Small Group Session I

(to view with answers)

Bed of the Stomach

Answer the following questions upon completion of your dissection of the stomach and
duodenum. (Questions A and B); Answer question C after the completion of the dissection of
posterior wall structures (kidneys, suprarenal glands etc.).

A. Carefully dissect the overlying large intestine from the underlying stomach and duodenum.
Identify each of the four subdivisions of the duodenum in your cadaver; including in your
description the length of each segment (cm.) , whether it is fixed (retroperitoneal) or free, and
vertebral level(s)

1) Superior part: _____________________________________________________________________
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2) Descending part: __________________________________________________________________
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3) Horizontal part: ____________________________________________________________________
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4) Ascending part: ___________________________________________________________________
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B. For each of the following ligaments that are attached or support the stomach; indicate the specific
names of the major structures (vessels, nerves, ducts, etc.) located within each.

1) Hepatogastric ligament: _____________________________________________________________
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2) Hepatoduodenal ligament: ___________________________________________________________
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3) Gastrocolic ligament: _______________________________________________________________
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4) Gastrophrenic ligament: _____________________________________________________________
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5) Gastrosplenic ligament: _____________________________________________________________
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6) Lienorenal ligament: ________________________________________________________________
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7) Greater Omentum : _________________________________________________________________
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8) Phrenicolcolic ligament: ______________________________________________________________
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8) Suspensory ligament of Duodenum: ____________________________________________________
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8) Transverse mesocolon: __________ ____________________________________________________
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C. Upon exposure of the posterior wall of the cadaver, replace into their relative positions, the stomach and
duodenum previously dissected. The "Bed of the Stomach" refers to all those major anatomical structures
that lie immediately behind the stomach. For example, this will include the left kidney and part of the
pancreas and major vessels. On the diagram below sketch in the relative position of the structures on your
cadaver that make-up the "Bed of the Stomach"

LIVER AND BILIARY SYSTEM

Answer the following questions upon completion of your dissection of the liver, biliary ducts
and pancreas.

A. Complete the drawing below of the drainage of the biliary tree as it occurs in your cadaver.
Be sure to include and label all ducts; including gall bladder, pancreas and duodenal papillae.
Note any variations from the normal pattern. Refer to Grant?s Atlas (Fig.2-83).

B. Identify the retro-hepatic space. With the body in the supine position, fluid in the peritoneal
cavity (acites) will accumulate in this area. Describe its boundary: ______________________
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C. One of the functions of the liver is to detoxify wastes of digestion. Such wastes are drained
from the large and small intestine through the portal veins into the sinusoids of the liver.
Cirrhosis of the liver replaces functional parenchyma with scar tissue and impedes portal blood
flow through the liver to the IVC. Examine your cadaver and describe at least two surgical
connections that can by-pass the portal flow through the liver.

(1) __________________________________________________________________________
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(2) __________________________________________________________________________
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Patients suffering from reduced blood flow through the liver commonly will exhibit vericosities
or enlargement of veins as portal venous blood attempts to seek alternate pathways through
systemic veins to return to the heart. Where are the four major connections located and what
would be the complaint of the patient for each?

(1) __________________________________________________________________________
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(2) __________________________________________________________________________
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(3) __________________________________________________________________________
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(4) __________________________________________________________________________
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D. Understand the concept of a physiological or hepatic lobes compared to an anatomical lobe.

(1) Describe the course of travel of an infection from a diverticula of the sigmoid colon to the liver; naming
all venous tributaries. ___________________________________________________________
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(2) Describe the course of travel of an infection from an inflamed appendix to the liver.
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E. Describe the attachments and contents of the two major peritoneal supports of the spleen. _____________________________________________________________________________
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F. Upon completing the dissection of the pancreas; examine the presence of an accessory
pancreatic duct on your cadaver. Does your cadaver have an accessory duct ? ___________
Based on that observation, in the living condition, what would be the consequences of a gall
stone becoming impacted in the duodenal ampulla in this cadaver. _____________________________________________________________________________
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