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Anatomy II > Esophagus - Liver > Flashcards

Esophagus - Liver Flashcards

1
Q

What are the parts of the esophagus?

How long is each part?

What are their boundaries?

What is their course?

A
  • pars cervicalis:
    • 5 - 8 cm
    • cartilago cricoidea C6/7 - T4
    • btw vertebral column + trachea
  • pars thoracica:
    • ​16 cm
    • T4 - hiatus oesophagus T11
    • parallel to trachea until bifurcatio trachae, then behind left atrium
  • pars abdominalis:
    • 1 - 4 cm
    • hiatus oesophageus of diaphragm → ostium cardiacum of stomach
    • intraperitoneal
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2
Q

At what level are the esophageal constrictions?

They are caused by… ?

A

constrictio cricoidea

  • C6 - behind cricoid cartilage
  • caused by circ. fibers of esophageal sphincter m.

constrictio bronchoaorticea

  • T4
  • caused by aorta laterally on left side

constrictio phrenica

  • T10 - hiatus oesophageus
  • caused by lig. phrenico-oesophageale

​

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3
Q

What is the angle of HIS?

A

The angle of HIS is an acute angle (< 80°) created between the cardia at the entrance to the stomach, and the esophagus by the collar sling fibres.

It forms a valve, preventing reflux of duodenal bile, enzymes and stomach acid from entering the esophagus, where they can cause inflammation.

BUT:

loss of tension → increased angle → reflux of HCl into esophagus

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4
Q

Which vessels supply/drain the esophagus?

Innervation?

A

supply:

  • cervical part: a. thyroidea
  • thoracic part: rr. of aorta + aa. intercostales
  • abdominal part: a. gastrica sin./a. phrenica inf. sin.

drainage:

  • cervical part: v. azygos/v. hemiazygos
  • thoracic part: v. thryoidea inf.
  • abdominal part: vv. oesophageales (anastomosis w/ v. gastrica sin.)

innervation:

  • n. vagus (X)
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5
Q

Where is the stomach located?

What shape does it have?

How much can it store?

A
  • crescent-shape
  • behind left dome of diaphragm, partially behind left costal angle, extends until L2/3
  • can store up to 1,500 ml
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6
Q

What attaches at the greater and lesser curvature of the stomach?

A
  • curvatura gastrica minor : **omentum minus **(to be precise: lig. hepatogastricum)
  • curvatura gastrica major: omentum majus
    to be precise:
    • lig. gastrocolicum
    • lig. gastrophrenicum
    • lig. gastrosplenicum
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7
Q

Where do the walls of the stomach attach to?

A
  • paries anterior → abdominal wall
  • paries posterior → bursa omentalis + pancreas
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8
Q

Which structures in the stomach increase the surface?

A
  • large gastric folds (plicae gastricae) w/ areae gastricae
  • gastric pits (foveolae gastricae) w/ gastric glands (visible on histological specimen)

additionally: in curvatura gastrica minor: gastric canal

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9
Q

Which muscles are responsible for vomiting?

A

diaphragm + abdominal mm.

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10
Q

What happens if there’s a disproportion btw mucous and gastric acid in the stomach?

What is the most common reason for such a disproportion?

A

can lead to ulcer in the stomach/duodenum,

(in 80% of the cases caused by helicobacter pylori)

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11
Q

1 - 5

A

1) truncus coeliacus
2) a. hepatica communis
3) a. hepatica propria
4) - r. sinister
5) - r. dexter

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12
Q

6 - 10

A

6) v. portae hepatis
7) a. gastrica dextra
8) a. gastroduodenalis
9) a. mesenterica sup.
10) a. gastroomentalis dex.

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13
Q

11 - 16

A

11) a. gastroomentalis sin.
12) a. splenica
13) a. gastrica sin.
14) aa. gastricae breves
15) a. cystica
16) a. prancreaticoduodenalis sup.

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14
Q

A - E

Why is B) im important?

A

A) esophagus

B) incisura cardiaca → angle of HIS, closes esophagus

C) cardia

D) fundus gastricus

E) corpus gastricum

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15
Q

F - J

A

F) curvatura gastrica minor

G) curvatura gastrica major

H) incisura angularis

I) antrum pyloricum

J) canalis pyloris + ostium pylorum

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16
Q

K - L

A

K) duodenum

L) ostium cardiacum

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17
Q

Differentiate btw the pathway of the vv. of the stomach in the greater and lesser curvature.

