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Y1 GI Anatomy > Anatomy > Flashcards

Anatomy Flashcards

1
Q

What are the muscles of mastication? What nerve are they supplied by?

A 
Temporalis
Masseter
Medial pterygoid
Lateral ptergoid
CNV3 - Mandibular division of trigeminal nerve
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2
Q

What are the attachments of the temporalis?

A

Coronoid process of mandible to temporal fossa

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3
Q

What are the attachments of the master?

A

Angle of the mandible to the zygomatic arch

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4
Q

What are the attachments of the lateral pterygoid?

A

Condyle of the mandible to ptyergotd plates of sphenoid bone

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5
Q

What are the attachments of the medial pterygoid?

A

Angle of the mandible (medial side) to pterygoid plates os of the sphenoid bone

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6
Q

Which is the only muscle of mastication responsible for opening the jaw (and not closing)

A

Lateral pterygoid

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7
Q

What is the CNS part of the course of the mandibular and maxillary division of the trigeminal nerve? (CN V2 and 3)

A

Attach to pons

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8
Q

What is the intracranial part of the course of the mandibular and maxillary division of the trigeminal nerve? (CN V2 and 3)

A

Inferior to the edge of the tentorium cerebella between the posterior and middle cranial fossae

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9
Q

What is the base of skull foramen part of the course of the mandibular division of the trigeminal nerve? (CN V3)

A

Through the foramen ovale in the sphenoid bone

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10
Q

What innervates the anterior (2/3) part of the tongue?

A

CN VII and CN V3

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11
Q

Which papillae are found on the anterior part of the tongue?

A

Foliate (taste buds)
Vallate (taste buds)
Fungiform (taste buds)
Filiform (temp/touch/etc.)

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12
Q

What innervates (brings taste and general sensation) the posterior part of the tongue?

A

CN IX (glossopharyngeal nerve)

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13
Q

What separates the anterior and posterior part of the tongue?

A

Terminal sulcus

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14
Q

What is the CNS part of the course of the facial nerve? (CN VII)

A

Junction between pons and medulla

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15
Q

What is the intracranial part of the course of the facial nerve (CN VII)?

A

Directly into internal acoustic meatus in the posterior cranial fossa

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16
Q

What is the base of skull foramen part of the course of the facial nerve (CN VII)?

A

In through internal acoustic meatus

Out through stylomastoid foramen

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17
Q

What is the extracranial part of the course of the facial nerve? (CN VII)

A

Most fibres pass through stylomastoid foramen

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18
Q

The chords tympani (branch of CN VII) connects to the lingual nerve branch of?

A

CN V3

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19
Q

CN VII parasympathetic axons supply (secretomotor) the?

A

Submandibular salivary gland and sublingual salivary gland

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20
Q

What provides general sensation to the superior half of the oral cavity (gingival oral vanity and palate)?

A

CN V2 (Maxillary division of trigeminal)

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21
Q

What provides general sensation so the inferior half of the oral cavity (gingiva of oral cavity and floor of the mouth)?

A

CN V3 (Mandibular division of the trigeminal)

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22
Q

The gag reflex is a protective reflex to prevent?

A

Foreign bodies entering the pharynx/larynx

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23
Q

The sensory part of the gag reflex is carried by nerve fibres within CN?

A

CN IX (Glossopharyngeal)

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24
Q

The motor part of the gag reflex is carried by nerve fibres within CN?

A

CN IX and CN X

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25
Q

Part of the reflex response to toughing the posterior wall of the _____ is to constrict the pharynx as the patient attempts to close it off as an entry point to the body

A

Oropharnyx

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26
Q

To numb the oral cavity for endoscopy, spraying local anaesthetic will “block” sensory action potentials in which cranial nerves?

A

CN V2
CN V3
CN VII
CN IX

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27
Q

Where does the CN V2 exit the base of the skull?

A

Foramen rotundam (Sphenoid bone)

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28
Q

What type of nerve supply does CN IX give?

A 
Special sensory
Sensory
Motor 
Visceral afferent
Parasympathetic
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29
Q

What is the CNS part of the course of the glossopharyngeal nerve (CN IX)?

A

Medulla

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30
Q

What is the intracranial part of the course of the glossopharyngeal nerve (CN IX)?

A

Directly towards jugular foramen in the posterior cranial fossa

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31
Q

What is the base of the skull foramen part of the course of the glossopharyngeal nerve (CN IX)?

A

Junction between temporal bone and occipital bone - jugular foramen

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32
Q

What is the extracranial part of the course of the glossopharyngeal nerve (CN IX)?

A

Axons mainly pass to or from the tongue and palate
Posterior wall of oropharynx
Parasympathetic secretomotor to parotid salivary glands

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33
Q

The parotid gland crosses face secretes into mouth by which tooth?

A

Upper 2nd molar

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34
Q

The submandibular duct enters floor of mouth and secretes via?

A

Lingual caruncle

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35
Q

The sublingual gland lays in floor of mouth and secretes via?

A

Several ducts superiorly

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36
Q

What are the three pairs of salivary glands?

A

Parotid
Submandibular
Sublingual

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37
Q

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

A

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

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38
Q

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

A

Modify the shape of the tongue during function

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39
Q

What are the four extrinsic muscles of the tongue?

