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alimentary Flashcards

1
Q

What does the oral cavity consist of?

A

Vestibule & oral cavity proper

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2
Q

What is the oral cavity proper?

A

Alveolar arches to palatoglossal folds

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3
Q

What is the vestibule?

A

space between lips/cheeks & teeth

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4
Q

Extent of nsaopharynx?

A

Choana to soft plate

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5
Q

Extent of oropharynx?

A

Soft plate to epiglottis

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6
Q

Extent of laryngopharynx?

A

post to larynx - epiglottis to top of trachea

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7
Q

Walls of pharynx?

A

mucosa + 3 verically overlapping constrictor muscles.

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8
Q

What is in the foregut?

A

Oesophagus, stomach, duodenum (to just below greater duodenal papilla), organs formed in the mesentaries of foregut (pancreas, spleen, liver, gall bladder & ducts)

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9
Q

What is the midgut?

A

Duodenum (from just below greater duodenal papilla), jejunum, ilieum, caecum, appendix, ascending colon, right 2/3 transverse colon

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10
Q

What is the hindgut?

A

Left 1/3 (approx) transverse colon, descending colon, sigmoid colon, rectum & most of anal canal

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11
Q

What is the microstructure of the alimentary canal?

A

Mucosa:

  • epithelium, glands, lamina propria, muscularis mucosa
  • submucosa: connective tissue
  • external muscle: usually inner circular and outer longitudinal
  • either adventitia: connecting ti surrounding fascia or
  • serosa - peritoneum
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12
Q

Extend of oesophagus?

A

C6-T11

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13
Q

What is posterior to the oesophagus?

A

Vertebral column,

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14
Q

What is anterior to the oesophagus?

A

Trachea, bronchi, pericardium & left atrium

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15
Q

What gives the oesphagus the characteristic appearance of longitudinal streaks?

A

Outer longitudinal layer of external muscle

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16
Q

Nerves to oesophagus?

A

Vagus and sympathetic trunk ? form oesophageal plexus.

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17
Q

How long is abdominal part of oesophagus?

A

1cm

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18
Q

Where does abdominal oesophagus lie?

A

Groove on posterior surface of liver.

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19
Q

How does the abdominal oesophagus attach to the diaphragm?

A

The gastrophrenic ligament. Attaches to posterior diaphragm.

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20
Q

What does the gastrophrenic ligament attach to?

A
  • Abdominal oesophagus
  • Fundus of stomach
  • Diaphragm
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21
Q

What does the gastrocolic ligament attach to?

A
  • Greater curvature of the stomach
  • Anterior part of transverse colon
  • First part duodenum
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22
Q

What does the gastrosplenic ligament attach to?

A
  • Greater curvature of the stomach

- Spleen

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23
Q

What are the constrictions in the oesphags?

A
  1. Upper sphincter - cricopharyngeus
  2. At level of arch of aorta
  3. At left of left primary bronchus
  4. At level of oesophageal hiatus - lower sphincter.
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24
Q

What does the lower oesophagel sphincter consist of?

A
  • specialised circular muscle in wall if oesophagus - maintained by tone of myentric plexus
  • muscle of right crus forms external sphincter - tightens during inspiration or when intraabdominal pressure is increased.
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25
Q

In the development of the gut, the ___ is attached to the posterior body wall by a_____. The stomach and first (foregut) part of the duodenum are attached to the ____ by a _____

A

entire abdominal part of the gut tube, dorsal mesentary, anterior body wall, ventral mesentary

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26
Q

What forms in the ventral mesentery?

A

The liver, the biliary system & ventral pancreas.

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27
Q

The part of the ventral mesentery ___ to the liver forms the ____

A

anterior, falciform ligament

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28
Q

The part of the ventral mesentery which is between the ____ ____ and _____ ______ will form the ____ ___

A

liver anteriorly, stomach posteriorly, less omentum

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29
Q

Dorsal mesentery forms?

A

Mesentery, mesoappendix, transverse mesocolon, sigmoid mesocolon

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30
Q

What forms in the dorsal mesentery?

A

Dorsal pancreas, spleen

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31
Q

What happens to the mesentery around retroperitoneal organs?

A

dorsal mesentery fuses with posterior body wall and is obliterated (fixation of the intestines)

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32
Q

MIdpart of duodenum (in development) is attached to what?

A

Dorsal mesentery to posterior abdominal wall.

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33
Q

What is the greater omentum?

A

Double fold of peritoneum, attached tp greater curvature of stomach and first part of the duodenum and transverse mesocolon.

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34
Q

Appearance of greater omentum.

