Term
| what structures are contained within the splenorenal ligament? |
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Definition
| tail of pancreas, splenic a and v. |
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Term
| which parts of the duodenum are secondarily retroperitoneal? |
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Definition
| 2nd-4th: descending, transverse, ascending |
|
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Term
| why is the first of the duodenum not considered retroperitoneal? |
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Definition
| it has a mesentery - hepatoduodenal ligament |
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Term
| what is significant about the 2nd part of the duodenum (i.e. what structures drain here?)? |
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Definition
| the main pancreatic duct and common bile duct comes together to empty into the duodenum at the greater duodenal papilla (Ampulla of Vater) when the sphincter of Oddi is relaxed. the accessory pancreatic duct also empties into the 2nd part of the duodenum via the lesser duodenal papilla |
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Term
| what structure cross the 3rd (tranverse) part of the duodenum? |
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Definition
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Term
| what marks the duodenal-jejunal junction? |
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Definition
| suspensory muscle of the duodenum (ligament of Treitz); suspended from right crus of diaphragm |
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Term
| what are the characteristics of the 1st part of the duodenum? why is this clinicaly significant? |
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Definition
| it is thin-walled, somewhat dilated; common site for ulcers |
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Term
| what vertebral levels are associated with the different parts of the duodenum? |
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Definition
1st: L1
2nd: descends from L1-L3
3rd: L3
4th: ascends L3-L2 |
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Term
| from what embryological precursor is the uncinate process derived? |
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Definition
|
|
Term
| what part of the pancreas is held within the curve of the duodenum? |
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Definition
|
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Term
| what is the main blood supply to the head of the pancreas? |
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Definition
|
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Term
| where does the gastroduodenal a. branch from, and what are its branches? |
|
Definition
from: common hepatic a.
to: right gastro-omental and anterior superior pancreaticoduodenal a. |
|
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Term
| where does the anterior inferior pancreaticoduodenal a. branch from? |
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Definition
|
|
Term
| what is Kocher's manuever? |
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Definition
| separation of the duodenum |
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|
Term
| what parts of the pancreas are retroperitoneal? |
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Definition
|
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Term
| what are 3 structures that the tail of the pancreas contacts? |
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Definition
| left kidney, left colic (splenic) flexure, hilum of the spleen |
|
|
Term
| what is the relationship between the gastroduodenal a. and the SMA? |
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Definition
| gastroduodenal gives off anterior & posterior branches of the SUPERIOR pancreaticoduodenal a. while the SMA gives off the ant & post INFERIOR pancreaticoduodenal a. The anterior SUPERIOR and INFERIOR a. anastomose via arcades, and the posterior SUP and INF anastomose a., on the head of the pancreas |
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Term
| what are the major arteries supplying the body and tail of the pancreas? |
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Definition
| great and dorsal pancreatic arteries from the splenic artery |
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Term
| what two arteries anastomose on the anterior surface of the head of the pancreas? what are their origins? |
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Definition
| Anterior superior pancreaticoduodenal (from gastroduodenal a) and anterior inferior pancreaticoduodenal (from SMA) |
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|
Term
| the common bile duct is formed by the union of which 2 ducts? |
|
Definition
| common hepatic and cystic ducts |
|
|
Term
| in what direction does bile flow in the cystic duct? |
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Definition
| bile flows from from liver into duct when storage is needed; flows from gallbladder to common bile duct to duodenum when being secreted |
|
|
Term
| what do the left and right hepatic ducts carry? |
|
Definition
| fresh bile from liver to common bile duct (secretion) or to cystic duct (for storage in gallbladder) |
|
|
Term
| describe the course of the main pancreatic duct |
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Definition
| begins in tail of pancreas and receives tributaries along its path to the head |
|
|
Term
| how do pancreatic secretions enter the gut? |
|
Definition
