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Anatomy Flashcards

1
Q

In which area of the body is the anus found?

A

Perineum

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2
Q

In which area of the body is the rectum and anal canal found?

A

Pelvis

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3
Q

Which GI organ is found in the chest?

A

Oesophagus

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4
Q

What is the scientific word for swallow?

A

Deglutition

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5
Q

What i the scientific word for chewing?

A

Mastication

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6
Q

What are the 4 functions of the upper GI tract?

A

Mastication, deglutition, taste and salivation

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7
Q

What is the Buccinator muscle and what is its function?

A

Cheek muscle which is used for facial expression and pushing lateral food bollus’

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8
Q

What is the nerve supply to the buccinator muscle?

A

CN VII (facial nerve)

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9
Q

How many teeth in the normal adult?

A

32- 16 on the mandibular dental arch and 16 on the maxillary dental arch

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10
Q 
What type of teeth are: 
1 and 2?
3?
4 and 5?
6, 7 and 8?
A

1 and 2 are incisors
3 is canine
4 and 5 are premolars
6, 7 and 8 are molars teeth

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11
Q

Which teeth are your wisdom teeth?

A

8

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12
Q

What is the head of the condylar process and where does it sit when the mouth is closed?

A

Head of the the mandible and sits in the mandibular fossa of the temporal bone, posterior to the articular tubercle

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13
Q

What is the zygomatic arch?

A

The extension of the temporal bone to meet the zygoma and contains the articular tubicle

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14
Q

What are the 3 muscles used to close the mouth?

A

Temporalis muscle, Masseter muscle (strongest) and the medial pterygoid muscle

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15
Q

What muscle is used to open the mouth?

A

Lateral pterygiod

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16
Q

What is the innervation of the 4 muscles of mastication?

A

Mandibular devion of the trigeminal nerve. CN V3

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17
Q

What in the origin and insertion of the temporalis muscle?

A 
Origin = Coronoid process of the mandible 
Insertion = the temporal fossa
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18
Q

What is the origin and insertion of the masseter muscle?

A 
Origin = angle of the mandable 
Insertion = zygomatic arch
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19
Q

What is the origin and insertion of the medial pterigiod muscle?

A 
Origin = angle of the mandable (medial side)
Insertion = pterigiod plates of the sphenoid bone
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20
Q

What is the origin and insertion of the lateral pterigiod muscle?

A 
Origin = Condyle of mandible 
Insertion = pterigiod plates of the sphenoid bone
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21
Q

Which branch of the trigeminal nerve has motor innervation?

A

CN V3

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22
Q

What are the 2 cavities of the TMJ and what are there functions?

A

Superior cavity for translation and inferior cavity for rotation.
Translation moves the condyler process of the mandable onto the articular tubicle of the temporal bone to allow for more rotation

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23
Q

What separates the 2 cavities of the TMJ?

A

Articular disc

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24
Q

What is the course of CN V3 (mandibular devision of the trigeminal nerve?

A

From pons and exits the skull through the foraman ovale to to muscles of mastication and sensory area

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25
Q

What types of nerve are in CN V3?

A

Motor and sensory

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26
Q

Bone in the body that does not articulate with any other bone?

A

Hyoid bone

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27
Q

Which tonsils are commonly removed?

A

Palatine tonsils

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28
Q

What part of the oral cavity is effected in gum disease?

A

Gingiva

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29
Q

What may cause the uvula to hang off centre?

A

Lesions of the vagal nerve

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30
Q

What separates the anterior 2/3rds and the posterior 1/3rd of the tongue?

A

Sulcus terminus

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31
Q

What is the function of the vertical part of the tongue and what is the innervation for these functions?

A

Taste and general sensation

CN IX glossopharangeal nerve

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32
Q

What is the function of the horizontal part of the tongue and what is the innervation for these functions?

A

Taste- CN XII (facial nerve)

General sensation- CN V3 (mandibular brach of the trigeminal nerve)

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33
Q

What are the papillae with taste buds? (3)

A

Foliate papillae
Vallate papillae
Fungiform papillae

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34
Q

What are papillae?

A

NOT taste buds but may contain tastebuds. Invaginations on the tongue

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35
Q

Which papillae are for general sensation of temperature and touch ect?

A

Filiform papilae

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36
Q

What is the course of the facial nerve (CN XII)?

A

From the pontomedullary junction through the temporal bone via the internal acoustic meatus to the stylomastiod foramen

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37
Q

What does the facial nerve supley?

A

Horizontal aspect of the tongue (taste)
Muscles of facial expression
Glands in the floor of the mouth

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38
Q

What nerve fibres does the facial nerve contain?

A

Special sensory, sensory, motor and parasympathetic

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39
Q

What is the general sensory innervation for the superior and inferior half of the oral cavity?

A

Superior half is CN V2

Inferior half is CN V3

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40
Q

Can people have a gag reflex when unconscious?

A

No

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41
Q

Spraying a local anasthetic in the mouth will block sensory action potentials in which nerves?

A

CN V2, V3, VII and IX

Used in endoscopy

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42
Q

Which nerve fibre carries the sensory part of the gag reflex?

A

CN IX glassopharageal

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43
Q

Which nerve fibre carries the motor part of the gag reflex?

A

CN IX and X

Mostly vagus

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44
Q

What is the course of CN V2 (maxillary devision of the trigeminal nerve)?

A

From the pons through the foraman rotundum (traveling anteriorly) to the sensory area of the mid face

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45
Q

What type of nerve fibres are found in CN V2?

A

Sensory ONLY

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46
Q

What is the course of CN IX (glossopharangeal nerve)?

A

From the medulla through the jugular foramen to the posterior wall of the oropharynx, parotid gland and vertical aspect of the tongue.

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47
Q

Which cranial nerves exit the brain through jugular foramen?

A

CN 9, 10 and 11

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48
Q

What are the 3 salivary glands?

A

Parotid gland
Submandibular gland
Sublingual gland

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49
Q

Where does the parotid gland secrete into the mouth?

A

Upper second molar (upper 7)

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50
Q

Where does the submandibular gland secrete into the mouth?

A

Lingual caruncle

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51
Q

Where does the sublingual gland secrete into the mouth?

A

Floor of the mouth

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52
Q

Which cranial nerve innervates the parotid gland?

A

CN IX

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53
Q

Which cranial nerve innervates the submandibular and sublingual gland?

A

CN VII

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54
Q

What are the 4 pairs of extrinsic muscles of the tongue?

A

Palatoglossus, Styloglossus
Genioglossus
Hyoglossus

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55
Q

Which CN innervates the muscles of the tongue?

A

All tongue muscles are innervated by CN XII (hypoglossal nerve) exept the palatoglossus which is the vagus

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56
Q

What is the function of extrinsic muscle of the tongue?

