Anatomy and Imaging Flashcards
1
Q
Skeletal muscle in the GI tract is found in the (4)
A
mouth
pharynx
upper oeso
external anal sphincter
2
Q
4 activities of the GI tract =
A
motility (mainly SM)
secretion
digestion
absorption
3
Q
contains epithelial, exocrine and endocrine gland cells
lamina propria
muscularis mucosae
A
GI mucosa
4
Q
4 layers of GI tract wall =
A
mucosa > submucosa > musularis externa > serosa
5
Q
Regulates the SA and shape of mucosa layer in gut
A
muscularis mucosae
6
Q
Lamina propria of gut wall contains:
A
capillaries
enteric NS
immune cells
7
Q
made up of connective tissue, blood and lymph vessels, glands and nerve network
A
submucosa
8
Q
regulates the absorptive and secretive functions of the submucosa
A
Meissner’s/submucosal plexus
9
Q
___ muscle then _____ plexus (regulates mechanical activity of the gut) then ____ muscle
In typical gut wall muscularis externa
A
circular
Myenteric/Auerbach’s
longitudinal
10
Q
Connective tissue layer of gut wall that secretes sticky fluid so gut slides over itself
A
serosa
11
Q
Contraction of gut circular muscle causes ___
A
tube to narrow and lengthen
12
Q
Contraction of gut longitudinal muscle causes ____
A
tube to shorten and fatten
13
Q
3 bands of muscularis externa longitudinal muscle in colon
A
teniae coli
14
Q
Slow wave electrical activity in the enteric NS is driven by ____
A
ICC pacemakers
Interstitial cells of Cajal
15
Q
ICCs lie in :
A
between muscle layers of muscularis externa
in submucosa
few in SM cells
16
Q
___ allow depolarisation and contraction in the gut to occur as a functional syncytium
A
gap junctions => single unit SM
17
Q
Upstroke of slow wave electrical activity in the gut is caused by ___
A
voltage activated Ca2+ channels = Ca2+ influx
18
Q
Downstroke of slow wave electrical activity in the gut is caused by ____
A
voltage and Ca2+ activated K+ channels = K+ efflux
19
Q
ICC are regulated by ,+_
A
enteric+autonomic nerves
hormones
20
Q
The force of gut contraction is directly proportional to the ___ from ICC
A
number of APs produced
21
Q
Determines the max. frequency, direction and velocity of gut contractions
A
Slow wave electrical activity - driven by ICCs
22
Q
BER (basic electrical rhythm) is determined by:
A
slow wave electrical activity
23
Q
BER in duodenum is greater/less than in ileum = food moves in ___ direction
A
greater
aboral
24
Q
BER in proximal colon is greater/less than in the sigmoid colon = food moves in ___ direction
A
less
oral
25
neuronal, hormonal and mechanical stimuli increase the chance of slow waves getting to threshold by ____
increasing basal depolarisation by opening Ca2+ L channels
26
Plexus in gut that modulates epithelia and blood vessels=
Meissner's/submucosal
27
Plexus in gut that regulates motility and sphincters =
Myenteric/Auerbach's
28
Key transmitters in enteric NS =
ACh, substance P, NO + VIP - regulate peristalsis
| 5-HT
29
sensory neurones in the gut are __,_+___ receptors
thermo, chemo and mechano
30
Most abundant type of neuron in enteric NS
| co-ordinate reflexes and motor programs
interneurones
31
motor neurones in the enteric NS supply the (4)
SM, secretory epithelium, endocrine glands + blood vessels
32
Vagus nerve supplies ___(4) in the gut with parasympathetics
```
oesophagus
stomach
small intestine
ascending colon
(synapses with ENS)
```
33
Supplies the descending and sigmoid colon with parasympathetics
pelvic nerves
| S2-4 (synapses with ENS)
34
Excitatory effects of parasympathetics on GI tract (3)
Increase gastric, pancreatic and small int secretions
increase blood flow to gut
increase SM contraction
35
Inhibitory effects of parasympathetics on GI tract
relax some sphincters and the stomach
36
Pre/postganglionic autonomic fibres synapse with ENS
| answer for para and symp
```
para = pre
symp = post (synapses first in superior cervical and prevertebral - celiac aand sup inf mesenteric - ganglia)
```
37
excitatory effects of sympathetics on GI tract
increase sphincter tone
38
inhibitory effects of sympathetics on GI tract
decrease motility, secretions and blood flow
39
Example of a local reflex in the GI tract
peristalsis
40
In local and short reflexes in the GI tract the sensory, inter and effector neurones are found in the
myenteric plexus in the muscularis externa
41
Example of a short reflex in the GI tract
intestino-intestinal inhibitory reflex
42
What happens in the intestino-intestinal inhibitory reflex?
