100 Concepts (41-50)

Which portions of the intestines can often times rotate around its mesentary

Jejunum

Ileum

Sigmoid

Volvulus results in

avascular necrosis

Rare congenital abnormality that results in intestinal obstruction (megacolon) because of congenital absence of postganglionic parasympathetic neurons inside the wall of the large intetine

Hirschsprung's disease

Location of the myenteric plexus

Smooth muscle wall of the intestines

Reason for Hirschsprung's disease

Defective migration or differentiation of neural crest cells

What syndrome is commonly associated with Hirschsprung's disease

Down syndrome

In a newborn, what are the chief signs and symptoms of Hirschsprung's disease

Failure to pass a meconium stool within 24-48 hours after birth

Reluctance to eat

Bile-stained (green) vomit

Abdominal distension

Treatment of Hirschsprung's disease

Removal of aganglionic portion of the colon

Celiac trunk originates from what level

aorta at the lower border of the T12 vertebrae

Superior mesenteric artery originates at what level

Lower border of L1 vertebrae

Inferior mesenteric artery originates at what level

L3

2 terminal branches of the aorta (common iliac arteries) originate at what spinal level

L4

Branches of the celiac artery (trunk)

Left gastric

Common hepatic

Splenic artery

What does the left gastric artery supply

Lesser curvature of the stomach

Esophagus

Branches of the left gastric artery

Esophageal branches

Gastric branches

What does the left gastric artery anastomose with

Right gastric artery

The common hepatic artery supplies

Superior surface of the 1st part of the duodenum

Common hepatic artery branches

Proper hepatic artery

Gastroduodenal artery

Proper hepatic artery branches

Right gastric artery

Right hepatic artery

Left hepatic artery

Which artery ascends with the hepatoduodenal ligament to reach the lesser omentum

Proper hepatic artery

Branch of the right heptic artery

Cystic artery

What does the right gastric artery supply

Right side fo the lesser curvature of the stomach

Gastroduodenal artery branches

Right gastroepiploic artery

Superior pancreaticoduodenal artery

What does the right gastroepiploic artery supply

Greater curvature of the stomach

What does the superior pancreaticoduodenaal artery supply

Head of the pancreas

Collateral circulation to the liver if the hepatic artery is ligated

Left and right gastric arteries

Left and right gastroepiploic arteries

Gastroduodenal arteries

Where can the right hepatic artery be mistakenly ligated when completing a holecystectomy

Calot triangle

If the cystic artery and right hepatic artery are ligated, what can occur

Right lobe hepatic necrosis

Location of the splenic artery

Upper border of the pancreas

Behind the peritoneum of the posterior wall of hte lesser sac

Splenic artery may be subject to erosion by a

penetrating ulcer of the posterior wall of the stomach into the lesser sac

When does the pancreas not become retroperitoneal

Reaches the tail of the pancrease where it enters the splenorenal ligament

branches of the splenic artery

Lenial

Neck, body, and tail of the pancreas

Left gastroepiploic

Short gastric

What do the short gastric arteries supply

Fundus of the stomach

Superior mesenteric artery branches

Inferior panceraticoduodenal arteries

Jejunal branches

Ileal branches

Ileocolic artery

Right colic

MIddle colic

Branches of ileocolic artery

Ascending branch

Anteiror cecal artery

Posterior cecal artery

Appendicular artery

Branches of inferior mesenteric artery

Left colic artery

Sigmoid artery

Superior rectal artery

The branches of the superior mesenteric artery and inferior mesenteric artery are interconnected at the level of the colon by what

Marginal artery of Drummond

Frequent cause of chronic mesenteric ischemia

Atherosclerosis

Mesenteric ischemia usually involves

superior mesenteric artery and small intestine

Which portions of the intestines are at most risk of mesenteric ischemia

Those far away from anastomoses (jejunum and ileum)

Patient population at high risk for mesenteric ischemia

>60 years

Smoking

High cholesterol

Location of the gallbladder

Fossa on the visceral surface of the liver right side of the quadrate lobe

What does the cystic duct join and form

Common hepatic duct forming the common bile duct

What forms the common hepatic duct

right and left hepatic ducts

Location of portal triad

hepatoduodenal ligament

What does the common bile duct join and form

Pancreatic duct hepatopancreatic ampulla

Where does the hepatopancreatic ampulla terminate

Sphincter of Oddi

Where is the sphincter of Oddi located

Posteromedial wall of the second part of the duodenum

Narrowest part of the hepatopancreatic ampulla

Distal

Common site for gallstone impactions

Distal portion of the hepatopancreatic ampulla

A stone lodged in the cystic duct may cause

biliary colic

A stone lodged in the common hepatic, bile, and duodenal papilla may cause

Scleral icterus and jaundice

T/F: Gallstones in the cystic duct will cause jaundice

FALSE

If gallstones erode through the posterior wall of the gallbladder, where might they end up

