecum inferior to the ileocaecal junction. Appendix has a short triangular mesentery

Answer 16

Derives parasympathetic and sympathetic from the superior mesenteric plexus . Sympathetic nerves originating in the lower thoracic part of the spinal cord and the parasympathetic nerves fibers derive from the gagus nerve

Answer 17

Branches unite to form loops or arches called arterial arcades which give rise to straight arteries called vasa recta Arises anteriorly form the lower border of the L1 vertebrae Runs in root of mesentery to ileocaecal junction Branches - Inferior pancretoduodenal - intestinal (jejunal and ileal) - middle colic which supplies the transverse colon - right colic: which supplies the ascending colon - ileocolic: terminal branch of SMA supplies the ilieum, caecum and ascending colon. Appendicular is a branch of the ileocolic and supplies the appendix The marginal artery anastomoses the SMA with the IMA is weakest at the left colic flexure

Answer 18

Arises at the level of L3 Descends retroperitoneally to left of abdominal aorta Branches - left colic which supplies the descending colln - sigmoid which supplies the descending and sigmoid colon - superior rectal: proximal part of rectum - middle rectal: midpart of rectum - inferior rectal: distal part of the rectum and anal canal

Answer 19

Pass superiorly on the right side of the abdominal cavity from the caecum to the liver where it turns left at the right colic flexure Narrower then the caecum and is secondarily retroperitoneal Lymphatic pass first the epicolic and paracolic lymph nodes next to the ileocolic and intermediate right colic lympn nodes to the superior mesenteric lymph nodes Nervous supply from the superior mesenteric plexus

Answer 20

Most mobile part of the intestine Runs from the left to right colic flexure Lies anterior to the inferior part of the left kidney and attaches to the diaphragm through the phreniocolic ligament. The transverse mesocolon loops down often inferior to the level of the iliac crest and is adherent ot or fused with the posterior wall of the omental busa. The root of the transverse mesocolon lies along the inferior border of the pancreas and is continuous with the parietal peritoneum Lymphatic drainage is to the middle colic and eventually into the superior mesenteric

Answer 21

Secondarily retroperitoneal position Short mesentery in 33% of people

Answer 22

S shaped loop of variable length (usually approx. 40cm) links the descending colon and the rectum Extends from the iliac fossa to the levee of S3 The teniae coli terminate approximately 15 cm from the anus Long mesentery The left ureter and the division of the left common iliac artery lie retroperitoneally posterior to the apex of the root of the sigmoid mesoclon Lymph drains through the intermediate colic lymph nodes along the left colic artery and then into the inferior mesenteric lymph nodes

Answer 23

12cm long 7cm wide, convex Receives the protection of the lower thoracic cage Largest of the lymphatic organs Completely surrounded by peritoneum except at the splenic hilum where the splenic branches of the splenic artery and vein enter and leave Located at the level of the 9th-11th ribs and separated from the diaphragm by the costodiaphragmatic recess Relations: Anterior: stomach Posterior: the left part of the diaphragm which separates it from the pleura, lung and ribs 9-11 Inferior: the left colic flexure Medially: kidney Splenic capsule is fibrous and composed of dense fibroeleastic connective tissue . Internally the trabeculae arising from the deep aspect of the capsule carries blood vessels to and from the parenchyma or splenic pulp Spleen contacts the posterior wall of the stomach and is connected to its greater curvature by the gastrosplenic ligament and to the left kidney by the splenorenal ligament. These ligaments containing splenic vessels are attached to the hilum of the spleen. The hilum of the spleen is in contact with the tail pancreas

Answer 24

The splenic artery is the largest branch of the celiac trunk and follows a tortuous course posterior to the omental bursa, anterior to the left kidney and superior to the border of the pancreaus. At the hilum of the spleen it divides into five or more branches. Lack of anastomoses results in the formation of vascular segments 2 in 84% of spleens and 3 in the other Venous drainage is by the splenic veins which is supplied by many tributaries. It is joined by the IMV and runs posterior to the body and tail of the pancreas. It then joins the SMV posterior to the neck of the pancreas to form the portal vein Lymph drainage is to the pancreaticosplenic lymph nodes

