Section 4 digestion and renal

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...

2

Pharynx length

under 10 cm

3

Esophagus length

23 cm

4

How much can the adult male stomach hold?

2 to 4 L

5

Stomach length

25 to 30 cm

6

length of the pyloric canal

2 to 3 cm

7

diameter of small bowel

4 cm

8

length of small bowel

6 m

9

length of duodenum

25 cm

10

length of jejunum

2.3 m

11

length of ilium

3.5 m

12

length of large bowel

2 m

13

Explain the Prenatal development of the GI tract

develops from the posterior yolk sac

Divides into 4 sections
foregut
midgut
hindgut
tailgut

14

What does the foregut develop into?

phyarynx
Esophagus
stomach
prox duodenum

celiac axis

15

What vessel supplies the foregut?

celiac axis

16

What does the midgut develop into?

Distal duodenum
small bowel
most of colon

Supplied by the SMA

17

What vessel supplies the midgut?

SMA

18

What does the Hindgut develop into?

left colon
IMA

19

What vessel supplies the Hindgut?

IMA

20

What does the tail gut develop into?

the tail gut is reabsorbed

21

What is Fetal gutogenesis

it is the development of the GI tract

dilation
twisting
herniation
twisting
un-herniation
canalzation

22

When does herniation occur?

5 weeks

23

When does un-herniation occur?

10 weeks

24

When does canalization occur?

12 weeks

25

Where does the esophagus start

cricoid cartilage

26

Where is the esophagus in relation to the trachea?

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lies posterior

27

Where is the esophagus in relation to the vertebra?

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lies anterior

28

Where is the esophagus in relation to the heart?

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lies posterior

29

What is the esophageal hiatus?

Where the esophagus passes through the diaphragm

30

Where is the fundus of the stomach?

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left posterior

31

Where is the pylorus

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pylorus is midline and anterior
pyloric orifice is the the right of midline

32

Where is the cardiac end of the stomach?

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cardiac end is at A

33

Where is the cardiac sphincter?

the opening to the stomach from esophagus

34

where is the greater curvature of the stomach?

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lies at E

Left border

35

Where is the lesser curvature of the stomach?

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lies at B

right border

36

What suspends the stomach within the abdomen?

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Greater and lesser omentum
gastrosplenic ligament
gastrophrenic ligament
gastrohepatic ligament
lienorenal ligament

37

What ligament surrounds the tail of the pancreas and splenic artery and vein?

lienorenal ligament

38

Where does the food go when it leaves the stomach?

through the pyloric sphincter into the duodenum

39

Which region does the stomach lie

left hypochondrial
epigastic

40

What are the sections of the Duodenum

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Duodenal Bulb
Descending portion
Transverse portion
Ascending portion

41

What happens in the small bowel?

Major portion of digestion and absorption of food

42

Where is the bulb of the duodenum?

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passes anterior to CBD, GDA, HA, and head of pancreas.

rest in the peritoneal

43

Where is the Descending duodenum?

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right of spine
receives ducts of wirsung & santori

rests in the restroperitoneal

44

Where is the transverse duodenum?

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moves right to left
extends from hepatic flexure to splenic flexure

45

Where is the ascending duodenum?

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travels between SMA & Aorta

intraperitoneal

held in place by the ligament of treitz

46

Where is the ligament of treitz

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47

What region is the jejunum in?

umbilical and left iliac

48

What region is the ileum in?

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umbilical
hypogastric

49

jejunum

Brunner's glands
valvulae conniventes on surface (valves of Kerckring)

50

valvulae conniventes (valves of Kerckring)

ridges on the surface that extend surface area

51

Brunner's glands

produce alkaline substance to reduce acidity of stomach acids

52

ileocecal valve

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controls passage into the colon

53

Cecum

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bind end tube

54

appendics

bind end tube

55

ascending colon

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run superiorly to the hepatic flexure

56

transverse colon

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largest portion 30 inches
pancreas lies posterior superior

runs from hepatic flexure to the splenic flexure

57

hepatic flexure

located on the visceral surface of the rt lobe of the liver

58

descending colon

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becomes the sigmoid colon

59

sigmoid colon

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at midline becomes the rectum

60

Haustra

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small pouches caused by sacculation, which give the colon its segmented appearance. The taenia coli run the length of the large intestine

61

Gastrin

stomach hormones causes release of gastric acid

62

Cholecystokinen

sm. intestine hormone cause the GB to contract and release of bile

63

secretin

sm. intestine hormone cause the secretion of bicarbonate

64

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

65

What structures lie posterior to the pancreas

connective prevertebral tissue
IVC
aorta
diamhragm

66

What structures lie anterior to the pancreas

stomach and transverse colon

67

The main pancreatic duct usually joins what?

common bile duct

68

where does the common bile duct enter the duodenum?

at the ampulla of vater

69

What is another name for the main pancreatic duct?

