DMI 403- Chapter 7- Abdomen

fourth (ascending) portion

About to put 5 cm in length and a sense on the left side of the aorta to the level of the L2 vertebrae, where it meets up with the jejunum at the duodenojejunal flexure

Epinephrine and norepinephrine hormones

Accelerate metabolism and increase energy; are responsible for the bodies fight or flight response

Glucagon

Acting in opposition to insulin, tends to raise plasma sugar levels by increasing the rate of glycogen breakdown and glucose synthesis in the liver

Renal Fascia function

Acts as a barrier, limiting the spread of infection that may arise from the kidneys

Each ______ has an outer cortex and inner Medulla , which function independently

Adrenal gland

Glucocorticoids

Affect glucose metabolism

Quadratus lumborum muscle action

Aid in a lateral flexion of the vertebral column

Hepatic artery proper

Ascends obliquely to the right in the hepatoduodenal ligament, adjacent to the portal vein and common bile duct

Abdominal aorta bifurcation

At the level of L4, bifurcates into the right and left common iliac arteries

Bare area (of spleen)

At the splenic hilum

Spleen attachment

Attached to the greater curvature of the stomach and left kidney by the gastrosplenic and lienorenal ligaments

Lesser omentum

Attaches the duodenum and lesser curvature of the stomach to the liver

Phrenocolic ligament

Attaches the left flexure of the colon to the diaphragm

Main pancreatic duct (duct of wirsung)

Begins in the tale of the pancreas and runs the length of the gland to the ampulla of vater, where it empties, together with the common bile duct, into the duodenum through the sphincter of Oddi

Infracolic compartment

Below the transverse colon

Anterior pararenal space

Between anterior surface of renal (Gerota's) fascia and posterior surface of peritoneum

Right paracolic gutters

Between ascending colon and right abdominal wall

Left paracolic gutters

Between descending colon and left abdominal wall

Left subhepatic space

Between left lobe of liver and kidney; includes lesser omentum

Posterior pararenal space

Between posterior renal (Gerota's) fascia and muscles of posterior abdominal wall

Splenic hilum location

Between the gastric and renal depression

Body (of the stomach)

Between the two curvatures, is the largest portion of the stomach

Structures of the urinary system located in the pelvis

Bladder and urethra

IVC drainage

Carries blood to the heart from the lower limbs, pelvic organs and the abdominal viscera, and abdominal wall

Main divisions of the large intestine

Cecum, colon, and rectum

Unpaired branches of the abdominal aorta

Celiac trunk, splenic, superior mesenteric, and inferior mesenteric arteries

Sphincter of Oddi

Circular muscle fibers that surround the ends of the main pancreatic duct and common bile duct

Spiral valves of Heister

Circular muscles within the neck of the gallbladder that create spiral folds within the mucosa

In males, the peritoneal cavity is a _______ cavity.

Closed

The _____ then curves slightly to the right, away from the portal vein, then courses posterior and medial to the first part of the duodenum behind the head of the pancreas

Common bile duct

As the common hepatic duct descedst in the free border of the lesser omentum, it is joined from the right by the cystic duct to form _______

Common bile duct (CBD)

Two vessels that can commonly be seen running through the head (of the pancreas)

Common bile duct in the right posterior aspect and the gastroduodenal artery in the anterior aspect

_________ courses to the right to enter the lesser omentum anterior to the portal vein

Common hepatic artery

What marks the beginning of the extrahepatic biliary system?

Common hepatic duct (CHD)

Biliary system

Composed of the gallbladder and bile duct (both intrahepatic an extra hepatic)

Transversus abdominis action

Compresses abdominal viscera

External oblique action

Compresses abdominal viscera, flexes and rotates spine

Internal oblique action

Compresses abdominal viscera, flexes and rotates spine

renal cortex (of kidney)

Comprises the outer 1/3 of the renal tissue and has extensions between the Renal pyramids of the Medulla

Lumbar arteries

Four pairs of arteries that arise from the posterior wall of the abdominal aorta at the level of L1 - L4

Nephron

Functional subunit of the kidney, consist of glomerules and convoluted tubules, which is responsible for filtration of urine

Gallbladder function

Functions as the reservoir for storing and concentrating bile before it is transported to the duodenum

Division of the gallbladder

Fundus, body, neck

The liver is entirely covered by peritoneum except for these area

Gallbladder fossa, the surface apposed to the inferior vena cava, and the bare area

Which structures are located posterior to the stomach?

Gastric portion of the spleen, and left adrenal gland and kidney, and the body and tail of the pancreas

Branches of the left hepatic branch

Gives off artery to the caudate lobe , as well as medial and lateral segmental arteries to supply the segments of the left lobe and the intermediate branch of the quadrate lobe

Left gastroepiploic (Gastro-omental) artery

Gives off epiploic and gastric branches to the greater omentum and anterior and posterior your walls of the fundus of the stomach

Categories of the corticosteroids

Glucocorticoids, mineralocorticoids, androgens and estrogens

Parts of the peritoneal cavity

Greater sac and lesser sac (Omental bursa)

______ or _____ are useful in defining the lobe and boundaries of the hepatic segments

Grooves, fissures

The hepatic veins course from the inferior aspect of the liver to the superior aspect of the liver, where the empty into the _____ just below the diaphragm

IVC

The largest vein of the body

IVC

Venous drainage of the liver occurs via the small interlobar and intersegmental hepatic vessels that merge into the three major hepatic veins, emptying directly into the ________, just below the diaphragm

IVC

The head (of the pancreas) is anterior to the _____ and _____

IVC, renal veins

Where does the loops of ileum terminate?