A

Hangs down to cover anterior surface of abdominal organs. Grainy appearance - fatty regions separated by translucent fat free regions. Accumulations of macrophages, may be recognised with eye in unembalmed tissue as whitish, opaque, ‘milk spots’

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35
Q

Development of greater omentum

A

Initially a double layer but layers fuse. Transverse mesocolon becomes attached to posterior surface.

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36
Q

Function of greater omentum

A

Thought to be protective (macrophages & other immune cells) and also because it adhere to areas of peritoneal damage and inflammation.

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37
Q

Lesser omentum

A

fold of peritoneum that extends from lesser curvature of stomach to posterior surface of liver. also has grainy fat.

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38
Q

What run in the lesser omentum just to the left of the free edge?

A

Hepatic artery, portal vein and bile duct (with lymph vessels and nerves)

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39
Q

Where is the lesser sac? function?

A

Space posterior to stomach and lesser omentum. Allows for movement & expansion of the stomach.

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40
Q

Greater sac?

A

rest of peritoneal cavity, (besides the lesser sac)

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41
Q

What connects the greater and lesser sacs?

A

The epiploic foramen

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42
Q

What is the stomach bed?

A

Posterior wall of lesser sac. includes retroperitoneal structures such as upper pole of left kidney & left suprarenal , diaphragm, part of spleen, pancreas, part of transverse mesocolon (which attaches to pancreas as well as greater omentum)

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43
Q

What is the function of the stomach?

A

Food storage and predigestion

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44
Q

Features of stomach.

A

HIghly distensible. cardia, fundus (fairly fixed). body, pyloric part (antrum, canal, sphincter). Rugae - temporary longitudinal folds. Mucosa has glands that produce mucus in cardia, pyloric part. Different glands in fundus and body which produce digestive enzymes and HCl.

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45
Q

Relationships of stomach?

A

Anterior - liver diaphragm

Posterior - omental bursa & structures of stomach bed

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46
Q

What controls gastric emptying of stomach?

A

Stretch, endocrine

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47
Q

Where is cardiac orifice (stomach)?

A

Level of 7th costal cartilage (attaches at ziphosteral joint and is about 3cm from midline)

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48
Q

Ligament that attaches Greater curvature of stomach to spleen?

A

Gastrosplenic

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49
Q

LIgament that attaches greater curvature of stomach to diaphragm?

A

Gastrophrenic

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50
Q

Small intestine.

A

Pyloris to ileocaecal valve. Duodenum, jejunum,ileum.

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51
Q

Small intestine function?

A

Digestion and absorption of nutrients

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52
Q

First part of duodenum. Relations.

A

superior part - attached to greater and lesser omentum. Portal vein and bile duct are posterior. Quadrate lobe of liver and gall bladder are anterior.

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53
Q

Second part of duodenum. Relations.

A

Descending part - head of pancreas is medial. Hilum of right kidney is posterior.

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54
Q

Third part of duodenum. Relations.

A

Horizontal part. Upper RIGHT psoas is posterior. Superior mesenteric vessels are anterior.

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55
Q

Fourth part of duodenum. Relations.

A

Ascending part. Upper LEFt posas is posterior.

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56
Q

At what level is the duodenojejunal junction?

A

Level of L2 just medial to Left kidney. Easy to recognise by appearance of mesentary to support jejunum.

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57
Q

At what level is the duodenojejunal junction?

A

Level of L2 just medial to Left kidney. Easy to recognise by appearance of mesentery to support jejunum.

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58
Q

Flexures in the duodenum?

A

Superior duodenal, inferior duodenal, duodenaljejunal

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59
Q

Jejunum

A

2/5 of length (of j+i) Largely in umbilical region.

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60
Q

Ilium

A

3/5 of length, mainly in lower abdomen and pubic regions.

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61
Q

Where does the root of mesentary run from?

A

Upper left to lower right. Fan shaped so intestinal edge is long.

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62
Q

What is the attachement of the mesentary for the jejunum and ilium to the posterior abdominal wall called?

A

Root of mesentary

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63
Q

Internal features of of jejunum & ilium.

A

Internal transverse folds - permanent. Mucosa with villi, THIN muscularis mucosae, submucosa and THICK external muscle.

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64
Q

What is the mesentary?

A

2 layers of peritoneum containing variably fatty CT & carrying vessels & nerves in & out of gut. also lymph nodes

65
Q

Jejunum.

A

mesentary: long vasa recta, relatively few side to side anastomoses (arcades) joining vasa recta. Less fatty mesentary. Thicker walled, more vascular. Folds larger and longer. Villi longer. Aggregated lymph follicles (payers patches) FEW & aggregations small.