A

Change the position of the tongue during masstication, swallowing and speech

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57
Q

What is the function of the intrinsic muscles of the tongue?

A

Modify the shape of the tongue during function

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58
Q

How many pairs of intrinsic muscles of the tongue?

A

4

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59
Q

What is the course of the Hypoglossal nerve?

A

From the medullas through the hypoglossal canal to the muscles of the tongue

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60
Q

What nerve fibres are contained in the hypoglossal nerve?

A

Motor ONLY

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61
Q

How many musclesare in the pharynx?

A

3 Circular constrictor muscles and 3 Longitudinal muscles

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62
Q

What are the names f the 3 circular muscles of the pharnx and which CN innervates them?

A

Superior, middle and inferiorconstrictor muscles all innervated by the vagus nerve

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63
Q

At what vertebral level is theupper oesophageal sphincter?

A

C6 cricopharyngeus (levelof the cricoid cartilage)

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64
Q

Where do all the constrictor muscles of the pharynx insert?

A

The midline raphe

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65
Q

What is the function of the muscles in the pharynx?

A

To elevate the pharynx and the larynx. to attach to the larynx and shorten the pharynx when contracting to raise the larynx to close over the laryngeal inlet.

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66
Q

Which nerves supply the longitudinal muscles of the pharynx?

A

CN X and IX

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67
Q

All the muscles involved in swallowing are skeletal/smooth muscles and the initiation of swallowing is voluntary/involuntary?

A

Skeletal

Voluntary

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68
Q

What normal ‘constrictionsof the oesophagusmay be seen with a barium swallow?

A

Diaphramatic constriction
Upper oesophageal sphinctre
Arch of the aorta
Left main bronchus

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69
Q

Where does the oesophagus start and end?

A

Starts at the inferior edge of the cricopharyngeus muscle (C6)
Ends by entering the cardia of the stomach

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70
Q

When no food is present are the walls of the oesophagus open or closed?

A

Closed

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71
Q

2 sphincters in the oesophagus. Which is anatomical and which is physiological and why?

A

Attomical is the upper oesophageal sphincter as it has full circular muscle around it.
Physiological is the the lower oesophageal sphincter as it closes due to external factors

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72
Q

Where is the oesophageal plexus found and what are the nerve fibres within it?

A

Surface of the oesophagus to supply the smooth muscle within its walls. Contains parasympathetics (vagus) and sympathetics which influence the ENS

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73
Q

What can dilation of the LA cause with reference to the GI tract?

A

Dysphagia as the oesophagus passes posterior to the surface of the heart (LA)

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74
Q

What 3 factors produce the sphincter effect at the LOS?

A

1) Contraction of the diaphragm
2) Intraabdominal pressure slightly higher than intragastric pressure
3) Oblique angle that the oesophagus enters the cardia of the stomach

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75
Q

What can lead to symptoms of reflux

A

Hiatus hernia either paraoesophageal hiatus hernia or sliding hiatus hernia

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76
Q

What is the Z line in the oesophagus?

A

Abrupt change in the type of mucosal lining in the oesophageal wall (pink to red) LOS lies superior to this.

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77
Q

What are the 5 anatomical areas of the stomch?

A

Cardia, Fundus,Body, Antrum and pylorus

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78
Q

Where does the stomach lie on surface anatomy?

A

Mainly in the left hypocondrium, epigastic and umbilical regions

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79
Q

What are rugae?

A

Folsing in the stomach which allow for increased expansion of the stomach. Can disappear in obese individuals

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80
Q

What are the anatomical relations of the stomach?

A 
Anterior
Lesser and greater omentum, Liver, gall bladder and transverse colon
Superior
Left hemi diaphragm
Posterior 
Splenic vessels, spleen and pancreas
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81
Q

What are the risks of a posterior stomach ulcer?

A

Damage to the spleen and pancreas

Haemorrhage of the spleenic vessels

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82
Q

What makes up the small intestine?

A

Duodenum, jujunum and illeum

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83
Q

What makes up the large intestine?

A

Caecum, Appendix, Ascending, transverse and descending colon, sigmoid colon, rectum, anal canal and anus

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84
Q

What is the foregut and what is the vessel and nerve supply?

A

Oesophagus- mid duodenum, liver, gall bladder, spleen and 1/2 pancreas
Caelliac artery and caelliac ganglion

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85
Q

What is the midgut and what is the vessel and nerve supply?

A

Mid duodenum- proximal 2/3rds of transverse colon and 1/2 pancreas.
Superior mesenteric artery and superior mesenteric ganglion

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86
Q

What is the hindgut and what is the vessel and nerve supply?

A

Distal 1/3rd of the transverse colon to the proximal 1/2 of anal canal
Inferior mesenteric artery and inferior mesenteric ganglion

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87
Q

What are the 9 superficial regions of the abdomen?

A

Left and right hypocondrium and epigastric
Left and right lumbar and umbilical
Left and right inguinal and pubic

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88
Q

Which planes divide up the superficial regions of the abdomen?

A

Mid clavicular planes

Subcostal plane and transtubercular plane

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89
Q

What is the muscle orientation of the external internal and transverse oblique?
The orientation of muscles is important for making surgical incisions

A 
External = hands in pockets 
Internal = hands on chest
Transverse = horizontal
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90
Q

What is guarding of the abdomen?

A

Contraction of abdominal and oblique muscles to guard the abdominal organs when injury threatens. Organs are irritating the peritoneum. This also occurs in peritonitis

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91
Q

What is the peritoneum?

A

A thin, transparent, semi-permiable, serous membrane. It lines the walls of the abdominopelvic cavity and organs.

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92
Q

The peritoneum is a continuous membrane. T of F?

A

True

Parietal on the body wall and visceral engulfing organs

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93
Q

What does the peritoneum secrete and why?

A

Lubricating fluid as the gut moves a lot

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94
Q

Is the peritoneal cavity enclosed in males and females?

A

Enclosed in males

Uterine tubes in the females mean it is not fully enclosed meaning UTIs can spread into the peritoneal cavity.

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95
Q

What can cause peritonitis?

A

Blood, pus or faeces in the peritoneal cavity will cause severe and painful inflammation. Infection and cancer can easily spread throughout the cavity

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96
Q

What is a intraperitoneal organ and give examples?

A

Almost completely covered in visceral peritoneum- minimally mobile.
Eg Stomach, liver, gall bladder, spleen, parts of the small intestine, transverse colon.

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97
Q

What are organs with a mesentary (intraperitoneal) and give examples?

A

Covered in visceral peritoneum and the visceral peritoneum wraps behind an organ to form a double layer- mesentary- which suspends the organ from the posterior abdominal wall (parietal peritoneum). Very mobile
Eg small intestine

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98
Q

What is a retroperitoneal organ and give examples?

