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Ductus arteriosus
-shunts blood from pulmonary artery to aorta in fetus
Four Quadrants of Abdomen
1. Right upper (contains liver)
2. Left upper (contains stomach and spleen)
3. Right Lower (contains ileum, jejunum, colon, appendix)
4. Left Lower (contains ileum, jejunum, colon)
Greater omentum
-first thing seen when abdominal wall is ipened
-double layered reflection of peritoneum
-hangs down from greater curvature of stomach
-attaches to transverse colon
-functions in fat storage
-adheres to areas of infection, enclosing and sealing off area
Peritoneal organs
-invested in peritoneum
1. Stomach
2. Spleen
3. Gallbladder
4. Liver
5. Jejunum
6. Ileaum
7. Transverse colon
8. Sigmoid colon
Retroperitoneal organs
-posterior to peritoneum
-anterior to abdominal wall
1. Kidneys
2. Ureters
3. Suprarenal glands
4. Pancreas
Secondarily Retroperitoneal Organs
-originally had a mesentery that attached them to the abdominal wall but during development have become attached posteriorly
1. Ascending colon
2. Descending colon
3. Pancreas
4. Parts of duodenum
Transverse colon
-largest and most mobile portion of colon
-extends from hepatic flexure to left colic flexure
-attached to abdominal wall by transverse mesocolon
-supplied by middle colic artery, branch of SMA
-drained by SMV
Transverse mesocolon
-mesentery of transverse colon
-root lies along inferior border of the pancreas and is continuous w/ parietal peritoneum posteriorly
Greater Sac of Abdominal Cavity
-contains most of the abdominal organs
-liver and stomach superiorly, colon and small intestines
-extension of the peritoneum containing blood vessels, nerves, lymphatics
Lesser Sac/Omental Bursa of Abdominal Cavity
-behind the stomach and inferior to the liver
-has superior and inferior recess
-connected to greater sac by epiploid foramen
-ends laterally at border of spleen
-lies anterior to retroperitoneal structures
-allows stomach to move in different planes as we digest food
-peritoneum secretes fluid allowing movement
What connects the Lesser Sac to the Greater sac and where?
-Foramen of Winslow/Epiploic Foramen
-lies posterior to the hepatoduodenal ligament
Boundaries of Foramen of Winslow
1. Anterior= hepatic portal vein, hepatic artery proper, bile duct contained w/in hepatoduodenal ligament
2. Posterior= inferior vena cava and right crus of the diaphragm covered w/ parietal peritoneum
3. Superior= caudate lobe of the liver covered w/ visceral peritoneum
4. Inferior= first part of the duodenum covered with visceral peritoneum
Inferior recess of lesser peritoneal sac
-extends inferiorly as far as greater omentum
-during development extended between the layers of the greater omentum
Superior recess of lesser peritoneal sac
-highest part of lesser peritoneal sac
-lies anterior to diaphragm and posterior to the caudate lobe of liver
What does the peritoneum that covers the pancreas form part of the posterior wall to?
-lesser peritoneal sac
What innervates the walls of the abdomen?
-costal nerves
Are intestines and other abdominal organs sensitive to pain?
-they are sensitive to being expanded or stretched though
Hepatoduodenal ligament
-surrounds portal vein, common bile duct, and hepatic artery as they enter and exit the liver at the hepatic portal area
-gall bladder
-bile ducts
-blood supply by way of celiac trunk
What does the celiac trunk supply?
-small intestine
-blood supply by superior mesenteric artery
-blood supply by inferior mesenteric artery
What artery supplies the midgut?
-superior mesenteric artery
What artery supplies the hindhgut?
-inferior mesenteric artery
-passes through esophageal hiatus of diaphragm
-connects to stomach
Esophageal sphincter
-prevents reflux of stomach contents
-formed by diaphragmatic fibers
-physiological sphincter
Barret Esophagus
-chronic peptic ulceration of lower esophagus caused by damage done by reflux of HCL and food contents
What can GERD be treated with?
