Lecture 24. Stomach and small intestine

Question 1

Surface projection of stomach

Answer 1

Only the cardiac and the pyloric end of the stomach have a relatively constant position: T10, ~2-3 cm on the left and L1, ~2-3 cm on the right, respectively.

Question 2

Identify

Answer 2

Question 3

Identify

Answer 3

Question 4

Identify

Answer 4

Question 5

Anterior surface of stomach is partially covered by (1)___, contacts (2)___ and according to the Labbé’s triangle,directly (3)___

Answer 5

1. the liver
2. the diaphragm
3. the abdominal wall.

Question 6

Identify this triangle

Answer 6

Gastric triangle (of Labbé)

Question 7

Gastric triangle (of Labbé) is bounded by ___ (5)

Answer 7

1. the inferior margin of the liver
2. the left costal arch
3. a horizontal line running along the transverse colon
4. the greater curvature
5. the 9th costal cartilages

Question 8

The greater curvature of the stomach is in contact with ___ and ___

Answer 8

the spleen and the transverse mesocolon.

Question 9

The rest of the posterior surface is isolated from ___ (3) by the omental bursa (lesser sac).

Answer 9

the pancreas, left kidney and left suprarenal gland

Question 10

Stomach: peritoneal relations

→ Identify

Answer 10

Question 11

: if an organ has at least one peritoneal duplication connecting it to the body wall or to other organs, it must be ___

Answer 11

intraperitoneal

Question 12

Stomach belongs to the forgut and is supplied by ____.

Answer 12

the dominant artery of that: the celiac trunk

Question 13

Along the lesser and greater curvatures (1)____ are found and from them the lymph is mainly drained toward (2)___ accumulating around (3)___

Answer 13

1. the primary lymph nodes
2. the (secondary) paraaortic lymph nodes
3. the celiac trunk.

Question 14

Duodenum extends from (1)___ to (2)____ as a horseshoe-shaped tube.

Answer 14

1. the pylorus
2. the duodenojejunal flexure

Question 15

Jejunum is mostly in ___ quadrant of the abdomen

Answer 15

the left upper

Question 16

. Ileum is mostly in ___ quadrant, has smaller diameter and thinner wall

Answer 16

the right lower

Question 17

1. ____ extends from the pylorus to the duodenojejunal flexure as a horseshoe-shaped tube.
2. ____ is mostly in the left upper quadrant of the abdomen and is larger in diameter and has a thicker wall than the ileum.
3. ____ is mostly in the right lower quadrant, has smaller diameter and thinner wall.

Answer 17

1. Duodenum
2. Jejunum
3. Ileum

Question 18

Identify

Answer 18

Question 19

Identify 4 parts of duodenum

Answer 19

Question 20

The horseshoe-shaped duodenum can be divided into four parts, which enclose ___

Answer 20

the head of pacreas.

Question 21

Name the planes and line

Answer 21

L1 – transpyloric plane

pylorus, superior horizontal part of duodenum, gall bladder, body and tail of pancreas

L3 – subcostal plane

inferior horizontal part of duodenum

medioinguinal line

on its medial side: descending part of duodenum

Question 22

Duodenum: surface projection

→ Identify

Answer 22

Question 23

Duodenum: adjacent organs

→ Superior horizontal part contacts __ and _

Answer 23

the right lobe of the liver and the gall-bladder.

Question 24

Duodenum: adjacent organs

The second part descends anterior to (1)___ and is crossed anteriorly by (2)___

Answer 24

1. the hilum of the right kidney
2. the transverse colon.

Question 25

**_Duodenum: adjacent organs_** Inferior horizontal part lies anterior to ___ and ___ (vessels)

Answer 25

the IVC and the abdominal aorta.

Question 26

**_Duodenum: adjacent organs_** (1)\_\_\_ cross the inferior horizontal and the ascending part, respectively.

Answer 26

Superior mesenteric vessels

Question 27

**_Duodenum: peritoneal relations_** Only the superior horizontal part of duodenum is (1)\_\_\_: its peritoneal duplication is the (2)\_\_\_\_ which encloses the common bile duct, the portal vein and the proper hepatic (and gastroduodenal) artery. The rest of theduodenum is **retroperitoneal**.

Answer 27

1. **intra-peritoneal** 2. hepatoduodenal ligament

Question 28

**_Duodenum: peritoneal relations_** Only the superior horizontal part of duodenum is **intra-peritoneal**: its peritoneal duplication is the hepatoduodenal ligament which encloses \_\_\_\_ The rest of theduodenum is \_\_\_

Answer 28

* the common bile duct, the portal vein and the proper hepatic (and gastroduodenal) artery. * **retroperitoneal**.

Question 29

**_Duodenum: blood supply_** Superior and inferior pacreaticoduodenal arteries form (1)\_\_\_and \_\_\_ → This anastomosis makes connection between (2)\_\_\_ and \_\_\_

Answer 29

Superior and inferior pacreaticoduodenal arteries

Question 30

**_Duodenum: blood supply_** Superior and inferior pacreaticoduodenal arteries form (1)\_\_\_ → This anastomosis makes connection between (2)\_\_\_ and \_\_\_

Answer 30

1. the lesser arch of Riolan. 2. the celiac trunk (main vessel of the foregut) and the superior mesenteric artery (dominant artery of the midgut.)

Question 31

the lesser arch of Riolan is formed by \_\_\_

Answer 31

Superior and inferior pacreaticoduodenal arteries

Question 32

Identify this structure. its role?

Answer 32

The **suspensory muscle of duodenum** (or the ligament of Treitz) that connects the duodenum to the left crus of the diaphragm

Question 33

What is **Root of mesentery?**

Answer 33

line of attachment of the mesentery. (Extends from the duodenojejunal flexure tothe iliocecal junction.)

Question 34

**Root of mesentery** → Extends from (1)\_\_\_\_ to (2)\_\_\_

Answer 34

1. the duodenojejunal flexure 2. the iliocecal junction.

Question 35

**Root of mesentery crosses**: (6 structures)

Answer 35

1. inferior part of duodenum 2. abdominal aorta 3. inferior vena cava 4. right gonadal artery and veins 5. right ureter 6. Psoas major

Question 36

Jejunum, ileum: blood supply??

Answer 36

**Branches of the superior mesenteric artery:** * jejunal arteries * iliac arteries * ileocolic artery

Question 37

Identify jejunum and ileum

Answer 37

Question 38

Identify

Answer 38

Question 39

Veinous drainage: portal system Everything absorbed from the GI tract gets into (1)\_\_\_ system. (2)\_\_\_\_ and ___ merge behind the head of pancreas to form theportal vein. Inferior mesenteric vein usually opens into (3)\_\_\_\_ Before entering the liver, portal vein picks up (4)\_\_\_\_ as the last tributary.

Answer 39

1. the portal veinous 2. Superior mesenteric vein and splenic vein 3. the splenic vein. 4. the coronary vein of the stomach