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Gastrointestinal > Anatomy > Flashcards

Anatomy Flashcards

1
Q

what causes jaundice?

A

increase in blood levels of bilirubin caused by an obstruction of the biliary tree

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2
Q

what is bilirubin?

A

a by-product of the breakdown of red blood cells

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3
Q

where does the breakdown of red blood cells occurs?

A

the spleen

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4
Q

what is bilirubin used for?

A

to form bile in the liver

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5
Q

what is the biliary tree?

A

a set of tubes connecting the liver to the 2nd part of the duodenum that bile travels through

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6
Q

what ducts make up the biliary tree?

A
  • right and left hepatic duct
  • to common hepatic duct
  • plus cystic duct
  • to bile duct
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7
Q

anatomically where is the bile duct?

A

descending posteriorly to the 1st superior part of the duodenum
travels in a groove to the posterior aspect of the pancreas
it then joins with the ampulla of vater
both then drain into the second part of the duodenum

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8
Q

what is endoscopic retrograde cholangiopancreatography (ERCP)?

A

investigation used to study the biliary tree and pancreas

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9
Q

what can cause an obstruction of the biliary? tree?

A

gallstones, carcinoma at head of the pancreas

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10
Q

anatomically, where is the pancreas?

A

retroperitoneal organ that lies transversely across the posterior abdomen, the duodenum surrounds the head

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11
Q

what are the exocrine functions of the pancreas?

A

acinar cells (pancreatic digestive enzymes into main pancreatic duct

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12
Q

what are the endocrine functions of the pancreas?

A

islets of langerhans (insulin and glucagon into bloodstream)

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13
Q

where do the sympathetic nerves of the pancreas come from?

A

abdominopelvic splanchnic nerves

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14
Q

where do the parasympathetic nerves of the pancreas come from?

A

vagus nerves

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15
Q

how do nerves reach the pancreas?

A

pass through the diaphragm, then follow arteries from the celiac and superior mesenteric plexus to reach the pancreas

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16
Q

what is the role of parasympathetic nerves in the pancreas?

A

secretomotor

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17
Q

how is pancreatic secretion controlled?

A

parasympathetic nerves but MAINLY by hormones formed in the duodenum and intestinal mucosa as a response to acid contents from the stomach

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18
Q

what arteries supply the pancreas?

A
  • pancreatic branches from the splenic artery
  • gastroduodenal artery (superior pancreaticoduodenal)
  • superior mesenteric artery (inferior pancreaticoduodenal)
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19
Q

what commonly causes pancreatic pain?

A

pancreatitis

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20
Q

what causes pancreatitis?

A

blockage of the ampulla by a gallstone so bile os diverted into the pancreas

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21
Q

where is pancreatic pain located?

A

epigastric region and/or umbilical region

can radiate to back

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22
Q

what does the small intestine consist of?

A
  • duodenum
  • jejunum
  • ileum
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23
Q

true or false: the 1st and 2nd part of the duodenum are foregut organs?

A

true

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24
Q

name the 4 parts of the duodenum

A

superior
descending
horizontal
ascending

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25
Q

where and what is the pylorc sphincter?

A

sphincter at beginning of duodenum that controls the flow of chyme from stomach to duodenum

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26
Q

what does the duodenum do?

A

secretes a number of peptide hormones into the blood ie gastrin and CCK

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27
Q

where does duodenal pain present?

A

epigastric region

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28
Q

what arteries supply the duodenum?

A

gastroduodenal artery and superior mesenteric artery

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29
Q

where does the jejunum begin?

A

duodenaljejunal flexure at around L2 vertebral level

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30
Q

where does the ileum end?

A

ileocaecal junction

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31
Q

does the mucosa differ in the jejunum and the ileum?

A

yes

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32
Q

what is the mucosa of the jejunum like?

A

highly folded (plicae circularis)

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33
Q

what is the arterial blood supply of jejunum and ileum?

A

superior mesenteric artery via jejunal and ileal arteries

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34
Q

venous drainage of jejunum and ileum

A

jejunal and ileal veins to superior mesenteric vein to hepatic portal vein

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35
Q

what is bile’s role in the absorption of fats?

A

helps from GI tract lumen into the intestinal cells

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36
Q

what happens to fats in intestinal cells?

A

absorbed into specialised lymphatic vessels of the small intestine called lacteals

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37
Q

where do fats go from lacteals?

A

travel via lymphatic system and drain at left venous angle to venous system

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38
Q

where do you find lymph vessels?

A

normally alongside arteries

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39
Q

what lymph node drains the foregut organs?

A

celiac

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40
Q

what lymph node drains the midgut organs?

A

superior mesenteric

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41
Q

what lymph node drains the hindgut organs?

A

inferior mesenteric

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42
Q

what lymph node drains the kidneys, posterior abdo wall, pelvis and lower limbs?

A

lumbar

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43
Q

where do superficial lymph vessels drain?

A

into deep lymph vessels

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44
Q

where are the venous angles?

A

junction between subclavian and internal jugular veins

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45
Q

how many paracolic gutters are there?

