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MD3002 > *Anatomy: Abdominal Oesophagus, Stomach & Duodenum > Flashcards

*Anatomy: Abdominal Oesophagus, Stomach & Duodenum Flashcards

1
Q

Describe the function of the oesophagus.

A

Transport of food and fluid to stomach by peristaltic waves

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2
Q

Describe the anatomical path of the oesophagus.

A
  • Starts in midline as a continuation of the pharynx at C6, inferior border of the cricoid cartilage.
  • Descends between trachea and vertebral column.
  • Enters thorax behind trachea, and the vertebral column, with the arch of the aorta to its left in the superior mediastinum
  • Enters the abdominal cavity at T10, slightly left of the midline (becomes posterior to L atrium)
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3
Q

Identify the non-pathological constrictions of the oesophagus, and the level of each.

A
  • Upper oesophageal sphincter (level of C6), aka Cricopharyngeal sphincter aka junction of oesophagus with pharynx
  • Oesophagus crossed by arch of aorta (level of T4)
  • Oesophagus compressed by L main bronchus
  • Diaphragm (level of T10), aka at the oesophageal hiatus
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4
Q

Identify the position of the oesophagus relative to the L atrium.

A

Oesophagus is posterior to the L atrium

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5
Q

What is the clinical significance of the constrictions of the oesophagus ?

A
  • More likely to cause blockages
  • Hinder passage of instruments
  • Slow down passage of caustic substances (i.e. more damage)
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6
Q

Describe the following for the superior 1/3 of the oesophagus:

  • Type of muscle
  • Swallowing
  • Arterial supply
  • Veinous drainage
  • Innervation
  • Lymphatic drainage
A
  • Type of muscle: Striated
  • Swallowing: Voluntary and rapid
  • Arterial supply: Inferior thyroid a
  • Veinous drainage: BC veins
  • Innervation: Vagus (recurrent laryngeal n)
  • Lymphatic drainage: Deep cervical
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7
Q

Describe the following for the middle 1/3 of the oesophagus:

  • Type of muscle
  • Swallowing
  • Arterial supply
  • Veinous drainage
  • Innervation
  • Lymphatic drainage
A
  • Type of muscle: Mixed
  • Swallowing:
  • Arterial supply: Aorta and bronchial aa
  • Veinous drainage: Azygos
  • Innervation: Oesophageal pl (vagus+T1-4, greater splanchnic n.)
  • Lymphatic drainage: Tracheobronchial
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8
Q

Describe the following for the inferior 1/3 (abdominal) part of the oesophagus:

  • Type of muscle
  • Swallowing
  • Arterial supply
  • Veinous drainage
  • Innervation
  • Lymphatic drainage
A
  • Type of muscle: Smooth
  • Swallowing: Involuntary and slow
  • Arterial supply: Left gastric a + Left inferior phrenic a
  • Veinous drainage: Left gastric v (to portal vein) + left oesophageal vv (to azygos vein)
  • Innervation: Oesophageal pl (vagus+T1-4, greater splanchnic n.)
  • Lymphatic drainage: Left gastric, Coeliac
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9
Q

What is the shortest part of the oesophagus ? Describe its path.

A

Abdominal oesophagus

  • From oesophageal hiatus to cardiac orifice of the stomach
  • Passes through the right crus of the diaphragm at T10
  • Tethered to the margins of the oesophageal hiatus by the phrenooesophageal ligament
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10
Q

There is a pressure gradient across the gastro-oesophageal junction at rest. How does this occur ?

A

There is a high pressure zone (HPZ) around the lower 2-4 cm of the esophagus (i.e. abdominal oesophagus), which corresponds to the lower oesophageal sphincter.

The intra-abdominal P is positive while the intra-thoracic P is negative.

Therefore, P gradient along abdominal oesophagus, and thoracic oesophagus is dilated

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11
Q

Identify the major and multiple minor anti-reflux mechanisms. What do these correspond to ?

A

2 major ones:

  • Circular smooth muscle fibers in the lower oesophagus
  • Right crus of diaphragm

2 minor ones:

  • Clasp fibers (below gastro-oesophageal junction. When stomach is distended, creates a P over this area)
  • Oblique entry of oesophagus into stomach

All these factors are collectively called lower oesophageal sphincter

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12
Q

Define Achalasia.

A

Ganglion cells in the myenteric plexus of the distal oesophagus and gastro-oesophageal junction may be reduced or absent.

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13
Q

Define Z-lines.

A

Given that gastric fundal mucosal folds extend a variable distance up the abdominal oesophagus, the gastro-oesophageal junction is usually identified by a circumferential zigzag line (Z-line) between the pale pink eosophageal squamous epithelium above and red columnar epithelium below

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14
Q

Define Barrett’s oesophagus.

A

Pathological replacement of oesophageal squamous epithelium with gastric columnar epithelium

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15
Q

What type of tissue is the stomach ?