A

Only has visceral peritoneum on its anterior surface and is localed in the retroperitoneum. Limited mobility and held in place.
Eg Kidneys, adrenal gland, pancreas, ascending colon and descending colon

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99
Q

Which system is the spleen part of?

A

Lymphatics- NOT GI

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100
Q

How des the peritoneum form?

A

Secondary to the growth and formation of the GI ract duing embryology. Similar to the pericardium. The GI tract grows out into the umbilicus of the baby during development as its too big and then receeds as the baby grows

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101
Q

What are the 3 types of peritoneal formations?

A

1) Mesentry- usually connects organs to posterior body wall
2) Omentum (greater and lesser)- double layer of peritoneum which passes from the liver/stomach to adjacent organs
3) Peritoneal ligaments- double layer of peritoneum connecting organs to each other or the body wall

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102
Q

What is within the mesentery?

A

Blood and lymph vessels, nerve, lymph nodes and fat

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103
Q

What are the 3 types of mesentery?

A

1) Mesentry proper (small intestine)
2) Transverse and sigmoid mesocolon
3) Mesoappendix

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104
Q

Describe the greater omentum

A

4 layered structure. Has a greater sac (anterior to stomach and all of intestine) and lesser sac (posterior to stomach). Hangs like an apron and attaches the greater curvature of the stomach to the transverse colon.

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105
Q

Describe the lesser omentum

A

Double layered structure wich attaches the lesser curvature of the stomach/duodenum to the liver. It has a free edge on the right.

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106
Q

Why is the free edge of the lesser omentum important?

A

Contains the portal triad (hepatic portal vein, hepatic artery proper and the common bile duct) and can be used in surgery to stem the blood supply to the liver

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107
Q

What makes the free edge and fixed edge of the lesser omentum?

A

Free edge = Hepatoduodenal ligament

Fixed edge = Hepatogastric ligament

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108
Q

How do the greater and lesser sacs of the omentum communicate?

A

Through the omenttal foramen (foramen of winslow)

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109
Q

What are the 4 peritoneal ligaments?

A

Splenorenal ligament
Gastosplenic ligament
Hapatogastic ligament
Hepatoduodenal ligament

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110
Q

What is the peritoneal pouch found in the male?

A

Rectovesical pouch

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111
Q

What are the peritoneal pouches found in the female?

A

Vesico-uterine pouch and recto-uterine pouch (pouch of douglas )

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112
Q

What is ascites?

A

Collection of fluid in the peritoneal cavity

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113
Q

What are the most common causes of ascites?

A

Cirrhosis and portal hypertension (liver)

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114
Q

How can ascitic fluid be drained?

A

Paracentesis (abdominocentesis)

Ultrasound guidance is recommended to check its fluid!

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115
Q

Where should the needle be placed in abdominocentesis?

A

Lateral to the rectus sheath avoiding th inferior epigastric artery.

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116
Q

Where does the inferior epigastric artery come from and what is its course?

A

Branch of the external illeac artery (medial to the deep inguinal ring) and ascends in anterior abdominal wall deep to the rectus abdominus

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117
Q

If there is a hernia medial to the inferior epigastric artery is it direct or indirect?

A

Direct

Indirect if the hernia is lateral to the artery

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118
Q

4 questions about abdominal pain?

A

1) Location? is it localised?
2) Character? Somatic pain is sharp whereas visceral pain is dull
3) Timing? Colicky pain due to peristalsis
4) Pain referral pattern?

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119
Q

Which nerves supply the organs and visceral peritoneum within the abdominal cavity?

A 
Visceral afferents (ENS) and piggy back sympathetics.
Autonomic nervous system (influences the ENS) including sympathetics and parasympathetics
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120
Q

Which nerves supply the abdominal wall from the skin to the parietal peritoneum?

A

Somatic sensory and motor nerves and sympathetic nerve fibres

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121
Q

How do sympathetic nerve fibres get from the CNS to abdominal organs?
Clue: Short pre ganglionic neurone, long post ganglionic neurone

A

1) Leave the spinal cord between levels T5 and L2
2) Enter the sympathetic chains but do NOT synapse
3) Leave sympathetic chain within abdominopelvic splanchnic nerves
4) Synapse at prevertebral ganglia
5) Postsynaptic fibres pass from the ganglia onto the surface of the arterial branches leaving the abdominal aorta
6) Take part in the periarterial plexues with other nerve fibres

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122
Q

Where are the pre vertebral ganglia found?

A

Anterior to the aorta at the exit points of major branches of the abdominal aorta

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123
Q

How do sympathetic nerve fibres get from the CNS to the adrenal gland?

A

1) Leave the spinal cord at T10-L1
2) Enter the abdominopelvic splanchnic nerves
3) Do NOT synapse at prevertebral ganglia
4) Carried with periarterial plexuses to the adrenal gland
5) Synapse directly onto cells.

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124
Q

How do parasympathetic nerve fibre get from the CNS to fore and mid gut?

A

Vagus nerve

1) presynaptic parasymapthetic neurones enter the abdominal cavity on the surface of the oesophagus
2) Travel into the periarterial plexus around the abdominal aorta
3) Carried to the walls of the organs where they synapse in ganglia

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125
Q

How do parasympathetic nerve fibres get from the CNS to the hing gut?

A

Pelvic splanchnic nerves (S2, 3, 4)
1) Presynaptic parasympathetic nerve fibres supply the smooth muscle and glands of the descending colon to the anal canal

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126
Q

Which superficial region is pain from the foregut organs felt in and why?

A

Epigastric

Visceral afferent nerve fibres from foregut structures enter the spinal cord at T6-T9

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127
Q

Which superficial region is pain from the midgut organs felt in?

A

Umbilical

Visceral afferent nerve fibres from midgut structures enter the spinal cord at T8-T12

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128
Q

Which superficial region is pain from the hindgut organs felt in?

A

Pubic

Visceral afferent nerve fibres from hindgut structures enter the spinal cord at T10-L2

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129
Q

Why is abdominal pain referred?

A

Pain fibres from most abdominal organs run alongside sympathetic fibres back to the spinal cord and pain from these organs tends to be perceived in the dermatomes of the levels at which they enter the spinal cord

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130
Q

What are the body wall nerves supplying the abdomen and what fibres to they contain?

A

Thoracoabdominal nerves T7-T11
Subcostal nerve T12
Iliohypogastric nerve- half of L1 anterior ramus
Ilionguinal nerve- half of L1 anterior ramus

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131
Q

Why are the thoracoabdominal nerves so named?

Which muscle layers to they travel between?

A

There are intercostal nerves which travel anteriorly and leave the intercostal space
Travel between the internal oblique and the transverse abdominus.