A

2 - left and right

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46
Q

where are the parcolic gutters?

A

between lateral edge of ascending and descending colon, and abdominal wall

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47
Q

where does the caecum and appendix lie?

A

both lie in the right iliac fossa

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48
Q

where is the appendiceal orifice?

A

on posteromedial wall of caceum

  • corresponds to McBurney’s point on the anterior abdominal wall
  • 1/3 of the way between the right ASIS to umbilicus
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49
Q

where does the sigmoid colon lie?

A

in left iliac fossa

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50
Q

characteristics of sigmoid colon?

A

has a long mesentery (sigmoid mesocolon) to give it movement

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51
Q

what risks are there with the mobility of sigmoid colon?

A
  • at risk of twisting around itself (sigmoid volvulus)

- results in bowel obstruction

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52
Q

anatomically where is the abdominal aorta?

A
  • midline, retroperitoneal

- lies anterior to vertebral bodies and to left of IVC

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53
Q

what are the midline branches of the abdominal aorta?

A

3 midline branches

  • celiac trunk (foregut organs)
  • superior mesenteric artery (hindgut organs)
  • inferior mesenteric trunk (hindgut organs)
54
Q

what do the lateral branches of the abdominal aorta supply?

A
  • kidneys/adrenal glands
  • gonads
  • posterolateral
55
Q

at what level does the abdominal aorta bifuricate?

A

L4

56
Q

what does the abdominal aorta bifuricate to??

A

external and internal left and right iliac arteries

57
Q

what side does the superior mesenteric artery supply?

A

right

58
Q

what are the branches of the superior mesenteric artery?

A
  • (inferior pancreaticoduodenal)
  • middle colic
  • right colic
  • ileum (ileocolic)
  • (appendicular)
59
Q

what side does the inferior mesenteric artery supply?

A

left

60
Q

what are branches of the inferior mesenteric artery?

A
  • left colic
  • sigmoid colic
    superior rectal
61
Q

what does the inferior mesenteric supply??

A

hindgut organs

62
Q

where is an arterial anastomoses in the abdominal aorta?

A

between the branches of the SMA and the IMA

63
Q

what is the arterial anastonmose beween SMA and IMA called?

A

marginal artery of Drummond

64
Q

what is a benefit of an arterial anastomose?

A

could prevent intestinal ischaemia by providing an alternative route by which blood can travel

65
Q

what could cause haematemesis?

A
  • peptic ulcer in wall of stomach or duodenum
  • erodes through the mucosa
  • stomach or duodenum fills with blood
  • bleeding from oesophageal varices
  • abdominal dilatd veins
  • thin walled, therefore have potential to rupture
  • formatio often due to pathology affecting the portal venous system
66
Q

name the 2 venous systems

A
  • hepatic venous system

- systemic venous system

67
Q

what is the hepatic portal vein in the venous system for?

A

drains blood from the foregut, midgut and hindgut structures to the liver fr the first pass metabolism

68
Q

what is the inferior vena cava for in the venous system?

A

drains cleaned blood from the hepatic veins into right atrium

69
Q

what is the role of the splenic vein in the venous system?

A

drains blood from foregut structures to hepatic portal vein

70
Q

what is the role of the superior mesenteric vein?

A

drains blood from midgut structures to hepatic portal vein

71
Q

what is the role of the inferior mesenteric vein?

A

drains blood from hindgut structures to splenic vein

72
Q

characteristics of anastamoses between the systemic and portal venous systems?

A
  • blood can flow both ways

- no valves

73
Q

what is portal hypertension?

A

clinical term given to increased blood pressure within portal veins

74
Q

why does portal hypertension occur?

A

liver pathology eg cirrhosis

75
Q

what happens in portal hypertension?

A

blood will be diverted through the collateral veins back to the systemic venous system

76
Q

what are the complications of portal hypertension?

A

the collateral veins have a much larger volume of blood through them than they are used to so they dilate, becoming varicose

77
Q

what does the control of the excretion of faeces require?

A
  1. a holding area (the rectum) to store faeces until appropriate
  2. normal visceral afferent nerve fibres to sense “fullness” of the rectum
  3. functioning muscle sphincters to contract and rela
  4. normal cerebral function
78
Q

what can faecal continence be affected by?

A

neurological pathology, medications, neural age

79
Q

where is the rectum located?

A

within the pelvic cavity

80
Q

at what level does the sigmoid colon become rectum?

A

anterior to S3

the rectosigmoid junction

81
Q

where does the rectum become the anal canal?

A

anterior to the tip of the occyx just prior to passing through the levator ani muscle

82
Q

where are the anal canal and anus loacted?

A

in the perineum

83
Q

where is the rectal ampulla located?

A

immediately superior to the levator ani muscle

84
Q

what muscles make up the levator ani? (lateral to medial)

A
  • iliococcygeus
  • pubococcygeus
  • puborectalis
85
Q

what do the levator ani muscle do?

A
  • provides continual support for the pelvic organs

muscle must relax to allow defecation and urination to occur

86
Q

what nerves supply the levator ani and at what level?

