...
Pharynx length
under 10 cm
Esophagus length
23 cm
How much can the adult male stomach hold?
2 to 4 L
Stomach length
25 to 30 cm
length of the pyloric canal
2 to 3 cm
diameter of small bowel
4 cm
length of small bowel
6 m
length of duodenum
25 cm
length of jejunum
2.3 m
length of ilium
3.5 m
length of large bowel
2 m
Explain the Prenatal development of the GI tract
develops from the posterior yolk sac
Divides into 4
sections
foregut
midgut
hindgut
tailgut
What does the foregut develop into?
phyarynx
Esophagus
stomach
prox duodenum
celiac axis
What vessel supplies the foregut?
celiac axis
What does the midgut develop into?
Distal duodenum
small bowel
most of colon
Supplied by the SMA
What vessel supplies the midgut?
SMA
What does the Hindgut develop into?
left colon
IMA
What vessel supplies the Hindgut?
IMA
What does the tail gut develop into?
the tail gut is reabsorbed
What is Fetal gutogenesis
it is the development of the GI tract
dilation
twisting
herniation
twisting
un-herniation
canalzation
When does herniation occur?
5 weeks
When does un-herniation occur?
10 weeks
When does canalization occur?
12 weeks
Where does the esophagus start
cricoid cartilage
Where is the esophagus in relation to the trachea?
lies posterior
Where is the esophagus in relation to the vertebra?
lies anterior
Where is the esophagus in relation to the heart?
lies posterior
What is the esophageal hiatus?
Where the esophagus passes through the diaphragm
Where is the fundus of the stomach?
left posterior
Where is the pylorus
pylorus is midline and anterior
pyloric orifice is the the
right of midline
Where is the cardiac end of the stomach?
cardiac end is at A
Where is the cardiac sphincter?
the opening to the stomach from esophagus
where is the greater curvature of the stomach?
lies at E
Left border
Where is the lesser curvature of the stomach?
lies at B
right border
What suspends the stomach within the abdomen?
Greater and lesser omentum
gastrosplenic ligament
gastrophrenic ligament
gastrohepatic ligament
lienorenal ligament
What ligament surrounds the tail of the pancreas and splenic artery and vein?
lienorenal ligament
Where does the food go when it leaves the stomach?
through the pyloric sphincter into the duodenum
Which region does the stomach lie
left hypochondrial
epigastic
What are the sections of the Duodenum
Duodenal Bulb
Descending portion
Transverse portion
Ascending portion
What happens in the small bowel?
Major portion of digestion and absorption of food
Where is the bulb of the duodenum?
passes anterior to CBD, GDA, HA, and head of pancreas.
rest in the peritoneal
Where is the Descending duodenum?
right of spine
receives ducts of wirsung & santori
rests in the restroperitoneal
Where is the transverse duodenum?
moves right to left
extends from hepatic flexure to splenic flexure
Where is the ascending duodenum?
travels between SMA & Aorta
intraperitoneal
held in place by the ligament of treitz
Where is the ligament of treitz
What region is the jejunum in?
umbilical and left iliac
What region is the ileum in?
umbilical
hypogastric
jejunum
Brunner's glands
valvulae conniventes on surface (valves of Kerckring)
valvulae conniventes (valves of Kerckring)
ridges on the surface that extend surface area
Brunner's glands
produce alkaline substance to reduce acidity of stomach acids
ileocecal valve
controls passage into the colon
Cecum
bind end tube
appendics
bind end tube
ascending colon
run superiorly to the hepatic flexure
transverse colon
largest portion 30 inches
pancreas lies posterior superior
runs from hepatic flexure to the splenic flexure
hepatic flexure
located on the visceral surface of the rt lobe of the liver
descending colon
becomes the sigmoid colon
sigmoid colon
at midline becomes the rectum
Haustra
small pouches caused by sacculation, which give the colon its segmented appearance. The taenia coli run the length of the large intestine
Gastrin
stomach hormones causes release of gastric acid
Cholecystokinen
sm. intestine hormone cause the GB to contract and release of bile
secretin
sm. intestine hormone cause the secretion of bicarbonate
True or false?
The pancreas is surrounded by peritoneal.
False
most of the pancreas is retroperitoneal only a
small portion of the head is surrounded by peritoneal
What structures lie posterior to the pancreas
connective prevertebral tissue
IVC
aorta
diamhragm
What structures lie anterior to the pancreas
stomach and transverse colon
The main pancreatic duct usually joins what?
common bile duct
where does the common bile duct enter the duodenum?
at the ampulla of vater
What is another name for the main pancreatic duct?