Duct of wirsung

70

what is the duct of santorini?

accessory duct that drains the head of the pancreas.

This duct is not seen on ultrasound images

71

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.

72
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...

73

What is the average length of the pancreas?

12 to 18 cm

74

How thick is the pancreas?

2.5 cm

75

What is the average width of the pancreas?

3 to 5 cm

76

What is the average weight range of the pancreas

60 to 80 grams

77

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.

78

Explain the biliary tree.

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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

79

What is the uncinate process of the pancreas

posterior medial projection off the head of the pancreas

80

Where is the uncinate process?

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all tissue lies medial to the splenic confluence

from the portal splenic confluence to the IVC

81

True or False

The uncinate process is anterior to the IVC and posterior to the SMV

True

82

Where do most tumors occur in the pancreas?

In the head

83

Where does the head of the pancreas lie in relation to the IVC?

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anterior

84

Where does the head of the pancreas lie in relation to the portal splenic confluence?

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right of

85

Where does the head of the pancreas lie in relation to the caudate lobe?

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inferior

86

Where does the head of the pancreas lie in relation to the duodenum?

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in the lap of the C-loop

87

What is the normal size of the head of the pancreas?

2 - 3.5 cm long

88

Where does the neck of the pancreas lie in relation to the portal splenic confluence?

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anterior

89

What is the portal vein made up of?

superior mesenteric vein and the splenic vein

90

what does the neck of the pancreas measure?

1.5 - 2.5 cm

91

What is the largest portion of the pancreas

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the body

92

Where does the pancreatic body start?

about midline anterior to the SMA and Aorta

93

What makes up the superior border of the pancreas?

the splenic artery

94

True or False

The body of the pancreas is torcherous and loopy

true

95

What makes up the anterior border of the pancreas?

posterior wall of the stomach

96

what is the pancreas body measurement?

2 - 3 cm

97

Where does the pancreatic tail extend to?

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the into the anterior pararenal space and to the hylin of the spleen

98

what is the pancreas body measurement?

1 - 2 cm

99

What vessels feed the pancreas?

Gastroduodenal artery
splenic artery

100

What vessels drain the pancreas?

splenic vein
superior mesenteric

101

The pancreas serves as what type of gland

digestive (exocrine)
hormonal (endocrine)

102

What percentage of the pancreas serves as exocrine gland?

98%

103

What type of cells carry out the exocrine function of the pancreas?

acini cells

104

How much pancreatic juice can the pancreas produce in a day?

2 liters

105

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

106

What is amylase?

a pancreatic enzyme that helps digest carbohydrates

107

What is lipase

a pancreatic enzyme that helps digest fats

108

What is trypsin, chymotrypsin & carboxpepidase

a pancreatic enzymes that helps digest proteins

109

What is nucleases?

a pancreatic enzyme that helps digest nucleic acid

110

What stimulates the production of pancreatic juice?

chyme in the duodenum

111

what is the sphincter of oddi?

a muscle surrounding the ampulla

it relaxes to allow pancreatic juice and bile to enter the dudenum

112

Where is the endocrine portion of the pancreas located?

the alpha, beta and delta cells in the islets of langerhans

113

What type of cells make up 60 - 70% of the endocrine cells?

beta

114

What do the beta cells produce?

insulin

115

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

116

What do alpha cells produce?

glucagon

117

What is the function of glucagon?

stimulates the liver to convert glycogen to glucose
and cells to release glucose

blood glucose levels rise.

118

What is the function of Delta cells?

produce somatostatin

hormone inhibits the production of insulin and glucagon

119

What makes up the upper urinary tract?

Kidneys and uterers

120

What makes up the lower urinary track?

Bladder and urethra

121

What type of organ are the kidneys?

excretory

122

True or False?

