Lecture 12 RH

Question 1

Where does the ileum end? What does it contain?

Answer 1

ileum ends at iliocecal junction which contains the iliocecal valve covering a smooth muscle sphincter.

Question 2

What structure does the large intestine form below the iliocaecal junction?

Answer 2

the caecum

Question 3

What are the parts of the large intestine?

Answer 3

Cecum

Ascending colon

Transverse colon

Descending colong

S-shaped sigmoid colon

Rectum

Question 4

How many layers of muscle does the large intestine contain?

Answer 4

2 muscular layers:

Inner circular

Outer longitudinal (continuous throughout the jejunum, ileum, and large intestine)

Question 5

How long is the large intestine?

Answer 5

1.5 meters

Question 6

What are the tenia coli?

Answer 6

3 discrete longitudinal muscle bands in the large intestine. They are visible from the outside.

Question 7

Why does the large intestine have a segmented appearance?

Answer 7

longitudinal muscle stripes are shorter than the mucosal tube inside them and that causes formation of haustrations of the mucosa.

Question 8

What are epiploic appendages?

Answer 8

fat tags on the large intestine

Question 9

What is the length of the cecum?

Answer 9

Cecum is variable in length between 3 and 4 inches long.

Question 10

What is important about the appendix histologically?

Answer 10

appendix contains lots of lymphoid nodules histologically.

Question 11

Where is the appendix located?

Answer 11

Everyone has an appendix at exactly the position where the tenea coli meet at the bottom of the cecum.

Question 12

What are the variations in the tip of the appendix?

Answer 12

Tip of the appendix:

hanging down into pelvis (known as a pelvic appendix) 25%

Appendix tucked onto the side of the large ascending colon. (Known as a retrocaecal appendix) 65% of cases

Question 13

What are the kinds of flexures that are present in the large intestine?

Answer 13

Right colic flexure or Hepatic flexure. (transition from ascending to transverse colon)

Left colic flexure or splenic flexure (transion from transverse colon to descending colon

Question 14

Where is the viscus located?

Answer 14

Right upper quadrant.

Question 15

How many surfaces does the liver have and what is their name/location?

Answer 15

Liver has 2 surfaces:

A smooth diaphragmatic surface

Visceral surface

Question 16

Why is the visceral surface not so smooth?

Answer 16

visceral surface bares (it’s bears you idiot) impressions from adjacent viscera

Question 17

What is the demarkation of the anterior and posterior surface of the liver? (where is the boundary between them?)

Answer 17

The inferior margin of the liver. It is tucked in to the right upper quadrant.

Question 18

What is the job of the falciform ligament?

Answer 18

The falciform ligament connects the anterior part of the liver to the anterior abdominal wall.

Question 19

What is the ligamentum teres of the liver?

Answer 19

Round ligamentum teres is a remnant of the umbilical vein from times of development.

Question 20

What lobes is the liver divided into ateriorly?

Answer 20

Large right lobe

Small left lobe

Question 21

What lobes is the liver divided into posteriorly?

Answer 21

caudate lobe superiorly

quadrate lobe inferiorly

Question 22

What delineates the left and right lobes of the liver functionally?

Answer 22

Hepatic veins

gallbladder

Question 23

What is the functional left lobe of the liver?

Answer 23

caudate lobe

quadrate lobe

left lobe

Question 24

Where is IVC located relative to the liver?

Answer 24

IVC is embedded into the visceral surface of the liver.

Question 25

What is the ligamentum teres and where does it attach? What is it called in the liver?

Answer 25

ligamentum teres is a cord that is remnant of the vein during development. For this reason it continues through the liver and then connects to IVC. When it reaches the liver's porta hepatis it is called the ligamentum venosum

Question 26

What is the hilum of the liver called?

Answer 26

porta hepatis

Question 27

What structures can be found in the hilum of the liver?

Answer 27

nerves arteries (proper hepatic artery divides into right and left hepatic arteries 1 for each functional half of the liver) On the left of the hilum veins (portal vein also splits in half) behind the artery to the left and the duct to the right. lymphatics hepatic ducts (right and left from functional halves) on the right of the hilum

Question 28

Where do the veins of the liver go?

Answer 28

venous drainage of the liver comes from the IVC. The portal veins penetrate IVC.

Question 29

What structure does the helpatic duct go through to reach the duodenum?

Answer 29

lesser omentum ends at the duodenum. At that location the structures entering and exiting the porta hepatis is embedded in the free edge of the lesser omentum. This free edge connects the hilum to the duodenum.

Question 30

Where does the gall bladder sit on the liver?

Answer 30

Gall bladder sits in a groove on the undersurface of the liver.

Question 31

What are the parts of the gall bladder (including the ducts)?

Answer 31

fundus (blind end) body Neck These structures are continuous and form the cystic duct and then the common hepatic duct and finally the common bile duct.

Question 32

What part of the duodenum does the common bile duct connect to? How does it get there?

Answer 32

It gets there by running behind the first part of the duodenum and then through the space between the pancreas and the duodenum and it inserts into the second part of the major duodenal papilla along with the pancreas.

Question 33

How does bile release get regulated before and after a meal?

Answer 33

sphincter of the hepatopancreatic ampulla is closed most of the time. It opens in response to fatty food.

Question 34

How does bile get stored in the gall bladder?

Answer 34

The closed sphincter (hepatopancreatic ampulla) causes build up of bile which falls into the gall bladder and gets stored and concentrated.

Question 35

How can gallstones be diagnosed?

Answer 35

fundus of gall bladder tips below the inferior margin of the liver. Gallstones can be palpated between right costal margin and right border of rectus abdominus after breathing in.

Question 36

Where is the pancreas located relative to other viscera of the abdominal wall?

Answer 36

head is within C-shaped duodenum. uncinate process is wedge shaped from the head and connects to superior mesenteric vessels. Neck overlies superior mesenteric vessels. Pyloris of stomach is superior to it. duodenal jejunal flexure corresponds to the body of the pancreas. Tail of the pancreas is right next to the hilum of the spleen.

Question 37

Is the pancreas intra or retro peritoneal?

Answer 37

retroperitoneal

Question 38

What is the function of the main pancreatic duct?

Answer 38

main pancreatic duct runs through the pancreas and opens into the duodenum. It joins the common bile duct at the major duodenal papilla. It collects the secretions of the pancreas and directs them to the duodenum.

Question 39

How is the secretion of pancreatic "stuff" regulated?

Answer 39

terminal portion of common bile duct and pancreatic duct has a common complex sphincter.

Question 40

What is the function of the minor duodenal papilla?

Answer 40

accessory pancreatic duct is usually present and drains the lower part of the pancreas into the minor duodenal papilla.

Question 41

How big is the spleen?

Answer 41

Spleen is approximately fist sized but this decreases with age.

Question 42

What are the surfaces that the spleen has?

Answer 42

Visceral surface Diaphragmatic surface

Question 43

What surface separates the diaphragmatic and the visceral surface of the spleen?

Answer 43

Visceral and diaphragmatic surface are separated by the notched margin.

Question 44

What structures does the splenic hilum contain?

Answer 44

Splenic artery which follows the body and tail of the pancreas towards the spleen. Splenic vein *spleen is very vascular

Question 45

Where is the spleen located relative to other structures?

Answer 45

spleen lies below the diaphragm in left upper quadrant. right above the left colic flexure. Directly under ribs 9, 10, 11.

Question 46

What is the clinical significance of the spleen's location?

Answer 46

fracture of 9, 10, and 11 can cause a tear in the spleen followed by a hemorrhage .