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Anatomy Flashcards

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1
Q

What is the length of the pharynx? diameter?

A

12 cm in total; widest at the epipharynx and narrowest at the laryngopharynx

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2
Q

Which part of the pharynx transmits both food and air?

A

Oropharynx/Mesopharynx

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3
Q

Which parts of the pharynx transmits air only?

A

Nasopharynx and Laryngopharynx

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4
Q

Location of the nasopharynx

A

found posterior to the nasal cavities

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5
Q

Location of the oropharynx

A

found posterior to the oral cavity

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6
Q

Location of the laryngopharynx

A

found posterior to the opening of the larynx and posterior surface of the larynx

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7
Q

Which part of the pharynx is non-collapsible?

A

Nasopharynx / Epipharynx

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8
Q

What are the boundaries of the pharynx?

A

Roof: Base of skull, Sphenoid and Occipital bone
Anterior: Continuous with nasal and oral cavities and pharynx
Base: Continuous with esophagus [lower border of C6] and lower border of cricoid cartilage
Posterior: Prevertebral layer of deep cervical fascia

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9
Q

What structure separates the pharynx from the cervical fascia?

A

Prevertebral layer of deep cervical fascia

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10
Q

What are the 8 attachments points of the pharyngeal wall?

A

Medial Pterygoid plate
Pterygoid hamulus
Pterygomandibular raphe
Mandible
Tongue
Hyoid Bone
Thyroid cartilage
Cricoid cartilage

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11
Q

What structures form the roof of the nasopharynx?

A

Body of sphenoid bone
Basilar portion of occipital bone

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12
Q

What structure is found at the posterior-superior portion of the Nasopharynx?

A

Pharyngeal tonsils/adenoids

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13
Q

What structure forms the floor of the nasopharynx?

A

Soft Palate

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14
Q

What passage forms the communication between the nasopharynx and oropharynx

A

Pharyngeal isthmus, which is found posterior to the soft palate

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15
Q

What structure forms the anterior wall of the nasopharynx?

A

Choanae [post nasal aperture]

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16
Q

What structure forms the posterior wall of the nasopharynx?

A

Superior pharyngeal constrictor [muscle]

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17
Q

What structures are found on the posterior wall of the nasopharynx?

A

Nasopharyngeal tonsils/adenoid
Pharyngeal bursa

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18
Q

Describe the histological changes seen in the gastroesophageal junction?

A

Abrupt epithelial transition from non-keratinized stratified squamous to simple columnar cells

Cardiac glands are present

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19
Q

What are cardiac glands?

A

Mucous secreting glands found in the mucosa [specifically in the lamina propria]

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20
Q

What type of epithelial cells line the esophagus?

A

Non-keratinized stratified squamous epithelium

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21
Q

Describe the adventitia of the esophagus

A

Its CT merges with the CT of the surrounding structures, as it passes around them, giving it support and supplying it with BV

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22
Q

Why is the esophagus lined superficially by adventitia not by serosa?

A

It is not covered by mesothelium [as it doesn’t push through a serous-lined cavity]

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23
Q

What type of CT is found in the submucosa of the esophagus?

A

Areolar CT [+ elastic fibers that assist in closing the distended tube]

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24
Q

What is found in the submucosa of the esophagus?

A

Areolar CT
BV
Mucous glands

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25
Q

Describe the changes seen in the Muscular Externa throughout the length of the esophagus?

A

Superior 1/3- Skeletal Muscle
Middle 1/3- Skeletal and Smooth muscle
Inferior 1/3- Smooth Muscle

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26
Q

Describe the structure of the Muscular externa?

A

Inner circular and outer longitudinal muscles

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27
Q

In order from deep to superficial, what are the layers that make up the esophagus [histology]?

A

Lumen of Esophagus
Mucosa
Muscularis mucosa [part of the mucosa]
Submucosa
Muscularis externa
Adventitia

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28
Q

What type of muscle is the muscularis mucosae?

A

Smooth muscle

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29
Q

Where are stem cells found in the esophagus?

A

In the stratum basale

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30
Q

What innervates the esophagus?

A

Esophageal nerve plexus

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31
Q

What nerves form the esophageal plexus?

A

Vagal trunks
Thoracic Sympathetic trunks
Periarterial plexuses
Middle Cervical ganglion

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32
Q

What is the parasympathetic supply to the esophagus?

A

Dorsal Vagal nuclei
Afferent fibers whose cell bodies are in the inferior ganglion of the vagi- for reflexes

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33
Q

What are the branches of the vagal trunks?

A

Anterior and Posterior gastric branches

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34
Q

How do the thoracic sympathetic trunks supply the esophagus?

A

Via Greater and Lesser abdominopelvic splanchnic nerves [T5-T12 spinal segments]

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35
Q

What structures are found around the periarterial plexus?

A

around the left gastric and inferior phrenic arteries

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36
Q

What part of the esophagus does middle cervical ganglion innervate?

A

The upper part

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37
Q

What innervates the lower part of the esophagus exclusively?

A

T1-T4 fibers

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38
Q

What innervates the striated muscles of the esophagus?

