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TableXVII
Page9
AnatomyoftheLargeIntestine
Portion
Description
Bloodsupply
Innervation
Blindpouch;intraperitoneal,butno
S:SMP(thoracic)
Cecum
Ileocolica.(SMA)
mesentery;sphincteratileocecaljunction
PS:vagus
Blinddiverticulum;mostoftenretrocecal
Appendiculara.
S:SMP(thoracic)
Appendix
(64%),hasmesentery(mesoappendix)
(SMA)
PS:vagus
Retroperitoneal,boundsrightparacolic
Ileocolica.,Rcolica. S:SMP(thoracic)
Ascendingcolon
gutter
(SMA)
PS:vagus
Largestandmostmobilepart,
S:SMP(thoracic)
Transversecolon
Middlecolica.(SMA)
intraperitoneal
PS:vagus
Retroperitoneal,boundsleftparacolic
S:IMP(lumbar)
Descendingcolon
Lcolica.(IMA)
gutter
PS:pelvicsplanchnic
Longmesentery,movesfreely,rectosigmoid
S:IMP(lumbar)
Sigmoidcolon
Sigmoida.(IMA)
junctionatS3
PS:pelvicsplanchnic
Rectum
Noteniaecoli,continuouswithanalcanal
Component
Description
Sacculationsincolicwallduetoteniaecolibeingshorterthanthecolon
Haustra
Contractupondistension,movingcontentstonexthaustrum
3longitudinalmusclebands:free,omental,mesocolic
Teniaecoli
Notpresentinappendix,rectum
Colicflexures
Right(hepatic):ascendingtransverse,Left(splenic):transversedescending
Omental(epiploic)
Lobulesoffatwhichprotectcolon,notpresentinsmallintestine
appendages
TableXVIII
Image
AnatomyofthePancreas
Location
Retroperitoneal,borderstransversemesocolon
Head
AttachedtoCshapedcurveofduodenum;SMA/Vcrossatuncinateprocess
Neck
Short,connectsheadandbody,overliesSMA/V
BodyandTail
Continuefromnecktoleftcolicflexure;rootoftransversemesocolonatanterioredge
Majorpancreaticduct
a.k.a.ofWirsung,fromtailthroughhead,mergesw/bileductathepatopancreaticampulla
Minorpancreaticduct
Opensintominorduodenalpapilla
Bloodsupply
Tail,body,neck:dorsalpancreatica.,greaterpancreatica.
Head:superiorpancreaticoduodenalaa.(SPDA),inferiorpancreaticoduodenalaa.(IPDA)
Venousdrainage
Pancreaticvv.intosplenicandsuperiormesentericvv.
TableXIX
AnatomyoftheLiver&Gallbladder
LiverComponent
Fissureforlig.venosum
Fissureforlig.teres
Portahepatis
FossaforInf.VenaCava
Fossaforgallbladder
Falciformlig.
Coronarylig.
Rightlobe
Caudatelobe
Caudateprocess
Quadratelobe
Leftlobe
Commonhepaticduct
Comonbileduct
Hepaticvv.
Properhepatica.
Portalv.
Location
Description
Posterior,upperleft
Obliteratedductusvenosus(portalIVCshunt)
Posterior,lowerleft
Obliteratedumbilicalv.,akaroundlig.ofliver
Posterior,horizontal
Passageofportalv.,hepatica.,comm.bileduct
Posterior,upperright
Afossaforthevenacava!
Posterior,lowerright
Afossaforthegallbladder!
Anterior,central
Containsroundlig.ofliver
Superiormargin
Formstriangularligaments,connectsdiaphragm
Rightoffissures,largestlobe SuppliedbyRhepatica.,bileoutbyRhep.duct
Superior,middle
SuppliedbyLhepatica.,bileoutbyLhepduct
Bottomrightofcaudatelobe SuppliedbyRhepatica.,bileoutbyRhepduct
Inferior,middle
SuppliedbyLhepatica.,bileoutbyLhepduct
Leftoffissures
SuppliedbyLhepatica.,bileoutbyLhepduct
Portahepatis
FormedbyunionofRandLhepaticducts
Portahepatis
Formedbyunionofcysticandcommonhepatic
Superior,rightandleft
DrainsR/LfunctionallobesintoIVC
Portahepatis
Supplieshepatocytesviasinusoids,splits
Portahepatis
SuppliesbloodfromGItosinusoids
Gallbladder
Fundus
wideend,projectsfrominferiorborder
th
ofliver,right9 costalcartilage
Body
contactsvisceralsurfaceofliverand
superiorpartofduodenum
Neck
narrow,tapered,anddirectedtoward
portahepatis;makesSshapedbend
Cysticduct
4cmlong,connectstheneckofthe
gallbladdertothecommonhepaticduct
Images
GastrointestinalExamITables
Page10
TableXX
VisceralBloodSupply
Lgastric
Lessercurvatureofstomach
Spleen
Lgastroomental
Greatercurvatureofstomach
Splenic(largest,
Tail,body,andneckof
Dorsalpancreatic
tortuous)
pancreas
Tail,body,andneckof
Greaterpancreatic
pancreas
Celiactrunk
Rhepatic
Properhepatic
Lhepatic
Rgastric
st
nd
Commonhepatic
1 and2 partsofduodenum
Rgastroomental
Gastroduodenal
SPDA
rd
IPDA
Jejunala
Ileala
Superior
Ileocolic
mesenteric
Middlecolic
Rcolic
Appendicular
Marginal
Lgastricv.(+/) Greatercurvatureofstomach
L&Rgastricvv. Stomach
Splenicv.
