The Abdomen Flashcards
(421 cards)
1
Q
What are the margins of the abdomen?
A
The inferior margin of the thorax to the superior margin of the pelvic bones.
2
Q
Does the inferior margin of the abdomen have a defined border?
A
No, since the abdomen and pelvic cavity are connected.
3
Q
Where is the abdomen in reference to the abdominopelvic cavity?
A
Superior
4
Q
Where is the diaphragm in reference to the liver?
A
The diaphragm is located superior, posterior and anterior to the liver.
5
Q
What area is directly inferior to the abdomen?
A
The pelvis
6
Q
What lines the abdomen?
A
Peritoneum
7
Q
What is peritoneum?
A
Membrane that covers viscera and abdominal wall.
8
Q
What is the largest organ in the body?
A
The liver
9
Q
Is the liver retroperitoneal or intraperitoneal?
A
Intraperitoneal
10
Q
What two things cover the external surface of the liver?
A
1) The Glisson’s capsule
2) Visceral peritoneum
11
Q
What is the size and shape of the liver?
A
Triangular shape when viewed from the anterior, size is variable.
12
Q
What are the functions of the liver?
A
1) Metabolic activities
2) The production and secretion of bile
3) Filtration of the blood
13
Q
What quadrant is the liver found in?
A
Primarily right upper quadrant, left lobe crosses into left upper quadrant.
14
Q
What region/s is the liver found in?
A
Right hypochondrium and part of epigastric regions
15
Q
In thin patients, what region may the liver be found in?
A
Left hypochondrium
16
Q
What 3 structures are located posterior to the liver?
A
1) Aorta
2) IVC
3) Spine
17
Q
What 3 structures are located left lateral to the liver?
A
1) Stomach
2) Spleen
3) Left Kidney
18
Q
What 3 structures are located inferior to the liver?
A
1) Right kidney
2) Gall bladder
3) Right colon
19
Q
Describe the diaphragmatic surface of the liver:
A
- Dome shape (takes convex shape of diaphragm surface)
- Smooth surface
20
Q
What surfaces of the liver are in contact with the diaphragm?
A
Superior, posterior and anterior
21
Q
What surfaces of the liver does the peritoneal membrane cover?
A
Most of the anterior and superior surface
22
Q
Where is the “bare area” of the liver and what does this mean?
A
The bare area is on the posterior surface of the liver, it has no peritoneum.
23
Q
What are the boundaries of the bare area on the liver?
A
- Coronary and triangular ligaments
- Includes a groove for the IVC
24
Q
What divides the anterior surface of the liver?
A
The falciform ligament.
25
Describe the visceral surface of the liver?
- Inferior surface
- Oblique orientation
- Covered with peritoneum
- In contact with several abdominal organs that form grooves/undulations on the surface
26
In the traditional method, how was the liver divided into left and right lobes?
The falciform ligament visible on the anterior surface.
27
In the traditional method, what divided the quadrate and caudate lobe?
Ligaments
28
How many lobes in the traditional method?
4
| Left, Right, Quadrate, Caudate
29
In the traditional method what lobes were also considered part of the right lobe?
The quadrate and caudate lobes.
30
What is the current method used to divide the liver?
The functional or segmental method
31
How many lobes in the functional method and how are they divided?
3 (Right, left, Caudate)
Divided by hepatic function
32
What are lobes?
Divisions according to anatomy
33
What are segments?
Divisions according to function
34
Describe the imaginary plane used to divide the liver into true right and left functional lobes?
A line connecting the gallbladder fossa to the IVC, it runs along the main lobar fissure as well as the middle hepatic vein.
35
How is the right lobe divided?
Anterior and posterior segments
36
What divides the right lobe into anterior and posterior segments?
The right intersegmental fissure.
37
How is the left lobe divided?
Medial and lateral segments
38
What divides the left lobe into medial and lateral segments?
The left intersegmental fissure.
39
What runs within the right intersegmental fissure.
The right hepatic vein and right portal vein.
40
What runs within the left intersegmental fissure?
The left hepatic vein, left portal vein and the ligamentum teres.
41
Where is the caudate lobe located?
Posterior and superior in the liver.
42
Where does the caudate lobe receive blood from?
Both right and left sides of liver.
43
How is the liver divided according to the couinade segmentation classification?
8 segments, numbered clockwise from 1-8
44
What number is the caudate lobe according to the couinaud segmentation classification?
1
45
How is the liver divided in the longitudinal plane in the couinaud segmentation classification?
Three major hepatic veins divide liver into 4 sections
46
How is the liver divided in the transverse plain according to the couinaud segmentation classification?
Right and left portal veins divide 4 sections into superior and inferior subsections.
47
Describe a segment of the liver from the couinade segmentation classification?
Each segment has a branch of the portal vein at it's centre and a hepatic vein at its periphery.
48
Which is bigger, left or right lobe?
