At what level does the abdominal esophagus begin? End?
Through what part of the diaphragm does the IVC pass through?
- Central tendon (through cavel opening)
Why is the cavel opening called an opening? Why are the aortic hiatus and esophogeal hiatus called hiatus?
- The IVC passes through the central tendon of the diaphragm, a tendon NOT a muscle, therefore termed opening
- The aorta and esophagus pass through muscles and are therefore termed hiatus
What spinal nerves supply the genitofemoral nerve?
Where does the sigmoid colon start? End?
- Iliac crest
What passes through the female inguinal canal?
- found ligament of uterus
- ilioinguinal n.
- genital branch of genitofemoral n.
- lymphatic vessels
Why are lymph vessels which travel through the inguinal canal important?
- important due to metastasis of cancer through these vessels
Name the second segment of the liver as if it was pinned on the practical test.
- Segment II, left lobe of liver
What are the KEYWORDS to remember and NOT confuse relating to the liver?
How many functional PARTS of the liver are theirDescribe the course of the superior mesenteric artery? List them.
How many LOBES of liver are there? List them
- left lobe
- right lobe
- cuadate lobe
- quadrate lobe
Which surface of the liver can all 4 lobes of the liver be seen?
- visceral surface
How many DIVISIONS of the liver are there? List them
- left lateral
- left medial
- right lateral
- right medial
How are the DIVISIONS of the liver divided?
- based on hepatic vein drainage
What constitutes a liver segment?
- an area of the liver which receives blood from a hepatic artery, hepatic portal vein, and bile duct (portal triad)
What defines a part of the liver?
- blood supply (both arterial and venous)
- bile drainage
List the hepatic veins
- left hepatic v.
- intermediate hepatic v.
- right hepatic v.
Which DIVISIONS are drained by the left hepatic v.
- left lateral division
- left medial division
Which DIVISIONS are drained by the right hepatic v.
- right lateral division
- right medial division
Which DIVISIONS are drained by the intermediate hepatic v.
- left medial division
- right medial division
Which SEGMENTS are drained by the right hepatic v.
Which SEGMENTS are drained by the left hepatic v.
Which SEGMENTS are drained by the intermediate hepatic v.
Why isn't SEGMENT 1 not considered a part of the 4 DIVISIONS of the liver?
- it drains directly into the IVC
Where do the hepatic veins drain?
How are the components of the portal triad oriented topographically? What pneumonic can help with this?
- proper hepatic artery (left)
- common bile duct (right)
- hepatic portal vein (posterior)
- LARD PP (Left Artery Right Duct, Portal Posterior)
Which segment is the quadrate lobe?
- S IV
Which segment is the caudate lobe?
- S I
What bile ducts unite to make the common hepatic duct?
- left hepatic duct
- right hepatic duct
What bile ducts unite to make the common bile duct (bile duct)?
- common hepatic duct
- cystic duct
What are the parts of the bile duct?
- supraduodenal part (above 1st part of duodenum)
- retroduodenal part (behind 1st part of duodenum)
- pancreatic part
- intramural part
Are males or females more likely to get gallstones?
What are the 4 "F's" to remember for most likely group affected by gallstones?
- Fat (obese patients)
- Fertile (premenopausal)
What is mechanical (obstructive) jaundice? Common causes?
- Jaundice caused by blockage of hepatopancreatic ampulla
- blockage of hepatopancreatic ampulla by gallstone
- compression of bile duct by tumor in head of pancreas
What are common symptoms of mechanical jaundice?
- pain in abdominal region
- white feces (due to lack of biliruben in feces)
- yellowing of skin and sclera of eyes (due to elevated bilirubin in bloodstream)
Where is the fundus of the gallbladder located according to surface anatomy?
- Right MCL
- 10th costal cartilage
Where is the bare area of the liver located?
- between the layers of the coronary ligament
What are the layers of the coronary ligament?
- hepatophrenic ligament (ant. layer)
- hepatorenal ligament (post. layer)
What are the adjacent structures related to the bare area of the liver?
- right kidney
- right suprarenal gland
Name the 4 portal systemic anastomoses
1. esophophogeal vv. draining into azygos vein (systemic) or left gastric (portal)
2. rectal vv. between the inferior and middle vv. draining into the IVC (systemic) and the superior rectal v. (continues as superior mesentaric v.) (portal)
3. paraumbilical vv. of anterior abdominal wall (portal) anastomsing with superficial epigastric vv. (systemic)
4. colic vv. (portal) with retroperiotoneal vv. (systemic)
What may develop during portal hypertension when the paraumbilical anastomoses are dilated?
- caput medusae (varicose veins radiating outward from the umbilicus)
What may develop during portal hypertension when the esophageal anastmoses are dilated?
- esophageal varices (dilated submucosal vv. in the lower third of the esophagus)
- patients have a strong tendency to develop bleeding which is often severe and may be fatal
What are the common causes of portal hypertension?
- cirrhosis due to:
- alcohol abuse
Is the pancreas an exocrine gland or an endocrine gland?
What are the functions of the pancreas?
- Exocrine: secrete digestive juices (pancreatic juice) into the duodenum through the major duodenal papilla (main pancreatic duct) or minor duodenal papilla (accessory pancreatic duct)
- Endocrine: release of hormones directly into the bloodstream (insulin) (glucagon) for regulation of blood glucose
What is the eponym for the main pancreatic duct? Accesory pancreatic duct?
- duct of Wirsung
- duct of Santorini
Is the pancreas intraperitoneal or retroperitoneal?
- head, neck and body of pancreas are secondarily retroperitoneal
- tail of pancreas is intraperitoneal
Within what ligament is the tail of pancreas located?
- splenorenal (lienorenal) ligament
How many sphincters are located in the area of the hepatopancreatic ampulla? What are there functions?
- sphincter of pancreatic duct (prevents reflux of bile into pancreatic duct)
- sphincter of bile duct (controls flow of bile)
- sphincter of hepatopancreatic ampulla (prevents contents of duodenum from entering the the ampulla)
What is the eponym for the hepatopancreatic sphincter?
- sphincter of Oddi
Is the spleen intraperitoneal or retroperitoneal?
Where is the spleen not surrounded by peritoneum?
- its hilum
What ribs are associated with the spleen?
- left ribs 9 to 11
Is damage of the spleen life-threatening? Can a person live without the spleen?
- yes to both
- damage to the spleen usually results in massive bleeding which can be fatal if left untreated
- if spleen cannot be repaired it can be safely removed without extreme issue to the patient
What are the consequences of a splenectomy to the patient?
- increased vulnerability to certain diseases such as pneumonia, meningitis, and malaria