A

Palatoglossus (attach to palate)
Styloglossus (from styloid process)
Genioglossus (from mandible)
Hypoglossus (from hyoid bone)

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40
Q

All the tongue muscles except the palatoglossus are innervated by?

A

CN XII (Hypoglossal)

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41
Q

Palatoglossus is innervated by?

A

The vagus nerve

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42
Q

What is the CNS part of the course of the hypoglossal nerve (CN XII)?

A

Via many rootlets that attach to the medulla oblongata

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43
Q

What is the base of the skull foramen part of the course of the hypoglossa nerve (CN XII)?

A

Hypoglossal canal (occipital bone, anterior wall of foramen magnum)

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44
Q

What is the extracranial part of the course of the hypoglossa nerve (CN XII)?

A

Descend in neck lateral to carotid sheath
At level of hyoid bone it passes anteriorly towards the lateral aspect of the tongue
Supplies most of the muscles of the tongue

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45
Q

The superior, middle and inferior constrictor muscles of the pharynx all?

A

Overlap

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46
Q

The extrinsic muscles of the pharynx are ______ but…?

A

Voluntary

Can’t control the sequence

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47
Q

The extrinsic muscles of the pharynx are innervated by?

A

CN X

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48
Q

All the extrinsic pharynx muscles insert onto the?

A

Midline raphe

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49
Q

The inner layer of muscle of the pharynx is _______ muscle?

A

longitudinal

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50
Q

What supplies the longitudinal muscles of the pharynx?

A

Mainly CN X and IX

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51
Q

What does innervation by CN X and IX do to the pharynx?

A

Elevate pharynx and larynx
—Attach to larynx
Contract to shorten pharynx
Raise the larynx to close over the laryngeal inlet

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52
Q

Which muscle prevents drooling and what is it innervated by?

A

Orbicularis Oris

CN VII

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53
Q

The tongue pushes the bolus of food posteriorly towards the oropharynx - this is action is innervated by?

A

Cranial nerve XII

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54
Q

Cranial nerve X allows sequential contraciton of the _________________ to push the bolus inferiorly towards the oesophagus

A

Pharyngeal constrictor muscles

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55
Q

At the same time as pharyngeal constrictor muscle contraction the ____________ of pharyngeal muscle contracts to raise the larnyx, shortening the pharynx and closing off the laryngeal inlet to help prevent?

A

Longitudinal layers

Aspiration

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56
Q

What innervates the inner longitudinal layer of pharyngeal muscles

A

CN IX and X

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57
Q

The initiation of swallowing is voluntary/involuntary?

A

Voluntary

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58
Q

What is the enteric nervous system?

A

Extensive system of nerves found only in walls of the GI tract ; acts completely independently but can be influenced by signals from the ANS

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59
Q

Sympathetic influence of the ENS leads to?

A

Slowed down peristalsis

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60
Q

Parasympathetic influence to the ENS leads to?

A

Sped up peristalsis

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61
Q

The oesophagus is the inferior continuation of the?

A

Laryngopharynx

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62
Q

Where dies the oesophagus begin?

A

Inferior edge of the cricopharynxgeus muscle (vertebral level C6)

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63
Q

How many sphincters are there in the oesophagus?

A

2

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64
Q

What runs on the surface of the oesophagus to supply the smooth muscles within the walls?

A

The oesophageal plexus

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65
Q

The para and sympathetic fibres of the oesophageal plexus act to alter the rate of?

A

Peristalsis

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66
Q

When does the oesophageal plexus terminate?

A

Cardia of the stomach

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67
Q

What causes the sphincter effect of the lower oesophageal sphincter?

A

Contraction of the diaphragm and intrabdominal pressure being slightly higher than intragastric pressure + the oblique angle at which the oesophagus enters the stomach

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68
Q

A hiatus hernia can lead to ___-like symptoms because of the decreased effectiveness of the LOS

A

Reflux

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69
Q

Where does the stomach mainly lie?

A

Left hypochondriac, epigastric and umbilical region (when the patient is supine)

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70
Q

What is the Z line of the stomach?

A

Abrupt change in wall mucosa

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71
Q

What makes up the foregut?

A

Oesophagus to mid-duodenum
Liver and gall bladder
Spleen
1/2 pancreas

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72
Q

What makes up the midgut?

A

Midduodenum to the proximal 2/3rds of transverse colon 1/2 pancreas

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73
Q

What makes up the hindgut?

A

Distal 1/3 of transverse colon to proximal 1/2 of anal canal

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74
Q

What is guarding?

A

Anterolateral abdominal wall muscles contract to ‘guard’ the abdominal organs when injury threatens or peritonitis

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75
Q

Describe the peritoneum?

A

Thin, transparent, semi-permeable serous membrane that lines the abdomino-pelvic cavity and organs

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76
Q

Peritoneum is a continuous membrane; parietal on the _______; visceral ______

A

Body wall

Engulfs the organs

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77
Q

Where is the peritoneal cavity?

A

Beween the visceral and parietal peritoneum

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78
Q

Blood, pus or faeces in the peritoneal cavity will cause sever and painful inflammation called?

A

Peritonitis

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79
Q

Intraperitoneal organs are almost completely covered in?