Duct of wirsung
what is the duct of santorini?
accessory duct that drains the head of the pancreas.
This duct is not seen on ultrasound images
Describe the location of the pancreas
extends from the epigastrum to the left hypochondrian
extends
from the C-loop (DUO) to the hylin of the spleen.
...
What is the average length of the pancreas?
12 to 18 cm
How thick is the pancreas?
2.5 cm
What is the average width of the pancreas?
3 to 5 cm
What is the average weight range of the pancreas
60 to 80 grams
The size of the pancreas usually _______ with age.
A)
increases
B) decreases
C) stays the same
B) decreases
The size of the pancreas usually decreases
with age.
Explain the biliary tree.
left and right hepatic ducts join to form the common bile duct.
the cystic duct connects the gallbladder to the common bile duct
the pancreatic duct joins the common bile duct and both empty
into the duodenum at the ampulla of vater
What is the uncinate process of the pancreas
posterior medial projection off the head of the pancreas
Where is the uncinate process?
all tissue lies medial to the splenic confluence
from
the portal splenic confluence to the IVC
True or False
The uncinate process is anterior to the
IVC and posterior to the SMV
True
Where do most tumors occur in the pancreas?
In the head
Where does the head of the pancreas lie in relation to the IVC?
anterior
Where does the head of the pancreas lie in relation to the portal splenic confluence?
right of
Where does the head of the pancreas lie in relation to the caudate lobe?
inferior
Where does the head of the pancreas lie in relation to the duodenum?
in the lap of the C-loop
What is the normal size of the head of the pancreas?
2 - 3.5 cm long
Where does the neck of the pancreas lie in relation to the portal splenic confluence?
anterior
What is the portal vein made up of?
superior mesenteric vein and the splenic vein
what does the neck of the pancreas measure?
1.5 - 2.5 cm
What is the largest portion of the pancreas
the body
Where does the pancreatic body start?
about midline anterior to the SMA and Aorta
What makes up the superior border of the pancreas?
the splenic artery
True or False
The body of the pancreas is torcherous
and loopy
true
What makes up the anterior border of the pancreas?
posterior wall of the stomach
what is the pancreas body measurement?
2 - 3 cm
Where does the pancreatic tail extend to?
the into the anterior pararenal space and to the hylin of the spleen
what is the pancreas body measurement?
1 - 2 cm
What vessels feed the pancreas?
Gastroduodenal artery
splenic artery
What vessels drain the pancreas?
splenic vein
superior mesenteric
The pancreas serves as what type of gland
digestive (exocrine)
hormonal (endocrine)
What percentage of the pancreas serves as exocrine gland?
98%
What type of cells carry out the exocrine function of the pancreas?
acini cells
How much pancreatic juice can the pancreas produce in a day?
2 liters
What is pancreatic juice composed of?
enzymes that help digest fats, proteins, carbohydrates and nucleic
acids
amylase - carbs
lipase - fats
trypsin
& chymotrypsin carboxpepidase - protein
nucleases - nucleic acid
What is amylase?
a pancreatic enzyme that helps digest carbohydrates
What is lipase
a pancreatic enzyme that helps digest fats
What is trypsin, chymotrypsin & carboxpepidase
a pancreatic enzymes that helps digest proteins
What is nucleases?
a pancreatic enzyme that helps digest nucleic acid
What stimulates the production of pancreatic juice?
chyme in the duodenum
what is the sphincter of oddi?
a muscle surrounding the ampulla
it relaxes to allow
pancreatic juice and bile to enter the dudenum
Where is the endocrine portion of the pancreas located?
the alpha, beta and delta cells in the islets of langerhans
What type of cells make up 60 - 70% of the endocrine cells?
beta
What do the beta cells produce?
insulin
What is the function of insulin?
insulin causes production of glycogen from glucose and cause glucose
receptor to take up glucose
blood glucose levels go down
What do alpha cells produce?
glucagon
What is the function of glucagon?
stimulates the liver to convert glycogen to glucose
and cells
to release glucose
blood glucose levels rise.
What is the function of Delta cells?
produce somatostatin
hormone inhibits the production of
insulin and glucagon
What makes up the upper urinary tract?
Kidneys and uterers
What makes up the lower urinary track?
Bladder and urethra
What type of organ are the kidneys?
excretory
True or False?
The kidneys are retropertoneal.
True
lie on each side of the spine between the
peritoneum and the back muscles
The kidneys are located between ____ and _____ vertebra.