A

Vagus nerve [nucleus ambiguous]

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39
Q

What innervates the smooth muscles of the esophagus\?

A

Vagus nerve [dorsal vagal nucleus]

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40
Q

What nerve is responsible for the general sensation in the esophagus?

A

Vagus nerve

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41
Q

What are the two types of sympathetic fibers supplying the esophagus?

A

Postganglionic fibers [cell bodies in sympathetic ganglion]

Afferent fibers for pain [cell bodies in DRG]

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42
Q

What is responsible for pain signals and mechanosensory signaling?

A

Sympathetic nerves
Vagal Afferents

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43
Q

What is responsible for coordination distal esophagus peristalsis with relaxation of LES during swallowing?

A

It is mediated by intrinsic nitrergic inhibitory neurons under vagal control

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44
Q

What group of lymph nodes does lymph drain into in cases of cancer of the lower esophagus?

A

Mediastinal lymph nodes

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45
Q

Where does lymph from the cervical part of the esophagus drain into?

A

Lymph from cervical part → Inferior deep cervical lymph nodes

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46
Q

Where does lymph from the thoracic part of the esophagus drain into?

A

Lymph from thoracic part → posterior mediastinal lymph nodes

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47
Q

Where does lymph from the Lower 1/3 and Abdominal part of the esophagus drain into?

A

Lymph from Lower 1/3 + AbdominaL → Left gastric lymph nodes → efferent vessel of left gastric nodes → celiac lymph nodes

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48
Q

Where do veins from the thoracic part of the esophagus drain into?

A

Hemiazygous veins → Azygous vein

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49
Q

Where do veins from the cervical part of the esophagus drain into?

A

Inferior thyroid veins

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50
Q

Where do veins from the abdominal part of the esophagus drain into?

A

2 ways: Mucosal submucosal veins
→ left gastric veins → portal venous system
→ esophageal veins → hemi/azygous veins → systemic venous system

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51
Q

Where do we have porto-caval anastomosis in the esophagus?

A

Anastomosis between left gastric veins tributaries + azygous veins tributaries

Gastric veins = portal system
Azygous vein = systemic vein system

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52
Q

What is hiatus hernia?

A

Condition that involves expansion of the esophageal hiatus and herniation of the stomach through the diaphragm into mediastinum

Either asymptomatic or associated with GERD

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53
Q

What are the types of hiatus hernia?

A

Sliding type
Para-esophageal
Mixed type

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54
Q

What is a complication of Para-esophageal hernias?

A

Obstruction or necrosis of herniated stomach

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55
Q

What is the more common type of hiatus hernia?

A

Sliding [90%]

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56
Q

In what population is hiatus hernias more common?

A

Obese and elderly people

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57
Q

Define a physiological sphincter?

A

A tubular structure that functions as a sphincter even though it does not have sphincter muscles

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58
Q

What type of Sphincter is the gastroesophageal sphincter?

A

Physiological sphincter

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59
Q

What is another name for the gastroesophageal sphincter?

A

Cardiac Sphincter

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60
Q

What is a surgical marker for the gastroesophageal sphincter in adults?

A

A fat pad found over the anterior surface of the junction. it is visible beneath the peritoneum

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61
Q

Where is the gastroesophageal junction found?

A

left to the T11 vertebrae on horizontal plane that passes through the tip of the xiphoid process [left 7th intercostal cartilage]

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62
Q

Surgically, what designates the gastroesophageal junction?

A

A z-jagged line that demarcates the sudden epithelial changes

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63
Q

What type of muscle is the muscular wall of the abdominal esophagus?

A

Smooth muscles

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64
Q

What forms the lower esophageal sphincter?

A

Narrowing of the diaphragmatic musculature, forming esophagal hiatus

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65
Q

Describe the shape of the abdominal esophagus?

A

Trumpet shaped [1.25 cm], broader at the cardiac orifice as compared to the diaphragmatic aperture

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66
Q

Where is the abdominal esophagus found?

A

Left of midline behind 7th costal cartilage, enter the abdomen through esophageal hiatus at T10. Ends at gastroesophageal junction

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67
Q

Which structure is found anterior to the abdominal esophagus?

A

Left lobe of liver

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68
Q

Which structures are found posterior to the abdominal esophagus?

A

Left Crus
Left Inferior phrenic vessels
Left Greater and Lesser Splanchnic nerves

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69
Q

Describe the right border of the abdominal esophagus

A

Continuous with the lesser curvature of the stomach

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70
Q

What separates the abdominal esophagus from the stomach?

A

Cardiac notch separates the left border of the esophagus from the fundus of the stomach

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71
Q

What structures are found in the CT and visceral peritoneum that lines the surface of the Abdominal esophagus?

A

Anterior and Posterior Vagus nerves
Esophageal branches of the left gastric vessels

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72
Q

What is the gastroesophageal ligament?

A

Ligament that attaches the margins of the muscular esophageal hiatus to the diaphragm

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73
Q

What forms the gastroesophageal ligament?