Clinical relevance?

A

vv. parallel to aa., BUT:
* in greater curvature: indirectly into v. portae via v. mesenterica sup./v. splenica (cf. vessel flashcards for more information)

  • in lesser curvature: v. gastrica dextra + v. prepylorica form v. coronaria ventriculi
    ⇒ directly into v. portae + connection to vv. oesophageales (portocaval anastomosis)

⇒ portal reflux, e.g. in case of liver cirrhosis or thrombosis in v. splenic, can cause esophageal varices

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18
Q

Which nerves innervate the stomach para- / sympathetically?

Effects?

A

symp. plexus coeliacus

parasymp.: truncus vagalis ant./post. (branches of n. vagus)

  • dilated blood vessels → incr. circulation
  • increased secretion of gastric juice + HCl
  • incr. stomach movements
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19
Q

How heavy is the pancreas?

Where does its body start?

Where does it attach to?

What is its function?

A
  • 40 - 120g, usually 70g
  • corpus starts at L1/2
  • facies posterior → post. abdominal wall
    facies anterior → covered by peritoneum

= most important digestive gland: 1.5 - 2l secretion/d → stored as zymogens (inactive precursors)

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20
Q

1 - 5

A

1) truncus coeliacus
2) a. gastrica sin.
3) a. splenica
4) a. hepatica communis
5) a. hepatica propria

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21
Q

6 - 10

A

6) a. gastroduodenalis
7) a. pancreaticoduodenalis sup.
8) a. gastroomentalis dex.
9) a. pancreaticoduodenalis sup. post.
10) a. pancreaticoduodenalis sup. ant.

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22
Q

11 - 15

A

11) a. pancreaticoduodenalis inf. ant.
12) a. pancreaticoduodenalis inf. post.
13) a. pancreaticoduodenalis inf.
14) a. mesenterica sup.
15) - r. duodenojejunalis

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23
Q

16 - 18

A

16) a. pancreatica dorsalis
17) a. pancreatica inf.
18) rr. pancreatici

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24
Q

Common features of the 3 parts of the small intestine?

A

drainage:

  • v. mesenterica sup. → v. portae

innervation:

  • symph: 3 nn. splanchnici T5-12 via plexus coeliacus/mesentericus sup.
  • parasymp: n. vagus (X)
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25
Q

What is the function of the small intestine?

A
  • digestion via enzymes + resorption via bile acids
  • endocrine cells regulate secretion ofpancreatic/gall bladder
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26
Q

How long is the duodenum?

List its parts and give their peritoneal relation.

A

duodenum = 12 finger → 25 - 30 cm

  • pars superior: intraperitoneal
  • pars descendens: retroperitoneal
  • pars horizontalis: retroperitoneal
  • pars ascendens: retroperitoneal
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27
Q

1 - 5

A

1) a. gastrica sin.
2) a. splenica
3) a. hepatica communis
4) a. hepatica propria
5) a. gastroomentalis dex.

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28
Q

6 - 10

A

6) a. pancreaticoduodenalis sup. ant.
7) a. pancreaticoduodenalis inf.
8) a. + v. mesenterica sup.
9) a. gastroduodenalis
10) pars superior duodeni

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29
Q

11 - 15

A

11) pars descendens duodeni
12) pars horizontalis duodeni
13) pars ascendens duodeni
14) flexura duodeni superior
15) flexura duodeni inferior

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30
Q

16 - 20

A

16) flexura duodenojejunalis
17) lig. hepatoduodenale (1 of 3 parts of omentum min.)
18) Treitz-muscle
19) v. portae hepatis
20) a. hepatica propria

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31
Q

21 - 26

Give 2 names for #21, 22, 23, 24/26

A

21) ductus choledochus (= common bile duct)
22) papilla dudodeni minor (=SANTORINI’s)
23) papilla duodeni major (=VATERI’s)

24+26) ductus pancreaticus (=WIRSUNG’s)

25) ductus pancreaticus accessorius

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32
Q

27 - 28

A

27) ductus cysticus
28) gall bladder

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33
Q

What can happen in case of an inflammation of the superior part of the duodenum?

A

adherence to gall ballder → rupture → bilestones/pus into duodenum → can cause a duodenal obstruction

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34
Q

Where does the Treitz-muscle attach?

