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MB1: Gastrointestinal > Anatomy > Flashcards

Anatomy Flashcards

1
Q

muscle opening law

A

lateral pterygoid

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2
Q

muscles closing jaw

A

masseter, temporalis, medial pteryoid

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3
Q

what innervates the muscles of the jaw

A

mandibular divison of trigeminal nerve

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4
Q

on what joint is the jaw held and what prevents it from dislocating

A

temporomandibular joint

articular tubercle

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5
Q

space between teeth and lips

A

vestibule

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6
Q

where is the parotid gland found and where does it empty

A

in front of ear

buckle and 2nd molar

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7
Q

where is the sublinqual gland found and where does it empty

A

under oral cavity

base of mouth

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8
Q

where is the submandibular gland found and where does it empty

A

base of jaw

frenulum of tongue

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9
Q

what is sensation in upper mouth supplied by

A

CN V2

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10
Q

what is sensation in lower mouth supplied by

A

CN V2

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11
Q

state the numbers of the teeth

A

1,2 - incisor
3 - canine
4,5 - premolar
6,7,8 - molar

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12
Q

what nerves control the gag reflex

A

sensory - IX

motor- IX, X

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13
Q

what nerves control anterior 2/3 tongue

A

sensory - CN V3 (mandibular of trigeminal)

Special sensory - VII (facial)

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14
Q

what nerves control the posterior 1/3 tongue

A

sensory/special sensory - IX (glossopharyngeal)

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15
Q

true/false - the palatoglossus/styloglossus, hyoglossus and genioglossus are all supplied by XII

A

false - palatoglossus has vagal innervation

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16
Q

what do Palatoglossus Styloglossus Hyoglossus

Genioglossus control

A

tongue position

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17
Q

what is the cricopharyngeus

A

C6, upper oesophageal sphincter

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18
Q

constrictor muscles are voluntary but contract ___

A

sequentially

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19
Q

constrictor muscles have ___ innervation

A

vagal

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20
Q

what innervation does the longitudinal inner layer pharynx have and what does it do?

A

elevates pharynx and larynx to close laryngeal inlet

CN X, IX

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21
Q

describe anatomy of swallow

A

closure of lips
tongue pushes bolus to oropharynx
sequential contraction of constrictor muscles
inner longitudinal pharyngeal muscles contract to prevent aspiration
bolus reaches oesophagus

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22
Q

where does the oesophagus begin

A

inferior edge of cricopharyngeus

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23
Q

what runs on the surface of the oesophagus

A

oesophageal plexus

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24
Q

where does the oesophagus pass through diaphragm

A

T10

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25
Q

the lower oesophageal sphincter is anatomical/physiological and how does it work?

A

physiological - higher intra-abdominal pressure over intragastric

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26
Q

4 parts of the stomach

A

cardia
fundus
body
pyloric antrum

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27
Q

where does the stomach lie

A

below left hemidiaphragm in left hypochondrium, epigastric and umbilical region

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28
Q

the stomach is said to be J shaped due to a ___ curvature on the left and a ____ on the right

A

greater

lesser

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29
Q

small intestine

A

duodenum
jejunum
ileum

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30
Q

large intestine

A 
caecum 
appendix 
ascending, transverse, descending, sigmoid colon 
rectum 
anal canal
anus
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31
Q

where does the foregut range from and what is contained in it

A

oesophagus to mid duodenum

liver, gallbladder, spleen, half of pancreas

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32
Q

where does the midgut range from and what is contained in it

A

mid duodenum to proximal 2/3 transverse colon

half of pancreas

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33
Q

where does the hindgut range from and what is contained in it

A

distal 1/3 transverse colon to proximal 1/2 anal canal

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34
Q

divisions of the 9 regions of the abdominal cavity

A

mid-clavicular
subcostal
trans-tubercular

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35
Q

9 stomach regions

A 
epigastrum
pubic 
umbilical 
right/left lumbar 
right/left iliac fossa 
right/left hypochondriac
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36
Q

4 body quadrants and their divisions

A

median and trans-umbilical planes

right/left upper/lower quadrants

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37
Q

muscles of anterolateral abdominal wall

A

rectus abdominis
externa/internal oblique
transversus abdominis

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38
Q

where is the peritoneal cavity located

A

between the visceral and parietal peritoneum

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39
Q

what is mesentery

A

double layer peritoneum

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40
Q

what are intraperitoneal organs?