local distension > (sensory neurone) > sympathetic pre-ganglion > (interneurone) > (effector neurone) > decreased muscle activity in adjacent areas
43
Example of a long reflex in the GI tract
gastroileal
44
What happens in the gastro-ileal reflex?
increased gastric activity > increased propulsion in terminal ileum
45
...> sensory neurone (outwith muscularis externa) > dorsal motor nucleus (of vagus in medulla oblongata) > interneurone > effector neurone > ...
occurs in which reflex?
Long reflex in GI tract eg. gastroileal
46
__+___ causes muscle layers in the gut to contract in peristalsis
ACh and substance P
47
__+___ cause muscle layers in the gut to relax in peristalsis
NO and VIP
48
In the gut segment in front of food in peristalsis
| longitudinal SM ___ and circular SM ___
In front =
longitudinal contracts
circular relaxes
49
In the gut segment behind food in peristalsis
| longitudinal SM ___ and circular SM ___
Behind =
longitudinal relaxes
circular contracts
50
```
Rhythmic circular contraction in the small intestine =
function =
occur in __ state
```
segmentation
mixes food
fed state
51
rhythmic circular contraction in large intestine that mixes food =
haustration
52
powerful contraction that moves faeces into the rectum and occurs a couple x per day
colonic mass movement
53
causes a powerful contraction to move food from the stomach to the terminal ileum
MMC - migrating motor complex
54
tonic contractions occur in organs with ___ function
eg. ___+___ = __ pressure
and in sphincters = ___ pressure
```
storage = gallbladder and stomach = low P
sphincters = high P
```
55
Two skeletal sphincters in GI tract
UOS and external anal
56
Pressure upstream/downstream of a sphincter ___ it
```
up = opens
down = shuts
```
57
UOS relaxes in ___
| closes in ___
```
open = swallowing
closes = inspiration
```
58
LOS relaxes in ___
| closes in ___
open in food>stomach
| closes to prevent reflux
59
Pyloric sphincter regulates ___ and prevents ___
gastric emptying
| prevents duodenal reflux
60
Muscle(s) that opens the mouth
lateral pterygoid
61
muscle(s) that close the mouth
medial pterygoid, masseter and temporalis
62
deglutition =
swallowing
63
1st/Voluntary/___ phase of deglutition:
___ receptors are stimulated when bolus reaches oropharynx
> afferents via ____ > __+___ > efferents ___ >
```
oral
mechanoreceptors
CN IX and X
pons and medulla
CN 7, 9, 10, 11
skeletal muscles of pharynx and larynx
```
64
2nd/pharyngeal phase of deglutition:
soft palate ___ and post. pharynx wall ___ to separate naso and oropharynx
ventilation is ___
___ muscles close the glottis and raise the ___
Sup. and middle pharyngeal ____
bolus moves ___ enters ___
```
soft palate rises
post. pharynx wall constricts
vent = inhibited
laryngeal muscles raise larynx
pharyngeal constrictors constrict
epiglottis -> oesopahgus
ventilation resumes
```
65
3rd/Oesophageal phase of deglutition lasts -
4-10 seconds
66
3rd/Oeso phase of deglutition:
| ___+___ > CNX -> ____ + ____
pons and medulla
| close UOS and cause primary peristaltic wave
67
If bolus is lodged in oesophagus ____ receptors cause ___ and increased ___
local pressure receptors =
| 2ndry more powerful peristaltic wave and increased saliva production
68
Parotid gland lies:
anterior to ear and below zygomatic arch
69
The parotid duct/ _____ enters the mouth opposite the ____
duct of Stensen
| 2nd maxillary molar teeth
70
Parotid gland makes up ___% of salivary production
25%
71
Parotid gland is innervated by ___
CN IX and sympathetic plexus
72
___ cells in the Parotid gland secrete and ___ solution
serous cells =
| watery α-amylase rich
73
Submandibular salivary glands lie ___
medial to body of the mandible
74
the submandibular salivary duct/____ enters mouth via the ___ at ____
duct of Wharten
| via sublingual caruncula at the lingual frenulum (under tongue)
75
Submandibular glands make up __% of saliva secretion
70%
76
Submandibular glands have ___ cells
| There secretion is more/less viscous than parotids
mucous and serous cells
| more
77
Submandibular salivary glands are innervated by :
CN 7 and sympathetic plexus
78
Sublingual salivary glands lie ___
medial to submandibular glands
79
Sublingual salivary duct/___ -> ___ duct and connects with duct of Wharten at the ___
ductus of Rivinus
common Bartholin
sublingual caruncula
80
Sublingual glands make up __% of saliva secretions
5%
81
Sublingual glands have ___ cells = a ___ solution
mucous
| mucus rich solution
82
Sublingual glands are innervated by ___
CN 7
83
Salivary glands are complex endo/exocrine glands.
