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X. MRCS: Anatomy > Abdomen: Small & Large Bowel > Flashcards

Abdomen: Small & Large Bowel Flashcards

1
Q

Parts of the Small Bowel

A

Duodenum
Jejunum
Ileum

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2
Q

Parts of the Duodenum

A

D1 - Superior (L1)
D2 - Descending (L1-L3)
D3 - Inferior (L3)
D4 - Ascending (L3-L2)

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3
Q

Superior part of duodenum

A

L1
Ascends upwards from pylorus of stomach
Connected to liver by hepatoduodenal ligament
Most common site of duodenal ulcers
Initial 3cm covered anteriorly and posteriorly by visceral peritoneum. The remainder is retroperitoneal

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4
Q

Descending part of duodenum

A

L1-L3
Curves inferiorly around head of pancreas
Posterior to transverse colon and anterior to right kidney.
Marked by major duodenal papilla

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5
Q

Inferior part of duodenum

A

L3
Travels laterally to the left over inferior vena cava and aorta
Located inferiorly to pancreas, posterior to superior mesenteric artery & vein

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6
Q

Ascending part of duodenum

A

L3 - L2
After crossing aorta ascends and curves anterior to join jejunum at sharp turn: duodena-jejunal flexure
at DJ flexure is suspensory muscle of duodenum (ligament of Trietz)

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7
Q

Blood supply to duodenum

A

Proximal to major duodenal papilla - gastroduodenal artery (branch of common hepatic artery from coeliac trunk)
Distal to major duodenal papilla - inferior pancreaticoduodenal artery (branch of SMA)

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8
Q

Blood supply to duodenum

A

Proximal to major duodenal papilla - gastroduodenal artery (branch of common hepatic artery from coeliac trunk)
Distal to major duodenal papilla - inferior pancreaticoduodenal artery (branch of SMA)

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9
Q

Venous drainage of duodenum

A

Veins follow arteries

Drain into hepatic portal vein

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10
Q

Lymphatic drainage of duodenum

A

Pancreatoduodenal nodes

Super mesenteric nodes

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11
Q

Origin of jejunum

A

Duodenojejunal flexure

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12
Q

Jejunum and Ileum peritoneal relations

A

Intraperitoneal

Attached to posterior wall by mesentery

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13
Q

Jejunum versus Ileum: Location

A

Jejunum: upper left quadrant
Ileum: lower right quadrant

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14
Q

Jejunum versus Ileum: Wall

A

Jejunum: thick intestinal wall
Ileum: thin intestinal wall

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15
Q

Jejunum versus Ileum: blood flow

A

Jejunum: Longer vasa recta
Ileum: shorter vasa recta

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16
Q

Jejunum versus Ileum: Arcades (arterial loops)

A

Jejunum: Less arcades
Ileum: more arcardes

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17
Q

Jejunum versus Ileum: colour

A

Jejunum: Red
Ileum: Pink

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18
Q

Blood supply to Jejunum and Ileum

A

Super mesenteric artery

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19
Q

Venous drainage from Jejunum/Ileum

A

Superior mesenteric vein

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20
Q

Lymphatic drainage from Jejunum/Ileum

A

Superior mesenteric nodes

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21
Q

Ileocaecal valve

A

Junction of ileum and cecum

Function is to prevent reflux of lateral back into ileum

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22
Q

Functions of the small bowel

A

Digestion

Absorption

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23
Q

Layers of the small bowel wall

A

Mucosa (epithelium, lamina propria, muscularis mucosae)
Submucosa
Muscular externa (two smooth muscles layers: inner circular, outer longitudinal. Myenteric plexus)
Adventitia

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24
Q

Cells of the epithelium in small bowel

A

Enterocytes: tall columnar, function: absorption
Goblet cells: exocrine glands, secrete mucin
Crypts of Lieberkuhn: contains cells to produce news cells to relish lining. Enteroendocrine cells also.
Paneth cells: secrete protective agents
Peyers patches: ileum containing MALT (mucosal associated lymphatic tissue)

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25
Q

Crypts of Lieberkuhn, Enteroendocrine cells

A

I cells: cholecystokinin (CCK)
S cell: secretin
K cells: gastric-inhibitory peptide (GIP)
Enterochromaffin Cells: Serotonin

26
Q

Function of cholecystokinin (CCK)

A

Produced by I cells in response to fat in small intestine
Stimulates:
1. contraction of gallbladder (pushes bile into cystic duct)
2. Release of pancreatic enzymes

27
Q

Functions of secretin

A

Produced by S cells
In response to low pH of chyme in small intestine
Secretin induces HCO3- secretion in pancreas and inhibits gastric emptying

28
Q

Functions of gastric-inhibitory peptide

A

Produced by K cells
In response to chyme entering small intestine
Stimulates insulin release

29
Q

Functions of serotonin in small bowel

A

Produced by Enterochromaffin Cells
In response to presence of chyme in small bowel
Acts on enteric nervous system to activate cystic fibrosis transmembrane regulators (CFTRs). Ion channel secretes Cl- into intestinal lumen with Na + and H2O. Na+ is required for absorption of certain nutrients

30
Q

Secretions small bowel receives for digestion

A

Bile
Pancreatic Enzymes
Alkaline juice

31
Q

Hepatopancreatic ampulla

A

Ampulla of vater
Formed from common bile duct and pancreatic duct
Opens into duodenum at major duodenal ampulla.
Secretions regulated by sphincter of Oddi

32
Q

Carbohydrate digestion and absorption in the small bowel

A

Starch digested by amylase (salivary and pancreatic) to form disaccharides.
Disaccharides converted to glucose by brush border enzymes (lactase, sucrase, trehalase).
Glucose and galactose absorbed across apical membrane by secondary active transport (Na-Glucose co transporter SGLT1). Fructose enters by facilitated diffusion through GLUT5. Sugars transported to blood via GLUT2 receptors.