A

organs completely covered by peritoneum

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41
Q

what are retroperitoneal organs and give examples

A

organs not fully covered by the peritoneum and so are located in the retroperitoneum
Pancreas and kidneys

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42
Q

what organ is held suspended by mesentery?

A

small intestine

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43
Q

what is the greater omentum

A

4 layer structure covering intestine

originates from greater curvature of stomach

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44
Q

where does the lesser omentum span

A

lesser curvature of stomach from inferior of liver

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45
Q

where do the greater peritoneal sac and lesser peritoneal sac communicate through

A

omental foramen

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46
Q

pouch formed by peritoneum in men

A

rectovesicle pouch

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47
Q

pouches formed by peritoneum in women

A

vesico-uterine pouch

recto-uterine pouch

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48
Q

describe the process of paracentesis

A

needle insertion lateral to rectus sheath avoiding inferior epigastric artery

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49
Q

nerve innervation modalities to abdominal wall?

A

somatic sensory
motor
sympathetic

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50
Q

nerve innervation modalities to visceral peritoneum and abdominal cavity organs

A

visceral afferent

ANS/ENS

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51
Q

where do sympathetic nerves leave the spinal cord for abdomen

A

T5-L2

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52
Q

describe path of sympathetic nerves from spinal cord to abdomen

A

enter sympathetic chains and pass through to abdominopelvic splanchnic nerves
synapse at prevertebral ganglia and travel down periarterial plexuses

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53
Q

why is sympathetic innervation unique to the adrenal gland

A

travels T10-L1

synapses directly onto adrenal cells

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54
Q

describe path of CN X

A

travel from surface of oesophagus
travels on periarterial plexus to organs
synapse in ganglia on organ

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55
Q

how much of the GI tract is supplied by vagal innervation

A

GI tract to distal of transverse colon

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56
Q

where do pelvic splanchnic nerves come from, where do they supply

A

S2-S4

smooth muscle and glands of descending colon to anal canal

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57
Q

foregut pain is often ____

A

epigastric

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58
Q

midgut pain is often _____

A

umbilical

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59
Q

hindgut pain is often ____

A

pubic

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60
Q

where do nerve bundles reach on spinal cord for the gut?

A

foregut - T6-9
midgut - T8-T12
hundgut - T10-L2

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61
Q

where is liver/gallbladder pain felt

A

right lumbar/hypochondrium, extending to back, patients shoulder tip

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62
Q

where is stomach pain felt

A

epigastric, interscapular or umbilical

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63
Q

where is appendix pain felt

A

umbilical, moving to right iliac fossa

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64
Q

where is splenic pain felt

A

right lumber or right of back

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65
Q

where is small intestine pain felt

A

umbilical region, or epigastric if duodenal

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66
Q

what make up the thoracoabdominal intercostal nerves

A

7-11th intercostal nerves

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67
Q

what makes up the subcostal nerve

A

T12, anterior ramus

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68
Q

what makes up the iliohypogastric nerve

A

half of the anterior ramus of L1

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69
Q

what makes up the ilioinguinal nerve

A

half of the anterior ramus of L1

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70
Q

what is bilirubin?

A

by product of breakdown of RBC

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71
Q

where does breakdown of RBC occur

A

spleen

liver

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72
Q

where is bile formed

A

liver

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73
Q

function of gallbladder

A

stores and concentrates bile

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74
Q

what is bile essential for

A

normal fat absorption

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75
Q

what is found in the portal triad

A

hepatic artery
hepatic portal vein
common bile duct
lymphatics and nerves

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76
Q

what is the celiac trunk and where does it supply

A

first of three branches of abdominal aorta at T12

supplies foregut organs

77
Q

the celiac trunk trifurcates to what?

A

splenic artery
hepatic artery
left gastric artery

78
Q

what are the anatomical relations of the spleen?