A

Two circumferential layers of elastin-rich CT and smooth muscle fibers

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74
Q

Describe the inferior layer of the gastroesophageal ligament

A

Thin and loosely attached to the esophagus
Extension of sub peritoneal transversalis fascia below diaphragm

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75
Q

Describe the superior layer of the gastroesophageal ligament

A

Thicker [more elastin] and runs cranially and obliquely to fuse firmly with the wall of the esophagus

Continuous with sub pleural end-thoracic fascia above diaphragm

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76
Q

Function of Gastroesophageal ligament?

A

Anchors esophageal to crural muscle fibers of diaphragm
Limits upward and downward mobility of the esophagus within the hiatus

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77
Q

What forms the Gastrophrenic ligament?

A

Peritoneal reflection posterior to esophagus and continues directly onto posterior surface of fundus of stomach

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78
Q

What structures are found in the Gastrophrenic ligament?

A

Esophageal branches of Left Gastric vessels
Celiac branches of Posterior Vagus

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79
Q

Which ligament also forms a mesentery to the abdominal esophagus?

A

Gastrophrenic ligament

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80
Q

Which part of the esophagus is a common site of cancer

A

Natural constrictions [Cervical, Thoracic and Diaphragmatic constrictions]

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81
Q

What are the three natural constrictions in the esophagus?

A

Cervical constriction
Thoracic constriction
Diaphragmatic constriction

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82
Q

What forms the cervical constriction of the esophagus?

A

Cricopharyngeus muscle

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83
Q

What esophageal constriction is referred as the UES?

A

Cervical constriction of the esophagus

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84
Q

Where does the cervical constriction of the esophagus begin at?

A

Pharyngoesophageal junction, 15 cm away from incisors

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85
Q

What forms the thoracic constriction?

A

1- Arch of aorta [22.5 cm away from incisors, seen anteroposterior]

2- Left main bronchus [27.5 cm away from incisors, seen laterally]

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86
Q

What forms the diaphragmatic constriction of the esophagus?

A

As it passes through the esophagus hiatus of diaphragm [40 cm from incisor teeth]

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87
Q

Describe the two curvatures of the esophagus

A

1- Curves to the left at the thoracic [T1]
2- Curves to the left at T7

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88
Q

Describe the two curvatures of the esophagus

A

1- Curves to the left at the thoracic [T1]
2- Curves to the left at T7

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89
Q

What structures are found to the left of the esophagus?

A

Thoracic duct

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90
Q

What structures are found on each side of the esophagus?

A

Thyroid Lobes

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91
Q

What structures are found anterior to the esophagus?

A

Trachea
Thyroid
Recurrent Laryngeal nerve

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92
Q

What structures are found posterior to the esophagus?

A

Vertebral column
Prevertebral muscles

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93
Q

Boundaries of the esophagus

A

Extends from lower border of criocoid cartilage [C6] to gastroesophageal junction

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94
Q

What is the length of the esophagus? Diameter?

A

25 cm long, ~ 2cm diameter

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95
Q

What structures are found anterior to the thoracic esophagus?

A

Trachea
Right pulmonary artery
Pericardium
Left Atrium
Left Bronchus

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96
Q

What structures are found posterior to the thoracic esophagus?

A

Vertebral column
Thoracic duct
Azygous vein
Thoracic aorta

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97
Q

What is the phrenicoesophageal ligament?

A

an extension of the inferior diaphragmatic fascia

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98
Q

What is the function of the phrenicoesophageal ligament?

A

Connects esophagus flexibly to the diaphragm and permits independent movement of each structure during respiration and swallowing [+ limits upward movement of esophagus]

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99
Q

What type of cells line the epithelium of the pharynx?

A

Non-keratinized stratified squamous epithelium

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100
Q

What are the histological characteristic of the pharnyx

A

NKS-squamous epithelium
Prominent elastic fibers in LP
Striated muscles
No muscularis mucosa
No submucosa

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101
Q

Where do all arteries that supply the pharynx originate from?

A

External carotid artery

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102
Q

What vessels supply the pharynx?

A

Ascending Pharyngeal
Ascending Palatine artery
Tonsillar branch
Dorsal lingual
Greater Palatine
Pharyngeal
Pterygoid

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103
Q

Which artery that supplies the pharynx is a branch of the facial artery?

A

Ascending palatine
Tonsillar branch

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104
Q

Which artery that supplies the pharynx is a branch of the maxillary artery?

A

Greater palatine
Pharyngeal
Pterygoid artery

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105
Q

Which artery that supplied the pharynx is a direct branch of the External carotid artery?

A

Ascending pharyngeal artery

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106
Q

Which artery that supplies the pharynx is a branch of the lingual artery?

A

Dorsal lingual artery

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107
Q

Where does lymph collected from the pharynx drain into?

A

→ retropharyngeal and deep cervical lymph nodes

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108
Q

Where does the pharyngeal plexus drain into?

A

IJV and Facial veins

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109
Q

What are the three outer circular muscle layers of the pharynx?

A

Superior, Middle and Inferior Constrictor

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110
Q

What are the three longitudinal muscles of the pharynx?