Have an external ___
fibrous ___ between lobes and lobules
lobules are composed of ___
EXOcrine
external CAPSULE
fibrous SEPTA
lobules composed of SALIVONS
84
3 main parts of a salivon =
secretory acinus
intercalated duct
striated duct
85
Basic structure of secretory acinus in salivon
pyramiddal acinar cells around a central lumen
86
Serous acinar cells in salivons secrete ___ from ___ secretory granules
watery α-amylase rich secretion
| small dense
87
Mucous acinar cells in salivons secrete ___ from ___ granules
mucus
| large, pale
88
Serous and mucous acinar cells in salivons are surrounded by ___ which ___
myoepithelial cells
| squeeze saliva into ducts
89
_____ at terminal end of secretory acinus in salivons secrete lysozymes
Serous demilunes
90
Intercalated ducts in salivons are made of ___ epithelium
cuboidal
91
Striated ducts in salivons are ___ epithelium with lots of ___ for active transport to modify saliva
combine to form __ and then ___
columnar epithelium with lots of mitochondria
| interlobular > excretory ducts
92
attachments of the masseter muscle
| closes mouth
angle of mandible
| zygomatic arch
93
attachments of the temporalis muscle
| closes mouth
coronoid process of mandible
| temporal fossa
94
attachments of the medial pterygoid
| closes mouth
medial side angle of mandible
| pterygoid plates of the sphenoid
95
attachments of the lateral pterygoid
| opens mouth
condyle of mandible
| pterygoid plates of the sphenoid
96
the muscles that open and close the mouth are supplied by ____ nerve
mandibular CNV division
| CNV3
97
course of CNV3
| attaches to pons -> inferior edge of ____ between post.+middle ____ > ____ in sphenoid bone > structures
pons >
tentorium cerebelli ; cranial fossa >
foramen ovale
98
provides sensation to anterior 2/3 of tongue
| special and general
```
general = CNV3
special = CNVII
```
99
provides sensation to posterior 1/3 of tongue
| special and general
general and special = CNIX
100
Provides sensation to the superior 1/2 of oral cavity
| gingivae and palate
general = CNV2
| Vert2go - vertigo=high part
101
Provides sensation to the inferior 1/2 of oral cavity
| gingivae and floor
general = CNV3
102
sensory nerves of gag reflex =
| respond to ___
CNIX
| touch to posterior wall of oral cavity
103
motor nerves of gag reflex =
| cause ___
CNIX and X
| pharynx to constrict
104
in endoscopy local anaesthetic spray blocks nerves:
CN V2, V3, VII, IX
| 5, 7, 9
105
Course of CNV2:
| __ > inf. edge of ____ between post. and middle ____> ____ in sphenoid > structures
pons
tentorium cerebelli ; cranial fossa
foramen rotundum
106
CN__ is the only nerve to attach directly to the pons
CNV
107
Course of CNVII/7:
junction between__+__>____ in posterior ___> in temporal bone ____ to _____ (most fibres) OR ___ (over tympanic membrane > + lingual branch > tongue and submandibular gland)
pons + medulla
internal acoustic meatus ; cranial fossa
internal acoustic meatus to stylomastoid foramen
OR chorda tympani
108
CN VII joins with ____ branch of CN_ to supply __ to the anterior tongue and parasympathetics(____) to ___ salivary glands
lingual branch of V3 ; taste
| secretomotor to submandibular
109
CNVII has __,__,__+__ nerve fibres
parasympathetic
special sensory
sensory
motor
110
The CNVII fibres that pass out of the stylomastoid foramen supply the____
muscles of facial expression
111
Course of CN IX/9:
___ > __ in posterior ___ between ___+___bone> posterior ___, palate, posterior ___ wall and parasympathetics to the ___
medulla>
jugular foramen ; posterior cranial fossa ; temporal and occipital bone>
