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Unit 1 Exam Flashcards

1
Q

8 Segments of the Liver

Know basic

A

The three hepatic veins are the longitudinal boundaries.

The transverse plane is defined by the right and left portal pedicles.

The caudate lobe (segment I) is situated posteriorly. Segment I includes the caudate lobe.

Couinauds’s system provides the anatomic basis for hepatic surgical resections. By using this system, the radiologist may be able to precisely isolate the location of a lesion for the surgical team. The description of the liver segments is based on the portal and hepatic venous segments.

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2
Q

8 Segments of the liver

A

The caudate lobe (segment I) is situated posteriorly.

Segments II and III include the left superior and inferior lateral segments.

Segments IVa and IVb include the medial segment of the left lobe. Segments V and VI are caudal to the transverse plane.

Segmebts VII and VIII are cephalad to the transverse plane.

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3
Q

Abdominal Aorta location

A

Begins approximately 25cm above Transpyloric line or at aortic hiatus in diaphragm

Left of midline

As it descends assumes a more midline path

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4
Q

Abdominal Muscles

A

Rectus Abdominus

External Obliqu

Internal Oblique

Transverse

Psoas Major

Quadratus Lumborum

Iliacus

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5
Q

Ant. Abdominal Wall Muscles read

A

Arrangement of these muscles provide support for abd. Viscera and prevents tearing of the muscles themselves

The muscles work posturally by contracting and may flex the spine (rectus abdominis, obliques working both sides at once) or twist the spine (individual obliques or opposite internal/external obliques working together).

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6
Q

Anteriolateral wall muscles know

A

The muscles of the anterior and lateral abdominal walls include the external oblique, internal oblique, transversus, rectus abdominis, and pyramidal is(*)

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7
Q

Aortic Bifurcation where does it occur

A

Occurs approximately L4 Right and Left Common iliac arteries

Further divides at L5 and sacrum, to internal and external branches

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8
Q

Aortic Branches read

A

Celiac Axis 1-2 cm long

Divides into hepatic

splenic, LGA

Hepatic Artery directed to right and enters liver thru the Porta Hepatis

Splenic Artery directed to the left, behind stomach and anterior border to part of pancreas, enters spleen thru the hilum

LGA, smallest often arises off splenic artery, directed to left to supply cardiac region of stomach, anastomose with RGA and branch of Hepatic Artery

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9
Q

Biliary Tree

A

Biliary Ducts originate in hepatocystes

  • *function Regulates flow**
  • *Transports to intestine**

Liver secretes 1-2 liters of bile per day

Right and left hepatic ducts exit the liver… (in region of porta hepatis)

Combine to form common hepatic Duct… (approx 4mm in diameter, then descends within edge of lesser omentum

Cystic duct joins CHD….

Common bile duct… (max. diameter of 6mm)

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10
Q

Body of the pancreas

A

Posterior surface rests on anterior surface of the SMA, SA, Lt Adrenal, Lt kidney and its vessels

Seperated from Stomach by the omental bursa

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11
Q

Branches and Bifurcations

A

From superior to inferior

Celiac axis

SMA

Renal arteries

R and L gonadal

Lumbar arteries*

IMA

Bifurcation

Median Sacral Artery

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12
Q

Branches of Aorta

A

Superior Mesenteric Artery

Arises just inferior to CA

L1

Branches and anatomizes with small intestine, supplies cecum, ascending colon and transverse

LRV between SMA and Aorta

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13
Q

CAUDATE LOBE OF LIVER read

A

Situated upon the posterior surface of right

lies opposite T11-12

Bounded anteriorly and caudad by the porta

bounded posterior by IVC

Bounded on left by Lt Sagittal Fossa

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14
Q

Common bile duct

A

First part lies in rt free edge of lesser Om.
Second part is located posterior to 1st part
of duodenum
Third part lies in a groove on posterior
surface of pancreas head
End then pierces 2nd part of duodenum
Joins pancreatic duct thru ammpula of
Vater, sphincter of Oddi

