Inguinal Rings
- Superficial inguinal ring is formed by the aponeurosis of the external oblique
- Internal inguinal ring is the aponeurosis of the transversalis fascia
- Cremaster muscle is from the internal oblique
- Common site of hernia, hernia that is strangulated will cause hematochezia, pain, fever, NH3 accumulatio etc. Keep in differential
Median Umbilical
Urachus that is obliterated. Communication between bladder and yolk sac
-Remnants can lead to adenocarcinoma of the bladder or urachal cysts
Medial Umbilical
Umbilical Arteries
Lateral Umbilial
Folds covering the inferior epigastric arteries
Falciform
-Contains ligament teres hepatis which is the remnant of the umbilical vein in the liver
Anterior wall nodes
Including penis, scrotum and anus drain to superficial inguinal and then to lumbar
Lesser sac
Behind stomach, formed by lesser omentum which connects from lesser curvature to liver
- May be accessed through the epiploic foramen near the pylorus of the stomach
- Free edge contains the portal vein, hepatic artery, and bile duct
Greater omentum
attaches from greater curvature to transverse colon
Rectouterine pouch
peritoneal and perineal mesentery merge leading to the lowest place and common place for blood and fluid to collect
First part of duodenum (Bulb)
- Peritoneal structure of the foregut that lies in the ligament of the lver
- Collects fromt pyloris, often called duodenal bulb
- Gastroduodenal artery runs behind, duodenal uler may lead to bleed
Second Part of Duodeum (Descending)
- Is the transition from perotneal and foregut to midgut and retroperioneal.
- Contains the ampulalla of vater and the accessory pancreatic duct
Third Part of Duodenum (Transverse)
- Crosses in front of aorta and IVC, midgut derived
- SMA runs over the top, can compress and lead to SMA syndrome
Fourth Part of Duodenum (Ascending)
- Ends at the ligament of trietz (connects bowel to posterior wall)
- Marks the transition from upper to lower GI
Jejunum
Minimal Peyers Patches
Ileum
Many peyers patches
- Contains the ileocecal valve which is a possible site for gallstone ileus.
- Also contains meckesl diverticulum (vitellin duct)
Large Intestine
Cecum (Peritoneal), with appendix
- Asceinding is secondarily retroperitoneal as is descending
- Sigmoid (peritoneal) with redundant mesentery leads to common site of volvulus
- Transverse
- Splenic flexure is common site of ischemia (watershed with SMA/IMA)
Pancreas
- Secondarily retroperitoneal (Except tail)
- Main duct is from ventral and accesory is from dorsal
- Tail is near the spleen and is peritoneal
- Lies in the floor of the lesser sac
Spleen
Mesodermally derived from dorsal mesentery of foregut
-Splenorenal ligament and splenogastric ligament
Celiac Artery
Supplies foregut and resides at T12. Three main branches
-Left Gastric, Common Hepatic, and Splenic
Left Gastric
-Small branch of celiac trunk, supplies lesser curvature and also gives off esophageal branches. Anastamoses with right gastric off common hepatic
Splenic
- Large branch that runs along the superior aspect of the pancreas and supplies the pancreas
- Short gastric branches supply the fundus of the stomach and are end branches. Most likely occluded space
- Runs in splenogastic ligament to reach spleen
- Gives off left gastroepiploic which supplies the greater curvature and anastamoses with the Right gastroepiploic off common hepatic
Common Hepatic
- Runs in free edge of lesser omentum with the bile duct and the portal vein
- Right Gastic runs along lesser curvature and anastamoses with left gastric
- Gives off gastroduodenal which gives off a superior pancreatic duodenal (SMA anastamoses) and then continues as the right gastroepiploic supplying the greater curvature and anastamosing with the L Gastroepiloic
- Hepatic proper and cystic supply liver and gallbladder
SMA
Runs over the third part of the duodenum and can compress (SMA syndrome)
- L1
- Inferior pancreaticoduodenal anastamoses with celiac (Common hepatic)
- Middle Colic supplies transverse colin
- Right Colic Supplies Ascending Colon
- Iliocecal supplies the ileum and secum
- Marginal artery supplies the anastamoses between territiories
IMA
Supplies Hindgut
- Left Colic artery
- Sigmoid artery
- Superior rectal artery