Answer 25

Retroperitoneal posterior to the stomach between the duodenum on the right and the spleen on the left Four parts Head: Expanded part of the gland that is embraced by the c-shaped duodenum. Firmly attached to the descending and horizontal portion of the duodenum. The uncinated process is a projection from the inferior part of the pancreatic head. Rest posteriorly on the IVC, right renal artery and vein and the left renal vein Neck: (1.5-2cm): Adjacent to the pyloris of the stomach. SMV joins the splenc posterior to this portion Body: Passes over the aorta and lies at the L2 vertebrae. Posterior portion is in contact with the aorta, SMA, left suprarenal gland and left kidney and renal vessels. Tail: Anterior to the kidney The main pancreatic duct begins in the tail of the pancreaus and runs through the parenchyma to the head of the pancreas. Most of the time the main pancreatic duct and the bile duct unite to form the hepatopancreatic ampulla (of Vater). In 25% of people the ducts open separately. There is a smooth muscle sphincter around the main pancreatic duct, the bile duct and the ampulla of vater(the sphincter of oddi) The accessory pancreatic duct opens at the summit of the minor duodenal papilla, is normally communicating with the main duct

Answer 26

Most of the blood supply to the pancreas comes from the tortous splenic artery which forms several aracades with pancreatic branches of the gastrodurodenal and SMA The anterior and posterior superior pancreatoduodenal branch of the gastroduodenal and the anterior and posterior inferior pancreatoduodenal of the SMA supply the head Most of the venous drainage is into the portal system Most lymphatic end in the pancreaticosplenic lymph nodes which in turn drain into to the superior mesenteric lymph nodes or to the celiac lymph nodes via the hepatic lymph nodes

Answer 27

Largest gland in the body Weighs approximately 1.5kg Two surfaces a convex diaphragmatic surface and a relatively flat or even concave visceral surface Subphrenic recesses – superior extensions of the peritoneal cavity exist between the diaphragm and the anterior and superior aspects of the liver. These are separated into right and left by the falciform ligament which joins the liver to the anterior abdominal wall (rectus sheath) as low as the umbilicus The round ligament is contained within the inferior portion of the falciform and moves between the quadrate and left lobe of the liver The hepatorenal recess (morison pouch) is the postero superior extension of the subhepatic space lying between the right part of the visceral surface and the right kindeyh. Gravity dependent when supine and receives drainage from the omental bursae The posterior part of the liver is covered in peritoneum except for its bare portion in which the liver is in contact with the diaphragm. The bare area is demaracated by reflection of the peritoneum from the diaphragm to it as the anterior (upper) and posterior(lower) layers of the coronary ligament. The coronary ligament holds the liver onto the inferior portion of the diaphragm. The layers of the coronary ligament meet on the right to form the right triangular ligament. The anterior portion of the coronary ligament is continuous on the left with the right layer of the falciform and the posterior layer is continuous with lesser omentum. The left coronary ligament also join to form the left triangular ligament. The IVC traverses a deep groove in the bare area The visceral surface of the liver is covered with peritoneum except at the fossa for the gallbladder and the porta hepatis Right sagittal fissures is the continuous groove formed anteriorly by the fossa for the gallbladder and posteriorly by the groove for the venacava. The left sagittal fissues is the continuous groove formed anteriorly by the fissue for the ligamentum teres (round ligament) and posteriorly by the fissure for the ligamentum venosum. The lesser omentum enclosing the portal triad passes from the liver to the lesser curvature of the stomach and the first 2 cm of the superior part of the duodenum. The thick free edge of the lesser omentum extends between the porta hepatis and the duodenum(the hepatoduodenal ligament). The sheet like remainder (the hepatogastric ligament)

Answer 28

Two topographical lobes and two accessory lobes These are not true lobes as the term is generally used in relation to glands and are only secondarily related to the livers internal architecture The essentially midline plane formed by the falciform ligament and the left sagittal fissure froms the right and much smaller left lobe The right and left sagittal fissures and the transverse porta hepatis demarcates two accessory lobes the anterior and inferior quadrate and the posterior superior caudate

Answer 29

The liver functionally has independent left and right lobes which are much more equal in size then the anatomical lobes. Each receives its own primary branch of the hepatic artery and portal vein and is drained by its own hepatic duct The caudate lobe can be considered a third liver, its vascularization is independent of the bifurcation of the portal triad and is drained by one or two small heaptic veins which enter directly into the IVC distal to the main hepatic veins . Can be further subdivided into 8 surgical resectable segment each served by independent blood supply

Answer 30

Dual blood supply Portal vein brings 75-80% of blood. This contains about 40% more oxygen then venous blood returning to the heart from the systemic circulation Carries all nutrients absorbed from the GIT except for fats Hepatic artery supplies 20-25% Portal veins is formed by the splenic and SMT behind the neck of the pancreas. It ascends anterior to the IVC as part of the portal triad in the hepatoduodenal ligament The hepatic arteries are a branch of the caeliac trunk – the common gives rise to the gastrodudenal and the right and left hepatic arteries At the porta hepatis the portal and common hepatic bifurcate into the right and left branches supplying the right and left livers respectively. They continue to bificate to form 8 vascularly independent segments The left right and intermediate hepatic veins formed by the union of collecting veins that in turn drain the central veins open into the IVC just inferior to the diaphragm.

