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Gross Anatomy > Abdomen: Small and Large Intestines > Flashcards

Abdomen: Small and Large Intestines Flashcards

1
Q

Mesentery of small intestines

A
  • Jejunum

- Ileum

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2
Q

Duodenum

A
  • Widest, least mobile of the SI (mostly retroperitoneal)
  • Derived from foregut and midgut
  • “Cs” the head of the pancreas
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3
Q

4 parts of the duodenum

A
  • Upper
  • Descending
  • Horizontal or inferior
  • Ascending
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4
Q

Upper (1st part) duodenum

A
  • Intraperitoneal

- Portal triad and IVC are posterior

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5
Q

Descending (2nd part) duodenum

A
  • Receives bile and pancreatic ducts (division between fore- and midgut)
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6
Q

Horizontal/inferior (3rd part) duodenum

A
  • Anterior to IVC, aorta, vertebral column

- Posterior to SMA and SMV

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7
Q

Ascending (4th part) duodenum

A
  • Joins jejunum at the duodenojejunal flexure

- Supported by suspensory muscle of duodenum (ligament of Trietz)

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8
Q

Ligament of Trietz

A
  • Fibromuscular band originating from the right crus of diaphragm
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9
Q

Duodenum blood supply

A
  • Branches from celiac trunk and superior mesenteric artery
  • Branches from gastroduodenal
  • Branches from SMA
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10
Q

Branches from gastroduodenal supplying blood to duodenum

A
  • Supraduodenal
  • Anterior superior pancreaticoduodenal
  • Posterior superior pancreaticoduodenal
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11
Q

Branches from SMA supplying blood to duodenum

A
  • Anterior inferior pancreaticoduondenal

- Posterior inferior pancreaticoduondenal

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12
Q

Jejunum and Ileum

A
  • 6-7 m long

- Suspended from posterior abdominal wall by mesentery

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13
Q

Jejunum

A
  • Proximal 2/5 of small intestines

- Often empty (after death, hence its name)

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14
Q

Jejunum (compared to ileum)

A
  • Thicker wall
  • Greater vascularity
  • Circular folds are more dense/taller
  • Less mesenteric fat
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15
Q

Ileum

A
  • Distal 3/5 of small intestines
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16
Q

Blood supply of jejunum and ileum

A
  • Expansive

- Superior mesenteric artery (jejunal and ileal branches)

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17
Q

Superior mesenteric artery (SMA)

A
  • Originates from abdominal aorta (~1cm below celiac trunk)

- Travels in the small intestine mesentery

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18
Q

Arteries of jejunum

A
  • Fewer arcades

- Longer vasa recta

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19
Q

Arteries of ileum

A
  • Many arcades

- Shorter vasa recta

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20
Q

Large intestines function

A
  • Water absorption

- Fecal storage

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21
Q

Large intestine consists of

A
  • Cecum
  • Appendix
  • Colon (ascending, transverse, descending, sigmoid)
  • Rectum
  • Anal canal
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22
Q

Omental appendices

A
  • Small fatty projections

- Not really present on appendix, cecum, rectum

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23
Q

Tenia coli

A
  • 3 bands of longitudinal muscle
  • Begin at base of appendix
  • Blend with longitudinal muscle of rectum
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24
Q

Haustra

A
  • Wall sacculations that give the colon a segmented appearance
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25
Q

Cecum

A
  • Blind end pouch below the ileocolic (ileocecal) junction
  • Right lower quadrant
  • Very mobile (covered by peritoneum)
  • Internal: Ileocecal valve (passive valve)
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26
Q

Blind end pouch below the ileocolic/ileocecal junction (cecum)

A
  • 2nd most common site of volvulus
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27
Q

Right lower quadrant of cecum

A
  • Lies in the iliac fossa on the psoas and iliacus muscles
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28
Q

Internal: Ileocecal valve (passive valve) of cecum contains

A
  • Ileal orifice
  • Lips and frenulum of ileocecal valve
  • Orifice of appendix
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29
Q

Appendix (vermiform appendix)

A
  • Worm-like diverticulum (6-10cm)

- Variable location

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30
Q

Appendix (vermiform appendix) lacks

A
  • Tenia coli and haustra
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31
Q

Appendix (vermiform appendix) contains

A
  • Lymphoid tissue

- Has its own mesentery (mesoappendix)

32
Q

Appendicitis

A
  • Inflammation of the appendix
33
Q

Appendicitis is caused by

A
  • Obstruction (fecalith)

- Lymph follicle hyperplasia

34
Q

Signs and symptoms of appendicitis

A
  • Early dull pain in the peri-umbilical region
  • Later severe pain in right lower quadrant
  • Tenderness around McBurney’s point
35
Q

Reason for early dull pain in the peri-umbilical region in appendicitis

A
  • Afferent fibers enter cord at T10

- Referred pain

36
Q

Reason for later severe pain in right lower quadrant in appendicitis

A
  • Parietal peritoneum irritation
37
Q

McBurney’s point

A
  • About 1.5 - 2 inches on a line from the ASIS to the umbilicus (spino-umbilical line)
38
Q

