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YEAR 1 - Organisation of the Body (Anton) > 9. Abdomen & Digestive System (TT) > Flashcards

9. Abdomen & Digestive System (TT) Flashcards

1
Q

How can the anterior abdominal wall be divided into different section?

A

Note: You can use either the trans-pyloric plane (L1) or the subcostal plane (L3) as the top line.

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2
Q

Draw a simpler way of dividing the anterior abdominal wall into sections.

A
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3
Q

Describe the position of the liver and gall bladder in surface anatomy of the anterior abdominal wall.

A
  • Liver -> Right upper quadrant with left lobe reaching the left upper quadrant
  • Gall bladder -> Lies in the transpyloric plane close to the right edge of rectus abdominis.
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4
Q

Describe the position of the stomach in surface anatomy of the anterior abdominal wall.

A

Mainly in the left upper quadrant, with the pylorus crossing the midline.

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5
Q

Describe the position of the caecum in surface anatomy of the anterior abdominal wall.

A

Right lower quadrant.

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6
Q

Describe the position of the descending colon in surface anatomy of the anterior abdominal wall.

A

Left lumbar region

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7
Q

Describe the 3 muscle layers of the anterior abdominal wall and the direction of their fibres. [IMPORTANT]

A
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8
Q

What is the line called that runs along the midline of your abs?

A

Linea alba

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9
Q

What is the inguinal ligament, where does it attach and what forms it?

A
  • It is the aponeurosis of the external oblique muscles
  • It attaches at the anterior superior iliac spine and pubic tubercle
  • It forms part of the boundaries of the inguinal canal
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10
Q

What is the conjoint tendon and what forms it?

A
  • It is the lower part of the common aponeurosis of the internal oblique muscle and the transversus abdominis
  • It forms part of the boundaries of the inguinal canal
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11
Q

What are the different layers that constitute the anterior abdominal wall? [IMPORTANT]

A
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12
Q

What are the abdominal muscles closest to the midline called?

A

Rectus abdominis

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13
Q

What are the rectus abdominis muscles contained within?

A

A sheath formed by the aponeuroses of abdominal wall muscles & transversalis fascia.

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14
Q

Where do the rectus abdominis muscles attach?

A
  • Superiorly at the costal margin
  • Inferiorly at the pubic bone
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15
Q

Describe the innervation of the anterior and anterolateral abdominal walls.

A

Ilioinguinal and iliohypogastric nerves innervate the lower parts of the abdomen.

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16
Q

Where do the lateral cutaneous nerves that innervate the abdominal wall travel?

A

Between the internal oblique and transversus abdominis muscle layers.

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17
Q

Draw the dermatomes of the anterior abdominal wall.

A
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18
Q

Describe the descent of the testis. [IMPORTANT]

A
  • The gubernaculum guides the descent of the testis through all of the layers of the abdominal wall except the parietal peritoneum
  • However, the peritoneum is pulls down with the testis
  • The canal the peritoneum forms is called the processus vaginalis
  • The peritoneum gives rise to a covering of the testis called the tunica vaginalis
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19
Q

How does an inguinal hernia occur? [IMPORTANT]

A

When the testes descend, if there is a patent processus vaginalis, the contents of the peritoneal cavity can herniate into the scrotum.

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20
Q

What important structure does the descent of the testis give rise to?

A

Inguinal canal

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21
Q

Does the inguinal canal also exist in females?

A

Yes

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22
Q

What is found at either end of the inguinal canal?

A
  • Deep inguinal ring -> On the proximal side
  • Superficial inguinal ring -> On the distal side
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23
Q

Show how the inguinal canal can be found using surface anatomy.

A
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24
Q

What forms each side of the inguinal canal?

A
  • Roof -> Arching fibres of internal oblique & transversus abdominis
  • Anterior wall -> External oblique aponeurosis
  • Posterior wall -> Transversalis fascia; medially, the conjoint tendon
  • Floor -> Infolding of inguinal ligament
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25
Q

What are the contents of the inguinal canal in females?

A
  • Round ligament of uterus
  • Ilioinguinal nerve
  • Genital branch of the genitofemoral nerve
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26
Q

What are the contents of the inguinal canal in males?

A
  • Spermatic cord and contents
  • Ilioinguinal nerve
  • Genital branch of the genitofemoral nerve
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27
Q

Label this view of the inguinal canal from the posterior side (from within the abdomen).

A
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28
Q

On this image, you can see the deep inguinal ring. Label roughly where the superficial inguinal ring is.

A
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29
Q

The deep inguinal ring is an outpouching of…

A

The transversalis fascia.

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30
Q

Describe the position of the deep inguinal ring relative to the epigastric vessels.

A

It is lateral to the vessels.

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31
Q

What are the boundaries of Hesselbach’s triangle?