T12 - L4
Describe the kidneys.
bean shaped bi-lobed
What two muscles lie posterior to the kidneys?
psoas
quadratus lumborum
Which kidney is inferior to the other?
right
The liver displaces the right kidney causing it
to lie lower than the left
What is the position of the right kidney to the IVC?
posterior
Explain the decent of the ureters.
ureters descend anterior to the psoas and aorta.
Continue until
after aorta bifurcation then descent posteriorly to the bladder
Where do the ureters exit the kidneys?
the ureters begin as an expanded area, the renal pelvis in the helium of the kidneys
Explain the difference between male and female ureter descent.
the ureters pass posteriorly to the ductus deferens in males and posteriorly to the uterine arteries in females
What is the position of the bladder in relation to the pubis symphysis?
posterior
Describe the urethra
membranous canal that carries urine out of the bladder
Which has a longer urethra?
A) Male
B) female
C) equal length
A) Male
What is the average size of the adult kidneys?
9 to 11 cm length
2.5 to 4 cm thick
4 to 6 cm in diameter
What is the average size of the neonatal kidneys?
3.3 to 5 cm length
1.5 to 2.5 cm thick
2 to 3 cm in diameter
What is the average size of the ureters?
25 to 30 cm length
4 to 7 cm in diameter
How do the ureters function?
peristolic action
What protects the kidneys?
tough fibrous capsule
layer of perirenal fat continuous with
fat in the sinus
renal fascia - Gerota's fascia
pararenal fat
Gerota's fascia
renal fascia
anchors the kidneys and limits any infection
quadratus lumborum
Psoas
The renal parenchyma consists of what two areas?
renal cortex
renal medulla
--medullary pyramids
describe the renal cortex.
outer portion of the parenchyma
contains functional unit of the
kidney
-renal corpuscle
-proximal convoluted tubes
-distal convoluted tubes
describe the renal medulla
inner portion of the parenchyma
contains medullary pyramids
--loop of henle
What function do the loops of henle have?
filtration and reabsorption
How many medullary pyramids are there
8 to 18
Describe the medullary pyramids
triangular
apex - narrow tip
base - broad base
apex sits within a minor calyx
What separates the medullary pyramids from each other?
bands of cortical tissue called
Columns of Bertin
Define renal lobes
portions of the kidney that consist of a single pyramid
bordered on both sides by interlobar arteries
Define the renal sinus
is the central portion of the kidney
houses
-renal arteries
-fatty fibrous tissue
-nerves
-lymphatics
-collecting system
What does the collecting system of the kidneys composed of?
infundibulum
renal pelvis
Infundibulum
compused of minor and major calyces
minor calyces
convey urine to the marjor calyces
The renal pelvis
is the upper expanded end of the ureter that receives urine.
renal helium
medial portion of the renal sinus where the renal arteries enter the kidneys
The ureters consist of three layers
inner mucosal layer
medial layer of circular and longitudinal
smooth muscle
outer fibrous
What supplies the ureters with blood?
branches from
-renal
-internal spermatic
-
hypogastric
-inferior vesical
Where does the ureters enter the bladder?
posteriorly at the trigone region
What are the layers of tissue in the bladder?
inner mucosa
submucosa
muscularis
outer serosa
Detrusor muscle
muscular layer of the bladder composed of 3 layers of smooth muscle
Describe the inferior portion of the bladder
consists of a base (trigone)
neck - communicates with the urethra
the inferolateral surface of the bladder is in contact with _______
pelvic floor muscles
The superior portions of the bladder is covered by what?
extension of the peritoneum.
What anchors the bladder to the pelvis?
ligaments that extend anteriorly from the bladder neck and attach to the pubic bone
What vessels supplies blood to the bladder?
superior, middle and inferior vesicles from the anterior trunk of the hypogastric artery (internal iliac)
What does the urethra consist of?
membranous, hollow canal that conveys urine from the bladder to outside the body
What are the kidneys primary function?
urine production - excrete metabolic waste
homeostasis -
maintain blood volume
How much blood does do the kidneys filter each minute?
1600 mL
How much urine do the kidneys produce each day?
150 mL
How is the amount of nitrogenous waste measured?
BUN - blood urea nitrogen
Cr - creatinine
What is the functional unit of the kidney called?
nephron
How does the nephron function?
by moving metabolic products from areas of high concentration to areas of low concentration
Osmosis
passive transport of cellular material
active transport
uses cellular energy to move material from one area to another
What are the two types of nephrons?
