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ANATOMY SEM 4 > accessory organs of digestion > Flashcards

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
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2
Q

the parotid gland is encapsulated by part of what?

A

investing layer of deep cervical fascia

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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

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4
Q

what gives rise to its 5 terminal branches in the parotid gland?

A

CN VII

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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)

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6
Q

what converge in the parotid gland to form the retromandibular vein?

A

superficial temporal and maxillary veins

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7
Q

arterial supply and venous drainage of the parotid gland

A

• arterial supply = posterior auricular and superficial temporal
• venous drainage - retromandibular vein

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8
Q

sensory innervation of the parotid gland

A

auriculotemproal nerve (CN V3 branch)

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9
Q

what does autonomic innervation of the parotid gland control?

A

saliva production rate

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10
Q

parasymapthetic innervation of the parotid gland

A

CN IX — otic ganglion — auriculotemporal nerve — parotid = increases saliva production

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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)

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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

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13
Q

what are the deepest and smallest salivary glands?

A

sublingual

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14
Q

the sublingual glands contribute to ____% of overall salivary volume, producing predominantly ______

A
  • 3-5%
  • mucus
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15
Q

what are the sublingual glands bordered laterally and medially by?

A

laterally — mandible
medially — genioglossus muscle of the tongue

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16
Q

the sublingual glands form a shallow groove on the medial surface of the mandible known as what?

A

sublingual fossa

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17
Q

what pass alongside the medial aspect of the sublingual gland?

A

submandibular duct and lingual nerve

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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)
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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

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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

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21
Q

where do the excretory ducts of the sublingual glands open out onto?

A

sublingual folds

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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.

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23
Q
A
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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
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25
Q

parasympathetic innervate of sublingual glands in FULL + effects

A

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

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26
Q

sympathetic sublingual gland innervation in FULL + effects

A

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

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27
Q

what kind of secretions do the bilateral submandibular glands secrete?

A

mixed = both serous and mucous

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28
Q

where are the submandibular glands located? (one on each side)

A

in the anterior part of the submandibular triangle

superior = mandible
anterior = anterior belly of digastric
posterior = posterior belly of digastric

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29
Q

what arms does the submandibular gland have?

A

superficial and deep

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30
Q

describe the superficial arm of the submandibular gland

A

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

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31
Q

describe the deep arm of the submandibular gland

A

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

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32
Q

via what do secretions from the submandibular gland travel into the oral cavity?

A

submandibular duct (aka Wharton’s duct)

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33
Q

the submandibular duct emerges anteromedially from the ___ arm of the gland between ____, _____ and ______ muslces

A
  • deep
  • mylohyoid, hypoglossus and genioglossus muscles
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34
Q

where does the submandibular duct open?

A

opens as 1-3 orifices on a small sublingual papilla (caruncle) at the base of the lingual frenulum bilaterally

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35
Q
A
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36
Q

what 3 nerves does the submandibular gland have anatomical relationships with?

A

lingual nerve, hypoglossal nerve and facial nerve (marginal mandibular branch)

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37
Q

vasculature of submandibular gland

A
  • submental artery (branch of facial) and sublingual artery (branch of lingual)
  • facial vein (directly into IJV) and sublingual vein (lingual vein then IJV)
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38
Q

parasympathetic innervation of submandibular gland in FULL + effects

A

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

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39
Q

sympathetic innervation of submandibular gland in FULL + effects

A

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

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40
Q
A
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41
Q

what is a calculus or sialolith? what is most susceptible to this out of the salivary ducts and why?

A

= 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
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42
Q
A

A = parotid gland
B = parotid duct
C = masseter

  1. serous saliva
  2. CN IX
  3. opposite 2nd upper molar
  4. CN VII, ECA, superficial temporal/maxillary arteries, superficial temporal/maxillary/retromandibular veins
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43
Q
A

A = mandible
B = mylohyoid muscle
C = anterior belly of digastric
D = submandibular gland

  1. between mylohyoid and hyoglossus muscles
  2. mixed = seromucous
  3. CN VII
  4. floor of mouth at sublingual papilla
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44
Q

across what level does the pancreas lie? exception?