A
  • Inguinal ligament
  • Inferior epigastric vessels
  • Rectus abdominis
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32
Q

Compare an indirect and direct inguinal hernia.

A

Indirect:

  • Congenital
  • Contents pass through deep inguinal ring, inguinal canal and then the superficial inguinal ring

Direct:

  • Not congenital
  • Contents buldge out through a weakness in Hesselbach’s triangle and pass through the superficial inguinal ring -> Do not pass through deep inguinal ring or inguinal canal
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33
Q

Where can the root of an inguinal hernia be felt?

A

It lies above the pubic tubercle (since the superficial inguinal ring is above the inguinal ligament, which attaches to the tubercle).

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34
Q

Draw the position of the femoral canal.

A

It is the space within the femoral sheath that contains the femoral artery and vein (but not nerve).

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35
Q

Where do the foregut, midgut and hindgut stretch from and to?

A
  • Foregut -> Inferior oesophagus to midway along duodenum
  • Midgut -> Midway along duodenum to 2/3rd along the transverse colon
  • Hindgut -> 2/3rd along the duodenum to the rectum
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36
Q

Describe the blood supply and innervation of the foregut.

A
  • Blood: Coeliac artery
  • Innervation: T5-T9
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37
Q

Describe the blood supply and innervation of the midgut.

A
  • Blood: Superior mesenteric artery
  • Innervation: T10-T11
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38
Q

Describe the blood supply and innervation of the hindgut.

A
  • Blood: Inferior mesenteric artery
  • Innervation: T12-L1
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39
Q

Describe the referred pain regions of the foregut, midgut and hindgut.

A
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40
Q

What is the abdomen and what are the two parts?

A
  • It is the region of the body below the diaphragm.
  • Two parts:
    • Abdomen proper
    • Pelvic cavity
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41
Q

What are the two layers of the peritoneum?

A
  • Visceral -> Covers organs
  • Parietal -> Covers the walls of the abdomen
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42
Q

Draw diagrams to show the layers of peritoneum on an intraperitoneal and retroperitoneal structures.

A
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43
Q

Are major nerve trunks and the aorta intraperitoneal or retroperitoneal?

A

Retroperitoneal

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44
Q

What are the lesser and greater omentum?

A

Structures related to the stomach:

  • Lesser ometum -> The double layer of peritoneum that extends from the liver to the lesser curvature of the stomach
  • Greater omentum -> A large apron-like fold of visceral peritoneum that hangs down from the anterior side of the stomach (ultimately attaches to the posterior absominal wall)
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45
Q

What forms the connection between the greater and lesser sac of the peritoneal cavity?

A

The lesser omentum has a free edge.

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46
Q

What are the different attachments of the liver?

A
  • Falciform ligament -> A ligament that attaches the liver to the front body wall
  • Lesser omentum -> Attaches the liver to the stomach (Can’t see the attachment on this diagram because this is the free edge. The superior edge of the omentum attaches to the liver.)
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47
Q

What structure are the green and blue parts of this diagram derived from?

A
  • Green -> Derived from ventral mesentry
  • Blue -> Derived from dorsal mesentry
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48
Q

Label this cross-section.

A
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49
Q

Describe the position of the spleen in the abdomen.

A

It is just below the ribs, on the left side of the abdomen, just left and posterior to the stomach.

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50
Q

What is the role of the spleen? [IMPORTANT]

A
  • Turnover of RBCs
  • Role in immunity is studied in second year
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51
Q

Where does the oesophagus start and end?

A

Begins at lower laryngopharynx and ends at the stomach (~25cm long).

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52
Q

What sort of muscle is found in the oesophagus?

A
  • Upper 1/3rd -> Skeletal muscle
  • Lower 2/3rd -> Smooth muscle
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53
Q

At what spinal level does the oesophagus start and what structure marks this?

A
  • C6/C7
  • This is marked by the upper oesophageal sphincter
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54
Q

Describe the position of the oesophagus relative to the trachea and left atrium.

A

Runs posterior to:

  • Trachea
  • Tracheal bifurcation
  • Left atrium
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55
Q

At what level does the oesophagus pass through the diaphragm?

A

T10

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56
Q

What is found at the gastro-oesophageal junction?

A
  • Lower oesophageal sphincter
  • This ‘sphincter’ largely works due to the diaphragm, which can contrict the oesophagus
  • It prevents reflux from the stomach
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57
Q

What nerves run with the oesophagus and cross the diaphragm with it?

A

Left and right vagus nerves

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58
Q

What nerve provides parasympathetic innervation to the oesophagus?

A

Vagus

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59
Q

What is the name for the part of the stomach where the oesophagus enters?

A

Cardia

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60
Q

What are the three main parts of the stomach?

