accessory organs of digestion Flashcards
1
Q
what are the boundaries of the parotid region?
A
- superior = zygomatic arch
- inferior = inferior border of mandible
- anterior = masseter muscle
- posterior = external ear and SCM
2
Q
the parotid gland is encapsulated by part of what?
A
investing layer of deep cervical fascia
3
Q
secretions from the parotid gland are transported to the oral cavity by what duct? what is the route of this duct?
A
Stensen Duct — arises from the anterior surface of the gland, transverse the masseter and then pierces the buccinator, moving medially to open put into the oral cavity near the 2nd maxillary molar
4
Q
what gives rise to its 5 terminal branches in the parotid gland?
A
CN VII
5
Q
what happens to the ECA in the parotid gland?
A
gives off the posterior auricular artery and then divides into superfical temproal and the maxillary arteries (its terminal branches)
6
Q
what converge in the parotid gland to form the retromandibular vein?
A
superficial temporal and maxillary veins
7
Q
arterial supply and venous drainage of the parotid gland
A
• arterial supply = posterior auricular and superficial temporal
• venous drainage - retromandibular vein
8
Q
sensory innervation of the parotid gland
A
auriculotemproal nerve (CN V3 branch)
9
Q
what does autonomic innervation of the parotid gland control?
A
saliva production rate
10
Q
parasymapthetic innervation of the parotid gland
A
CN IX — otic ganglion — auriculotemporal nerve — parotid = increases saliva production
11
Q
sympathetic supply of parotid gland
A
superior cervical ganglion (part of paravertebral chain) — fibres travel along ECA - increased activity inhibits saliva production via vasoconstriction)
12
Q
what are some disorders of the parotid gland?
A
• common site of salivary gland tumours : usually benign, such as adenolymphoma
• damage to CN VII — paralysis, loss of tone, sagging and ptosis (inferior eyelid can fall away from the eyeball)
• parotitis — inflammation often due to infection. parotid gland is enclosed in a tough fibrous capsule that limits swelling and produces pain
13
Q
what are the deepest and smallest salivary glands?
A
sublingual
14
Q
the sublingual glands contribute to ____% of overall salivary volume, producing predominantly ______
A
- 3-5%
- mucus
15
Q
what are the sublingual glands bordered laterally and medially by?
A
laterally — mandible
medially — genioglossus muscle of the tongue
16
Q
the sublingual glands form a shallow groove on the medial surface of the mandible known as what?
A
sublingual fossa
17
Q
what pass alongside the medial aspect of the sublingual gland?
A
submandibular duct and lingual nerve
18
Q
both sublingual glands unite anteriorly and form a single mass through a horseshoe configuration around what? what does the superior aspect of this form?
A
- the lingual frenulum
- an elevated, elongate crest of mucous membrane called the sublingual fold (plica sublingualis)
19
Q
each sublingual fold extends from a posterolateral position and transverses anteriorly to join what at the midline, either side of the lingual frenulum?
A
sublingual papillae
20
Q
secretions of the sublingual glands drain into the oral cavity via what ducts?
A
minor sublingual ducts (of Rivinus), of which there are 8-20 excretory ducts per gland
21
Q
where do the excretory ducts of the sublingual glands open out onto?
A
sublingual folds
22
Q
Through anatomical variance, a major ______ duct (of Bartholin) can be present in some people. This large accessory duct arises from the ______ aspect of the _______ gland and then adheres to the passing submandibular duct on its medial side. Drainage then follows the submandibular duct out through the __________ papillae.
A
Through anatomical variance, a major sublingual duct (of Bartholin) can be present in some people. This large accessory duct arises from the inferior aspect of the sublingual gland and then adheres to the passing submandibular duct on its medial side. Drainage then follows the submandibular duct out through the sublingual papillae.
23
Q
A
24
Q
arterial supply and venous drainage of sublingual glands
A
- arterial supply = sublingual (lingual) and submental (facial) arteries, which arise from the ECA
- venous drainage = sublingual (lingual) and submental (facial) veins, which drain into the IJV
25
parasympathetic innervate of sublingual glands in FULL + effects
superior salivatory nucleus —> chorda tympani branch of CN VII —> unifies with lingual branch of CN V3 —> submandibular ganglion
postganglionic innervation consists of:
1) secretomotor fibres — directly induce the gland to produce secretions
2) vasodilator fibres — accompany arteries to increase blood supply
PS innervation INCREASES saliva production
26
sympathetic sublingual gland innervation in FULL + effects
superior cervical ganglion —> vasoconstrictor fibres travel as a plexus on the internal and external carotid, facial and sublingual + submental arteries
increased sympathetic drive reduces glandular blood flow through vasoconstriction and decreases the volume of salivary secretions, resulting in more mucus saliva
27
what kind of secretions do the bilateral submandibular glands secrete?