Right
49
What separates the left lobe from the right?
Imaginary line from gallbladder fossa to IVC
50
What structures outline the boundary between the left and right lobes?
Main lobar fissure, middle hepatic vein, galbladder to IVC
51
What lobe is found lateral to the imaginary boundary between the left and right lobes?
Right lobe
52
What divides the right lobe into anterior and posterior segments?
Right intersegmental fissure (RIF)
53
On ultrasound how is the RIF distinguished?
By the right hepatic vein inferiorly and the right portal vein inferiorly.
54
What is immediately left of the anterior segment of the right lobe?
The medial left lobe
55
What area is the left lobe found in the body?
Left Upper Quadrant or epigastrium
56
What divides the left lobe into medial and lateral segments?
The left intersegmental fissure.
57
What was the medial segment of the left lobe formally known as?
The quadrate lobe.
58
What is the smallest lobe in the liver?
Caudate
59
Where is the caudate lobe located?
In the superior posterior aspect of the liver.
60
What is the anterior boundary to the caudate lobe?
Left portal vein and ligamentum venosum
61
What is the posterior boundary of the caudate lobe?
The IVC
62
What is the Reidel's lobe?
A normal variant of the liver where the inferior right lobe extends caudally to the iliac crests.
63
Describe what ligaments and peritoneal attachments are and what they do.
They are fibrous, stretchy attachments that tether organs in place (the liver to the abdominal wall).
- They form the boundaries for the lobes and segments of the liver
- They are great UT landmarks
64
What is the falciform ligament?
A peritoneal fold that runs along the anterior surface of the liver from the diaphragm to the umbilicus.
65
What does the falciform ligament connect?
The liver to the diaphragm and anterior abdominal wall.
66
What ligament is the falciform ligament continuous with and where?
The ligamentum teres on the visceral surface.
67
In the traditional method what does the falciform ligament divide?
The left and right lobes.
68
What spaces does the falciform ligament divide?
The left and right subphrenic spaces.
69
What is the ligamentum teres?
The remnant of the fetal left umbilical vein, it arises from the umbilicus and extends posteriorly on the inferior surface of the liver to join the ligamentum venosum.
70
What does the ligamentum teres connect?
Connects to the falciform ligament on the anterior inferior surface of the liver.
71
What is another name for the ligamentum teres?
Round ligament.
72
What does the ligamentum teres divide?
The Left lobe into medial and lateral segments.
73
Can the ligamentum teres be identified on UT?
Yes.
74
What is the ligamentum venosum?
It is the obliterated remnant of the ductus venosus of the fetus, it runs posteriorly from ligamentum teres at level of porta hepatis on the visceral surface of the liver.
75
What does the ligamentum venosum divide?
The left lateral lobe and the caudate lobe of the liver.
76
What does the ligamentum venosum attach?
Attaches the inferior surface of the liver to the stomach/duodenum.
77
Can the ligamentum venosum be identified on UT?
Yes
78
What is a fissure?
A groove/cleft or deep furrow in an organ that forms a natural division.
79
What does the right intersegmental fissure divide?
The right lobe into anterior and posterior segments.
80
What travels through the right intersegmental fissure fissure superiorly?
Right hepatic vein
81
What courses through the right intersegmental fissure inferiorly?
Right portal vein
82
What are the two other names for the main lobar fissure?
1) Middle intersegmental fissure
| 2) Interlobar fissure
83
What does the MLF divide?
The functional right and left lobe
84
What travels through the MLF superiorly?
Middle hepatic vein
85
In transverse plane, what does the MLF line up with?
Line from the gall bladder to the IVC
86
What does the MLF look like and where can it be found on UT?
In a sagittal plane the MLF can be seen as a hyperechoic line superior to the gallbladder neck extending to the right portal vein.
87
What does the left intersegmental fissure divide?
The medial and lateral segments of the left lobe.
88
How is the left intersegmental fissure divided?
Into thirds.
Cranial, middle and caudal.
89
What structure is found in the cranial portion of the left intersegmental fissure?
Left hepatic vein
90
What structure is found in the middle portion of the left intersegmental fissure?
The anterior portion of the left portal vein
91
What structure is found in the caudal portion of the left intersegmental fissure?
The ligamentum teres
92
Where do they hepatic veins drain blood?
From the liver into the IVC
93
What direction to the hepatic veins travel?
They course from an inferior-anterior aspect of the liver to the superior-posterior aspect and into the IVC.
94
How many hepatic veins are there?
Three
Right, middle and left
95
How common are accessory hepatic veins?
30% of the population
96
Where do the hepatic veins join the IVC?
Just inferior to the diaphragm
97
Where do the hepatic veins widen?
As they approach the IVC
98
What does the right hepatic vein drain?
The right lobe
99
What does the left hepatic vein drain?
The left lobe
100
What does the middle hepatic vein drain?
The medial left lobe (quadrate) and the anterior segment of right lobe.