Ileocecal valve

It's in the _____ that intrinsic factor from the stomach combines with vitamin B 12 for absorption in the ______

Ileum, terminal Ileum

Quadratus lumborum origin

Iliac crest

Internal oblique origin

Iliac crest, lumbodorsal fascia, and inguinal ligament

Branches of the superior mesenteric artery

Inferior pancreaticoduodenal artery, Jejunal arteries, I leap arteries, middle colic artery, right colic artery, and ileocolic artery

The _______ extends to supply the inferior surface of the diaphragm

Inferior phrenic arteries

Tributaries of the IVC

Inferior phrenic, lumbar, right gonadal, Renal , right suprarenal, and hepatic veins, throughout its course in the abdomen

Paired branches of the abdominal aorta

Inferior phrenic, lumbar, suprarenal, renal, and gonadal artery's

Pyloric antrum

Inferior portion of the stomach

_______ extends from the anterior superior iliac spine to the pubic tubercle and gives rise to the lowermost fibers of the internal oblique and transversus abdominis muscles

Inguinal ligament

Left portal vein

Initially courses to the left, then turns medially toward the ligamentum teres. It branches to supply the lateral segments (segment II, III)of the left lobe and the superior and inferior sections of segment IV

Endocrine hormones (name)

Insulin, glucagon

Which duct forms the right and left hepatic duct?

Intrahepatic bile ducts

_______ merge into successively larger ducts as they follow a course from the periphery to the central portion of the liver eventually forming the right and left hepatic ducts

Intrahepatic bile ducts

Gonadal arteries

Originate from the anterior wall of The anterior wall of the aorta just inferior to the renal arteries; they descend along the sows muscle to reach their respective organs

Kidney composition

Outer cortex, inner medulla

Adrenal (suprarenal) glands

Paired Retroperitoneal organs located superior to each kidney

Ureters

Paired muscular tube that transport urine to the urinary bladder

Rectus abdominis muscles

Paired, visualized on the anterior surface of the abdomen and pelvis

The _______ is unencapsulated and has a distinct lobulated appearance, making identification easy in cross-section

Pancreas

Retroperitoneal spaces

Pararenal spaces (anterior, posterior) , perirenal space ( right, left)

Which Space contains the kidneys, adrenal glands, lymph nodes, blood vessels, and perirenal fat?

Pararenal spaces (left and right)

Division of the abdominal Peritoneum

Parietal peritoneum, visceral peritoneum

The outer, longitudinal muscle of the large intestine forms three thickened band called ______

taenia coli

Right gastric artery supply

Supplies the lower part of the lesser curvature of the stomach and anastomoses with the left gastric artery within the lesser curvature of the stomach

Anterior and posterior superior pancreaticoduodenal arteries

Supplies the superior part of the duodenum and head of the pancreas, and the right Gastroepiploic (gastro-omental) artery

Jejunal and Ileal arteries supply

Supply jejunum and ileum, except the end segment near the cecum

Lumbar arteries supply

Supply the posterior abdominal wall, lumbar vertebrae, and the inferior and of the spinal cord

Anterior and posterior segmental arteries

Supply the segments of the right and caudate lobes of the liver

Division of Peritoneal spaces

Supracolic and infracolic compartment

Right Adrenal gland drainage

Suprarenal vein that empties directly into the IVC

Coronary ligaments

Surround the superior pole of the liver and attach the liver to the diaphragm, forming the margins of the bare area

What gathers the cecum and colon into series of pouch like folds?

Taenia coli

In females, the peritoneal cavity communicates with the exterior (opens into the pelvis) through the ____, ____, and ____

uterine tube (fallopian tube), uterus, vagina

third (horizontal) portion

Is about 10 cm long and run horizontally in front of the third lumbar vertebra; in its horizontal course from right to left, this portion of the duodenum runs anterior to the IVC, aorta, and inferior mesenteric artery, and posterior to the superior mesenteric artery

Neck (of gallbladder)

Is narrow, lies to the right of the Porta hepatis and continues as the cystic duct

The ______ contains numerous circular folds that give it a feathery appearance on barium or CT examination

Jejunum

This section of small bowel is where the bulk of chemical digestion and nutrient absorption occurs

Jejunum

Sigmoid colon

Joins the rectum, which is the terminal portion of the colon

Structures of the urinary system located within the abdomen

Kidney and ureters

The _____ are embedded in perirenal fat

Kidneys

______ Lies at an oblique orientation, with the upper pole more medial and posterior then the lower poles

Kidneys

Structures of the urinary system

Kidneys, ureter's, bladder, and urethra

Retroperitoneum structure

Kidneys, ureters, adrenal glands, pancreas, most of the duodenum, aorta, inferior vena cava, bladder, uterus, and prostate gland; descending and ascending colon as well

Left hepatic artery supply

branches to supply the caudate, quadrate, and medial and lateral segments of the lobe of the liver

Largest organ of the Abdomen, occupies a major portion of the right hypochondriac and epigastric region, sometimes extending into the left hypochondriac and umbilical regions

Liver

The peritoneum forms a cavity that encloses which organs?

Liver (except for the bare area), gallbladder, spleen, stomach, ovaries, and majority of the intestines

Three short hepatic veins (right, middle, left) begin as smaller vessels that collects blood from the _____

Liver parenchyma

Portal hepatic system

Liver receives nutrient rich blood from the gastrointestinal tract via this system

Bare area

Liver surface between the superior and inferior coronary ligament

Contents of the abdominal cavity

Liver, gallbladder and biliary system, pancreas, spleen, adrenal gland's, kidneys, ureter's, stomach, intestines, and vascular structures

Division of liver according to surface anatomy

Lobes

Supracolic compartment location

Located above the transverse colon

Common hepatic duct location

Located anterior to the portal vein and lateral to the hepatic artery in its caudal descent from the porta hepatis

Subphrenic spaces (left and right)

Located between the diaphragm and the anterior portion of the liver

Greater sac

Located between the inner surface of the anterior abdominal wall and the outer surface of the abdominal viscera; it is bounded by the parietal and visceral peritoneum