Why is it clinically relevant?

Give other names, too.

A

= m. suspensorius duodeni, sometimes also called suspensory lig. of the duodenum (but actually additional coll. fibers that are clearly differentiable from Treitz-muscle itself)

  • from pars ascendens → aortic origin of a. mesenterica sup.
  • defines clinically border btw upper/lower gastrointestinal bleeding
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35
Q

Which aa. supply the duodenum?

A

a. pancreaticoduodenalis sup./inf. ant./post.

→ anastomosis btw truncus coeliacus & a. mesenterica sup.

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36
Q

Where do the jejunum and ileum start and end?

Peritoneal relation?

A
  • lie in pars infracolica
  • flexura duodenojejunalis (L2) → valva ileocaecalis (Bauhin-valve): first 2/5 jejunum, last 3/5 ileum
  • intraperitoneal
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37
Q

What is a Meckel’s diverticulum?

Why can it be clinically relevant?

A

= remnant of vitelline duct in 3% of population, approx. 50 - 120 cm above Bauhin-valve

⇒ if inflammed often mistaken with appendicitis

38
Q

How do you call a mirrored arrangement of the abdominal viscera?

A

situs inversus

39
Q

Which aa. supply jejunum + ileum?

What do they form?

A

a. mesenterica superior

  • 4-5 aa. jejunales
  • 12 aa. ileales

⇒ form arterial arcades

40
Q

What are the parts of the large intestine?

Peritoneal relations?

What is its overall lengh?

A
  • 1.5 m

intraperitoneal: (~ all horizontal parts)

  • cecum + appendix
  • colon transversum
  • colon sigmoideum

sec. retroperitoneal: (~ all vertical parts)

  • colon ascendens
  • colon descendens
  • rectum

subperitoneal

  • canalis analis
41
Q

What is the function of the large intestine?

A
  • reabsorption (~ 1.5l/d) of H20 from chymus
  • indeg. contents broken down by bacteria
42
Q

In what way is the colon different from the previous segments of the gastrointestinal tract?

A
  • taeniae
  • haustrae/plicea semilunares (produced by muscular contractions)
  • appendices epiploicae (fatty appendages)
43
Q

What are the different taeniae of the colon?

A
  • taenia libera = visible
  • taenia omentalis = inserts in omentum majus
  • taenia mesocolica = inserts in mesocolon
44
Q

Where is the cecum located?

How big is it?

Where does it start and end?

A
  • 6 - 8 cm in fossa iliaca dextra
  • Bauhin-valve → appendix vermiformis
45
Q

Explain the variations of cecum’s peritoneal relation.

A
  • caecum mobile: completely covered by peritoneum (→ intraperitoneal)
  • caecum liberum: own mesocaecum (→ intraperitoneal)
  • caecum fixum: fixed to post. abdominal wall (→ sec. retroperitoneal)

⇒ most commonly intraperitoneal

46
Q

What is the function of the appendix?

How big is it (also diameter)?

Where is it located (most common variations)?

What is its peritoneal relation?

A
  • part of immune system (abundant lymph follicles)
  • 8 - 10 cm long, 6 mm diameter
  • 65% retrocecal
    31% subcecal
  • intraperitoneal, sometimes own mesoappendix
47
Q

1 - 4

Where is #3 and #4. Why are they clinically important?

A

1) colon ascendens
2) cecum

3) McBurney point:
→ opening to appendix, right 1/3 on line btw navel and r. S.I.A.S. ⇒ physical examination of appendicitis

4) Lanz point:

→ projection of tip of appendix if subcecal variation, right 1/3 on line btw 2 S.I.A.S.

48
Q

1 - 5

A

1) a. ileocolica
2) - r. colicus
3) - r. ilealis
4) a. caecalis ant.
5) a. ceacalis post.

49
Q

6 - 10

Another name for #10.

A

6) a. appendicularis
7) colon ascendens
8) cecum
9) ostium appendicis vermiformis
10) valva ileocaecalis (=Bauhin-valve)

50
Q

11 - 15

A

11) papilla ilealis
12) labium ileocolicum
13) labium ileocaecale
14) frenulum ostii ilealis
15) appendix vermiformis

51
Q

What are the parts of the colon?

What are their peritoneal relations?

Where do they start and end?

