Flashcards in Stomach, Liver, & Gallbladder Deck (78):
What is the max capacity of the stomach and whats are its functions?
2-3L, acts as a reservoir. Digests food by mechanical and chemical means, and has limited absorption (like alcohol)
What are the smooth muscle layers of the stomach?
Inner: Oblique (incomplete)
What are the rugae of the stomach?
Nonpermanent folds of the mucosa that is prominent when the stomach is empty, and flattens out when the stomach is distended
What is the gastric canal?
The permanent channel which can serve as a route for liquids entering from the esophagus to the first part of the duodenum without expending the stomach (from base 75 mL)
What are the five regions of the stomach, from esophagus to duodeum?
1. Cardiac - connects to esophagus
2. Fundus - top, usually filled with gas and in contact with thoracic diapraghm
3. Body - largest region, responsible for secretion of stomach
4. Pyloric antrum - transition from body to pyloric canal (more muscular)
5. Pyloric canal - terminal part of stomach ending as pyloric sphincter
What is the cardiac notch?
A sharp indentation of the stomach located between cardiac portion and fundus.
What is the angular notch?
Less well defined notch on lesser curvature defining the boundary between the body and the pyloric region
What are the phrenoesophageal ligaments and what vertebral level are they at?
Junction of esophagus + stomach is at TV10.
Ascending phrenoesophageal - above the thoracic diaphragm is
Descending phrenoesophageal - below the thoracic diapraghm
What structure is located at the terminal part of the esophagus?
Esophageal sphincter - a functional valve
What is the pyloric sphincter?
A smooth muscle valve which is regulated by autonomics (sympathetics + parasympathetics) and controls the flow of digested food / liquid from the stomach into the duodenum
How is the diaphragm related to the stomach?
In direct contact with the fundus region
What is superior to the body and pylorus of the stomach?
Liver (mostly left lobe)
Where is the spleen located?
To the left of the body of the stomach
What is located inferior / posterior to the body of the stomach?
Transverse colon and left colic flexure (splenic flexure)
What structures sit in the posterior wall of the omental bursa? Include major vessels
Pancreas, left kidney, left adrenal gland, diaphragm (part), transverse colon (part), spleen (part)
Celiac artery (trunk + branches)
Splenic artery + vein
Terminal part of superior mesenteric artery & vein
What is the gastrophrenic ligament?
Ligament inserting from cardiac portion of stomach and lateral margin of fundus to the left diaphragm
What is the gastrosplenic ligament?
Continuation of gastrophrenic, extends from greater curvature of stomach to the spleen just medially
What is the splenorenal ligament? What is contained within it?
Continuation of gastrosplenic ligament posteriorly, attaches anteriorly to left kidney (from spleen)
Inside: Terminal branches of splenic artery (short gastrics), and tail of pancreas
What is the hepatoduodenal ligament and what does it contain? What is its location?
Attaches superior region of first part of duodenum (to right of pyloric sphincter) to the liver. It maintains the position of the pyloric region of the stomach
Contains: Hepatic portal vein, and the hepatic, cystic, and common bile ducts. Also contains hepatic artery (right and left)
What is the celiac trunk? What level is it at?
One of three single midline abdominal arteries (along with superior and inferior mesenteric arteries) that supply the viscera. It is the primary source of arterial flow to the stomach, and is located just inferior to the crura of the diaphragm. It is at TV12
What are the three primary branches of the celiac trunk?
1. Left gastric
3. Common hepatic
What is the left gastric artery, its function, major branch, and fate?
A branch of the celiac trunk
Function: supplies left half of lesser curvature
1. Ascending esophageal - anastomoses with thoracic esophageal to supply cardiac region of stomach
It will anastomose with the right gastric artery (branch of proper hepatic) within lesser omentum
What is the splenic artery, its major branches, and its function?
A branch of celiac trunk within the splenorenal ligament
Function: blood to pancreas, spleen, stomach
1. Branches to pancreas (3)
2. Short gastric arteries - 2-3 - supply fundus of stomach
3. Left gastro-omental artery (gastroepiploic) - follows greater curvature of stomach within greater omentum on left side. Anastomoses with right gastro-omental
Why does the splenic artery have a tortuous path?
Accommodates enlargement of spleen at night. By winding it, it doesn't get ripped out when the spleen enlarges
What is the common hepatic artery and its major branches?
