Abdomen 4 Flashcards
How long is the oesophagus?
25cm
What are the functions of the oesophagus?
Functions to transport food from pharynx to
stomach
Where does the oesophagus extend from?
Extends from pharyngo-oesophageal junction
(C6) to cardiac orifice of stomach (T11)
Where does the oesophagus pierce the diaphragm at?
Pierces diaphragm at oesophageal hiatus (T10)
What are the 2 anti-reflux barrier sphincters?
- Upper esophageal sphincter
- Lower oesophageal sphincter
What is the upper oesophageal sphincter?
Anatomical sphincter composed off
Cricopharyngeus muscle
What can a malfunction of the lower oesophageal sphincter result in?
Malfunction of sphincter:
Gastrooesophageal reflux disorder (GORD)
may lead to Barrett’s oesophagus
What are the 4 oesophageal layers?
- Mucosa
- Submucosa
- Muscularis externa
- Adventitia(proximal)/ serosa(very distal end)
Where are the constrictions of oesophagus?
ABCD
A-Arch of aorta
B-Bronchus
C-Cricoid cartilage
D-Diaphragmatic hiatus
What is the function of the stomach?
-Storage of ingested food
-Mechanical and chemical breakdown of food
-Regulate rate of emptying into small intestines
What is the cardia part of the stomach?
Opening of oesophagus into stomach
What shape is the fundus?
Dome shaped
What colour does the fundus appear on an x-ray and why?
-Black on an x-ray as its full of gas
What does the sphincter of the cardiac orifice prevent?
Cardiac
sphincter
prevents
backflow of
food and
digestive
enzymes to
oesophagus
What does the pyloric sphincter open into?
Opens into duodenum
What is the gastric canal?
Temporary groove formed when swallowing
What are gastric rugae/folds?
Folds in gastric mucosa
What do gastric rugae allow the stomach to do?
Allows stomach to expanad
What is an example of 3 gastric glands?
- Cardiac glands: mucus
- Fundic glands: Hydrochloric acid
- Pyloric glands: gastrin
What is the mucosa of the stomach made up of?
Columnar epithelium
What is the submoca made up of?
Meissner’s(submucosal) plexus
What is the Auerbach’s plexus made of?
Muscularis externa:
-Oblique layer
-Circular layer
-Longitudinal layer
What is the serosa continuous with?
Serosa continuous with peritoneum
Where does the duodenum receives chyme from?
Chyme from pyloric part of
stomach.
Where does the duodenum receive bile from via?
Bile from liver and gallbladder via common bile
duct
Where does the duodenum receive enzyme from and via what?
Enzymes from pancreas via main and accessory
pancreatic duct
What are the 4 divisions of the duodenum?
- First part/Superior
- Second part/Descending
- Third part/Inferior/Horizontal
- Fourth part/Ascending
Is the duodenal cap within the peritoneum?
Yes its intraperitoneal
Is the distal portion of the duodenum in the peritonem?
No it is retroperitoneal
What is the first part of the duodenum a common site of?
Common site of duodenal ulcers
Why are there clinical consequences of duodenal ulcers in the first part?
Clinical consequence, as gastroduodenal
artery runs posteriorly
What is the first part of the duodenum suspended from?
Suspended from mesentery (hepatoduodenal
ligament)
What is the duodenum the most common site for?
Most common site for diverticula
What is the second part of the duodenum the opening of?
- Hepatopancreatic ampulla
- Accessory pancreatic duct
What does the hepatopancreatic ampulla mark division of?
Marks division of foregut and midgut
What vertebrae level is the third part of the duodenum?
Level of L3
What vasculature is the third part of the duodenum crossed by?
Crossed by superior mesenteric artery and vein
What does the duodenum join at the fourth part of the duodenum?
Joins jejunum at duodenojejunal
flexure
What ligaments is the fourth part of the duodenum held by?
Held in place by ligament of Treitz (suspensory ligament of the duodenum)
What is the relative position of the pancreas to the stomach?
Posterior to stomach
What part of the pancreas does the transpyloric plane pass through and at what vertebrae level?
Transpyloric plane passes through neck (L1)
What is the exocrine function of the pancreas and what cells produce it?
