GI-ANATOMY-PRACTICAL-short-version by linzhengnd


									Rohen pages
     Thyroid, vessels & neck muscles: p169-186
     Abd organs, chap 5, p291-322
     Retroperitoneal organs & kidneys, p323-335
AZYGUS venous system
     Azygus vv
     Hemiazygus vv
     Ascessory Hemiazogys vv
Inferior Vena Cava
     Right-side of body
     Veins that drain into it:
          o Hepatic vv, inferior phrenic vv, suprarenal vv, renal vv, gonadal vv,lumbar vv, common iliac vv
          o Mnemonic: I Like To Rise So High
     Inferior Phrenic aa.
     Celiac Trunk
     Middle Suprarenal aa.
     Superior Mesenteric a.
     Renal aa.
     Gonadal aa.
     Lumbar aa.
     Inferior Mesentric aa.
     Bifurcation: Common Iliac aa
     Common Iliac nodes→ Inf Mesenteric nodes→ Pre Aortic nodes→ Superior Mesenteric nodes→ Celiac nodes→
      Lumbar/ Lateral Aortic nodes→ Cysterna Chyli
     Cricoid cartilage
     Cardia of stomach
     Thoracic part of Eso
     Esophageal hiatus
     Phrenicoesophagela lig
     Gastro-esophageal junction (Z-line)
     Abdominal portion of eso
     Arterial supply
          o Upper 1/3, cervical eso : eso branches of inferior thyroid aa
          o Middle 1/3, thoracic eso : eso branches of thorac ao
          o Lower 1/3, abdominal eso: inferior phrenic aa & eso branches of LEFT gastric aa
     Venous
          o UNIQUE: portoa-caval anastomoses, how pts get esophageal varices
          o Upper 1/3: inferior thyroid vv (drains into SVC)
          o Middle 1/3: azygus vv
          o Lower 1/3: LEFT gastric vv (drain into portal vv)
     PARTS:
         o Cardiac notch
         o     Angular notch
         o     body of the stomach
         o     cardia
         o     fundus (5th ICS)
         o     greater curvature (convex)
         o     lesser curvature (concave; angular notch)
         o     Pyloric region
                    pyloric antrum
                    pyloric canal
                    pyloric orifice
                    pyloric sphincter
     Ligament:
          o Gastrocolic lig
          o gastrolienal ligament (AKA gastrosplenic ligament)
     Arteries
          o Right gastric aa ( from common hepatic aa)
          o Left gatric aa (from celiac trunk)
          o Right gastro-omental aa (from gastroduodenal aa)
          o Left gastro-omental aa (from splenic aa)
          o Short gastric (from splenic aa, supplies fundus)
          o Posterior gastric aa (from splenic aa, supplies upper body)
     Veins
          o R & L gastric vv → portal vv
          o Short gastric vv →splenic vv →Portal vv
          o L & R gastro-omental vv → SMV→portal vv
          o Prepyloric vv (surgeons us to ID pylorus→ascends over pylorus→ R gastric vv→ Portal vv
     Lymphatic: will drain to celiac nodes
     3 parts
          o Sternal part: costal part: vertebral part (crura)
     Muscular Part: right & left crus
     Lateral arcuate ligaments      (quadratus lumborum m.)
     Medial arcuate ligaments      (psoas m.)
     Median arcuate lig
     Crura of diaphragm:
     Openings in the diaphragm
          o Caval opening: IVC: T8, esophageal hiatus:Esophagus: T10, aortic hiatus: Ao: T12
                   Mnemonic: I ate ten eggs at twelve
     innervation: phrenic nn (C3-5)
     Greater omentum (apron-like)
         o Divided into 3 parts:
                 Gastrocolic lig: from greater curve of stomach to tranverse colon, part of ant wall of lesser sac
                 Gastrosplenic lig
                 Gastrophrenic lig
      Lesser omentum
           o Ligaments: hepatoduodenal lig, hepatogastric lig, hepato-esophageal lig
           o Omental/ epiploic foramen of Winslow
OMENTAL BURSA (AKA lesser sac)
PERITONEAL FOLDS & RECESSES (???)               (visible only on anterior abd wall)

