Flashcards in GI Viscera II Deck (38):
Trace the structures of the extrahepatic biliary tree
Right and Left Hepatic ducts merge to become Common Hepatic Duct, Cystic Duct merges with this to form Common Bile Duct
What is the narrowest part of the extrahepatic biliary tree and what is the clinical significance of this?
Where the common bile duct and pancreatic duct merge into the duodenum. Gallstones can get lodged here (as well as other places in the tree)
Inflammation of the gallbladder might trigger inflammation in and eventually fistulas with what two neighboring structures?
Duodenum and Transverse Colon
What structures does the extrahepatic biliary tree connect to upstream, what structure downstream, and what also flows into this downstream structure at a nearby site?
Liver and gallbladder (upstream) to duodenum (downstream). The pancreas also connects into the duodenum at this site via the main pancreatic duct
Gallstones stuck at the common bile duct-duodenum junction may cause bile to back up into what structure and what structure may act as a relief valve in some individuals?
May backup into the pancreas. Individuals with an accessory pancreatic duct may use this as a relief valve
For gallstones lodged in the cystic duct and common bile duct respectively, will the patient present with jaundice or not, and why?
Cystic duct - No, only the gallbladder is occluded (not liver), Common bile duct - Yes, both gallbladder and liver are occluded
Three common areas of referred pain from biliary disease
Right upper quadrant, right back at level of RUQ, right shoulder (especially into back right shoulder)
Where is the common bile duct inserted into the duodenum?
In the second part of the duodenum
What type of papilla are present in the section of the duodenum receiving the common bile duct and major pancreatic duct, and what section of the duodenum is this?
Second section of duodenum, major papilla are present
In what percentage of the population is an accessory pancreatic duct present, and in these individuals does this duct attach proximal or distal to where the major pancreatic duct attaches to the duodenum?
10 percent of individuals. The accessory pancreatic duct attaches proximal to where the major pancreatic duct attaches
In individuals with an accessory pancreatic duct, what type of duodenal papilla is present at the location that this duct attaches?
Minor duodenal papilla (in contrast to major papilla present where major pancreatic duct attaches)
What is the triangular ligament of the liver?
The space between the anterior and posterior leaves of the coronary ligaments
Where is the gallbladder relative to the liver?
Along the posteroinferior surface
Where is the round ligament of the liver found?
In the free margin of the falciform ligament
What separates the left and right anatomical lobes of the liver and what is this structure composed of?
The falciform ligament, which is really peritoneum
What anatomical lobe of the liver are the quadrate and caudate lobes a part of, and where are these two lobes in relation to each other?
They are part of the anatomical right lobe and the quadrate is inferior to the caudate
How many functional segments are there to the liver and how many are surgically resectable?
8. They are all surgically resectable.
What are the functional segments of the liver based upon?
Distribution of the portal triad
What portion of blood flow into the liver comes from the portal vein?
What are three things the inferior mesenteric vein may do at its termination and which is most common?
Terminate into the splenic vein (most common), Terminate into the superior mesenteric vein, or terminate directly into the portal vein
Three most common places of extrahepatic portocaval anastamosis
1) Deep to the umbilicus, 2) At the gastroesophageal junction, 3) In the distal sigmoid colon
What is distinguishing about the superior border of the spleen?
It is notched (remnant of the lobular nature of the spleen during development)
Where is the largest aggregation of lymphatic tissue in the human body?
Give the two names for the area between the ascending and transverse colon
Hepatic flexure, Right colic flexure
Give the two names for the area between the transverse and descending colon
Splenic flexure, left colic flexure
What are the jejunum and ileum attached to?
The root of the mesentery
List the structures crossed by the root of the mesentery
3rd and 4th portions of duodenum, Abdominal aorta, IVC, Right ureter, Right psoas muscle, Right gonadal vessels
Give the preganglionic and postganglionic courses of sympathetic innervation to the jejunum and ileum
Preganglionic - Greater and less thoracic splanchnic nerves (T5-T9) synapsing in celiac and superior mesenteric ganglia. Postganglionic - Fibers follow blood vessels to the target organs
What is the source of parasympathetic innervation to the ileum and jejunum?
Preganglionic fibers traversing the vagal trunks (postganglionic cells located on or near target organs)
Name the parts of the colon which are retroperitoneal
Ascending and descending colon
Name the parts of the colon which are peritoneal
Cecum, Transverse Colon, Sigmoid Colon
What are the tenia coli?
3 narrow, longitudinal bands of smooth muscle on the cecum through sigmoid colon which turn into a longitudinal coat approaching the rectum
What are the haustra?
Small pouches caused by sacculation which give the colon a segmented appearance
What is the most common location of the appendix and in what percentage of individuals is this the case?
Retrocecal (65 percent of individuals)
What organs does the SMA supply?
Portions of duodenum and pancreas, Jejunum, Ileum, Appendix, Cecum, Ascending Colon, 3/4 of Transverse colon
What structures of the colon does the IMA supply?
Distal 1/4 of transverse colon, Descending colon, Sigmoid colon, Superior rectal artery (terminating branch of IMA)
Where does parasympathetic innervation to the colon change and what is the innervation before and after the switch?
Switches at distal end of transverse colon. Proximal to this innervation is vagal, distal to this it is pelvic splanchnic nerves (S2, S3, S4) via inferior hypogastric nerve plexus