A

transpyloric plane = L1

exception = tail = retroperitoneal organ (deep in upper abdomen in the epigastrium and left hypochondrium regions)

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45
Q

what separates the pancreas from the stomach?

A

lesser sac

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46
Q

how does the duodenum lie in relation to the pancreas?

A

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

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47
Q

what attaches to the anterior surface of the pancreas?

A

transverse mesocolon

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48
Q

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?

A

common bile duct

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49
Q

where is the spleen to the pancreas?

A

posterior and lateral

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50
Q

what is formed from peritoneum and connects the spleen to the tail of the pancreas?

A

the lineorenal ligament

51
Q

the _____ and inferior vena cava pass ____ to the ___ of the pancreas

A
  • aorta
  • posteriorly
  • head
52
Q

the _______ artery lies behind the _____ of the pancreas and anterior to the ________ process

A
  • superior mesenteric artery
  • neck
  • uncinate
53
Q

what unite posterior the neck of the pancreas to form the hepatic portal vein?

A

splenic and superior mesenteric veins

54
Q
A
55
Q
A

A = head
B = neck
C = body
D = tail
E = uncinate process

  1. superior mesenteric vein (F) and superior mesenteric artery (G)
  2. SMV unites with splenic vein to form the portal vein
  3. the SMA arises from the aorta and supplies the structures of the foregut
56
Q
A

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
Q

what is the only part of the pancreas that is intraperitoneal?

A

tail

58
Q

describe the pancreatic duct system to the pancreatic duct

A
  • 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
Q

the pancreatic duct runs the entire length of the pancreas then unites with what? what does this form?

A

unites with common bile duct to form the hepatopancreatic ampulla of Vater

60
Q

via what does the hepatopancreatic ampulla of Vater open into the duodenum?

A

major duodenal papilla

61
Q

Secretions into the duodenum are controlled by a muscular valve – the sphincter of ____. It surrounds the _____________, acting as a valve.

A

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
Q
A
63
Q
A
64
Q

mneumonic for pancreatitis causes

A

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
Q

Pancreatitis creates severe _______ pain which often radiates to the ______, nausea, vomiting and diarrhoea.

A
  • epigastric
  • back
66
Q
A

A = main pancreatic duct
B = bile duct
C = 2nd part of duodenum

  1. hepatopancreatic ampulla
  2. major duodenal papilla
  3. 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
Q

what do the superior and inferior pancreaticoduodenal veins drain into?

A

both — superior mesenteric vein

68
Q

what unites to form hepatic portal vein?

A

superior mesenteric and splenic veins

69
Q
A

A = right lobe of liver
B = left lobe of liver
C = gall bladder
D = falciform ligament

  1. right hypochondrium and epigastrium
  2. ligamentum teres (round ligament) = remnant of umbilical vein
70
Q
A
  1. diaphragmatic
  2. visceral

A = right
B = left
C = caudate
D = quadrate
E = gall bladder
F = IVC

71
Q
A

A = caudate lobe
B = IVC
3. hepatic veins
4. ligamentum venosum = remnant of ductus venosus
5. bare area

72
Q
A

A = hepatic artery proper
B = portal vein
C = hepatic ducts

  1. ligamentum teres/round ligament
  2. right kidney
73
Q
A

A = liver
B = gall bladder

C = right hepatic duct
D = left hepatic duct
E = common hepatic duct
F = bile duct
G = cystic duct

  1. H = portal vein , I = hepatic artery
  2. portal triad
74
Q

the right and left _____ exit the liver and unite to form the ______ duct which unites with the ____ duct to form the _____ duct

A

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
Q

what makes up the portal triad?

A

bile duct, portal vein and hepatic artery proper

76
Q

what is the bare area not covered by?

A

visceral peritoneum

77
Q

what are the left and right coronary ligaments?