      1st or superior part
      2nd or descending part
      3rd or horizontal part
      4th or ascending part (L2 on left)
      Duodeno-jejunal flexture
      Ligament of Treitz AKA suspensory muscle of duodenum
      Arterial supply
           o From Celiac trunk: Ant & post superior pancreaticoduodenal aa (from gastroduo aa)
           o From SMA: Ant & post inferior pancreaticoduodenal aa (from inferior pan-duo aa)
      Venous drainage
           o SMV: Distal Structures
           o Portal vv: Via Post and Ant. Superior Pancreaticoduodenal veins - Proximal structures
      Lymphatics: to celiac nodes

Jejunum & Ileum
      Root of the mesentery
      Arterial suppy
           o SMA→ileal & jejunal aa →arterial Arcades→ straight aa (AKA vessa rectae)
      Venous drainage
           o SMA → Portal vv
      Lymphatics:
           o Juxta-Intestinal nodes→ Mesenteric nodes → Sup central nodes→ Sup mesenteric nodes→ Intestinal
                Lymphatic trunk →Chyle cistern →Lymphatic (Thoracic )duct

      Omental appendices (AKA fat/ epiploic appendices)
      Haustra ( outpouchings or sacculations) (produced by the contractions of taenia coli)
      Taeniae coli (longitudinal bands of smooth muscle)
          o Free (libra), Mesocolic, Omental
    orifice of the vermiform appendix
    Arterial supply: ileocecal aa (terminal branch of SMA)
    Venous drainage: ileoceca vv → SMV
Appendix, vermiform
    mesoappendix
   Arterila supply: appendicular aa (from Posterior cecal aa )
      Right paracolic gutter
      Righ colic flexture AKA hepatic flexture
      Blood supply: ileocolic & right colic aa (from SMA), same name veins
     Transvers mesocolon
     Left colic flexture AKA splenic flexture
     Arterial supply: middle colic aa (SMA)
     Venous: SMV
     Left paracolic gutter
     Recto-sigmoid junction
     Sigmoid mesocolon
     tail of the pancreas
     Body
     Head
      Neck
     uncinate process
     Hepatopancreatic ampulla of Vater
     Sphincter of Oddi
     Arterial supply:
           o Branches of splenic aa: body & tail
           o Superior (ant & posterior) pancreaticoduodenal aa (from gastroduodenal aa): HEAD pancreas
           o Inferior (ant & posterior) pancreaticoduodenal aa( from SMA): HEAD of pancreas
     Venous drainage:
           o Head
                    Superior pancreaticoduodenal vv → Portal vv
                    Inferior pancreaticoduodenal vv→ SMV
           o Body & tail
                    Splenic vv→ Portal vv

     diaphragmatic surface (convex), visceral surface (concave)
     hilum
     Ligaments:
          o Lienogastric (gastrosplenic)
          o Lienorenal (splenorenal)
     Vasculature: splenic aa, splenic vv,
     Innervation: Celiac nerve plexus (ONLY organ supplied by celiac trunk NOT originate from primitive foregut)
ABDOMINAL WALL (D’Amato’s lecture)
     Epigastric aa
     Fascia:
          o Camper’s
          o Scarpa’s
          o Transversalis
     linea alba
     Semilunaris line
     Inguinal Ligament (extension of external abdominis)
     Muscles
         o Iliacus, psoas major , quadratus lumborum
         o transversus abdominis
         o abdominal obliques external and internals
         o aponeurosis of muscles
         o pyramidalis
         o rectus abdominis
         o tendinous intersection (of rectus abdominis: transverse, give u “6-pack)
         o transversus abdominis
    Nerves:
         o Iliohypogastric nn (L1, superficial, supplies suprapubic skin)
         o ilioinguinal (L1)
         o thoracoabdominal3
         o Laterla femoral cutaneous (L2,3)
         o Genitofemoral (L1,2)
         o Femoral nn (L2,3,4)
    Veins:
         o Inferior epigastric vein
         o Superior epigastric vv
    Arcuate line
         o Transition b/w post wall of rectus abdominis sheath
         o Below arcuate line: only transversalis fascia
                     Crus
    Falx inguinalis:
         o conjoint tendon,made up of extension of transverse abdominis and internal oblique mm
         o forms posterior wall of canal
    intercrural fibers (go across, make-up inguinal lig)
     superficial inguinal ring (medial end of inguinal lig)
    Deep inguinal ring (enterance to inguinal canal)
         o midpoint of inguinal lig(midway b/w ASIS & the pubic tubercle)
    Hesselbach’s Triangle (rectus abdominus mm, inf epigastric aa, inguinal lig)