mixed = both serous and mucous
28
where are the submandibular glands located? (one on each side)
in the anterior part of the submandibular triangle
superior = mandible
anterior = anterior belly of digastric
posterior = posterior belly of digastric
29
what arms does the submandibular gland have?
superficial and deep
30
describe the superficial arm of the submandibular gland
greater portion of the gland lying inferior to the posterior half of the mandible, with ion the submandibular fossa. it is situated outside the boundaries of the oral cavity
31
describe the deep arm of the submandibular gland
hooks around the posterior margin of mylohyoid through a triangular aperture to enter the oral cavity proper. it lies on the lateral surface of hypoglossus, lateral to the root of the tongue
32
via what do secretions from the submandibular gland travel into the oral cavity?
submandibular duct (aka Wharton’s duct)
33
the submandibular duct emerges anteromedially from the ___ arm of the gland between ____, _____ and ______ muslces
- deep
- mylohyoid, hypoglossus and genioglossus muscles
34
where does the submandibular duct open?
opens as 1-3 orifices on a small sublingual papilla (caruncle) at the base of the lingual frenulum bilaterally
35
36
what 3 nerves does the submandibular gland have anatomical relationships with?
lingual nerve, hypoglossal nerve and facial nerve (marginal mandibular branch)
37
vasculature of submandibular gland
- submental artery (branch of facial) and sublingual artery (branch of lingual)
- facial vein (directly into IJV) and sublingual vein (lingual vein then IJV)
38
parasympathetic innervation of submandibular gland in FULL + effects
superior salivatory nucleus —> chorda tympani of CN VII —> this then unifies with lingual branch of CNV3 —> synapses at submandibular ganglion
1) secretomotor fibres — induce gland to produce secretions
2) vasodilator fibres — accompany arteries to increase blood supply
PS PROMOTES SALIVA SECRETION
39
sympathetic innervation of submandibular gland in FULL + effects
superior cervical ganglion —> vasoconstrictor fibres travel as a plexus on the internal and external carotid, facial and submental arteries
increased sympathetic drive reduces glandular blood flow through vasoconstriction and decreases the volume of salivary secretions, resulting in more mucus and enzyme-rich saliva
40
41
what is a calculus or sialolith? what is most susceptible to this out of the salivary ducts and why?
= calcified deposit which can block the lumen of a duct
- submandibular duct most susceptible (80% of all cases) thought to be due to:
1. torturous length (5cm)
2. ascending secretory pathway
3. nature of salivary secretion
42
A = parotid gland
B = parotid duct
C = masseter
2. serous saliva
3. CN IX
4. opposite 2nd upper molar
5. CN VII, ECA, superficial temporal/maxillary arteries, superficial temporal/maxillary/retromandibular veins
43
A = mandible
B = mylohyoid muscle
C = anterior belly of digastric
D = submandibular gland
2. between mylohyoid and hyoglossus muscles
3. mixed = seromucous
4. CN VII
5. floor of mouth at sublingual papilla
44
across what level does the pancreas lie? exception?
transpyloric plane = L1
exception = tail = retroperitoneal organ (deep in upper abdomen in the epigastrium and left hypochondrium regions)
45
what separates the pancreas from the stomach?
lesser sac
46
how does the duodenum lie in relation to the pancreas?
The “C” shaped duodenum curves around and outlines the head of the pancreas. The first part of the duodenum lies anteriorly whereas the second part of the duodenum including the ampulla of Vater lies laterally to the right of the pancreatic head
47
what attaches to the anterior surface of the pancreas?
transverse mesocolon
48
what descends behind the head of the pancreas before opening into the second part of the duodenum alongside the major pancreatic duct through the major duodenal papilla?
common bile duct
49
where is the spleen to the pancreas?
posterior and lateral
50
what is formed from peritoneum and connects the spleen to the tail of the pancreas?
the lineorenal ligament
51
the _____ and inferior vena cava pass ____ to the ___ of the pancreas
- aorta
- posteriorly
- head
52
the _______ artery lies behind the _____ of the pancreas and anterior to the ________ process
- superior mesenteric artery
- neck
- uncinate
53
what unite posterior the neck of the pancreas to form the hepatic portal vein?
splenic and superior mesenteric veins
54
55
A = head
B = neck
C = body
D = tail
E = uncinate process
2. superior mesenteric vein (F) and superior mesenteric artery (G)
3. SMV unites with splenic vein to form the portal vein
4. the SMA arises from the aorta and supplies the structures of the foregut
56
1 . gastroduodenal artery — branch of common hepatic that arises from the coeliac trunk
2. superior pancreaticoduodenal artery — supplies head and uncinate process
3. splenic artery, arises from coeliac trunk — supplies neck, body, and tail of pancreas
4. inferior pancreaticoduodenal artery — arises from superior mesenteric — supplies head and uncinate process
57
what is the only part of the pancreas that is intraperitoneal?