The kidneys are retropertoneal.

True

lie on each side of the spine between the peritoneum and the back muscles

123

The kidneys are located between ____ and _____ vertebra.

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T12 - L4

124

Describe the kidneys.

bean shaped bi-lobed

125

What two muscles lie posterior to the kidneys?

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psoas
quadratus lumborum

126

Which kidney is inferior to the other?

right

The liver displaces the right kidney causing it to lie lower than the left

127

What is the position of the right kidney to the IVC?

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posterior

128

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

129

Where do the ureters exit the kidneys?

the ureters begin as an expanded area, the renal pelvis in the helium of the kidneys

130

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

131

What is the position of the bladder in relation to the pubis symphysis?

posterior

132

Describe the urethra

membranous canal that carries urine out of the bladder

133

Which has a longer urethra?

A) Male
B) female
C) equal length

A) Male

134

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

135

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

136

What is the average size of the ureters?

25 to 30 cm length
4 to 7 cm in diameter

137

How do the ureters function?

peristolic action

138

What protects the kidneys?

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tough fibrous capsule
layer of perirenal fat continuous with fat in the sinus
renal fascia - Gerota's fascia
pararenal fat

139

Gerota's fascia

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renal fascia
anchors the kidneys and limits any infection

140
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quadratus lumborum

141
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Psoas

142

The renal parenchyma consists of what two areas?

renal cortex
renal medulla
--medullary pyramids

143

describe the renal cortex.

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outer portion of the parenchyma
contains functional unit of the kidney
-renal corpuscle
-proximal convoluted tubes
-distal convoluted tubes

144

describe the renal medulla

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inner portion of the parenchyma
contains medullary pyramids
--loop of henle

145

What function do the loops of henle have?

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filtration and reabsorption

146

How many medullary pyramids are there

8 to 18

147

Describe the medullary pyramids

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triangular
apex - narrow tip
base - broad base

apex sits within a minor calyx

148

What separates the medullary pyramids from each other?

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bands of cortical tissue called

Columns of Bertin

149

Define renal lobes

portions of the kidney that consist of a single pyramid
bordered on both sides by interlobar arteries

150

Define the renal sinus

is the central portion of the kidney

houses
-renal arteries
-fatty fibrous tissue
-nerves
-lymphatics
-collecting system

151

What does the collecting system of the kidneys composed of?

card image

infundibulum
renal pelvis

152

Infundibulum

compused of minor and major calyces

minor calyces convey urine to the marjor calyces

153

The renal pelvis

is the upper expanded end of the ureter that receives urine.

154

renal helium

medial portion of the renal sinus where the renal arteries enter the kidneys

155

The ureters consist of three layers

inner mucosal layer
medial layer of circular and longitudinal smooth muscle
outer fibrous

156

What supplies the ureters with blood?

branches from
-renal
-internal spermatic
- hypogastric
-inferior vesical

157

Where does the ureters enter the bladder?

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posteriorly at the trigone region

158

What are the layers of tissue in the bladder?

inner mucosa
submucosa
muscularis
outer serosa

159

Detrusor muscle

muscular layer of the bladder composed of 3 layers of smooth muscle

160

Describe the inferior portion of the bladder

consists of a base (trigone)
neck - communicates with the urethra

161

the inferolateral surface of the bladder is in contact with _______

pelvic floor muscles

162

The superior portions of the bladder is covered by what?

extension of the peritoneum.

163

What anchors the bladder to the pelvis?

ligaments that extend anteriorly from the bladder neck and attach to the pubic bone

164

What vessels supplies blood to the bladder?

superior, middle and inferior vesicles from the anterior trunk of the hypogastric artery (internal iliac)

165

What does the urethra consist of?

membranous, hollow canal that conveys urine from the bladder to outside the body

166

What are the kidneys primary function?

urine production - excrete metabolic waste
homeostasis - maintain blood volume

167

How much blood does do the kidneys filter each minute?

1600 mL

168

How much urine do the kidneys produce each day?

150 mL

169

How is the amount of nitrogenous waste measured?

BUN - blood urea nitrogen
Cr - creatinine

170

What is the functional unit of the kidney called?

nephron

171

How does the nephron function?

by moving metabolic products from areas of high concentration to areas of low concentration

172

Osmosis

passive transport of cellular material

173

active transport

uses cellular energy to move material from one area to another

174

What are the two types of nephrons?