Juxtamedullary
cortical
Juxtamedullary nephrons
originate in the inner 3rd of the renal cortex
longer
loops of Henle
cortical nephrons
originate in the outer 2/3s of the renal cortex
What does the nephron consists of?
renal corpuscle
-Bowmans capsule
-glomerularis
renal tubule
-proximal convoluted tube
-loop of
Henle
-distal convoluted tube
-collecting ducts
What parts of the nephron is in the medulla?
loop of Henle
collecting ducts
What parts of the nephron is in the cortex?
glomerlaris
Bowmans capsule
proximal convoluted tube
distal convoluted tube
Name the steps of Urine formation
Filtration - glomerlaris
Tubular reabsorption -
proximal convoluted tube and loop of Henle
Tubular
secretion - distal convoluted tube
Filtration =
The blood plasma is filtered through the capillaries of the glomerulus into the Bowman's capsule. The Bowman's capsule empties the filtrate into a tubule that is also part of the nephron.
where does Tubular reabsorption occur
proximal convoluted tube and loop of Henle
Where does Tubular secretion occur?
distal convoluted tube
Antidiuretic hormone
ADH-a decrease in blood volume triggers ADH to be released by
posterior pituitary
*increases the quantity of water
absorbed back into the body from the distal convoluted tube
*urine output decreases blood volume increases
Aldosterone hormone
a decrease in blood volume triggers aldosterone to be released from
the renal cortex
causes water and salt to be reabsorbed
into the blood stream from the nephron
increases blood volume
Juxtaglomerular apparatus
*when blood pressure drops the Juxtaglomerular cells within the
afferent tubule release renin
*renin causes the release
of angiotensin which causes vasoconstriction in the afferent
arteriole to increase blood pressure through the nephron
*maculadensa cells in the distal convoluted tube all regulate
the flow rate and will signal Juxtaglomerular cells to constrict or
dialate to
Erythropoietin hormone
released by the kidneys in response to a decrease in oxygen.
acts on bone marrow to produce RBCs and the release of mature
RBCs from bone marrow
What are the two parts of the adrenal glads called
cortex and medulla
What region does the liver lie?
major portions of the Rt. hypochondiac
extends
inferiorly into the epigastrum
laterally into the left hypochondium
what regions of the liver are in contact with the diaphragm?
superior
anterior surface
portion of posterior surface
Explain the anatomy of the liver on inspiration
right lobe rises to the area of the 4th rib
left lobe rises to
the area of the 5th rib
What is the livers fibrous capsule called?
Glission's capsule
What is the bare are of the liver?
the portion which is not covered by the greater sac of the peritoneum and that comes in contact with the diaphragm
What protects the posterior surface of the liver?
the bony and muscular posterior abdominal wall
Where does the inferior liver rest?
upper abdominal organs
Liver
Describe Right-sided inferior indentation
Rt hepatic flexure
Rt kidney and adrenal
first part of
duodenum and gal bladder
Liver
Describe the Left side of inferior surface
gastric indentation
marked by the groove surrounding the IVC
inferior anterior midportion of left lobe
quadrate lobe
posterior midportion of inferior surface of the liver
caudate lobe
Where does the right lobe of the liver?
lies close to the anterolateral abdominal wall
The left lobe of the liver is closely related to what?
under surface of diaphragm
Where is the left lobe of the liver in relation to the pancreas
anterior
Where is the left lobe of the liver in relation to the splenic vein and artery
anterior
Where is the left lobe of the liver in relation to the pancreas
anterior
What is the caudate lobe covered by?
lesser sac of the peritoneum
What is on the anterior boundary of the caudate lobe?
posterior surface of the left portal vein
What is on the posterior boundary of the caudate lobe?
IVC
The caudate lobe is separated by the left lobe by what?
Portal
Hepatic Artery
The caudate lobe is separated by the left lobe by what?
ligament venosum
where are the falciform ligament and the ligamentum teres
within the intersegmental fissure
What does the right hepatic vein drain?
anterior and posterior segments of the right lobe
What does the left hepatic vein drain?
the medial and lateral segments of the left lobe
What does the middle hepatic vein drain?
right and meadial left lobe
What does the smaller inferior hepatic veins drain?
the caudate and postermedial portion of the right liver lobe
What is the portal triad?
consist of portal vein, hepatic artery, and bile ducts
Hemiliver
right and left liver division
How many main tributaries to the portal splenic confluence?
3
splenic vein
superior mesenteric vein
*inferior
mesenteric vein
What happens to the main portal vein after it enters the portal hepatis
divides into left and right branches
What happens to the right portal
supplies the bulk of the liver centrally with blood from the gastrointestinal track for processing
How does the left portal ascend?
anteriorly, proximal to the falciform ligament.