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132
Q

Why does pain from appendicitis begin as dull and achy pain in the umbilicus and become sharp in the right illieac fossa

A

Appendix is a mid gut organ- so as the appendix inflames it irritates the visceral peritoneum which is felt in the umbilicus region as it enters the spinal cord at T8-T12. As the appendix becomes more inflamed it irritates the parietal peritoneum in the right iliac fossa which is a body wall structure and is felt as a sharp localised pain

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133
Q

What is jaundice?

A

Yellowing of the sclera (white of the eyes) and skin

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134
Q

WHat causes jaundice?

A

Increase in the blood levels of billirubin

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135
Q

Which organs are involved in the production of billirubin and bile?

A

Liver, Spleen, pancreas, gallbladder and small intestine

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136
Q

What is bilirubin?

A

Normal byproduct of the breakdown of red blood cells

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137
Q

Where does the breakdown of RBC normally occur?

A

Spleen

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138
Q

Where does bile enter the duodenum?

A

2nd part of the duodenum

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139
Q

What is bilirubin used to form?

A

Bile in the liver

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140
Q

Why is bile important?

A

For the normal absorption of fats from the small intestine and the nutralisation of chyme

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141
Q

What are the functions of the liver?

A

Glycogen storage, bile secretion and other metabolic functions

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142
Q

Where is the liver located? (surface anatomy)

A

Right upper quadrant

Right hypochondrium and epigastric regions

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143
Q

Why does the location of the liver change on breathing?

A

Because it is attached to the inferior surface of the diaphragm and moves with the diaphragm.

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144
Q

Which ribs protect the liver?

A

Ribs 7-11

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145
Q

What are the anatomical relations of the liver?

A 
Superiorly = right hemidiaphragm
Posterior and inferior = Gall bladder 
Inferior = hepatic flacture of colon
Posterior = Right kidney, right adrenal gland, IVC and abdominal aorta
Posterior at the left side = stomach
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146
Q

What are the 4 anatomical lobes of the liver?

A

Left lobe
Right lobe
Caudate lobe (looks like a tail and flicks under IVC but is superior)
Quadrate lobe

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147
Q

What is the porta hepatis?

A

Site for entrance of portal triad structures

148
Q

Which ligament separates the right and left lobes of the liver?

A

Falciform ligament- structure of the peritoneum

149
Q

Whatis the round ligament of the liver?

A

Remnant of the umbilical vein

150
Q

Is the IVC attached to the liver?

A

Not normally although the liver can grow around the IVC

151
Q

How many functional segments of the liver?

A

8

152
Q

Which anatomical lobe is also a functional lobe?

A

Quadrate lobe is functional lobe 1

153
Q

What does each segment of the liver have?

A 
Its own 
Branch of the hepatic artery
Branch of the hepatic portal vein
Bile drainage into the bile duct 
Venous drainage into the IVC
154
Q

Why is increased central venous pressure directed to the liver?

A

Because the IVC and hepatic veins lack valves

155
Q

Do hepatic veins contain oxygenated or deoxygenated blood?

A

Deoxygenated blood

156
Q

Where is the portal triad found?

A

Within the hepatoduodenal ligament

157
Q

What is within the portal triad?

A 
Hepatic portal vein
Hepatic artery (medial)
Bile duct (lateral)
158
Q

What is the first midline branch of the abdominal aorta?

A

Coeliac trunk

159
Q

Where is the coeliac trunk in relation the to the peritoneum?

A

Reteroperitoneal

160
Q

At what vertebral level does the coeliac trunk leave the aorta?

A

T12

161
Q

What does the coeliac trunk supply?

A

Fore gut

162
Q

What are the branches of the coeliac trunk?

A

Splenic artery (posterior to the stomach)
Left gastric artery
Common hepatic artery

163
Q

What are the branches of the common hepatic artery?

A

Hepatic artery proper and the gastroduodenal artery

164
Q

What provides the anastamosis of the foregut and midgut vasculature?

A

Superior pancreaticoduodenal artery

165
Q

Why does the splenic artery have a torturous course?

A

Superior boarder of the pancreas

166
Q

Where is the spleen in relation to the peritoneum?

A

Intraperitoneal

167
Q

Where is the spleen on surface anatomy?

A

POSTERIOR aspect of Left hypochondrium

168
Q

Which ribs protect the spleen?

A

ribs 9-11

169
Q

What are the anatomical relations of the spleen?

A 
Posterior/superior= diaphragm
Anterior = stomach
Inferior = splenic flecture
Medial = left kidney
170
Q

What is the function of the spleen?

A

Break down RBC to produce bilirubin and immune role

171
Q

Does the spleen move with respiration?

A

Yes- anatomically related to diaphragm

172
Q

How is the spleen palpated?

A

Patient takes deep breath in. Push the spleen up from the back of patient and push upwards o the front

173
Q

What is the major blood supply to the stomach?

A

1) Right and left gastric arteries along junction of lesser curvature and lesser omentum (anastamose)
2) Right and Left gastro-omental arteries along greater curvature and greater omentum (anastamose)

174
Q

What is the minor blood supply to the stomach?

A

Posterior gastric arteries (from splenic arteries)

Short gastric arteries (from splenic arteries

175
Q

Where does the left gastric artery branch from?

A

coeliac trunk

176
Q

Where does the right gastric artery branch from?

A

Hepatic artery proper

177
Q

Where does the Left gastro-omental artery branch from?

A

Splenic proper

178
Q

Where does the Right gastro-omental artery branch from?

A

Gastero duodenal artery

179
Q

What is the blood supply to the liver?

A

Hepatic artery proper which divides into the left and right hepatic arteries (oxygenated blood)
Hepatic portal vein (nutrient rich blood)

180
Q

What proportion of blood to the liver come from hepatic arteries?

A

20-25%

181
Q

Is the blood in the hepatic portal vein oxygenated or deoxygenated?

A

Mostly oxygenated despite going around the GI tract. This is supplemented by hepatic arteries

182
Q

What shape is a liver lobule?

A

hexagonal- loss of this shape => pathology

183
Q

What is at the centre and each cornor of a liver lobule?

A 
Centre = central vein which drains into the hepatic veins and then IVC
Corner = interlobular portal triad with a branch of the hepatic portal vein, hepatic artery and billary duct
184
Q

How many hepatic vein join the IVC?

A

3

185
Q

What are the 2 peritoneal cavities related to the liver?

Are they in the greater or lesser sac?

A

Hepatorenal recess
Subphrenic recess

Greater sac

186
Q

Where is the lowest part of the peritoneal cavity when supine and therefore where fluid collects?

A

Hepatorenal recess

187
Q

Where does the hepatic portal vein drain blood from?

A

Foregut, midgut and hindgut

188
Q

Which 2 veins form the hepatic portal vein?

A 
Splenic vein (drains the foregut)
Superior mesenteric vein (drains the mid gut)
189
Q

Where does the inferior mesenteric vein, which drains the hind gut, drain blood into?