101
What do the hepatic veins mark within couinaud's segments?
The lateral boundaries
102
Describe the brightness of the hepatic veins?
The walls are less hyperechoic than the portal veins
103
Are the hepatic veins long or short axis in transverse/sagittal planes?
The hepatic veins are long axis in both sagittal and transverse planes because they travel obliquely through the liver.
104
How much blood does the hepatic artery supply to the liver?
20-30%
105
What/where does the hepatic artery branch from?
It is the right branch of the celiac axis, branches towards the liver.
106
What artery travels from the celiac axis to the gastroduodenal artery (GDA)?
Common hepatic artery
107
What direction does the common hepatic artery travel?
Towards the right side
108
What artery travels from gastroduodenal artery to the bifurcation of the right and left hepatic arteries?
Hepatic artery proper
109
What direction does the hepatic artery proper travel?
Courses superior and right lateral toward and into the liver.
110
What is the porta hepatis?
The entrance/exit of the liver
111
What enters/exits the liver via the porta hepatis?
Arteries, veins, ducts
112
What is another name for the porta hepatis?
The 'hilum' of the liver
113
What does the portal triad consist of?
1) A hepatic artery
2) A portal vein
3) A bile duct
114
What is the portal triad at the region of the porta hepatis composed of?
1) The hepatic artery
2) The main portal vein
3) Common Bile Duct
115
What is located anterior to the main portal vein and medial to common bile duct?
Hepatic artery proper
116
Are the right and left hepatic arteries intrahepatic?
Yes, they are within the liver.
117
What do the right and left hepatic arteries travel in unison with?
A billary duct and corresponding portal vein.
118
What does the right hepatic artery supply?
Mainly right lobe with branches to caudate
119
What does the left hepatic artery supply?
Mainly left lobe
120
How much nutrient rich blood does the portal system supply the liver with?
70-80%
121
Where does the portal system receive it's nutrient rich blood from?
The gastrointestinal (GI) system
122
Is the blood from the portal system high in oxygen or low?
Low because it drains from gastric but nutrient dense.
123
Do vessels of the portal system connect directly to the IVC?
No!
124
Where does the blood from the portal veins flow?
Toward and within the lobes of the liver
125
What forms the main portal vein?
The union of the superior mesenteric vein (SMV) and the splenic vein (SV)
126
Where is the main portal vein formed?
Behind the neck of the pancreas at the level of L2
127
How do portal veins differ from the hepatic veins on UT?
The portal veins have bright vessel walls
128
What does the superior mesenteric vein drain?
The small intestine (right side), ascending colon and transverse colon.
129
What direction does the SMV course?
Superiorly
130
What vessel does the SMV meet superiorly and where?
The SMV meets the splenic vein at the portal confluence
131
What happens to the distal end of the SMV?
It terminates posterior to the pancreatic neck
132
Where is the SMV located to the SMA?
The SMV is located to the right side of the SMA
133
What does the splenic vein drain?
The spleen, other tributaries from pancreas and stomach
134
What is the portal confluence?
The junction of the SMV with SV.
Origin of the main portal vein.
135
How does the portal confluence appear on UT?
It's a widened area seen in the transverse plane
136
Where does the splenic vein travel?
Travels along the posterior surface of the pancreatic body and tail.
137
Where does the splenic vein meet the SMV?
The SV courses from the hilum of the spleen to meet the SMV on the right side of the midline
138
What direction does the splenic vein course towards the splenic artery?
Inferior
139
Where does the splenic vein terminate?
Behind the neck of the pancreas
140
What is the splenic vein located anterior to?
Aorta, IVC, SMA and renal vessels
141
What does the Inferior mesenteric vein drain?
The left side of the small bowel, descending colon, sigmoid and rectum.
142
Where does the IMV join the splenic vein?
Posterior to the body of the pancreas (left of midline).
143
Is the IMV seen on UT?
Rarely.
144
Look at UT pictures in notes.
.
145
Where is the origin of the main portal vein?
Junction of the SMV and SV
146
Where is the main portal vein formed?
Behind the neck of pancreas
147
Describe the travel of the main portal vein.
Ascends obliquely towards the right side of the body and enters the liver at the porta hepatis
148
Where is the main portal vein in reference to the hepatic artery proper?
Posterior
149
Where is the main portal vein located in reference to the CBD and CHD billary ducts?
Posterior
150
What happens to the main portal vein at the liver hilum?
It bifurcates into the left and right portal veins.
151
Where is the main portal vein in reference to the duodenum?
Posterior
152
Where is the main portal vein located in reference to the IVC?
Posterior
153
What encloses the main portal vein?
The free edge of the lesser omentum
154
How does the right portal vein divide?
Divides into anterior and posterior branches within the right lobe of the liver.
155
How does the left portal vein travel?
Ascends anteriorly
156
How does the left portal vein divide?
