stomach, liver, spleen

What 3 structures make up the portal triad?
Hepatic artery, bile duct, portal vein

What two ligaments is the lesser omentum comprised of?
Its part of the lesser omentum so does it attach to greater or lesser curvature?
hepato-duodenal & hepato-gastric ligaments
lesser curvature

The stomach has two borders…what are they?
greater and lesser curvatures

what is the name of the “angular notch” located in lower part of lesser curvature?
incisura angularis

There are 2 orifices of the stomach, what are they?
How are they different?
cardial orifice (upper opening) – only has a functional sphincter that prevents food flowback into esophagus
pyloric orifice (lower openin) – true anatomical sphincter, formed by thickening of circular muscle

What are the 4 parts of the stomach..give in order in which food passes through it?
Fundus(mostly gas) –> Body –> Pyloric antrum –> Pyloric canal (where pyloric sphincter is)

What are these rugae (ru guy) or gastric folds?
mucosa that is folded numerous times…flattens out when the stomach is distended (stretched)

Name the 3 muscular layers of the stomach wall from superficial to deep?
Oblique, circular, longitudinal

What is the name of the visceral peritoneum that covers the stomach?
serosa

What is the z-line?
Where is this?
junction of gastric and esophageal mucosa
near cardiac opening

The abdominal aorta has many visceral branches…what are the paired & nonpaired branches?
unpaired: celiac trunk, superior mesenteric artery, inferior mesenteric artery
paired: middle suprarenal artery, renal artery, ovarian/testicular artery

what are the parietal branches (found in parietal peritoneum) of abdominal aorta?
unpaired: median sacral artery
paired: inferior phrenic arter, lumbar artery

What originates off the abdominal aorta and what are the 3 immediate branches that are formed?
Celiac trunk divides into
left gastric artery, splenic artery, common hepatic artery

What does the celiac trunk supply?
stomach, liver, gallbladder, spleen, and pancreas

detail for me the path of the descending thoracic aorta from superior to inferior?
descending thoracic aorta becomes abdominal aorta at T12…descends anterior to lumbar vertebra and left of IVC…ends at L4 by dividing into right and left common iliac arteries

First branch off the abdominal aorta is what?
What does it supply?
celiac trunk…mostly stomach…but also liver, gallbladder, spleen, and pancreas

The celiac trunk supplies the stomach so..what are the arteries that arise from the celiac that supply the stomach and give origins)
-left and right gastric arteries (branches of celiac and hepatic)
-left and right gastroepiploic (branch of splenic and gastroduodenal)
-short gastric arteries (branch of splenic)

What are the vessels that run along the lesser curvature?
What about the greater curvature
right and left gastric arteries
right and left gastroepiploic arteries

Why is the liver considered to be functionally independent?
b/c right and left lobes have their own arterial & portal supply…along with separate venous drainage

What divides the liver into separate lobes…what else does this ligament connect?
falciform ligament divides liver but also connects liver to diaphragm

What is the remnant of the left fetal umbilical vein?
round ligament of liver (teres hepatis)

What are the four lobes of the liver?
What is the left lobe composed of “functionally” ?
right, left, quadrate, caudate
cuadate and quadrate are actually part of left lobe

How is the “french system” of dividing liver different?
How do we count in this system?
divides segments based on branching of hepatic vein
start at cuadate lobe and count counterclockwise (should get 8)

What is name of space between the diaphragm and liver?
sub-phrenic space

What is this coronary ligament all about?
What about the spots with no coronary ligament…what are these called?
-peritoneal reflection on top of liver that also attaches the liver to the diaphragm
-these are called “bare areas” b/c not covered by peritoneum and liver directly touches diaphragm

What is the portal hepatis?
transverse fissure on posterior liver where there is an opening for portal vein, hepatic artery, and R/L hepatic bile ducts

How is liver attached to stomach and duodenum?
by the lesser omentum ( remember the lesser omentum is made of 2 ligaments – hepatogastric & hepatoduodenal)

What percentage of blood flow to liver is provided by
hepatic artery?
portal vein?
hepatic artery = 30 %
portal vein = 70 %

What percentage of oxygen is provided by
hepatic artery?
portal vein?
hepatic artery = about 50 %
Portal vein = about 50 %

**IMPORTANT**…describe path of arterial blood flow from aorta to liver?
from the celiac trunk we get common hepatic artery which shortly becomes –> proper hepatic artery ( which then divides) –> right and left branches right before entering porta hepatis (portal triad)

What is the general function of the portal vein?
What veins make up the portal vein?
-portal vein collects blood from GI tract, gallbladder, pancreas, spleen and brings the blood to liver
-superior mesenteric and splenic vein unite to form portal vein

What happens to the inferior mesenteric vein?
joins up with splenic vein before the splenic vein joins up with superior mesenteric to form the portal vein

what is venous drainage of liver?
hepatic vein drains —>directly into inferior vena cava (just below diaphragm)

What is lymphatic drainage of liver?
the hepatic nodes which drain into –> celiac nodes

Give me a lil info on gall bladder?
stores bile and located next to liver…neck of gallbladder becomes continuous with cystic duct

State the arterial supply of the gall bladder?
cystic artery ( usually branch of right hepatic artery) but…there is lots of variability

What are the folds in the mucous membrane of the cystic duct of the gallbladder?
spiral valves of heister

Trace the flow of bile from gallbladder to intestine
-bile goes from out of infundibulum into cystic duct
-cystic duct joins with common hepatic duct to form common bile duct
-common bile duct is joined with main pancreatic duct
– enters second part of duodenum via hepato-pancreatic ampulla (aka vater)

Name the 2 muscular sphincters in the distal biliary tract (bile tract)?
choledochal sphincter (located distal end of bile duct)
hepatopancreatic sphincter ( located at hepatopancreatic ampulla…aka Vater)

What is special about the spleen?
largest lymphoid organ of body
located between stomach and diaphragm
sheltered by lower ribs

describe sleen’s venous drainage?
by splenic vein….joins superior mesenteric vein behind pancreas to form…portal vein

What 4 abdominal organs are normally in contact with the spleen?
What is the one other one many forget…??
stomach, left kidney, pancreas, colon
the diaphragm

what are the ligaments of the spleen?
gastro-leinal (gastro-splenic)
Spleno-renal

What structures run within the 2 ligaments of the spleen?
gastrosplenic = short gastric & gastroepiploic artery
spleno-renal = splenic artery, vein, & tail of pancreas

How big is spleen?
What artery contributes to the spleen’s major blood supply?
What is the accessory spleen?
-Size of mah fist
– splenic artery
-splenic tissue found near hilum ( 20% of pop)

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