-H2 blockers
-these drugs inhibit secretion of excess acid
Zig-zag line
-junction of smooth portion of esophagus with rugae of stomach
-below the diaphragm
Cardiac notch
-also called "cardial notch"
-to the left of the junction of the stomach w/ esophagus
-betweem esophagus and fundus
-dilated superior part of stomach that is related to the left dome of the diaphragm and is limited inferiorly by horizontal plane of cardial orifice
-superior part of fundus usually reaches 5th intercostal space
-folds in the stomach wall
-allow for increased surface area of acid secreting cells
Phrenoesophageal ligament
-joins stomach to diaphragm on each side of esophagus
-digested food and hydrochloric acid
Greater Curvature of Stomach
-greater omentum attaches here
Parts of the Stomach
1. cardiac = located superiorly, esophagus joins it
2. fundus
3. body
4. pyloric antrum
5. pylorus
Pyloric canal
-dumps into duodenum
Pyloric sphincter
-regulates the flow of digestive fluid from stomach to duodenum
-can use barium tracer to see if this sphincter is functioning properly
Pyloric orifice
-junction between pyloric portion of stomach and duodenum
-excision of a part of the stomach
Why is stomach cancer usually a very poor prognosis?
-drainage of stomach into hepatic portal vein has many lymph nodes surrounding it
-both exocrine (secretes digestive enzymes and endocrine (secretes hormones)gland
-secondarily retroperitoneal
Parts of Pancreas
-head (with uncinate process)
Where does the tail of the pancreas end?
-hilum of spleen
What are the two pancreatic ducts and what do they empty into?
1. Principle (Wirsung) pancreatic duct
2. Accessory (Santorini) pancreatic duct
-empty into descending portion of duodenum
Hepatopancreatic duct
-common bile duct joins with main pancreatic duct to enter Greater Papillae of duodenum
Acute pancreatitis
-very deadly
-from viral infections or problems w/ gall bladder
Cancer of pancreas
-almost always involves the head and is deadly
-cancer of the tail often good prognosis
-peritoneal structure
-attached to inferior border of diaphragm by coronary ligament
-has right and left triangular ligaments
-produces proteins, bile, storage of carbohydrates, detoxification
-all blood from abdominal organs passes through here for detox.
-produces serum albumin from breakdown of proteins
-attached to anterior abdominal wall by falciform ligament
-four lobes
Coronary ligament
-attaches liver to inferior border of diaphragm
Serum Albumin
-produced by the liver from breakdown of proteins
-vitally important to maintenance of oncotic pressure
-albumin levels are reflection of ingested protein
-if level drops below 2, patient can't maintain enough fluid in cardiovascular system and begins to "third space" it
Falciform ligament
-attaches liver to anterior abdominal wall
-remnant of ventral mesentery during embryological development
Ligamentum teres
-in inferior posterior edge of falciform ligament
-remnant of umbilical vein
Four anatomic lobes of liver
1. Right
2. Left
3. Caudate
4. Quadrate
Inferior border of liver
-H shaped group of fissures
-gall bladder and IVC form one leg
-hepatic portal area forms transverse part of H
-Round ligament and ligamentum venosum form other leg of H
-these fissures form the boundaries of anatomical lobes
what is the largest organ in the body?
-produced by liver for emulsification, absorption, and digestion of fats in digestive tract
Gall Bladder
-stores and concentrates bile from liver
-located in gall bladder fossa in right edge of quadrate lobe
-Parts = fundus, body, neck, cystic duct
Cystic Duct
-connects gall bladder to common bile duct
Common bile duct
-formed by common hepatic duct joined with cystic duct
-drains (inferiorly) into the major duodenum papilla of Vater along with the major pancreatic duct
-largest lymphatic organ in body
-peritoneal organ
-suspended from gastrosplenic ligament and splenorenal ligaments in left upper quadrant
-splenic artery and vein enter and exit through hilum
-can be removed
-chyme from stomach passes into here
-mucosa has permanent folds called plicae curculares
-superior portion joins stomach at pyloric sphincter
-descending portion is retroperitoneal and contains the major duodenal papilla
-horizontal portion is retroperitoneal and passes between superior mesenteric artery and aorta
-ascending portion is both retroperitoneal and peritoneal, swings up then anteriorly
Plicae circulares
-permanent folds in mucosa of duodenum
Major duodenal papilla (of Vater)
-main opening for common bile duct and pancreatic duct
-in second (descending) portion of duodenum
Superior mesenteric artery
-major branch to intestines
Duodenojejunal Flexure
-where ascending portion of duodenum joins jejunum
Ligament of Treits/Suspensory ligament of duodenum
-attaches ascending (fourth) part of duodenum to right crus of diaphragm
-located just proximal to duodenojejunal junction
What portion of the duodenum contains the major duodenal papilla?