Answer 31

Liver is the major lymph producing organ. Between ¼ and 50% of the lymph received by the thoracic duct is from the liver Superficial lymphatic vessels occur in the subperitoneal fibrous capsule of the liver and the deep in the connective tissue which accompany the ramifications of the portal triad Most lymph is formed in the perisinusoidal space (of Disse)and drains to the deep lymphatics in the surrounding intralobular portal triads . Superificial lymph drains into the hepatic lymph nodes, efferent vessels from these nodes drain into celiac lymph nodes which in turn drain into the chyle cistern, a dilated sac at the inferior end of the thoracic duct. Superficial lymphatic from the posterior asepctes of the diaphragmatic and visceral surfaces of the liver drain into the bare space into phrenic lymph nodes Deep drains into the posterior mediastinal lymph nodes

Answer 32

Via the hepatic plxus the largest derivative of the celiac plexus

Answer 33

Hepatocytes secrete bile into the bile canaliculi formed between them. The canaliculi drain into small interlobular bilary ducts and then into large collecting bile ducts of the intrahepatic portal triads, Which merge to form the right and left hepatic ducts. The right and left hepatic ducts drain the right and left parts of the liver. Shortly after leaving the porta hepatis the right and left hepatic ducts unite to form the common hepatic duct which is joined on the right side by the cystic duct

Answer 34

Forms in the free edge of the lesser omentum by the union of the cystic duct and the common hepatic duct The length of the bile duct varies from 5-15cm, depending on where the cystic duct joins the common hepatic duct. Descends posterior to the superior part of the duodenum and lies in groove on the posterior face of the head of the pancreas On the left side of the descending portion of the duodenum the bile duct comes into contact with the main pancreatic duct When the sphincter of oddi is contracted the bile backs up and passes through the cystic duct to the gall bladder.

Answer 35

- Cystic artery a branch of the right hepatic supplying the proximal part - right hepatic supplying the middle part - posterior superior pancreaticoduodenal artery and gastroduodenal artery supply the retroduodenal part of the duct

Answer 36

7-10cm long lies in the fossa for the gallbladder on the visceral surface of the liver The relationship of the gallbladder and the superior part of the duodenum is intermit so much so that at autopsy is often stained with bile. Naturally lies anterior to the duodenum and its neck and cystic duct are immediately superior to the duodenum. Has three parts - Fundus: the wide end of the organ, projects from the inferior border of the lvier and isually located at the tip of the 9th costal cartilage in the MCL - Body: - Neck

Answer 37

3-4cm long connects neck of the gallbladder with the common hepatic duct. The mucosa of the neck spirals into the spiral fold (spiral valve). This helps keep the cystic duct open and thus bile can easily be diverted into the gall bladder . Passes between the layers of the lesser omentum usually parallel to the common hepatic duct which ti joins to form the bile duct Cystic artery from the right hepatic artery supplies the gallbladder and cystic duct Veins drain to the portal tract Lymphatic to the hepatic lymph nodes often through the cystic lymph nodes Supplies by the coeliac nerve plexus, the vagus and the right phrenic

Answer 38

Formed by the splenic and SMV, anterior to the IVC and posterior to the neck of the pancreas. Large vessel with a short course contained most withint the hepatoduodenal ligament Collects blood from the SMV, IMV, splenic , gallbladder and pancreas Splenic with products of RBC breakdown passes mostly to the left liver Blood from the SMV nutrient dense passes mostly to the right

Answer 39

Areas in which the portal system communicates with systemic venous system are found in - the inferior oeophagus - submucosa of the anal canal - paraumbilcal region - posterior aspects of secondarily retroperitoneal viscera or the liver Nil valves in these anastomoses and blood can flow either way

Answer 40

Retroperitoneal Lie at the level of T12-L3 with the right lying inferior ot the left due to the lvier. Measure approximately 10*5*2.5 Related superiorly with the diaphragm and inferiorly with the quadratus lumborum The subcostal nerves and vessels and the iliohypogastric and ilioinguinal nerves descend diagonally across the posterior surface of the kidneys The liver duodenum and ascending colon are anterior to the right kidney Left kidney is related to the stomach spleen pacnreaus duodenum and descednign colon. At the concave medial margin of each kidney is a vertical cleft the renal hilum. The vein is anterior to the artery at the hilum. Renal hilum is the entrance to the renal sinus which is occupied by the renal pelvis, calices, vessels and nerves and a variable amount of fat The renal pelvis is the flattened funnel shaped expansion of the superior end of the ureter. The renal pelvis receives two or three major calices each of which divides into two or three minor calices. Each minor calyx is indented by the renal papilla the apex of the renal pyramid from which urine is secreted

