219 Questions
What is the main purpose of applying pressure to the abdominal wall during diagnosis of peritonitis?
To induce rebound tenderness
What is the primary function of the peritoneum in peritoneal dialysis?
To allow rapid bidirectional transfer of substances
Which nerve is responsible for innervating the parietal peritoneum in the pelvis?
Obturator nerve
What is the primary location of the inflamed appendix in relation to the pelvis?
Hanging down into the pelvis
What is the purpose of introducing a watery solution, the dialysate, during peritoneal dialysis?
To remove waste products from the blood
What is the result of suddenly withdrawing the finger during diagnosis of peritonitis?
Extreme local pain
What is the main advantage of peritoneal dialysis compared to hemodialysis?
Fraction of the efficiency achieved by hemodialysis
What is the purpose of performing a rectal or vaginal examination during diagnosis of peritonitis?
To palpate the parietal peritoneum
What is the cause of pain referred to a characteristic site in the skin?
Stretch of the mesentery
What is the result of overdistension of a viscus or pulling on a mesentery?
Referred pain in the skin
What is the function of the peritoneal lining cells?
To diffuse the products of metabolism from the blood vessels into the dialysate
What is the significance of the 6th week of development in peritoneum and peritoneal cavity development?
The capacity of the abdominal cavity becomes greatly reduced
What is the significance of the inferior mesenteric vein in relation to the paraduodenal recess?
It lies in the anterior wall of the paraduodenal recess
What is the characteristic of pain arising from an abdominal viscus?
It is dull and poorly localized
What is the embryonic origin of the GI tract?
It arises as a midline structure
What can occur when a loop of intestine enters a peritoneal pouch or recess?
It becomes strangulated
What is the term for the cavity formed between the somatic and splanchnic layers of the lateral mesoderm?
Intraembryonic coelom
What is the derivative of the part of the embryonic coelom situated caudal to the septum transversum?
Peritoneal cavity
During which week of development does the physiological herniation of the midgut take place?
6th week
What is the origin of the ventral mesentery?
Mesoderm of the septum transversum
What is the structure that divides the peritoneal cavity into right and left halves early in development?
Dolostel mesentery
What is the fate of the ventral mesentery?
All of the above
What is the origin of the dorsal mesentery?
Fusion of the mesoderm of the cervical somites
What is the communication between the peritoneal cavity and the extraembryonic coelom during the earliest stages of development?
Wide and free
Where does the root of the mesentery of the small intestine attach?
To the posterior abdominal wall
What is the characteristic of the mucous membrane in the first part of the duodenum?
Smooth and thick
What is the relation of the gallbladder to the transverse colon and duodenum?
The gallbladder is adjacent to the transverse colon and duodenum
What is the location of the superior mesenteric artery?
In the root of the mesentery
What is the structure that the right hepatic duct drains into?
The bile ducts
What is the location of the hilum of the right kidney?
Posteriorly
What is the junction where the small intestine meets the large intestine?
Ileocecal junction
What is the part of the small intestine where the plicae circulares are located?
Second part of the duodenum
What is the posterior relation of the first part of the duodenum?
The lesser sac
At which level does the second part of the duodenum run vertically downward?
Right side of the second and third lumbar vertebrae
Where does the accessory pancreatic duct open into the duodenum?
On the summit of the minor duodenal papilla
What is the anterior relation of the second part of the duodenum?
The fundus of the gallbladder
Where does the bile duct pierce the duodenal wall?
On the medial border of the second part of the duodenum
What is the superior relation of the first part of the duodenum?
The entrance into the lesser sac
What is the inferior relation of the first part of the duodenum?
The head of the pancreas
What is the level at which the afferent pain fibers from the appendix enter the spinal cord?
10th thoracic segment
What is the procedure called when the cecum or transverse colon is brought to the surface through a small opening in the anterior abdominal wall?
Cecostomy
What type of injuries commonly occur where mobile parts of the colon join the fixed parts?
Blunt injuries
What is the result of sudden rotation of the sigmoid colon around its mesentery?
Complete cut-off of blood supply
Where is the pain initially referred to in appendicitis?
Umbilicus
What is the purpose of cecostomy or colostomy?
To relieve large-bowel obstructions
What contributes to the appendix's predisposition to infection?