Divides into medial and lateral branches within the left lobe of the liver.
157
What type of blood supply does the liver have and what makes it up?
Dual
The hepatic artery and the portal vein.
20-30% from hepatic artery
70-80% from portal vein
158
What does the biliary system do?
Produces, concentrates, secretes and transports bile from liver to the duodenum
159
Where is bile formed?
In the liver cells and drains through the ducts
160
What is bile used for?
Digestion of fatty foods.
161
Where is the biliary system located?
Right upper quadrant, right hypochondrium, epigastric region
162
What is the purpose of the gall bladder?
Storage of bile
163
Is any bile produced in the gall bladder?
NO
164
What is the shape of the gallbladder?
Oblong, pear
165
Where is the gall bladder in reference to the peritoneum?
Intraperitoneal
166
Is the gall bladder attached to anything?
Peritoneum binds the neck and body of the gallbladder to the liver.
167
Is the gallbladder a landmark?
Yes, it is the anterior landmark dividing the left and right lobe of liver.
168
What does the gallbladder line up with?
The main lobar fissure
169
Where does the gallbladder lie in reference to the IVC?
Lateral to IVC
170
Where does the gallbladder lie in reference to the right kidney?
Medial to the right kidney
171
How is the gallbladder divided?
Neck, body and fundus
172
What is a good way to optimize an image of the gallbladder?
Fasting, patient will be less gassy and the gallbladder will be full of bile and easy to see.
173
Describe the "neck" of the gallbadder.
Narrow, superior portion of gallbladder that is fixed in place.
174
What part of the gall bladder does the main lobar fissure extend from?
MLB extends from neck of the gallbladder to the RPV.
175
What is the body of the gallbladder?
The middle portion between the neck and the fundus
176
What is the fundus of the gallbladder?
The mobile inferior and anterior portion of the gallbladder.
177
Where can the gall bladder sometimes extend?
Beyond the inferior margin of right lobe of liver
178
What is a phrygian cap?
A normal variant in the gallbladder where there is a fold in the fundus.
179
What are junctional folds?
Normal variants in the liver where there is a fold at the junction of the neck and body.
180
What is a hartmann pouch?
Small posterior pouch near gall bladder neck.
181
What is the duct system?
A pathway way of ducts collecting and transporting bile secreted by the liver to the small intestine.
182
How is the duct system subdivided?
Intrahepatic and extrahepatic ducts
183
What is the ductal network that has several branches along it's bath called?
Biliary tree
184
What are intrahepatic ductules?
Very small bile ducts within the liver collecting bile secretions from liver tissue
185
In what direction do intrahepatic ductules get larger?
Along the biliary tree
186
What course do the intrahepatic ductules follow?
The course of the portal veins and hepatic arterial branches.
187
Are intrahepatic ductules seen on UT?
Rarely in normal conditions.
188
What makes up the portal triad?
1) Hepatic artery
2) Portal Vein
3) Bile duct
189
Where does the right hepatic duct collect bile from?
Right lobe of liver
190
Where foes the left hepatic duct collect bile from?
Left lobe of liver
191
Where do the right and left hepatic ducts join?
Roughly at the hilum (porta hepatus)
192
What is the RHD? LHD?
Right hepatic duct
Left hepatic duct
193
What is the CHD?
Common hepatic duct
194
Where is the common hepatic duct formed?
At the junction of left and right hepatic ducts
195
What does the distal segment of the CHD course alongside?
The anterior aspect of the right/main portal vein.
196
Where does the common hepatic duct terminate?
At the junction of the cystic duct
197
Is the common hepatic duct seen with UT?
Not usually
198
What does the cystic duct do?
Drains the gallbladder
199
What does the cystic duct contain?
Spiral valves of Heister
200
What are the spiral valves of Heister?
They are mucosal folds that provide structural support
201
Do the spiral valves of Heister act as "true valves" and control flow?
No, they just provide support.
202
What does the cystic duct merge with to form the Common Bile Duct?
The Common hepatic duct
203
What is the common bile duct formed by?
The union of the cystic duct and the common hepatic duct
204
Is the cystic duct seen by UT?
Rarely
205
Where does the common bile duct travel?
The CBD travels inferiorly toward the head of the pancreas to join the pancreatic duct
206
What does the junction between the pancreatic duct and the common bile duct form?
The ampulla of Vater
207
What does the ampulla of vater do?
Dumps bile into the duodenum via the sphincter of Oddi
208
What controls the flow of bile into the duodenum?
The sphincter of oddi
209
What is the difference between the ampulla of vator and the sphincter of oddi?
The ampulla of vator is the door frame (hole) into the duodenum and the sphincter of Oddi is the door.
210
How long is the common bile duct?
6-8 cm long
211
What lies posterior to the common bile duct?
The main portal vein
212
What lies medial to the common bile duct?
The hepatic artery proper
213
What does the distal common bile duct travel alongside?