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15
Q

Drainage of Blood Adominally

A

Anterior Abdominal Wall Main Venous Drainage Branches of superficial epigastric and lateral thoracic veins

Posterior Abdominal Wall oLumbar Veins oAzygos veins

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16
Q

Gall bladder Normal Anatomy

A

Lies of undersurface of right lobe of Liver

Lies anterior to Right Kidney

Extends from MLF to anterior free margin of the liver

Lateral to MPV

Medial to liver dome
Superior to Hepatic Flexure of Colon

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17
Q

External Oblique Muscles

A

The opposite of the internal obliques, they course downward and inward, largest and strongest abdominal muscles. They are on the surface and begin at ribs 5 to 12 and connect to the linea semilunaris.

start superior and course medial

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18
Q

External Olbique

A

Outermost layer of lateral muscles

Orignate at ribs and extend downward/medially

Terminates in a broad aponeurosis

Aponeurosis inserts on

Linea alba

Iliac crest

Pubic tubercle

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19
Q

Four Fossae

Where is it exactly?

A

1.IVC FOSSA (Right Sagittal fossa)

  1. Portal Fossa
  2. Left Sagittal Fossa

4.Gallbladder Fossa

Fossae of the RUQ/LIVER

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20
Q

Four muscles make up the anterior 5 lateral wall:

A

Rectus abdominis

External oblique

Internal oblique

Transverse abdominis

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21
Q

Gallbladder function

A

Storage and concentration of Bile

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22
Q

Gallbladder Size

Location

A

Size 8-9 cm 2-4cm in diameter -walls less than 3mm • Shape- Pear shaped Oblong

Location RUQ

Under surface of Liver

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23
Q

Greater Omentum

A

Attached to greater curvature of stomach and hangs down like an apron in space between sm. intestine and abd. wall Folded back on itself and attached to inferior border of the colon

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24
Q

Greater Sac

A

Primary compartment of peritoneal cavity Extends across anterior abdomen and from diaphragm to pelvis

