Abdomen 3 Flashcards
What is the oesophagus?
Muscular tube that extends from the pharynx to the stomach
What are the 3 constrictions of the oesophagus?
Cervical
Thoracic
Diaphragmatic
What is the vertebral level of the oesophageal hiatus in the diaphragm?
T10
What is A?
Trachea
What is B?
Oesophagus
What is C?
Thoracic duct
What is D?
Left subclavien vein
What is E?
Aortic arch
What is F?
Left bronchi
What is G?
Thoracic aorta
What is H?
Pericardium (cut edge)
What is I?
Oesophageal hiatus
What is J?
Left crus of diaphragm
What is K?
Aortic hiatus
What is L?
Chyle cistern
What is M?
Inferior vena cava
What is N?
Right crus of diaphragm
What is O?
Thoracic duct
What is P?
Oesophagus
What is Q?
Left bronchi
What is R?
Tracheobronchial lymph nodes
List the structures that traverse the oesophageal opening?
Oesophagus
Left inferior phrenic artery
Left gastric artery
Lymphatics
What is the blood supply of the abdominal part of the oesophagus?
Branches of left gastric artery
What is the venous drainage of the abdominal part of the oesophagus?
Left gastric vein
What is the lymphatic drainage of the abdominal oesophagus?
Left gastric lymph nodes then to celiac lymph nodes
What is the relationship between the oesophagus and portal hypertension?
Lower end of oesophagus is important site for portosystemic anastomoses
In portal hypertension, anastomoses opens and forms venous dilations called oesophageal varices
Their rupature causes severe haematemesis
What is the stomach?
Muscular bag
What are the 2 orifices of the stomach?
Cardial orifice
Pyloric orifice
What are the 2 curvatures of the stomach?
Greater curvature
Lesser curvature
What are the 2 surfaces of the stomach?
Anterior
Posterior
What is A?
Duodenum
What is B?
Pyloric canal
What is C?
Body of stomach
What is D?
Fundus
What is the pyloric sphincter?
Band of smooth muscle between the pyloris and duodenum
What is the function of the pyloric sphincter?
Controls flow of partically digested food between stomach and duodenum
Stops acid entering duodenum
The pyloric sphincter is formed from the thickening of which layer of the gut tube?
Circular layer of smooth muscle (muscularis externa)
Where does the lesser omentum extend from?
Lesser curvature of the stomach to the liver
Where does the greater omentum extend from?
Greater curvature of stomach to transverse colon
What is A?
Pyloric sphincter
What is B?
Gastric canal
What is C?
Cardiac orifice
What is D?
Gastric folds (rugae)
What is E?
Pyloric antrum
What is F?
Pyloric canal
What are gastric folds/rugae formed from?
Gastric mucosa
In which portions of the stomac are gastric folds most apparent?
Pyloric region
Greater curvature
Which sphincter controls the discharge of food from the stomach to the duodenum?
Pyloric sphincter
What is the collective name of the structures that the stomach lies on?
Stomach bed
What structures from the stomach bed?
Left dome of diaphragm
Transverse mesocolon
Spleen
Left kidney
Left suprarenal gland
Colon
Pancreas
Splenic artery
What is A?
Right gastric artery
What is B?
Left gastric artery
What is C?
Splenic artery
What is D?
Left gastro-omental artery
What is E?
Right gastric-omental artery
What is the venous drainage of the stomach via?
Portal system
What is A?
Portal vein
What is B?
Left gastric vein
What is C?
Superior mesenteric vein
What is D?
Inferior mesenteric vein
What is E?
Splenic vein
What is F?
Right gastric artery
Where do the primary lymph nodes of the stomach eventually drain to?
Celiac lymph nodes
What is A?
Celiac lymph nodes
What is B?
Superior and inferior pyloric lymph nodes
What is C?
Pancreaticoduodenal lymph nodes
What is D?
Gastric-omental lymph nodes
What is E?
Splenic lymph nodes
What is F?
Pancreaticosplenic lymph nodes
What is G?
Gastric lymph nodes
What effect does the vagus nerve have on the pylorus?
Opens the pyloric sphincter
What effect does the vagus nerve have on gastric secretion?
Increases
What nerve is key in controlling gastric motility?