A

Visceral peritoneum

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80
Q

How mobile are intraperitoneal organs? List them

A

Minimally mobile

Liver, gallbladder, stomach, spleen, parts of SI

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81
Q

Organs with a mesentery are covered in?

A

Visceral peritoneum (wraps around the organ to form a double layer called the mesentery)

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82
Q

What defines retroperitoneal organs? List them

A

Only has visceral peritoneum on its anterior surface Located in retroperitoneum
Kidneys, adrenal gland, pancreas, ascending and descending colon

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83
Q

Mesentery usually connects?

A

Organs to the posterior body wall

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84
Q

What is omentum?

A

Double layer of peritoneum that connects stomach to adjacent organs

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85
Q

What is peritoneal ligaments?

A

Double layer of peritoneum that connect organs to one another on body wall

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86
Q

Mesentery has a core of?

A

Connective tissue with blood, lymph, nerve, lump nodes and fat

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87
Q

The mesentery proper is associated with?

A

The small intestine

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88
Q

What are the other types of mesentery besides the mesentery proper?

A

Transverse and sigmoid mesocolon

Mesoappendix

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89
Q

How many layers does the greater omentum have?

A

4-layered

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90
Q

What is the macroscopic appearance of the greater momentum?

A

Hangs like an apron

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91
Q

What does the greater omentum attach to?

A

Attaches the greater curvature of the stomach to the transverse colon

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92
Q

How many layers does the lesser omentum have?

A

2

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93
Q

Where does the lesser momentum run?

A

Between the lesser curvature of the stomach and duodenum to the liver

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94
Q

What is the characteristic feature of the lesser momentum? What exists here?

A

Has a free edge

Portal triad

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95
Q

The omenta divide the peritoneal cavity into?

A

A greater and lesser sac

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96
Q

How do the greater and lesser sac communicate?

A

Via the mental foramen aka Foramen of Winslow

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97
Q

What makes up the portal triad?

A

Proper hepatic artery
Hepatic portal vein
Common bile duct

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98
Q

Inferiorly the peritoneum drapes over the superior aspect of the pelvic organs forming which pouches?

A

Males: retro-vesical pouch (aka Pouch of Douglas)
Females: vesico-uterine pouch/recto-uterine pouch

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99
Q

What is ascites?

A

Collection of fluid in the peritoneal cavity

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100
Q

What most commonly causes ascites?

A

Liver disease (cirrhosis causes portal hypertension)

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101
Q

Ascites can be drained by which procedures?

A

Paracentesis

Abdominocentesis

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102
Q

How can the pouch of Douglas be drained?

A

Transvaginally

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103
Q

During abdo/para-cenesis a needle must be placed where? Why?

A

Lateral to the rectus sheath
Avoids the inferior epigastric artery (main supply to the abdominal wall)
Use USS guidance if available

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104
Q

Where do the inferior epigastric arteries arise from?

A

The external iliac medial to the deep inguinal ring

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105
Q

Between visceral and somatic pain; which is easy and which is hard to localise?

A 
Somatic = easy to localise
Visceral = hard to localise
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106
Q

What character is typical of visceral pain?

A

Dull, achy and nauseating

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107
Q

What character is typical of somatic pain?

A

Sharp and stabbing

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108
Q

What does colic pain indicate?

A

Obstruction

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109
Q

Organs within the abdominal cavity including visceral peritoneum are innervated by?

A

Visceral (sensory) afferents
ENS
ANS (can influence ENS)

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110
Q

The abdominal wall from skin to parietal peritoneum is innervated by (3)?

A

Somatic sensory
Somatic motor
Sympathetic nerve fibres (no real parasympathetic supply)

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111
Q

Sympathetic nerves to the abdominal organs leave the spinal cord between?

A

T5 and L2

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112
Q

Sympathetic nerves to the abdominal organs leave the spinal cord between T5 and L2 and enter the _____.
How do they leave the sympathetic chains?

A 
Sympathetic chains (bilaterally) 
They don't synapse - leave sympathetic chains within abdomino-pelvic splanchnic nerves and synapse at the pre vertebral ganglia which are located anterior to the aorta at the exit points of the major branches of the abdominal aorta.
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113
Q

Postsynaptic sympathetic nerves fibres pass from the pre vertebral ganglia (coeliac/SMA/etc.) onto the surface of?

A

The arterial branches of the abdominal aorta

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114
Q

The postsynaptic sympathetic nerve fibres from the pre vertebral ganglia (coeliac/SMA/etc.) take part in the ________ with other never fibres on arterial branches of the abdominal aorta

A

Periarterial plexuses

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115
Q

How do postsynaptic sympathetic nerve fibres pass from the pre vertebral ganglia to the smooth muscle and glands of the organ?

A

By hitching a ride to/away with the other nerve fibres in the periarterial plexuses on the surface of the arterial branches of the abdominal aorta

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116
Q

How are sympathetic nerves for the adrenal gland unique?

A

Leave spinal cord at T10-L1 and enter the abdominosplanchnic nerves.
Don’t synapse at the pre vertebral ganglia
Carried with periarterial plexus to the adrenal gland Synapse directly onto the cells

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117
Q

The vagus nerve pre-synaptic nerve fibres enter the abdominal cavity on the surface of the?