    surface(s): visceral (sharp borders), diaphragmatic
    Lobe(s)
         o Caudate, Quadrate, left (lobe), right lobe
    Spaces
         o Suprarenal/ Hepatorenal recess (Morison pouch)
         o Subhepatic space
         o Subphrenic recess (b/w diaphragm & liver)
    bare area liver
    Ligaments
         o Coronary lig
         o Triangular lig (Right & left)
         o Ligamentum venosum
         o Round lig (ligamentum teres)
    fissure(s) (H-shaped, visceral surface of liver)
          o Left & right sagittal fissure , Tranverse fissure
    Porta Hepatis
          o Portal vein
          o Hepatic aa
          o Common Hepatic aa
          o IVC
    NERVES of LIVER: Hepatic plexus

    Portal triad
    Hepatoduodenal lig (small part)
    Hepatogastric lig (big part)

    Ampulla of Vater
    Blood supply:
         o Proximal part: cystic aa Middle part: proper hep aa retroduodenal part: superior pancreaduodenal aa
    Venous
         o Most of the smaller veins enter the liver directly from the body of gallbladder
         o Posterior and Anterior cystic veins  Posterior superior pancreaticoduodenal vein  Portal vein
    Lymph: cystic nodes, hep nodes (on the hep aa), celiac lymph nodes
    Cytohepatic triangle of Calot:

    Fundus
    Body
     Neck
    Fossa for gallbladder
    Blood supply:
         o Cystic aa (branch of right hep aa, variations)
                   In the cystohepatic triangle of Calot (surgical landmark)
                           Borders: Inferiorly-Cystic duct, Med- Common hepatic duct, Sup-Cystic artery
         o Cystic vv (ant & post)
                   Drain the neck of the gallbladder and cystic duct in to the Superior posterior
                      pancreaticoduodenal vein (portal vein)
         o Smaller gallbladder veins: drain directly into liver sinosoids of portal vein
    Lymphatics: Cystic nodes, hep nodes, celiac nodes
    Innervation: celiac nerve plexus, vagus, right phrenic(somatic/pain, referred to R. shoulder area)
    cystic duct (b/w layers of lesser omentum)++

Thyroid gland
    Isthmus
    Deep to sternothyroid and sternohyoid muscles
    Arterial supply
         o Superior thyroid a.
         o Inferior thyroid a.
         o Thyroid ima artery
    Venous of thyroid gland
        o Superior pole – Superior thyroid vein – Internal Jugular Vein (IJV)
        o Middle pole – Middle thyroid vein – IJV
        o Inferior pole – Inferior thyroid vein –brachiocephalic vein
    Lymph
        o Usually to prelaryngeal, pretracheal, paratracheal lymph nodes
        o Superior, middle and inferior cervical (sympathetic) ganglia via the cardiac and superior and inferior
            thyroid periarterial plexuses
        o Vasomotor, not secretomotor
        o They cause constriction of blood vessels
        o Endocrine secretion is regulated by the pituitary gland.

ADRENAL GLAND                     (suprarenal glands)
            Location: Superomedial kidney & diaphragm
            Attached to crura of diaphragm
            Right: Triangular, more apical,IVC
            Left: Crescent, medial, spleen,stomach,pancreas
            Hilum: Veins / lymphatics
            Structure
                 o Cortex: Corticosteroids/Androgens
                 o Medulla: Nervous tissue secretes epi- and    norepinephrine
            Arterial supply
                 o 50-60 branches penetrate the capsule
                 o Superior suprarenals – inferior phrenic
                 o Middle suprarenals – abdominal aorta near SMA
                 o Inferior suprarenals – renal arteries
            Veins of adrenal glands
                 o Right Suprarenal - IVC
                 o Left Suprarenal - Left renal vein
            Lymphatics: lumbar nodes
            Nerves of adrenal glands
                o Celiac Plexus
                o Abdominopelvic sphlancnic nerves
                o Aorticorenal Plexus
                o Nerves supply chromaffin cells of medulla - presynaptic sympathetic fibers pass through both
                    the paravertebral and prevertebral ganglia w/o synapsing (IML= intermediolateral cell column)

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