Fill in the blanks of the retroperitoneal structures in direct contact with the posterior abdominal wall
What are the primary retroperitoneal structures?
Abdominal aorta and its branches
Inferior vena cava and its tributaries
Kidneys and ureters
Nerves (lumbar plexus and sympathetic trunk)
What does primary retroperitoneal structure mean?
Those structures that developed outside the parietal peritoneum - never had a mesentery
List 3 superimposed structures in the abdomen
Duodenum, pancreas and spleen - all retroperitoneal apart from spleen and tail of pancreas
What are the 4 parts of the duodenum and how are they related to structures around them?
First part has a mesentery and lies anterior to the bile duct, HPV and gastroduodenal artery Secondary part has the bile/pancreatic ducts opening to it and the roof of the transverse mesocolon crosses it Third part is crossed anteriorly by the superior mesenteric artery and vein Fourth part leads into the jejunum
How do the superimposed structures appear? FITB
Sketch from vessels, kidney, spleen and finally duodenum and pancreas
Where does the pancreas lie in relation to the surrounding structures?
Head, neck and uncinate processes lie in G of duodenum anterior to left kidney Body extends to left side across aorta to left kidney Tail is from kidney to spleen in dorsal foregut mesentery (lieno-renal/spleno-renal ligament)
What are the kidneys surrounded by when in situ?
Perinephric fat, renal fascia and paranephric fat
What are the relations of the kidneys? FITB
NB: each kidney is different and liver is anterior to upper RK and jejunum to lower LK
What are the visceral relations of the kidney?
Adrenal glands on both sides Liver on the right 2nd part of duodenum on the right Ascending colon on the right Descending colon and stomach on the left Spleen on the left Tail of pancreas on the left Coils of small bowel especially on the left
What surface projections occur from the kidneys?
What are the positions of the 2 kidneys relative to each other?
There is greater separations at inferior ends of kidneys and ureters are located anterior to transverse processes of lumbar vertebrae Right is often lower than left 12th ribs run diagonally across posterior surfaces of kidney
What are the posterior relations of the kidneys?
Lie on the diaphragm, psoas, quadratus lumborum and transversus abdominis Between kidneys and muscles cross the T12 (subcostal) and L1 (ilio-hypogastric and ilioinguinal) nerves
When is a posterior approach to the kidneys used?
For open surgery and renal biopsy
Fill in the blanks of the posterior relations of the kidney
Fill in the blanks of the embryo in 5th week of IUL
Fill in the blanks of the mesenteries in relation to the stomach, liver and spleen
Where does the liver develop and what structures is it attached to?
Develops in ventral foregut mesentry Connected to anterior abdominal wall by falciform ligament Connected to stomach by lesser omentum Direct contact with part of diaphragm
What is the surface anatomy of liver?
Deep to ribs 7-11, mostly under cover of ribs Extends across R hyperchondrium, epigastrum and left hyperchondrium
Fill in the blanks of the anatomical lobes of the liver, anteriorly
Fill in the blanks of the anatomical lobes of the liver, posteriorly
What are the names of the 4 lobes of the liver?
Right/left vascular lobe Quadrate lobe, caudate lobe
What is the visceral surface of the liver surrounded by (which viscera)?
Gall bladder and IVC mark the separation into functional R and L lobes Grooves for foetal veins mark out minor parts of function L lobe (quadrate/caudate lobes) Porta of liver separates Q and C lobes
What does the porta carry?
Hepatic artery, portal vein, common bile duct and lymphatics
What are the anatomical relations of the liver?
Covered by costal margin, except in upper epigastrum Convex diaphragmatic surface Complex visceral surface in contact with stomach, duodenum, right kidney and colon
What are the posterior visceral relations of the liver? FITB
What is the blood supply to the liver?
Hepatic artery is derived from the coeliac axis, supplies arterial blood to the liver Portal vein drains venous blood from GIT and spleen into liver Venous blood from liver drains directly into IVC via 3 short hepatic veins
What are the different portal-systemic anastamoses at each site?
A - oesophageal vein (S) w/L gastric vein (P) B - Inf. rectal vein (S) w/Sup. rectal vein (P) C - Epigastric vein (S) w/Paraumbilical vein (P) D - Retroperitoneal vein (S) w/visceral vein (P)
What are important sites of portal-systemic anastamoses and what could occur?
May become dilated if portal blood flow through liver is obstructed in liver disease Important: Lower oesophagus, rectum and para-umbilical veins First 2 sites commonly have haemorrhage
How are the biliary ducts and gall bladder organised?
Pancreatic duct and bile duct join to form the hepatopancreatic ampulla of Vater Sphincter of Oddi guards the ampulla of Vater Separate sphincters for the bile duct and pancreatic duct Neoplasms of head of pancreas can obstruct the ducts here
What is the structure of the biliary tract?
L/R hepatic ducts form the common hepatic duct Cystic duct from gall bladder joins the common hepatic duct and becomes the common bile duct
Where does the common bile duct pass by?
Behind the 1st part of duodenum and head of pancreas to enter second part of duodenum at major papilla, usually joining the major pancreatic duct
Fill in the blanks of the relations of the gall bladder
What is the spleen?
Largest lymphoid organ in the body Fist sized, suspended in dorsal foregut mesentery (attached to gastro-splenic and lieno-renal ligaments)
Where does the spleen lie and what relations does it have?
Posteriorly on left side under ribs 9-11 Relations with stomach, L kidney, Splenic flexure of colon and tail of pancreas
What is the hilar surface of the spleen connected to? FITB
What are the 2 splenic ligaments and what happens at these ligaments?
Gastrosplenic and splenorenal ligaments - both part of greater omentum Blood vessels to the spleen enter through these ligaments