Left hepatic artery

Located between the lesser curvature of the stomach and it approaches the liver in the lesser omentum

Neck (of the pancreas) location

Located between the pancreatic head and body

Small intestine (small bowel)

Located between the pylorus and ileocecal valve and consist of loops of bowel averaging 6 to 7 meters in length

Right Subhepatic Space

Located between the right lobe of the liver and kidney

Gallbladder location

Located in the gallbladder fossa on the anteroinferior portion of the right lobe of the liver, closely associated with the interlobar Fissure

Right adrenal gland location

Located just posterior to the IVC, medial to the posterior segment of the right hepatic lobe, and lateral to the right cross of the diaphragm

Quadrate lobe

Located on the anteroinferior surface of the left between the gallbladder and the round ligament

External and internal oblique muscles

Located on the outer lateral portion of the abdomen and extend from the cartilages of the lower ribs to the level of the iliac crest

Subhepatic Space (right and left)

Located posterior and inferior between the liver and the abdominal viscera

Spleen location

Located posterior to the stomach in the left upper quadrant of the abdomen, protected by the ninth through 11th rib

Lesser sac (omental bursa)

Located primarily between the posterior surface of the stomach and the posterior abdominal wall

Colon

Longest portion of the large intestine and can't be divided into four distinct portions

Linea alba

Longitudinal band of fibers that forms a central anterior attachment for the muscle layers of the abdomen

The striated appearing pyramids contain _____ and _____ and function as the beginning of the collecting system

Loop of Henle, collecting tubules

Ileum

Lower 3/5 of the small intestine, is the largest portion, averaging 3.5 m long and located in the right lower abdomen

External oblique origin

Lower eight ribs

Transversus abdominis Origin

Lower six Rib, iliac crest, and lumbodorsal fascia

Internal oblique insertion

Lower three ribs

Serous fluid

Lubrication that separates the two layers of peritoneum to allow organs to move against each other without friction

______ Receive veins from the vertebral Plexes and then travel horizontally along the transverse processes deep to the psoas muscles

Lumber veins

Lumbar trunks

Lymph from the abdominal cavity empties into this trunk; drains lymph from the legs, lower abdominal wall, and the pelvic organs

______ may be difficult to visualize and cross-section unless they are enlarged as a result of abnormality

Lymph nodes

The common bile duct follows a groove on the posterior surface of the pancreatic head, then pierces the medial wall of the second part of the duodenum along with the ______ through the______

Main pancreatic duct (duct of wirsung), ampulla of vater

Testicular arteries

Male gonadal arteries which supply the testes and scrotum

Hepatic flexure

Marks the beginning of the transverse colon

Uncinate process (of the pancreas)

Medial and posterior extension of the head

Hilum (of the kidney)

Medial indentation in the kidney; allows the renal artery and vein and ureters to enter and exit the kidney

Middle hepatic vein drainage

Medial segment of the left lobe and the anterior portion of the right lobe

The remainder of the small intestine, the jejunum and ileum, is suspended from the posterior abdominal wall by a fan shaped ______

mesentery

Each kidney has 7 to 14 ____ that merge into two or three

minor calyces, major calyces

______ appears as small oblong soft tissue masses oriented parallel to their acompanying vessels

Abdominal lymph nodes

Right and left perirenal space

Around kidney and adrenal gland's; completely enclosed by renal (Gerota's) fascia

Gonadal veins (both)

Ascend the abdomen along the psoas muscle, anterior to the ureters

Curves sharply to the left, creating the hepatic flexure

Ascending colon

Portions of the colon

Ascending, transverse, descending and sigmoid

Right hepatic branches into what?

Cystic artery

Why is the right kidney slightly lower than the left?

Due to displacement by the liver

The ______ is mostly retroperitoneal, making it less mobile than the rest of the small intestine

Duodenum

Division of small intestines

Duodenum, jejunum, ileum

Quadratus lumborum muscle

Forms large portion of the posterior abdominal wall

Commonly appears as a triangular or Y shaped configuration

Left adrenal gland

Peritoneal ligaments in the greater omentum

(3) gastrocolic, gastrosplenic, and Gastrophrenic

Typically, lymph nodes are considered enlarged if their short axis diameter is greater than ____

1 cm

Quadratus lumborum insertion

12th rib and transverse processes of lumbar vertebrae

Pancreas

A long, narrow retroperitoneal organ that lies posterior to the stomach and extends transversely at an oblique angle between the duodenum and splenic hilum

Ileocecal valve

A sphincter that controls the flow of materials from the ileum into the cecum of the large intestine

Ligament of Treitz

A suspensory ligament created from the connective tissue around the celiac axis and left crus of the diaphragm; keeps the Duodenojejunum in place

Delivers blood to all the abdominal pelvic organs and structures

Abdominal aorta

Inferior mesenteric artery location

Arises 3-4 cm above the bifurcation of the aorta at approximately the level of L3-L4

Common hepatic artery

Arises as one of the three branches off the celiac artery

Digestive enzymes (names)

Amylase, lipase, peptidases, sodium bicarbonate

Interlobar Fissure (main lobar Fissure)

An imaginary line drawn through the gallbladder fossa and the middle hepatic vein to the inferior vina cava, divides the right from the left lobes of the liver

Renal fascia function

Anchors the kidneys to surrounding structures and attempts to prevent bumps and jolts to the body from injuring the kidneys

Which space contains the retroperitoneal portions of the ascending and descending colon, the pancreas, and the duodenum?