A

Salpingopharyngeus
Palatopharyngeus
Stylopharyngeus

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111
Q

What forms the pharyngeal raphe?

A

when muscles of the pharynx course posterolaterally to the midline and meet forming this raphe

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112
Q

What are the two parts of the inferior constrictor?

A

Thyropharyngeus and Cricopharyngeus muscles

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113
Q

What lines the constrictor muscles internally?

A

Pharyngobasilar fascia

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114
Q

What lines the constrictor muscles externally?

A

Buccopharyngeal fascia

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115
Q

What is the action of the superior constrictor muscle

A

contributes to closing oropharyngeal isthmus and pushes bolus down

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116
Q

Describe the structure of the superior constrictor muscle

A

quadrilateral thin muscle, palest

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117
Q

What is the action of the middle constrictor muscle?

A

contributes to pushing food bolus down

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118
Q

Describe the structure of the middle constrictor muscle

A

Fan-shaped muscle

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119
Q

What is the significance of the middle constrictor muscle?

A

forms part of floor of carotid triangle of neck

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120
Q

What structures are found lateral to the origin of the middle constrictor muscle?

A

Hyoglossus muscle
Posterior belly of digastric muscle
Stylohoid muscle

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121
Q

Describe the structure of the inferior constrictor muscle

A

thickest of the constrictor muscles

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122
Q

What is the significance of the inferior constrictor muscle?

A

Form floor of carotid triangle [same as middle constrictor]
related to medial surface of lobe of thyroid gland

123
Q

What is the action of the inferior constrictor muscle?

A

contributes to pushing the food bolus down

124
Q

What is the significance of the two origins of the inferior constrictor muscle?

A

Thyropharyngeal part : propulsive in action

Cricopharyngeal part: acts as a sphincter of the lower pharynx

Thyropharyngeal contracts to push food down while cricopharyngeal relaxes to accept the food bolus into the esophagus

125
Q

What nerve innervates the inferior constrictor muscle?

A

Thyropharyngeus portion: Pharyngeal plexus
Cricopharyngeal portion: recurrent laryngeal nerve

126
Q

Which part of the inferior constrictor is considered weak? Why?

A

Lower part of thyropharngeal as its not covered by another constrictor muscle

127
Q

What is the Killian’s triangle?

A

triangular area in muscular wall of pharynx between the cricopharynxgeus and thyropharyngeus,

128
Q

What is the anatomical abnormality causing Zenker’s diverticulum?

A

When thyropharyngeal portion of the inferior constrictor contracts, the cricopharnygeus does not relax due to neuromuscular incoordination [each has separate innervation]

129
Q

What is Killian’s dihiscence?

A

location of minor resistance [lower part of thyropharyngeus]

130
Q

What is trotter’s triad?

A

conductive deafness
Ipsilateral paralysis of soft palate
Trigeminal neuralgia

131
Q

What causes Trotter’s triad?

A

Nasopharyngeal carcinoma invading laterally into the sinus of Morgagni

132
Q

What structure pass through the gap formed between the base of the skull and the pharyngeal aponeurosis?

A

Sinus of Morgagni

133
Q

What structures pass through the sinus of Morgagni?

A

Auditory tube
Levator veli palatine
Ascending palatine artery
Palatine branch of ascending pharyngeal artery

134
Q

What structures pass through the gap formed between the super and middle constrictor muscles?

A

Glossopharyngeal nerve
Stylopharyngeus muscle

135
Q

What structures pass through the gap formed between the middle and inferior constrictor muscle?

A

Internal laryngeal nerve
Superior Laryngeal vessels

136
Q

What structures pass below the inferior constrictor muscle?

A

Inferior laryngeal nerve
Inferior laryngeal vessels

137
Q

What is the function of the three longitudinal muscles of the pharynx?

A

Elevate pharynx and larynx during swallowing [shorten pharynx during swallowing and speaking]

138
Q

What innervates the three longitudinal muscles?

A

Salpingopharynx + Palatpharynz = Vagal neve via pharyngeal plexus

Stylopharyngeus = glossopharyngeal nerve [CN 9]

139
Q

Describe the clinical presentation of a patient presenting with Vagal nerve injury

A

Dysphagia
uvula will move to the contralateral side
Muscle of the soft palate will fall to raise ipsilateral to the injured nerve

140
Q

What is the parasympathetic supply of the pharynx?

A

secreto-motor from facial nerve passing through lesser palatine nerve

141
Q

What forms the pharyngeal nerve plexus?

A

Cranial part of accessory through pharyngeal branch of
vagus

Pharyngeal branch of glossopharyngeal nerve

Pharyngeal branch of superior cervical ganglion of sympathetic trunk lie on the middle constrictor m

142
Q

What supplies sensory innervation to the pharynx?

A

Nasopharynx - Pharyngeal branch of CN5 V2 [maxillary division of trigeminal nerve]

Oropharynx- CN IX [glossopharyngeal]

Laryngopharynx- CN X [Internal branch of superior laryngeal nerve]

143
Q

What are the layers of the pharynx from the inside to the outside?

