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which structures are retroperitoneal?
- Duodenum (2,3,4)
- Ascending colon
- Descending colon
- Kidney and ureters
- Pancreas (except tail)
- aorta
- IVC
- Adrenal glands
- rectum
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Falciform ligament
connects what?
contains which structures?
derivative of ?
- connects liver to anterior abdominal wall
- contains ligamentum teres
- derivative of fetal umbilical VEIN
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hepatoduodenal ligament
- liver to duodenum
- contains portal triad (hep artery, portal vein, common bile duct)
- connects greater and lesser ommentum
- put your finger in the omental foramen and press on this to control bleeding
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gastrohepatic
- connects liver to lesser curvature of stomach
- contains gastric arteries
- separates right greater and lesser sacs
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gastrocolic ligament
- connects greater curvature of stomach to transverse colon
- contains gastroepiploic arteries
- is part of the greater omentum
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gastrosplenic ligament
- connects greater curvature of stomach to the spleen
- contains short gastrics
- separates left greater and lesser sacs
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splenorenal
- connects the spleen to posterior abdominal wall
- contains splenic artery and vein
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Layers of the gut wall
- 1. Mucosa
- - epithelium (stratified squamous at the ends -esophagus and anus and simple columnar in the middle)
- - lamina propria
- - muscularis mucosae (smooth muscle)
- 2. Submucosa
- includes Meissner's plexus (submucosal plexus)
- 3.Muscularis propria - the muscle is smooth muscle but in upper 1/3 of esophagus its skeletal
- - inner circular layer of muscle
- - Auerbach's plexus (myenteric plexus)
- - outer longitudinal layer of muscle
- 4. Serosa/adventitia
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Esophagus histo
stratified squamous epithelium
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Stomach histo
- gastric glands
- parietal cells are pink
- chief cells are blue
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Small intestine Histo
D/J/I?
- Villi and micro villi are greater duodenum>jejunum> ileum
- duodenum - Brunnner's glands (submucosal) and crypts of Lieberkuhn
- Jejunum - goblet cells (most in SI); plicae circularis and crypts of lieberkuhn
- Ileum - peyer's patches (lamina propria, submucosa), plicae circularis (proximal), and crypts of Lieberkuhn
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Colon histo
(dif from SI)
Crypts no villi
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Foregut and blood supply and nerve
- Stomach -> proximal duodenum
- liver, gallbladder, pancreus, spleen
- Celiac artery
- Vagus Nerve
- T12/L1 level
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Midgut and blood supply
Distal duodenum --> proximal 2/3 of transverse colon
- superior mesenteric artery
- vagus nerve
- L1
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Hindgut and its supply
- Distal 1/3 of transverse colon to upper part of rectum
- splenic flexure in watershed region
- IMA
- Pelvic - parasympathetic innervation (NOT vagus)
- L3 vertebral level
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What are the nerve plexuses in GI tract? Where are they? What do they do?
Myenteric (Auerbach's) - located b/w the outer longitudinal muscle layer and the inner circular muscle layer; coordinates Mobility of the entire wall
Submucosal (Meissner's) - located in the submucosa (b/w mucosa and muscularis layers); regulates local secretions
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Where do we see varices in portal hypertension? (also which vessels are compensating)
Esophagus (esophageal varices because blood from left gastric vein (portal)--> esophageal vein )
Umbilicus (caput medusae because blood from paraumbilical veins (portal) --> umbilical veins)
Rectum (internal hemorrhoids because blood from superior rectal veins (portal) --> middle and inferior rectal veins)
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What shunts could you use to relieve portal hypertension?
1. Portocaval shunt - b/w splenic (portal) and left renal vein
2. Connect portal vein to IVC
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Pectinate line
where hind gut meets ectoderm
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Hemorrhoids above and below pecitnate
above - internal, not painful, sign of portal htn
below - external, painful
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cancer above and below pectinate
- above - adenocarcinoma
- below - squamous cell carcinoma
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Arterial supply and venous drainage above the pectinate line
arterial supply - superior rectal artery (branch of inferior mesenteric artery)
venous drainage - superior rectal vein --> inferior mesenteric vein --> portal system
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Arterial supply and venous drainage below the pectinate line
arterial supply - inferior rectal artery from internal pudendal artery
venous drainage - inferior rectal --> internal pudendal --> internal illiac --> IVC
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