Anterior pararenal space

Abdominal nodal groups

Aorta, IVC, and organs of the abdomen

Kidneys segments according to the vascular supply

Apical, anterosuperior (upper anterior), anteroinferior (middle inferior), inferior and posterior

As each renal artery reaches the Renal Hilum, it typically divides into anterior and posterior branches from which these five segmental arteries arise

Apical, upper, middle, lower, and posterior

Jejunum

Approximately 2.5 m long and occupies the left upper abdomen or umbilical region of the abdomen

Gastrocolic ligament

Apron portion of the greater omentum attached to the transverse colon

As the interlobar arteries curve over the renal pyramids they become the ________ arteries from which the interlobar arteries arise to supply the renal cortex

Arcuate

Renal drainage

Blood leaves the kidney by way of the interlobular veins that carry blood from the renal cortex to their arcuate veins, which carry blood from the medulla to the interlobar veins

Medial border of the spleen

Bordered on this side by the left kidney, splenic flexure of the colon, and pancreatic tail

Pancreas function

Both endocrine and exocrine function

Arterial supply of the pancreas

Branches of the celiac and superior mesenteric arteries

Superior suprarenal arteries

Branches of the inferior phrenic arteries

Head (of pancreas)

Broad, flat portion of the pancreas,

Right gastric artery

Can come from the common hepatic or gastroduodenal artery

Which gland is located in a triangle formed by the eagle order, pancreatic tail, and left kidney?

Left adrenal gland

Hepatoesophageal ligament

Connects the liver and esophagus

Hepatorenal ligament

Connects the liver and kidney

Hepatogastric ligament

Connects the liver to the lesser curvature of the stomach

Splenorenal (Lienorenal) ligaments

Connects the spleen and kidney

Hepatoduodenal ligament

Connects the superior region of the duodenum to the liver

Rectum

Considered a pelvic organ

Lumbar veins

Consist of four pairs of vessel that collect a blood from the posterior abdominal wall from the level of L1- L4

renal medulla

Consist of segments called Renal pyramid

Neck (of the pancreas)

Constricted portion of the gland

red pulp (of spleen)

Contains large quantities of blood

white pulp (of spleen)

Contains lymphoid tissue and white blood cells

renal cortex (of kidney)

Contains nephron

Transverse fissure (portal)

Contains the horizontal portions of the right and left portal vein

Proper hepatic artery

Continuation of the common hepatic artery as it branches into the right gastric and gastroduodenal arteryies just above the duodenum and continues in the hepatoduodenal ligament as this artery

Venous drainage of the stomach

Corresponds to the arterial supply; gastric veins usually drain directly into the portal vein or into the superior mesenteric vein

Rectus abdominis insertion

Costal cartilage of 5th, sixth, seventh rib; xiphoid process of sternum

Ileocolic artery

Courses behind the peritoneum across the right ureter into the right iliac fossa and divides to supply a portion of the ascending colon, cecum, vermiform appendix, and terminal portion of the ileum

Left suprarenal vein

Courses from the inferior pole of the left suprarenal glad to empty directly into the left renal vein or left inferior phrenic vein

Right Suprarenal vein

Courses from the medial side of the right suprarenal gland to empty directly into the IVC

Left gastric artery

Courses superiorly and leftward within the Lesser omentum to supply the cardiac region of the stomach

IVC path

Courses superiorly through the retroperitoneum along the anterior aspect of the vertebral column and to the right of the aorta

Sigmoid branches (2 or 3)

Courses within the mesentery to supply branches to the terminal Descending colon and to the sigmoid

Visceral peritoneum

Covers the organs

Superior rectal artery

Crosses the common iliac artery and vein as it descends to the branch and supply the rectum

The posterior surfaces of both the right and left adrenal gland border the _____ of the diaphragm

Crus

Minor Calyces

Cup shaped; Arises from the renal papilla

Curves to become the S shape sigmoid colon posterior to the bladder

Descending colon

Gastroduodenal artery

Descends behind the pylorus to give off many branches, including the anterior and posterior superior pancreaticoduodenal arteries

Inferior mesenteric artery path

Descends in front of the abdominal aorta and then to the left where it gives off to different branches

The anterior surface of the stomach is in contact with you which structures?

Diaphragm, anterior abdominal wall, and left lobe of the liver

Lipase

Digestion of lipids

Amylase

Digestion of starch

Exocrine function of the pancreas

Digestive enzymes

Stomach

Dilated portion of the digestive system that acts as a food reservoir and is responsible for the early stages of digestion

The abdominal aorta gradually ________ in diameter as it descends the abdomen just left of the midline next to the vertebral bodies

Diminishes

Cystic artery

Dispatches to the gallbladder and divides into the anterior and posterior segmental arteries

Right hepatic vein

Divides the Right lobe into anterior and posterior sections

Fissure for the round ligament

Divides the left hepatic lobe into medial and lateral segments

Left hepatic vein

Divides the left lobe into medial and lateral sections

Middle hepatic vein

Divides the liver into right and left lobes

Mesentery

Double layer of peritoneum, which encloses the intestines and attaches it to the abdominal wall

Interlobar veins

Drain into the segmental vein

Intestinal trunks

Drain organs located within the abdominal cavity; joins the thoracic duct and ultimately enter the venous system

Venous drainage of the small intestine

Drained by the branches of the superior mesenteric vein

Right inferior phrenic vein

Drains directly into the IVC

Median sacral vein drainage

Drains into the left common iliac vein, but they maybalso drain into the junction of the common iliac veins

Right hepatic vein drainage

Drains the right lobe of the liver

The pancreatic enzymes are carried to the Duodenum via what system?