A

Muscle

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16
Q

Which anatomical abdominal chamber is the stomach located in ?

A

Epigastric, left hypogastric (hyponchondrial), and partially umbilical regions

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17
Q

Define the Labbe triangle.

A

Location where the stomach is normally in contact with the abdominal wall. The margins of this triangle are:

  • Left costal arch
  • Lower border of the liver
  • Horizontal line connecting the tips of the right and left 9th CC
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18
Q

Identify the main functions of the stomach.

A
  • Temporary storage of indigested food
  • Mechanical breakdown of solid food
  • Chemical digestion of proteins
  • Mixes food with gastric secretions to form chyme
  • Regulation of the rate of passage of the chyme to the duodenum
  • Secretion of:
    a) acid to aid digestion and absorption of iron
    b) intrinsic factor for vitamin B12 absorption
    c) gut hormones
  • Microbial defence
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19
Q

What are the main parts of the stomach ? Describe the location of each.

A

1) Cardiac: surrounds the opening of the oesophagus into the stomach
2) Fundus: area above the level of the cardiac orifice (usually filled with air)
3) Body
4) Pyloric part:
a. Pyloric antrum (opening to the body of the stomach
b. Pyloric canal (opening to the duodenum)

ALSO
Greater curvature (lateral surface) 
Lesser curvature (medial surface) 
Anterior surface
Posterior surface
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20
Q

What kinds of muscular fibers are in the stomach wall ? What kinds of fibers make up the pyloric sphincter ?

A
  • Longitudinal, circular, and oblique muscle fibers in the muscular stomach wall
  • Circular fibers in the pyloric region make up the pyloric sphincter
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21
Q

What is the role of the pyloric sphincter ?

A

Control outflow of gastric contents into duodenum

22
Q

Identify the structures making up foregut, midgut, and hindgut.

A

Foregut: Oral cavity to part of dudenum (not all of it)
Midgut: Part of duodenum to part of large intestine
Hindgut: Part of large intestine to anus

23
Q

Identify the general arterial supply of each of foregut, midgut, hindgut.

A

Foregut: Coeliac trunk and branches
Midgut: Superior mesenteric artery and branches
Hindgut: Inferior mesenteric artery and branches

24
Q

Identify the main branches of the coeliac trunk (arterial supply of the foregut).

A

Left gastric, common hepatic, splenic arteries

25
Q

Describe the arterial supply of the stomach, identify the arteries involved, their path, and the exact structures they supply.

A

All arteries derive either directly (primary branches), or from branches of the coeliac trunk (secondary branches), that form an anastomotic ring around the stomach

1) L gastric (direct branch of coeliac trunk)
- path: runs along lesser curvature
- structures supplied: abdominal oesophagus, proximal lesser curvature and adjacent body of the stomach

2) R gastric (branch of common hepatic)
- path: runs along lesser curvature
- structures supplied: distal lesser curvature and adjacent body of the stomach

3) L gastroepiploic (gastro-omental, branch of the splenic artery)
- path: runs in the gastro-splenic (gastro-lienal) ligament
- structures supplied: left side of the greater curvature and adjacent body of the stomach

4) R gastroepiploic (gastro-omental, branch of the gastroduodenal branch of common hepatic artery)
- structures supplied: R side of the greater curvature and adjacent body of the stomach

5) Short gastric arteries (branches of the splenic artery):
- path: runs in gastro-splenic (gastro-lienal) ligament
- structures supplied: fundus of stomach

26
Q

What is the anatomical location of the origin of the coeliac trunk ?

A

Coeliac trunk originates at the upper border of the L1 vertebra.

27
Q

Describe the veinous drainage of the stomach.

A

All veins run parallel to the arteries:

1) L and R gastric veins drain into the portal vein
2) Short gastric and L gastroepiploic veins drain into splenic vein, which drains into portal vein
3) R gastroepiploic vein drains into superior mesenteric vein, which drains into portal vein

28
Q

Describe the lymphatic drainage of the stomach.

A

Initially, lymph passes to nodes that lie along gastric and gastroepiploic arteries (e.g. gastro-omental, gastric, pyloric, mesenteric nodes).
Eventually, lymph will be drained by the coeliac nodes

29
Q

Describe the nerve supply of the stomach.

A

1) Sympathetic:
- Granter splanchnic nerve (T5-9) + Coeliac plexus
- Pain + vasomotor

2) Parasympathetic:
- Vagal trunks
- Secretion + motility + afferent for emesis

30
Q

Where is pain from the stomach referred ?

A

Pain from stomach referred to epigastric region and lower chest

31
Q

Is there a therapeutic benefit to cutting vagus ? What are different ways in which this can be performed ?

A

Reduce gastric acidity and prevent ulcers

Truncal (whole trunk), selective (branches of trunk), or selective proximal (branches of branches of trunk) vagotomy

32
Q

Can are possible side effects of a vagotomy ?

