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Stomach, Duodenum, P

Stomach, Duodenum and Pancreas

What part of the gut is stomach? Duodenum and Pancreas? Stomach is foregut, Duodenum is half foregut and half midgut and Pancreas develops at junction between foregut and midgut
Where can ventral mesentery be found in the foregut? Ventral mesentery extends to the top of the duodenum. Ventral mesentery can be found between the anterior body wall and liver
Where is the ligamentum teres hepatis? It is at the free edge of the falciform ligament
What region can the developing liver be found? In the region of the septum transversum
Name the divisions of the stomach Fundus, Cardiac part, body, pylorus antrum, pyloric canal, pylorus
What is the proximal end of the stomach attached to? It is attached to the esophagus at the esophagogastric junction
How does the epithelium change between stomach and esophagus? There is an apparent zig zag line
What marks the distal end of the stomach? The distal end of the stomach is marked by the pylorus which connects the stomach to the duodenum
What is the pylorus? It is a very tight sphincter because at that point you want to eject the acidic contents of the stomach in a very regulated manner into the first part of the duodenum
Does the pH change at the duodenum? What is introduced here? Yes, it is where the pH chnages and bile acids and pancreatic enzymes are introduced
What is the pyloric antrum? It is a functional demarcation where the muscles tend to form a stricture around the back
Where does the pyloric canal and the the pyloric antrum end? They end at the pylorus
Where does the stomach lie? It lies on the stomach bed and the pancreas is included
What happens when there is inflammation in the stomach? It appears as if it is coming from the heart. Visceral afferents give the impression of an angina attack or myocardinal infarction
What is reflux gastritis? When fluid come back into the esophagus
Where does the pylorus enter the duodenum? It enters through the duodenal cap
Different parts of the stomach have.... Different functions
Where do fluids go in the stomach? They come down the cardiac orifice into the gastric cancal or magenstrasse
What is in the gastric canal that allow fluids to flow down? There are longitudinal folds allowing water to percolate down the lesser curvature into pyloric orifice
Where do semi-solids and solid go in the stomach? They must churn with peptic enzymes in the acid pH environment of the gastric and fundic zones
Where does the esophagus enter the diaphragm? At T 10
Why is the distal end of the stomach significantly anchored? Because of the heptoduodenal ligament
At the esophagogastric junction there needs to be the ability to expand, how is this acheived? You pack it with fat
What can happen when the esophagogastric junction is compromised? You can have a hiatus hernia. Stomach can go into thorax
What is a sliding hiatus hernia? Where the gastroesophageal junction moves above the diaphragm together with some of the stomach
What is a paraesophageal hiatus hernia? Does it need to be corrected? Part of the stomach herniates through the esophageal hiatus and lies beside the esophagus without movement of the gasroesophageal junction. Most times do not need to be corrected
What is in the supracolic compartment? (above transverse colon) The stomach, liver and spleen
What is the ends of the transverse colon demarcated by? The left colic (splenic flexture) and the right colic (hepatic flexture)
What two components does the liver consist of from GI tract and septum transversum? Epithelia (endothermal) coming from the GI tract and parenchymal cells from the cells of the septum transversum
What is the heptagastric ligament and the heptaduodenal ligament? Heptagastric ligament: Expanse of ventral mesentery from liver to stomach. Heptaduodenal: Expanse of ventral mesentery from liver to duodenum
What is a ligament? A thin sheet of peritoneum with two serous layers with some fat in between
Where does the spleen develop? It develops in the dorsal meesentery and there is a gastrosplenic ligament connecting the spleen and the greater curvature of the stomach which is an extension of dorsal mesentery
What structures are in the hepatduodenal ligament? The portal vein, the common bile duct and the hepatic artery proper
What is between the inferior vena cava and the heptaduodenal ligament? The foramen of Winslow
What makes up the lesser omentum? Two mesothelial sheets. It is attached from the lesser curvature of the stomach across the liver to the fissure for the ligamentum venosum
Where does the superior recess of the lesser sac run? All the way up to the backside of the liver and it stops where the bare area of the liver begins
If you go behind the stomach where will you be stopped? You will be stopped at the inferior recess of the omental bursa