A
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61
Q

What are the parts of the pylorus of the stomach?

A
  • Pyloric antrum
  • Pyloric canal
  • Pyloric sphincter
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62
Q

What is the pyloric sphincter?

A

A sphincter between the stomach and the first part of the duodenum.

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63
Q

Label this diagram of the stomach.

A
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64
Q

What demarcates the boundary between the fundus and body of the stomach?

A

The fundus is everything above the cardiac notch.

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65
Q

What demarcates the boundary between the body and pylorus of the stomach?

A

Angular notch

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66
Q

How many layers of muscle does the stomach have?

A

It has 3, which is one more than most organs:

  • Longitudinal
  • Circular
  • Oblique
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67
Q

What is pyloric stenosis and what may it result in?

A
  • A narrowing of the pylorus of the stomach.
  • Symptoms include projectile vomiting without the presence of bile.
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68
Q

What are gastric ulcers and what are the symptoms?

A
  • A break in the inner lining of the stomach
  • Symptoms include: Abdominal pain, bloating, etc.
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69
Q

What are the 4 parts of the duodenum?

A
  • 1st (superior)
  • 2nd (descending)
  • 3rd (horizontal)
  • 4th (ascending)
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70
Q

Which side of the abdomen does the duodenum curve out to?

A

Right side

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71
Q

Between what vertebral levels is the duodenum?

A

L1 and L3

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72
Q

What demarcates the boundary between the foregut and the midgut?

A

The entry of the biliary and pancreatic ducts into the duodenum.

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73
Q

Where in the duodenum do the biliary and pancreatic ducts enter?

A

2nd (descending) part

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74
Q

What demarcates the point where the dudodenum becomes the jejunum?

A

The ligament of Treitz (which joins the duodenum to the diaphragm).

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75
Q

Is the duodenum intraperitoneal or retroperitoneal?

A

The first cm is mobile, but the rest is retroperitoneal.

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76
Q

Describe the blood supply to the duodenum.

A
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77
Q

Draw the relations of the duodenum.

A
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78
Q

What is the sphincter of Oddi?

A

The smooth muscle that surrounds the end portion of the common bile duct and pancreatic duct. This muscle relaxes during a meal to allow bile and pancreatic juice to flow into the intestine.

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79
Q

What are the ligaments on the anterior side of the liver?

A
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80
Q

What are the ligaments on the posterior side of the liver?

A
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81
Q

What is the entry/exit point of the hepatic portal vein, bile duct, hepatic artery into the liver?

A
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82
Q

What structures does the free edge of the lesser omentum contain?

A
  • Common bile duct
  • Hepatic artery
  • Hepatic portal vein
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83
Q

What is the name for the entrance to the lesser sac?

A

Epiploic foramen

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84
Q

What are the three parts of the gall bladder?

A
  • Fundus
  • Body
  • Neck
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85
Q

Describe the structure of the biliary system. [IMPORTANT]

A
  • The left and right hepatic ducts drain the left and right lobes of the liver
  • They converge to give the common hepatic duct
  • Bile flows through this and into the cystic duct, after which it is stored in the gall bladder
  • Upon eating, the bile is released from the gall bladder into the cystic duct and then into the common bile duct
  • From there it passes into the duodenum
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86
Q

What height does the top of the gall bladder (fundus) reach?

A

9th costal cartilage

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87
Q

Describe the position of the gall bladder in the abdomen.

A

The fundus of the bladder is where the lateral border of the rectus abdominis muscle crosses the right 9th intercostal cartilage.

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88
Q

What is the name for gall bladder pain and where can it be referred to?

A
  • Cholecystitis
  • Can be referred to right shoulder, right hypochondrium or epigastric region
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89
Q

What structure does the upper part of the common bile duct lie within?

A

Free margin of the lesser omentum

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90
Q

What does the common bile duct enter the duodenum with? [IMPORTANT]

A

It enters the duodenum with the pancreatic duct (it enters at the hepatopancreatic ampulla).

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91
Q

Is the pancreas intraperitoneal or retroperitoneal?

A

Retroperitoneal

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92
Q

Describe the position of the pancreas.

A

It is roughly along the midline of the body, with the head tucked into the curve of the duodenum. The body and tail are off on the left side.

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93
Q

What are the different parts of the pancreas? [EXTRA]

A
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94
Q

What is the relation of the pancreas to the duodenum? (In terms of position and function)

A
  • The head of the pancreas is in the curve of the duodenum
  • The major duodenal papilla is a drainage point for pancreatic and hepatic (bile) secretions
  • The minor duodenal papilla also receives the accessory pancreatic duct
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95
Q

Describe the relation of different parts of the pancreas to surrounding organs and structures.