It is the rightmost branch of the celiac trunk
2 major branches:
1. Proper hepatic
What are the branches of the proper hepatic artery?
1. Right gastric - to anastomose with left gastric along lesser curvature, also supplies pyloric region
2. Right hepatic artery - to right side of liver
3. Left hepatic artery - to left side of liver
What are the branches of the gastroduodenal artery? Where does it travel?
Ascends posterior to junction of the pylorus and duodenum and gives rise to two major branches:
1. Right gastro-omental - to anastomose with left gastro-omental in greater omentum
2. Superior pancreaticduodenal
What forms the hepatic portal vein? What is it?
It is formed by the junction of the splenic vein and superior mesenteric vein and travels within the hepatoduodenal ligament. It is the venous drainage of the entire digestive system distal to the esophagus and proximal to anal canal
What veins of the stomach drain into the splenic vein?
Left gastro-omental and short gastric veins
What veins of the stomach drain directly into the portal vein?
Right and left gastric veins
What vein of the stomach drains into the superior mesenteric vein?
Right gastro-omental vein
What is the lymphatic drainage of the stomach?
Named by corresponding artery, and drain directly in to celiac lymph nodes which are clustered around the celiac trunk and drain into the thoracic duct
What is the parasympathetic innervation of the stomach? What is their function?
Vagus nerve via anterior vagal trunk - increase glandular secretion and stimulate peristalsis of the stomach
What is the sympathetic innervation of the stomach? Function?
Preganglionics from greater splanchnic nerve (T5-T9) arrive and synapse in celiac ganglion, giving off post-ganglionic fibers to the stomach.
Function: Reduce peristalsis, glandular secretion, and constrict pyloric sphincter
How do visceral afferent stretch and pain receptors of the stomach communicate with the brain?
Use the sympathetic pathway of greater splanchnic nerve to refer pain to T5-T9.
What is the enteric nervous system?
Endogenous neuronal network spanning the alimentary tract which functions independently to provide glandular secretion and auto-peristalsis. It is regulated by SANS and PANS, but like the SA node, it works independently
What is the largest and most vascularized organ in the body?
What are the functions of the liver?
Primary site of detoxification and intermediate metabolism.
1. Glycogen storage
2. Bile, protein, and cholesterol synthesis
3. Retires old blood cells and reclaims their iron
4. Produces lymph (>50% of lymph entering thoracic duct)
Where is the liver found?
Right upper quadrant of abdominal cavity. Hidden by the thoracic cage completely. It is found deep to ribs 7-10 and its sharp inferior border follows the contour of the right costal margin
What are the two surfaces of the liver?
1. Diaphragmatic - smooth contoured surface that is directly related to the thoracic diaphragm, divided into two lobes
2. Visceral - Inferior aspect of the liver, related to gallbladder, stomach, and duodenum (the viscera)
What is the falciform ligament?
Ligament on ventral surface of liver which divides it into the right and left anatomical lobes
What are the anterior and posterior coronary ligaments, and what are their intersections?
They are ligaments which suspend the liver from the thoracic diaphragm, and are continuous with falciform ligament. Since they are derived from ventral mesogastrum and are separated / pulled away, they create transition zones called the left and right triangular ligaments.
All 4 ligaments suspend the liver from the thoracic diaphragm
Where do the hepatic veins empty into the inferior vena cava?
In the bare area of the liver which is bounded by the 4 ligaments suspending it from the thoracic diaphragm (since it is pulled away ventral mesogastrum)
What is the subphrenic recess?
Space which is ventral to the anterior coronary ligament, between liver and diaphragm
What is the hepatorenal recess?
Space which is dorsal / inferior to the posterior coronary ligament, between right kidney and liver
What is the function of the ligaments on the visceral surface of the liver?
Divide it into 4 lobes: Right, left, caudate, and quadrate lobes
What lobes are contained in the right anatomical lobe?
Right visceral, quadrate, and caudate lobes
What lobes are contained in the left anatomical lobe?
Only the left visceral lobe
What ligaments separate the left visceral lobe from the quadrate and caudate lobes? Define them.
Ligamentum teres - embryological remnant of umbilical vein embedded in free margin of falciform ligament. Adjacent to quadrate
Ligamentum venosum - embryological remnant of ductus venosus. Adjacent to caudate
What is the porta hepatis? What does it separate?
