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Anatomy Exam 1 > Abdominal Contents: Midgut & Hindgut > Flashcards

Abdominal Contents: Midgut & Hindgut Flashcards

1
Q

Divisions of the gut tube

  • What are the three divisions?
  • What does each division share?
A

Divisions of the gut tube

  • foregut
  • midgut
  • hindgut

Organs derived from the same division of the gut tube share:

  • common blood supply
  • route of venous drainage
  • route of lymphatic drainage
  • innvervation
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2
Q

Midgut

  • Derivatives?
  • Blood supply?
  • Venous drainage?
  • Lymphatic drainage?
A

Midgut​

  • Derivatives:
    • distal duodenum
    • jejunum
    • ileum
    • cecum
    • appendix
    • ascending colon
    • proximal 2/3 of transverse colon
  • Blood supply:
    • SMA
  • Venous drainage:
    • SMV
  • Lymphatic drainage:
    • superior mesenteric lymph nodes
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3
Q

Hindgut

  • Derivatives?
  • Blood supply?
  • Venous drainage?
  • Lymphatic drainage?
A

Hindgut

  • Derivatives:
    • distal 1/3 of transverse colon
    • descending colon
    • sigmoid colon
    • rectum
  • Blood supply:
    • IMA
  • Venous drainage:
    • IMV
  • Lymphatic drainage:
    • inferior mesenteric lymph nodes
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4
Q

Small intestine

  • What are the three parts?
  • What are the parts of the duodenum and where are they derived from? Quadrant of duodenum?
A

Small intestine

  • Duodenum
    • RUQ
    • Proximal half
      • 1st and 2nd parts are foregut
    • Distal half
      • 3rd and 4th parts are midgut
  • Jejunum
  • Ileum
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5
Q

Small intestine

Distal duodenum

Horizontal (3rd) part

  • What kind of retroperitoneal organ?
  • What kind of vessels pass by and where?
A

Small intestine

Distal duodenum

Horizontal (3rd) part

  • Secondarily retroperitoneal
  • Superior mesenteric vessels emerge superior and pass anterior to this part
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6
Q

Small intestine

Distal duodenum

Ascending (4th) part

  • What kind of retroperitoneal organ?
  • What is the acute angle and what does it mark?
  • What is this structure supported by and what is it tethered to?
A

Small intestine

Distal duodenum

Ascending (4th) part

  • Secondarily retroperitoneal
  • Duodenojejunal flexure - acute angle that marks the duodenojujenal junction where it transitions from secondarily retroperitoneal duodenum to intraperitoneal jejunum
  • Suspensory muscle of the duodenum (ligament of Treitz) - this supports the flexure, tethering it to the diaphragm
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7
Q

Small intestine

Jejunum

  • Type of retroperitoneal organ?
  • Location?
  • What structures are prominent in jejunum?
A

Small intestine

Jejunum

  • Intraperitoneal (robust mesentary)
  • Central position in abdomen
  • Plicae circulares - very prominent in jejunum
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8
Q

Small intestine

Ileum

  • Type of retroperitoneal organ?
  • Location?
  • What structures are present and absent?
  • Where does the ileum end?
A

Small intestine

Ileum

  • Intraperitoneal (robut mesentary)
  • Central position in abdomen
  • Plicae circulares are sparse proximally and absent distally
  • Lymphoid nodules (Peyer’s patches) are present in ileum
  • Ileum ends at ileocecal junction
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9
Q

Small intestine

Ileal (Meckel’s) diverticulum of the ileum

  • What is it?
  • What is it a remnant of?
  • Occurence?
  • Clinical significance?
A

Small intestine

Ileal (Meckel’s) diverticulum of the ileum

  • Blind pouch on the antimesenteric side of ileum
  • Remnant of the yolk stalk (embryonic connection between the yolk sac and developing gut)
  • 1-2% occurrence
  • Congenital
  • Typically 50 cm from ileocecal junction
  • Inflammation of an ileal diverticulum can produce pain similar to appendicitis
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10
Q

Large intestine

  • What are the parts?
  • Where does the midgut / hindgut transition lie?
A

Large intestine

  • Includes:
    • cecum
    • appendix
    • colon
      • ascending colon
      • transverse colon
      • descending colon
      • sigmoid colon
    • rectum
  • Includes both midgut and hindgut derivatives
  • Midgut / hindgut transition lies at the junction of the proximal 2/3 and distal 1/3 of the transverse colon
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11
Q

What are the features of the large intestine?