A
  1. colon ascendens
    ​    cecum → flexura colica dextra
    - sec. retroperitoneal
  2. colon transversum
    → flexura colica sinistra
    - intraperitoneal
  3. colon descendens
    → fossa iliaca sin.
    - sec. retroperitoneal
  4. colon sigmoideum
    →     rectum (at L2/3)
    intraperitoneal
52
Q

Which structures attach at the different parts of the colon?

A

colon transversum

  • mesocolon transversum
  • lig. hepatocolicum (ext. of lig. hepatoduodenum)
  • lig. gastrocolicum
  • lig. phrenicocolicum (flexura colica sinistra)

colon sigmoideum

  • mesocolon sigmoideum which continues as recessus intersigmoideus
53
Q

Which structure forms the splenic nest?

A

lig. phrenicocolicum

flexura coli sinistra → post. abdominal wall

54
Q

Which aa. supply the different parts of the colon?

A

a. mesenterica inf.

colon ascendens + transversum

  • a. colica dex. (anastomosis w/ r. colicus from a. ileocolica, w/ a. colica med.)
  • a. colica med. (anastomosis w/ a. ascendens from a. colica sin. = greater Riolan’s anastomosis)

colon descendens + sigmoideum

  • a. colica sin.
  • a. sigmoidea (anastomosis w/ a. rectalis sup. = Sudeck’s anastomosis)
  • a. rectalis sup. (s.a.)
55
Q

Which nerves innervate the colon?

Any special features?

A

symp: plexus mesentericus sup./inf.

parasymp:** **

  • n. vagus (X) → Cannon-Böhm point (end of vagus innervation)
  • after Cannon-Böhm point: nn. from sacral spinal cord S2-4/5
56
Q

From where to where does the rectum extend to?

How long is it?

What can you say about its shape?

A

​from colon sigmoideum (S2/3) → canalis analis
∽ 12cm

flexures:

  • 1st flexure: flexura sacralis (dorsal)
  • 2nd flexure: flexura perinealis (ventral)
    • lateral flexures
57
Q

Which special structures can you find in flexura perinealis?

A

plicae transversae recti (2 left, 1 right)

→ the right one is the biggest, ∽6-7 cm above anus = Kohlrausch-fold: defines opening to ampulla recti

58
Q

1 - 5

What is special abt #3?

Are the mm. shown here striated (= voluntary contraction) or smooth (= involuntary contraction)?

A

1) ampulla recti
2) m. levator ani = striated
3) m. puborectalis = striated (= part of m. levator ani)
4) m. corrugator ani = smooth
5) m. sphincter ani inf. = smooth

59
Q

6 - 10

What are the parts of #6?

Is it striated (= voluntary contraction) or smooth (= involuntary contraction) muscle?

What is #7 responsible for?

A

6) m. sphincter ani externus = striated

→ pars profunda, pars superficialis, pars subcutanea

7) corpus cavernosum recti → produces columnae anales
8) plexus venosus rectalis ext.
9) zona cutanea
10) linea anocutanea

60
Q

11 - 15

Another name for #11. In what way is it different from the overlying structure?

What is special abt #14?

Give 3 names for #15.

A

11) pecten analis (= zona alba), here: change of simp. colum. to str. squ. non-ker. ep.
12) valvae anales
13) junctio anorectalis
14) sinus anales (origin of gll. anales)
15) columnae anales (columns of Morgagni, zona columnalis)

61
Q

16 - 18

Another name for #17 and #18.

Why is #18 clinically important?

A

16) prostate gland
17) linea pectinata (= linea dentata)
18) gll. anales (= proctodeal glands, site for anal fistulas)

62
Q

What is special abt the blood supply/drainage around the canalis analis?

A

blood supply differs in 2 areas (zona columnaris, zona alba & cutanea), demarcated by linea dentata

  • blood supply ABOVE linea dentata:
    a. mesenterica sup. → a. rectalis sup. → v. rectalis sup. → portal venous system
  • blood supply BELOW linea dentata:
    a. iliaca int. → a. rectalis inf./med. → v. rectalis inf./med. → systemic circulation

​ ⇒ anastomosis btw portal & caval system

63
Q

Analogous to the pathway of blood vessels in the rectum there is also a seperation of lymph vessels.

Explain.

Why is it clinically relevant?

