Flashcards in Lecture 11 DA Deck (48):
Where do kidneys develop? What is a consequence as a result of this?
Kidneys develop lower down the abdinal wall, but they do not migrate. The differential growrate means they are found up higher, they take the blood supply of the level they were at. These vessels obliterate, called accessory renal artery, found in 25%.
Where does the accessory renal artery enter the kidney? What is its significance?
Accessory renal artery enters the hilum or penetrates the cortex/capsule directly. Significant for surgeons in segmental resection of kidneys.
What is the drainage of the kidney like?
Veins mirror arteries, most anterior, have segmental veins, merge to form renal vein at hilum.
What is the pathway taken by the left renal vein?
Left renal vein is anterior to the aorta, but behind the superior mesenteric artery.
Where does the left and right testicular vein drain to?
Left testicular vein drains the left renal vein. Right testicular vein goes direct to inferior vena cava.
What is the post posterior structure in the renal hilum?
Renal pelvis is the most posterior, gives off the ureter.
How many major calyces contribute to the renal pelvis? How many minor to the major?
3 major calyces contribute to the pelvis. The superior major calyx has 3 minor, while the other two have two each. Each minor calyx inserts to the apex of a medullary pyramid.
What is the pathway taken by the ureters?
Ureters descend on the posterior wall on psoas major, run anterior to the external iliacs. It receives blood supply as it descends.
Where are the narrowings of the ureter?
At the beginning, as it passes over the pelvic brim and the final one as it enters the bladder.
Why are narrowings of the ureter a clinical significance?
They can be the site of obstructions - kidney stones etc.
What does ureter descent roughly correspond with?
Tips of the transverse processes.
How many regions does the oesophagus traverse?
3, the neck, thorax and abdomen.
How much of the oesophagus is in the abdomen?
Half an inch (went full yankee there).
What side of the stomach does the oesophagus enter? Why is this significant?
It enters on the right side, and prevents reflux.
What are the 3 sites of narrowing for the oesophagus?
One at the cervical region - upper oesophageal sphincter.
Thoracic - aortic arch.
Abdominal - diaphragmatic orifice.
What can be said about the oesophageal lymph and blood supply on metastasis?
Different regions ahve different blood supply, so a metastasis can end up in different regions depending on the supply.
Where is the abdominal oesophagus supplied and drained by?
Supplied by left gastric artery, drained by portal, left gastric and systemic vein.
Lymph drainage is to pre-aortic nodes.
Where is the thoracic oesophagus supplied and drained by?
Supplied by oesophageal branches off the descending aorta.
Drained by azygous vein.
Lymph drainage is to mediastinal nodes.
What is a hiatus hernia?
When part of the stomach that herniates up through the oesophageal hiatus into the thorax.
paraoesophageal - stomach fold slides up, rare, 5%.
sliding - when stomach slides upward, causing oesophageal bulge.
Where is the stomach found?
Upper left quadrant.
What are the openings of the stomach?
Cardiac orifice, proximal on the right.
Distal is pyloric orifice.
What are the curvatures of the stomach?
Lesser curvature, found superiorly.
Greater curvature, found inferiorly.
What is special about the fundus of the stomach?
It is the superiormost structure of the stomach, above the cardiac orifice and usually full of gas. Tucks under left diaphragm.
What is below the fundus of the stomach?
The body, called corpus.
What is the angular notch?
Notch found on the lesser curvature. Landmark for the end of the corpus.
What is the pyloric antrum?
A triangular area found after the corpus, defined by the angular notch.
What is the pyloric canal?
Continuation of the pyloric antrum, which funnels into it.
What is the pyloris?
Final part of the stomach that funnels into the duodenum.
What is the hepatogastric ligament?
Connects to the under surface of the liver superiorly by the lesser curvature (lesser omentum).
What is the greater omentum?
Mesentery hanging off the greater curvature.
What are the muscles of the stomach called?
Rugae. They are more prominent to the pyloris.
Is the stomach intraperotineal?
What is the stomach supplied by?
Left and right gastric arteries along the lesser curvature.
Left and right gastroepiploic arteries along the greater curvature.
What is the duodenum?
First 10 inches, and is a C shaped loop. Surrounds the head of the pancreas.
Is the duodenum intraperotineal?
No, only the first inch is inraperotineal, the rest is retroperotineal.
What is the duodenal cap?
First 2 inches of the duodenum. Directed back and up, lies on the right crus and psoas major, and overlies right kidney's hilum.
Where do ulcers most commonly happen?
At the duodenal cap, as mucosa isn't secreted by it.
What is the vertical duodenum?
The second part of the duodenum, 3 inches long. Descends on the right psoas, next to head of pancreas.
What is a landmark for the vertical duodenum?
A double-lined perotineum, which is the perotineum of the colon coming off the posterior wall.
What is the horizontal duodenum?
Third part of the duodenum, 4 inches long.
passes over right psoas, in front of the aorta, and ivc, and tethers to the left psoas. Found at L3.
What is the fourth part of the mesentery?
Becomes the fourth part after tethering to the left psoas, called duodenojejunal flexure.
What major structure is found in the vertical duodenum?
Major duodenal papilla about halfway down. Accessory pancreatic duct enters minor duodenal papilla superior to the major, about halfway between it and the top.
Where is the root of THE MESENTERY found?
On the horizontal duodenum, beneath the head of pancreas.
How long is the small intestine minus the duodenum?
What percentage of the small intestine is jejunum or ilium?
First 40% is jejunum, final 60 is ilium.
What suspends the small intenstines?
Which quadrant are the ilium and jejunum found.
Jejunum is the upper left quadrant, and ilium is lower right.