A

anterior to lower diaphragm
posterior to stomach
superior to splenic fixture
lateral to left kidney

79
Q

functions of the spleen?

A

break down RBC to bilirubun
immunological protection
storage of blood

80
Q

what ribs protect the spleen

A

9-11

81
Q

the left and right gastric arteries anastomose together and run on the greater/lesser curvature of the stomach

A

lesser

82
Q

the left and right gastro-omental arteries anastomose together and run on the greater/lesser curvature of the stomach

A

greater

83
Q

from what vessels does blood flow to the liver

A

hepatic artery

hepatic portal vein

84
Q

in what quadrant is the liver located

A

upper right, extending into upper left

85
Q

anatomical relationships to the diaphragm

A

diaphragm, superior, anterior and posterior
anterior stomach is medial
gallbladder posterior and inferior
right kidney, adrenal IVC, abdominal aorta posterior

86
Q

what ribs offer protection to the liver

A

7-11

87
Q

4 anatomical lobes of the liver

A

right, left, caudate, quadrate

88
Q

how many functional segments does the liver have?

A

8

89
Q

what does each functional segment of the liver have?

A

hepatic arterial, hepatic portal and bile supply

90
Q

what is the hepatorenal recess

A

morisons pouch

one of the lowest points of peritoneal cavity when patient is supine

91
Q

what are the 2 pouches of the peritoneal cavity

A

hepatorenal

sub-phrenic

92
Q

function of the hepatic portal vein

A

drains blood from foregut, midgut and hindgut for first pass metabolism

93
Q

function of the splenic vein

A

drains blood from foregut to hepatic portal vein

94
Q

function of the inferior mesenteric vein

A

drains blood from hindgut to splenic vein

95
Q

function of the superior mesenteric vein

A

drains midgut blood to hepatic portal vein

96
Q

function of the IVC in hepatic blood supply

A

drains blood from 3 hepatic veins to right atrium

97
Q

anatomical relationships of the gallbladder

A

posterior of liver, anterior of duodenum

98
Q

the neck of the gallbladder narrows to become?

A

the cystic duct

99
Q

where would gallstones likely impact on a patient

A

the cystic duct

100
Q

where does blood supply to the gallbladder come from?

A

cystic artery, from right hepatic artery (usually)

101
Q

where would pain in the gallbladder

A

epigastric as T6-9 but may be in hypochonrium or roght shoulder if there is diaphragmatic irritation

102
Q

what is jaundice

A

yellowing of sclera/skin due to blood bilirubin increase

103
Q

what composes common bile duct and where does it drain to

A

common hepatic duct (L+R hepatic duct)
Cystic duct
2nd part of duodenum

104
Q

the common bile duct combines with the main pancreatic duct to form the ___ and drains into duodenum via ____

A

ampulla of vater

major duodenal papilla

105
Q

3 sphincters of the biliary tree

A

bile duct sphincter
pancreatic duct sphincter
sphincter of oddi

106
Q

What is ERCP and what is it used for

A

endoscopic retrograde cholangiopancreatography

studies biliary tree and pancreas and may be used to treat certain pathologies

107
Q

describe how jaundice forms due to biliary obstruction

A

biliary obstruction causes bile to back up into liver and overspills into blood, with bilirubin

108
Q

causes of biliary obstruction

A

gallstones

carcinoma at head of pancreas

109
Q

what are the 4 parts of the pancreas

A

head
neck
body
tail

110
Q

where does the head of the pancreas lie

A

over superior mesenteric vessels

111
Q

where does body of pancreas lie

A

L2

aorta

112
Q

where is tail of pancreas anterior to

A

left kidney

113
Q

anatomical relationships of pancreas

A

posterior to stomach
duodenum to right, spleen left
anterior to left/ right kidney, IVC, SMA/SMV
splenic vessels superoposteriorly

114
Q

where does sympathetic and parasympathetic innervation to the pancreas come from

A

sympathetic - abdominopelvic splanchnic nerves

parasympathetic - vagus nerves

115
Q

blood supply to pancreas?