A

Mucosa
Submucosa
Pharyngobasilar fascia [pharyngeal aponeurosis]
Overlapping Muscular layers
Buccopharyngeal fascia

144
Q

What innervates the laryngopharynx?

A

Glossopharyngeal and Vagus nerves [sensory]

145
Q

What structures are found on the lateral walls of the nasopharynx?

A

Pharyngeal opening of auditory tube
Tubal elevation
Tubal tonsils
Pharyngeal recess
Salpingopalatine fold [anteiorly]
Salpinopharyngeal fold [posteriorly]

146
Q

Where are the tubal tonsils found?

A

In the submucosa covering the end of the auditory tube

147
Q

What is the pharyngeal recess?

A

small depression in lateral wall behind the tubal elevation

148
Q

What structures are found to deep to the lateral walls of the nasopharynx?

A

Tensor veli palatini
Levator veli palatini
Salpingopharyngeal
Pharyngobasilar fascia

149
Q

What innervates the nasopharynx?

A

pharyngeal branch of pterygopalatine ganglion

150
Q

What is mucosa of the nasopharynx lined by?

A

Ciliated columnar to pseudo stratified epithelium

151
Q

What is the most common site of nasopharyngeal carcinoma?

A

Pharyngeal recess

152
Q

What type of epithelium lines the oropharynx?

A

NKSS

153
Q

What innervates the roof of the oropharynx?

A

Glossopharyngeal and Vagus nerves [same as laryngopharynx]

154
Q

What forms the roof of the oropharynx?

A

Soft palate and Pharyngeal isthmus

155
Q

What forms the floor of the oropharynx?

A

Posterior 1/3 of tongue
Area between tongue and anterior aspect of epiglottis

156
Q

What forms the anterior wall of the oropharynx?

A

oropharyngeal isthmus/ mouth opening

157
Q

What forms the posterior wall of the oropharynx?

A

Pharyngeal constrictor muscle [supported by body of C2 and Upper part of C3]

158
Q

What forms the lateral walls of the oropharynx?

A

from anterior to posterior:
Palatoglossal arch
tonsillar fossa
Palatppharyngeal arch

159
Q

What structures are found on the lateral surface of the palatine tonsils?

A

Tonsillar arteries
Internal carotid a.
External palatine vein
Para tonsillar vein

160
Q

What are the tonsillar arteries?

A

facial
ascending palatine
ascending pharyngeal
lesser palatine

161
Q

What structures are found on the medial surface of the palatine tonsils?

A

Tonsillar cavities [tonsillar crypts and Intratonsillar cleft/pits]

162
Q

What are palatine tonsils?

A

Two lymphoid tissue masses found in the triangular sinus/palatine fossa, which is on the lateral wall of the oropharynx.

163
Q

What covers the palatine tonsils?

A

covered by the mucous membrane with thickening on the lateral surface, the capsule and mucous tonsillar gland

164
Q

What are the superior and inferior boundaries of the laryngopharnyx?

A

Superiorly: Upper border of epiglottic cartilage
Inferiorly: lower border of cricoid cartilage [C6]

165
Q

What is a common site for lodging of foreign bodies?

A

Piriform fossa on the posterior larynx [lateral wall of laryngopharynx]

166
Q

What passes through the piriform fossa?

A

internal laryngeal nerve

167
Q

What forms the anterior wall of the laryngopharynx?

A

Inlet of the larynx and posterior surface of the larynx (cricoid cartilage and arytenoid cartilage)

168
Q

What forms the posterior wall of the laryngopharynx?

A

Pharyngeal constrictor muscles and bodies of C3 –C6 cervical vertebrae

169
Q

What forms the lateral walls of the laryngopharynx?

A

Thyroid cartilage and associated structures.

Piriform recess (Fossa) on each side of the posterior larynx

170
Q

What arteries provide an additional supply to the posterior surface of the esophagus?

A

branches of upper short gastric arteries

reinforced by terminal arteries from the esophageal branches of the thoracic aorta

occasionally an ascending branch of the posterior gastric artery

171
Q

Describe the path of the esophageal branches of the left gastric artery?

A

Ascend beneath the visceral peritoneum to
supply perforating branches to the intramural
and submucosal plexuses.

172
Q

Describe the branching that gives off esophageal branches of left gastric artery

A

Esophageal branches of left gastric artery a branch of
celiac trunk and left inferior phrenic artery

173
Q

Where do esophageal arteries arise from?

A

inferior thyroid
Thoracic aorta
intercostal arteries
phrenic
left gastric

174
Q

Pharyngeal bursa??

A

Attachment of cranial end of Notocord;

Rarely cartilaginous tumor

Pharyngeal hypophysis (remnant of Rathke’s pouch of stomodeum

175
Q

How long are the small intestines?

A

6-7m long

176
Q

What is the terminal ileum?

A

Distal 30 cm of the ileum

177
Q

Where are the Jejunum and Ileum found?

A

Jejunum is Proximal 2/5 and ileum is the distal 2/3 to the duodena-jejunal junction

178
Q

Where is the the Gastroduodenal junction found?