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25
**Head of the pancreas**
**Broad , flattened** **Right extremity** **Lies in C of duodenum** **Small Uncinate process projects inferiorly and medially** **Rests on IVC and LRV** **SMV anterior to uncinate proces**
26
How many Quadrants are they? Name them? Whats in each quadrant?
![]() ![]()There are 4 quadrants Right Upper Quadrant ,Left upper Quadrant Right Lower Quadrant, Right Lower Quadrant Right upper quadrant – liver, part of ascending colon and transverse colon, part of duodenum, right kidney. Left upper quadrant – stomach, part of duodenum, transverse and descending colon, spleen, left kidney, Right lower quadrant – cecum and appendix, part of ascending colon, small intestines, female gonad, part of bladder Left lower quadrant – part of descending colon, sigmoid colon, small intestines, female gonad, part of bladder
27
How many regions are they? Name the regions Whats in each quadrant?
There are 9 Regions 1. Right hypochondriac region 2. Epigastric region 3. Left hypochondriac region 4. Right Lumbar region 5. Umbilical region 6. Left lumbar region 7. Right Illiac region 8. Hypogastric region 9. Left Illiac Region
28
If liver resection is needed for removal of tumor what do we need to know?
**it is important to know the tumor(s) location in relation to the hepatic vessels** Liver resections must follow the hepatic veins to preserve venous outflow and the portal veins and hepatic arteries to provide vascular inflow. Furthermore, bile ducts must be preserved to provide biliary outflow.
29
Illiacus muscle read
Large triangular sheet of muscle Located in the iliac fossa on the medial side of wings the ilium Located in false pelvis not abdomen Close realtinship to Psoas inferior to Psoas major Can be referred to as iliopsoas when assoc with psoas Extends the length of the iliac fossa. The psoas muscle passes through the iliac fossa medial to the iliacus. The psoas and iliacus muscles merge as they extend into the true pelvis. The iliopsoas muscle takes on a more anterior location caudally to lie along the lateral pelvic side wall.
30
Inferior Vena Cava
Originate anterior to L5 by joining of common Iliacs veins Receives tributaries as it ascends Goes posterior to Liver Enters chest thru Caval hiatus (T8)
31
Inferior Vena Cava Fossa read
Short depression of posterior surface between caudate lobe and bare area of the liver. Separated from the porta by the caudate lobe Holds the IVC
32
Internal Oblique
Extends opposite to External Upward and medially Fibers runs perpendicular to external Extends from the iliac crest to inferior borders of the ribs Sandwiched in the middle between the external obliques and the transversus abdominis, the internal obliques begin from the side of the hip crest and the inguinal ligament, and connect with the linea semilunaris
33
Intraperitoneal Organ: Liver
**The surface of the liver in enclosed by peritoneum except the “Bare Area”, which is the posterior surface that comes in contact with the Diaphragm.  Bare area is bordered by Coronary Ligaments (peritoneal reflections)**
34
Kidney a Retroperitoneal space
• Kidneys **Kidneys lie in the retroperitoneum** in the paravertebral gutters of the posterior abdominal wall. Some refer to the as the lying in the flanks. Retroperitoneal organs
35
Kidney Anatomy read
**HILUM** Slit located medially in kidney Right at level of L1 Left at the level of L1/L2 Structures pass to and from kidney thru this Pelvis most anteriorly and renal vein posteriorly with the artery lying between. Lymph and nerves also enter at the hilum
36
Kidney Lies
They lie obliquely with the upper poles more medial/posterior than the lower poles.
37
Kidney parts
Two main portions PARENCHYMA- Outer portion SINUS- Inner Portion
38
KIDNEY SIZE
Size • Length- 9-12cm Wide 5-6cm A/P 3.5cm Extend the length of approximately 3 and a half vertebrae. Usually at level of T12-L4
39
Kidneys
The kidneys are essentially regulatory organs which maintain the volume and composition of body fluid by filtration of the blood and selective reabsorption or secretion of filtered solutes
40
Kidneys
The kidneys are essentially regulatory organs which maintain the volume and composition of body fluid by filtration of the blood and selective reabsorption or secretion of filtered solutes
41
know the bilirary metabolism
see lecture
42
LEFT LOBE Read
Contains medial and lateral segments Medial segment often referred to as the quadrate lobe Smaller and flatter than right situated in epigastrium and Lt Hypochondria Upper surface convex and molded onto diaphragm Under surface presents the gastric impression and omental tuberosity
