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Anatomy yr 1 > ABDOMEN IV > Flashcards

ABDOMEN IV Flashcards

1
Q

Where does the foregut end to become the midgut?

A

The major duodenal papilla

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2
Q

What does the midgut consist of?

A

The distal duodenum, the jejunum, the ilium, the caecum, the ascending colon and the proximal 2/3 of the transverse colon

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3
Q

Where does the ileum become the caecum?

A

The ileocaecal junction in the right iliac fossa

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4
Q

Where is the midgut in relation to the greater omentum?

A

Posterior

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5
Q

Where does the jejunum start?

A

The duodenojejunal junction

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6
Q

What holds the duodenojejunal junction in place?

A

The ligament of Treitz

The suspensory ligament of the duodenum

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7
Q

What are the names of the many folds on the luminal surface of the jejunum?

A

Plicae circulares

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8
Q

Compare plicae circulares in the jejunum to in the ilium

A

There are a lot in the jejunum and few in the ilium because there’s much less nutrient reabsorption in the ilium

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9
Q

Compare the walls of the jejunum and ilium

A

The jejunum has thick muscular walls, while the ilium has thin walls

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10
Q

Compare lumens of the jejunum and ilium

A

The jejunum has a wide lumen, whereas the ilium has a narrower lumen

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11
Q

What are Peyer’s patches?

A

Aggregations of lymphatic follicles

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12
Q

Compare Peyer’s patches in the jejunum to those in the ilium

A

Peyer’s patches are far more densely populated in the ilium than the jejunum

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13
Q

Are the jejunum and ilium retroperitoneal or intraperitoneal?

A

Completely intraperitoneal

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14
Q

What suspends the jejunum and ilium from the posterior abdominal wall?

A

A double-fold of peritoneum called the mesentery

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15
Q

What is the secondary function of the mesentery?

A

It acts as a conjugate for blood vessels

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16
Q

What are arterial arcades?

A

Intermesenteric arterial anastomoses (Riolan arcades)- a series of anastomosing arterial arches between the arterial branches of the jejunum and ileum

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17
Q

What arise from arterial arcades?

A

Vasa recta that supply the jejunum and ileum

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18
Q

Compare the mesentery of the jejunum to that of the ileum

A

The jejunal mesentery is far less fatty than that of the ileum, so the blood vessels can be seen as the mesentery is translucent

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19
Q

Compare the jejunal vasa recta to the ileal vasa recta

A

The jejunal vasa recta are longer and come from fewer arterial arcades. The ileal vasa recta are shorter but come from more arterial arcades

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20
Q

Where is the root of the mesentery?

A

Where the parietal peritoneum is reflected off the posterior abdominal wall to form 1 layer of the fold, then it wraps over the coils of the intestine to form the visceral peritoneum and the second fold, running down to the other side of the root

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21
Q

How long is the root of the mesentery and where does it run between?

A

It’s 15cm long and comes from the duodenojejunal junction proximally to the sacroiliac joint distally.

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22
Q

What 2 halves does the mesentery split the abdomen into?

A

The right and left infracolic compartments

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23
Q

Is the appendix intraperitoneal or retroperitoneal?

A

Intraperitoneal

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24
Q

What supplies the appendix with blood?

A

The appendicular artery, which arises from the ileocolic artery, a branch of the superior mesenteric artery

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25
Q

Where is the appendix located?

A

Subcaecally, or posterior to the caecum

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26
Q

What is the caecum?

A

A blind-ended pouch which marks the start of the large intestine.

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27
Q

Is the caecum intraperitoneal or retroperitoneal?

A

It’s mostly retroperitoneal

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28
Q

What is lateral to the ascending colon?

A

The right paracolic gutter

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29
Q

What supplies the ascending colon with blood?

A

The right colic artery- a branch of the superior mesenteric artery

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30
Q

Is the transverse colon retroperitoneal or intraperitoneal?

A

It’s intraperitoneal

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31
Q

What is the function of the transverse mesocolon?