Techniques used for removal of appendix

A
  • Muscle splitting technique of McBurney (open appendectomy)

- Laparoscopic appendectomy is commonly performed

39
Q

Ascending colon

A
  • Up to right colic (hepatic) flexure

- Secondarily retroperitoneal

40
Q

Transverse colon

A
  • Up to left colic (splenic) flexure
  • Very mobile
  • Phrenicocolic ligament
41
Q

Transverse colon is very mobile because of

A
  • Transverse mesocolon (variable position)
42
Q

Phrenicocolic ligament of transverse colon

A
  • Peritoneum that connects left colic flexure to the diaphragm
43
Q

Descending colon

A
  • Up to left iliac fossa

- Secondarily retroperitoneal

44
Q

Sigmoid colon

A
  • S-shaped
  • Iliac fossa to S3, joins rectum
  • Has a mesentery (sigmoid mesocolon)
45
Q

Sigmoid colon is the most common site of

A
  • Volvulus
46
Q

Rectosigmoid junction

A
  • Site where sigmoid colon (from iliac fossa to S3) joins rectum
  • Termination of teniae coli, lack of omental appendices
47
Q

Colon primary blood supply

A
  • Superior mesenteric artery
  • Interior mesenteric artery
  • Marginal artery (of Drummond)
  • Vasa recta
48
Q

Branches of SMA supplying colon

A
  • Ileo-colic
  • Right colic
  • Middle colic
49
Q

Ileo-colic artery supplies

A
  • Cecum
  • Ascending colon
  • Appendix
  • Ileum
50
Q

Branches of ileo-colic artery supplying parts of the colon

A
  • Colic and ilieal branches
  • Appendicular
  • Anterior and posterior cecal
51
Q

Right colic artery primarily supplies

A
  • Ascending colon
52
Q

Branches of right colic artery supplying parts of the colon

A
  • Ascending and descending branches
53
Q

Middle colic artery primarily supplies

A
  • Transverse colon
54
Q

Branches of middle colic artery supplying parts of the colon

A
  • Left and right branches
55
Q

Branches of interior mesenteric artery

A
  • Left Colic
  • Sigmoid artery
  • Superior rectal artery
56
Q

Branches of left colic artery supplying parts of the colon

A
  • Ascending and descending branches
57
Q

Sigmoid artery primarily supplies

A
  • Sigmoid colon
58
Q

Superior rectal artery supplies

A
  • Rectum

- Continuation of inferior mesenteric

59
Q

Marginal artery (of Drummond)

A
  • Continuous artery along the inner border of colon
  • Connects SMA and IMA
  • Allows for collateral blood flow in case of stenosis/blockage or ligature
60
Q

Vasa recta

A
  • Straight vessels that supply colon
61
Q

Lymph drainage of colon invovles

A
  • Superior mesenteric nodes
  • Celiac nodes
  • Inferior mesenteric nodes
62
Q

Midgut lymph drains to

A
  • Superior mesenteric nodes
63
Q

Foregut lymph drains to

A
  • Celiac nodes
64
Q

Hindgut lymph drains to

A
  • Inferior mesenteric nodes
65
Q

All lymph drains from nodes to

A
  • Intestinal lymph trunk > cisternal chyli > thoracic duct
66
Q

Venous drainage of GI tract

A
  • IMV drains into Splenic vein
  • Splenic vein joins SMV to form portal vein
  • Can have tri-union with IMV
67
Q

Venous drainage of foregut

A
  • Directly into portal vein
  • Superior mesenteric vein
  • Splenic vein
68
Q

Venous drainage of midgut

A
  • Superior mesenteric vein
69
Q

Venous drainage of hindgut

A
  • Inferior mesenteric vein
70
Q

Portal vein (PV)

A
  • Union of SMV and splenic veins
  • Posterior to pancreas neck
  • Runs in hepatoduodenal ligament
71
Q

Portal-systemic (caval) anastomoses

A
  • Connections between veins that drain into portal system with systemic venous system
  • Collateral circulation if portal venous system becomes obstructed
72
Q

Obstruction of portal venous system may cause

A
  • Portal hypertension
73
Q

Portal-systemic (caval) anastomoses connect to

A
  • Left gastric (portal) and esophageal veins (systemic)
  • Superior (portal) and inferior rectal veins (systemic)
  • Paraumbilical veins (portal) and superficial epigastric veins (systemic)
  • Veins of the GI tract and renal, lumbar, phrenic, suprarenal
74
Q

Varicose veins

A
  • Dilation of the systemic veins
75
Q

Portal hypertension

A
  • Increased pressure in portal vein
76
Q

Liver cirrhosis can cause the following observable symptoms (example of portal hypertension)

A
  • Ascites in the peritoneal cavity due to blood stasis of portal vein tributaries
  • Internal hemorrhoids via the superior rectal vein
  • Esophageal varices via the esophageal vein of the left gastric vein
  • Caput medusa via superficial veins on the abdomen
77
Q

Treatment for liver cirrhosis caused by portal hypertension

A
  • Portosystemic shunts
  • Transjugular intrahepatic portosystemic shunt (TIPSS)
  • Liver transplant

Gross Anatomy (50 decks)

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