-descending(retroperitoneal) portion
What portion of the duodenum passes between the superior mesenteric artery and aorta:
-horizontal (third) portion
What portion of the duodenum is both retroperitoneal and peritoneal?
-Ascending (fourth) portion
What portion of the duodenum joins the jejunum at the duodenojejunal flexure?
-Ascending portion
Where does the fourth (ascending) part of the duodenum become peritoneal?
-as it joins the jejunum
Major ampulla
-located in second (descending) portion of duodenum
-receives the junction of the major pancreatic duct and common bile duct
Major duodenal papilla/Vater
-where descending duodenum receives the hepatopancreatic ampulla
Secondary/minor duodenal papilla
-usually superior to major duodenal papilla
-receives accessory pancreatic duct of Santorini
Where does Santorini duct join duodenum?
-Minor duodenal papilla
Where does the suspensory ligament of Treitz attach to the diaphragm?
-right crus
Jejunum and Ileum
- 6-7 m long
- extend from ligament of Treitz to ileocecal junction
- jejunum is shorter than ileum
-both suspended from posterior body wall by the mesentery
-supplies by SMA
-drained by SMV
- shorter than ileum (~2/5 of entire length)
-less fat in its mesentery than ileum
-vasa recta are long and straight
-wall thick and heavy
-deeper red in color
-large, tall, closely packed circular folds
-few lymphoid nodules
-more vascularity
- longer than jejunum
-more fat in mesentery than jejunum
-vasa recta shorter w/ more complex arcades
-paler pink in color
-thin and light wall
-less vascularity
-circular folds low and sparse, absent in distal part
-many lymphoid nodules
-for absorption, dehydration, and lubrication of fecal material
-Ascending, transverse, descending, and sigmoid portions
Teniae coli
-feature of large intestine
-3 longitudinal bands of fascia running along large intestine
-feature of large intestine
-sacculation or pouches of colon between teniae coli
Epiploic/Omental Appendices
-small, fatty appendices of colon
-small portion that hangs off cecum of ascending colon
-blind intestinal diverticulum
-has a short triangular mesentery called mesoappendix which derives from posterior side of mesentery of terminal ileum
-usually retrocecal
-lies deep to McBurney Point
-Supplied by appendicular artery, a branch of the ileocolic artery
-drained by ileocolic vein
Ileocecal junction
-where ileum empties into colon
Ascending colon
-continuous w/ transverse colon at right colic flexure (hepatic colic flexure)
-passes superiorly on the right side of the abdominal cavity from the cecum to the right lobe of the liver
-narrower than cecum
-separated from anterolateral abdominal wall by greater omentum
-has vertical groove lined w/ parietal peritoneum (right paracolic gutter) on lateral aspect
-supplied by ileocolic and right colic arteries (branches of SMA)
-drained by ileocolic and right colic veins (branches of SMV)
Descending colon
-secondarily retroperitoneal
-passes from left colic flexure into left iliac fossz
-continuous w/ sigmoid colon
-covered by peritoneum anteriorly and laterlly
-bound to posterior abdominal wall by peritoneum
-short mesentery in iliac fossa in 33% of people
-passes anterior to lateral border of left kidney
-paracolic gutter on lateral aspect
-supplied by left colic and sigmoid arteries (branches of IMA)
-drained by IMV
Sigmoid colon
-S shaped loop of colon linking descending colon to rectum
-variable in length
-extends from iliac fossa to third sacral segment where it joins the rectum
-termination of tenia coli indicates rectosigmoid junction
-usually has long mesentery called sigmoid mesocolon
-supplied by sigmoid artery (branch of IMA)
-drained by IMV
Root of sigmoid mesocolon
-inverted V shaped attachment
-extends medially and superiorly along the external iliac vessels and then medially and inferiorly from the bifurcation of the common iliac vessels to the anterior aspect of the sacrum
Marginal artery
-formed by anastamoses of all or most of the branches of arteries supplying blood to colon
-forms a continuous anastamotic channel
-iliocolic a., right, middle, and left colic aa., sigmoid aa.

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