3G. Anatomy of bleeding GI

Question 1

describe the 3 parts of the abdominal organs based on their embryological origins

Answer 1

foregut- oesophagus to mid duodeum/liver, gallbladder,spleen and half of pancreas

midgut- second part of duodeum, 2/3rds of transverse colon, other half of pancreas

hindgut - 1/3rd of transverse colon and anal canal

Question 2

name the 3 abdominal aorta midline branches

Answer 2

coeliac trunk
superior and inferior mesenteric arteries

Question 3

name what 3 places the lateral branches on the abdominal aorta supply

Answer 3

kidneys/adrenal glands
gonads- testes/ovaries
body wall

Question 4

what does the abdominal aorta eventually bifurcate into

Answer 4

common iliac artery - internal and external

Question 5

which midline branch of abdominal artery comes first

Answer 5

coeliac trunk

Question 6

which vertebral level does the coeliac artery branch occur

Answer 6

T12

Question 7

what does the coeliac artery supply

Answer 7

foregut

Question 8

where is the coeliac trunk in regards to the peritoneum

Answer 8

retroperitoneal

Question 9

what 3 branches does the coeliac trunk trifurcate into

Answer 9

splenic artery
hepatic artery
left gastric artery

Question 10

where does the splenic artery have to travel to get to the spleen

Answer 10

along the superior border of the pancreas

Question 11

describe the spleen in terms of where it is

Answer 11

intraperitoneal organ with left hypochondrium

anatomically related to
- posterior to diaphragm
-anterior to stomach
- inferior to splenic flexure
- medial to the left kidney

Question 12

which ribs protect the spleen

Answer 12

9-11

Question 13

do the spleen and liver move with respiration

Answer 13

yes but thats because they are anatomically related to the diaphragm

Question 14

what vessel supplies the stomach

Answer 14

right and left gastric arteries
right and left gastro-omental arteries

Question 15

which blood vessels run along the lesser curvature of the stomach

Answer 15

left and right gastric arteries (anastomses)

Question 16

which blood vessels run along the greater curvature of the stomach

Answer 16

left and right gastro omental arteries (anastomoses)

Question 17

where does the liver get their blood from

Answer 17

hepatic arteries (left and right) 20/25%

Hepatic portal vein

Question 18

what are the branches of the superior mesenteric artery

Answer 18

inferior pancreaticduodenal
middle colic
right colic
ileocolic
appendicular
jejunal and ileal

Question 19

name the branches of the inferior mesenteric artery

Answer 19

left colic
sigmoid arteries
superior rectal arterywh

Question 20

which artery is a direct continuation of the inferior mesenteric artery

Answer 20

superior rectal artery

Question 21

which is narrower. The ascending colon or the cecum

Answer 21

ascending colon

Question 22

what is the left colic flexure also called

Answer 22

splenic flexure

Question 23

what flexure is more superior and less mobile

Answer 23

splenic flexure (left)

Question 24

what is the transverse colon suspended by

Answer 24

the transverse mesocolon (anterior border of pancreas)

Question 25

ascending and descending retro or intra peritoneal

Answer 25

momentarily retroperitoneal

Question 26

what are paracolic gutters and what are they lined with?

Answer 26

The paracolic gutters are spaces in your abdomen. Imagine two vertical grooves or channels running alongside the sides of your large intestine (colon). One is next to the ascending colon and the other is next to the descending colon These gutters are lined with a thin layer called the parietal peritoneum, which is a membrane that covers the walls of the abdominal cavity. The main function of these gutters is to help direct the flow of fluids within the abdomen, such as pus, bile, or blood, especially when there's an infection or injury.

Question 27

what is identifiable about the sigmoid colon

Answer 27

it is a S shaped loop

Question 28

where does the sigmoid colon sit in the body

Answer 28

extends from the iliac fossa to the third sacral S3

Question 29

is the rectum free moving or fixed

Answer 29

fixed

Question 30

where does the rectum start

Answer 30

S3 vertabra

Question 31

what is the arterial anastomoses called that is between the branches of the superior and inferior mesenteric arteries

Answer 31

marginal artery of drummond

Question 32

what blood vessel supplies the hindgut organs

Answer 32

inferior mesenteric artery

Question 33

where does the hind gut extend to

Answer 33

the proximal half of the anal canal (the pectinate line)

Question 34

what supplies the remainder of the GI tract after the IMA supplies the hindgut up till half of the anal canal

Answer 34

the internal iliac artery

Question 35

if a patient is vomiting up blood what could be the cause (2 options)

Answer 35

peptic ulcer in wall of stomach or duodenum bleeding from the oesophageal varices

Question 36

what is the sequence of events with the hepatic portal venous system

Answer 36

inferior mesenteric artery gets blood from the hind gut and transports it to the splenic artery (a branch of the coeliac) which gets blood from that and the foregut structures. It then combines with the inferior mesenteric artery which is carrying drained midgut blood to become the hepatic portal vein which takes the blood to the liver to be cleaned. (first pass metabolism) the blood it then taken out the liver by the hepatic veins and given to the IVC which dumps it in the right atrium

Question 37

how many venous anastomoses are there- describe them

Answer 37

3 distal end of oesophagus skin and umbilicus rectum/anal canal

Question 38

at these sites - distal end of oesophagus skin and umbilicus rectum/anal canal there is a presence of what veins? and what is unique about them

Answer 38

collateral veins - blood can flow both ways either into systemic or hepatic portal venous system. THEY HAVE NO VALVES

Question 39

in the rectal region, what is present that highlights that blood circulates locally

Answer 39

the venous plexus

Question 40

superior rectal vein drains into what

Answer 40

inferior mesentery vein

Question 41

middle and inferior rectal veins connect to what

Answer 41

internal iliac vein

Question 42

what is portal hypertension

Answer 42

increased BP in portal veins

Question 43

what pathology causes portal hypertension

Answer 43

cirrhosis

Question 44

if there is portal hypertension where does blood go

Answer 44

diverted through the collateral veins back into systemic venous system

Question 45

when blood is diverted through the collateral veins back into systemic venous system due to portal hypertension what does this cause and why

Answer 45

varicose veins (in the collateral veins) as there is much larger volume than usual