A

lymph flow differs in 2 areas (zona columnaris, zona alba & cutanea), demarcated by linea dentata

  • lymph flow ABOVE linea dentata:
    → lnn. rectalis sup. → lnn. mesenterici inf., iliaci int. (in lumbar area)
  • lymph flow BELOW linea dentata:
    → lnn. inguinales sup. (in pelvic area)

⇒ metastasis of rectal carcinomas in various directions

→ sup. carcinomas: painless (arise from col. ep.)
→ inf. carcinomas: painful (arise from strat. squ. ep.)

64
Q

What is a reason for hemorrhoids?

A

portal hypertension (e.g. in case of liver cirrhosis) → enlargement of rectal portocaval anastomosis in corpus cavernosum of anus (= v. rectalis sup. + med./inf.)

65
Q

Why is rectal administration of drugs (= suppositories) so effective?

A

drugs get in rectal portocaval anastomosis via v. rectalis med./inf. (→ v. iliaca int. → v. cava inf.) into systemic circulation

66
Q

Which structures are part of the organ of continence?

What is the “normal” situation?

A

organ of continence:

  • rectum
  • anal sphincter mm.
  • corpus cavernosum recti

⇒ sustained tonic contraction of sphincter mm.

⇒ sling formed by m. puborectalis closes anus

⇒ supported by corpus cavernosum recti

67
Q

What happens in the process of defecation?

A
  1. content of colon → increases wall tension of ampulla recti
  2. reflexive relaxation of m. sphincter ani int. + contraction of rectum/colon sigmoideum
  3. voluntary relaxation of m. sphincter ani ext. (n. pudendus)
68
Q

Where is the liver located?

What is its peritoneal relation?

How heavy is it?

How do you call its main surfaces?

A
  • located under right costal dome
  • intraperitoneal, except:
    • area nuda (attaches to diaphragm)
    • porta hepatis
    • fossa vesicae biliaris
    • sulcus v. cavae
  • 1,200 - 1,800g
  • facies visceralis (= back), facies diaphragmatica (= top)
69
Q

What attaches to the liver and where?

A
  • lig. hepatoduodenale (part of omentum minus)
    on tuber omentale → duodenum
  • lig. hepatogastricum
    in sulcus lig. venosi → curvatura gastrica minor
  • lig. falciforme
    front → parietal peritoneum
70
Q

What are the functions of the liver?

A
  • metabolism: produces proteins for blood clotting, cholesterol, storage of glycogen
  • detoxication
  • exocrine gland: produces bile
  • storage of lipid soluble vitamins (esp. vit A)
  • immune defense: produces Kupffer-cells, plasmaproteins
  • during fetal period: hematopoiesis
71
Q

Which structures divide the liver into functional liver parts (= partes hepatis dextra/sinistra)?

Which segments belong to each part?

Why is it segmented?

A - I.

A

sagittal plane through gall bladder + v. cava inf.

  • segments I-IV: left lobe
  • segments V-VIII: right lobe

​segmented accordingly to pathways of Glisson’s triad (v. portae, a. hepatica, bile ducts + vv. hepaticae)

⇒ important for liver resection to ensure as little blood loss as possible

A = VII<br></br>B = V<br></br>C = III<br></br>D = IVa<br></br>E = VI<br></br>F = VIII<br></br>G = IVb<br></br>H = II<br></br>I = I = lobus caudatus

72
Q

1 - 5

A

1) vesica biliaris
2) lobus quadratus
3) lig. teres hepatis
4) incisura lig. teretis
5) fissura lig. teretis

73
Q

6 - 10

What attaches to #6?

A

6) margo inf.
7) porta hepatis
8) lobus hepatis sin.
9) impressio gastrica
10) tuber omentale → omentum minus

74
Q

11 - 15

A

11) impressio oesophagea
12) appendix fibrosa hepatis
13) lobus caudatus
14) v. cava inferior
15) lig. venae cavae

75
Q

16 - 20

A

16) area nuda
17) impressio suprarenalis
18) lig. coronarium
19) v. porta hepatis
20) impressio renalis

76
Q

21 - 25

A

21) impressio duodenalis
22) a. cystica
23) impressio colica
24) lobus hepatis dex.
25) lig. venosum

77
Q

26 - 30

A

26) fissura lig. venosi
27) fissura venae cavae
28) ductus choledochus
29) proc. caudatus
30) proc. papillaris

78
Q

What are the 3 hepatic veins?