A

To act as a conjugate for blood vessels

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32
Q

What compartments does the transverse colon separate the abdominal cavity into?

A

The supracolic and infracolic compartments

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33
Q

How are the superior mesenteric artery and vein located relatively?

A

The vein is to the right of the artery

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34
Q

At what level does the superior mesenteric artery arise from the aorta?

A

L1, around 1cm below the coeliac trunk at T12

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35
Q

What branches does the superior mesenteric artery give off as it runs inferiorly?

A

Jejunal branches, ileal branches, the ileocolic artery, the right colic artery and the middle colic artery

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36
Q

What do the jejunal branches and ileal branches become?

A

Arterial arcades and vasa recta

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37
Q

What does the ileocolic artery give off?

A

Branches to the distal ileum and the caecum, and the appendicular artery which travels through the mesoappendix

38
Q

What does the middle colic artery pass through?

A

The transverse mesocolon

39
Q

What is the superior mesenteric vein joined by to form the hepatic portal vein?

A

The splenic vein, which runs behind the pancreas

40
Q

What do the lymphatics of the midgut drain into?

A

The intestinal lymphatic trunks and the cisterna chyli

41
Q

What is the cisterna chyli?

A

A dilated lymphatic sac at the lower end of the thoracic duct which drains all the abdominal viscera, including those of the pelvis, perineum and the lower limbs

42
Q

What provides parasympathetic innervation to the midgut?

A

The vagus nerve innervates the enteric NS of the midgut (and foregut)

43
Q

What gives sympathetic supply to the midgut, and what nerve roots are these from?

A

The lesser splanchnic nerves (nerve roots T9-T11)

44
Q

What is IBD?

A

Inflammatory bowel disease is an umbrella term for ulcerative colitis and Krohn’s disease

45
Q

What is ulcerative colitis?

A

Inflammation of the distal end of the colon, from the sigmoid all the way round to the caecum, sparing the rectum

46
Q

Why is initial pain from appendicitis in the umbilical region, but it moves to the right iliac fossa?

A

Initial pain is visceral so it is referred to the umbilical region. Once the appendix is inflamed enough that it swells and presses on the parietal peritoneum, pain becomes local

47
Q

Where is the McBurney’s point?

A

2/3 laterally between the ASIS and the umbilicus, which is where the appendix is.

48
Q

Where is the midgut pain referred to?

A

The umbilical region, as these dermatomes share convergent nerve roots with the lesser splanchnic nerves (T9-T11)

49
Q

What is psoas sign?

A

RLQ pain with extension of the right hip or flexion of the right hip against resistance

50
Q

What does the hindgut consist of?

A

The distal 1/3 of the transverse colon, the descending colon, sigmoid colon, rectum and anal canal

51
Q

What give the large intestine its saturated appearance?

A

Haustra

52
Q

What are tendini coloi?

A

3 longitudinal bands of muscle which run the length of the large intestine, before converging at the base of the appendix

53
Q

What are appendices epiploicae?

A

Peritoneal pouches along the colon that are filled with fat

54
Q

What nerve supplies the hindgut sympathetically?

A

The inferior mesenteric plexus

Sympathetic innervation comes via the lumbar splanchnic nerves (L1-L2)

55
Q

What nerves take over parasympathetic innervation for the hindgut?

A

The pelvic splanchnic nerves (S2-S4)

56
Q

What is lateral to the descending colon?

A

The paracolic gutter, where peritoneal fluid can pool

57
Q

Is the sigmoid colon intraperitoneal or retroperitoneal?

A

Intraperitoneal

58
Q

Is the descending colon intraperitoneal or retroperitoneal?

A

Retroperitoneal, apart from in 33% of people

59
Q

What run in the sigmoid mesocolon?

A

Blood vessels

60
Q

At what level does the sigmoid colon become the rectum?

A

S3

61
Q

What causes rectal constrictions?