The posterior aspect of the head of pancreas
214
What is the pancreas?
An elongated, lobuar gland
215
What does lobular mean?
Lumpy/bumpy
216
How does the pancreas lie?
Generally transverse and oblique across the midline and extends towards the spleen.
217
What area/level is the pancreas?
Transpyloric level
Pylorus region (epigastric)
218
Does the pancreas have a capsule?
No and it is difficult to distinguish on UT because of it.
219
Where is the pancreas in reference to the peritoneum?
Retroperitoneal except for a small part of the tail.
220
What types of glands does the pancreas have?
Endocrine and exocrine
221
How much of the pancreas is exocrine?
99%
222
How much of the pancreas is endocrine?
1%
223
What do the exocrine glands do?
The acini cells secrete enzymes to assist in digestion.
224
What do the endocrine glands do?
Islets of the langerhans cells secrete hormones (insulin and more) into the blood stream to regulate blood sugars
225
What does the duct system in the pancreas transport?
Bile and pancreatic juices to the duodenum
226
What location is the pancreas found in?
RUQ, LUQ, epigastric and hypochondrium regions.
227
Describe the shape of the pancreas?
It varies.
Can look like a boomerang, sausage, dumbell and tadpole.
228
What is the head of the pancreas?
Bulbous portion of pancreas
229
Where is the head of the pancreas located in the body?
Right of midline
230
What is the head of the pancreas surrounded by?
Four parts of the duodenum
231
Describe the lateral head edge of the pancreas?
The head is cradled by a medial curve of descending duodenum.
232
Describe the medial edge of the pancreas head?
It is marked by the SMV and the neck of pancreas
233
What vessel lies posterior to the head of the pancreas?
IVC
234
What vessels travel posterior to the head of pancreas?
Right renal artery and vein
235
What area does the gastroduodenal artery lie alongside of the pancreas?
The GDA lies along the anterolateral portion of the head of the pancreas.
236
What is positioned along the posteolateral aspect of the head of the pancreas?
Common Bile Duct
237
Where does the common bile duct meet the pancreatic duct?
At the ampulla of Vator within the central portion of the head
238
What is another name for the ampulla of vator?
Hepatopancreatic ampullla
239
What does the ampulla of vator drain?
Drains secretions towards the medial wall of the descending duodenum via the sphincter of Oddi.
240
What is sometimes found in the head of the pancreas?
Accessory pancreatic duct
241
What is an uncinate process?
A posteromedial extention of the pancreatic head
242
What is directly anterior to the SMV and anterior to the IVC?
Uncinate process
243
Describe the size of the uncinate process?
Varies
244
Look at diagram on PG 16 in notes.
And sketch!
245
What part of the pancreas lies directly anterior to the SMV near the portal confluence?
The neck
246
What is the most anterior aspect of the pancreas between the neck and tail?
The body
247
What is the most superior portion of the pancreas?
The tail
248
Where does the neck of the pancreas lie?
Directly posterior to pylorus of stomach
249
Where does the body of the pancreas lie posterior to?
- Posterior to the antrum of stomach
250
What 6 things does the body of the pancreas lie anterior to?
- Aorta
- SMA
- Splenic Vein
- Left renal vein
- Left renal artery
- Spine
251
What does the body of the pancreas lie inferior to?
The splenic artery
252
Which side of the SMA does the neck of the pancreas lie on?
Right side
253
What does the pancreas tail extend between?
The left lateral edge of spine to the hilum of spleen
254
Relationship between pancreatic tail and left kidney?
Tail anterior to upper/middle portion of left kidney
255
Relationship between pancreatic tail and stomach/transverse colon?
Tail is posterior to stomach and transverse colon.
256
Relationship between pancreatic tail and spine?
Tail is lateral to spine
257
Relationship between pancreatic tail and spleen?
Tail is medial to spleen
258
Relationship between pancreatic tail and splenic artery?
Splenic artery courses along superior surface of tail.
259
Relationship between pancreatic tail and splenic vein?
Splenic vein travels along mid-posterior surface of tail.
260
What is another name for the Main Pancreatic Duct?
Duct of Wirsung
261
How long is the main pancreatic duct?
Extends entire length of pancreas centrally (2mm in diameter)
262
Where does the main pancreatic duct join the common bile duct?
Head of pancreas
263
What forms the ampulla of vator?
The joining of the main pancreatic duct and the common bile duct
264
Where does the ampulla of vator drain into?
The medial wall of the duodenum via the sphincter of Oddi.
265
What is the sphincter of Oddi?
A flow control valve that allows bile, hormones, enzymes, to enter the duodenum and prevents gastric byproducts from refluxing into the biliary system
266
Can you see the main pancreatic duct on UT?
Yes, very often.
267
What is another name for the accessory pancreatic duct?
Duct of Santorini
268
What is the accessory pancreatic duct?