| the main pancreatic duct usually joins with the common bile duct before reaching the 2nd part of the duodenum. contents empty into the duodenum via the greater duodenal papilla. accessory pancreatic duct empties via the lesser duodenal papilla |
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|
Term
| what foreign-sounding structure comprise the greater duodenal papilla? |
|
Definition
| ampulla of Vater and the sphincter of Oddi |
|
|
Term
| (physio correlate): what causes relaxation of the sphincter of Oddi? |
|
Definition
| CCK activates inhibitory neurons which release NO, VIP, causing smooth muscle relaxation and allowing bile to enter duodenum |
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|
Term
| what is the ligamentum venosus? what is the ligamentum teres? |
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Definition
L.V. - fibrous remnant of fetal ductus venosus that shunted blood from umbilical vein to the IVC (bypassing liver) before birth (runs b/w caudate and left lobe)
L.T. - round ligament of liver, obliterated umbilical vein that that carried O2-rich blood from placenta to fetus (found in falciform ligament) |
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|
Term
| which two major vessels supplying the liver follow similar branching patterns within the right lobe? |
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Definition
|
|
Term
| what are the variations in arterial blood supply to the liver? |
|
Definition
83%: common hepatic -> proper -> r & l
14%: right hepatic branches from SMA
18%: left hepatic branches from left gastric
4%: common hepatic a comes from SMA |
|
|
Term
| what are some of the variations in branching of the cystic a? |
|
Definition
72%: cystic branches from r. hepatic a
6%: cystic branches from proper hepatic
3% branches from gastroduodenal
3% branches from l. hepatic |
|
|
Term
| what structure does the falciform ligament contain? what is its significance? |
|
Definition
| ligamentum teres hepatis (round ligament of liver); used to be the umbilical v., bringing O2-rich blood from placenta to fetal heart |
|
|
Term
| what forms the right and left triangular ligaments? |
|
Definition
| the joining of the anterior and posterior layers of the coronary ligaments |
|
|
Term
| what is the difference b/w the anatomical and functional divisions of the liver? |
|
Definition
anatomical- based on external appearance (4 lobes)
functional- based on blood supply and bile drainage (8 lobes) |
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|
Term
| what is the path of the posterior superior pancreaticoduodenal a. with relation to the common bile duct? |
|
Definition
| the posterior superior pancreaticoduodenal a branches from the gastroduodenal a, wraps around the common bile duct (anterior to posterior) and then descends posterior to the duct |
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|
Term
| where is the lesser duodenal papilla usually found in relation to the greater duodenal papilla? |
|
Definition
|
|
Term
| what forms the hepatic veins? how many are there and where do they drain? |
|
Definition
formed by the union of the central vs
3: left, right and middle hepatic vv. drain into the IVC |
|
|
Term
| what is a complication of porto-caval anastomoses? |
|
Definition
| blood is bypassing liver, toxins aren't removed, so can develop hepatic encephalopathy |
|
|
Term
| how might pancreatic cancer cause jaundice? |
|
Definition
| the tumor can obstruct the common bile duct, preventing the outflow of bile, which contains bilirubin. the bilirubin will end up in the tissues |
|
|
Term
|
Definition
| cholesterol crystals that precipitate out of bile |
|
|
Term
| what is a cholecystectomy? |
|
Definition
| surgical removal of the gallbladder |
|
|
Term
| what are some major indicators of portal hypertension? |
|
Definition
| esophageal varices, hemorrhoids, enlarged veins on ant abdominal wall (caput medusa), and ascites |
|
|
Term
| why is the Kocher manuever performed? |
|
Definition
| to gain access to the posterior side of the pancreas |
|
|
Term
| what is duodenal atresia? what should you be worried about in pts w/ this condition? |
|
Definition
a blind end in the duodenum, caused by recanalization of the duodenum during development.
70% of pts with this condition also have other malformations, inc. Down's syndrome, cardiac or GI defects |
|
|
Term
| what is the name of the procedure that can be done to surgically establish a communication b/w the gallbladder and jejunum? |
|
Definition
|
|
Term
|
Definition
| itching caused by drug reaction, food allergy, liver disease, cancers, parasites, aging or dry skin |
|
|
Term
| what procedure would you perform to visualize the pancreatic and biliary duct system by retrograde injection of contrast media? what does it entail? |
|
Definition
| endoscopic retrograde cholangiopancreatography - uses fiberoptic endoscopy and cannulation of the hepatopancreatic ampulla |
|
|
Term
| what manuever would you perform to stop bleeding from the liver? what does it entail? |
|
Definition
| Pringle manuever - compress portal v and hepatic artery; i.e. clamp down on structures in the hepatoduodenal ligament |
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Term
|
Definition
| a mass resembling neoplastic tissue |
|
|
Term
| what is the benefit of laparoscopic cholecystectomy? how is it performed? |
|
Definition
greatly reduced recovery time (pt usually home within 24 hrs), small incision near navel
done via fiberoptic scope |
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Term
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Definition
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