The presence of lymphoid tissue in its wall
What type of pain is produced by distension of the appendix or spasm of its muscle?
Visceral pain
What obstructs the lumen of the appendix, leading to stagnation of its contents?
Hardened intestinal contents
What is the characteristic of the pain in the later stages of appendicitis?
Severe and localized
Why does the appendix have a high risk of perforation?
Its blood supply is not anastomosed with other arteries
What is the result of the appendix's predisposition to infection and perforation?
All of the above
What is the term for the inflammation of a diverticulum?
Diverticulitis
Where does the passage of the mucosal diverticulum occur?
Through the circular muscle between the teniae coli
What is the consequence of perforation of the appendix or transmigration of bacteria through the inflamed appendicular wall?
Infection of the peritoneum of the greater sac
What is the significance of the greater omentum in relation to peritoneal infection?
It helps to contain the spread of peritoneal infection
What is the typical age range for the development of large bowel cancer?
Over 50 years
What is the primary method of bloodstream spread in large bowel cancer?
via the portal circulation
What is the most common type of intussusception in children?
Ileocollc
What is the possible cause of the high incidence of intussusception in children?
Relatively large size of the large bowel
What is the term for the herniation of the lining mucosa through the weak points of the colon muscle?
Diverticulosis
What is the result of the rotation of the stomach during embryonic development?
The dorsal and ventral mesenteries change position
What is the origin of the digestive tube?
Yolk sac
What is the consequence of intussusception?
Cutting off the blood supply to the gut
What is the result of the stomach's rotation during development?
The duodenum is forced to rotate to the right.
What is the fate of the dorsal mesentery during duodenum development?
It remains as a thin layer of smooth muscle and fibrous tissue.
What is the origin of the liver and pancreas during development?
They arise as entodermal buds from the developing duodenum.
What is the characteristic of the stomach's development?
It develops as a dorsal dilatation of the foregut.
What is the result of the esophageal blastena hemia in the diaphragm?
The esophagus becomes shorter than normal.
What is the part of the duodenum where the ventral mesentery is attached?
The upper half of the second part of the duodenum.
What is the structure that forms the greater curvature of the stomach?
The dorsal border of the stomach.
What is the characteristic of the fundus of the stomach?
It appears as a dilatation at the upper end of the stomach.
What is the direction of the stomach's rotation due to the great growth of the right lobe of the liver?
To the right
What is the consequence of the rapid proliferation of the lining cells during the development of the duodenum?
The lumen becomes completely obliterated
What is the name of the nerve attached to the right surface of the stomach?
Right vagus nerve
What is the term for the cavity formed between the somatic and splanchnic layers of the lateral mesoderm?
Coelom
What is the structure that divides the peritoneal cavity into right and left halves early in development?
Septum transversum
What is the fate of the ventral mesentery?
It forms the falciform ligament
What is the origin of the dorsal mesentery?
Splanchnic mesoderm
Where does the root of the mesentery of the small intestine attach?
At the level of the lumbar vertebrae
Where does the bile duct pierce the duodenal wall?
At the major duodenal papilla
What is the capacity of the gallbladder?
30 to 50 mL
What is the function of the sphincter of Oddi when digestion is not taking place?
Remains closed
What is the relation of the gallbladder to the transverse colon and duodenum?
Anterior
What is the function of the gallbladder?
Stores bile and concentrates it by absorbing water
What is the structure that surrounds the fundus of the gallbladder?
Peritoneum
What is the part of the gallbladder that comes in contact with the anterior abdominal wall?
Fundus
What is the direction of the bile flow when the sphincter of Oddi is closed?
Into the gallbladder
What is the approximate percentage of lymph produced by the liver?
One third to one half
Which ligament forms the upper layer of the coronary ligament on the right side?
Right triangular ligament
What is the name of the fibrous band that is the remnant of the ductus venosus?
Ligamentum venosum
Where do the lymph vessels from the liver enter?
Celiac nodes
What is the name of the area of the liver that is devoid of peritoneum?
Bare area of the liver
What is the origin of the sympathetic and parasympathetic nerves that form the celiac plexus?
Anterior vagal trunk
What is the purpose of the peritoneal ligaments in the liver?
