Lecture 3 - Abdominal Viscera and Collateral Circulation

Question 1

Gastrocolic ligament

Answer 1

Connects the stomach to the transverse colon. Great window into the lesser sac if you incise here.

Question 2

Know all branches of celiac trunk, sup. mesenteric, and inf. mesenteric.

Answer 2

On sheet

Question 3

Marginal Artery of Drummond

- vasa recta

Answer 3

Each of the colics as well as the sigmoid arteries divides into a proximal and distal portion. They then anastomose at what is called marginal arteries. From there, they give off small end arteries called vasa recta.

Question 4

Branches of IVC

Answer 4

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- Inf Phrenic, Hepatic, Renal, Gonadal, Lumbar, Common Iliac

Question 5

Branches of Portal Vein

Answer 5

• Left gastric
• Splenic - inf. mesenteric comes off of it.
• Sup. mesenteric - superior rectal comes off of it.

Question 6

Supracolic vs. infracolic

Answer 6

Depends on whether you are above or below the transverse colon. They are two compartments of the greater sac. Based on the pictures in the lecture, I believe that the greater sac is both above the greater omentum as well as beneath the greater omentum below the lesser sac

Question 7

Portacaval anastemosis

Answer 7

1) Between superior rectal (portal) and middle and inferior rectal (caval). Internal hemorrhoids.
2) Between esophageal branch of left gastric (portal) and esophageal (caval). Esophageal varices.
3) Between Paraumbilcal (portal) and epigastric (caval). Caput Madussae.

Question 8

Procedures used to avoid esophageal varices

Answer 8

1) portacaval shunt

2) splenorenal shunt

Question 9

TIPS procedure

Answer 9

Connect portal and hepatic through the liver.

Question 10

Lymphatic drainage

Answer 10

lymph nodes are preaortic and paraaortic. They drain into the Cysterna Chylae and then from there the thoracic duct.

Question 11

3 openings in the diaphragm

Answer 11

1) Caval Hiatus - lets the IVC through
2) Esophageal Hiatus - lets the esophagus in
3) Aortic Hiatus - Lets the aorta in

Question 12

2 types of hiatus hernias1

Answer 12

1) sliding - everything slides upwards. Fundus, abdominal esophagus, cardia. Will have symptoms of regurgitation.
2) Nonsliding - Only fundus slides up. No real symptoms

Question 13

3 layers of smooth muscle in the stomach

Answer 13

Outer longitudinal
Middle circular
Inner oblique

Question 14

Arterial supply to the stomach

Answer 14

R and L gastric
R and L gastro-omental
Short Gastric AA

Question 15

Suspensory Ligament of Treitz

Answer 15

Supports the duodenojejunal junction.

Question 16

What is the name of the flexure between the duodenum and jejunum?

Answer 16

Duodenojejunal flexure

Question 17

Arterial supply to the duodenum

Answer 17

Gastroduodenal artery
superior pancreaticoduodinal
inferior pancreaticoduodenal
superior mesenteric

Question 18

Pancreatic ducts

Answer 18

Major duct and minor duct
The common biliary duct also is in this area and at the point that it meets up with the major duct is called the hepatopancreatic ampula

Question 19

Blood supply to pancreas

Answer 19

Superior pancreatiduodenal
Inferior pacreaticoduodenal
Splenic artery

Question 20

Whipple procedure

Answer 20

used when you have to remove the head of the pancreas. You have to remove the ties between the duodenum ad the jejunum and stomach. Then you need to split the blood supply of the arteries going to the duodenum. Remove the head of the pancreas from the neck. Then reanastomose the bile duct. Reanastomose the stomach to the jejunum.

Question 21

Portal Triad

Answer 21

Common Bile Duct
Proper Hepatic Artery
Portal Vein

Question 22

Blood supply to liver and gall bladder

Answer 22

cystic artery, right and left hepatic artery.

Question 23

Hepatocystic triangle

Answer 23

Cystic artery runs through here.

Boundaries are cystic duct, common hepatic duct, and the liver

Question 24

Differences between jejunum and ileum

Answer 24

Jejunum is more vascuularized, larger vasa recta, less fat in mesentery, larger, deeper red