A

Oesophagus

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118
Q

The vagus nerve travels into ___________ around the abdominal aorta

A

Periarterial plexuses

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119
Q

The vagus nerve supplies parasympathetic nerve fibres to what in the abdomen?

A

GI tract

Abdominal organs up to the distal end of the transverse colon

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120
Q

Pelvic splanchnic nerves (S2,3,4) presynaptic parasympathetic nerve fibres innervate?

A

Smooth muscle/glands of the descending colon to the anal canal (Supply genitalia and descending colon)

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121
Q

(RHYME): S2, 3, 4 keep..

A

…your guts off the floor

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122
Q

Where does foregut pain tend to be felt?

A

In the epigastric region

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123
Q

Where does midgut pain tend to be felt?

A

Umbilical

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124
Q

Where is hindgut pain usually felt?

A

Pubic

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125
Q

Foregut structures enter the spinal cord at approx.?

A

T6-T9

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126
Q

Midgut structures enter the spinal cord at approx.?

A

T8-T12

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127
Q

Hindgut structures enter the spinal cord at approx.?

A

T10-L2

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128
Q

Somatic motor sensory and sympathetic nerves supplying the abdominal body wall are conveyed within?

A

Thoracoabdominal nerves 7-11th intercostal nerves

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129
Q

The 7th to 11th intercostal nerves travel anteriorly, then leave the intercostal spaces in the plane between?

A

The internal oblique and transversus abdominus as thoraco-abdominal nerves

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130
Q

Where do subcostal nerves leave the spinal cord?

A

T12 anterior ramus

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131
Q

Where do Iliohypogastric nerves leave the spinal cord?

A

Half of the L1 anterior ramus (suprapubic)

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132
Q

Where to Ilioinguinal nerves leave the spinal cord?

A

Half of the L1 anterior ramus(pubic)

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133
Q

How does pain from an appendicitis usually present?

A

Usually initially dull, aching pain in the umbilical region As an appendicitis worsens, the appendix will start to irritate the right iliac fossa

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134
Q

Why is pain from an appendicitis usually initially dull, aching pain in the umbilical region

A

Because visceral afferents from midgut organs enter the spinal cord between T8-T12 (appendix is T10 = umbilicus)

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135
Q

List the parts of the SI and LI?

A

Duodenum, jejunum, ileum

Caecum, appendix, ascending, transverse, descending, sigmoid

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136
Q

The liver, spell, gallbladder, pancreas and small intestine all produce?

A

Bilirubin and bile

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137
Q

What is bilirubin?

A

Normal by-product of the breakdown of red blood cells

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138
Q

What is jaundice (icterus)?

A

Yellowing of the sclera and skin caused by an increase in blood levels of bilirubin

139
Q

Where does RBC breakdown mainly occur?

A

In the spleen

140
Q

Bilirubin is used to form ___ in the liver

141
Q

Bile is important for?

A

The normal absorption of fats from the SI

Contributes to pancreatic enzymes in digesting food in the SI

142
Q

What is the function of the liver?

A

Glycogen storage
Bile secretion
Other metabolic functions

143
Q

What is the surface anatomy of the liver?

A

Mainly located in the RUQ

Protected by ribs 7-11

144
Q

What happens to the position of the liver during inspiration?

A

Lowers down

145
Q

The liver is inferior to?

A

The right hemiödiaphragm

146
Q

How is the gallbladder anatomically related to the liver?

A

It is posterior and inferior to the liver

147
Q

The hepatic flexure is _____ to the liver

148
Q

The right kidney, adrenal gland, IVC and abdominal aorta are _____ to the liver

149
Q

The stomach is ______ at the ______ side of the liver

A

Posterior mid-left

150
Q

What are the 4 anatomical lobes of the liver?

A

Right lobe
Left lobe
Caudate lobe (superior)
Quadrate lobe (inferior)

151
Q

Which of the lung lobes contains a bare area?

A

Quadrate lobe

152
Q

What is meant by a “bare area”?

A

Not touched by any peritoneum = pure liver parenchyma

153
Q

What is the falciform ligament?

A

A remnant of ventral mesentary

154
Q

What is the round ligament?

A

A remnant of the umbilical vein

155
Q

The porta hepatis is closely associated with the gallbladder at _______ aspect

156
Q

How many functional divisions of the liver are there?

157
Q

Why can individual functional lobes be removed from the liver?

A

Because each lobe has a branch of the hepatic artery, hepatic portal vein and bile drainage (to bile duct) and venous drainage (to IVC)

158
Q

The hepatic veins directing deoxygenated blood from the liver come tiger as _ veins before entering the IVC

159
Q

What does the portal triad contain?

A

Hepatic portal vein
Hepatic artery proper
Bile duct

160
Q

The portal triad runs within which ligament?

A

The hepato-duodenal ligament

161
Q

The coeliac trunk is the ___ midline branch of the aorta

162
Q

Is the coeliac trunk intra or retroperitoneal?

A

Retroperitoneal

163
Q

Where does the coeliac trunk leave the abdominal aorta?

164
Q

The coeliac trunk trifurcates into?