A
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96
Q

Draw how an annular pancreas occurs. [EXTRA]

A
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97
Q

Name the different parts of the small and large intestine.

A

Small intestine:

  • Duodenum
  • Jejunum
  • Ileum

Large intestine:

  • Ascending colon -> Including caecum and appendix
  • Transverse colon
  • Descending colon
  • Sigmoid colon
  • Rectum
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98
Q

How long is each part of the small intestine?

A
  • Duodenum -> 25cm
  • Jejunum -> 2.5m
  • Ileum -> 3.5m
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99
Q

Are the parts of the small intestine intraperitoneal or retroperitoneal?

A
  • Start of duodenum -> Intraperitoneal
  • Rest of duodenum -> Retroperitoneal
  • Jejunum -> Intraperitoneal
  • Ileum -> Intraperitoneal
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100
Q

How is the small intestine suspended in the abdomen?

A

It is attached by a mesentry to the posterior abdominal wall.

101
Q

Compare the structure of the jejunum and the ileum.

A

The ileum has smaller and fewer mucosal folds than the jejunum.

102
Q

Label this large intestine.

A
103
Q

Describe the appearance of longitudinal muscle in the large intestine.

A

It is condensed into thin stripes called taeniae coli.

104
Q

What are the puffy parts of the large intestine called?

A

Haustra

105
Q

On which side of the body is the ascending colon?

A

Right

106
Q

What prevents reflux from the caecum to the ileum?

A

Ileocaecal valve

107
Q

Which parts of the large intestine are retroperitoneal and which are intraperitoneal?

A
  • Caecum -> Intraperitoneal
  • Ascending colon -> Secondary retroperitoneal
  • Transverse colon -> Intraperitoneal
  • Descending colon -> Secondary retroperitoneal
  • Sigmoid colon -> Intraperitoneal
  • Rectum -> Superior 2/3rd retroperitoneal
108
Q

Describe the position of the appendix of the large intestine.

A

It is at the start of the caecum, although the direction it points in is variable.

109
Q

What artery supplies the appendix of the large intestine?

A

Appendicular artery (originating from the superior mesenteric artery)

110
Q

What is appendicitis and what are the symptoms? [IMPORTANT]

A
  • It is inflammation of the appendix of the large intestine, usually due to infection
  • Symptoms:
    • Initial pain around the bellybutton due to the appendix being innervated by the T10 nerve root
    • Pain later at McBurney’s point
111
Q

At what vertebral level does the rectum begin?

A

S3

112
Q

Where is the anorectal junction?

A

It is at the point when the rectum pierces the pelvic floor muscles.

113
Q

What are the folds in the rectum called? Describe them.

A

They are called the ‘valves of Houston’:

  • 2 are on the left
  • 1 is on the right
114
Q

Compare the muscles and innervation of the two anal sphincters.

A
  • Internal anal sphincter:
    • Smooth muscle
    • Autonomic control
  • External anal sphincter:
    • Striated muscle
    • Pudendal nerve (s2-S4) control
115
Q

Which nerve and nerve roots innervate the external anal sphincter?

A
  • Pudendal nerve
  • S2-S4
116
Q

What does the coeliac artery arise from?

A

Aorta (at the T12 level)

117
Q

Describe what the coeliac artery supplies (and via what arteries it does this).

A

It has 3 main branches:

  • Left gastric artery
    • Lower part of oesophagus
    • Stomach (anterior + posterior)
  • Splenic artery
    • Spleen
    • Pancreas
    • Stomach
  • Common hepatic artery
    • Stomach
    • Duodenum
    • Liver
118
Q

Describe the drainage of the GI tract.

A
  • All of the blood ultimately drains into the liver via the hepatic portal vein
  • The hepatic portal vein is formed by the confluence of the splenic vein and the superior mesenteric vein
  • The inferior mesenteric vein drains into the splenic vein before the confluence
  • The organs drained by each are similar to those supplied by the corresponding arteries
119
Q

What are portosystemic anastamoses?

A
  • A specific type of anastomosis that occurs between the veins of the portal circulation and those of the systemic circulation.
  • These mean that blood from the viscera can go to the heart instead of via the liver, and vice versa.
120
Q

When can portosystemic anastomoses open?

A

When pressure in the portal venous system increases.

121
Q

What are the 5 main sites of portosystemic anastomoses?

A
  • Inferior oesophagus
    • Portal: Left gastric veins
    • Systemic: Oesophageal veins (tributaries to the azygos veins)
  • Wall of the anal canal
  • Umbilicus
  • Rectum
  • Bare area of liver
122
Q

Describe the blood supply to the liver and gall bladder.

A
  • Right and left hepatic arteries supply the liver
  • The cystic artery (a branch of the right hepatic artery) supplies the gall bladder
123
Q

Describe the blood supply to the pancreas.