A

at L1

179
Q

What are the part of the duodenum and how long is each part?

A

1st part [5 cm]
2nd part [7.5 cm]
3rd part [10 cm]
4th part [2.5 cm]

180
Q

What is the function of M cells?

A

Take up microorganism from lumen and discharge into intracellular space near CD4+ T lymphocytes

181
Q

Where are M cells found?

A

Overlies Peyer’s patch

182
Q

Describe the structure of M cells?

A

Microfolds not microvilli

183
Q

Where are intermediate cells found?

A

In the lower half of intestinel glands

184
Q

What is the function of intermediate cells?

A

can convert into other types of cells

185
Q

Where are Enteroendocrine cells found?

A

Concentrated at lower portion of intestinal glands

186
Q

What is the function of Enteroendocrine cells?

A

secretes CCK, Secretin. GIP, Motilin, somatostatin and Histamine

187
Q

What is the function of Paneth cells?

A

regulate normal bacterial flora of the small intestines [contain anti-bacterial enzymes- lysozyme and alfa-defensins]

188
Q

Where are paneth cells found?

A

At the base of intestinal glands

189
Q

What intestinal cells are found at the lower portion of glands?

A

Paneth cells
Enteroendocrine cells
Intermediate cells

190
Q

What is the function of Goblet cells?

A

Secrete mucous

191
Q

Describe the distribution of Goblet cells throughout the intestines?

A

incidence increases from duodenum to ileum

192
Q

Describe the structure of goblet cells

A

Mucinogen granules accumulate in Golgi cisternae

193
Q

Describe the structure of Paneth cells

A

Contain basophilic cytoplasm, supranuclear Golgi, and intensely acidophilic secretory granules (c.f.)

194
Q

What cells are found in the lamina propria of the small intestines?

A

Plasma cells
Macrophages
Mast cells

195
Q

What is the length of the rectum?

A

12 cm

196
Q

What is the rectum?

A

last part of the large intestines that is a continuation of the sigmoid colon [at S3] and then continues as the Anal canal

197
Q

Where is the rectum found?

A

in the true pelvis

198
Q

What is the function of the rectum?

A

Temporary storage of feces

199
Q

What features distinguishes the rectum from the colon?

A

No tenia coli
No sacculation
No omental appendices

200
Q

What is tenia coli?

A

Thickening of longitudinal muscle layer

201
Q

What are sacculations?

A

outwards pockets of gut wall

202
Q

What are omental appendices?

A

fat-filled peritoneal pockets

203
Q

What forms the base of the ischioanal fossae?

A

Skin and Fascia

204
Q

What forms the apex of the ischioanal fossae?

A

Meeting of the medial and lateral walls

205
Q

What forms the posterior boundaries of the ischioanal fossae?

A

Lower border of gluteus Maximus
Sacrotuberous ligament

206
Q

What forms the anterior boundaries of the ischioanal fossae?

A

Posterior border of the Perineal membrane
Bodies of the Pubic bones [inferior to origin of puborectalis]

207
Q

What is the main function of the large intestines?

A

Water absorption and feces storage

208
Q

What forms the lateral wall of sischioanal fossae?

A

Vertical wall:
Ischium + overlapping inferior part of obturator interns covered with obturator fascia and obturator foramen
Medial surface of the ischial tuberosity below the attachment of the opt. fascia

209
Q

What forms the sacral flexors of the rectum?

A

follows curve of sacrum and coccyx

210
Q

What forms the anorectal flexure of the rectum?

A

formed by Tone of puborectalis muscle

211
Q

What significantly contributes to fecal continence?

A

tone of puborectalis muscle

212
Q

What are the permanent mucosal folds in the rectum?

A

Superior, Middle and Inferior transverse rectal folds

213
Q

What type of curvatures are seen in the rectum?

A

3 lateral curvatures
Anteroposterior curvate [concavity anteriorly]

214
Q

What lateral curvatures are seen in the recum?

A

3 lateral curvatures [2 towards the left and 1 towards the right] LRL

215
Q

What supports the ampulla of the rectum?

A

Levator ani muscle

216
Q

What is the ampulla of the recum?

A

Final segment of rectum that is located between the middle and inferior flexures. It is continuous with the anal canal.

217
Q

What is the function of the ampulla of the recum?

A

Relaxes and expands to accumulate and temporarily stores feces until defecation occurs

218
Q

What structures are found anterior to the rectum in males?

A

Sigmoid colon
Ileum
Fundus of urinary bladder
Lower parts of ureters
Ductus Deferens
Seminal vesicles
Prostate glands

219
Q

What structures are found anterior to the rectum in females?

A

Sigmoid colon
Ileum
Lower part of the Uterus
Vagina
Urinary bladder
Lower parts of ureters

220
Q

What does the rectovesical septum separate?

A

Found in males between the fundus of the bladder and Ampulla of the rectum

221
Q

What does the rectouterine pouch separate?

A

Found in females between the posterior part of the fornix and the cervix

222
Q

What structures are found posterior to the rectum?