Transverse colon

If gallstones erode through the body of the gallbladder through the posterior wall, where might they end up

Duodenum

Sensory innervation of the liver by which nerve

right phrenic nerve

Pain of the liver may radiate to

Right shoulder

Liver has parasympathetic innervation from what nerve

Vagus (CN X) from celiac plexus

Sympathetic fibers of preganglionic neurons have what spinal segments

T5-T9

Major cause of portal-systemic anastomoses

Portal hypertension

Treatment fo portal hypertension

Extrahepatic portocaval shunt (splenic vein anastomoses to left renal vein after removing the spleen)

Shunt between the portal vein and hepatic veins

intrahepatic portocaval shunt

Metastases of the large intestine typically reach the liver via

portal venous system

Common anastomoses when blood undergoes retrograde movement in portal hypertension

Esophageal veins

Paraumbilical veins

Rectal veins

What veins are implemented in esophageal anastomosis

Left gastric vein

Azygous vein

Esophageal anastomoses can result in

Esophageal varices and hematemesis

Umbilical anastomoses implement which veins

Paraumbilical veins

Superior and inverior epigastric veins

Clinical manifestation of umbilical anastomoses

Caput Medussae

Veins implemented in rectal anastomosis

Superior rectal vein

Inferior rectal vein

Clinical manifestations of rectal anastomoses

Internal hemorrhoids

Bleeding per anus

Carcinoma of what part of the pancreas usually results in obstructive type jaundice

Head

Pain in the pancreas is conveyed to sensory neurons where

T5-T9 dorsal root ganglia via celiac plexus and greater splanchnic erve

What structure is posterior to the neck fo the pancrease

Portal vein

What forms the portal vein

Splenic vein

Superior mesenteric vein

The body of the pancrease asses anterior to

aorta

left kidney

plenic vein

Tail of the pancreas enters what ligament

Splenorenal

Only part of the pancreas that is intraeritoneal

Tail

The tail of the pancreas contains lots of _____ resulting in sugar diabetes if it is accidentally removed in a splenectomy

endocrine cells

Arterial supply to the head of the pancreas

Superior pancreasticoduodenal arteries

Inferior pancreasticoduodenal arteries

Arterial supply to the neck, body, and tail of the pancreas

Pancreatic branches of splenic artery

Malformation of the pancreas resulting in ventral and dorsal pancreatic buds forming a ring around the duodenum causing an obstruction of the duodenum and polyhydramnios

Annular pancreas

Symptoms of annular pancreas

Feeding intolerance in newborns

Fullness after eating

Nausea and bile-staining vomiting

What can cause spleen rupture

left 9th & 10th rib fractures

blunt trauma

Spleen is a _____ organ in the upper left quadrant

Peritoneal

Spleen follows the contour of what rib

10th

When blood is collected deep to the diaphragm, what nerve is irritated and where is pain referred

Phrenic nerve, left shoulder

T/F: When the spleen is ruptured, you cannot suture it and it must be removed

TRUE

Which rib is the border between the spleen and upper pole fo the left kidney

11th

Normal length of the kidney

11-12 cm

Normal width of the kidney

5-6 cm

Normal thickness of the kidney

2-3 cm

What spinal level is the hilum of the kidney located

L1

What structures are anterior to the right kidney

Right suprarenal gland

2nd part of the duodenum

Right lobe of the liver

Right colic flexure

Small intestine

What structures are anterior to the left kidney

Left suprarenal gland

Stomach

Spleen

Body of pancreas & splenic vessels

Descending colon

Small intestine

What structure encloses the perinephric fat

renal fascia

What is enclosed in renal fascia

Suprarenal glands

Perinephric fat

Most infections of the perinephric space occur secondary to

Ascending UTI associated with nephrolithiasis or tuberculosis

Perinephric abscess typically descends down between 2 sheets of renal fascia along the ______

psoas major muscle

If there is an abscess located behind he psoas major muscle, what may be affected

Hip joint

If a perinephric abscess ascends, what structures may be affected

Diaphragm and phrenic nerve resulting in shoulder pain