To support the liver in the upper part of the abdominal cavity
What is the characteristic of the liver that makes it prone to trauma?
It is a soft, friable structure
What is the location of the interlobular ducts in the liver?
In the portal canals
What is the function of the interlobular ducts in the liver?
To receive bile canaliculi
What is the length of the common hepatic duct?
1.5 in. (4 cm)
Where does the cystic duct join the common hepatic duct?
In the right free margin of the lesser omentum
What is the relationship of the bile duct to the portal vein and hepatic artery?
It lies in front of the portal vein and on the right of the hepatic artery
Where does the bile duct lie in the second part of its course?
Behind the first part of the duodenum
What is the length of the bile duct?
3 in. (8 cm)
Where do the bile and pancreatic ducts enter the duodenum?
In the second part of the duodenum
What is the primary function of the bile salts in the bile?
To emulsify the fat in the intestine and assist with its digestion and absorption
Which artery supplies the gallbladder?
Cystic artery
What is the course of the lymph vessels from the gallbladder?
Into the cystic lymph node and then into the hepatic nodes
What is the length of the cystic duct?
3.8 cm
What is the characteristic of the mucous membrane in the cystic duct?
It is raised to form a spiral fold
What is the effect of the hormone cholecystokinin on the gallbladder?
It contracts the gallbladder
What is the location of the small arteries and veins that run between the liver and gallbladder?
In the lesser omentum
What is the structure formed by the union of the cystic duct and the common hepatic duct?
Bile duct
What is the consequence of an impaction of a stone in the ampulla of Vater?
The passage of infected bile into the pancreatic duct
What is the anatomic arrangement that determines whether infected bile is likely to enter the pancreatic duct?
The type of duct system present
What is the consequence of gallstones ulcerating through the gallbladder wall into the transverse colon?
The production of intestinal obstruction
What is the reason why the gallbladder rarely becomes gangrenous?
Because it has a cystic artery and small vessels from the visceral surface of the liver
What is the variation of the blood supply to the gallbladder that is commonly seen?
A cystic artery and small vessels from the visceral surface of the liver
During development, what happens to the cystic duct?
It opens into the common hepatic duct to form the bile duct
What is the consequence of including the common hepatic duct or the main bile duct in the arterial ligature?
Disastrous consequences
What is the relationship between the gallbladder and the transverse colon or duodenum?
Gallstones may ulcerate through the gallbladder wall into the transverse colon or duodenum
What is the primary function of the kidneys in the urinary tract?
To filter waste and excess fluids from the blood
What is the name of the muscle located between the posterior abdominal wall and the kidney?
Quadratus lumborum
What is the term for the space behind the peritoneum?
Retroperitoneal space
What is the name of the layer of fascia that surrounds the kidney?
Renal fascia
What is the structure that the ureters, urinary bladder, and urethra are part of?
Urinary tract
What is the location of the kidneys in the body?
Behind the peritoneum in the abdominal cavity
What is the color of the kidneys?
Reddish brown
What is the structure that the kidneys are closely related to?
Inferior vena cava
What is a possible indication of peritoneal irritation?
Tenderness in the lumbar and iliac regions
What is the potential consequence of a leaking aortic aneurysm?
Retroperitoneal hemorrhage
What is the anatomical structure that forms the anterior boundary of the retroperitoneal space?
Peritoneum
What is the term for the narrowing of the ureter at three specific sites?
Ureteral waist
What is the anatomical structure that projects medially from the renal hilar region?
Pepwa
What is the location of the renal col111DDS?
Medulla of the kidney
What is the primary function of the kidneys?
To filter the blood and regulate electrolyte balance
What is the name of the vertical slit in the medial concave border of each kidney?
Hilum
What is the term for the space formed between the somatic and splanchnic layers of the lateral mesoderm?
Coelom
What is the structure that divides the peritoneal cavity into right and left halves early in development?
Septum transversum
What is the purpose of the renal sinus?
To transmit the renal vein, renal artery, and ureter
What is the cause of the right kidney being slightly lower than the left kidney?
The large size of the right lobe of the liver
What is the movement of the kidneys during respiration?
Upward and downward movement
What is the purpose of CT scans in cases of trauma to retroperitoneal space organs?