A

Transverse rectal folds (thickenings of muscle)

62
Q

What is the distal portion of the rectum?

A

The ampulla, which dilates in the presence of faeces and is important for continence

63
Q

What’s on top of the pelvic organs?

A

The inferior layer of peritoneum of the abdominal cavity

64
Q

What does the inferior peritoneum cover?

A

The top part of the rectum, and then either the uterus or the bladder (female or male)

65
Q

What is the space between the rectum and uterus called?

A

The rectouterine pouch (of Douglas)

66
Q

What’s the name of the space between the rectum and bladder?

A

The rectovesical pouch

67
Q

As the rectum passes through the pelvic diaphragm to become the anal canal, what is there?

A

A slight bend at 80°, which is really important to faecal continence

68
Q

What does the pectinate line represent?

A

The termination of the hindgut

69
Q

Describe epithelium above and below the pectinate line

A

Above- columnar

Below- stratified squamous

70
Q

Describe arterial supply above and below the pectinate line

A

Above- superior rectal artery, a branch of the inferior mesenteric artery
Below- branches of the middle and inferior rectal arteries, which come from the anterior division of the internal iliac artery

71
Q

Describe venous drainage above and below the pectinate line

A

Above- superior rectal veins, which unite with the inferior mesenteric veins and drain into the portal system
Below- middle and inferior rectal veins, which drain into systemic circulation

72
Q

Describe innervation above and below the pectinate line

A

Above- inferior hypogastric plexus

Below- inferior rectal nerves

73
Q

Describe lymphatic drainage above and below the pectinate line

A

Above- internal iliac nodes

Below- superior inguinal nodes

74
Q

What forms the pelvic floor?

A

The blending of the external anal sphincter with the elevator ani muscle

75
Q

What are the 3 parts to the external anal sphincter?

A

The subcutaneous, superficial and deep parts

76
Q

What level does the inferior mesenteric artery arise from?

A

The level of L3

77
Q

What does the inferior mesenteric artery give off?

A

The left colic artery, sigmoidal arteries, and the superior rectal artery, and a branch forms an anastomosis between the midgut and hindgut called the marginal artery of Drummond

78
Q

What is the marginal artery of Drummond for?

A

It acts as a collateral supply in cases of blockage of the other arteries

79
Q

What does the superior rectal artery supply?

A

The first part of the rectum

80
Q

What trunk of the internal iliac artery does the middle rectal artery branch from?

A

The anterior trunk

81
Q

What branch gives off the inferior rectal artery?

A

The inferior pudendal artery

82
Q

How do the veins to the hindgut run?

A

They are venae communicantes

83
Q

What do the lymphatics of the hindgut ultimately drain into?

A

The intestinal trunks, forming the cysterna chyli

84
Q

What provides parasympathetic innervation not the distal 1/3 of the transverse colon?

A

The pelvic splanchnic nerves (S2-S4)

85
Q

What provides sympathetic innervation to the distal 1/3 of the transverse colon?

A

The lumbar splanchnic nerves (L1-L2)

86
Q

Where does hindgut pain get referred to?

A

The hypogastric (suprapubic) region, due to dermatomes L1 and L2

87
Q

What is diverticular disease?

A

Symptomatic out pouching of the bowel caused by weakening in the muscle wall

88
Q

What causes diverticulitis?

A

If food builds up in diverticuli, bacteria can build up and cause infection an inflammation

89
Q

Where do diverticuli often occur?

A

The sigmoid colon, due to higher pressure

90
Q

What is diverticulosis?

A

Asymptomatic diverticuli

91
Q

What is the clinical significance of the portosystemic anastomosis in the anal canal?

A

Portal hypertension backs up blood flow in the inferior mesenteric artery. This can lead to varicose veins and rupture could cause fatal blood loss

92
Q

What is caput medusae?

A

The appearance of distended and engorged superior epigastric veins, which are seen radiating from the umbilicus across the abdomen

Anatomy yr 1 (20 decks)

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