Ducts

Superior mesenteric artery

Emerges just below the celiac trunk at approximately the level of L1

Renal fascia (Gerota's fascia)

Encloses the kidneys and adrenal gland

Right gonadal vein

Enters the anterolateral wall of the IVC just below the opening for the right renal vein

Hormones produced by the adrenal Medulla

Epinephrine and norepinephrine

Supply the abdominal esophagus and adjacent anterior and posterior your walls of the body of the stomach

Esophageal and gastric branches

Vitamin B 12

Essential for normal red blood cell formation and nervous system function

Middle Suprarenal arteries

Exits the lateral wall of the aorta near the base of the superior mesenteric artery

Psoas muscle

Extend along the lateral surfaces of the lumbar vertebrae to insert on the lesser trochanter of the femur

Inferior phrenic veins

Extend from the inferior surface of the diaphragm

Inferior suprarenal arteries

Extend from the renal arteries

Rectus abdominis muscles insertion

Extend vertically to the xiphoid process and coastal cartilage of the fifth, sixth, and seventh rib

Falciform ligament

Extends from the liver to the anterior abdominal wall and diaphragm

Transversus abdominis muscles

Extends from the lower six costal cartilages, lumbar fascia, iliac crest, and inguinal ligament to insert into the xiphoid process, Linea Alba, and pubic symphysis

Pancreatic tail location

Extends into the left anterior pararenal space, anterior to the left kidney, to the end at the splenic hilum

Inferior pancreaticoduodenal artery

Extends to the head of the pancreas and duodenum, then divides into the posterior ramus anastomosing with the posterior superior pancreaticoduodenal artery and the anterior ramus, which anastomoses with the anterior superior pancreaticoduodenal artery

Body (of the pancreas) location

Extends transversely to the left, anterior to the aorta and superior mesenteric artery

Forms a plane that divides the liver anatomically into right and left lobe

Falciform ligament

What structure divides the left and right subphrenic spaces?

Falciform ligament

________ provides the structural support that attaches the upper surfaces of the liver to the diaphragm and upper abdominal wall

Falciform ligament

Renal sinus

Fat filled cavity surrounding the renal pelvis

Greater omentum

Fat laden fold of peritoneum that drapes down from the greater curvature of the stomach; connects the stomach with the spleen and transverse colon

Ovarian arteries

Female gonadal arteries which supply the ovaries, uterine tubes, and uterus

Inguinal ligament

Fibrous band formed by the thickened inferior border of the aponeurosis of the external oblique muscles

Primary function of the urinary system

Filter blood, produce and excrete urine, and help maintain normal body physiology

Division of the duodenum

First (superior) portion, second (descending) portion, third (horizontal) portion, fourth (ascending) portion

Inferior phrenic arteries

First to branch from the lateral surface of the abdominal aorta just as a descends through the aortic hiatus

Rectus abdominis muscles action

Flex the lumbar vertebrae and support the abdomen

Quadratus lumborum action

Flexes spine laterally

Psoas muscle action

Flexes the thigh and trunk

Rectus abdominis action

Flexes trunk

Mesentery, Omenta, and peritoneal ligaments

Fold or double layers of peritoneum that extend between organs, serving to hold them in position and at the same time and close the vessels and nerves proceeding to each part

Linea alba formation

Formed at the midline, by the interlacing fibers from the rectus abdominis and oblique muscles

First (superior) portion

Formed by the first 2 inches of the duodenum, the conical shaped duodenal bulb

Posterior abdominal wall

Formed by the five lumbar vertebrae, the 12 pair of ribs, the upper proportion of the pelvis, quadratus lumborum muscles and psoas muscles

Anterior abdominal wall

Formed by the lower portion of the thoracic cage and by layers of muscle that include the rectus abdominis, external Oblique , internal oblique, and transversus abdominis

second (descending) portion

Formed by the next 4 inches of duodenum that descends along the right side of the vertebral column; contains the ampulla of vater and receives pancreatic and biliary drainage

IVC formation

Formed by the union of the common iliac veins at approximately the level of L5

Portal vein

Formed in the retroperitoneum by the union of the superior mesenteric and splenic veins, posterior to the neck of the pancreas

Superior Abdominal wall

Formed superiorly by the diaphragm and is inferiorly continuous with the pelvic cavity at the pelvic inlet

Bile

Formed within the liver, is collected for transport to the gallbladder

Division of the pancreas

Head, uncinate process, neck, body, and tail

Segmental classification (of kidney)

Helps with surgical planning for partial nephrectomies

Occasionally, the _______ artery will branch from the superior mesenteric artery and not the celiac

Hepatic

The common hepatic artery crosses to the right toward the superior aspect of the Dwight it up and divide into what?

Hepatic artery proper, gastroduodenal artery

The common bile duct (CBD) continues a causal descent along with the hepatic artery and portal vein within the _____.

Hepatoduodenal ligament

Peritoneal ligaments of the lesser omentum

Hepatogastric, hepatoduodenum

Early arterial phase image after IV contrast injection

Heterogeneous

Cellular components of the spleen

Highly vascular, spongy parenchyma

Porta hepatis

Hilum of the liver, located on the inferomedial border of the liver

Gallbladder

Hollow pear-shaped

Normal splenic parenchyma

Homogenous

The ______ is 1.5 m long, starting at the ileocecal Junction and ending at the anus

Large intestine

Liver

Large, complex organ with numerous functions, which include metabolic regulation, hematologic regulation, and bile production

The _______ intestine has a larger diameter and thinner walls than the ________ intestine

Large, small

Body (of the pancreas)

Largest and most anterior portion

Splenic (lineal) artery

Largest branch of the celiac trunk and passes to the left behind the stomach and along the upper border of the pancreas within the splenorenal ligament, to the hilum of the spleen

Spleen

Largest lymph organ in the body composed of lymphoid tissue

Bifurcates into ascending and descending branches that supply the wall of the left third of the transverse colon and the entire descending colon

Left Colic artery

Before entering the porta hepatis, the proper hepatic artery divides into which branch?