A

It forms at the junction between the foregut and midgut, so it is supplied by both the coeliac and superior mesenteric arteries:

  • Splenic artery (from coeliac artery)
  • Anterior superior pancreaticoduodenal artery (from coeliac artery)
  • Anterior inferior pancreaticoduodenal artery (from superior mesenteric artery)
124
Q

What are the branches of the superior mesenteric artery?

A
125
Q

What does the superior mesenteric artery arise from and at what vertebral level?

A
  • Arises from the aorta, just below the coeliac artery
  • It is at the L1 level
126
Q

What are the branches of the inferior mesenteric artery?

A
127
Q

What does the inferior mesenteric artery arise from and at what vertebral level?

A
  • Arises from the aorta
  • At the L3 level
128
Q

Describe the blood supply to the rectum.

A

Superior part of the rectum:

  • Superior rectal artery, which is a branch of the inferior mesenteric artery

Middle part of the rectum:

  • Middle rectal artery, which is a branch of the internal iliac artery

Inferior part of the rectumL

  • Inferior rectal artery, which is a branch of the pudendal artery, which is a branch of the internal iliac artery
129
Q

Describe the venous drainage of the rectum. [EXTRA]

A
  • Superior rectal vein -> Drains to inferior mesenteric vein (portal system)
  • Middle rectal vein + Inferior rectal vein -> Drain to internal pudendal vein, then internal iliac vein, then IVC
130
Q

What are the different ways we can image the GI tract?

A
  • Plain films
  • Barium studies
  • CT colonography and virtual colonoscopy
  • MR Enterography
  • Angiography: CT and digital subtraction angiography
131
Q

Compare the appearance of the small and large bowel on CT.

A
132
Q

What element is useful as a contrast agent for imaging the GI tract? [EXTRA]

A

Barium

133
Q

What is virtual colonoscopy?

A
  • It is an alternative to conventional colonoscopy.
  • Instead of the barium contrast CT scan, the patient’s bowel is pumped full of air and then a CT scan is done, which is reconstructed digitally to give a model of how the bowels look
134
Q

At what height do the coeliac, superior mesenteric and inferior mesenteric arteries branch off the aorta?

A
  • Coeliac artery -> T12
  • Superior mesenteric artery -> L1
  • Inferior mesenteric artery -> L3
135
Q

At what height does the aorta bifurcate (into the common iliac arteries)?

A

L4

136
Q

Draw the different branches of the aorta.

A
137
Q

Label this CT of the abdomen.

A
138
Q

What are 3 important structural features of tissues of the alimentary tract?

A
  1. Modified epithelium
    • Secretion/absorption/ protection
  2. Well developed immune system
    • Protection -> Exposed to vast array of pathogens
  3. Stem Cells
    • Regeneration -> Cell replacement
139
Q

What percentage of the immune system is found in the alimentary tract?

A

70%

140
Q

What things does the epithelium of the alimentary tract have to secrete and absorb?

A

Secretes:

  • Mucus
  • HCl
  • Hormones
  • Enzymes

Absorbs:

  • Products of digestion
141
Q

Does intercellular transport occur in the alimentary tract?

A

Not much, since there are tight junctions between cells.

142
Q

What is immunological protection of the ailmentary tract carried out by?

A

GALT (gut-associated lymphoid tissue) and other systems

143
Q

Give some examples of diffuse and organised lymphoid structures in the alimentary tract.

A
144
Q

What are the 4 layers (and sub-layers) of the alimentary tract wall? [IMPORTANT]

A

From inside to outside:

  • Mucosa
    • Epithelial lining
    • Lamina propria
    • Muscularis mucosae (smooth muscle)
  • Submucosa
    • Connective tissue
    • Meissner’s nerve plexus
  • Muscularis
    • Circular internal muscular layer
    • Auerbach’s nerve plexus
    • Longitudinal external muscular layer
  • Serosa
    • Connective tissue
145
Q

What are the 3 layers of the mucosa of the alimentary tract?

A
  • Epithelium
  • Lamina propria
  • Muscularis mucosae (muscle)
146
Q

What is the submucosa of the alimentary tract? What is found in it?

A
  • It is a layer of connective tissue, containing blood and lymph vessels.
  • Meissner’s nerve plexus is also in this layer.
147
Q

What is the muscularis layer of the alimentary tract? What is found in it?

A
  • It is a layer of muscle
  • It also contains Auerbach’s plexus
  • The plexus is between an inner and outer muscular layer
148
Q

What is the serosa layer of the alimentary tract? What is found in it?

A
  • Connective tissue with mesothelium covering
  • Epithelium lining producing lubricating slippery fluid to facilitate movement
149
Q

What are the two plexuses of the myenteric nervous system and where in the wall is each found?