A

Splenic artery
Left gastric artery
Common hepatic artery

165
Q

The common hepatic artery branches into? then becomes?

A

Gastroduodenal artery

Hepatic artery proper

166
Q

The splenic artery has a _______ course along the _____ border of the pancreas

A

Torturous superior

167
Q

Is the spleen intra- or retroperitoneal?

A

Intraperitoneal

168
Q

Where is the spleen?

A

Left hypochondrium

169
Q

What are the anatomical relations of the spleen?

A

Diaphragm posteriorly
Stomach anteriorly
Splenic flexure inferiorly
Left kidney medially

170
Q

Major blood supply to the stomach comes from?

A

The right and left gastric arteries and right and left gastro-omental arteries

171
Q

Where do the right and left gastric arteries anastomose?

A

Along the junction of the lesser curvature and lesser omentum of the stomach

172
Q

Where do the right and left gastro-omental arteries anastomose?

A

Along the junction of the greater omentum and greater curvature of the stomach

173
Q

Blood supply to the liver comes from?

A

Right and left hepatic arteries

174
Q

The right and left hepatic arteries are branches of?

A

The hepatic artery proper

175
Q

Histologically, the liver consists of?

A

Hexagonal iver lobules with a central vein at the centre and an interlobular portal triad at each corner

176
Q

What does the interlobular portal triad consist of?

A

Branch of the HPV, branch of HA and biliary duct

177
Q

> Both the hepatorenal recess (Morrison’s pouch) and the sub-phrenic recess are located within the?

A

Peritoneal cavity

178
Q

The hepatorenal recess is one of the lowest parts of the peritoneal cavity when the patient is?

179
Q

Pus in the sub-phrenic recess can drain into the _____ when the patient is bedridden

A

Hepatorenal

180
Q

The HPV drain blood from where into the liver for 1st pass metabolism

A

Fore, mid and hindgut

181
Q

The HPV is formed by?

A

The splenic and superior mesenteric vein

182
Q

The IVC is retroperitoneal and drained cleaned blood from the ________ into the right atrium

A

Hepatic veins

183
Q

Anatomically how are the portal triad structures arranged anterior to posterior?

A

Bile duct
HAP
HPV

184
Q

What is the function of the gallbladder?

A

Store and concentrate bile between meals

185
Q

The gallbladder lies on the ______ aspect of the liver (often firmly attached) and ____ to the duodenum

A

Posterior

Anterior

186
Q

Bile flows in and out of the gall bladder via?

A

The cystic duct

187
Q

Blood supply to the gall bladder comes from the?

A

Cystic artery

188
Q

In 75% of people the cystic artery is a branch of the?

A

Right hepatic artery

189
Q

The right cystic artery is located in the?

A

Cystohepatic triangle (of Calot)

190
Q

What makes up the triangle of Calot (aka cystohepatic triangle)

A

Liver border
Common hepatic duct
Cystic duct

191
Q

Inflammation of the gallbladder/cystic duct can follow irritation from or impaction of a?

192
Q

The gall bladder is part of the ____-gut?

193
Q

Visceral afferents from the gall bladder enter the spinal cord at?

194
Q

Early pain from cholyangitis will develop in the ______

A

Epigastrium

195
Q

Where can pain from cholyangitis arise besides the epigastrium?

A

Hypochondrium +/- pain referral to the right shoulder as a result of anterior diaphragmatic irritation

196
Q

What is a cholecystectomy?

A

Surgical removal of the gallbladder

197
Q

What are the parts of the pancreas?

A

Head
Neck
Body
Tail

198
Q

The head of the pancreas is surrounded by?

A

C-shaped curve of the duodenum

199
Q

What are the 4 parts of the duodenum?

For each of these parts state whether they are intra- or retroperitoneal.

A

Superior (intra) with duodenal cap
Descending (retro)
Horizontal (retro)
Ascending (retro)

200
Q

What is the start and end of the duodenum?

A

Pyloric sphincter

Duodenojejunal flexure

201
Q

The duodenum secretes _____ and ______ into the blood

A

Gastrin

CCK

202
Q

Pain from duodenal ulcers to to present in which region?

A

Epigastric

203
Q

What is found posterior to the pancreas?

A 
Right kidney and adrenal gland 
IVC 
Bile duct
Abdominal aorta
Superior mesenteric vessels (start at head of pancreas)
Left kidney and adrenal gland 
Part of portal venous system
204
Q

What is found anterior to the pancreas?

205
Q

What is found superoposteriorly to the pancreas?

A

Splenic vessels

206
Q

What are the exocrine functions of the pancreas?

A

Acinar cells release digestive enzymes into the pancreatic duct

207
Q

What are the endocrine functions of the pancreas?

A

Islets of Langerhans secrete insulin and glucagon into the blood stream

208
Q

The bile duct travels _____ to the superior part of the duodenum to a grove in the posterior aspect of the ____ where it joins with pancreatic duct to form the?

A

Posterior
Pancreas
Ampulla of Vader/Hepatopancreatic ampulla

209
Q

The ampulla of Vater/hepatopancreatic ampulla drains into the duodenum via?

A

The major duodenal papila

210
Q

It is possible to have accessory pathways of the pancreatic duct into the duodenum via?