tail
58
describe the pancreatic duct system to the pancreatic duct
- a million ‘berry-like’ clusters of cells (acini) connected by short intercalated ducts
- the intercalated ducts unite with those draining adjacent lobules and drain into a network of intralobular collecting ducts
- these in turn drain into the pancreatic duct
59
the pancreatic duct runs the entire length of the pancreas then unites with what? what does this form?
unites with common bile duct to form the hepatopancreatic ampulla of Vater
60
via what does the hepatopancreatic ampulla of Vater open into the duodenum?
major duodenal papilla
61
Secretions into the duodenum are controlled by a muscular valve – the sphincter of ____. It surrounds the _____________, acting as a valve.
Secretions into the duodenum are controlled by a muscular valve – the sphincter of Oddi. It surrounds the ampulla of Vater, acting as a valve.
62
63
64
mneumonic for pancreatitis causes
GET SMASHED
Gall stones
Ethanol
Trauma
Steroids
Mumps
Autoimmune
Scorpion stings
Hypertriglyceridemia, hypercalcaemia and hyperparathyroidism
ERCP – endoscopic retrograde cholangiopancreatography
Drugs – such as sodium valproate, azathioprine and sulphonamides
65
Pancreatitis creates severe _______ pain which often radiates to the ______, nausea, vomiting and diarrhoea.
- epigastric
- back
66
A = main pancreatic duct
B = bile duct
C = 2nd part of duodenum
2. hepatopancreatic ampulla
3. major duodenal papilla
4. presence of fat in the duodenum leads to the release of cholecystokinin (CCK) which opens the sphincter of Oddi and bile and pancreatic juice can enter
67
what do the superior and inferior pancreaticoduodenal veins drain into?
both — superior mesenteric vein
68
what unites to form hepatic portal vein?
superior mesenteric and splenic veins
69
A = right lobe of liver
B = left lobe of liver
C = gall bladder
D = falciform ligament
2. right hypochondrium and epigastrium
3. ligamentum teres (round ligament) = remnant of umbilical vein
70
1. diaphragmatic
2. visceral
A = right
B = left
C = caudate
D = quadrate
E = gall bladder
F = IVC
71
A = caudate lobe
B = IVC
3. hepatic veins
4. ligamentum venosum = remnant of ductus venosus
5. bare area
72
A = hepatic artery proper
B = portal vein
C = hepatic ducts
2. ligamentum teres/round ligament
3. right kidney
73
A = liver
B = gall bladder
C = right hepatic duct
D = left hepatic duct
E = common hepatic duct
F = bile duct
G = cystic duct
3. H = portal vein , I = hepatic artery
4. portal triad
74
the right and left _____ exit the liver and unite to form the ______ duct which unites with the ____ duct to form the _____ duct
the right and left hepatic ducts exit the liver and unite to form the common hepatic duct which unites with the cystic duct to form the bile duct
75
what makes up the portal triad?
bile duct, portal vein and hepatic artery proper
76
what is the bare area not covered by?
visceral peritoneum
77
what are the left and right coronary ligaments?
reflections of visceral peritoneum extending form the posterior/superior surface of the liver to the diaphragm
78
what are the right and left triangular ligaments?
right/left extremities of coronary ligametns
79
what 2 ligaments does the lesser omentum consist of?
1. hepatoduodenal ligament — free border of lesser omentum that extends from the duodenum to the liver
2. hepatogastric ligament — extends from the lesser curvature of the stomach to the liver
80
what does the hepatoduodenal ligament contain?
bile duct, portal vein and hepatic artery (portal triad)
81
82
what hepatic recesses are there?
subphrenic, subhepatic and Morison’s pouch
83
describe the subphrenic spaces
located between the diaphragm and the anterior and superior aspects of the liver. They are divided into a right and left by the falciform ligament.
84
describe the subhepatic space
a subdivision of the supracolic compartment (above the transverse mesocolon), this peritoneal space is located between the inferior surface of the liver and the transverse colon.
85
describe Morison’s pouch
a potential space between the visceral surface of the liver and the right kidney. This is the deepest part of the peritoneal cavity when supine (lying flat), therefore pathological abdominal fluid such as blood or ascites is most likely to collect in this region in a bedridden patient.
86
87
descirbe the falciform ligament
- attaches the liver to the anterior abdominal wall and divides the liver into the left and right lobes
- it is a broad and thin fold of peritoneum
- divides the subphrenic space into right and left
88
the liver is covered by a fibrous layer, known as what?
Glisson’s capsule
89
what is a remnant of the foetal umbilical vein?
ligamentum teres
90
what is a remnant of foetal ductus venous?
ligamentum venosum
91
what separates the caudate and quadrate lobes?
porta hepatis — transmits all the vessels, nerves and ducts entering or leaving the liver, with the exception of the hepatic veins
92
Microscopically, the cells of the liver (known as _______) are arranged into ________. These are the structural units of the liver.