A

gastroduodenal to superior pancreaticoduodenal

SMA to inferior pancreaticoduodenal

116
Q

causes of pancreatitis

A

blocked ampulla of vater causing direction of bile to pancreas

117
Q

where is pancreatic pain felt

A

epigastric and/or umbilical and may radiate to back

118
Q

true/false - all of the duodenum is foregut

A

false - the first 2 parts are but the rest is midgut

119
Q

4 parts of the duodenum

A

superior
descending
horizontal
ascending

120
Q

duodenal ulcer pain presents as ___

A

epigastric

121
Q

blood supply to duodenum?

A

gastroduodenal - superior pancreaticoduodenal

SMA - inferior pancreaticoduodenal

122
Q

where does jejunum begin

A

duodenaljejunal flexure

123
Q

where does ileum end

A

ileocaecal junction

124
Q

what are plicae circularis

A

folds in the mucosa of jejunum

125
Q

where does blood supply to jejunum and ileum come from

A

jejunal and ileal arteries, from SMA

126
Q

describe venous drainage from jejunum and ileum

A

drains via jejunal and ileal veins, drains to SMVs and onto hepatic portal vein

127
Q

main abdominal lymph node groups

A

celiac
superior mesenteric
inferior mesenteric
lumbar

128
Q

where is fat within chylomicrons absorbed into from enterocytes

A

lacteals

129
Q

what parts of the colon are mobile

A

caecum and appendix
transverse
sigmoid colon
hepatic/spenic flexure - barely

130
Q

what parts of the colon are not mobile

A

ascending colon

descendin colon

131
Q

where are the paracolic gutters found and in what sac of the peritoneum would they be found

A

lateral edge of ascending and descending colon and abdominal wall
part of greater sac of peritoneal cavity

132
Q

where is the appendiceal orifice

A

posteromedial wall of caecum

133
Q

the sigmoid colon has a long mesentery for good movement, what is the disadvantage of this

A

sigmoid volvulus

causes obstruction of infarction

134
Q

3 midline branches of abdominal aorta?

A

Celiac trunk
SMA
IMA

135
Q

what anastomosis connects SMA to IMA

A

marginal artery of drummond

136
Q

branches of SMA?

A 
inferior pancreaticoduodenal 
jejunal and ileal arteries 
ileocolic artery
right colic artery
middle colic artery
appendicular artery
137
Q

branches of IMA

A

left colic artery
sigmoid colic artery
superior rectal artery

138
Q

true/false - IMA supplies all of rectum and anal canal

A

false - internal ileac supplies below pectinate line

139
Q

3 anastomoses of portal circulation

A

distal end of oesophagus
skin around umbilicus
rectal/anal canal

140
Q

describe distal end of oesophagus anastomosis

A

inferior systemic to hepatic portal and most superior GI to azygous vein

141
Q

describe skin around umbilicus anastomosis

A

blood flows around umbilicus via epigastric arteries before joining IVC

142
Q

describe rectal/anal canal anastomosis

A

rectum and superior anal canal to IMV, most inferior of GI tract to internal ileac veins

143
Q

what is portal hypertension and describe the consequence

A

increased BP in portal veins

causes blood to be diverted to anastomoses and so dilate and become varicose

144
Q

function of the rectum

A

hold faeces until appropriate to defecate

145
Q

what level does the sigmoid colon become rectum

A

S3, rectosigmoid junction

146
Q

when does rectum become anal canal

A

tip of coccyx and prior passing through levator ani

147
Q

rectal ampulla is superior/inferior to levator ani

A

superior

148
Q

anatomical relationships of the rectum

A

peritoneum covers superior
rectouterine/rectovesical pouch anterior to superior rectum
prostate anterior to inferior rectum
cervix/vagina anterior to inferior/middle rectum

149
Q

true/false - levator ani is usually relaxed

A

false - it is usually tonically contracted

150
Q

what nerves supply levator ani

A

nerve to levator ani

pudendal nerve

151
Q

contraction of the puborectalis causes?