A
  • Meissner’s (submucosal) plexus -> In the submucosa
  • Auerbach’s (myenteric) plexus -> In the muscularis
150
Q

What does Meissner’s (submucosal) plexus govern?

A
  • Secretory function
  • Mucosal movement
  • Localised blood flow
151
Q

What does Auerbach’s (myenteric) plexus govern?

A
  • Outer muscularis muscle layer -> Responsible for peristaltic activity
152
Q

Are Meissner’s and Auerbach’s plexuses sympathetic or parasympathetic?

A
  • Meissner’s -> Parasympathetic
  • Auerbach’s -> Sympathetic and parasympathetic
153
Q

What type of epithelium is in the oesophagus?

A

Stratified squamous

154
Q

What does the lamina propria of the oesophagus wall contain?

A
  • Mucus-producing cells with secretory granules -> Produce mucous to lubricate epithelium to aid passage of food
  • Houses GALT system
155
Q

What important cells are found interspersed in the epithelium of the oesophagus? [IMPORTANT]

A

Langerhans cells

156
Q

What are Langerhans cells and what is their role? [IMPORTANT]

A

They are dendritic cells involved in antigen presentation.

157
Q

What is found in the submucosa of the oesophagus?

A

Oesophageal glands proper -> Mucous and serous cells

158
Q

What do the oesophageal glands (in the submucosa) produce?

A

Produce:

  • Mucus
  • Pepsinogen
  • Lysozymes
159
Q

Label this image of the oesophagus.

A
160
Q

What is the name for the thick fluid into which food is processed in the stomach?

A

Chyme

161
Q

Compare the volume of the stomach at rest and at maximum distension.

A
  • At rest = 50ml
  • Max. distension = 1500ml
162
Q

What are the folds on the inside of the stomach called?

A

Rugae

163
Q

What are the different parts of the stomach?

A
  • Cardiac – Narrow region at gastroesophageal junction
  • Fundus – Dome shaped region to left of oesophagus filled with gas
  • Body – Largest portion responsible for formation of chyme
  • Pylorus – Funnel shaped constricted portion with pyloric sphincter that controls release of food into duodenum
164
Q

What is unusual about the gastric epithelium?

A

It invaginates into the mucosa.

165
Q

What is another name for gastric pits?

A

Foveolae

166
Q

How many gastric glands open into each gastric pit (foveolae)?

A

5-7

167
Q

In what part of the stomach wall are gastric glands?

A

Lamina propria (in the mucosa)

168
Q

What are the different cell types and functions in the gastric pits? (In order from superficial to deep)

A
169
Q

What is the function of surface-lining cells in gastric pits?

A
  • Cytoplasm houses secretory granules containing precursor of visible mucus
    • Protects stomach from auto digestion
    • HCO3- have buffering capacity
  • Lateral cell membranes form zona occludens and zona adhernes with neighbouring cells
170
Q

What is the function of mucous cells in gastric pits?

A
  • Surface granules secrete mucus different from surface lining cells -> Soluble and lubricates gastric contents
  • Lubricates epithelium and protects cells from acidic and enzymatic properties of gastric juices
171
Q

What shape are mucous neck cells in the stomach?

A

Columnar

172
Q

What is the function of regenerative cells in the gastric pits?

A

Proliferate to replace all of the specialised cells in the stomach.

173
Q

Where are regenerative cells found in gastric pits?

A

Interspersed among the mucus neck cells in the isthmus of gastric pits.

174
Q

Describe the structural features of regenerative cells in gastric pits.

A
  • Do not have many organelles but have a rich supply of ribosomes
  • Basally located nucleus
175
Q

What is another name for parietal cells in gastric pits?

A

Oxyntic cells

176
Q

What is the function of parietal (oxyntic) cells in gastric pits?

A
  • Manufacture HCl
  • Manufacture gastric intrinsic factor (binds vitamin B12)
177
Q

What do parietal (oxyntic) cells produce HCl in response to?

A
  • Histamine
  • Parasympathetic activity
  • Gastrin
178
Q

Describe the main features of the secretory network of parietal (oxyntic) cells.

A
  • Canaliculi lined by microvilli
  • Tubovesicular system
  • Mitochondria
179
Q

What is another name for Chief cells in gastric pits?

A

Zymogenic cells

180
Q

What is the function of Chief (zymogenic) cells in gastric pits?

A

Manufacture (and house in secretory granules):

  • Pepsinogen
  • Renin
  • Gastric lipase
181
Q

What stimulates pepsinogen release from Chief (zymogenic) cells?

A

Vagus nerve stimulation

182
Q

Describe the structural features of Chief (zymogenic) cells.

A
  • Have basophilic cytoplasm with basal nucleus and rich RER and extensive Golgi
  • Short blunt microvilli
183
Q

What does DNES cells stand for?