A

Lies against inferior 3 sacral vertebra + coccyx
Piriformis muscles
Coccygeus muscles
Levator ani muscles
Anococcygeal ligament
Median sacral vessels
Inferior end of sympathetic trunks
Sacral plexus and nerves

223
Q

What artery supplies the proximal part of the rectum?

A

Superior rectal artery

224
Q

What artery supplies the middle and inferior parts of the rectum?

A

Middle rectal artery

225
Q

What artery lies posterior to the rectum?

A

Median sacral artery

226
Q

What artery supplies the anorectal junctions and anal canals?

A

Inferior rectal artery

227
Q

What artery does the median sacral artery branch off of?

A

Aorta [direct branch]

228
Q

What artery does the inferior rectal artery branch off of?

A

inferior pudendal arteries

229
Q

What artery does the middle rectal artery branch off of?

A

Internal iliac arteries

230
Q

What artery does the superior rectal artery branch off of?

A

Continuation of inferior mesenteric artery

231
Q

What is mainly responsible for the venous drainage of the rectum?

A

through rectal venous plexus

232
Q

Where does the superior rectal vein drain into?

A

Superior rectal vein → portal venous system

233
Q

Where do the middle and inferior rectal veins drain into?

A

→ internal iliac vein → IVC

234
Q

Where does the median sacral vein drains into?

A

→ internal iliac veins

235
Q

What is a portocaval anastomosis in female [rectum]

A

In the wall of the anal canal:
Uterovaginal plexus

236
Q

What is a rectal portocaval anastomosis in males?

A

In the wall of the anal canal:
Vesical plexus

237
Q

What are the two part of the rectal plexus? Where are they found?

A

Internal rectal venous plexus [deep to mucosa]
External rectal venous plexus [external to muscular wall of anal canal]

238
Q

What provides sympathetic innervation to the rectum?

A

Lumbar splanchnic nerve
Sacral splanchnic nerves

239
Q

What arteries and nerves form the periarterial plexus found in the rectym?

A

Postganglionic fibers of the sacral splanchnic nerves

Inferior mesenteric artery
Superior rectal artery

240
Q

What is the role of the sympathetic supply to the rectum?

A

inhibitory to colonic muscles

241
Q

What provides parasympathetic supply to the rectum?

A

S2-S4 via pelvic splanchnic nerve to inferior hypogastric plexus

242
Q

What is the role of the parasympathetic supply to the rectum?

A

Postganglionic neurons innervate glands and muscles

243
Q

What is the role of the visceral afferent fibers to the rectum?

A

conveys sensation of rectal filings
involved in reflection propulsive activity

244
Q

What provides visceral afferent fibers to the rectum?

A

parasympathetic fibers retrogradely to sacral dorsal root ganglia (mostly S1 and S2)

245
Q

describe the lymphatic drainage of the lower rectum

A

→ internal iliac nodes [follows internal rectal a.] → presacral nodes [follows median sacral a.]

246
Q

Describe the lymphatic drain of the rectum and anal canal / above dentate line

A

Intramural lymph → pararectal nodes → lymphatics along superior rectal artery → lymphatics along inferior mesenteric artery → pre-aortic nodes

247
Q

What structures can be palpated anteriorly in a digital rectal exam?

A

Cervix [f]
Prostate + Seminal vesicle [m]

248
Q

What structures can be palpated posteriorly in a digital rectal exam?

A

Sacrum
Coccyx

249
Q

What cells line the epithelium of the rectum?

A

Simple columnar epithelium

250
Q

How long is the anal canal?

A

2.5-3.5 cm

251
Q

What is the anal canal?

A

Terminal portion of the large intestines that lies in the perineum and extends from the superior aspect of the pelvic diaphragm to the anus. It remains collapsed, except during passage of feces

252
Q

What two structures surround the anal canal?

A

Internal and External anal sphincters

253
Q

What is the anus?

A

external outlet of the alimentary tract

254
Q

Describe the structure of the anal canal?

A

Begins at anorectal junction, then descends posteroinferiorly between the anococcygeal ligament and the perineal body and ends at the anus

255
Q

What is the anorectal junction?

A

Rectal ampulla narrows as the level of the u-shaped sling formed by the puborectalis muscle

256
Q

What muscle forms the anorectal junction?

A

Puborectalis muscle

257
Q

What structure is found posterior to the anal canal?

A

Anococcygeal ligament

258
Q

What structure is found lateral to the anal canal?

A

Ischioanal fossae

259
Q

What is the function of ischioanal fossae?

A

supports the pelvic viscera and allows distension of anal canal during defecation

260
Q

What structures pass through the ischioanal fossa?

A

inferior rectal vessels and nerves

261
Q

What structures are related to the anal canal inferiorly?

A

Perianal fat

262
Q

What structures are related to the anal canal anteriorly in males?

A

Perineal body
Urogenital diaphragm
Membranous part of urethra
Bulb of penis

263
Q

What structures are related anteriorly to the anal canal in females?

A

Perianal body
Urogenital diaphragm
Lower part of vagina

264
Q

What is the perineal body?

A

Fibromuscular structure that serves as attachment for several msucles

265
Q

Which of the anal sphincters is voluntary and involuntary?