Answer 41

Muscular ducts 25-30cm in length Run inferiorly from the apex of the renal hila passing over the pelvic brim at the bifurcation of the common iliac. Run along the lateral wall of the pelvis and enter the urinary bladder. Constricted to a variable degree in three places 1: at the junction of the ureters and renal pelves 2: where the ureters cross the pelvic brim of the pelvic inlet 3: during their passage through the wall of the urinary bladder The ureters intersect the tips of the transverse processes of the lumbar vetebrae Arterial supply to the abdominal portion of the ureters is consistently from the renal arteries with less constant branches form the testicular or ovarian arteries, the AA and the common ilaics. These branches approach the ureters medially and divide into ascending and descending branches forming an anastomosis Veins drain inot the renal or gonadal veins Lymph drains directly to the right or left lumbar lymph nodes and the common iliac lymph nodes

Answer 42

Superomedial aspects of the kidney Surrounded by significant amounts of perinephric fat Enclosed in renal fascia by which they are attached to the crura of the diaphragm. Rich blood supply. The suprarenal arteries branch freely before entering the gland and 50-60 arteries penetrate the capsule. Blood supply is from - superior sprarenal arteries (from the inferior phrenic) - middle suprarenal arteries (from the abdominal aorta level of the sma) - Inferior suprarenal arteries (from the renal arteries)

Answer 43

Renal artery arises inferior to the celiac trunk at the level of L1-l2 The longer right renal artery passes posterior to the IVC. Typically, each artery divides close to the hilum into five segmental arteries that are end arteries. Segments include the superior, anterosuperior, anteroinferior, inferior and posterior segmental arteries Renal veins exit anterior to the artery and empty into the IVC. The left renal is longer then the right Lymph drains into the right and left lumbar lymph nods

Answer 44

The sympathetic part of the autonomic innervation of the abdominal viscera consists of the - abdominopelvic splanchnic nerves from the thoracic and abdominal sympathetic trunks - prevertebral sympathetic ganglia - abdominal aorta plexus and its extensions, the periarterial plexuses The abdominopelvic splanchin nerves convey presynaptic fibers to the abdominal viscera and arise from cell bodies in the IML of the gray matter of the spinal cord segements t5-l2,3. They pass through the anterior roots, anteiro rami and white communicating branches of thoracic and upper lumbar spinal nerves to reach the sympathetic trunk. They pass through the paravertebral ganglia or the trunk without synapsing to enter the abominopelvic splanchnic nerves. The abdominopelvic splanchnic nerves include - lower thoracic splanchin nerevs (greater, lesser and least) - Lumbar splanchnic nerves (lumber part of the sympathetic trunks)

Answer 45

The main source of presynaptic fibers serving the abdominal viscera The greater (t5-9/10), lesser (10-11) nad least (12), lower thoracic splanchnic nerves pierce the crus of the diaphragm to supply sympathetic fibers to the celiac, superior mesenteric and aorticorenal sympathetic ganglia respectively

Answer 46

Arise from the abdominal part of the sympathetic trunk. Medially the lumbar sympathetic trunks five off three to four lumber splanchnic nerves which pass to the intermesenteric, inferior mesenteric and superior hypogastric plexuses conveying presynaptic sympathetic fibers to the associated prevertebral ganglia of those plexuses

Answer 47

The cell bodies of postsynaptic sympathetic neruons consititue the major prevertebral ganglia that cluster around the roots of the major branches of the abdominal aorta. The celiac, aorticorenal, superior mesenteric, and inferior mesenteric Synapse between pre and post synaptic sympathetic fibers occur in the prevertebral ganglia. Postsynaptic fibers pass from the prevertebral ganglia to the abdomainl viscera by means of the periarterial plexuses associated with the branches of the abdominal aorta. Mainly involved in vasoconstriciotn and slowing of Gi motility

Answer 48

Pass into the posterior root to the spinal sensory ganglia. Stomach (foregut) t6-9 Small intestine through the trasnver colon (midgut) t8-12 Descending t12-l2 Sigmoid s2-s4