What supplies the caudate lobe with blood for processing?
branches from both the right and left portal veins
What artery supplies the liver with blood?
the common hepatic artery
The proper hepatic artery branches into what?
courses superiorly supplying the liver through the right middle and left hepatic arteries
What is the triangle ligament formed by?
extension of the coronary ligament inferiorly to the right
What is the function of the falciform ligament?
connect the liver to the anterior abdominal wall and to the diaphragm
Liver weight
1200-1600 grams
Liver
right to left measurement
10-22.5 cm
Liver
Anterior to posterior measurement
10-12.5 cm
Liver
Superior to inferior measurement
15-17 cm
What parts of the liver are interpertoneal?
all except for the bare area
What are the functions of the liver?
Digestion - Produce bile
Carbohydrate metabolism - glucose to
glycogen
storage - vitamins
detoxification - breaks down poisen
What function does the liver play in digestion?
produce bile
What is the function of bile
digestion and absorption of fats and fat-soluble vitamins in the small intestine
What is stored in the liver?
vitamins
What is carbohydrate metabolism?
the process of converting glucose to glycogen and vice versa
define detoxification
breakdown of poisons
Where is the ligament teres?
located on the free edge of the falciform
what is another name for the ligament teres?
round ligament
How does the ligament teres divide the liver?
medial and lateral sections
Where is the ligament venosum?
separates the caudate lobe from the left lateral lobe
where does the falciform lie?
extends from the umbilical to diaphragm
What is the function of the falciform ligament?
attach the liver to the abdominal wall
suspends liver from
anterior diaphragm
What does the falciform ligament divide?
right and left lobes
Main lobar fissure
The ductus venosum turns unto what ligament?
ligament venosum
The ductus arteriosum turns what ligament?
ligament arteriosum
What does the umbilical vein turn into?
ligament teres
What does the umbilical arteries turn into?
hypergastic ligament
Where is the right triangular ligament?
rt inferior extension of the coronary ligament
Where is the coronary ligament?
make up the boundaries of the bare area of the liver
attaches posterior superior surface of the liver to the
posterior abdominal wall and posterior diaphragm
What separates the right lobe of the liver from the left?
Main Hepatic vein
main lobar fissure
6
What separates the left lobe of the liver from the caudate?
ligamentum venosum
The left lobe is separates into medial and lateral sections by what?
ligamentum teres
Left portal vein
Hepatopetal
flow of blood towards the liver
Hepatofugal flow
flow out through through the hepatic vein
What is the portal triad?
portal vein
hepatic artery
bile duct
what is does the portal triad consist of at the lobule level?
bile ductile
heaptic arterial
portal venule
What do you do to search for problems in the biliary tree?
elongate the ducts to look for blockage
What is the function of the gallbladder?
concentrate bile
store bile
transport the bile to the doudenum
where does the gallbladder lie on the liver?
between left and right lobes
intraperitoneal
What are the parts of the Gallbladder?
Neck
Body
Fundus
Where is the fundus?
the fundus lies lateral inferior and anterior
pokes out
Explain the layers of the GB wall
serous
fibro-muscular layer
muscular layer
GB has rugae
...
Where is the neck of the GB?
neck extends medially/posteriorly
fixed anatomic
relationship with the lobar fissure
What is the relationship between the GB and the porta hepatis?
GB lies to the right
The body and neck position is variable!
...
What is hartman's pouch?
lowest portion of GB neck
tends to collect stones
What is the valve of Heister?
2 way (enter/exit) bile
prevents over distention of
cystic duct from collapsing
what do you have to be careful about with the valve of Heister?
sometimes the valve shadows and looks like stones
What is the composition of Bile?
82% water
12% bile salts
6% cholesterol, bilirubin,
proteins, electrolytes, mucus
What are the variants of the gallbladder?
phrygian cap
agenesis - none
septated
What are the variants of the biliary system?
choledachal cyst - bile duct cyst
extrahepatic ducts
biliary atresia - blocked ducts
Length of the GB?
10 cm
GB walls
3 cm
diameter of GB
3-5 cm
Cystic duct length
3-4 cm
Cystic duct diameter
4 mm
Common bile duct length
8 - 11 cm
Common bile duct diameter
1 - 6 mm
pancreatic duct
less than 2 mm
what is the storage capacity of the GB
40 ml
8 table
How much bile is produced per day?
1 - 2 L
What artery feeds the GB?
cystic artery
off the hepatic artery
What vein drains the GB?
cystic vein
drains into portal vein
physiology of GD
food enters 2nd portion of duo
hormones released
sphincter of oddi opens
bile is squirted
wind blows from high to low