Vagus nerve
Where does the small intestine extend from?
Pylorus of the stomach to the ileocecal junction
What are the 3 parts of the small intestine?
Duodenum
Jejenum
Ileum
Which part of the small intestine recieves the opening of the bile and pancreatic duct?
Descending (2nd part) of duodenum
Where is the foregut/midgut boundary in the small intestine?
Between descending and inferior duodenum
How is the duodenum peritonised?
Bulb is intraperitoneal, rest is retroperitoneal
How is the jejenum peritonised?
Intraperitoneal
How is the ileum peritonised?
Intraperitonised
Which part of the small intestine is the shortest, widest and most fixed?
Duodenum
How does the colour differ between the jejenum and ileum?
Jejenum - deeper red
Ileum - paler pink
How does the wall differ between the jejenum and ileum?
Jejenum - thick and heavy
Ileum - thin and light
How does the vascularitiy differ between the jejenum and ileum?
Jejenum - greater
Ileum - less
How does the vaso recta differ between the jejenum and ileum?
Jejenum - long
Ileum - short
How does the arcades differ between the jejenum and ileum?
Jejenum - few large loops
Ileum - many short loops
How does the fat in mesentery differ between the jejenum and ileum?
Jejenum - less
Ileum - more
How does the circular folds differ between the jejenum and ileum?
Jejenum - large, tall and closely packed
Ileum - low and sparse, absent in distal part
What is A?
Ileum
What is B?
Duodenum
What is C?
Jejenum
Explain how the morphology of the small intestine changes between the jejenum and ileum?
There is no step transition, but the morphology gradually alters with either end looking quite different
Which of A and B is jejenum and which is ileum?
A is ileum
B is jejenum
What are arterial arcades?
Arterial loops or arches
Do arcades in jejenum or ileum have many loops?
Ileum
Which part of the autonomic nervous system stimulates reduction in the secretions and motility of the intestine and also acts as a vasoconstrictor?
Sympathetic
What features distinguish the large intestine from the small intestine?
Teniae coli
Haustra
Omental appendices
Caliber (internal diameter much larger)
What are teniae coli?
3 seperate longitudinal ribbons of smooth muscle on the outside of the colon
What are haustra?
Small pouches caused by sacculation
What are omental appendices?
Small pouches of the peritoneum filled with fat
How is the caecum peritonised?
Intraperitoneal
How is the ascending colon peritonised?
Retroperitoneal
How is the transverse colon peritonised?
Intraperitoneal
How is the descending colon peritonised?
Retroperitoneal
How is the sigmoid peritonised?
Intraperitoneal
What is A?
Caecum
What is B?
Ascending colon
What is C?
Transverse colon
What is D?
Descending colon
What is E?
Sigmoid colon
What does the superior mesenteric artery branch into to supply the colon?
Ileocolic artery
Right colic artery
Middle colic artery
Marginal artery (connects superior to inferior mesenteric artery)
What artery connects the superior to the inferior mesenteric artery?
Marginal artery
What does the inferior mesenteric archery branch into to supply the colon?
Left colic artery
Sigmoid arteries
In which abdominal region is the caecum and appendix located?
Right iliac region
What is A?
Frenulum of ileocecal valve
What is B?
Orifice of appendix
What is C?
Terminal ileum
What is D?
Ileocaecal valve
What is E?
Ileocaecal orifice
What is F?
Haustrum of ascending colon
Which 2 structures open into the cavity of caecum?
Appendix and ileum
What is strange about the anatomical location of the appendix?
Base of appendix is consistently located, but the tail has anatomical variation
What is McBurnery’s point and why is it useful clinically?
Point of most pain in acute appendicitis
Where does the rectum pierce the pelvic floor?
Ano-rectal junction where it becomes the anal canal
What is the arterial supply, venous drainage, and peritonisation of the superior 1/3 of the rectum?
Artery - superior rectal artery
Vein - superior rectal vein
Peritonisation - front and sides
What is the arterial supply, venous drainage, and peritonisation of the middle 1/3 of rectum?
Artery - right and left middle rectal arteries
Vein - right and left middle rectal veins
Peritonisation - front
What is the arterial supply, venous drainage, and peritonisation of the inferior 1/3 of rectum?