A normal variant, it is a secondary duct draining the upper anterior portion of the pancreatic head
269
Where does the accessory pancreatic duct enter the duodenum?
The medial aspect of the descending duodenum approximately 2cm proximal to the ampulla vater.
270
Is the accessory pancreatic duct seen on UT?
Rarely
271
Two functions of the urinary system?
1) Maintains chemical balance
| 2) Excretes liquid waste products
272
What substances does the urinary system maintain the chemical balance of?
1) Water
| 2) Electrolytes
273
What does changing the chemical balance of water and electrolytes effect?
Changes the blood pressure regulation and the pH balance
274
What structures are included in the urinary system?
Kidneys, ureters, bladder and urethra
275
How do the kidneys lie in the abdomen and at what level?
Obliquely
T12 to L4 level
276
Which kidney is higher in the abdomen? Why?
The left
The liver forces the right one down further.
277
How long is an adult kidney?
9-12 cm
278
Where are the kidneys in reference to the peritoneum?
Retroperitoneal
279
What are the psoas muscles?
Two bands of muscle that run on either side of the spine.
280
What is the lumborum?
Right and left muscle sitting posterior to the right and left kidney
281
What are the kidneys lateral to?
Spine, aorta and IVC
282
Where do the kidneys lie in reference to the psoas muscle?
Anterolateral
283
Where do the kidneys lie in reference to the lumborum muscle?
Anterior
284
Which pole of the kidney lies more posterior?
The upper
| Kidneys are tipped back into the body
285
Which pole of the kidneys lies more medial?
The upper pole
| The upper poles lean in towards eachother "talking"
286
Why do we get patients to past for kidney exams?
Lots of bowel surrounding kidneys in order to see them there can't be a lot of gas.
287
Structures anterior to RIGHT kidney?
Liver
Ascending colon
Transverse colon
Duodenum
Small bowel
Right adrenal gland
288
Stuctures anterior to left kidney?
Stomach
Descending colon
Transverse colon
Body and tail of pancreas
Small bowel
Left adrenal gland
289
What is the renal parenchyma?
Outer portion of the kidney between the renal capsule and the base of the pyramids
290
What does the renal parenchyma include?
The outer cortex and the inner medulla
291
What is the renal cortex?
Located between the renal capsule and medulla
Contains functional units (nephron)
292
What are the renal columns?
Cortex that extends between renal pyramids into medulla
293
What is another name for the columns?
Columns of Bertin
294
What is another name for medulla?
Medullary pyramids
295
What are the medulla?
Located between cortex and renal sinus
296
How do pyramids appear on UT?
Triangular shape
Hypoechoic
8-18 of them
Wide base towards cortex
Apex (tip) towards sinus
297
What is the cental/medial aspect of the kindey?
The renal sinus
298
What does the renal sinus include?
Minor calyx
Major calyx
Renal pelvis
Vessels
299
How does the renal sinus appear on UT? Why?
Hyperechoic, packed with fat.
300
Describe the minor calyx.
8-18 (same # as pyramids)
They receive the apex of the renal pyramids
301
Describe the major calyx
2-3
Receive urine from minor calyx
302
What is the renal pelvis?
The flared upper portion of the ureter, it is posterior to the renal vessels.
303
Which is more anterior, renal vein or renal artery?
The renal vein is anterior to the renal artery.
304
Look at UT pictures of kidney
.
305
What are the 4 coverings of the kidney from inner to outer?
1) Renal capsule
2) Perirenal fat
3) Renal fascia
4) Pararenal fat
306
What's another name for the renal fascia?
Gerota's fascia
307
What does the renal fascia/gerota's fascia do??
Keeps kidney in place.
308
What is the normal variant of the kidney where there is a localized bulge on the lateral boarder of the left kidney?
(Spelling!!)
Dromedary Hump
309
What is the normal variant of the kidney that often indents the renal sinus and occurs in varying degree?
(Spelling!)
Hypertrophied Column of Bertin
310
What is the normal kidney variant where there is a defect located at the junction of upper and middle third of the kidney? (More often in right)
(Spelling!)
Parenchymal Junctional Defect
311
What is the normal kidney variant where the lower poles of the kidneys are fused together? (Congenital)
(Spelling!)
Horseshoe kidney
312
What is the normal kidney variant where a kidney is located outside of the renal fossa?
Ectopic Kidney
313
Look at handout of variant kidney images
.
314
What are the ureters?
Paired muscular tubes that convey urine from the kidneys to the urinary bladder
315
What direction do the ureters travel?
Inferiorly through the retroperitoneum
316
What do the ureters extend between?
From the renal hilum to the posterior portion of the bladder at trigone.
317
How do the ureters change in size?
They decrease in diameter as they course towards the bladder.
318
What area is the lower half of the ureters located in?
The pelvis
319
Where are the ureters in reference to the internal iliac artery?
Anterior
320
Where are the ureters in reference to the ovary in females?