66
Q

Ilium.

A

Shorter vasa recta, more arcades, more fat in mesentary. Folds decrease and almost disappear in distal part. Thinner wall. More peyers patches.

67
Q

Large intestine parts. Function?

A

Caecum and appendix, ascending, transverse, descending colon, sigmoid colon, rectum, anus. Absorption of water and ions.

68
Q

Features of large intestine.

A

Sacculations/haustra (regular expanded areas of colon interspersed with constrictions. Taenia coli (3 thickenings on longitudinal part of external muscle - not present in appendix and rectum junction). Epiploic/emntal appendices (not on caucum, present TV and sigmoid). No villi in large int.

69
Q

The Caecum is found in the __ ___ ___. It is a _____ intestinal _____(_ ____). Suspended from ascending colon.

A

Right iliac fossa, blind, pouch, no mesentary.

70
Q

Where is junction of caecum and ascending colon?

A

level of ileocaecal valve.

71
Q

Edges of ileoceacal valves?

A

Frenulae. (tightens)

72
Q

What is the gastroileal reflex?

A

food in stomach initiates contration of small intestine and thus expulsion of ileal contents into caecum.

73
Q

Where is the appendix found?

A

Often in the retrocaecal recess (behind caecum) or hanging down over pelvic brim, close to opening of uterine tube in females.

74
Q

Opening of appendix is where?

A

McBurneys point - junctino of lateral and middler thirds of line from umbilicus with ASIS.

75
Q

Is the appendix suspended?

A

Yes. on mesoappendix which is attached to ileal mesentary.

76
Q

Is the caecum suspended?

A

Yes. but no mesentary.

77
Q

What are features of the appendix?

A

Ring of lymphatic nodules in mucosa & submucosa. No taenia coli, no epiploic appendices.

78
Q

Extent if the ascending colon?

A

From ileocaecal valve to right colic flexure.

79
Q

Relations of ascending colon?

A

Anterior to right kidney & descending duodenum. Posterior to fundus of gall bladder.

80
Q

Is the transverse colon retroperiotoneal?

A

Usually described as retropreitoneal but up to 50% of individuals have a very SHORT mesentery (no mobility)

81
Q

Where does transverse mesocolon attach?

A

Greater omentum, pancreas, transverse colon.

82
Q

The _____ attaches the ___ colic flexure to ______.

A

Phrenicocolic ligament, left, diaphragm.

83
Q

Where is the left colic flexure located?

A

In front of left kidney and below Spleen and Pancreas.

84
Q

Which ligaments provide support for the spleen?

A

Splenocolic & phrenicocolic

85
Q

Extent of descending colon?

A

Left colic flexure to pelvic inlet.

86
Q

What structures do the descending colon cross?

A

Gonadal (testicular/ovarian) vessels and external iliac vessels.

87
Q

Sigmoid colon extent.

A

Pelvic brim to S3. (approx middle of sacrum)

88
Q

Is the sigmoid suspended?

A

Yes. Sigmoid mesocolon forms and inverted V. There is a intersigmoidal recess behind sigmoid mesocolon.

89
Q

What lies behind sigmoid mesocolon?

A

intersigmoidal recess

90
Q

What are the relations of the sigmoid mesocolon?

A

Overlies left ureter & external iliac vessels.

91
Q

Rectum features.

A

Retroperitoneal, no sacculations, no epiploic appendices, no taenia.

92
Q

Extent of the rectum

A

S3 to pelvic diaphragm

93
Q

Relations of the rectum

A

Post: Sacrum, coccyx, pelvic diaphragm
Lat: Pelvic diaphragm, sigmoid colon, ilium
Ant: male: rectovesicular pouch then base of bladder, seminal vesicles, ductus deferens, prostate. female: rectouterine pouch then uterus, vagina

94
Q

Anal canal features

A

Upper part- 6-10 vertical folds or columns. Lower ends columns joined by transverse folds - valves. Spaces between columns are sinuses.

95
Q

What is the extent of the anal canal?

A

From top of columns to anus.

96
Q

What are the relations of the anal canal?

A

Posterior: Annococcygeal ligament (dense Ct from coccyx to anal margin)
Anterior: perineal body + membranous urethra/bulb of penis OR vagina.
Lateral: ischiorectal fossa

97
Q

What are the regions of the pancreas?

A

Head and uncinate process (within curve of duodenum), Body (triangular in profile with transverse mesocolon attached to ANTERIOR angle), Tail.

98
Q

What is the peritoneal realtions of the rectum?