post. tongue, post. oropharynx wall , parasymp to parotids
112
CN IX has ____(5) fibres
```
special sensory
sensory
motor
visceral afferent
parasympathetic
```
113
4 extrinsic muscles of the tongue =
palatoglossus
styloglossus
hyoglossus
genioglossus
114
palatoglossus attaches to ___ and the tongue
palatine bone
115
styloglossus attaches to ___ and the tongue
styloid process of temporal bone
116
hyoglossus attaches to ___ and the tongue
hyoid bone
117
genioglossus attaches to ___ and the tongue
genial tube on the mandible
118
There are ___ intrinsic muscles of the tongue
4 intrinsic muscles of the tongue
119
All tongue muscles (except _____) are supplied by CN___
CN XII - hypoglossal nerve
| except palatoglossus = CNX
120
palatoglossus is supplied by CN ___
CNX - vagus
121
The course fo CNXII (12):
___ > ____ in posterior ___ >____ at anterior wall of ___ in ___ bone > descends lateral to ____ > level of __ bone and supplies ___
medulla >
hypoglossal canal in posterior cranial fossa
hypoglossal canal at ant. wall of foramen magnum in occipital bone
lateral to carotid sheath
hyoid bone
tongue
122
External layer of the pharynx = ___muscles
superior, medial and inferior layers ___
involuntary/voluntary muscles
constrictor/circular
overlap
voluntary
123
External circular muscles of pharynx are innervated by ___
| muscles insert onto midline ___
CN X
| midline raphe
124
The UOS / _____ muscle is at __ level and marks the boundary between _+_ and __+__
cricopharyngeus muscle
C6
pharynx>oeso
larynx>trachea
125
The internal muscles of the pharynx (4) are ___ innervated by ___/___
Function =_+_
```
longitudinal muscles
CNX - 3 muscles
CNIX - sylopharyngeus
contract to shorten - elevates pharynx
close over laryngeal inlet - elevates larynx
```
126
the oesophageal plexus has __+___ fibres that supply the ___ NS and alters the rate of ___
para(CNX) and symp
enteric NS
para increases + symp decreases = peristalsis
127
Oesophageal plexus stops at ___
cardia of the stomach
128
All of the muscles involved in the initial stage of swallowing (until the oeso) are ___ and supplied by __
skeletal
| cranial nerves
129
Normal anatomical indents in oesophagus shown in barium swallow =
cervical - C6 cricopharyngeus
2x thoracic - aortic arch and L bronchus
diaphragmatic - diaphragm and LOS
130
LOS is a ____ sphincter and lies superior to ___
| which is an abrupt mucosal change = ____
physiological sphincter
GOJ
Z-line
131
Indent in lesser curvature in stomach =
incisura angularis
132
Longest > shortest part of small intestine
ileum (4m)
jejunum (3m)
duodenum (short)
133
Foregut organs =
oeso-> mid duodenum + liver, gallbladder, spleen and 1/2 pancreas
134
Midgut organs =
mid duodenum to 2/3rds of transverse colon
| 1/2 pancreas
135
Hindgut organs =
distal 1/3 of transverse colon -> prox. 1/2 anal canal
136
4 lines that split the 9 regions of the gut =
mid clavicular x2
trans-tubercular
subcostal
137
Thin, transparent, semi-permeable, serous membrane =
peritoneum
138
Liver is a ___peritoneal organ = __ movement
intraperitoneal
| little movement
139
double layers of mesentery =
condensations
140
lesser omentum is from __ to ___
liver to stomach
141
greater omentum has __ layers of mesentery and hangs from ___
4
| stomach
142
free edge of lesser omentum contains the ___
portal triad
143
greater and lesser omentum communicate via the ____
omentum foramen
144
Pericentesis for ascites:
| needle is inserted___ to avoid ___
lateral to rectus sheath
| avoids inferior epigastric artery behind the rectus abdominus
145
inferior epigastric artery branches off the ___, __ to deep inguinal ring
