right subhepatic (answer d)and the hepatorenal spaces (answer e),may
be the seat of abscess formation related to gallbladder disease or perfora-
tion of a duodenal ulcer. The right subphrenic space is located between the
liver and the diaphragm and communicates with the pouch of Morison. All
these spaces are in communication with the greater sac (answer a)of the
peritoneal cavity.
385.The answer is e.(Moore and Dalley, pp 305–307.)Because of an
enlarged liver and the history of excessive alcohol consumption, you sus-
pect cirrhosis of the liver, which resulted in portal hypertension. Because
the blood is bright red, suggesting that it has notbeen exposed to duodenal
or gastric secretions, the most likely source would be esophageal varices, as
blood is trying to return from the portal system to the systemic circulatory
system. Hemorrhoids (answer a)are commonly associated with cirrhosis
of the liver, but at the other end of the GI tract. Colon cancer (answer b)
doesnotpresent with upper GI bleed, rather lower GI bleeding. Neither
duodenal(answer c)norgastric ulcers (answer d)present with bright red
blood.
386.The answer is e.(Moore and Dalley, p 290.)The omental (epiploic)
foramen connects the lesser sac with the hepatorenal (subhepatic) recess of
the greater sac (seeMoore and Dalley, p 290 for an excellent picture of this
relationship). The hepatorenal recess then communicates with the right
subphrenic recess and right paracolic gutter. The subhepatic recess is per-
haps the most frequently infected intra-abdominal space as a result of
appendicitis, liver abscess, perforated duodenal and gastric ulcers, or per-
foration of the biliary tree. The infracolic compartment is (answer a)part
of the greater omentum. The left colic gutter (answer b)is further inferior
and left. The left subphrenic recess (answer c)and right subphrenic space
(answer d)are further cranial on top of the liver.
387.The answer is e.(Moore and Dalley, p 430.)The rectum receives
blood from the superior rectal (hemorrhoidal) artery and from the paired
middle and inferior rectal arteries. The superior rectal artery is a direct con-
tinuation of the inferior mesenteric artery, but the middle and inferior rec-
tal arteries are branches of the internal iliac artery and continue to supply
the distal rectum despite occlusion of the inferior mesenteric artery. It
should be noted that Sudeck’s point, between the last sigmoidal artery and
520 Anatomy, Histology, and Cell Biology