A

Diffuse neuroendocrine cells

184
Q

How many DNES cell types are there?

A

At least 13

185
Q

What is the function of DNES cells in gastric pits?

A

Manufacture hormones.

186
Q

How many different agents can a single DNES cell type secrete?

A

Usually one, but sometimes two.

187
Q

Do all DNES cells reach the lumen of the gut?

A
  • Some do (open) but some do not (closed).
  • That is why the cells can be endocrine, paracrine or neurocrine.
188
Q

What is the principle hormone manufactured by DNES cells?

A

Gastrin -> Peptide that is important in control of acid secretion and gastric motility.

189
Q

Draw the position of different cell types in gastric pits.

A
190
Q

How long is the small intestine?

A

7m

191
Q

What are some different ways in which the surface area of the small intestine is increased?

A
  • Plicae circulares (valves of Kerckring)
  • Villi
  • Microvilli
  • Crypts of Lieberkuhn
192
Q

What are plicae circulares?

A

Transverse folds of the small intestine that increase its surface area by 2 to 3 times.

193
Q

What is the difference between villi and microvilli?

A
  • Villi
    • They are the projections that are made up of multiple cells
    • Increase surface area by factor of 10
  • Microvilli
    • They are the tiny projections on the apical plasmalemma of epithelial cells covering villi
    • Increase surface area by factor of 20
194
Q

What are crypts of Lieberkuhn?

A
  • Found in the small intestine and large
  • Invaginations of epithelium into lamina propria forming intestinal glands
  • Think of them as equivalents of gastric glands, but in the intestine
195
Q

What is the main cell type in the small intestine?

A

Enterocytes

196
Q

What is the type of epithelium in the small intestine?

A

Columnar epithelium (ciliated)

197
Q

What is the name for the border of the absorptive epithelium in the small intestine?

A

Brush border

198
Q

What forms the core of villi?

A
  • Lamina propria
  • The epithelium covering of each villi is made up of epithelial cells
199
Q

What are lacteals in the small intestine? [IMPORTANT]

A

Lymphatic capillaries inside villi that absorb dietary fats.

200
Q

What is found inside villi?

A
  • Core is made of lamina propria
  • Capillaries -> Transport digestive products to hepatic portal vein
  • Lacteals -> Lymphatic vessels that drain into larger vessel (transport lipids)
201
Q

What forms the brush border in the small intestine?

A

Microvilli

202
Q

Describe the structure of microvilli in the small intestine.

A
  • Do not contain organelles
  • Structural core is formed by cross-linked actin filaments
  • Structural core is attached to the plasma membrane by myosin and calmodulin
203
Q

What are the different types of cell in the small intestine epithelium and what is the function of each?

A
  • Absorptive cells (enterocytes)
    • Tall columnar cells with brush border for terminal digestion and absorption of water and nutrients
  • Goblet cells
    • Manufacture mucinogen whose hydrated from is mucin -> Provides protection
  • DNES cells – Produce paracrine and endocrine hormones – 1% of cells
  • Regenerative cells
  • Paneth cells
    • Host defence cells
    • Manufacture lysozome, defensin, and TNF
204
Q

What is the name for the glands in the duodenum and where in the wall are they found?

A
  • Brunner’s glands
  • Found in the submucosa
205
Q

What are the Brunner’s glands and what is their function?

A
  • Branched tubuloalveolar glands in the submucosa of the duodenum
  • Produce:
    • Mucous, bicarbonate rich fluid -> Neutralises acid
    • Urogastrone (HEGF) -> Inhibits production of HCl
206
Q

Label this.

A
207
Q

Describe the different immune structures in the small intestine.

A

Ileum has:

  • Peyer’s patches
  • M cells
208
Q

What are Peyer’s patches? [IMPORTANT]

A
  • Collections of lymphocytes and antigen-presenting cells (APCs).
  • They are found under the epithelium of the small intestine.
209
Q

What are M cells?

A
  • They specialised epithelial cells that are found in the small intestine.
  • They perform a surveillance role, looking for antigens.
210
Q

What does the M in M cell stand for?

A

Microfold

211
Q

How are Peyer’s patches and M cells related?

A
  • M cells have basal membrane invaginations that form pits containing Peyer’s patches
  • The M cells sample antigens in small intestine lumen and phagocytose them
  • The basement membrane under M cells is discontinuous, which allows transport of antigens to antigen presenting cells (APCs) in the Peyer’s patch
  • These can then present the antigens to lymphocytes in the Peyer’s patch
212
Q

What does chronic inflammation of the small intestine result in?

A
213
Q

What are the main segments of the large intestine?

A
  • Cecum
  • Colon
  • Rectum
  • Anus
214
Q

How long is the large intestine?