A

Features of the large intestine

  • Teniae coli
    • Three longitudinal bands of smooth muscle
    • Teniae = ribbon in Latin
  • Haustra
    • Pouches between the teniae coli
  • Omental (epiploic) appendices
    • Fat
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12
Q

Large intestine

Cecum

  • What kind of organ?
  • Quadrant?
  • Looks like a?
  • What is the valve associated?
A

Large intestine

Cecum

  • Intraperitoneal
  • RLQ
  • Round pouch
  • Ileocecal valve - between the ileum and cecum, closes when cecum is distended
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13
Q

Large intestine

Appendix

  • Type of organ?
  • Quadrant?
  • Location?
  • Looks like?
  • What converges there?
  • What does root of appendix lie? Clinical significance of this?
A

Large intestine

Appendix

  • Intraperitoneal (mesoappendix mesentery)
  • RLQ
  • Typically retrocecal (behind cecum) but this can vary
  • Worm like appendage of the cecum
  • Teniae coli converge at appendix
  • McBurney’s Point
    • Root of appendix
    • 1/3 of the way from the ASIS to the umbilicus
    • Location of appendectomy incision
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14
Q

Large intestine

Ascending colon

  • Type of organ?
  • Quadrant?
  • What is the fixture and gutter? Location?
A

Large intestine

Ascending colon

  • Secondarily retroperitoneal
    • Although it has mobile mesentery in 25% of people, so it can be intraperitoneal
  • RLQ and RUQ
  • Extends superiorly along right side of abdominal cavity between the cecum and the right colic (hepatic) flexure
  • Right paracolic gutter is lateral to the ascending colon and fluid can accumulate there
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15
Q

Large intestine

Transverse colon

  • Type of organ?
  • Quadrant?
  • Extends horizontally between what two flexures?
  • Which flexure sits higher and why?
A

Large intestine

Transverse colon

  • Intraperitoneal (transverse mesocolon mesentery)
  • RUQ and LUQ
  • Extends horizontally between the right colic (hepatic) flexure and the left colic (splenic) flexure
  • Left colic flexure sits higher due to liver being on the right
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16
Q

Large intestine

Descending colon

  • Type of organ?
  • Quadrant?
  • Extends inferiorly along what side of abdominal cavity and between what?
  • What is directly lateral? Clinical significance of these structures?
A

Large intestine

Descending colon

  • Secondarily retroperitoneal
    • Although there is mobile mesentery in 33% of people, so it can be intraperitoneal
  • LUQ and LLQ
  • Extends inferiorly along the left side of abdominal cavity between the left colic flexure and sigmoid colon
  • Left paracolic gutter
    • Lateral to descending colon
    • Paracolic gutters are conduits for the spread of fluid within the peritoneal cavity
    • If patient has abdominal infection and lays down, infection can spread to parietal pleura
    • Patient with abdominal infections should stay sitting up
17
Q

Large intestine

Sigmoid colon

  • Type of organ?
  • Quadrant?
  • Extends between what?
  • What shape does it form?
A

Large intestine

Sigmoid colon

  • Intraperitoneal (sigmoid mesocolon mesentery)
  • LLQ
  • Extends from descending colon to rectum
  • S shaped but variable in position
18
Q

Large intestine

Rectum

  • Type of organ?
  • Continues proximally with? Distally with?
  • Lacks what structures?
  • Where do the rectum and anal canal meet?
  • Location and function of rectal ampulla?
A

Large intestine

Rectum

  • Primarily retroperitoneal
  • Continous proximally with sigmoid colon and distally with anal canal
  • Lacks:
    • teniae coli
    • haustra
    • omental appendices
  • Not a straight tube, has lateral flexures
  • Anorectal flexure
    • ​The abrupt angle with the rectum and anal canal meet
    • Maintained by the puborectalis muscle
  • Rectal ampulla
    • Lies superior to the anorectal flexure
    • Expands to store fecal matter
19
Q

Midgut - SMA

  • Arises from abdominal aorta at what level?
  • Posterior to what?
  • Passes anterior to what?
  • What are the branches of the SMA?
A

Midgut - SMA

  • Arises from the abdominal aorta at L1 vertebrae
  • Posterior to the pancreas
  • Passes anterior to the horizontal (3rd) part of the duodenum
  • Branches of SMA:
    • Anterior and posterior inferior pancreaticoduodenal arteries
    • Jejunal and ileal arteries
    • Colic arteries
20
Q

Midgut - SMA

Anterior and posterior inferior pancreaticoduodenal arteries

Anastomose with what?