43
**Left Sagittal Fossa** **know** sepates what?
**Fossa of the RQU/LIVER** **Separates right /left lobes** **Holds the falciform ligament** Porta joins at rightangle and divides in 2 parts Holds the falciform ligament Falciform liagment telescopes into ligament of terres inferiorly Recanilization of Umb vein would occur in this fossa
44
Lesser Omentunm
Slings the lesser curvature of stomach to the undersurface of the liver Gastrosplenic omentum ligament connects stomach to spleen
45
Lesser Sac
Extensive peritoneal pouch located behind the lesser omentum and stomach Extends upward to diaphragm and inferior between the layers of the greater omentum
46
Ligamentum teres
(LT, arrows) appears as a bright echogenic focus in the left lobe of the liver on a transverse image.
47
List the functions of the liver
1. Formation of Bile 2. Activity of Reticulo-Endothelial Tissues 3. Metabolism of Carbs, Lipids, Proteins for preparation and excretion. 4. Storage Depot 5. Blood Reservoir 6. Heat Production 7. Detoxification 8. Lymph Production
48
Name the liver lobes
Left lobe, Right lobe, Caudate lobe, Quadrate lobe
49
LOCATION OF Kidneys
Kidneys lie in the retroperitoneum in the paravertebral gutters of the posterior abdominal wall. Some refer to the as the lying in the flanks. • Retroperitoneal organs
50
Location of the liver
The liver occupies most of the Rt. Hypochondrium, the epigastrium, and extends into the left hypogastrium. May extend to the Left Mamillary line. The Liver is an Intraperitoneal Organ
51
Main Lobar Fissure
Main lobar fissure (MLF) extends between the long axis neck of the gallbladder (GB) and the main portal vein (PV) on the longitudinal image. B, Falciform ligament extends from the umbilicus to the diaphragm in a longitudinal plane.
52
Mesentary
Two layered fold of peritoneum Attaches part of intestines to posterior abd wall and includes mesentery of small intesine, transvers mesocolon and sigmoid mesocolon
53
Mesenteric
SMA SV and Body of pancreas are anterior to SMA Inferior Mesenteric Arteries Inferior to SMA Arises off ventral surface (L3) Curves to left to supply distal transverse colon and descending, sigmoid and rectur
54
Name the land marks
Lateral Margins (costal margins) Midline (aligns with the spine) Xyphoid  Superior landmark of abd cavity Umbilicus Seperates Abd/Pelvis S-Pubis Inferior landmark
55
Name the planes and views
Anterior, posterior,superior, inferiror, Medial, lateral, proximal, distal.
56
Neck and Body
Posterior surface rests on anterior surface of the SMA, SA, Lt Adrenal, Lt kidney and its vessels  Seperated from Stomach by the omental bursa
57
Nephron
Functional unit of the kidney Consists of glomerulus, convuoluted tubules responsible for filtration of urine
58
Normal Anatomy of the liver ## Footnote **Weight and Length Which Rib**
**Right lobes exceeds the left by a 6:1 ratio** **Weight: 1400 to 1600g** **Length: us. 15-17 cm** **Lower border at costal cartilage of 8-9 rib** **Each Lobule is 1 X 2 mm**
59
OMENTUM
Two-layered peritoneum that attaches the stomach to another viscus organ Broken into Greater Omentum Lesser Omentum
60
Paired Visceral Branches
Suprarenal (L1) Renal (L2) Gonadal (inf L2) Four pairs of Lumbar Post/lateral surface L1-L4
61
Pancreas
Lies deep in the epigastrium Retroperitoneal Anterior to the prevertebral vessels Tranverse Oblique Plane
62
Parenchymal cortex in the Kidney
Cortex- outer extensions referred to as the columns of Bertin This separates the medulla into individual pyramids makes up one third of functional subunit (nephron
63
PARENCHYMA in the kidney
Parenchyma made up of an outer and inner component
64
Parietal and Visceral Layer
Parietal Portion that lines the abdominal wall Does not cover the organs Visceral Covers organs
65
Parts of Gall bladder
NECK- Lies most posterior ,Lies towards Porta BODY Largest portion FUNDUS, ies lateral, caudal and anterior to neck Often extends just inferior to liver edge
66
Peritoneal cavity?
Serous membrane Lines the abdominal cavity Covers the peritoneal organs Formed by a single layer of cells **MESOTHELIUM** Divided into two layers Parietal Visceral Potential space between the parietal and visceral layers.. Cavity that contains small amount of lubrication Serous fluid lubricates with serous fluid and helps organs move on one another without friction
67
Peritoneal Relations
Only covered with Peritoneum on it’s anterior surface Extends from duodenum to splenic hilum Divided into 3 parts