What makes up the greater omentum? 4 layers of peritoneum
Where is the bloodvessels located in abdomen? On the posterior abdominal wall retroperitoneal
What branches does the celiac trunk break into? Left gastric artery, splenic artery and common hepatic artery
Where does the splenic artery run? Into the stomach bed along the superior border of the pancreas and reaches spleen through the splenorenal ligament to reach hilum
Where does the left gastric artery run? Runs retroperitoneally and supplies left side of lesser curvature of stomach. Eventually becomes intraperitoneal. Branches go into esophagus at the same time
Where does the common hepatic artery go? Reaches the lesser omentum where it breaks up and gives off hepatic artery proper and gastroduodenal artery
What does the gastroduodenal artery branch into? The right gastroomental artery
Where does the right gastric artery come off and run to? It comes off the hepatic proper and runs to the lesser curvature of the stomach to anastomose with left gastric artery
What does the right gastroomental artery anastomose with? With the left gastroomental artery
What does the splenic artery branch into? Branches into the short gastric artery and left gastroomental artery(gastroepiploic artery)
What does the left gastroomental artery supply? The greater omentum on the left side
What supplies the fundus of the stomach? The short gastric artery
Where does venous drainage end up? The portal vein
What is the portal vein? A remnant of the vitelline vein and the venous draingage ends up in the hepatic portal system
Where does venous return also come from? the lower end of the esophagus that goes into the portal system and the azygos system. (secondary pathway if there is blockage)
What do the lymphatics follow? The veins
Why do gastric cancer diagnosis tend to be late? By the time the cancer invades the lymphatic to a size that they can be detected they could spread in mulitple different directions
What innervates the stomach? The vagus nerve (parasympathetic motor). Sympathetic fibers coming from the celiac ganglion with presynaptic fibers from greater splanchnic nerves
Where is the pain referred when you have a gastric ulcer? To the heart because of visceral afferents piggy-backing along the vagus and sympathetic paths
Where does the left vagus nerve go when it enters the abdomen? The anterior vagul trunk into the esophageal plexus
Where does the right vagus nerve enter the abdomen? Posteriorly on the posterior vagul trunk
What parts is the duodenum divided into? 1st, 2nd, 3rd and 4th
Where does the first part of the duodenum run? From the pylorus to the liver (intraperitoneal)
Where does the 2nd and third part of duodenum run? 2nd: Inferiorly down on the side of vertebral column. 3rd: horizonal extension anteriorly to abdominal aorta. (secondary retroperitoneal)
4th part of duodenum? Anteriorly and is continous with the jejunum
What supplies blood to duodenum? The gastroduodenal artery (from common hepatic from celiac trunk) and superior mesenteric artery
What does the gastroduodenal artery branch to? The superior pancreaticoduodenal arteries that supply pancreas and duodenum
What does the superior mesenteric artery branch inot? The inferior pancreaticoduodenal arteries that anastosome with the superior pancreaticoduodenal arteries
What are the folds inside the duodenum called? Plicae circularies
What is the major duodenal papilla? Where the common bile duct and Pancreatic duct come into the duodenum
What is the ampulla of vater? Where the common bile duct and pancreatic duct open located at the major duodenal papilla
What is the ligament of Tretitz? Where the duodenum is anchored to the posterior abdominal wall by a connective tissue that makes up a suspensory ligament
What does the dorsal pancreatic bud represent? A tubular invagination of the endoderm into the dorsal mesentery
What does the ventral pancreatic duct open into? The major duodenal papilla
What does the venral pancreatic bud develop into? The head and uncinate process of pancreas
What does the dorsal pancreatic duct open into? the minor duodenal papilla
What does the dorsal pancreatic bud develop into? The body and tail of the pancreas
What do the splenic vein and superior mesenteric vein combine and become? The hepatic portal vein
Where can the inferior mesenteric vein drain? Anywhere, but most of the time into the splenic vein
What innervates the pancreas and duodenum? Both parasympathetic and sympathetic innvervation
What regulates the sphincter of Oddi? Opening and closing regulated by a peptide hormone cholecystokinin
What can pancreatic cancer lead to? Obstruction of bile flow because common bile duct is close to head of pancreas. can manifest itself in jaundice
What is the sphincter of Oddi? controls the opening of the major duodenal papilla



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