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Liver to duodenum
- Contains: Portal triad
- - hepatic artery
- - portal vein
- - common bile duct
- May be compressed between thumb and index finger placed in omental foramen to control bleeding.
- Connects greater and lesser sac.
Meissner's (submucosal) plexus
Regulates local secretions, blood flow, and absorption
Abdominal aorta branches and vertebrae level
- Celiac trunk T12
- Superior mesenteric artery L1
- Left renal artery L1
- Testicular/ovarian arteries L2
- Inferior mesenteric artery L3
- Bifurcation of abdominal aorta L4
Foregut embryonic gut region
- Celiac artery
- Vagus parasympathetic innervation
- Stomach to proximal duodenum
- spleen (mesoderm)
Collateral circulation if the abdominal aorta is blocked.
1. Internal thoracic/mammary(subclavian) -- superior epigastric(internal thoracic) -- inferior epigastric(external iliac)
2. Superior pancreaticoduodenal(celiac trunk) -- inferior pancreaticoduodenal(SMA)
3. Middle colic(SMA) -- left colic (IMA)
4. Superior rectal(IMA) -- middle rectal (internal iliac)
ABove the pectinate line characteristics
- Arterial: superior rectal artery (IMA)
- Venous: superior rectal vein -> inferior mesenteric vein -> portal system
Femoral sheath contents
Femoral vein, artery, and canal(deeo inguinal lymph nodes)
NOT the femoral nerve
Sliding versus paraesophageal hernia
Both Diaphragmatic hernias
Sliding- GE junction is displaced - hourglass stomach
Paraesophageal- GE junction is normal. Cardia moves into the thorax
Indirect inguinal hernia
Goes through internal (deep) inguinal ring, external (superficial) inguinal ring, and into the scrotum.
Covered by all 3 layers of spermatic fascia
G cells (antrum of stomach)
- + gastric H+ secretion
- + growth of gastric mucosa
- + gastric motility
- + by stomach distention/ alkalinization, amino acids, peptides, vagal stimulation
(-) by stomach pH <1.5
I cells (duodenum, jejunum)
- + pancreatic secretion
- + gallbladder contraction
- (-) gastric emptying, spinchter of Oddi relaxation
- + by fatty acids, amino acids
Parietal cells (stomach)
- decreases sotmach pH
- + by Histamine, ACh, gastrin
- (-) by somatostatin, GIP, prostaglandin, secretin
What uses the Gq pathway in gastric Parietal cells?
Vagus ACh stimulation of M3 receptor
G cells Gastrin stimulation of CCkb receptors (enhanced by GRP)
Secrete alkaline mucus to neutralize acid contents entering the duodenum form the stomach.
* Located in duodenal submucosa (only gland in submucosa)
Hypertrophy seen in peptic ulcer disease
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