A

Upper 1/3 - on anterior and sides
Middle 1/3 - on anterior only
Lower 1/3 - no peritoneum

99
Q

What are the features of the pancreas? where is it>

A

12-15cm long. duodenum to spleen behind stomach. retroperitoneal apart from tail in splenorenal ligament.

100
Q

What marks the junction of the anal canal and the rectum?

A

Rectoanal junction: Sling of skeletal muscle (puborectalis), at level of the top of the columns, narrower than ampulla.

101
Q

What is the mucosa of the anal canal?

A

Transition from simple columnar epithelium (as rectum), to transitional zone of non-keratinised stratified squamous to skin (keratinised). Transition zone begins below pectinate line.

102
Q

Where does the transition zone begin?

A

Below pectinate line/Mucocutaneous junction.

103
Q

What are the sphincters in the anal canal?

A

Internal - upper 2/3 - thickened circular layer of external smooth muscle (stops at junction with skin).
External - lower 2/3 - skeletal muscle. 3 parts. Partly reflex, partly voluntary.

104
Q

What is the movement of BOLUS?

A

slow rhythmic movements. 1-3 hours in stomach, 1-6 hours in small intestine - segmenting contractions & peristalsis from one end to the other (motilin). Gastrocolic reflex: ileum –> Large intestine

105
Q

what controls Continence (bowels)?

A
  • muscle tone in Sphincters & puborectalis. (stimulated by SYMPATHETIC nerves) keep anus closed. Tone noramlly increases when intraabdominal pressure rises
  • Puborectalis - tone pulls upper part of anal canal forward and presses on upper part of external sphincter.
  • reverse peristalsis
  • relaxation of muscle wall of rectum & sigmoid
106
Q

What is the control of the gastrocolic reflex?

A

Parasymp nervous system , gut homones e.g. motilin

107
Q

What triggers defecation? What happens during defecation?

A

Rectal stretching. Prior to defecation feces pases into ampulla and held until voided. Defecation reflex from MEDULLA oblongata. Relaxation of sphincters & puborectalis. Peristalsis in descending and sigmoid colon increases. Contration of abdominal muscles and diaphragm –> increases abdominal pressure.

108
Q

What triggers defecation? What happens during defecation?

A

Rectal stretching. Prior to defecation feces pases into ampulla and held until voided. Defecation reflex from MEDULLA oblongata. Relaxation of sphincters & puborectalis. Peristalsis in descending and sigmoid colon increases. Contration of abdominal muscles and diaphragm –> increases abdominal pressure. Feces from splenic flexure down is voided

109
Q

From where in the alimentary canal is feces voided?

A

From splenic flexure (descending colon) down.

110
Q

What is the function of the pancreas?

A

Exocrine - digestive enzymes

Endocrine - islets of Langerhans

111
Q

What do the pancreatic buds look like intitally?

A

Series of branching epithelial lined tubules arising from distal foregut.

112
Q

What will the tubules in the pancreatic buds form?

A

Pancreatic ducts, acini develop by further growth later. Iselts arise from tubule cells - lie in CT between tubules.

113
Q

Which way does the ventral pancreas rotate?

A

Posteriorly.

114
Q

Which duct remains as the main pancreatic duct?

A

Ventral duct. Most of dorsal duct rearanges to drain into this

115
Q

What is the minor pancreatic duct from?

A

Part of dorsal duct nearest to duodenum.

116
Q

What does the ventral pancreatic bud become?

A

Inferior head and uncinate process

117
Q

Relations of head and uncinante process (pancreas)

A

IVC and Aorta are posterior.

118
Q

Relations of body of pancreas.

A

Anterosuperior surface faces lesser sac & the anteroinferior surface the greater sac

119
Q

Which surface of the pancreas faces the lesser sac?

A

Anterosuperior

120
Q

What attaches to the anterior angle of the pancreas?

A

Transverse mesocolon

121
Q

What might the main pancreatic duct and bile duct join to form?

A

hepatopancreatic ampulla

122
Q

Describe the distribution of ducts within the pancreas.

A

“herringbone” pattern of LOBAR ducts draining into the main pancreatic duct.

123
Q

How can you tell the difference between a spleen and kidney?

A

Kidney - visceral/hilar surface is pointed. Spleen is flattened. Spleen also has notched anterior border.

124
Q

Function of the spleen?

A

Red pulp - Haemolytic (breaks down RBC)

White pulp - lymphoid tissue (production of lymphocytes and immunosurveilance)

125
Q

Where does the spleen develop? (LAYER)

A

In the mesenchyme (connective tissue) of the dorsal mesentery as MULTIPLE primordia with own blood supply. Then fuse to form lobulated structure - seen as notching on ext surface especially the superior border.