Posterior to ovary
321
How do the ureters enter the bladder?
At an oblique angle on the posterior lateral surface
322
What can cause obstruction of ureter and consequently affect the respective kidney in females?
Pelvic pathology
323
What are the two ureteral junctions?
1) UPJ (Ureteropelvic Junction)
| 2) UVJ (Ureterovesicular Junction)
324
What is the ureteropelvic junction?
Junction of the renal pelvis and ureter
325
What is the ureterovesicular junction?
Junction between the lower ureters and bladder
326
What is the bladder?
A hollow, symmetrical muscular organ that is a reservoir for urine.
327
What are the four layers of the bladder from inner to outer?
1) mucosa
2) Submucosa
3) Muscularis
4) Serosa
328
Is the bladder fixed? If so, where?
It is relatively mobile and therefore varies in shape but it is fixed at the inferior neck (base).
329
Where is the bladder located?
Posterior to symphysis pubis and anterior to the uterus and vagina
330
What area of the bladder is covered in peritoneum?
Superior surface
331
What forms potential spaces in the pelvis?
Peritoneal reflections
332
What is the apex of the bladder?
Superior portion covered in peritoneum
333
What is the base of the bladder?
Inferior portion that is fixed
334
What is the Trigone of the bladder?
Triangular area in the base accommodating the bladder inlets and outlet.
335
What are the bladder inlets?
The ureterovescular junctions (UVJ's) and the urethra
336
What is the urethra?
Muscular tube that transports urine out of the bladder (out of the body).
337
How long is the female urethra?
4 cm long
338
How long is the male urethra?
Approx 15-20 cm
339
Where is the female urethra located?
Directly posterior to the pubic symphysis
340
What is the direction of the female urethra?
Runs obliquely inferiorly and anteriorly
341
What is the path of the male urethra?
Prostate --> urogenital diaphragm --> penis
342
Describe the adrenal glands
Bilateral, pyramid shaped "caps" on the superior pole of kidneys sitting slightly medial to the kidney
343
Where are the adrenal glands in reference to the peritoneum?
Retroperitoneal
344
Describe the structure of the adrenal glands
1) Capsule (outer surface)
2) Cortex
3) Medulla (innermost portion)
345
Describe the location of the right adrenal gland?
Posterior and lateral to IVC
Posterior and medial to right liver
346
Describe the location of the left adrenal gland?
Posterior to pancreatic tail, splenic vessels and stomach.
Lateral to aorta
347
Can you see adrenal gland on UT?
Not in adults, only in babies unless a cyst or mass occurs.
348
Where is the spleen in reference to the peritoneum?
Intraperitoneal
349
What are the functions of the spleen?
| 4
Part of body's defence system.
Produces lymphocytes, phagocytes, plasma cells and antibodies.
Filters out old Redblood cells and platelets
Blood reservoir
350
Do you need a spleen to live?
No, not essential to life
351
How does the spleen appear on UT?
Homogenous parenchyma
Smooth surfaces
Hilum
352
What is the word for the formation of new red blood cells?
| Spelling!
Hematopoiesis
353
Describe the size and shape of the spleen.
Variable on body size
Crescent or inverted comma.
Same size as left kidney
354
What is the length of the spleen in sag and transverse?
Sag - 12-13 cm
Trans - 7-8cm
355
What area is the spleen located in?
LUQ, left hypochondrium
356
Describe the splenic hilum
Structures enter/exit on the central visceral surface, no peritoneal covering at hilum.
357
What structures enter/exit at the splenic hilum?
Splenic artery, splenic vein, lymph vessels and nerves
358
What is a common splenic variant? Describe.
Accessory spleens or splenule
10% of population has them
Often found at splenic hilum
1 cm or smaller
May be multiple
Can be ectopic (brain, scrotum etc.)
359
Where is the GI tract located?
All quadrants and all regions. (Mouth to anus)
360
What are 2 other names for the gastrointestinal tract?
1) Digestive system
| 2) alimentary tract
361
What is the function of the GI tract?
Break down food, distribute and absorb nutrients and dispose of waste.
362
What are the 4 GI layers?
1) Mucosa
2) Submucosa
3) Muscularis
4) Serosa
363
How does the GI lining appear on UT?
Like a target.
All 4 layers have a different echogenicity.
364
Describe the salivary glands?
Located in mouth
Release enzymes that lubricate mouth and initiate food breakdown
365
Describe the course of the esophagus.
Extends from mouth, courses through thorax just anterior to the thoracic spine and pierces the diaphragm at T10 where it enters the abdominal cavity (stomach)
366
Where is the esophagus in relation to the aorta?
Located anterior and left of aorta.
367
What is the terminal end of the esophagus called?
GE junction
| Gastroesophageal junction
368
What is the GE junction?
"Door to stomach"
Allows food to enter stomach and prevents reflux into esophagus.