Greatercurvatureofstomach
st
nd
1 and2 partsofduodenum,
headofpancreas
Sigmoidcolon
Esophagealvv. Esophagus(upper)
Esophagealvv. Esophagus(lower)
Portalv.
Rlobe,caudateprocessofliver
L,quadrate,caudatelobes
Lesser curvatureofstomach
th
Descendingcolon
3 and4 partsofduodenum,headof
pancreas
Jejunum
Ileum
Ileum,cecum,ascendingcolon
Transversecolon
Ascendingcolon
Appendix
AnastomosisofSMA&IMA
Lcolic
Inferior
mesenteric Sigmoid
Azygos
v.
Shortgastricv.
Stomach
Lgastroomentalv.
Greatercurvatureofstomach
Inferiormesentericv. Descending&sigmoidcolon
Superior
mesentericv.
Pancreaticvv.
Pancreas
Rgastroomentalv.
Lessercurvatureofstomach
Ileocolicv.
Asc.colon,cecum,appendix
Rcolicv.
Ascendingcolon
TableXXI
EmbryonicSection
OverviewofGIEmbryology
Adultstructures
Foregut
EsophagustoMDP,liver,gallbladder,pancreas
Midgut
MDPtoproximal2/3oftransversecolon
Hindgut
Distal1/3oftransversecolontorectum
Adultstructure Development
Bloodsupply /
ganglion
Celiactrunk
Superiormesenteric
Inferiormesenteric
Innervation
S:Greaterthoracicsplanchnicn.(T59);PS:Vagus n.(CNX)
S:Lesser(T1011),least(T12)thoracicsplanchnicnn.;PS:Vagusn.(CNX)
S:Lumbarsplanchnicnn.(L12);PS:Pelvicsplanchnicnn.(S24)
Anomalies
Atresia:failureofrecanalizationordeviationintracheoesophagealseptum;
surgicallycorrected
Partitioningoftracheafollowedbyocclusionoflumenandrecanalization
Esophagus
Muscle:upper1/3frombranchialarches,lower1/3fromsplanchnicmesoderm Stenosis: incompleterecanalizationorfailureofvasculature
Shortesophagus:congenitalhiatalhernia
Beginsasdilationofforegut,rotates90clockwiselongitudinally
Congenitalhypertrophicpyloricstenosis:stomachdistenstion,projectile
Stomach
Dorsalmesogastriumgreateromentum,ventrallesser
vomiting
Stenosis: failureofrecanalization,bileinvomitifcaudaltoMDP
FormsCshapedloop,proximalportionremainsintraperitoneal
Duodenum
Restbecomesretroperitonealafterrotationofstomach
Atresia:Uncommon;2030%haveDowns,doublebubble sign,bilevomit
Hepaticdiverticulumfromcaudalforegut,fromcranial septumtransversum
Extrahepaticbiliaryatresia:uncommon,failureofductstorecanalize;
Liver
Endodermhepaticcords/ducts,mesodermsinusoids,hematopoietic
presentswithjaundice,correctedsurgicallyofbytransplantation
Gallbladder
Smallercaudalpartofseptumtransversum;bileentersduodenumweek14
Entranceofbilecausesgreenmeconium(normal)
Pancreas
Mostlyfromdorsalbudofendodermmesentery,retro duetostomachrotation Annularpancreas: uncommon,moreofteninmales,growsaroundduodenum
Mesenchymalcellsindorsalmesogastrium;lobulatedinfetus
Spleen
Rotationofstomach:fusionofperitoneum(splenorenallig.),twistssplenica.
Midgutvolvulus:failureofreentryofgut&fixation;obstruction,gangrene
Craniallimbofmidgutlooprotates90counterclockwisewhileherniated,
Smallintestine
thenanother180CCW(total90clockwise)asherniaisreduced
Meckelsdiverticulum:remnantofyolksac(vitellineduct) inileum
Congenitalomphalocoel: persistenceofumbilicalhernia,mayincludeliver
Cecum/Appdx Cecaldiverticulumofcaudallimbofmidgutloop
Mobilececum: 10%ofpopulation,incompletefixationofascendingcolon
Desc.colon
Remainsretroperitoneal,sigmoidretainsmesentery
Urorectalseptumfuseswiththecloacalmembrane(atperinealbody)dorsal Hirschsprungs:cong. megacolon,absentautonomicganglia,mostcommon
Cloacal
analmembraneandaventralurogenitalmembrane,ext.analsphincter(post) Anorectalagenesis:rectumendssuperiortopuborectalis, analanomalies
development
Analcanal:supfromhindgutendoderm,inffromproctodeumectoderm Otheranorectalanomalies:mostlyfromimproperfusionofurorectalseptum