- hepatocytes
- lobules
93
what drains each lobule of the liver?
a central vein
94
what shape do the liver lobules have? what is at the periphery of these shapes?
Each anatomical lobule is hexagonal-shaped and is drained by a central vein. At the periphery of the hexagon are three structures collectively known as the portal triad:
- Arteriole – a branch of the hepatic artery entering the liver.
- Venule – a branch of the hepatic portal vein entering the liver.
- Bile duct – branch of the bile duct leaving the liver.
95
descirbe the blood supply of the liver
- Hepatic artery proper (25%) – supplies the non-parenchymal structures of the liver with arterial blood. It is derived from the coeliac trunk.
- Hepatic portal vein (75%) – supplies the liver with partially deoxygenated blood, carrying nutrients absorbed from the small intestine. This is the dominant blood supply to the liver parenchyma, and allows the liver to perform its gut-related functions, such as detoxification
96
what do the hepatic veins open into?
IVC
97
describe the hepatic plexus
- innervates the parenchyma of the liver
- sympathetic (greater splanchnic, postganglionic arise at coeliac plexus) and parasympathetic (CNX) nerve fibres
- these fibres enter at the porta hepatis and follow the course of branches of the hepatic artery and portal vein
98
what innervates Glisson’s capsule, the fibrous covering of the liver?
branches of lower intercostal nerves
99
distension of Glisson’s capsule results in what kind of pain?
sharp, well localised pain
100
in what region is the gallbladder?
right hypochondriac
101
where does the gallbladder lie?
in a fossa between the right and quadrate lobes on the inferior aspect of the liver
102
what is the primary function of the gall bladder?
to concentrate and store bile, which is produced by the liver
103
the stored bile, as part of the gustatory response, is released from the gallbladder in response to what?
cholecystokinin (CCK)
104
what entirely surrounds the gallbladder?
peritoneum
105
what are the 3 parts of the gallbladder?
- Fundus – the rounded, distal portion of the gallbladder. It projects into the inferior surface of the liver in the mid-clavicular line
- Body – the largest part of the gallbladder. It lies adjacent to the posteroinferior aspect of the liver, transverse colon and superior part of the duodenum
- Neck – the gallbladder tapers to become continuous with the cystic duct, leading into the biliary tree.
106
what is the name of a mucosal fold in the neck of the gall bladder, that is a common location for gallstones to become lodged, causing cholestasis?
Hartmann’s Pouch
107
label this gall bladder
108
109
vasculature of gall bladder
- cystic artery - branch of right hepatic artery = itself from common hepatic (one of the 3 major branches of the coeliac trunk)
- cystic veins - drain directly into portal vein
110
innervation to gall bladder
- coeliac plexus — sympathetic and sensory
- PS — CN X
111
Parasympathetic stimulation produces contraction of the gallbladder, and the secretion of bile into the _____ duct due to relaxation of the sphincter of ____. The majority of this response however, is mediated by circulating ______ as part of the gustatory response.
Parasympathetic stimulation produces contraction of the gallbladder, and the secretion of bile into the cystic duct due to relaxation of the sphincter of Oddi. The majority of this response however, is mediated by circulating cholecystokinin as part of the gustatory response.
112
add anatomy wrap up stuff once done
ew
113
The head (including ucinate process) of the pancreas are supplied by the ______________________. The remainder of the pancreas is supplied by the _____________
The head (including ucinate process) of the pancreas are supplied by the superior and inferior pancreaticoduodenal arteries. The remainder of the pancreas is supplied by the splenic artery.
114
The superior pancreaticoduodenal artery is a branch of the gastroduodenal artery. From which vessel does the gastroduodenal artery arise?
hepatic artery
115
From which vessel does the inferior pancreaticoduodenal artery arise?
superior mesenteric artery
116
in which of the 9 abdominal regions is a healthy liver located in?
right hypochondriac, epigastric, left hypochondriac
117
118
From which vessel does the cystic artery usually arise?
right hepatic
119
The cystic artery is usually located in the triangle between the inferior border of the liver, cystic duct and common hepatic duct.
What is the name given to this triangle?
Calot’s triangle
120
what section of the duodenum has the ampulla of vater?
descending
121
where does the horizontal duodenum extend?
abdominal aorta to IVC
122
where is the duodenum connected to the liver?
superior part by hepatoduodenal ligament
123
where is the duodenum connected to the back of the abdominal wall and by what?
ascending part by suspensory ligament of Treitz
124
summarise blood supply of duodenum
superior pancreaticoduodenal (anterior and posterior) = from gastroduodenal artery
inferior pancreaticoduodenal = from SMA