Artery - right and left middle rectal arteries
Vein - right and left middle rectal veins
Peritonisation - none
What is A?
Superior rectal artery
What is B?
Middle rectal artery
What is C?
Inferior rectum artery
What is the role of the pelvic floor in maintaining continence?
Automatically gently contracted to prevent leakage
What structures, other than the pelvic floor, are involved in faecal continence?
Internal anal sphincter
External anal sphincter
What is the significance of understanding the differences between visceral and somatic innveration of the anal canal?
Above pectinate line is autonomic, below is somatic
What lymphatics drain above the pectinate line of the rectum?
Internal iliac lymph nodes
What lymphatics drain below the pectinate line of the rectum?
Superficial inguinal lymph nodes
What is A?
Internal anal sphincter
What is B?
External anal sphincter
What are the main peritoneal folds?
Greater omentum
Lesser omentum
Mesentery
The hepatoduodenal and hepatogastric ligaments are parts of what omentum?
Lesser
What is the falciform ligament?
Attaches liver to anterior abdomen wall
and seperates left and right lobes of the liver
What lies within the free border of the falciform ligament?
Ligamentum teres in free border
What embryological structure is the ligamentum teres a remnant of?
Left umbilical vein
How many layers of peritoneum are present in the greater omentum?
4
Is it a souble sheet of peritoneum folded in on itself
What is the greater omentum often called?
Abdominal policeman
What functions of the greater omentum cause it to be known as the abdominal policeman?
Role in fighting intra-abdominal infections
What are paracolic gutters?
Spaces between colon and abdominal wall
Where are paracolic gutters found in relation to the colon?
Lateral
What is the clinical significance of knowing about paracolic gutters?
Determine flow of ascitic fluid
List 3 abdominal viscera which lie in the free edge of a double layer of peritoneum described as a mesentery?
Transverse colon
Sigmoid colon
Appendix
What muscle types forms the muscularis externa of the oesophagus?
Upper 1/3 is skeletal muscle
Lower 2/3 is smooth muscle
What kind of epithelium is in the oesophagus?
Stratified squamous
What type of muscle makes up the muscularis mucosae of the oesophagus?
Smooth muscle
What are the large folds present in the wall of the stomach?
Rugae
What secretory cells are present in gastric pits?
Gastric cells (also known as G cells)
What structure is this?
Oesophagus
What structure is this?
Stomach
What are the large folds that can be seen extending into the lumen of the small intestine called?
Villi
What structure is this?
Small intestine
What are the numerous finger like processes cut in different planes on villi of the small intestine?
Microvilli
What is the epithelium of the small intestine?
Simple columnar
What type of muscle is the muscularis mucosae of the small intestine?
Smooth
Where along the gut tube do glands extend down beyond the muscularis mucosae into the submucosa (they do not normally do this)?
Brunner’s cells (found only in duodenum)
What are the white bits that appear to be empty spaces in the small intestine histology?
Contents of secretory cells
They are goblet cells
What do goblet cells secrete?
Mucus
What types of cells are present in the surface epithelium of the small intestine?
Enterocytes (absorptive cells) with scattered goblet cells
What are Payer’s patches and where are they found?
Small masses of lymphatic tissue found in the ileum
What is the predominant cell present in the epithelium of the colon?
Enterocytes
What structure is this?
Colon
What structure is this?
Recto-anal junction
What indicates the change from the rectum to anal canal in this image?
Stratified squamous changing to simple columnar
What is the transpyloric plane?
Imaginary horizontal plane
How would you locate the transpyloric plane on a patient?
Halfway between jugular notch and upper border of symphysis pubis
Or 9th costal cartilage
List the structures present in the transpyloric plane?
Pylorus of stomach
Hila of kidneys
Beginning of duodenum
Neck of pancreas
Superior mesenteric artery from aorta
What is the vertebral level of the transpyloric plane?
L1
What is the vertebral level of the highest point of the iliac crest?
L4
What organ is being examined in 1, 2 and 3?
1 - stomach
2 - small intestine
3 - colon
What is 1, 2, 3 and 4?
1 - Liver
2 - right kidney
3 - jejenum
4 - transverse colon
What is 1, 2, 3 and 4?
1 - spleen
2 - liver
3 - stomach
4 - aorta
