Abdominal Viscera 1

Question 1

Length of oesophagus

Answer 1

25cm

Question 2

Path of oesophagus

Answer 2

Starts at C6. Descends in midline behind trachea, deviates to the left and pierces muscular diaphragm at T10.

Question 3

Why is the oesophagus constricted on inspiration?

Answer 3

Right and left cruses form sleeves around oesophagus which form a sphincter around oesophagus when diaphragm contracts.

Question 4

Cellular feature of junction between oesophagus and stomach

Answer 4

Sharp line of demarcation between simple squamous cells of oesophagus and gastric lining of stomach

Question 5

Narrowings of oesophagus 1 2 3

Answer 5

1) Upper oesophageal sphincter in neck 2) Aortic arch and left main bronchus in thorax 3) Diaphragmatic orifice in abdomen

Question 6

Arterial supply of cervical oesophagus

Answer 6

Inferior thyroid artery

Question 7

Arterial supply of thoracic oesophagus

Answer 7

Oesophageal branches of descending aorta

Question 8

Arterial supply of abdominal aorta

Answer 8

Left gastric artery from aorta

Question 9

Venous drainage of cervical oesophagus

Answer 9

Brachio-cephalic system

Question 10

Venous drainage of thoracic oesophagus

Answer 10

Azygous and systemic

Question 11

Venous drainage of abdominal oesophagus

Answer 11

Left gastric portal overlaps systemic

Question 12

Lymphatic drainage of cervical oesophagus

Answer 12

Deep cervical nodes

Question 13

Lymphatic drainage of thoracic oesophagus

Answer 13

Mediastinal nodes

Question 14

Lymphatic drainage of abdominal oesophagus

Answer 14

Pre-aortic nodes

Question 15

Two types of oesophageal herniations

Answer 15

1) Paraoesophageal histal hernia 2) Sliding hiatal hernia

Question 16

Paraoesophageal histal hernia

Answer 16

Only ~5% of oesophageal hernias. Where proximal stomach pushes through oesophageal hiatus, enters thorax beside oesophagus.

Question 17

Sliding hiatal hernia

Answer 17

Most common form of oesophageal hernia (~95% of cases). Where oesophagus pulls into the thorax, bringing some of the stomach with it.

Question 18

Quadrant where stomach is

Answer 18

LUQ

Question 19

*Stomach in situ

Answer 19

Question 20

*Components of stomach

Answer 20

Question 21

Angular notch

Answer 21

A notch on the lesser curvature of the stomach, separating the body from the pylorus

Question 22

Stomach after the angular notch

Answer 22

Pyloric antrum narrows to the pyloric canal and pyloric sphincter.

Question 23

How does the stomach relate to the liver?

Answer 23

Tethered to the liver by the lesser omentum. Lesser omentum is a serous membrane stretching between the lesser curvature of the stomach and the visceral surface of the liver

Question 24

Name for ridges lining interior of the stomach

Answer 24

Rugae

Question 25

Blood supply of the stomach

Answer 25

Gastric vessels overlie lesser curvature. Gastroepiploic vessels overlie greater curvature. These come from the right and left inferior phrenic arteries, which comes from the aorta.

Question 26

Is the duodenum retro- or intraperitoneal?

Answer 26

Retroperitoneal

Question 27

Primary function of duodenum

Answer 27

Absorption, digestion

Question 28

Name for very first structure in the duodenum

Answer 28

Duodenal cap

Question 29

Significance of duodenal cap

Answer 29

Can get peptic ulcers, because of proximity to gastric acid

Question 30

Parts and lengths of duodenum

Answer 30

1st - 2’ 2nd - 3’ 3rd - 4’ 4th - 1’

Question 31

1st part of duodenum 1 2

Answer 31

1) Arches upwards, backwards to posterior abdominal wall. 2) Associated with right crus, right psoas, medial to right kidney

Question 32

2nd part of duodenum 1 2 3 4

Answer 32

1) Head of pancreas is to the left. 2) Right kidney is to the right. 3) Posteromedial wall has major duodenal papilla about halfway down 4) Mesentary of mesocolon passes over here

Question 33

3rd part of duodenum 1 2 3

Answer 33

1) Passes over right and left psoas 2) Travels over the front of IVC, aorta 3) Superior mesenteric artery and vein travel from aorta, IVC over the top of duodenum

Question 34

4th part of duodenum 1 2

Answer 34

1) Turns upwards, forwards, joining the jejunum in the duodenal-jejunal flexure 2) Attached to left psoas with fibrous tissue

Question 35

Proportions of small intestine that are jejunum and ileum

Answer 35

Jejunum is 1st 40%. Ileum is last 60%

Question 36

Differences between jejunum and ileum 1 2 3 4 5

Answer 36

1) Location - Jejunum is mostly LUQ, ileum is mostly RLQ 2) Lumen of jejunum is wider than ileum 3) More mucosal folds in jejunum (more absorption takes place here) 4) Mesentery of jejunum has less fat than that of the ileum, so vessels are easier to see in the jejunal mesentery 5) Lots of arcadesm short vasa recta in ileum. Shorter arcades and more vasa recta in jejunum

Question 37

Name for where the small intestine becomes the large intestine

Answer 37

Ileo-caecal junction

Question 38

Where does the appendix always begin?

Answer 38

Where the tenia choli join at the caecum

Question 39

Differences between small and large intestines 1 2 3

Answer 39

1) Size 2) Position 3) Small intestine has a continuous longitudinal muscle coat. Large intestine has three discontinuous tenia coli 4) Large intestine has omental appendicies (fat tags)

Question 40

Parts of large intestine 1 2 3 4

Answer 40

1) Caecum 2) Transverse colon 3) Descending colon 4) Sigmoid colon

Question 41

Caecum

Answer 41

Blind pouch hanging below ileo-caecal junction Appendix hangs from here, where tenia coli join

Question 42

Appendix 1 2 3

Answer 42

1) Narrow tube of variable length (~7-10cm) 2) Base is always attached to where the 3 tenia coli join at the caecum. 3) The position of the apex is variable (~25% of the time is pelvic appendix, most of the time is retro-caecal)

Question 43

Transverse colon 1 2

Answer 43

1) Has right colic/hepatic flexure and left colic/splenic flexure. 2) Travels right to left

Question 44

Path of the tenia coli at the rectum

Answer 44

Become continuous