68
Porta Fossa
Short deep fissure extending transversely across under surface of left lobe Separates quadrate lobe in front (anteriorly) from caudate behind **Transmits PV( portal vein), HA (hepatic artey), BD(Bile ducts) , nerves, Lymphatic**
69
Portal Venous System
Blood from digestive system travels to liver thru Portal system of veins, prior to entering IVC to return to heart Blood from SMV joined by splenic vein enter liver as MPV IMV, usually empties into SV prior to Portal Confluence
70
Portal Venous System
?
71
Posterior Abdominal Wall Muscles
Psoas major muscle Lateral to lumbar region of Vertebra Fibers begin on Transverse processes, borders and lumbar intervertebral discs Pass along the pelvic brim Enter the thigh to insert at lesser trichinae of femur
72
Posterior View of Liver
Posterior view of the diaphragmatic surface of the liver. The caudate lobe is located on the posterosuperior surface of the right lobe, opposite the tenth and eleventh thoracic vertebrae
73
Potal Vein
Portal Vein Confluence Main Portal Vein Right Portal Vein Left Portal Vein Posterior to BD and HA Anterior to caudate lobe Surrounded by Connective tissue
74
Pre Vertebral Vessels
Arteries arising from aorta Veins draining into IVC Portal Venous System Combo Bring blood to Liver
75
PSOAS MAJOR MUSCLE
The psoas muscle extends from the mediastinum to the thigh Major are more posterior than minor Major are more superior than minor Origins at the transverse processes and vertebral bodies of T12-L5 and insertions at the lesser trochanter of the femur.
76
Quadrate lobe read
Obsolete term for medial aspect of left lobe situated on the under surface of left lobe Boudned anteriorly by the anterior margin of liver/ posteriorly by ports; right by GB fosse, and on left by Lt sagittal fossa. Oblong in shape
77
Quadratus Lumborum Muscle
This muscle originates from the iliolumbar ligament, the adjacent iliac crest, and the superior borders of the transverse process of L3 and L4 and inserts into the marg Appears lateral and posterior to psoas muscle on transverse section
78
Rectus Abdominis
On contraction, its lateral margin forms a palpable curved surface, termed the linea semilunaris, Starting from the linea alba and working out, we first come to the rectus abdominis. [Shown in the image above with black vertical arrows. This is the left side of the body.] Starting from the pubic bone, these muscles connect with the fifth, sixth and seventh ribs and xiphoid process.
79
Rectus Abdominis
This extends from the ninth costal cartilage to the pubic tubercle. The anterior surface of the rectus muscle is crossed by three tendinous intersections, These are firmly attached to the anterior wall of the rectus sheath.
80
Rectus Abdominis
Lie lateral to the linea alba Extends the length of the abdominal wall Xyphoid to SP Enclosed by a sheath Sheath formed by aponeuroses
81
Rectus Abdominis
The rectus abdominis muscle rises from the front of the symphysis pubis and the pubic crest.
82
Rectus Abdominis/ Pyramidal
The pyramidalis muscle arises by its base from the anterior surface of the pubis and inserts into the linea alba. It lies anterior to the lower part of the rectus abdominis muscle. More pelvic than abdominal
83
Rectus Abdominis
They are divided into compartments by strips of tendon that creates what body builders inaccurately call a "six pack", as there are 8 or possible 10 segments, or 4 to 5 pairs. These pairs can, if trained to do so, contract individually.
84
Relational anatomy
**Anteriorly** • Right kidney liver second portion of the duodenus ascending colon small intestinal loops Left kidney stomach pancreas and its vessels spleen splenic flexure jejunal loops
85
**Relational anatomy**
**•Superiorly** •Adrenal gland more medial on right
86
Renal Medulla
Broken into pyramids by the Columns of Bertin, the apices of the pyramids are called papillae and jut into the calyces. Pyramids radiate from sinus to outer portion of kidney Striated area contain Loops of Henle and collecting tubules Function as the proximal collecting system
87
Renal pyramids
The base of each pyramid starts at the corticomedullary border The apex ends in the renal papilla which merges to form the renal pelvis and then on to form the Uterer
88
Renal Sinus
Inner portion of kidney tissue Arises from the apices of the pyramids as cup-shaped minor calyces Each kidney has 7-14 MINOR CALYCES Each kidney has 2-3 MAHOR CALCYES Sinus- Contains, major and minor calyces, vessels, nerves, lymphatic's, proximal pelvis, and is surrounded by fat Variation of interfaces cause this portion to look highly echogenic All tissues that transport sound well, small structures beyond resolution when not dilated