126
Q

Why are accessory spleens common?

A

Start of as multiple primordia in fetus which then fuse to form single spleen. Could be result of unsuccessful fusing.

127
Q

The spleen is initially a ____ organ but is later colonised by ___ cells.

A

Haemopoitic, lymphoid

128
Q

True or False: The anterior border is often notched in the spleen.

A

FALSE: the superior border (sometimes inferior)

129
Q

Where is the spleen located?

A

Related to Left ribs 9-11. Long axis parallel to rib 10. Upper left posterior region of stomach between fundus of stomach and diaphragm

130
Q

Is the spleen suspended?

A

Yes. But splenorenal and gastrosplenic ligaments.

131
Q

What are the surfaces of the spleen?

A

Diaphragmatic, visceral (with impressions).

132
Q

What are the borders of the spleen?

A

Superior (most common site of notching), inferior, anterior (often SHARP), posterior (often ROUNDED)

133
Q

What are the impressions on the spleen?

A

Gastric (broad, concave impression ABOVE hilus), Pancreatic (small, may not be visible) & colic (anteriorly, BELOW hilus), Renal (posterior, Below hilus)

134
Q

What forms the colic impression on the spleen?

A

The left (splenic flexure)

135
Q

What impression on the spleen is posterior and below the hilus?

A

Renal impression

136
Q

TRUE or FALSE: Different cells in the liver are needed to carry out the many functions.

A

FALSE: one cell type - hepatocyte

137
Q

What is the cell of the liver?

A

Hepatocyte.

138
Q

What are the functions of the liver?

A

Complex exocrine (bile) and endocrine gland and metabolic organ. Also detoxification.

139
Q

What is the exocrine function of the liver?

A

Produces bile which is involved in digestion of fats. Contains bile pigments from breakdown of RBC in spleen.

140
Q

What is metabolic function of liver?

A

Especially protein and carbs.

141
Q

What is endocrine function of liver?

A

Release of glucose, plasma proteins etc into blood.

142
Q

Where is the Liver located?

A

Under the lower right ribs and diaphragm. Extends from level of 5th rib to costal margin. Gall bladder protrudes from below its lower surface at about level of 9th costal cart and linea semilunaris.

143
Q

What are the features of the liver?

A

Largest organ (1.5 kg approx) - approx 2% body weight in adults, 5% in kids. HIGHLY vascular

144
Q

What are the surfaces of the liver?

A

Diaphragmatic and visceral. Covered with peritoneum except sites of attachments of ligaments.

145
Q

What are the anatomical lobes of the liver?

A

Left, right, caudate (superior), quadrate (inferior)

146
Q

How is right liver separated from left?

A

Line drawn up through fossa for gall bladder.

147
Q

What are the functional lobes of the liver?

A

Left (with caudate and quadrate). Right. On the basis of supply by right or left hepatic arteries.

148
Q

What are the ligaments of the liver?

A

Coronary ligament, Left and right triangular ligaments on either side, falciform ligament, lesser omentum.

149
Q

What is the place on the liver called that lacks peritoneum?

A

Bare area.

150
Q

The ___ ligament derived from ____ mesentery, extends from ____ surface of liver to ____ abdominal wall

A

Falciform, ventral, anterior, anterior

151
Q

Where do they coronary and triangular ligaments attach?

A

Attaches superior liver to right dome and central tendon diaphragm. BARE AREA (lacks peritoneum)

152
Q

Where does the lesser omentum attach?

A

From lesser curvature of stomach & first part of duodenum to surround porta hepatis & then superiorly into fissure for ligamentum VENOSUM. Finally attached to diaphragm and surrounds osephagus.

153
Q

What are the fissures in the liver?

A

Fissure for ligamentum venosum (between L and caudate), fissure for ligamentum teres.(between l and quadrate)

154
Q

What is the hilum of the liver known as?

A

Porta hepatis, marks lower edge pf lesser omentum.

155
Q

What are the remnants of the left feotal umbilical vein?

A

Ligamentum venosum and teres.

156
Q

Function of the left umbilical vein

A
  • brought OXYGEN RICH blood from the placenta to fetal IVC - mostly bypassed the liver apart from a connection to the left branch of the portal vein which collected oxygen rich blood to nourish the liver.
157
Q

Function of the gall bladder?

A

Sore, concentrate and transport bile.

158
Q

Gall bladder location.

A

In fossa on post. surface of right hepatic lobe.

159
Q

Ducts - biliary system

A

Left and right hepatic ducts join to form common hepatic duct. That joins cystic duct to form bile duct.

visceral (12 decks)

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