To define the extent of injury to the organs
Where is the urinary bladder located?
In the pelvic cavity
What is the function of the ureters?
To transmit urine from the kidney to the urinary bladder
What is the function of the renal fascia?
To support the kidneys and hold them in position on the posterior abdominal wall
What is the name of the space within the hilum that contains the upper expanded end of the ureter?
Renal pelvis
What is the structure that indents each minor calyx?
Renal papilla
What is the term for the striations that extend from the bases of the renal pyramids into the cortex?
Medullary rays
What is the name of the layer of fat surrounding the kidney?
Pararenal fat
What is the relationship between the suprarenal gland and the kidney?
The suprarenal gland is anterior to the kidney
What is the structure that divides the renal pelvis into two or three major calyces?
Ureter
What is the name of the structure that collects the urine from the nephrons?
Collecting tubule
Which nerve runs downward and laterally and is related to the kidney?
Ilioinguinal nerve
What is the location of the pararenal fat?
External to the renal fascia
What is the term for the functional units of the kidney?
Nephrons
What is the function of the perirenal fat?
To support the kidneys and hold them in position on the posterior abdominal wall
What is the name of the structure that separates the peritoneal cavity into right and left halves?
Septum transversum
What is the term for the inner part of the kidney?
Medulla
What is the name of the structure that connects the kidney to the abdominal wall?
Renal fascia
What is the name of the structure that contains the glomerulus?
Renal corpuscle
Which artery arises from the celiac artery?
Splenic artery
What is the name of the artery that branches off from the hepatic artery?
Cystic artery
Which artery supplies the small intestine?
Jejunal and ileal arteries
What is the name of the artery that branches off from the superior mesenteric artery?
Middle colic artery
Which artery supplies the right side of the transverse colon?
Right colic artery
What is the name of the artery that supplies the cecum?
Anterior cecal artery
Which artery supplies the left side of the transverse colon?
Left colic artery
What is the name of the artery that supplies the jejunum and ileum?
Jejunal and ileal arteries
What is the origin of the suprarenal gland's cortex?
Coelomic mesothelium
What is the significance of the fetal cortex in the suprarenal gland?
It is present in the suprarenal gland at birth and then retrogresses
What is the location of the internal iliac arteries?
In the pelvic cavity
What is the structure that the aorta enters the abdomen through?
Aortic hiatus
What is the significance of the posterior abdominal wall?
It contains skeletal elements, muscles, and parts of the urinary and GI tracts
What is the embryonic origin of the medulla of the suprarenal gland?
Neural crest cells
Why are the suprarenal glands susceptible to trauma at birth?
Due to the friability of the cortex during involution
What is the relationship between the medulla and the cortex of the suprarenal gland?
The medulla invades the cortex on its medial side
Which artery is a branch of the thoracic part of the aorta?
Posterior intercostal artery
Which artery is a branch of the abdominal aorta?
Left renal artery
Which artery anastomoses with the inferior epigastric artery?
Superior epigastric artery
Which part of the aorta gives rise to the lumbar arteries?
Abdominal part
Which artery is a branch of the ileocolic artery?
Marginal artery
Which artery is located at the fourth lumbar level?
Inferior epigastric artery
What are the three anterior visceral branches of the abdominal aorta?
Celiac artery, superior mesenteric artery, and inferior mesenteric artery
Where does the external iliac artery enter the thigh?
By passing under the inguinal ligament
What is the origin of the inferior epigastric artery?
Just above the inguinal ligament
How many lumbar arteries arise from the abdominal aorta?
Four
What is the terminal branch of the abdominal aorta that goes to the midline?
Median sacral artery
What is the branch of the abdominal aorta that supplies the inferior rectal region?
Superior rectal artery
What is the branch of the abdominal aorta that supplies the kidneys?
Renal artery
What are the three lateral visceral branches of the abdominal aorta?
Suprarenal artery, renal artery, and testicular or ovarian artery
What is the primary route through which visceral pain from the appendix travels to the spinal cord?
Through the superior mesenteric plexus and the lueer planchnic nerve
What is the characteristic of pain felt in the dermatomes (T10 to T9) on the lower chest and upper abdominal walls?
Vague referred pain
What is the location of the severe somatic pain when the inflammatory process involves the parietal peritoneum of the anterior abdominal wall?