Left and right hepatic arteries

Branches of the inferior mesenteric artery

Left colic artery, sigmoid arteries, and the superior rectal arteries

After supplying the cardiac region of the stomach, ________ passes along the lesser curvature toward the pylorus, giving off to esophageal and gastric branches

Left gastric artery

The _______ artery continues toward the right to anastomose with the right gastric artery, which is a branch of the hepatic artery

Left gastric artery

Celiac trunk branch

Left gastric, common hepatic, splenic arteries

Just before the splenic artery terminate is into numerous splenic branches, it gives rise to _____

Left gastroepiploic (Gastro-omental) artery

The smallest hepatic vein

Left hepatic vein

______ courses between the medial and lateral segments of the left lobe, drains segments II and III, then enters the left anterior surface of the IVC

Left hepatic vein

Left hepatic vein drainage

Left lobe of the liver

Gastrosplenic ligament (Gastrolienal ligament)

Left portion of the greater omentum that connects the hilum of the spleen to the greater curvature and fundus of the stomach

Left adrenal gland drainage

Left suprarenal vein, which empties into the left renal vein

Lobes of the liver

Left, right, caudate and quadrate

Typically the _______ kidney is higher than the _____ kidney, which means the ______ renal artery is generally slightly superior to the ______

Left, right, left, right

Borders of the stomach

Lesser and greater curvatures

Kidneys location

Lies against the posterior abdominal wall on either side of the vertebral column between T 12 and L4

Left adrenal gland location

Lies anteromedial to the upper pole of the left kidney

Uncinate process (of the pancreas) location

Lies between the superior mesenteric vein and inferior vena cava

Transversus abdominis muscles

Lies deep to the internal oblique muscles, it's fibers extend transversely across the abdomen to provide maximum support for the abdominal viscera

IVC

Lies in a groove along the posterior wall of the liver and extends into the thoracic cavity through the caval hiatus of the diaphragm and enters the right atrium of the heart

Large intestine (large bowel)

Lies inferior to the stomach and liver and almost completely frames the small intestine

External oblique insertion

Linea Alba and iliac crest

________ extends from the xiphoid process of the sternum to the pubic synthesis

Linea alba

Parietal peritoneum

Lines the abdominal wall

What structure divides the right and left infracolic spaces?

Mesentery of the small intestine

omentum

Mesentery or double layer of peritoneum that is attached to the stomach.

Which two veins frequently converge to form a common trunk before emptying into the IVC just below the diaphragm?

Middle and left hepatic veins

________ lies in the interlobar Fissure, drains of segments IV, V, and VIII, then enters the IVC at the anterior or right anterior surface

Middle hepatic vein

(3) Hepatic veins that divide the liver longitudinally into four sections

Middle hepatic vein, right hepatic vein, left hepatic vein

These arteries courses laterally and slightly superior to supply the adrenal gland

Middle suprarenal arteries

Left lobe

Most anterior of the liver lobe, extending across the midline

External oblique

Most extensive of the three broad abdominal muscles and contains a triangular opening (the superficial inguinal ring) that allows for the passage of the spermatic cord or round ligament of the uterus

Cholecystokinin

Muscular wall that contracts when stimulated by this chemical, forcing bile through the extrahepatic biliary system into the duodenum

Continues as the cystic duct

Neck of the gallbladder

Sodium bicarbonate

Neutralize gastric acid

Abdominal Lymph nodes

Occurs in chains along the main branches of the arteries of the intestine and abdominal aorta

Left inferior phrenic vein

Often doubled and drains into either the left suprarenal vein, left renal vein, or the IVC

When is omentum visible?

Omentum is usually imperceptible on routine scans, visible only one fluid is present

Left inferior phrenic artery

Passes behind the stomach and the abdominal part of the esophagus

Left renal vein

Passes posterior to the superior mesenteric artery and anterior to the aorta on its route from the left kidney to enter the left lateral wall of the IVC

IVC path through abdominal cavity

Passes the posterior surface of the liver and pierces the diaphragm at the caval Hiatus to enter the right atrium of the heart

right Gastroepiploic (gastro-omental) artery

Passes through the greater omentum, anastomoses with the left gastroepiploic artery on the inferior surface of the greater curvature, and dispatches numerous gastric branches to the anterior and posterior your walls of the pyloric and body portion of the stomach

Right Colic artery

Passes to the ascending colon

Right inferior phrenic artery

Passes upward on the right side behind the IVC

______ are not ligaments in the classic sense, but are distinct regions of mesentery connecting the structures for which they are named

Peritoneal ligaments

The central location for vessels to enter and exit the liver

Porta hepatis

Where does the portal vein branch into right and left main portal vein?

Porta hepatis

Location of where the portal vein is formed (by the merging of the superior mesenteric and splenic vein)

Portal splenic confluence

Major vessel of the portal hepatic system

Portal vein

_______ passes obliquely to the right, posterior to the hepatic artery within the lesser omentum, and enters the liver at the Porta hepatis

Portal vein

Where does the right and left hepatic duct unite?

Porter hepatis

Which space contains no solid organs, just fat and vessels?

Posterior pararenal space

Portal splenic confluence

Posterior to the neck

Cecum

Pouch like section of the proximal portion of the large intestine located at the ileocecal valve

haustra

Pouch-like folds

Adrenal cortex

Produces more than two dozen steroids, collectively called Adrenocortical steroids or corticosteroids

Spleen function

Produces white blood cells, filter abnormal blood cells from the blood, store iron from red blood cells, and initiate the immune response

Spiral valves of Heister location

Prominent at the bend formed by the neck and cystic duct

Rugae

Prominent folds on the inner surface of the stomach

Renal fascia (Gerota's fascia)

Protective layer surrounding the kidneys and Perirenal fat

Peptidases

Protein digestion

Duodenum

Proximal portion of the small intestine, begins at the gastric pylorus and curves around the head of the pancreas, forming the C