A

Internal → involuntary
External → voluntary

266
Q

Which parts of the anal canal does the internal anal sphincter surround?

A

Superior 2/3 of anal canal

267
Q

Which parts of the anal canal does the external anal sphincter surround?

A

Inferior 2/3 of anal canal

268
Q

What are the three part of the external anal sphincter?

A

Deep
Superficial
Subcutaneous

269
Q

What are the anterior and posterior attachments of the external anal sphincter?

A

Anterior : perineal body
Posterior: coccyx via anococcygeal ligament

270
Q

Relation of the external anal sphincter and puborectalis

A

E. anal sphincter blends superiorly with puborectalis

271
Q

What are the other names of the pectinate line?

A

Dentate line
Mucocutaneous junction

272
Q

What is the pectinate line?

A

Inferior comb-shaped limit of the anal valves forms an irregular line indicates the junction of superior part of anal canal and inferior part

273
Q

What is the significance of pectinate line?

A

Demarcates superior visceral endodermal hindgut and inferior somatic proctoderm ectodermal parts of anal canal.

274
Q

What is the anorectal junction?

A

the point where the wide rectal ampulla abruptly narrows as it traverses pelvic diaphragm,

275
Q

What demarcates the anorectal junction?

A

it is indicated by the superior ends of anal columns where the rectum joins the anal canal

276
Q

What is the anal verge?

A

junction on the outside of the anus of hair-bearing and non hair-bearing skin

277
Q

What is Hiltons’ white line?

A

anocutaneous intersphincteric groove indicates the line of attachment of perianal fascia externally.

278
Q

What are anal columns?

A

series of mucosal longitudinal ridges extending from the anorectal junction in the superior half of the anal canal,

279
Q

What structures are contained in the anal columns?

A

Superior rectal arteries and veins

280
Q

Where are anal valves found?

A

Inferior end of the anal column

281
Q

What are anal sinuses?

A

Small recesses where ducts of mucous anal glands open. It is found superior to the valves into

282
Q

What role does anal sinuses play in defecation?

A

When compressed by feces, anal sinuses exude mucus, which aids in evacuation of feces from anal canal

283
Q

What artery supplies the upper part of the anal canal?

A

Superior rectal artery [continuation of the inferior mesenteric artery]

284
Q

What artery supplies the lower part of the anal canal?

A

Inferior rectal artery [branch of internal pudendal artery]

285
Q

What forms the recto-uterine pouch?

A

Peritoneal reflection from the rectum to the posterior part of the fornix of the vagina

286
Q

What forms the rectovesical pouch?

A

Peritoneal reflection from the rectum to the posterior wall of the fundus of the bladder

287
Q

How does the peritoneum cover the upper 1/3 of the rectum?

A

Covered on the anterolateral aspect

288
Q

How does the peritoneum cover the middle 1/3 of the rectum?

A

Anteriorly only

289
Q

How does the peritoneum cover the lower 1/3 of the recum?

A

Not covered below the peritoneal reflection

290
Q

What is the pararectal fossa?

A

found on the upper 1/3 of the rectum as its covered anterolaterally by the peritoneum

291
Q

What is the pudendal canal?

A

fascia enclosed on the internal pudendal vessels and nerves in the lateral wall

292
Q

What structures are found in the fat bodies in the ischianal fossa?

A

Inferior rectal vessels and nerves
Perforating branch of S2 and S3
Perineal branch of S4
Postscrotal nerves and vessels

293
Q

What is the surgical significance of the ischioanal fossa?

A

an important plane during resections of the anal canal and anorectal junction for malignancy [bloodless].

It encompasses all of the muscular structures of the anal canal and leads to the inferior surface of levator ani, through which the dissection is carried

294
Q

What is the role of Internal anal sphincter in defecation?

A

Parasympathetic fibers via pelvic splanchnic nerves inhibits its contraction, thus relaxes the sphincter, opening the anal canal

295
Q

What are the three major gross differences between the small and large intestines?

A

Omental appendices
Haustrations
Teniae coli

296
Q

When is the cecum palpable?

A

When its distended with either feces or gas

297
Q

Attachment of the cecum

A

No mesentery, but maybe attached to the lateral abdominal wall by cecal folds

298
Q

What is the function of the Enteric nervous system?

A

Responsible for enteric reflex
Peristalsis
Maintain functional integrity of the gut

299
Q

What is the effect of sympathetic and parasympathetic denervation on the GIT?

A

Transiently effects gut motility

300
Q

Describe Enteric excitatory neurons

A

Projects in oral directions
ACh and Substance P as a cotransmitter

301
Q

Describe Enteric Inhibitory neurons

A

Projects in Anal direction
ATP [in intestines] and VIP [in stomach], with NO as a cotransmitter

302
Q

What are the two types of intrinsic motor neurons?

A

Enteric excitatory and inhibitory neurons

303
Q

What triggers the impulses from intrinsic sensory neurons in peristalsis reflex?

A

stretching of the gut
chemical stimulation of sensory endings in mucosa

GIT Module (16 decks)

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