A

“nerve to levator ani” ( a branch of the sacral plexus) and pudenal (S2, 3 and 4)

87
Q

what is the function of the puborectalis muscle?

A

contraction of this muscle decreases the anorectal angle, acting like a sphincter.
skeletal muscle so under control, voluntary contraction will help to maintain continence

88
Q

how many anal sphincters are there and what are they called?

A

2

- internal and external

89
Q

what type of muscle is the internal anal sphincter?

A

smooth muscle

90
Q

what type of muscle is the external anal sphincter?

A

skeletal

91
Q

what area of anal canal is the internal anal sphincter found?

A

superior two thirds of anal canal

92
Q

how is contraction of internal anal sphincter stimulated?

A

sympathetic nerves

93
Q

how is contraction of internal anal sphincter inhibited?

A

parasympathetic nerves

94
Q

is internal anal sphincter always contracted?

A

yes

95
Q

where is the external anal sphincter found in the anal canal?

A

inferior two thirds of the anal canal (superior part of the sphincter is continuous with the puborectalis muscle)is

96
Q

how is contraction of external anal sphincter stimulated?

A

by the pudendal nerve

97
Q

is the external anal sphincter under voluntary contraction?

A

yes

98
Q

what causes voluntary contraction of external anal sphincter?

A

along with puborectalis in response to rectal ampulla distension and internal sphincter relaxation

99
Q

what level are the sympathetic fibres that contract the internal anal sphincter from?

A

T12-L2

100
Q

where do the sympathetic fibres supplying the rectum and anal canal travek?

A

from T12-L2 to inferior mesenteric ganglia then to periarterial plexus around branches of IMA

101
Q

where do the visceral afferents go to and what do they sense?

A

S2-S4 with parasympathetics

sense stretch, ischaemia etc

102
Q

where do the parasympathetic fibres supplying rectum and anal canal run from?

A

from S2-S4 via pelvic splanchnic nerves, synapse in walls of rectum

103
Q

what do the parasympathetic nerves do in the rectum/anal canal?

A
  • inhibit internal anal sphincter

- stimulate peristalsis

104
Q

what do the sympathetic nerves do in the rectum/anal canal?

A
  • contraction of anal sphincter

- inhibit persitalsis

105
Q

what does somatic motor innervation do?

A

from pudendal nerve (s2-S4) and nerve to levator ani (S3-S4) contract external anal sphincter and puborectalis

106
Q

what levels is the pudendal nerve found?

A

S2, S3 and S4

107
Q

where does the pudendal nerve exit the pelvis?

A

via the greater sciatic foramen

108
Q

what does the pudendal nerve supply?

A

external anal sphincter

109
Q

where doe the pudendal nerve enter the perineum?

A

via lesser sciatic foramen

110
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 tha formed the skin (ectoderm)

111
Q

what supply is superior to pectinate line?

A

visceral

112
Q

what supply is inferior to line?

A

parietal

113
Q

what is the nerve supply above the pectinate line?

A

autonomic

114
Q

what is the arterial supply above the pectinate line?

A

from inferior mesenteric artery

115
Q

what is the venous drainage above the pectinate line?

A

to portal venous system (IMV)

116
Q

what is the lymphatic drainage above the pectinate line?

A

inferior mesenteric nodes (internal iliac nodes)

117
Q

what is the nerve supply below the pectinate line?

A

somatic and pudendal

118
Q

what is the arterial supply below the pectinate line?

A

from internal iliac artery

119
Q

what is the venous drainage below the pectinate line?

A

to systemic venous system (internal iliac)

120
Q

what is the lymphatic drainage below the pectinate line?

A

superficial inguinal nodes

121
Q

name the main groups of lymph nodes draining the pelvic organs

A
  • internal iliac (draining inferior pelvic)
  • external iliac (draining lower limb and more superior pelvic structures)
  • common iliac (draining from external and internal iliac nodes)
  • lumbar nodes (from common iliac)
122
Q

what artery supplies the hindgut organs?

A

inferior mesenteric artery

123
Q

where does the hindgut end?

A

at the proximal half of the anal canal (the pectinate line)

124
Q

what does the internal iliac artery supply?

A

remainder of GI tract after pectinate line

125
Q

what does the inferior mesenteric vein do?

A

drains the hindgut organs above the pecrinat line via the portal venous system

126
Q

what does the internal iliac vein do?

A

drains below the pectinate line via the systemic venous system

127
Q

how do rectal varices form?

A

in relation to portal hypertension, dilation of collateral veins between portal and systemic venous systems

128
Q

how are haemorrhoids formed?

A

as prolapses of the rectal venous plexus
not related to portal hypertension
its raised pressure ie chronic constipation, pregnancy

129
Q

what are ischioanal fossa?

A

lie on each side of anal canal and are filled with fat and loose connective tissue
- communicate with each other posteriorly

130
Q

what is an infection within the ischioanal fossa called?

A

ischioanal abscess

Gastrointestinal (22 decks)

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