A

Minor duodenal papillae

211
Q

Where are the 3 points of flow control of bile?

A

Bile duct sphincter
Pancreatic duct sphincter
Sphincter of Oddi

212
Q

What does ERCP stand for?

A

Endoscopic retrograde cholangiopancreatography

213
Q

What is ERCP used for?

A

To study the pancreas and biliary tree

214
Q

Jaundice is caused by?

A

Increased levels of bilirubin in the blood

215
Q

What are extra-hepatic causes of jaundice?

A

Obstruction of the biliary tree (gallstones/carcinoma) leading to back-up of bile to the liver and overspill in the blood

216
Q

Blockage of the ampulla can causes bile to be diverted into the pancreas leading to?

A

Pancreatitis

217
Q

Where is pancreatitis pain felt?

A

Epigastric and umbilical region

+ Patient’s back

218
Q

Acute pancreatitis can be caused by?

A

Gall stone obstruction leading to reflux of bile and pancreatic juice into the main pancreatic duct

219
Q

What is Grey-Turner’s and Cullen’s sign of acute pancreatitis? What is the cause?

A

Vascular haemorrhage can cause blood accumulation in the retroperitoneal space

Grey-Turner’s sign = right +/- left flank
Cullen’s sign = around umbilicaus via falciform ligament

220
Q

Where does the jejunum begin?

A

At the duodenaljejunal flexure

221
Q

Where does the ileum end?

A

At the ileocaecal junction

222
Q

Which, of the jejunum and ileum, is thicker and heavier?

223
Q

Which, of the jejunum and ileum, has more fat?

224
Q

Which, of the jejunum and ileum, is more vascular?

225
Q

Which, of the jejunum and ileum, has sparse folds?

226
Q

Which, of the jejunum and ileum, contains Peyer’s Patches?

227
Q

What is the arterial supply to the jejunum/ileum?

A

SMA via ileal and jejunal arteries

228
Q

Where does the SMA leave the aorta?

229
Q

What drains the jejunum/ileum?

A

Jejunal/ileal veins

230
Q

The jejunum/ileal veins drain into the?

231
Q

The SMV drains into the?

232
Q

The vascular supply to the jejunum and ileum travels within the?

233
Q

The SMA and SMV are located ____ to the neck of the pancreas

234
Q

The SMA and SMV travel ________ to the uncinate process to enter the mesentery proper

A

Anteroinferior

235
Q

Fat digestion is aided by _______. With chylomicrons they are absorbed into specialised lymphatic vessels in the SI called?

A

Bile

Lacteals

236
Q

Lacteals travel through lymphatics and enter the venous system at?

A

Left venous angle

237
Q

Lymph vessels tend to travel alongside?

238
Q

Minor blood supply to the stomach comes from?

A

Posterior gastric arteries

Short gastric arteries

239
Q

What ducts form to make the bile duct?

A

Common hepatic duct

Cystic duct

240
Q

Where does the bile duct drain?

A

Into the 2nd part of the duodenum

241
Q

What are the main groups of lymph vessels draining the abdomen and where soecifically do they drain?

A

Coeliac (foregut)
SM (midgut)
IM (hindgut)
Lumbar (kidneys, posterior abdominal wall, pelvis, lower limbs)

242
Q

How many paracolic gutters are there between the lateral edge of the ascending/descending colon and the abdominal wall?

243
Q

The paracolic gutters are part of the _______ and are potential sites for ____

A

Greater sac

Pus or fluid collection

244
Q

What are omental appendices of the colon?

A

Small pouches of the peritoneum filled with fat and situated along the colon, but are absent in the rectum

245
Q

What are the teniae coli of the colon?

A

3 distinct longitudinal bands of thickened smooth muscle, running from the caecum to the distal end of the sigmoid colon

246
Q

The 3 bands of the teniae coli of the colon come together at the caecum to form?

A

The appendix

247
Q

What are haustra?

A

Small pouches formed by sacculation; because the tenure coli are shorter than the intestine, the colon becomes sacculated between them forming hasutra

248
Q

The caecum and appendix both lie in the?

A

Right iliac fossae

249
Q

The appendiceal orifice is located?

A

On the posteromedial wall of the wall of the caecum

250
Q

The appendiceal orifice corresponds to _______ on the anterior abdominal wall approximately ___ of the way between the _____ to _______-

A

McBurney’s point
1/3
ASIS (anterior superior iliac spine)
Umbilicus

251
Q

McBurney’s point is the theoretical area of?

A

Maximal tenderness of appendicitis

252
Q

The appendix is typically located?

A

Behind the caecum (position is variable)

253
Q

Where does the sigmoid colon lie?

A

In the LIF

254
Q

The long sigmoid mesocolon gives the sigmoid colon a?

A

Considerate degree of mobility

255
Q

What is the risk associated with the considerate degree of mobility of the sigmoid colon?

A

Risk of twisting during embryological development (sigmoid volvulus) resulting in bowel obstruction and infarction if untreated

256
Q

The abdominal aorta is a midline retroperitoneal structure anterior to vertebral bodies and left to the?

257
Q

What are the midline branches of the abdominal aorta and at which vertebral level do they come off?