Pancreatic juice: acinar cells
How do the pancreatic juices from the pancreas enter the duodenum?
Enters duodenum through main and
accessory ducts
What is the endocrine function of the pancreas?
Glucagon and insulin: Pancreatic islets of
Langerhans
What is a whipple’s procedure?
Pancreaticoduodenectomy
Why would we carry out a Pancreaticoduodenectomy?
If there’s cancer in the head of the pancreas
What is removed in a Pancreaticoduodenectomy?
- Head of pancreas
- Duodenum
- Gallbladder
- Bile duct
What is the spleen protected by?
Protected by 9th-11th ribs
What is the function of the spleen?
-White cell proliferation
-Immune surveillance
-Filters and stores red blood cells and platelets
What are the contents of the hilum of the spleen?
Splenic artery and vein
What do the splenic artery and vein run in?
Run in splenorenal ligament
What may cause splenomegaly?
May be caused by portal hypertension
Where may the spleen be palpable in splenomegaly?
May be palpable in right iliac fossa
How can splenomegaly be treated?
Can treat with splenectomy
What is the arterial supply of structures in the foregut?
Coeliac trunk
What is the arterial supply of structures in the midgut?
Superior mesenteric artery
What is the arterial supply of structures in the hindgut?
Inferior mesenteric artery
Where does the coeliac trunk arise and at what vertebrae level?
Arises directly from aorta (T12)
What are the 3 main branches of the coeliac trunk?
-Left gastric
-Common hepatic
-Splenic
What is the left gastric artery a branch of?
Branch of coeliac trunk
What does the left gastric artery run along?
Runs along lesser curvature in lesser
omentum
What artery supplies the lower oesophagus?
Left gastric artery
What is the right gastric artery a branch of?
Branch of hepatic artery proper
What does the right gastric artery run along?
Runs along lesser curvature in
lesser omentum
What are the short gastric arteries branches of?
Branches of splenic artery
What is the left gastro-omental/gastroepoploic artery a branch of?
Branch of splenic artery
What does the left gastro-omental/gastroepiploic artery run along?
Runs along Greater curvature in greater omentum
What is the right gastro-omental/gastroepiploic artery a branch of?
Branch of gastroduodenal artery
What does the right gastro-omental/gastroepiploic run along?
Runs along greater curvature in greater omentum
What is the arterial supply to pancreas and duodenum?
- Splenic artery
- Gastroduodenal artery
- Inferior pancreaticoduodenal artery
- Superior pancreaticoduodenal artery
What do the lymphatic vessels of the stomach follow?
Follow blood vessels
What do all lymph eventually pass in the stomach?
All lymph eventually passes into coeliac nodes
Why are the lymphatics of the stomach important?
Important for cancer spread: gastrectomy
How do the lymphatics of duodenum follow arteries superiorly?
Follows arteries
superiorly from superior
pancreaticoduodenal to
gastroduodenal to
coeliac nodes
How do the lymphatics of duodenum follow arteries inferiorly?
Follows arteries inferiorly
from inferior
pancreaticoduodenal to
superior mesenteric
nodes
What is the vagus nerve to gastric glands?
Secretomotor to gastric glands
What cells does the vagus nerve innervate in the foregut?
Innervates secretory cells
What does the vagus nerve motor to of the foregut?
Motor to smooth muscular walls of GIT (peristalsis)
What sphincter does the vagus nerve relax?
Relaxes pyloric sphincter
What trunk does the right vagus nerve innervate?
Posterior vagal trunk
What trunk does the left vagus nerve innervate?
Anterior vagal trunk
What do the greater splanchnic nerves do to blood vessels?
Vasoconstriction
What do greater splanchnic nerves inhibit
Inhibits peristalsis
What are greater splanchnic nerves motor to?
Motor to pyloric sphincter
What do pain fibers(visceral afferents) hitchhike with in the foregut?
Pain fibers (visceral afferent) hitchhike with splanchnic nerves
What is pain from foregut referred to?
Pain from foregut referred to epigastric region
What is the course from the preganglionic sympathetic fibres to the coeliac plexus?
Preganglionic sympathetic fibres (T5-T9)–>enters sympathetic chain–>Greater thoracic splanchnic nerve–>Coeliac plexus