Juxtamedullary
cortical

175

Juxtamedullary nephrons

originate in the inner 3rd of the renal cortex

longer loops of Henle

176

cortical nephrons

originate in the outer 2/3s of the renal cortex

177

What does the nephron consists of?

renal corpuscle
-Bowmans capsule
-glomerularis

renal tubule
-proximal convoluted tube
-loop of Henle
-distal convoluted tube
-collecting ducts

178

What parts of the nephron is in the medulla?

loop of Henle
collecting ducts

179

What parts of the nephron is in the cortex?

glomerlaris
Bowmans capsule
proximal convoluted tube
distal convoluted tube

180

Name the steps of Urine formation

Filtration - glomerlaris

Tubular reabsorption - proximal convoluted tube and loop of Henle

Tubular secretion - distal convoluted tube

181

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.

182

where does Tubular reabsorption occur

proximal convoluted tube and loop of Henle

183

Where does Tubular secretion occur?

distal convoluted tube

184

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

185

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

186

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

187

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

188

What are the two parts of the adrenal glads called

cortex and medulla

189

What region does the liver lie?

major portions of the Rt. hypochondiac

extends inferiorly into the epigastrum

laterally into the left hypochondium

190

what regions of the liver are in contact with the diaphragm?

superior
anterior surface
portion of posterior surface

191

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

192

What is the livers fibrous capsule called?

Glission's capsule

193

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

194

What protects the posterior surface of the liver?

the bony and muscular posterior abdominal wall

195

Where does the inferior liver rest?

upper abdominal organs

196

Liver
Describe Right-sided inferior indentation

Rt hepatic flexure
Rt kidney and adrenal
first part of duodenum and gal bladder

197

Liver
Describe the Left side of inferior surface

gastric indentation
marked by the groove surrounding the IVC

198

inferior anterior midportion of left lobe

quadrate lobe

199

posterior midportion of inferior surface of the liver

caudate lobe

200

Where does the right lobe of the liver?

lies close to the anterolateral abdominal wall

201

The left lobe of the liver is closely related to what?

under surface of diaphragm

202

Where is the left lobe of the liver in relation to the pancreas

anterior

203

Where is the left lobe of the liver in relation to the splenic vein and artery

anterior

204

Where is the left lobe of the liver in relation to the pancreas

anterior

205

What is the caudate lobe covered by?

lesser sac of the peritoneum

206

What is on the anterior boundary of the caudate lobe?

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posterior surface of the left portal vein

207

What is on the posterior boundary of the caudate lobe?

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IVC

208
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The caudate lobe is separated by the left lobe by what?

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Portal

209
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Hepatic Artery

210
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The caudate lobe is separated by the left lobe by what?

ligament venosum

211

where are the falciform ligament and the ligamentum teres

within the intersegmental fissure

212

What does the right hepatic vein drain?

anterior and posterior segments of the right lobe

213

What does the left hepatic vein drain?

the medial and lateral segments of the left lobe

214

What does the middle hepatic vein drain?

right and meadial left lobe

215

What does the smaller inferior hepatic veins drain?

the caudate and postermedial portion of the right liver lobe

216

What is the portal triad?

consist of portal vein, hepatic artery, and bile ducts

217

Hemiliver

right and left liver division

218

How many main tributaries to the portal splenic confluence?

3
splenic vein
superior mesenteric vein
*inferior mesenteric vein

219

What happens to the main portal vein after it enters the portal hepatis

divides into left and right branches

220

What happens to the right portal

supplies the bulk of the liver centrally with blood from the gastrointestinal track for processing

221

How does the left portal ascend?

anteriorly, proximal to the falciform ligament.

222

What supplies the caudate lobe with blood for processing?

branches from both the right and left portal veins

223

What artery supplies the liver with blood?

the common hepatic artery

224

The proper hepatic artery branches into what?

courses superiorly supplying the liver through the right middle and left hepatic arteries

225

What is the triangle ligament formed by?

card image

extension of the coronary ligament inferiorly to the right

226

What is the function of the falciform ligament?

connect the liver to the anterior abdominal wall and to the diaphragm

227

Liver weight

1200-1600 grams

228

Liver
right to left measurement

10-22.5 cm

229

Liver
Anterior to posterior measurement

10-12.5 cm

230

Liver
Superior to inferior measurement

15-17 cm

231

What parts of the liver are interpertoneal?

all except for the bare area

232

What are the functions of the liver?