A

60% splenic vein

40% superior mesenteric vein

190
Q

What are the portal triad structures from anterior to posterior?

A

Bile duct -anterior
Hepatic artery proper
Hepatic portal vein- posterior

191
Q

Where does the gall bladder lie in relation to the duodenum?

A

Anterior to the duodenum

192
Q

What is the function of the gallbladder?

A

Stores and concentrates bile in between meals

193
Q

What are the parts of the gallbladder?

A

Fundus, body and neck

194
Q

Which ducts join to form the common bile duct?

A 
Cyctic duct (gallbladder)
Common hepatic duct (from liver)
195
Q

There are sphincres in the common bile duct which are closed between meals. What does this lead to?

A

The liver is producing bile continuously and when the sphincters are closed the bile backs up and gets pushed into the gallbladder for storage

196
Q

How does bile flow in and out of the gallbladder?

A

Cystic duct

197
Q

What is the valve in the cystic duct?

A

Spiral valve- glaa stone narrowing

198
Q

What is the blood supply to the gallbladder?

A

Cystic artery- branch of the right hepatic artery

199
Q

What are the sides of the triangle of Calot?

A

Inferior boarder of the liver
Common hepatic duct
Cystic duct

200
Q

What is always found in the triangle of calot?

A

Cystic artery

201
Q

What is the venous drainage of the gallbladder?

A

Where the gallbladder adheres to the liver there are lots of little veins which pass into the liver and the blood is cleaned and enters the IVC through hepatic veins

202
Q

What causes gall bladder pain?

A

Irritation from gallstones

203
Q

Where is gall bladder pain felt?

A

Foregut organ- pain in epigastric region (visceral afferent T6-T9)

204
Q

If gall badder irritates anterior of diaphragm where will pain be felt?

A

Right hypochondrum with referral to the right shoulder (C3, 4, 5)

205
Q

What is the surgical removal of the gallbladder called?

A

Cholecystectomy

206
Q

What is requires for a cholecystectomy?

A

Identification of the cystic duct and cystic artery.

Variation can occur in both structures

207
Q

Where does the break down of RBCs usually occur?

A

Spleen

208
Q

What is Bilirubin used for?

A

Formation of bile in the liver

209
Q

What are the 4 named billary vessels?

A

Left hepatic duct (drains the left lobe)
Right hepatic duct (drains the right lobe)
Common hepatic duct (when the left and right hepatic ducts unite.
Common bile duct (when the common hepatic duct joins with the cystic duct. Within the portal triad)

210
Q

What are the 4 parts of the duodenum?

A

1) Superior (intraperitoneal) with the duodenal cap
2) Descending (retro peritoneal)
3) Horizontal (retroperitoneal)
4) Ascending (retroperitoneal)

211
Q

Where does the duodenum begin and end?

A

Begins at pyloric sphincter

Ends at the duodenojejunal flexure

212
Q

What is the duodenal cap?

A

An outpouching on the superior part of duodenum which is mobile

213
Q

WHat is the duodenojejunal flexture?

A

Small functional sphincter

214
Q

When does the intestine become intraperitoneal again after the deuodenum?

A

duodenaojejunal flexure

215
Q

Which 2 peptide hormones are secreted by the duodenum?

A

Gastrin and CCK (cholycystokinin)

Enter the blood stream

216
Q

What is the function of CCK released by the duodenum?

A

Gall bladder contraction and relaxation of the billary sphincters

217
Q

Where does pain from a duodenal ulcer present?

A

Epigastric region because although it’s a modly mid gut organ its very high up

218
Q

Where is the duodenum in relation to the pancreas?

A

The duodenum curves around the head of the pancreas. Pancreas in the C shape curve of duodenum. Therefore enlargement of the pancreas can effect the duodenum

219
Q

Is the pancreas intra or retro peritoneal?

A

Retroperitoneal

220
Q

What are the 4 parts of the pancreas?

A

Head (with uncinate process)
Neck
Body
Tail

221
Q

Where is the tail of the pancreas found?

A

In the hylum of the spleen

222
Q

How does the pancreas develop?

A

Develops in 2 parts from the duodenum. It develops intraperitoneal and becomes retroperitoneal therefore it is secondarily retroperitoneal

223
Q

What are the posterior anatomical relations of the pancreas?

A

Right kidney and adrenal gland, IVC, Bile duct, Abdominal aorta, Superior mesenteric vessels
Left kidgey and adrenal gland, part of the portal venous system

224
Q

What are the anterior, lateral and superoposterior anatomical relations of the pancreas?

A 
Anterior = stomch
Lateral = duodenum
Superoposterior = Splenic vessels
225
Q

Posterior stomch ulcers can effect the splenic vessels and pancreas. T or F?

A

True

226
Q

Is the spleen intra or retroperitoneal?

A

Reteroperitoneal

227
Q

What are the functions of the pancreas?

A

Exocrine (acinar cells)- digestive enzymes
Lipase, amylase, protease (trypsinogen, chymotrypsinogen, procarboxypeptidase A and B)
Endocrine (islets of langerhans) Insulin, glucagon and somatostatin.

228
Q

Where do pancreatic enzymes drain to?

A

Main pancreatic duct (tail to head) Drains into the Common bile duct
Accessory pancreatic duct (head)
Drains directly into the minor duodenal papilla in the descending duodenum

229
Q

WHat is the nerve supply to the pancreas?

A

Vagus = parasympathetic
Abdomino pelvic splanchnic = sympathetic
Coeliac and superior mesenteric ganglia.
Sympathetic and parasympathetic form a periarterial plexus on the pancreas

230
Q

What is the course of the common bile duct around the duodenuma dn pancreas?

A

Descends posterioly to the superior part of the duodenum
Travels into a grove on the posterior aspect of the pancreas and joins with the main pancreatic duct forming the Hepatopancreatic ampulla (Ampulla of Vater) (bulge)
Both then drain into the descending duodenum at the major duodenal papilla

231
Q

What is the hepatopancreatic ampulla?

A

The bulge at the joining of the common bile duct and main pancreatic duct

232
Q

What are the 3 anatomical sphincters in the billary system?

A

Bile duct sphincter and ancreatic duct sphincter just above the hepatopancreatic ampulla in both cases (allow change in concentration of bile and pancreatic enzymes entering the duodenum.
Sphincer of Oddi- controls the entry pf bile and pancreatic enzymes into the duodenum at the major duodenal papilla.

233
Q

What is a ERCP (Endoscopic Retrograde Cholangiopancreatography) and how is it carried out?

A

Investigation used to study the bilary tree and pancreas and treat some pathogies within it.
Endoscop is inserted through mouth into duodenum and a cannula is placed in the major duodenal papilla ad radioopaque dye injected back into the bilary tree. Images are then taken

234
Q

What are the 2 main extra hepatic causes of jaundice associated with the bilary tree

A

1) Gall stones
2) Carcinoma of the head of the pancreas
Both block the bile duct at variable points causing back up of bile and possibly pancreatic enzymes to the liver.