A

reflections of visceral peritoneum extending form the posterior/superior surface of the liver to the diaphragm

78
Q

what are the right and left triangular ligaments?

A

right/left extremities of coronary ligametns

79
Q

what 2 ligaments does the lesser omentum consist of?

A
  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
Q

what does the hepatoduodenal ligament contain?

A

bile duct, portal vein and hepatic artery (portal triad)

81
Q
A
82
Q

what hepatic recesses are there?

A

subphrenic, subhepatic and Morison’s pouch

83
Q

describe the subphrenic spaces

A

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
Q

describe the subhepatic space

A

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
Q

describe Morison’s pouch

A

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
Q
A
87
Q

descirbe the falciform ligament

A
  • 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
Q

the liver is covered by a fibrous layer, known as what?

A

Glisson’s capsule

89
Q

what is a remnant of the foetal umbilical vein?

A

ligamentum teres

90
Q

what is a remnant of foetal ductus venous?

A

ligamentum venosum

91
Q

what separates the caudate and quadrate lobes?

A

porta hepatis — transmits all the vessels, nerves and ducts entering or leaving the liver, with the exception of the hepatic veins

92
Q

Microscopically, the cells of the liver (known as _______) are arranged into ________. These are the structural units of the liver.

A
  • hepatocytes
  • lobules
93
Q

what drains each lobule of the liver?

A

a central vein

94
Q

what shape do the liver lobules have? what is at the periphery of these shapes?

A

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
Q

descirbe the blood supply of the liver

A
  • 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
Q

what do the hepatic veins open into?

A

IVC

97
Q

describe the hepatic plexus

A
  • 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
Q

what innervates Glisson’s capsule, the fibrous covering of the liver?

A

branches of lower intercostal nerves

99
Q

distension of Glisson’s capsule results in what kind of pain?

A

sharp, well localised pain

100
Q

in what region is the gallbladder?

A

right hypochondriac

101
Q

where does the gallbladder lie?

A

in a fossa between the right and quadrate lobes on the inferior aspect of the liver

102
Q

what is the primary function of the gall bladder?

A

to concentrate and store bile, which is produced by the liver

103
Q

the stored bile, as part of the gustatory response, is released from the gallbladder in response to what?

A

cholecystokinin (CCK)

104
Q

what entirely surrounds the gallbladder?

A

peritoneum

105
Q

what are the 3 parts of the gallbladder?

A
  • 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
Q

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?

A

Hartmann’s Pouch

107
Q

label this gall bladder

A
108
Q
A
109
Q

vasculature of gall bladder

A
  • 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
Q

innervation to gall bladder

A
  • coeliac plexus — sympathetic and sensory
  • PS — CN X
111
Q

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.

A

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
Q

add anatomy wrap up stuff once done

A

ew

113
Q

The head (including ucinate process) of the pancreas are supplied by the ______________________. The remainder of the pancreas is supplied by the _____________

A

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
Q

The superior pancreaticoduodenal artery is a branch of the gastroduodenal artery. From which vessel does the gastroduodenal artery arise?

A

hepatic artery

115
Q

From which vessel does the inferior pancreaticoduodenal artery arise?

A

superior mesenteric artery

116
Q

in which of the 9 abdominal regions is a healthy liver located in?

A

right hypochondriac, epigastric, left hypochondriac

117
Q
A
118
Q

From which vessel does the cystic artery usually arise?

A

right hepatic

119
Q

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?

A

Calot’s triangle

120
Q

what section of the duodenum has the ampulla of vater?

A

descending

121
Q

where does the horizontal duodenum extend?

A

abdominal aorta to IVC

122
Q

where is the duodenum connected to the liver?

A

superior part by hepatoduodenal ligament

123
Q

where is the duodenum connected to the back of the abdominal wall and by what?

A

ascending part by suspensory ligament of Treitz

124
Q

summarise blood supply of duodenum

A

superior pancreaticoduodenal (anterior and posterior) = from gastroduodenal artery

inferior pancreaticoduodenal = from SMA

ANATOMY SEM 4 (12 decks)

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