Right lower quadrant
What is the structure that can give rise to referred pain over the shoulder when involved in the inflammatory process?
Central diaphragmatic parietal peritoneum
What is the characteristic of pain produced by distension of the appendix or spasm of its muscle?
Visceral pain
What is the location of the intense pain when the inflammatory process involves the peripheral diaphragm?
Through to the back below the inferior angle of the scapula
What is the purpose of radiographic imaging in evaluating the abdominal contents?
To provide unique insights into the complex topography of the abdomen
What is the significance of the Spinal cord segment (T10) in relation to the pain felt in the region of the umbilicus?
It is the segment where the pain is first referred to
What is the time frame in which the barium meal reaches the ileocecal junction after ingestion?
30 minutes to 2 hours
What is the administration method that provides a more satisfactory demonstration of the large intestine?
Barium enema
What is the characteristic of the barium shadow in the jejunum and upper part of the ileum?
Scatters the barium shadow due to mucosal folds and peristaltic activity
What is the area where the barium meal tends to form a continuous mass of barium?
Last part of the ileum
What is the amount of barium sulfate emulsion administered through the anal canal to outline the bowel?
Two to three pints
What is the projection in which the entire outline of the large intestine can be seen?
Anteroposterior projection
What is the name of the flexure marked in the radiograph in Figure 7.83?
Duodenojejunal flexure
What is the purpose of arteriography in the context of the GI tract?
To visualize the arterial supply to the GI tract
What is the characteristic of the bowel when it is filled, as seen in the radiograph?
The sacculations are well-seen
What is the result of manipulating the catheter into the opening of the appropriate artery during arteriography?
The arterial supply to the GI tract is demonstrated
What is the part of the duodenum marked in the radiograph in Figure 7.83?
Second part
What is the purpose of inserting a catheter into the femoral artery during arteriography?
To visualize the arterial supply to the GI tract
What is the location of the barium in the radiograph in Figure 7.83?
In the body of the stomach
What is the characteristic of the mucosal pattern after the enema has been evacuated?
It is clearly demonstrated
What is the purpose of injecting radiopaque material through a catheter?
To obtain an arteriogram
What is the typical shape of the gallbladder as seen on a radiograph?
Pear-shaped
What is the route by which an iodine-containing compound is absorbed into the body?
Orally, then through the liver, then with the bile
What is the location of the gallbladder as seen on a radiograph?
In the right upper quadrant of the abdomen
What is the effect of giving a fatty meal on the gallbladder?
It causes the gallbladder to contract
What is the purpose of injecting barium into the duodenum?
To visualize the duodenum
What is the route by which barium reaches the small intestine?
Orally, then through the stomach
What is the typical appearance of the large intestine on a radiograph after a barium enema?
A series of curvilinear opacities
Study Notes
Abdominal Cavity
- The gallbladder is located under the diaphragm, near the esophagus and urinary bladder.
- Referred visceral pain occurs when an inflamed parietal peritoneum is stretched, causing extreme local pain.
Peritoneum
- The peritoneum is a semipermeable membrane that allows rapid bidirectional transfer of substances across it.
- The surface area of the peritoneum is enormous, making it useful for peritoneal dialysis in patients with acute renal insufficiency.
- The parietal peritoneum in the pelvis is innervated by the obturator nerve and can be palpated through a rectal or vaginal examination.
Visceral Afferent Nerves
- Visceral afferent nerves innervate the visceral peritoneum, including the mesenteries.
- Stretching the mesentery gives rise to the sensation of pain, which is commonly referred to a characteristic site in the skin.
- Typical sites of referral of visceral pain are shown in Figure 7.17.
Embryology of Peritoneum and Peritoneal Cavity
- The peritoneal cavity is derived from the part of the embryonic coelom situated caudal to the septum transversum.
- The peritoneal cavity is initially in free communication with the extraembryonic coelom, but this communication becomes restricted to the small area within the umbilical cord.
- The peritoneal cavity is divided into right and left halves by a central partition formed by the dorsal mesentery, the gut, and the small ventral mesentery.
Peritoneal Ligaments and Mesenteries Formation
- The peritoneal ligaments are developed from the ventral and dorsal mesenteries.