Variations?

A
  • v. hepatica dex.
  • v. hepatica sin.
  • v. hepatica intermed.

BUT: in 2/3 v. hepatica sin. + intermed. form truncus hepaticus sin.

79
Q

What are possible causes for portal hypertension?

Explain the process.

A
  1. a) alcoholism → can cause liver cirrhosis
    b) hepatitis B/C
  2. scar tissue in liver
  3. increased resistance to blood flow due to compression of vessels
  4. portal hypertension

​

80
Q

What are possible effects of portal hypertension?

A
  • splenomegaly: 30-50% of all patients
  • Cruveillhier-Baumgarten murmur: loud venous murmur audible over upper abdomen
  • dilation of portocaval anastomoses
    • ​caput medusae syndrome: dilated vv. paraumbilicales + reopening of v. umbilicalis
    • esophageal varices: most common cause of death (bleeding)
    • in rectum
    • in stomach
    • in retroperitoneum
    • in spleen
    • in kidneys
81
Q

Explain the blood flow in the liver.

A
  1. a) a. hepatica propria (= vas privatum)
    b) v. portae hepatis (= vas publicum)
  2. a) interlobular a.
    b) interlobular v.
  3. hepatic sinusoids
  4. hepatocytes
  5. central v.
  6. collecting v.
  7. vv. hepaticae
82
Q

Where is the gall bladder located?

Describe its structure (incl. duct).

A

in fossa vesicae biliaris on liver → 1/2 covered by peritoneum

structure:

  • fundus
  • corpus
  • collum
  • ductus cysticus with plica spiralis (= Heister’s), closes duct
83
Q

How much bile can be stored in the gall bladder?

How does it get filled?

A
  • usually 40 - 70 ml, when dilated up to 200 ml
  • gets filled by reflux of bile when papilla is closed
84
Q

Explain the intrahepatic bile flow.

A

synthesized by hepatocytes

  1. bile canaliculi btw hepatocytes
  2. canals of Hering
  3. interlobular bile ducts
  4. unite
  5. ductus hepaticus dex./sin.
85
Q

Explain the extrahepatic bile flow.

A
  1. ductus hepaticus communis (4 - 6cm)
    ductus cysticus
  2. ductus choledochus (6 - 8 cm long, 0.4 - 0.9 cm diameter)
  3. papilla duodeni major
86
Q

What are the parts of ductus choledochus?

A
  • pars supraduodenalis (in lig. hepaticoduodenale)
  • pars retroduodenalis
  • pars pancreatica (in head of pancreas)
  • pars intraduodenalis (to duodenum desc.)
87
Q

Explain the most frequent variation of the structure of papilla duodeni major.

A

in 60% ampulla hepatopancreatica + 2 sphincter mm.

  • ​m. sphincter ductus pancreatici
  • 2nd sphincter has 2 names
    • upper part = m. sphincter ductus choledochi
    • lower part = m. sphincter ampullae (= Oddi’s)
88
Q

Explain blood supply/drainage + innervation of the gall bladder.

A
  • blood supply:​ a. cystica (supplied by r. dex. of a. hepatica propria)
  • blood drainage: v. cystica → v. portae
  • innervation:
    • symph./parasymph.: plexus hepaticus
    • sensory: n. phrenicus dex.
89
Q

Which structures form trigonum cholecystohepaticum?

Give another name.

Explain its clinical relevance.

A

= Calot’s triangle: in 75% origin of a. cystica

  • ductus cysticus
  • ductus hepaticus communis
  • liver

⇒ a. cystica/ductus cysticus must be sealed before gall bladder can be removed

90
Q

What are possible causes for obstructive jaundice?

A

chronic pancreatitis/pancreas carcinomas can cause reflux of bile (= cholestase) into ductus choledochus → deposit of bile pigments in skin → yellow

BUT: enlargement of ductus choledochus (> 1 cm) can also be caused by bile stones or inflammation

91
Q

What could be a symptom of an inflammed gall bladder and why?

A

radiating pain in the right shoulder due to same sensory innervation (n. phrenicus)

92
Q

What is a possible reason for an acute pancreatitis?

A

reflux of bile into pancreas due to bile stone stuck in ampulla

(lower risk if ductus choledochus + Wirsung’s duct seperated → no common ampulla)

Anatomy II (13 decks)

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