A

Midgut - SMA

Anterior and posterior inferior pancreaticoduodenal arteries

Anastomose with anterior and posterior superior pancreaticoduodenal arteries from the celiac trunk

21
Q

Midgut - SMA

Jejunal and ileal arteries

  • What pattern do these arteries form?
  • How do you characterize jejunal vs ileal?
A

Midgut - SMA

Jejunal and ileal arteries

  • Form anastomosing arcades that terminate in straight arteries (vasa recta)
  • Jejunum arteries
    • Few arcades
    • Long straight arteries
  • Ileum arteries
    • Multiple arcades
    • Short straight arteries
22
Q

Midgut - SMA

Colic arteries

  • Contribute to what artery?
  • What are the three colic arteries?
  • What is the branch off artery?
A

Midgut - SMA

Colic arteries

  • Contribute to the marginal artery (an anastomosing loop that parallels the colon)
  • Colic arteries
    • Middle colic artery
    • Right colic artery
    • Ileocolic artery
      • Appendicular artery (in mesoappendix)
23
Q

Hindgut - IMA

  • Arises from the abdominal aorta at what vertebrae?
  • What are the three branches of the IMA?
  • What do the branches contribute to?
A

Hindgut - IMA

  • Arises from the abdominal aorta at L3
  • Branches of IMA:
    • Left colic artery (contributes to marginal artery)
    • Sigmoid arteries (contribute to marginal artery)
    • Superior rectal artery (terminal branch of IMA)
24
Q

Portal system in the midgut and hindgut

  • What vein goes to midgut and hindgut?
  • What do the tributaries of the veins parallel?
  • Where does it form or empty to?
A

Portal system in the midgut and hindgut

Midgut - SMV

  • Tributaries parallel branches of the SMA
  • Joins with the splenic vein to form the portal vein

Hindgut - IMV

  • Tributaries parallel branches of IMA
  • Empties into the splenic vein posterior to the body of the pancreas
25
Portal-caval anastomoses Where does this take place in the midgut / hindgut?
**Portal-caval anastomoses** Portal tributaries draining the _colon_ communicate with the paired veins of the IVC, providing an alternative route in cases of portal hypertension
26
Lymphatics of the midgut and hindgut * Where does the midgut and hindgut lymph drain to?
**Lymphatics of the midgut and hindgut** **Midgut** * Lymph drains to superior mesenteric lymph nodes --\> chyle cistern **Hindgut** * Lymph drains to inferior mesenteric lymph nodes --\> superior mesenteric lymph nodes OR lumbar lymph nodes (along aorta)
27
Midgut parasympathetic innervation
**Midgut parasympathetic innervation** Stimulates peristalsis and secretion * Preganglionic cell bodies: brain * Preganglionic fibers: vagus nerve (CN X) * Postganglionic cell bodies: wall of organ * Postganglionic fibers: wall of organ
28
Hindgut parasympathetic innervation
**Hindgut parasympathetic innervation** Stimulates peristalsis and secretion * Preganglionic cell bodies: _intermediate gray matter at S2 - S4 levels of spinal cord_ * Preganglionic fibers: ventral root, spinal nerve, ventral ramus, _pelvic splanchnic nerves_ * Postganglionic cell bodies: wall of organ * Postganglionic fibers: wall of organ
29
Midgut sympathetic innervation
**Midgut sympathetic innervation** Inhibits peristalsis and constricts GI blood vessels * Preganglionic cell bodies: lateral horn of thoracic spinal cord * Preganglionic fibers: ventral root, spinal nerve, white ramus communicans, sympathetic trunk, _thoracic splanchnic nerves (greater, lesser, or least)_ * Postganglionic cell bodies: _celiac ganglia OR superior mesenteric ganglia_ * Postganglionic fibers: follow arterial branches to target organ
30
Hindgut sympathetic innervation
**Hindgut sympathetic innervation** Inhibits peristalsis and constricts GI blood vessels * Preganglionic cell bodies: lateral horn of _lumbar_ spinal cord * Preganglionic fibers: ventral root, spinal nerve, white ramus communicans, sympathetic trunk, _lumbar splanchnic nerves_ * Postganglionic cell bodies: _inferior mesenteric ganglion_ * Postganglionic fibers: follow arterial branches to target organ
31
Midgut vs hindgut for parasympathetic innveration * What is the nerve for each? * Where is the divison on the large intestine?
**Midgut vs hindgut for parasympathetic innveration** * Midgut - vagus nerve (CN X) * Hindgut - pelvic splanchnic nerve * The midgut / hindgut transition lies at the junction of the proximal 2/3 and distal 1/3 of the transverse colon
32
Visceral pain * What is the pathway? * Describe pain from appendicitis
**Visceral pain** * Follow the sympathetic and parasympathetic pathways back to spinal cord * Pain from appendicitis presents as diffuse periumbilical pain (T10 dermatome). But as the parietal peritoneum becomes involved, somatic innervation *localizes* the pain to RLQ

Anatomy Exam 1 (8 decks)

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