- The ventral mesentery is formed from the mesoderm of the septum transversum and gives rise to the falciform ligament, the coronary ligament, and the triangular ligament of the liver.
Posterior Relations of the Duodenum and the Pancreas
- The duodenum has four parts, which have the following posterior relations:
- Anteriorly: Quadratic lobe of the liver and the gallbladder
- Posteriorly: Lesser sac, gastroduodenal artery, bile duct, portal vein, and inferior vena cava
- Superiorly: Entrance into the lesser sac (epiploic foramen)
- Inferiorly: Head of the pancreas
Second Part of Duodenum
- The second part of the duodenum runs vertically downward in front of the hilum of the right kidney
- The bile duct and the main pancreatic duct pierce the duodenal wall, unite to form the ampulla, and open on the summit of the major duodenal papilla
- The accessory pancreatic duct, if present, opens into the duodenum a little higher up on the minor duodenal papilla
Relations of the Second Part of Duodenum
- Anteriorly: Fundus of the gallbladder, right lobe of the liver, transverse colon, and coils of the small intestine
- Posteriorly: Hilum of the right kidney and the right ureter
Mucous Membrane and Duodenal Papillae
- The mucous membrane of the duodenum is mostly thick and smooth in the first part
- The duodenal papillae are two: major and minor
Root of Mesentery
- The root of the mesentery of the small intestine attaches to the posterior abdominal wall
- It extends from the duodenojejunal flexure on the left of the aorta, downward, and to the right to the ileocecal junction
- The superior mesenteric artery lies in the root of the mesentery
Appendiceal Predisposition to Infection
- The appendix's shape and structure contribute to its predilection to infection: it is a long, narrow, blind-ended tube, which encourages stasis of large-bowel contents.
- The appendix has a large amount of lymphoid tissue in its wall, making it prone to infection.
- The lumen of the appendix tends to become obstructed by hardened intestinal contents (enteroliths), leading to further stagnation of its contents.
Appendiceal Predisposition to Perforation
- The appendix has a single, long, small artery that does not anastomose with other arteries, making it prone to ischemia.
- The terminal branches of the appendicular artery supply the blind end of the appendix.
- Inflammatory edema of the appendicular wall compresses the blood supply to the appendix, often leading to thrombosis of the appendicular artery.
- This can result in necrosis or gangrene of the appendicular wall, leading to perforation.
Appendicitis Pain
- Visceral pain in the appendix is produced by distention of its lumen or spasm of its muscle.
- The afferent pain fibers enter the spinal cord at the level of the 10th thoracic segment, and a vague referred pain is felt in the region of the umbilicus.
- Later, the pain shifts to where the inflamed appendix irritates the parietal peritoneum, and the pain becomes precise, severe, and localized.
Cecum and Colon Trauma
- The cecum and colon are prone to trauma due to their anatomic mobility.
- Blunt injuries commonly occur where mobile parts of the colon (transverse and sigmoid) join fixed parts (ascending and descending).
- Penetrating injuries following stab wounds are also common.
Volvulus
- The sigmoid colon can rotate around its mesentery, leading to volvulus.
- This can correct itself spontaneously or continue until the blood supply to the gut is cut off completely.
Large Bowel Cancer
- Cancer of the large bowel is relatively common in persons over 50 years old.
- The growth is restricted to the bowel wall for a considerable time before spreading via the lymphatics.
- Bloodstream spread via the portal circulation to the liver occurs late.
- If diagnosed early, a partial colectomy can be performed, accompanied by removal of the lymph vessels and lymph nodes draining the area, and a cure can be anticipated.
Diverticulosis
- Diverticulosis of the colon is a common clinical condition.
- It consists of a herniation of the lining mucosa through the weak points in the muscle wall of the colon.
- The term diverticulitis refers to the inflammation of a diverticulum or diverticula, which may result in perforation of the gut wall.
Cecostomy and Colostomy
- Cecostomy and colostomy are procedures used to relieve large-bowel obstructions.
- The cecum or transverse colon is brought to the surface through a small opening in the anterior abdominal wall.
- The bowel contents may be allowed to drain by this route.
Embryology Notes
- The digestive tube is formed from the yolk sac.