235
Q

What happens when bile backs up to the liver?

A

Overspill’s into the blood and this causes jaundice

236
Q

WHat is the course of the cystic duct?

A

Spiral course

237
Q

What happens if pancreatic enzymes are backed up?

A

Leak out into the blood or abdomen and digest stuff leading to pancreatisits

238
Q

What is the intrahepatic causes of jaundice?

A

Liver failure (cause is directly related to the liver)

239
Q

What is the blood supply to the duodenum and pancreas?

A

Superior pancreatoduodenal artery
Inferior pancreatoduodenal artery
These anastamose in the head of the pancreas.
Dorsal pancreatic ateries also supply body and tail of pancreas

240
Q

Where does the superior pancreatoduodenal artery come from?

A

Coeliac trunk

common hepatic artery Gastroduodenal artery

241
Q

Where does the inferior pancreatoduodenal artery come from?

A

Superior mesenteric artery

242
Q

Where so the dorsal pancreatic arteries come from?

A

Coeliac trunk

Splenic artery

243
Q

At what level does the superio mesenteric artery leave the aorta?

A

L1

244
Q

Why is the superior duodenum and pancreas foregut and the inferior parts mid gut?

A

The anastamosis of superior and inferior pancreatoduodenal arteries

245
Q

What can cause pancreatic pain?

A

Pancreatists

246
Q

What is one cause of pancreatisis?

A

Blockage of the hepatopancreatic ampulla with a gallstone and bile is diverted to pancreas leading to irritation and inflammation

247
Q

Where does pain from the pancreas present?

A

Epigastric or umbilical regions as its foregut and midgut. It can also radiate to the centre of the back at level T10 ish

248
Q

In advanced cases of pancreatisis, vascular haemorrhage can occur. Where does this occur and why?

A

Blood fluid will accumulate in the retroperitoneal spaces. Pancreas=tic enzymes can digest blood vessels etc

249
Q

What is Grey-Turner’s sign?

A

Purple bleeding in right or left flanks

250
Q

What is Cullens sign?

A

Purple haemorrhage around the umbilicus via the falciform ligament

251
Q

Where does the ejunum begin and the illeum end?

A

Jejunum begins at the duodenaljujunal flexure

Illeum ends at the illeocaecal junction where there is a valve

252
Q

Is the transition between jejunum and illeum obvious?

A

No- it transitions slowly over a distance of the small intestine

253
Q

What is the function of the ileocaecal valve?

A

Stop back flow of faecal material

254
Q

What are the differences between the jejunum and ileum in:

a) Colour
b) wall
c) vascularity
d) mesenteric fat
e) circular folds
f) lymphoid tissue

A

a) Colour = J is more red than I
b) wall = J is thicker and heavier than I
c) vascularity = J is more vascular than I
d) mesenteric fat = I has more than J
e) circular folds = J has large tall and closely packed folds, I has low and sparse folds
f) lymphoid tissue = I has peyer’s patches

255
Q

What is a Plicae Circularis?

A

Circular fold

256
Q

What is the blood supply to the Jejunum and Ileum?

A

Superior mesenteric artery via jejunal ad ileal arteries

257
Q

What is the venous drainage for the jejunum and ileum?

A

Jejunal and ileal veins into the superior mesenteric vein and then the hepatic portal vein

258
Q

Which food groups are absorbed in the small intestine and tacked to the portal venous system to the liver?

A

Proteins and carbohydrates

259
Q

Where are the vessels for the jejunum and ileum found?

A

Withinthe mesentary

260
Q

What is the course of the superior mesenteric artery?

A

Levels aorta at L1
Travels posterior to the neck of the pancreas
Travels inferiorly, anterior to the uncinate process ot the pancreas and duodenum to enfter the mesentary proper

261
Q

What is the function of bile?

A

Neutralise chyme and emulsify fat to allow then to be absorbed into intestinal cells

262
Q

Do fats enter the portal system?

A

No

263
Q

How do absorbed fats enter the systemic circulation?

A

Fats within chylomicrons are absorbed from intestinal cells into specialised lymphatics of the small intestine- lacteals.
They travel in the lymphatics and enter the circulation at the left venous angle via the horacic duct

264
Q

Where are the juxta ileal lymph nodes found and where do they converge?

A

Ileum and converge on the superior mesenteric artery

265
Q

Lymph vessels tend to lie alongside arteries. What are the main groups of lymph nodes draining abdominal organs?

A 
Coeliac (foregut organs)
Superior mesenteric (midgut organs)
Inferior mesenteric (hind gut organs)
Lumbar (kidneys, posterior abdominal wall, pelvis and lower limbs)
266
Q

What forms the venous angle?

A

Junction between the subclavian vein and the internal jugular veins

267
Q

What are the parts of the colon?

A

Caecum, Appendix, Ascending, Transverse adn descending colon, sigmoid colon

268
Q

What are the functions of the large intestine?

A

1) Defence- they have commensal bacteria
2) Absorption of water and electrolytes
3) Excretion of formed stool

269
Q

Why are the ascending and descending colon secondarily retroperitoneal?

A

Because their initial development was intraperitoneal and they became retroperitoneal.

270
Q

Which parts of the colon have a mesentry and are therefore movile?

A

Appendix and caecum (little mesentry)
Sigmoid colon
Transverse colon

271
Q

Why is it important that some parts of teh colon are retroperitoneal?

A

You don’t want all the contents to be moving around in the abdominal cavity

272
Q

Where are the paracolic gutters?

A

2 paracolic gutters (Left and right) Between the lateral edge of the ascending and descending colon and the abdominal wall?

273
Q

What are the paracolic gutters and what is there function?

A

Part of the greater sac of the peritoneal cavilty.

Site for collection of pus and fluid in the abdomen (similar to subphrenic and hepatorenal recesses

274
Q

What are teh 3 features of the colon which distinguish it from the rest of the Intestine?

A

1) Omental appendices
2) Teniae coli
3) Haustra

275
Q

What are omental appendices?

A

Small fatty projections. With a lympoid function. Not found in the small intestine or rectum

276
Q

What are Teniae coli?

A

3 distinct longitudianl bands of thickened smooth muscle running form caecum to distal end of sigmoid colon. Orgigionate
at the appendix and converge on the rectum to form continuous smooth muscle. Help to form the haustra

277
Q

What are haustra?

A

Bumps on the transverse colon formed by tonic contraction of the teniae coli

278
Q

Is it normal to see air in the colon and mottled faeces in the rectum?

A

Yes, especially when no contrast is used

279
Q

Where would you find the caecum and appendix?

A

Right iliac fossa.

280
Q

What is the most common position of the appendix?

A

Retrocaecal.