external iliacs
| medial to deep inguinal ring
146
Visceral peritoneum and the abdo organs are innervated by
enteric NS and autonomic NS
147
Parietal peritoneum and body wall are innervateed by
somatic sensory and motor
| sympathetic NS
148
Sympathetic nerves to abdomen leave via ___ > enter symp chain > ______ nerves > synapse at prevertebral ganglia ____) > postsynaptic nerves > ___ plexus where combine with para and visceral afferents ->
```
T5-L2
abdomino-pelvic splanchnic nerves
anterior to aorta - celiac, aortico-renal and sup+inf mesenteric ganglia
periarterial plexus
SM and glands of organs
```
149
Adrenal glands are supplied by sympathetic nerves from __ which become ____ nerves -> periarterial plexus > synapse directly onto adrenals
T10-L2
| abdomino-pelvic splanchnic nerves
150
Parasympathetic supply to gut organs up until distal end of transverse colon =
CNX
151
Parasympathetic supply to descending colon> anal canal =
pelvic splanchnic nerves (S2,3 and 4)
152
Pain in foregut is felt in ___ region
epigastric
153
Pain in midgut is felt in ___ region
umbilical
154
Pain in hindgut is felt in ___ region
pubic
155
Visceral afferents from foregut enter spinal cord at ____
T6-9
156
Visceral afferents from midgut enter spinal cord at ____
T8-12
157
Visceral afferents from hindgut enter spinal cord at ____
T10-L2
158
the 7th-11th intercostal nerves extend to become the ___ nerves and travel between ____+___
supply __
thoracoabdominal nerves
internal oblique and transversus abdominis
body wall
159
T12 anterior rami becomes ___ to supply
subcostal nerve
| body wall
160
iliohypogastric nerve comes from __
half of L1 anterior ramus
161
ilioinguinal nerve comes from ___
half of L1 anterior ramus
162
Body wall nerves = (4)
thoracoabdominals
subcostal
iliohypogastric
ilioinguinal
163
Pancreatic pain is felt __ +___
epigastric
| upper back
164
liver and gallbladder pain are felt
RUQ
back RUQ
right shoulder
165
Icterus =
| caused by
jaundice
| increased bilirubin in the blood
166
Portal triad =
hepatic artery
HPV
common bile duct
(+ nerves and lymphatics)
167
3 midline anterior branches of abdominal aorta
| superior -> inferior
celiac
superior mesenteric
inferior mesenteric
168
Celiac trunk arises at __ level
T12
169
Celiac trunk trifurcates into
hepatic artery
splenic artery
L gastric artery
170
Runs a tortuous course over the top of the pancreas
splenic artery
171
Spleen is __peritoneal
| protected by ribs ___
intraperitoneal
| ribs 9-11
172
Hepatic artery branches into __+___+_ ->
R and L hepatic
R gastric (anastamoses with L gastric)
gastroduodenal ->superior pancreatico-duodenal + R-gastric omental
173
Branch of splenic artery that supplies greater curvature of the stomach
anastamoses w. ___
L gastro-omental artery
| anastamoses with R. gastric-omental from hepatic artery
174
Ribs ___ protect the liver
Ribs 7-11
175
4 anatomical segments of liver =
| _ functional segments
right, left, caudate (superior), quadrate (next to gallbladder)
8
176
Posterior recesses of peritoneal cavity
| both lie within the ___ omentum
hepatorenal (Morrison's)
subphrenic
greater omentum
177
Ligaments of the liver
```
coronary ligaments (attach to diaphragm)
falciform ligament ( splits L+R lobe and attach to ant. abdo. wall)
ligamentum teres/round ligament (to umbilicus)
```
178
The ___ artery supplies the gallbladder
In 75% of people branches off of ___
In 25% of people branches off of __
cystic
R hepatic 75%
L hepatic/hepatic/celiac 25%
179
Biliary tree =
| descends posterior to ___
R+L hepatic > common hepatic