- The esophagus, stomach, and duodenum develop from the foregut, midgut, and hindgut, respectively.
- The stomach develops as a dilatation of the foregut, with a ventral and dorsal mesentery.
- The stomach rotates to the right, and the ventral and dorsal mesenteries change position.
- The duodenum has a mesentery that extends to the posterior abdominal wall, which disappears as the stomach rotates.
Liver Supports and Surgery
- The liver is held in position in the upper part of the abdominal cavity by the attachment of the hepatic veins to the inferior vena cava.
- The peritoneal ligaments and the coronary ligament also play a role in supporting the liver.
- The bare area of the liver is an area devoid of peritoneum, formed by the widely separated peritoneal layers of the coronary ligament.
Ligamentum Teres and Ligamentum Venosum
- The ligamentum teres passes into a fissure on the visceral surface of the liver and joins the left branch of the portal vein in the porta hepatis.
- The ligamentum venosum, a fibrous band, is the remains of the ductus venosus and is attached to the left branch of the portal vein.
Hepatic Ducts
- The right and left hepatic ducts emerge from the right and left lobes of the liver in the porta hepatis.
- The right hepatic duct drains the right lobe of the liver, and the left duct drains the left lobe, caudate lobe, and quadrate lobe.
- The hepatic ducts unite to form the common hepatic duct, which is about 1.5 inches (4 cm) long.
Bile Duct
- The bile duct (common bile duct) is about 3 inches (8 cm) long and is formed by the union of the common hepatic duct and the cystic duct from the gallbladder.
- The bile duct lies in the right free margin of the lesser omentum in front of the opening into the lesser sac.
- In its course, the bile duct lies in front of the right margin of the portal vein and on the right of the hepatic artery.
Gallbladder
- The gallbladder is a pear-shaped sac lying on the undersurface of the liver, with a capacity of 30 to 50 mL.
- The gallbladder is divided into the fundus, body, and neck, and stores bile, which it concentrates by absorbing water.
- The fundus of the gallbladder projects below the inferior margin of the liver, where it comes in contact with the anterior abdominal wall.
Blood Supply to the Gallbladder
- The cystic artery, a branch of the right hepatic artery, supplies the gallbladder.
- The cystic vein drains directly into the portal vein.
- Several small arteries and veins also run between the liver and gallbladder.
Lymph Drainage of the Gallbladder
- The lymph drains into a cystic lymph node situated near the neck of the gallbladder.
- From here, the lymph vessels pass to the hepatic nodes along the course of the hepatic artery and then to the celiac nodes.
Nerve Supply to the Gallbladder
- The gallbladder contracts in response to the hormone cholecystokinin, which is produced by the duodenum.
- Sympathetic and parasympathetic vagal fibers form the celiac plexus, which supplies the gallbladder.
Cystic Duct
- The cystic duct is about 1.5 inches (3.8 cm) long and connects the neck of the gallbladder to the common hepatic duct to form the bile duct.
- The cystic duct is usually somewhat S-shaped and descends for a variable distance in the right free margin of the lesser omentum.
- The mucous membrane of the cystic duct is raised to form a spiral fold that is continuous with a similar fold in the neck of the gallbladder.
Urinary Tract
- The urinary tract consists of the kidneys, ureters, urinary bladder, and urethra.
- The kidneys function to excrete waste products of metabolism and play a major role in controlling water and electrolyte balance and maintaining acid-base balance of the blood.
Kidneys
- The two kidneys are reddish brown and lie behind the peritoneum high up on the posterior abdominal wall on either side of the vertebral column.
- The right kidney lies slightly lower than the left kidney due to the large size of the right lobe of the liver.
- The hilum is a vertical slit in the medial concave border of each kidney that is bounded by thick lips of renal substance, extending into a large cavity called the renal sinus.
- The hilum transmits the renal vein, two branches of the renal artery, the ureter, lymph vessels, and sympathetic fibers.
Coverings of the Kidneys
- Fibrous capsule: surrounds the kidney and is closely applied to its outer surface.
- Perirenal fat: covers the fibrous capsule.
- Renal fascia: a condensation of connective tissue that lies outside the perirenal fat and encloses the kidneys and suprarenal glands, continuous laterally with the transversalis fascia.