Transversus abdominis insertion

Pubic bone and linea alba

Rectus abdominis origin

Pubic bone near symphysis

Rectus abdominis muscles origin

Pubic symphysis

______ extends from the iliac crest to the inferior border of the 12th rib and transverse processes of the lumbar vertebrae

Quadratus lumborum muscle

Renal pyramids location

Radiates from the renal sinus to the outer surface of the kidney

Major functions of the large intestine

Reabsorption of water and the storage and elimination of fecal matter

Middle colic artery

Reaches the transverse colon

Arterial supply of small intestine segments

Receive blood from branches of the superior mesenteric artery

Adrenal gland's arterial supply

Receive blood from the superior, middle, and inferior suprarenal arteries

Tributaries of the left renal vein

Receives left gonadal vein, left inferior phrenic vein, and generally the left suprarenal vain

The anterior surface of the _____ is crossed by 3 tendinous intersection that course transversely, forming individual muscle bellies that can contract separately

Rectus abdominis muscles

Peritoneal ligaments

Search to connect in Oregon with another Oregon or abdominal wall

Superior mesenteric artery supply

Supplies the head of the pancreas and the majority of the small and large intestines

Coronary ligaments

Reflections of the peritoneum that surround the bare area of the liver

Abdominal cavity

Region located between the diaphragm and sacral promontory

Insulin

Regulate cellular absorption and utilization of glucose, thereby affecting carbohydrate, protein, and lipid metabolism and body tissues

Mineralocorticoids

Regulate sodium and potassium levels

Round ligament

Remnant of the left umbilical vein and runs within the free inferior margin (free edge) of the falciform ligament to the umbilicus

This vessel travels horizontally to the hilum of the corresponding kidney

Renal arteries

The major calyces join to form _____

Renal pelvis

Five segmental veins correspond to their respective segmental arteries and merge to form the _____

Renal vein

Androgens and estrogens

Responsible for promoting normal development of bone and reproductive organs

Ascending colon

Retroperitoneal and commences at the cecum, and ascending the right lateral wall of the abdomen to the level of the liver

Descending colon

Retroperitoneal and continues inferiorly along the left lateral abdominal wall to the iliac fossa

Kidneys

Retroperitoneal bean shaped organs

Abdominal aorta

Retroperitoneal structure beginning, extension of the thoracic aorta at the aortic hiatus of the diaphragm

Left Colic artery path

Retroperitoneal structure that passes along the posterior body wall on the anterior surface of the left Psoas and quadratus lumborum muscle

Includes abdominal and pelvic structures

Retroperitoneum

Structures located posterior to the peritoneum, yet lined by it anteriorly are considered to be in the ______

Retroperitoneum

Which hepatic artery is larger?

Right

Which space contains the Morison's pouch

Right Subhepatic Space

Commonly appears as an inverted V in cross-section

Right adrenal gland

Which adrenal gland is lower and more medial?

Right adrenal gland

Arteries that branch and supply the lobes of the liver

Right and left hepatic arteries

The hepatic artery proper divide near the Porta hepatis into what?

Right and left hepatic branches, and usually gives off the right gastric artery

Which ducts form the proximal portion of the common hepatic duct (CHD)?

Right and left hepatic ducts

Which veins follow the course of the right and left hepatic arteries?

Right and left main portal vein

Which ligaments are the extensions of the coronary ligament?

Right and left triangular ligament

Which ligaments attach the liver to the diaphragm?

Right and left triangular ligament

The liver is bordered superiorly, laterally, and anteriorly by the _______

Right hemidiaphragm

______ passes posterior to the uncinate process of the pancreas and runs along the posterior wall of the bile duct into the right hepatic lobe

Right hepatic artery

Largest hepatic vein

Right hepatic vein

_______ Lies between the right anterior and posterior hepatic segments, drains segments V, VI, and VI, and enters the IVC at the right lateral aspect

Right hepatic vein

This artery passes posterior to the IVC and right renal vein on its course to the right kidney

Right renal artery

Due to the position of the aorta on the left side of the vertebral column, the ______ renal artery is slightly longer than the ______ renal artery

Right, left

Peritoneal Ligaments associated specifically with the liver

Round ligament(Ligamentum trees), falciform ligament, and coronary ligament

Fundus (of the gallbladder)

Rounded distal portion of sac, that is frequently in contact with the anterior abdominal wall

fundus (of the stomach)

Rounded surface on the superior surface of the body

Splenic vein

Runs along the posterior surface of the body (of the pancreas ) on its route to the portal splenic confluence

Intrahepatic bile ducts

Runs beside the hepatic arteries and portal vein's throughout the liver parenchyma

Each ______ can be considered functionally independent with its own branch of hepatic artery, portal vein, and bile duct and is drained by a branch of the hepatic veins

Segment

Division of liver according to vascular supply

Segments

The liver can be divided into _______ based on the branching of the portal and hepatic veins (according to French Anatomist Couinaud)

Segments

Right portal vein

Sends branches to the caudate lobe and then divides into anterior and posterior branches that subdivided into superior and inferior branches to supply the right lobe of the liver

Perirenal fat

Separates the adrenal gland from the kidneys and provide cushioning for the kidney

Fissure for the ligamentum Venosum

Separates the caudate lobe from the left lobe

Interlobar Fissure

Separates the right lobe from the left

Perirenal fat

Separates the superior surface of the kidneys from the adrenal glands

Peritoneum

Serous membrane that lines the wall of the abdominal cavity

Mesentery function

Serve as a route for blood vessels, lymphatics, and nerves to reach of the small intestine

Hepatogastric, hepatoduodenum

Serves to connect the stomach and duodenum to the liver

Biliary system function

Serves to drain the liver of bile and store it until it is transported to duodenum to aid in digestion

Vermiform appendix

Slender, attaches to the posteromedial surface of the cecum

epiploic appendages

Small fat filled sacs of omentum on the outer surface of the large intestine

The enzymes of the pancreas drains into what?

