| Flap 1 |  |
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| Flap 2 | |
|
| Omental Foramen boundary- anterior | portal v., hepatic a., bile duct |
| Omental foramen boundary -posterior | interior vena cava |
| Omenatl foramen boundary-superior | caudate lobe of liver |
| omental foramen boundary-inferior | superior aspect of 1st part of duodenum |
| Esophagus | passes through esophageal hiatus in diaphragm at T10, joins stomach at T11 |
| Diaphragm | around hiatus - forms physiological sphincter |
| physiological sphincter | prevents gastroesophageal reflux |
| upper 1/3 | under conscious control |
| middle 1/3 | mixid |
| inferior 1/3 | under autonomic control exclusively |
| vagus n. forms | plexus on esophagus & passes w/it through esophageal hiatus into abdomen |
| L. gastric a. | from celiac trunk |
| R. gastric a. | from hepatic a. |
| R. gastro-omental | from gastroduodenal |
| L. gastro-omental | from splenic |
| Short gastric | from splenic |
| Duodenum | 4 parts |
| part 1, Duodenum | horizontal at L1 - peritonealized |
| part 2, Duodenum | vertical from L1-L3, retroperitoneal, contains ampulla for bile/pancreatic duct |
| part 3, Duodenum | horizontal at L3, retroperitoneal |
| part 4, Duodenum | curves forward & becomes peritonealized at L2 |
| Jejunum & Ilium | Peritonealized in "the mesentery" |
| Jejunum | more vascular, more prominent vasa recta & more circular folds (plicae circulares for absorption) |
| Cecum & appendix | intraperitoneal |
| ascending colon | retroperitoneal |
| transverse colon | intraperitoneal |
| descending colon | retroperitoneal |
| sigmoid colon | intraperitoneal |
| tenia coli | longitudinal muscular bands |
| haustra | pouch like sacculations |
| Celiac trunk level | T12 |
| Celiac trunk branches | L. gastric, splenic, common hepatic |
| Celiac trunk supplies | esophagus, stomach, spleen, liver, gallbladder, part of duodenum, part of pancreas |
| Superior Mesenteric A. level | L1 |
| Superior Mesenteric A. branches | jejunal, ileal, ileocolic, r. colic, middle colic |
| Superior Mesenteric A. supplies | uncinate process of pancreas, jejunum, ilium, cecum, appendix, ascending colon, most of transverse colon |
| Inferior Mesenteric A. level | L3 |
| Inferior Mesenteric A. branches | L. colic, sigmoid, superior rectal |
| Inferior Mesenter A. supplies | distal end of transverse colon, descending colon, sigmoid colon, rectum |
| Inferior Mesenteric V. drains into | splenic v. |
| Splenic & superior mesenteric vv. join to form | hepatic portal v. |
| L. gastric v. drains into | portal v. |
| Sympathetics-Celiac trunk | Greater splanchnic n. T5-T9 |
| Sympathetics-Superior Mesenteric A. | Lesser splanchnic n. T10-T11 |
| Sympathetics-Inferior Mesenteric A. | Lumbar Splanchnic nn. L1-L2 |
| Parasympathetics blood leaving aorta above L2 | Vagus n. |
| Parasympathetics-blood leaving aorta below L2 | Pelvic splanchnic nn. (S2-S4) |
| Spleen | on L. side opposite ribs 9-11 |
| Spleen supported by | phrenicocolic ligament |
| Spleen rupture causes | severe intraperitoneal hemorrhage |
| Major site of stress-induced immune suppresssion | spleen |
| Spleen becomes enlarged with | monnucleosis & portal hypertension |
| Pancreas | retroperitoneal except tip of tail |
| Pancreas forms | bed of stomach posterior to omental bursa |
| main pancreatic duct joins | common bile duct, accessory duct is present sometimes |
| abdominal impact | results in rupture against verterbral column |
| duct damage | results in auto-digestion |
| Pancreatitis | results from blockage of ducts (gallstones), excessive alcohol consumption, medications |
| Liver #___ Lobes | 4 |
| Lobes of liver | right, left, caudate, quadrate |
| Liver recieves blood from | hepatic artery & portal v. |
| Liver drains into | inferior vena cava |
| Liver toxicity | alcohol, acetominophen, antifreeze |
| Liver disease | cirrhosis |
| Liver - a lot of matastases because | organs which drain through poral vein |
| R. & L. hepatic ducts join to | form common hepatic duct |
| Common hepatic duct joins cystic duct to form | common bile duct |
| cystic duct has | spiral configuration - serves as valve |
| Gallbladder | in costal margin at midclavicular line |
| Gallstones | block duct causing pain (following high lipid meal) |
| Gallbladder innervation | celiac plexus - receive sensory afferents from R. Phrenic n. perceived in C3-C5 dermatomes |
| Esophageal & azygos vv. | esophageal varices |
| Superior & inferiro rectal vv. | hemorrhoids |
| paraumbilical vv. to anterior abdominal wall | caput medusae |