89
RENAL VEINS
Renal Veins they drain directly into the IVC Left renal vein has a longer course than the right and must pass anterior to the aorta to reach the IVC. Left also receives the Inferior phrenis, adrenal and gonadal veins of that side.
90
Retroperitoneal Spaces
Anterior Pararenal space Vs Gerota’s fascia and post peritoneum Asc and Descending colon also in this area Posterior Pararenal Space vs. post renal fascia and PAW muscles only fat and vessels in this
91
Retroperiotneal area
Perirenal Space directly around the kidney enclosed by renal fascia Kidneys, adrenals, lymph nodes, vessels and perirenal fat iin this area
92
Right renal artery
has a longer course and is more inferior than the left. RRA passes posterior to the IVC Each renal artery divides into trhee branches one posterior, anterior/upper anterior lower which passes anterior to renal pelvis They then further branch and subdivide into segmental, interlobar, arcuate and interlobular arteries.
93
SACS
Greater and Lesser Sac Division of peritoneal cavity
94
See Pictures of the pancreas
cross sectional
95
Splenic vein and Artery in the pancreas
Splenic Artery runs anterior to the body and tail of the pancreas Originates superiorly as a branch of the celiac axis (aorta) Splenic Vein runs posterior to the body and tail of the pancreas Originates superiorly at splenic hilum
96
Superior Cross section
Read abt it in the lecture
97
Surrounding anatomy in the kidney
**Posteriorly** Upper third of kidney diaphragm and 12th rib and the costodiaphragmatic recess of the pleura Lower third of the kidney medial to lateralpsoas, quadratus lumborum and transverses abdominis muscles
98
Tail of the pancreas
Left extremity of pancreas ## Footnote Close proximity to splenic hilum Most superior and posterior portion of pancreas
99
Tail of the Pancreas
Left extremity of pancreas Close proximity to splenic hilum Most superior and posterior portion of pancreas
100
The hapatic veins How Many are they?
The hepatic veins are divided into three components: right, middle, and left. They all drain into the inferior vena cava at the level of the diaphragm.
101
The head of the pacreas lies where
on the duodenum
102
Transversus
The deepest muscles of the abdominal muscles, the transversus abdominis go horizontally from front to back.
103
Transversus Abdominis
Innermost of the three flat muscles Fibers pass in a horizontal direction
104
Vascular Anatomy for Liver whats Oxygenated and Deoxigenated
Receives nutrients from HA and PV **from both** **PV is 80% saturated and supplies 50-60% of oxygen** requirements **for hepatocytes** PV and HA both have echodense walls Collegen connective sheaths cause reflections. **Portal Vein walls are thicker only in that region in the liver** **HV walls less echodense (thiner)** **PV run in horizontal plane (oblique)** intralobar path HV vary in calliper with location and breathing **HV run more longitudinally between segments** **Portal Vein Bring oxygenated to the liver** **Hepatic arteries does not bring oxygenated so its deoxygenated blood in the liver ONLY IN THE LIVER** **Thought out, they normally are oxygenated but not in the liver.**
105
RETROPERITONEUM
Space posterior to Peritoneal cavity Contains the following: Kidneys **\*Uterus Ureters** **\*Duodenum** Adrenals Prostate Pancreas **\*COLON** Great Vessels Bladder
106
Vessels
Main Artery Supply Abdominal Wall mainly supplied by Internal thoracic arteries Parietal branches of Abdominal Aorta Main Artery Supply Posterior Abdominal Wall Lumbar arteries Direct tributaries of Aorta
107
**What surrounds the liver?**
**Rt. Kidney lies inferior and posterior** **Great vessels lie Posteriorly** **Portal Triad enters medially** **Pancreas lies inferior and posterior** **Left lobe of liver can serve as a window to image the pancreas**
108
Whats is the Couinaud’s hepatic segments?
**divide the liver into 8 segments.** **Each segment is independent because it has its own vascular inflow, vascular outflow, and biliary outflow...all of which are necessary to the proper functioning of the liver**
109
Where is the Fossa in the liver
Short linear depression located on posterior surface between caudate lobe and bare area of liver Separates Quadrate lobe in front from caudate lobe behind Separated from portal by caudate

Cross Sectional Anatomy (5 decks)

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