The variations mean that patients can present differently with appendicitis.

281
Q

Where does the appendix attach to the caecum?

A

Appendiceal orifice on the posterior medial wall of the caecum.

282
Q

What is McBurney’s point?

A

Point above the appendiceal orifice.
Line between ASIS and umbilicus. 1/3rd of the way along the line.
Where maximum tenderness is felt in appendicitis.

283
Q

What is the function of the ileocaecal valve and orifice?

A

To prevent back frlow of stool into thesmall intestine. Moderately good at this due to small amount of smooth muscle in the valve.

284
Q

Why does apendicitus pain reduce when lieing in the foetal position?

A

Because it relaxes the muscles around the appendix

285
Q

Where is the sigmoid colon found?

A

Left iliac fossa with a long mesentry (sigmoid mesocolon)

286
Q

What are the benefits and issues with the sigmoid mesocolon?

A

+ Lots of movement

- At risk of twisting around on itself

287
Q

What is Sigmoid Volvulus?

A

Twisting of the colon resulting in bowel obstruction.
Can be congenital or aquired later in life.
Bowel at risk of infarction

288
Q

What is the treatment for Sigmoid volvulus?

A

Emergency surgery to prevent infarction

Symptoms are campaction of stool and pain due to necrosis

289
Q

Where is the abdominal arota found?

A

Midline, retroperitoneal, anterior to vertebral bodies and LEFT of IVC

290
Q

What are the lateral branches of the abdominal aorta?

A

Renal artery L1
Gonadal artery at L2
Lumbar arteries supplying the posterolateral body wall

291
Q

Where does the abdominal aorta bifurcate and what does it bifurcate into?

A

L4 (same level of the top of the iliac crest.
Common iliac arteries.
Further bifurcation into the internal and exteranl iliac arteries

292
Q

What are teh branches of the SMA?

A

1) Inferior pancreaticoduodenal artery (anastamoses with the superior pancreaticoduodenal artery of the foregut)
2) Middle colic artery (supplies the transverse colon)
3) Right colic artery (supplies the ascending colon)
4) Ileocaecal branches (supplies the caecum and ascending colon)
5) Appendicular (runs within the mesoappendix)
6) Jejunal and ileal arteries (many of these

293
Q

What level do the coelic, SMA adn IMA leave the aorta?

A 
Coeliac = T12
SMA = L1
IMA = L3
294
Q

What are the features of the jejuna arteries?

A

Longer vasa rectae

Langer and fewer arterial arcades

295
Q

What are the features of ileal arteries?

A

Shorter vasa rectae

Smaller and many arcades

296
Q

What re the branches of the IMA?

A

1) Left colic artery (supplies the descending colon)
2) SIgmoid arteries (multiple)
3) Superior rectal artery

297
Q

What is the marginal artery of Drummond?

A 
Arterial anastamosis between the hind gut and mid gut. 
Middle colic (SMA) and Left colic (IMA) join.
298
Q

What is the function of the marginal artery of Drummond?

A

Collateral route for blood to prevent intestinal ischmia and infarction if there is an obstruction

299
Q

Where does the hindgut end?

A

Pectinate line. After the proximal half of the anal canal- this is supplied by the superir rectal artery.

300
Q

What supplies the most distal part of the GI tract?

A

Internal iliac artery => Middle and inferior rectal arteries.

301
Q

There is an arterial anastamosis around the rectum. What vessels is this between?

A

Middle rectal artery (Interanl iliac artery)

Superior rectal artery (IMA)

302
Q

What are the major veins forming the portal venous system?

A

Hepatic portal vain made up of the Splenic vain and the superior mesenteric vain.
The inferior mesenteric vein drains into the splenic vein.

303
Q

All the venous system is retro/intraperitoneal?

A

Retroperitoneal

304
Q

What is a portal systemic anastamosis?

A

Venous anastamosis where blood can flow into the systemic or portal venous system because the portal system has no valves.

305
Q

Where are the 3 clinically important sites of portal systemic anastmosis?

A

1) Skin around umbilicus
2) Rectum/anal canal
3) Distal end oesophagus

306
Q

Which veins formthe umbilical anastamosis?

A

Paraumbilical veins and epigastric veins
Paraumbilical vains drain to the hepatic portal vein along the round ligamant of the liver
Epigastric veins drain into the systemic system

307
Q

Which veins for the anastamosis it the rectum/anal canal?

A

Inferior mesenteric vein (portal) and the internal iliac vein (systemic)

308
Q

Which veins form the anastamosis at the distal end of the oesophagus?

A

Left gastric vein (portal) and the azygous vein (systemic)

309
Q

What is portal hypertention and what are the consequences?

A

Elevation of BP in the portal system (normally due to liver disease)
Leads to reversal of blood flow- no valves. => Larger volumes of blood in venous anastamosis causing them to become dilated and varicose.

310
Q

What are the consequences of varicose anastamoses?

A 
Oesophageal varices,
Caput medusae (external on abdomen)
Rectal varicies (=> rectal bleeding as they burst on deffication (increased pressure))
311
Q

What can cause haematemisis?

A

Peptic ulcers in stomach or duodenum

Oesophageal varicies

312
Q

What is the function of the rectum?

A

Store faeces until it is appropriate to defficate

313
Q

Which nerve fibres sense fullness in the rectum?

A

Stretch receptors linked to visceral afferent neurones

314
Q

Normal cerebral function is required to control the appropriate time to defficate. What neural pathologies can lead to incontinence?

A

Dementia, stroke, MS, trauma (spinal cord or during childbirth)

315
Q

Apart form the cerebral function, what else can effect faecal continence?

A

Medications
Age-relatedegeneration of nerves
Consistency of stool

316
Q

Describe the position of the pelvic cavity?

A

Located within the boney pelvis and is continuous with the abdominal cavity (only separated by peritoneum)
Lies between the pelvic inset and the pelvic floor.
Formed by the 2 boes of the pelvis and bridged by the sacrum at the back.

317
Q

Where is the rectum found?

A

Pelvic cavity

318
Q

How many holes in the pelvic floor in males and females?

A 
Males = 2 (anal canal and urethra (semen enters here)
Female 3 (anal canal, urethra, cervix
319
Q

Where is the perineum?

A

Beneath the pelvic floor

320
Q

At what level does the sigmoid colon become the rectum?

A

S3

321
Q

At what level does the rectum become the anal canal?

A

Coccyx

322
Q

What is the anus?

A

The orifice through which faeces pass

323
Q

Where is the anal canal and anus?

A

Perineum

324
Q

Does the rectum have haustra?

A

No

325
Q

How many lateral folds does the rectum have and what is their function?

A

3 lateral folds which allow for expansion and prevent tearing

326
Q

Where is the rectal ampulla and what is its function?

A

Immediately superior to the levator ani muscle.