Digestion - Produce bile
Carbohydrate metabolism - glucose to glycogen
storage - vitamins
detoxification - breaks down poisen

233

What function does the liver play in digestion?

produce bile

234

What is the function of bile

digestion and absorption of fats and fat-soluble vitamins in the small intestine

235

What is stored in the liver?

vitamins

236

What is carbohydrate metabolism?

the process of converting glucose to glycogen and vice versa

237

define detoxification

breakdown of poisons

238

Where is the ligament teres?

card image

located on the free edge of the falciform

239

what is another name for the ligament teres?

round ligament

240

How does the ligament teres divide the liver?

card image

medial and lateral sections

241

Where is the ligament venosum?

card image

separates the caudate lobe from the left lateral lobe

242

where does the falciform lie?

extends from the umbilical to diaphragm

243

What is the function of the falciform ligament?

attach the liver to the abdominal wall
suspends liver from anterior diaphragm

244

What does the falciform ligament divide?

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right and left lobes

245
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card image

Main lobar fissure

246

The ductus venosum turns unto what ligament?

ligament venosum

247

The ductus arteriosum turns what ligament?

ligament arteriosum

248

What does the umbilical vein turn into?

ligament teres

249

What does the umbilical arteries turn into?

hypergastic ligament

250
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Where is the right triangular ligament?

card image

rt inferior extension of the coronary ligament

251

Where is the coronary ligament?

card image

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

252

What separates the right lobe of the liver from the left?

Main Hepatic vein
main lobar fissure
6

253

What separates the left lobe of the liver from the caudate?

ligamentum venosum

254

The left lobe is separates into medial and lateral sections by what?

ligamentum teres
Left portal vein

255

Hepatopetal

flow of blood towards the liver

256

Hepatofugal flow

flow out through through the hepatic vein

257

What is the portal triad?

portal vein
hepatic artery
bile duct

258

what is does the portal triad consist of at the lobule level?

bile ductile
heaptic arterial
portal venule

259

What do you do to search for problems in the biliary tree?

elongate the ducts to look for blockage

260

What is the function of the gallbladder?

concentrate bile
store bile
transport the bile to the doudenum

261

where does the gallbladder lie on the liver?

between left and right lobes

intraperitoneal

262

What are the parts of the Gallbladder?

Neck
Body
Fundus

263

Where is the fundus?

the fundus lies lateral inferior and anterior

pokes out

264

Explain the layers of the GB wall

serous
fibro-muscular layer
muscular layer

265

GB has rugae

...

266

Where is the neck of the GB?

neck extends medially/posteriorly

fixed anatomic relationship with the lobar fissure

267

What is the relationship between the GB and the porta hepatis?

GB lies to the right

268

The body and neck position is variable!

...

269

What is hartman's pouch?

lowest portion of GB neck

tends to collect stones

270

What is the valve of Heister?

2 way (enter/exit) bile

prevents over distention of cystic duct from collapsing

271

what do you have to be careful about with the valve of Heister?

sometimes the valve shadows and looks like stones

272

What is the composition of Bile?

82% water
12% bile salts
6% cholesterol, bilirubin, proteins, electrolytes, mucus

273

What are the variants of the gallbladder?

phrygian cap
agenesis - none
septated

274

What are the variants of the biliary system?

choledachal cyst - bile duct cyst
extrahepatic ducts
biliary atresia - blocked ducts

275

Length of the GB?

10 cm

276

GB walls

3 cm

277

diameter of GB

3-5 cm

278

Cystic duct length

3-4 cm

279

Cystic duct diameter

4 mm

280

Common bile duct length

8 - 11 cm

281

Common bile duct diameter

1 - 6 mm

282

pancreatic duct

less than 2 mm

283

what is the storage capacity of the GB

40 ml

8 table

284

How much bile is produced per day?

1 - 2 L

285

What artery feeds the GB?

cystic artery

off the hepatic artery

286

What vein drains the GB?

cystic vein

drains into portal vein

287

physiology of GD

food enters 2nd portion of duo
hormones released
sphincter of oddi opens
bile is squirted

wind blows from high to low