A

1.5m

215
Q

Does the large intestine have villi or folds?

A

No

216
Q

Are any nutrients absorbed in the large intestine?

A

No

217
Q

Compare the structure of the wall of the small and large intestine.

A
218
Q

Are there any pits in the large intestine?

A

Yes, there are the crypts of Lieberkuhn.

219
Q

How does the number of goblet cells change along the large intestine?

A

The number increases from cecum to sigmoid colon.

220
Q

How frequently is the epithelial lining of the crypts of Lieberkuhn in the large intestine replaced?

A

Every 6-7 days

221
Q

What are taniae coli?

A

Three separate longitudinal ribbons (taeniae meaning ribbon in latin) of smooth muscle on the outside of the ascending, transverse, descending and sigmoid colons

222
Q

Describe Crohn’s disease.

A
223
Q

Draw how the histological structure of the GI tract changes along the length.

A
224
Q

Describe the different levels of the ducts in a digestive gland.

A
  • Acinus
  • Intercalated duct
  • Interlobular duct
  • Lobar duct
  • Main duct
225
Q

What are the 3 types of cell in the secretory portion of the salivary glands? What is the function of each?

A
  • Serous cells -> Secrete proteins and polysaccharides
  • Mucous cells -> Secrete mucous
  • Myoepithelial (basket) cells -> Have several long processes that envelope the acinus
226
Q

Describe the histological structure of the exocrine pancreas.

A
  • Acinar cells secrete enzymes
  • Centroacinar cells are duct cells that extend into the acinus -> They secrete buffer
227
Q

What is the liver surrounded by?

A

Glisson’s capsule

228
Q

How many lobes are in the liver?

A

4

229
Q

What type of cell are hepatocytes?

A

Epithelial cells

230
Q

What is the porta hepatis?

A

The inferior region of the liver where blood vessels enter and leave. The hepatic ducts also leave the liver here.

231
Q

What are the two structural and two functional models of the a liver lobule?

A

Classical liver lobule model (structural):

  • Central vein, seen as single holes
  • Peripheral portal triads set at angles to the polygons
  • Hepatocytes radiating from the central vein separated by vascular sinusoids

Portal lobule model (structural):

  • Portal tracts and triads are at the centre of this model

Acinar model (functional):

  • Region irrigated by a single distributing vein
  • Based on functional considerations:
    • O2 gradients
    • Distribution of drugs
    • Zones of damage following insult

Primary lobule model (functional):

  • This model is based on angioarchitecture and metabolic gradients which are sub-divisions of the classic hepatic lobule.
232
Q

What is a liver lobule?

A
  • Small divisions of the liver defined at the microscopic (histological) scale.
  • It consists of a portal triad, hepatocytes arranged in linear cords between a capillary network, and a central vein.
233
Q

What are portal triads in the liver?

A
  • A portal triad is the structure that is found in each corner of a liver lobule
  • In it, there are:
    • Branches of the hepatic artery
    • Tributaries to the hepatic portal vein
    • Bile ducts
234
Q

What type of capillary is found in the liver?

A

Sinusoidal

235
Q

What are sinusoids and spaces of Disse in the liver?

A
  • Sinusoids are sinusoidal capillaries that flow through the liver
  • Spaces of Disse are the spaces in between the capillary and the sinusoids
236
Q

How much bile does the liver produce?

A

600-1200ml/day

237
Q

What is the lifespan of hepatocytes?

A

150 days

238
Q

What are Kupffer cells and where are they found?

A
  • They are resident macrophages found in the liver.
  • They tend to be found lining the sinusoids.
239
Q

Describe the polarity of hepatocytes.

A
240
Q

What are these cells?

A

Kupffer cells

241
Q

What are stellate cells involved in?

A

Response to liver injury

242
Q

Where in the gall bladder are gallstones most frequently lodge?

A

Hartman’s pouch -> An outpouching in the neck of the gall bladder.

243
Q

What are the layers of the gall bladder wall?

A
  • Epithelium
  • Lamina propria
  • Smooth muscle
  • Adventitia
244
Q

What is the epithelium in the gall bladder?

A

Simple columnar epithelium, with microvilli

245
Q

Does the gall bladder have a muscularis mucosa?

A

No

246
Q

Which layer of the gall bladder wall contains the lymphatics?

A

Submucosa

247
Q

What is the outer layer of the gall bladder called?

A

Serosa (it is continuous with the peritoneum

248
Q

How does the wall of the gall bladder compare with that of the different parts of the alimentary tract?

A
  • No muscularis mucosae (this is the thin muscular layer just outside the lamina propria)
  • Muscular fibres not arranged in distinct layers

YEAR 1 - Organisation of the Body (Anton) (15 decks)

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