- Pararenal fat: lies external to the renal fascia and forms part of the retroperitoneal fat.
Renal Structure
- Each kidney has a dark brown outer cortex and a light brown inner medulla.
- The medulla is composed of about a dozen renal pyramids, each having its base oriented toward the cortex and its apex, the renal papilla, projecting medially.
- The cortex extends into the medulla between adjacent pyramids as the renal columns.
- Extending from the bases of the renal pyramids into the cortex are striations known as medullary rays.
Important Relations
Right Kidney
- Anteriorly: suprarenal gland, liver, second part of the duodenum, right colic flexure.
- Posteriorly: diaphragm, costodiaphragmatic recess of the pleura, 12th rib, psoas, quadratus lumborum, and transversus abdominis muscles.
Left Kidney
- Anteriorly: suprarenal gland, spleen, stomach, pancreas, left colic flexure, and coils of the jejunum.
- Posteriorly: diaphragm, costodiaphragmatic recess of the pleura, 12th rib, psoas, quadratus lumborum, and transversus abdominis muscles.
Posterior Abdominal Wall
- Consists of skeletal elements (lower ribs, lumbar vertebrae, and part of the pelvis), large muscles (psoas, iliacus, quadratus lumborum, and transversus abdominis), part of the urinary tract (kidneys and ureters), and part of the GI tract (duodenum, ascending colon, and descending colon)
Embryology of Suprarenal Gland
- Cortex develops from the coelomic mesothelium covering the posterior abdominal wall
- Fetal cortex forms first, then becomes covered by a second final cortex
- Fetal cortex retrogresses and its involution is largely completed in the first few weeks of life
- Medulla is formed from the neural crest cells, which invade the cortex on its medial side
Susceptibility to Trauma at Birth
- Suprarenal glands are relatively large at birth due to the presence of the fetal cortex
- During involution, the cortex is friable and susceptible to damage and severe hemorrhage
Abdominal Aorta
- Enters the abdomen through the aortic opening (hiatus) of the diaphragm in front of the 12th thoracic vertebra
- Gives off three anterior visceral branches: celiac artery, superior mesenteric artery, and inferior mesenteric artery
- Gives off three lateral visceral branches: suprarenal artery, renal artery, and testicular or ovarian artery
- Gives off five lateral abdominal wall branches: inferior phrenic artery, four lumbar arteries, and external iliac artery
- Gives off three terminal branches: two common iliac arteries and the median sacral artery
Abdominal Pain
- Visceral pain from the appendix is produced by distension of its lumen or spasm of its smooth muscle coat
- Visceral pain travels in nerve fibers that accompany sympathetic nerves through the superior mesenteric plexus and the lueer planchnic nerve to the spinal cord (T10 segment)
- Vague referred pain is felt in the region of the umbilicus (T10 dermatome)
- Later, if the inflammatory process involves the parietal peritoneum, the severe somatic pain dominates the clinical picture and is localized precisely in the right lower quadrant
Abdominal Cavity: Small Intestine
- A barium meal enters the jejunum in a few minutes and reaches the ileocecal junction in 30 minutes to 2 hours.
- In the jejunum and upper part of the ileum, the mucosal folds and peristaltic activity scatter the barium shadow.
- In the last part of the ileum, the barium meal tends to form a continuous mass of barium.
Abdominal Cavity: Large Intestine
- The large intestine can be demonstrated by the administration of a barium enema or a barium meal.
- The bowel may be outlined by the administration of two to three pints (1 L) of barium sulfate emulsion through the anal canal.
- Oblique and lateral views of the colic flexures may be necessary.
- The characteristic sacculations (haustra) are well seen when the bowel is filled.
- After the enema has been evacuated, the mucosal pattern is clearly demonstrated.
- The appendix frequently fills with barium after an enema.
Abdominal Cavity: Biliary Tree
- The bile passages normally are not visible on a radiograph.
- Their lumina can be outlined by the administration of various iodine-containing compounds orally or by injection.
- When taken orally, the compound is absorbed from the small intestine, carried to the liver, and excreted with the bile.
- The concentrated iodine compound mixed with the bile reveals the gallbladder as a pear-shaped opacity.
Make Your Own Quizzes and Flashcards
Convert your notes into interactive study material.
Get started for free