33
Q

Protein digestion and absorption in the small bowel

A

Protein digestion starts in stomach from pepsin (active form of pepsinogen released by chief cells).
Proteins –> amino acids + oligopeptides
Digestion completed in small intestine with brush border and pancreatic enzymes.
Amino acids are absorbed by Na cotransporter.

34
Q

Lipid digestion and absorption in the small bowel

A

10% - lingual/gastric lipase
90% - emulsification via bila acids to smaller fat goblets (micelles)
Pancreatic lipase, phospholipase A2, cholesterol ester hydrolase: hydrolyse micelles = fatty acids + monoglycerides + cholesterol + lysolecithin
Lipids packaged inside cells to form chylomicron and enter lymphatic system via lacteals

35
Q

Water absorption in the small bowel

A

Most water and electrolyte absorption occurs in small intestine
Na+ is reabsorbed from intestinal lumen with cotransported Glucose/Amino acids
H2O follows Na via osmosis

36
Q

Parts of the large bowel

A

Ascending Colon
Transverse Colon
Descending Colon
Sigmoid Colon

37
Q

Blood supply to the cecum

A

Ileocolic artery (Branch of SMA)

38
Q

Venous drainage from Cecum

A

Ileocolic vein (drains into superior mesenteric vein)

39
Q

Lymphatic drainage from Cecum

A

Ileocolic lymph nodes

40
Q

Ascending colon anatomical position

A

Rises from cecum to right colic (hepatic) flexure

Retroperitoneal

41
Q

Blood supply to the ascending colon

A

Ileocolic artery
Right colic artery
(both branches of SMA)

42
Q

Venous drainage from the ascending colon

A

Ileocolic and right colic veins (draining into SMV)

43
Q

Lymphatic drainage from the ascending colon

A

Superior mesenteric lymph nodes

44
Q

Nerve supply to ascending colon

A

Sympathetic, parasympathetic, sensory from superior mesenteric plexus

45
Q

Transverse colon anatomical position

A

Extends from right colic (hepatic) flexure to the left colic (splenic) flexure
Attached to diaphragm at splenic flexure by phrenicocolic ligament
Intraperitoneal. Enclosed by transverse mesocolon

46
Q

Blood supply to Transverse colon

A

Right colic artery (SMA)
Middle colic artery (SMA)
Left colic artery (IMA)

47
Q

Venous drainage from transverse colon

A

Middle colic vein, drains into SMV

48
Q

Lymphatic drainage to transverse colon

A

Superior mesenteric nodes

49
Q

Innervation to transverse colon

A

Proximal 2/3: superior mesenteric plexus
Distal 1/3: inferior mesenteric plexus (parasympathetic: pelvic splanchnic nerves. Sympathetic: lumbar splanchnic nerves)

49
Q

Innervation to transverse colon

A

Proximal 2/3: superior mesenteric plexus
Distal 1/3: inferior mesenteric plexus (parasympathetic: pelvic splanchnic nerves. Sympathetic: lumbar splanchnic nerves)

50
Q

Descending colon anatomical position

A

Descends inferior from the left colic (splenic) flexure
Retroperitoneal in majority
Anterior to left kidney

51
Q

Blood supply to descending colon

A

Left colic artery (branch of IMA)

52
Q

Venous drainage from descending colon

A

Left colic vein (drains into IMV)

53
Q

Lymphatic drainage from descending colon

A

Inferior mesenteric nodes

54
Q

Innervation to descending colon

A

Inferior mesenteric plexus (parasympathetic: pelvic splanchnic nerves. Sympathetic: lumbar splanchnic nerves)

55
Q

Sigmoid colon anatomical position

A

Left lower quadrant.
Forms when the descending colon turns medially.
Left iliac fossa to S3 vertebra
Attached to posterior wall by mesentery (sigmoid mesocolon)

56
Q

Blood supply to sigmoid colon

A

Sigmoid artery (branches of IMA)

57
Q

Venous drainage from sigmoid colon

A

Sigmoid veins (drains into IMV)

58
Q

Innervation to sigmoid colon

A

Inferior mesenteric plexus (parasympathetic: pelvic splanchnic nerves. Sympathetic: lumbar splanchnic nerves)

59
Q

Characteristics of large bowel wall

A 
Mental appendices (pouches of peritoneum, filled with fat)
Teniae coli (3 strips of longitudinal muscle along surface of large bowel): mesocolic, free and mental coli. 
Haustra (sacculations formed from teniae coli contraction)
Wider diameter (9cm cecum, 6cm large bowel, 3cm small intestine)
60
Q

Cell types in the epithelium of large bowel

A

Crypts of Lieberkuhn: glands and mucus-producing goblet cells
GALT (gastrointestinal associated lymphoid tissue)

61
Q

Water and Ion absorption in the large bowel

A

Na+: Na/H antiporter, epithelial sodium channels, enhanced absorption of short-chain fatty acids via specialised symporters
Cl-: Cl follows Na+ absorption, in exchange for bicarb (net bicarb loss)
H2O: absorbed following osmotic gradient
K+: diffuses down electrochemical gradient caused by Na+/H2O absorption
Vits: B6, B12, K are produced by digestion of chyme by commensal guy flora

X. MRCS: Anatomy (18 decks)

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