A

Coeliac trunk - T12
SMA - L1
IMA - L3

258
Q

What are the lateral branches of the abdominal aorta and at which vertebral level do they come off?

A

Left/right renal artery - L1
Gonadal arteries - L2
Lumbar arteries - L4

259
Q

What do the lumbar arteries supply?

A

The posterolateral body wall

260
Q

The bifurcation of the abdominal aorta into the iliac arteries occurs at which vertebral level?

261
Q

The common iliac arteries divide into?

A

External and internal iliac arteries

262
Q

What are the branches of the SMA (in order)

A 
Inferior pancreaticoduodenal (pancreas/duodenum)
Middle colic artery (transverse colon)
Right colic artery (ascending colon)
Ileocolic branches (ascending colon) 
Appendicular (runs within mesoappendix)
263
Q

What do the ileocolic branches of the SMA give off?

A

Jejunal and ileal arteries

264
Q

What is a noticeable difference between the jejunal and ideal arteries’ vasa rectae and arcades?

A

The jejunal arteries have longer vasa rectae and larger & fewer arcades than the ileal arteries

265
Q

What is the marginal artery of Drummond (aka juxta-colic artery)?

A

Arterial anastamoses between the SMA and IMA

266
Q

Whatis function of the marginal artery of Drummond?

A

Help prevent ischaemia of the intestines by providing collateral routes for blood flow

267
Q

The rectum and anal canal are perfused by?

A

The superior rectal artery (branch of IMA)

268
Q

The inferior rectal artery supplies?

A

The perineum, genitalia and rectum

269
Q

What is the pectinate line?

A

Division of upper 2/3rds of the anal canal and lower 1/3rd

270
Q

The pectinate line is the site of border between which arteries?

A

Superior, middle and inferior rectal arteries

271
Q

At the pectinate line there are anastamoses between which vessels?

A

Superior, middle and inferior rectal arteries

272
Q

What are the two venous systems?

A

Portal and systemic venous system

273
Q

The hepatic portal vein drains blood from ______- to the liver for first pass metabolism

A

Fore, mid and hindgut

274
Q

The splenic vein drains from ______ to _______

A

Foregut structures to hepatic portal vein

275
Q

The SMV drains blood from ______ to ______

A

Midgut structures hepatic portal vein

276
Q

The IMV drains blood from ______ to _______

A

Hindgut structures to splenic vein

277
Q

Porto-systemic anastomoses consist of?Varices/enlargement of these vessels is the result of?

A

Small collateral valve-less veins

Portal hypertension

278
Q

What are the anastomoses at the distal end of the oesophagus?

A

Inferior part drains into the HPV

Superior part drains into azygous vein

279
Q

What are the anastomoses at the skin around the umbilicus?

A

Connection between para-umbilical veins (to HPV along round ligament of liver) and epigastric veins (to caval system)

280
Q

What are the anastomoses at the rectum/anal canal?

A

Rectum and superior anal canal (superior rectal vein) drain into IMV
Inferior part of GI tract (middle and inferior rectal veins) drains into internal iliac veins

281
Q

What can cause portal hypertension?

A

Liver pathology (cirrhosis) +/- tumour compressing the HPV leading to reversal of blood flow (varicosed collateral veins)

282
Q

What is the clinical presentation of portal hypertension?

A

Oesophageal varices
Caput medusa dilated paraumbilical and epigastric veins)
Rectal varices

283
Q

Prolapse of rectal varicose can lead to?

A

Haemorrhoids (piles)

284
Q

What is haematemesis? What are the two main causes?

A

Vomiting blood
Peptic ulcer in stomach/ duodenal wall erodes
Bleeding from oesophageal varices

285
Q

What are the branches of the inferior mesenteric artery in order?

A

Left colic artery (descending colon)
Sigmoidal arteries
(Branch of sigmoid: superior rectal artery)

286
Q

Where are the three sites of porto-systemic anastomosis in the GI tract?

A

At the distal end of the oesophagus
Skin around the umbilicus
Rectum/anal canal (and descending colon)

287
Q

Visceral afferents from the rectum send _____ signals to the brain

A

“fullness”

288
Q

What can affect faecal contience?

A

Neural (dementia, stroke, MS, trauma) pathology
Medication
Age-related natural nerve degeneration
Consistency of stool

289
Q

Where is the pelvic cavity?

A

Between the pelvic inlet and pelvic floor (within bony pelvis)

290
Q

What separates the pelvic cavity and perineum?

A

The pelvic diaphragm

291
Q

The pelvic cavity is ______ with the abdominal cavity

A

Continuous

292
Q

What makes up the pelvic floor?

A

The levator ani muscle

293
Q

The levator ani muscle forms the musculo-fascial inferior part of?

A

The pelvic cavity

294
Q

Openings in the pelvic floor allow which structures to pass through into the perineum?

A

The bladder
Uterus
Rectum

295
Q

The sigmoid colon becomes the rectum at the _______ junction at vertebral level?

A

Rectosigmoid

S3

296
Q

Rectum becomes anal canal anterior to the ____ just before passing through _______ muscle

A

Tip of the coccyx

Levator ani

297
Q

The walls of the rectal ampulla can relax to?

A

Accomodate faecal material

298
Q

What is the difference in macroscopic appearance of the rectum between when its empty and full?