A

Sphinteric dysfunction, fullness (sphincter not working, stomach cannot push out the food)

33
Q

What are possible solutions to reduce acid secretion while maintaining the motility ?

A

Preserve branches to pyloric sphincter (i.e. selective or highly selective vagotomy)

34
Q

Define hiatus hernia. What are the types, symptoms, treatments, and epidemiology of this ? Where is the pain from this referred ?

A

Herniation of the stomach through the diaphragm into the mediastinum (≠ diaphragmatic hernia)

  • Types:
    a) Sliding (90%): your stomach and esophagus slide into and out of your chest through the hiatus
    b) Para-oesophageal (rolling): part of your stomach pushes through your diaphragm and stays there
  • Symptoms: May be asymptomatic, or be associated with symptoms of gastro-oesophageal reflux.
  • Epidemiology: more common in elderly and obese
  • Treatment: of a symptomatic sliding hiatus hernia is directed at managing associated gastro-oesophageal reflux, which may require anti-reflux surgery
  • Referred pain: Pain from lower oesophagus is referred to retrosternal area.
35
Q

What is a possible complication of para-oesophageal hernias ?

A

Can cause obstruction and/or ischaemia of the herniated stomach

36
Q

What are the boundaries of the small intestine ?

A

Pylorus to the ileocaecal valve

37
Q

What is the longest part of the alimentary canal ?

A

Small intestine

38
Q

What is the main function of the small intestine ?

A

Most of the digestion and absorption happens here

39
Q

What are the main parts of the small intestine ?

A

Duodenum
Jejunum
Ileum

40
Q

DUODENUM

  • Parts
  • Functions
  • Other special features
A 
DUODENUM
-Parts: 
Superior (ampulla or duodenal cap)- intraperitoneal
Descending- retroperitoneal
Horizontal- retroperitoneal
Ascending- retroperitoneal

-Functions:
Digestion (especially of fats)
Absorption

-Other special features:
Common bile duct and pancreatic ducts open into duodenum

41
Q

Identify the anatomical level of each part of the duodenum.

A

Superior, transpyloric plane (lower L1)
Descend, right of the midline from L2 to L3
Horizontal at L3
Ascending to L2

42
Q

What is the border between duodenum and jejunum ?

A

Duodenojejunal flexure (ligament of Treitz), border between duodenum and jejunum

43
Q

Describe the anatomical location of the pancreas relative to the small intestine.

A

Head of the pancreas lodged in the arch of the duodenum.

44
Q

Identify any special features of the descending (second) part of the duodenum.

A

Minor duodenal papilla
-Opening of the accessory pancreatic duct

Major duodenal papilla (2-2.5 cm distal)

  • Common opening of the common bile and pancreatic ducts
  • Boundary between foregut and midgut
45
Q

Describe the arterial supply of the duodenum.

A

♠ Part of the duodenum up to the major duodenal papilla (ampulla of Vater) is derived from foregut. Suppled by branches of the common hepatic artery:

  • Gastroduodenal artery
  • Supraduodenal artery
  • Superior pancreaticoduodenal artery (anterior and posterior)

♠ Rest of the duodenum is derived from the midgut. Supplied by inferior pancreaticoduodenal artery (anterior and posterior)

♠ Collateral circulation between coeliac trunk and superior mesenteric artery (in case something goes wrong)

46
Q

What is the clinical significance of the gastroduodenal artery ?

A

Gastroduodenal artery is at risk with posterior ulcers of the first part of the duodenum.

47
Q

Describe the veinous drainage of the duodenum.

A

Veins drain to portal vein, either directly or indirectly through the superior mesenteric and splenic veins.

48
Q

Describe the lymphatic drainage of the duodenum.

A

Lymph vessels drain to superior mesenteric (posterior) or pancreaticoduodenal (anterior) and pyloric nodes (anterior)

49
Q

Describe the nerve supply of the duodenum.

A

Sympathetic fibers: Via greater splanchnic nerve (T5-9)

Parasympathetic fibers: from vagus via coeliac and superior mesenteric plexuses

50
Q

Define bariatric surgery, giving the main types of it.

A

Surgery to help patients lose weight.

1) Gastric bypass: “surgical staples are used to create a small pouch at the top of the stomach. The pouch is then connected to your small intestine, missing out (bypassing) the rest of the stomach.”
2) Gastric sleeve (aka vertical gastrectomy): “part of the stomach removed and narrow tube or “sleeve” made out of the rest. The new, banana-shaped stomach is much smaller than the original stomach.”
3) Adjustable gastric banding: “Band containing an inflatable balloon is placed around the upper part of the stomach and fixed in place. This creates a small stomach pouch above the band with a very narrow opening to the rest of the stomach. Restricts the amount of food that your stomach can hold, so you feel full sooner, but it doesn’t reduce the absorption of calories and nutrients.”

MD3002 (95 decks)

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