369
Where is the GE junction in reference to the diaphragm?
Inferior
370
Where is the GE junction in reference to the aorta?
Anterior and slightly left
371
Where is the GE junction in reference to the left lobe of liver?
Posterior
372
What is chyme?
The liquidy breakdown of food that moves through the intestines.
373
Where is the stomach located?
Between the esophagus and the duodenum
374
Where is the stomach located in reference to the peritoneum?
Intraperitoneal
375
What are rugae? Function?
Internal folds of stomach that increase surface area to increase absorption.
376
What is the cardia?
Entrance to the stomach on superior medial aspect of organ
377
What is the fundus of the stomach?
Rounded portion above the GE junction
378
What is the body of the stomach?
Major portion of stomach, between fundal and pyloric region.
379
What is the pylorus?
Lower section of stomach between the body and duodenum
380
How is the pylorus divided?
2 Parts:
Antrum
Canal
381
Describe the antrum of the stomach?
Wider portion, near midline of body.
382
What level of the body is the antrum and canal located at?
L1-L2
383
Describe the stomach canal
Narrow portion between antrum and duodenum
Posterior to liver
Slightly right of midline
384
What part of the stomach is anterior to the pancreatic body?
Antrum of the pylorus
385
What part of the stomach is anterior to the pancreatic neck?
Pylorus canal
386
What part of the stomach communicates with the 1st part of the duodenum?
Pylorus canal
387
Describe the greater curvature of the stomach
Marks the left border of the organ
388
Describe the lesser curvature of the stomach
Marks the right border of the organ
389
What does the lesser curvature of the stomach extend between?
Cardiac orifice and the pyloric orifice
390
What is the site of attachment of the lesser omentum to the liver?
The lesser curvature of the stomach
391
How long is the small intestine?
6-7 meters
392
Where is the small intestine found?
RLQ and LLQ
393
What are the three parts of the small intestine?
1) Duodenum
2) Jejunum
3) Ileum
394
What is the shortest portion of the small intestine?
Duodenum
395
Describe the duodenum?
Found in epigastric region
Connects to pylorus and pyloric sphincter
Has 4 parts
396
What are the 4 parts of the duodenum?
1) Superior (bulb) 1st
2) Descending 2nd
3) Tranverse 3rd
4) ascending 4th
397
Where is the duodenum located in reference to the peritoneum?
The superior (1st) section of the duodenum is Intraperitoneal, the other three sections are retroperitoneal
398
Where is the superior duodenum located?
Intraperitoneal
Anterior to the pancreatic head
Posterior to gall bladder fundus
399
Where is the descending duodenum located?
Retroperitoneal
(Vertical portion)
Right lateral to pancreatic head
Posterior to transverse colon
400
Where is the transverse duodenum located?
Retroperitoneal
Anterior to aorta and IVC
Inferior to pancreatic head
401
Where is the ascending duodenum located?
Retroperitoneal
Inferior and medial to pancreatic head
Anterior to aorta
402
What is the jejunum?
Tightly coiled tube mainly located in the umbilical region.
403
Where is the jejunum located in reference to the peritoneum?
Intraperitoneal
404
What is the ileum?
The final and longest portion of small bowel
405
Where does the ileum terminate?
At the ileocecal junction
406
What is the ileocecal junction?
Junction of the ileum and cecum (ascending colon)
407
What is the large intestine?
Frames small bowel
Large diameter
Has haustra and multiple divisions
408
What are haustra?
Puckered sacs along the length of colon
409
What are the divisions of the large intestine?
1) cecum
2) colon
3) sigmoid
4) rectum
5) anus
410
What is the cecum?
Pouch like portion at origin of ascending colon
Located in RLQ
RT iliac region
411
What extends from the inferior portion of the cecum?
Appendix
412
What is the appendix?
6-10 cm long blind tube that courses inferior and medial.
| No function.
413
What are the 4 sections of the colon?
1) Ascending
2) Transverse
3) Descending
4) Sigmoid
414
Describe the ascending colon.
Superior path along right flank.
Retroperitoneal
Hepatic flexure
Bends 90 degrees to connect to transverse
415
Describe the transverse colon
Travels horizontally along midline
Extends from hepatic flexure to splenic flexure
Intraperitoneal
416
What is the hepatic flexure?
90 degree turn connecting ascending colon and transverse colon beside the liver
417
What is the splenic flexure?
90 degree turn connecting the transverse colon and descending colon beside the spleen
418
Describe the descending colon
Starts at splenic flexure and travels inferiorly along left flank.
Retroperitoneal
419
Whish is more superior the hepatic flexure or the splenic flexure?
Splenic because the liver forces the hepatic downwards
420
Describe the sigmoid colon
S-shaped terminal end of colond
Left inguinal and supraphrenic region
421
Describe the location of the rectum?
Located in the true pelvis (pubic region)
Posterior to the bladder and uterus in females.