A

decreased anorectal angle to allow defecation

152
Q

when does internal anal sphincter relax

A

rectal distention

153
Q

when is the external anal sphincter contract and what nerve does this

A

response to rectal distention and internal sphincter relaxation
pudendal nerve

154
Q

where do sympathetic fibres to rectum originate from and what do they do

A

exit T12-L2
contract internal anal sphincter
inhibit peristalsis

155
Q

where does nerve to levator ani and pudendal exit and what do they supply

A

nerve to levator ani -S2-S4
pudendal -S3-S4
contract external anal sphincter and puborectalis

156
Q

describe the path of the pudendal nerve

A

exits pelvis via greater sciatic foramen
enters lesser sciatic foramen to enter perineum
panches to supply structures

157
Q

how can labour lead to faecal incontinence or weakened muscle wall

A

stretch of pudendal nerve or muscle tear during labour

158
Q

where do visceral afferents and parasympathetics run and what do they stimulate

A

S2-S4
visceral afferents - sense stretch and ischaemia
parasympathetic - inhibit internal anal sphincter and stimulate peristalsis

159
Q

lymphatic drainage below pectinate line?

A

superficial inguinal nodes

160
Q

internal iliac lymphatics drain?

A

inferior pelvic structures

161
Q

external iliac lymphatics drain?

A

drains lower limb, superior pelvic structures

162
Q

common iliac lymphatics drain what and drain to what?

A

drains internal and external iliac nodes to lumbar nodes

163
Q

blood supply to rectum?

A

IMA

164
Q

blood supply to anus?

A

internal iliac artery

165
Q

Venous drainage of rectum

A

IMV to portal system

166
Q

venous drainage of rectum

A

internal iliac vein to systemic venous

167
Q

what is a rectal varice?

A

dilation of collateral veins between portal/systemic systems
usually related to portal hypertension

168
Q

what is a haemorrhoid

A

prolapses of rectal venous plexuses due to raised pressure

not postal hypertension

169
Q

what are the ischioanal fossae

A

fat and connective tissue that lie on each side of the anal canal

170
Q

what is a hernia

A

structure passing through another and ending in the wrong place

171
Q

what factors are required usually for herniation

A

structural weakness

increased pressure ie intraabdominal pressure

172
Q

sites of herniation

A 
femoral 
diaphragmatic 
inguinal 
incisional
spigelian
umbilical
epigastric
173
Q

what muscle is most superficial and extends from linea alba to linea semilunaris

A

rectus abdominis

174
Q

what is the most superficial muscle running from the linea semilunaris across the lateral abdominal wall and in what direction is its fibres

A

external oblique muscle

anteroinferior

175
Q

what muscle lies beneath the external oblique and what direction does its fibres run

A

internal oblique

anterosuperior

176
Q

what muscle is deep to internal oblique and in what direction do its fibres run?

A

transversus abdominis

horizontal

177
Q

what exactly is the inguinal ligament and where does it attach?

A

thickening of external oblique muscle

superior iliac spine to pubic tubercle

178
Q

what is the inguinal canal, how long is it, what direction does it run and what is the entry and exit

A

oblique passage between abdomen and perineum
4cm
inferomedially
superficial/deep inguinal ring

179
Q

contents of the inguinal canal?

A

spermatic cord in males
round ligament of uterus in females
ilioinguinal nerve
blood and lymphatics

180
Q

anterior border of inguinal canal?

A

external oblique muscle

internal oblique muscle

181
Q

posterior border of inguinal canal?

A

transversalis fascia

conjoint tendon

182
Q

superior border of inguinal canal?

A

transversalis fascia
external oblique aponeurosis
arches of internal oblique and transversus abdominis

183
Q

inferior border of inguinal canal

A

gutter of infolded inguinal ligament

184
Q

borders of hesselbachs triangle and significance?

A

inferior epigastric artery
inguinal ligament
lateral border of rectus abdominis
site of direct inguinal herniation

185
Q

what is direct inguinal herniation

A

directly through abdominal wall structures in hesselbachs triangle

186
Q

what is indirect inguinal herniation

A

use of inguinal canal to allow abdominal contents to herniate

187
Q

surface anatomy - deep inguinal ring?

A

superior to halfway point along inguinal ligament

188
Q

surface anatomy - superficial inguinal ring

A

superior and lateral to pubic tubercle

MB1: Gastrointestinal (19 decks)

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