A

Goes from S-shape to straight

299
Q

The superior rectum is covered by?

A

Peritoneum

300
Q

The rectouterine/-vesicle pouch lies ____ to the superior rectum

301
Q

The prostate gland/vagina lies ___ to the ________ rectum

A

Anterior

Middle/inferior

302
Q

What makes up the levator ani muscle?

A

Puborectalis (swing around rectum and attaches to pubis on either side)
Pubococcygeus (pubic bone - coccyx)
Ileococcygeus (ilea region - coccyx)

303
Q

What innervates the levator ani?

A

The “nerve to levator ani”

304
Q

The nerve to lavator ani is a branch of which two nerves?

A

Puodendal nerve

Sacral plexus

305
Q

Where does the puodendal nerve originate from?

306
Q

Pubcorectalis contraction decreases the _______ angle

A

Anorectal angle

307
Q

The puborectalis is ____ muscle

308
Q

What are the two sphincters in the anal canal?

A

Internal and external anal sphincter

309
Q

Outline the internal anal sphincter - type of muscle, location, nerve supply and function

A

Smooth muscle
Superior 2/3 of anal canal
Contraction stimulated by sympathetic nerves and inhibited by parasympathetic
Usually closed, releases reflexively to distension of rectal ampulla

310
Q

Outline the external anal sphincter - type of muscle, location, nerve supply and function

A

Skeletal muscle
Inferior 1/3 of anal canal
Contraction stimulated by puodendal nerve
Voluntary control

311
Q

Sympathetic nerve supply to the rectum/anal canal comes from ______ -> inferior mesenteric ganglia which synapses via ________ around branches of the ____

A

T12-L2 periarterial plexus

IMA

312
Q

Sympathetic innervation of the rectum/anal canal stimulates?

A

Contraction of internal anal sphincter and inhibition of peristalsis

313
Q

Parasympathetic fibres from ______ via pelvic _______ nerve synapse in __________

A

S2,3,4 (spinal cord level)
Splanchnic
Walls of rectum

314
Q

What is the effect of parasympathetic innervation of the rectum/anal canal?

A

Inhibit internal anal sphincter and stimulate peristalsis

315
Q

Visceral afferents follow _______ back to ______. They sense stretch, _____, etc.

A

Parasympathetics
S2,3,4 (spinal cord level)
Ischaemia

316
Q

Somatic motor supply from the puodendal nerve comes from _______

A

S2,3,4 (spinal cord level)

317
Q

Nerve to levator ani comes from?

A

S2,3,4 (spinal cord level)

318
Q

Nerve to leaver ani stimulates?

A

Contraction of external anal sphincter and puborectalis

319
Q

The puodendal nerve exits the pelvis via?

A

Greater sciatic foramen

320
Q

Pudodenal nerve enters the perineum via?

A

Lesser sciatic foramen

321
Q

Stretching of the puodenal nerve and/or tearing of the fibres of the puborectalis or external anal sphincter muscle can result in weakened muscle leading to?
Give an example of when this can occur?

A

Faecal incontinence

During vaginal delivery

322
Q

The pectinate line is the junction between _____ and _______ during embryological development

A

Endoderm (GI tract)

Ectoderm (skin)

323
Q

What is the nerve supply superior to the pectinate line?

324
Q

What is the arterial supply superior to the pectinate line?

325
Q

What is the venous drainage superior to the pectinate line?

A

IMV (portal)

326
Q

What is the lymphatic drainage superior to the pectinate line?

327
Q

What is the nerve supply inferior to the pectinate line?

A

Somatic/Puodendal

328
Q

What is the arterial supply inferior to the pectinate line?

A

Internal iliac artery

329
Q

What is the venous drainage inferior to the pectinate line?

A

To internal iliac vein (systemic)

330
Q

What is the lymphatic drainage inferior to the pectinate line?

A

Superficial inguinal nodes

331
Q

Pelvic lymphatics tend to follow the ____

332
Q

What are the main lymph node groups in the pelvis?

A

Internal iliac
External iliac
Common iliac
Lumbar

333
Q

The internal iliac nodes drain…

A

Inferior pelvic structures

334
Q

The external iliac nodes drain …

A

Lower limb

Superior pelvis

335
Q

The common iliac nodes drain…

A

External and internal iliac nodes

336
Q

The lumbar nodes drain…

A

Common iliac nodes

337
Q

The IMA supplies the hindgut which extends unto the pectinate line. The remainder is supplied by?

A

The internal iliac artery

338
Q

What drains the hindgut? The remainder?

A

IMV

Internal iliac vein

339
Q

What are haemorrhoids? Why are they different than rectal varices?

A

Prolapse of rectal venous plexuses

Not related to portal hypertension - increased pressure (e.g. chronic constipation, straining, pregnancy)

340
Q

Ischioanal fossa (R&L) lie on either side of the?

A

Anal canal

341
Q

The ischioanal fossa communicate with each other ______

A

Posteriorly

342
Q

Pus collection within the ischioanal fossae can lead to…

A

Ischioanal abscess

343
Q

A PR exam is assessing the stregth of which sphincter?

A

External anal sphincter

Y1 GI Anatomy (2 decks)

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