Its walls relax to accommodate faecal material. Full of stretch receptors

327
Q

What are the anatomical relations of the rectum in the male?

A

Peritoneum covers superior rectum.
Rectovesical pouch lies anterior to superior rectum
Prostate gland lie anterior to the inferior rectum

328
Q

What are the anatomical relations of the rectum in the female?

A

Peritoneum covers superior rectum.
Rectouterine pouch of douglas lies anterior to superior rectum
vagina and cervix lie anterior to the inferior/middle rectum

329
Q

Which muscles make up the pelvic floor?

A

Levator Ani muscle

Coccygeus muscle

330
Q

What are the 3 muscle fibres within the Levator Ani muscle from medial to lateral?

A

Puborectalis
Pubococcygeus
Iliococcygeus

Named by origins and insertions

331
Q

What type of muscle is the pelvic floor and what is its function?

A

Skeletal and is under conscious contraol.
Prevent abdominal organs falling out when intra abdominal pressure increases eg coughing or straining
Tonically contracted most of the time.

332
Q

When must the pelvic floor relax?

A

To allow defecation and urination to occur.

333
Q

Which nerves supplies the lavator ani?

A

Duel supply
Branch of the sacral plexus
Pudendal nerve (S2, 3, 4)

S2, 3, 4 keep the guts of the floor

334
Q

Which muscle within the levator ani muscle is the most impotant for maintaining faecal continence and why?

A

Puborectalis
Acts like a functional sphincter.
Contraction of the muscle decreases the anorectal angle inhibiting the passage of faeces.
When the rectal ampulla is relaxed and filled with faeces, contraction of this muscle will help to maintain continence.

335
Q

What is the anal cushion?

A

Vasculature in the walls of the anal canal

336
Q

What type of muscle is the internal and external anal sphincter?

A

Internal is just a thickening of the involuntary circular smooth muscle in the GI tract.
External anal sphincter is skeletal muscle uder voluntary control.

337
Q

Where are the internal and external anal sphincters found?

A

Internal is the superior two thirds of the anal canal

External is the inferior two thirds of the anal canal.

338
Q

What stimulates contraction of the internal anal sphincter?

A

Sympathetic nerves.

Therefore relaxation is triggered by parasympathetic nerves

339
Q

When does the internal anal sphincter relax?

A

Reflexively in response to distention of the rectal ampulla

340
Q

What stimulates contraction of the external anal sphincter?

A

Pudendal nerve and is voluntarily contracted (with puborectalis) in response to rectal ampulla distention and internal anal sphincter relaxation

341
Q

Below the pelvic floor is the body wall. WHich nerves supply this area?

A

Somatic sensory and motor

342
Q

Above the pelvic floor is the body cavity. WHich nerves supply this area?

A 
Autonomic nerves (parasympathetic and sympathetic) 
Visceral afferents
343
Q

What is the sympathetic outflow in general and which sympathetics supply the rectum?

A

Sympathetic outflow is T1-L2 (thoracolumbar)

To the rectum is T12-L2.

344
Q

Where do the sympathetics to the rectum synapse?

A

Not in the sympathetic chain but in the inferior mesenteric pre-vertebral ganglia

345
Q

What path do the sympathetic nerves take to the rectum?

A

Piggy back on the IMA and then in periarterial plexuses around branches of the IMA including the superior rectal artery

346
Q

What is the function of sympathetics to the rectum?

A

Contract the internal anal sphincter and inhibit peristalsis

347
Q

What is the parasympathetic outflow to the hind gut, including the rectum?

A

S2, 3, 4

NB: Not the same as the pedendal nerve which is somatic motor

348
Q

What path do parasympathetic fibres take to the rectum?

A

Pelvic splanchnic nerves which synapse in the walls of the rectum

349
Q

What is the function of parasympathetics to the rectum?

A

Faeces impact the ampulla and stretch receptors activate visceral afferent which reflect back down the parasympathetic outflow to relax internal anal sphincter and stimulate peristalsis

350
Q

Where to the visceral afferents from the rectum travel back to?

A

S2, 3, 4. (Run with parasympathetics and sense stretch and ischemia

351
Q

What is the pudendal nerve?

A

Branch of the sacral plexus. S2, 3, 4 anterior rami

352
Q

What is the path of the pudendal nerve?

A

Exits the pelvis via greater sciatic foramen and enters the perineum via lesser sciatic foramen.
Branches to supply structures of the perineum

353
Q

What damage can occur during child birth which may lead to incontinence?

A

Branches of the pudendal nerve may be stretched

Fibres within the puborectalis or external anal sphincter may be torn

354
Q

What is the pectinate line?

A

Marks the junction between the part of the embryo which formed the GI tract- endoderm and the part that formed the skin- excoderm

355
Q

Why is the pectinate line important?

A

Arterial supply, venous and lymph drainage and nerve supply is different above and below the line.
Above = visceral
Below = Parietal

356
Q

What is the nerve supply, arterial supply, venous dranaine and lymphatic drainage from ABOVE the pectinate line?

A

Nerve supply = autonomic
Arterial supply = From the IMA
Venous drainage = IMV into the hepatic portal system
Lymphatic drainage = Inferior mesenteric lymph nodes via internal iliac nodes

357
Q

What is the nerve supply, arterial supply, venous dranaine and lymphatic drainage from BELOW the pectinate line?

A

Nerve supply = somatic
Arterial supply = From internal iliac artery
Venous drainage = Internal iliac vain to the systemic venous system
Lymphatic drainage = Superficial inguinal nodes

358
Q

What are the main groups of lymph nodes draining the pelvic organs ?

A 
Internal illiac (inferior pelvic structures)
External iliac (draining lower limb and superior pelvic structures)
Common iliac (Joining of vessels above)
Lumbar nodes  which surround the aorta => thoracic duct
359
Q

What is the cause of rectal varicies?

A

Portal hypertension => dilation of the collateral veins between the portal and systemic circulations in the rectum

360
Q

What are haemorrhoids?

A

Prolapses of the rectal venous plexuses and dilation of anal cushions

361
Q

What causes haemorrhoids?

A

Raised pressure due to chronic constipation, straining or bearing down.
Also in pregnancy

362
Q

What is the difference in pain between internal and external haemorrhoids?

A 
Internal= less painful
External = more painful
363
Q

What is the ischioanal fossa?

A

Spaces which lie on the right and left side of the anal canal (communicate posteriorly) filled with fat and lose connective tissue.

364
Q

What is an infection in the ishioanal fossa called and what are the consequences?

A

Caused by a fistulla into the anal canal.
Called and ishioanal abscess.
Not much pain and the infection can spread all the way around the back

365
Q

What is a proctoscopy?

A

Scope to see the rectum.

366
Q

What are you checking on a PR exam?

A

Anal tone,

Prostate/Cervix

GI (48 decks)

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