Answer 49

Consists of the following - Anterior and posterior vagal trunks - pelvic splanchnic nerves - Abdomianl autonomic plexus - intrinsic parasympathetic ganglia The anterior and posterior vagal trunks are continuations of the left and right vagus nerve that emerge from the oesophageal plexus and pass through the oesophageal hiatus The pelvic splanchinic nerves are distinct from other splanchnic nerves in that they - have nothing to do with the sympathetic trunks - derive directly form anterior rami of spinal nerve s2-4 - convey presynaptic parasympathetic fibers to the inferior hypogastric plexus Presynaptic fibers terminate on the isolated and widely scattered cell bodies of postsynaptic neurons lying on or within the abdominal viscera consitituing intrinsic ganglia

Answer 50

Vagal presynaptic parasympathetic and visceral afferent reflex fibers are conveyd by the vagus nerves extend to the lower oesophagus, stomach, small intestine indcluding the duodenum, ascending colon and most o fthe transverse. Those conveyed by the pelvic splanchnic nerves are the descending and sigmoif parts of the colon, rectum and pelvic organs

Answer 51

Nerve networks consisting of both sympathetic and parasympathetic fibers which surround the abdominal aorta and its major branches. - Superior mesenteric plexus has one median root and two lateral roots - inferior mesenteric plexus has one median and one lateral root

Answer 52

Main muscle of inspiration Central parts descends during inspiration, lateral parts don’t as they are fixed During inspiration the right dome can reach as high as the fifth rib and the left as high as the 5th intercostal space. The muscular part of the diaphragm is situated peripherally with fibers that converge radially on the trifoliate central aponeurotic part, the central tendon. The central tendon has nil bony attachment and is incomplete divided into three leaves resembling a wide clover leaf. The caval opening through which the IVC passes through the central tendon The muscular portion of the diaphragm forms a continuous sheet but is divided into three parts for description 1: sternal part: consisting of two muscular slips that attach to the posterior aspect of the xiphoid process 2: Costal part: consisting of wide muscular slips that attach to the internal surface of the inferior six costal cartilages and their adjoining ribs on each side; the costal parts form the right and left domes 3: lumbar part: arising from two aponeurotic arches the medial and lateral arcuate ligaments, and the three superior lumbar vertebrae; the lumbar part forms the right and left muscular crura that ascend to the central tendon The crura of the diaphragm and musculotendinous bundles that arise from the anterior surfaces of the bodies of the superior three lumbar vertebrae, the anterior longitudinal ligament and the IV discs. The right crus is large and longer The oesophageal hiatus is a formation of the right crus even though it lies left of the midline The right and left crus and the medial arcuate which unites them forms the aortic hiatus The medial and lateral arcuate ligaments are thickening of fascia covering the psoas major and the quadratus lumborum

Answer 53

Superior surface is supplied by the pericardiacophrenic and musculophrenic arteries branches of the internal thoracic artery and the superior phrenic artery arising from the thoracic aorta The arteies supplying the inferior surface are the internal phrenic nerve arising from either the abdominal aorta or the coeliac trunk Venous drainage on the superior surface are the pericardiacophrenic and musculophrinc veins which empty into the internal thoracic venis and on the right side the superior phrenic vine which drains itno the iVC Some veins from the posterior curvature drain into the azygos and hemiazygos veins The right inferior phrenic vein usually opens into the ICV where as the left is double with once branching passing through the oesophageal hiatus to end in the IVC and the other joining the left suprarenal vein

Answer 54

The lymphatic plexuses on the thoracic and abdomainl surfaces of the diaphragm communicate freely, The anterior and posterior diaphragmatic lymph nodes are on the thoracic surface of the diaphragm. Lymph from these nodes drains into the parasternal, posterior mediastinal and phrenic nodes. Lymphatic from the abdominal side drain into the anterior diaphragmatic phrenic and superior lumbar lymph nodes.

Answer 55

Via the left and right phrenic nerves each arising from the anterior rami of C3-5 segments of the spinal cord and distributed to ipsilateral half of the diaphgragm. Also supplies sensory(pain and proprioception) Peripheral parts of the diaphragm receive supply from the intercotal nerves (lower 6-7) and the subcostal nerves

Answer 56

- Caval opening: T8: IVC and terminal branches of the right phrenic - Eosophageal hiatus: T10: eosophagus, anterior and posterior vagal trunks, oeophageal branches of the left gastric vessel and lymphatics. The fibers of the left and right crus decussate inferior to the hiatus forming a sphincter. Superior and left of the aortic hiatus - Aortic hiatus: t12 transmits the aorta and thoracic duct and sometimes the azygos and hemiazygos. Does not pierce the diaphragm and is unaffected by contraction of the same. - Small apertures of the diaphragm which transmits lymphatic vessels from the diaphragmatic surface of the liver and the superior epigastric vessel.s

Describe Abdominal Viscera Flashcards

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