The door to the liver, containing left and right portal veins, hepatic arteries, and hepatic ducts.
Separates quadrate lobe (ventral) from caudate lobe (dorsal)
What separates the right visceral lobe from the quadrate + caudate lobes?
Ventrally: Gall bladder + cystic duct
Dorsally: Inferior vena cava
What is a hepatic triad and how many functional lobes are there in the liver?
8 function lobes
Hepatic portal blood
Hepatic duct system (carrying bile)
Not part of triad: hepatic vein, which all drains into IVC
What is the primary blood supply to the liver?
Via the portal vein!!! It is full of nutrients from small intestines, and is relatively oxygenated compared to systemic circulation. It divides into right and left hepatic portal branch at the porta hepatis
What is the secondary blood supply to the liver?
Oxygen-rich blood from the proper hepatic artery, which divides into left and right hepatic arteries at porta hepatis (like the portal vein)
What is the portal triad?
Portal vein + proper hepatic artery + hepatic duct
Why are hepatic veins not included in the portal triad?
They drain in the bare region of the liver by 2-3 of them into the IVC
Where is the gall bladder located and what is its function?
Located in gallbladder fossa on visceral surface of liver between right and quadrate lobes.
Concentrate and store bile. When cholecystokinin (CCK) is released, it contracts and injects bile into 2nd part of duodenum via common bile duct
What does the fundus of the gall bladder rest on?
The first part of the duodenum. It is in direct contact with the anterior abdominal wall (at costal margin)
What are the three parts of the gall bladder?
3. Neck - empties into cystic duct
Where does the cystic duct empty and what is inside it?
It joins with the common hepatic duct to form the (common) bile duct
Inside: Spiral valve. Not a functional valve, but has a spiral path inside that looks like a valve
Where does the common bile duct travel?
Anterior to the portal vein, and lateral to the proper hepatic artery within the hepatoduodenal ligament. It passes POSTERIOR to the first part of the duodenum
What is the bile duct sphincter? How does it function?
It is the sphincter at the end of the bile duct which is closed until fatty foods are ingested. Bile produced by liver is dilute, and modified by the gallbladder while the sphincter is closed. Water and essential metabolites are reabsorbed here.
What drains into the hepatopancreatic ampulla? What controls this opening?
The common bile duct and the pancreatic duct. This opening into the 2nd part of the duodenum is controlled by the sphincter of hepatopancreatic ampulla
What is the major duodenal papilla?
Opening of hepatopancreatic ampulla which is visible in medial wall of the duodenal mucosa as a raised mound
What supplies blood to the gall bladder?
Cystic artery, which is a branch of the right hepatic artery (branch of proper hepatic, from common hepatic, from celiac trunk)
What is the course of the cystic artery?
Within the hepatoduodenal ligament, it passes posterior to the common hepatic duct, and reaches the neck of the gall bladder.
What is the cystohepatic triangle?
A surgically important area containing cystic artery and right hepatic artery
What are the boundaries of the cystohepatic triangle?
Medially: Common hepatic duct
Laterally: Cystic duct
What are the SANS and PANS innervation of the gall bladder?
SANS: preganglionics from greater splanchnic nerve, postganglionics from celiac ganglion
PANS: Vagus nerve
How is visceral sensory of the gallbladder relayed? How does this relate to referred pain?
Visceral afferent via greater splanchnic nerve (T7-T9) = right spine to epigastric region
Right phrenic nerve (C3-C5) = right shoulder region
What is a hiatus hernia?
Where a portion of the stomach is pulled away through the esophageal hiatus of diaphragm into thoracic cavity. Due to phrenoesophageal ligament dysfunction
What can rupture of the liver cause?
What types of cancer are the liver and stomach a site of?
What is cirrhosis?
Causes progressive destruction of hepatocytes and liver failure
What is hepatitis?
Inflammation of liver that is usually caused by viral infection or chemical toxins
What is jaundice?
Elevated level of bile pigment found in blood stream causing a yellow appearance in skin and conjunctiva of eyes. Can be due to blockage of bile duct system via a gallstone, preventing further processing of bile pigment (bilirubin) from blood
What is the most common site of blockage via gallstone?