Small intestines

Caudate lobe

Smallest lobe, located on the inferior and posterior liver surface, sandwiched between the IVC and the ligamentum Venosum

Variation of lumbar vein drainage

Some enter the lateral walls of the IVC and others empty into the common iliac vein or are united on each side by a vertical connecting been termed the ascending lumbar vein

A common area for gallbladder impaction during acute or chronic cholecystitis

Spiral valves of Heister

Intraperitoneal organ that is covered entirely with peritoneum except at its small bare area

Spleen

Arterial blood supply of spleen

Splenic artery

_______ gives off numerous pancreatic branches as it courses near the border of the pancreas, including the dorsal, great, and caudal pancreatic arteries that supply the body and tail of the pancreas

Splenic artery

Venous drainage of spleen

Splenic vein

Red and white pulp

Spongy parenchyma

The ______ is one of the most vascular organs within the body

Stomach

The medial surface of the liver is bordered by which structures?

Stomach, duodenum, and transverse colon

Four major functions of the stomach

Storage of food, mechanical breakdown of food, a dissolution of chemical bonds via acid and enzymes, and production of intrinsic factor

Glisson's capsule

Strong connective tissue that surrounds the liver, giving shape and stability to the soft hepatic tissue

Arterial supply of the large intestine

Superior and inferior mesenteric arteries

Venous drainage of the large intestine

Superior and inferior mesenteric veins

________ Descends behind the body of the pancreas, and over the horizontal portion of the duodenum to course in the mesentery to the ileum

Superior mesenteric artery

Gastrophrenic ligament

Superior portion of the greater omentum attached to the diaphragm and posterior aspect of the fundus and esophagus

Arterial blood supply of the stomach

Supplied by branches of gastric, splenic , and gastroduodenal arteries

Splenic flexure

The beginning of the descending colon

Pancreatic tail

The body tapers superiorly and posteriorly into this portion

Which gutter is a common site for free fluid collection?

The deeper right gutter

Morison's pouch

The deepest point of the abdominal cavity in a supine patient and a common site for collection of fluid

Epiploic foramen ( foramen of Winslow)

The greater sac communicate with the lesser sac through this hole

Renal pelvis

The largest dilated portion of the collecting system and is continuous with the ureters

Right lobe

The largest of the four lobes

Dual blood supply

The liver is unique, receiving arterial blood (20 to 25%) from the common hepatic artery and nutrient rich venous blood (75 to 80%) from the portal vein

Peritoneal spaces

The peritoneal cavity contains potential spaces resulting from folds of peritoneum that extend from the viscera to the abdominal wall

Splenic hilum

The splenic artery and vein enter and exit the spleen through this

Gastrocolic, gastrosplenic, and gastrophrenic

These ligaments attach the greater omentum to the transverse column, hilum of the spleen, greater curvature in fundus of the stomach, diaphragm, and esophagus

Why are the left lumbar veins longer?

They cross over the vertebral column to drain into the IVC

Posterior border of the spleen

This border is in contact with the diaphragm, pleura, left lung, and ribs

intrahepatic bile ducts

Transports bile from the liver to the gallbladder

Bends sharply downward, creating the splenic flexure

Transverse colon

The _________ is located within the peritoneal cavity and is the largest and most mobile portion of the large intestine, making its position quite variable in the patient

Transverse colon

Transverse colon

Travels horizontally across the anterior abdomen toward the spleen

Superficial inguinal ring

Triangular opening in the external oblique muscle

Right and left paracolic gutters

Trough like spaces located lateral to the ascending and descending colon

True or false. the median sacral vein may accompany the median sacral artery

True

Renal arteries

Two large arteries that arise from the lateral wall of the aorta just below the superior mesenteric artery

Left gonadal vein

Typically empties directly into the left renal vein

Right renal vein

Typically lower than the left renal vein as it travels it's a short course to enter the right lateral wall of the IVC

Stomach the location

Under the left job of the diaphragm

Each _______ originates at the renal pelvis and descends anteriorly and medially toward the psoas muscle, (just anterior to the transverse processes of the lumbar spine), then enters the posterior wall of the ______ at an oblique angle

Ureter, bladder

Venous drainage of the pancreas

Venous blood drains from the pancreas into the portal vein via the superior mesenteric or splenic vein

The endocrine hormones of the pancreas drain into what?

Venous system

Celiac trunk

Very short vessel that leaves the anterior wall of the aorta just after the aorta passes through the diaphragm

duodenojejunal flexure

Where the duodenum reaches the jejunum

Triangular (left and right) ligament

Where the layers of the coronary ligament meet to the left and right, respectively

Body (of gallbladder)

Widest portion, gently tapers superiorly into the neck

Oblique muscles action

Work together to flex and rotate the vertebral column and compresses the abdominal

Rugae function

allows the stomach to expand with the ingestion of food

Head (of the pancreas)

at approximately the level of L2 - L3

Endocrine function of the pancreas

help control plasma glucose concentration

The inferior surface of the Iiver is bordered by which structure?

hepatic flexure of the colon

Infracolic compartment spaces

infracolic spaces (Right and left), paracolic gutters (right and left)

Each segmental artery further divides into _______ arteries, one for each pyramid and adjoining cortex

interlobar

Head (of the pancreas) location

lies inferior and to the right of the body and tail, nestled in the curve of the second portion of the duodenum

________ marks the entry of the small bowel into the peritoneal cavity

ligament of treitz

The lumbar veins on the left are typically _____ than those of the right

longer

Pyloric antrum empties into the duodenum through the _______

pyloric sphincter

supracolic compartment spaces

right and left subphrenic spaces, right and left subhepatic spaces

Right hepatic artery supply

supplies the majority of the right lobe of the liver

Gastroesophageal junction

where the superior portion of the stomach joins the esophagus