+ cystic duct > CBD
first part of duodenum and pancreas
180
CBD joins pancreatic duct at ___ which leads to ___ and drains into the ___
the ampulla of Vater
major duodenal papilla
2nd part of duodenum
181
Post-hepatic causes of jaundice are due to ___
| eg.s =
bile backflow into liver and blood
| gallstones, pancreatic cancer, cholangitis, pancreatitis
182
Pre-hepatic causes of jaundice are due to ___
| eg.s =
increased haemolysis of RBCs
| malaria, sickle cell, AI
183
Hepatic causes of jaundice cause an increase in ____ bilirubin
eg.s =
unconjugated+/conjugated
| cirrhosis, hepatitis, drugs, liver ca, AI, Gilbert's
184
5 parts of pancreas =
```
uncinate process
head
neck
body
tail
```
185
Pancreas is at level of ___
L1-2
186
Nerve supply for pancreas
para=
symp=
+___
para = vagus
symp = abdomino-pelvic splanchnic nerves
visceral afferents
187
blood supply to pancreas
pancreatic arteries off of splenic artery (mainly)
superior pancreaticoduodenal off of gastroduodenal
inferior pancreaticoduodenal off of superior mesenteric
188
What parts of duodenum are foregut?
1st and 2nd
189
1st/___ part of duodenum/____
__ in length
Is ___peritoneal
superior
duodenal cap
2cm
intraperitoneal
190
Which parts of duodenum are intra and retroperitoneal
```
1st = intraperitoneal
2,3,4th = retroperitoneal
```
191
Duodenum:
2nd part=
3rd part=
4th part=
2=descending
3=horizontal
4=ascending
192
Blood supply to duodenum =
superior and inferior pancreaticoduodenal arteries
193
Beginning of the jejunum
| is ___ degrees
duodenaljejunal flexure
| 90 degrees
194
jejunum is ___peritoneal
the mucosa is ___ folded
folds =
intraperitoneal
highly
plicae circularis
195
blood supply and drainage to jejunum
superior mesenteric > jejunal arteries (long loops)
| jejunal veins>sup mes
196
Ileum is ___peritoneal
Has __ folds+ muscle than jejunum
Absorbs ___+__
intraperitoneal
less
bile and B12
197
Blood supply and drainage to ileum
sup mes > ileal arteries - short loops
| ileal vein > sup mes
198
Fat absorbed in gut enters blood via the ____
left venous angle
199
```
Lymph nodes that drain:
foregut:
midgut:
hindgut
kidneys, post abdo. wall, pelvis, lower limbs
```
foregut=celiac nodes
midgut=superior mesenteric nodes
hindgut = inferior mesenteric nodes
kidneys etc. = lumbar nodes
200
Parts of colon that are 2ndry retroperitoneal
ascending and decending = less mobile
201
Parts of colon that are intraperitoneal and so are mobile
caecum
transverse (very mobile)
sigmoid
202
lateral edge of asc + desc colon and abdominal wall=__
| is part of the ___
paracolic gutters
| greater sac of the peritoneal cavity
203
teniae coli are present on the colon until the ___
sigmorectal junction
204
64% of the time the appendix lies ___
retrocaecal
205
Appendix lies at ___ point, max area of pain in appendicits, which =
McBurney's
| 1/3 of the way between ASIS and umbilicus
206
Most likely part of colon to form a volvulus
sigmoid
207
Abdominal aorta lies to the L/R of the IVC
| lateral branches and final bifurcation sup to inf =
```
L
renal
gonadal
body wall (posterolateral)
common iliac
```
208
internal iliac artery supplies the ___
pelvic organs
209
external iliac becomes the femoral artery after ___
after going behind the inguinal ligament
210
Branches off of the superior mesenteric artery superior to inferior
inferior pancreaticoduodenal
middle colic (transverse)
right colic (ascending)
ileocolic -> appendicular, jejunal and ileal
211
middle colic branch of sup mes artery supplies
transverse colon
212
right colic branch off of sup mes artery supplies
ascending colon
213
inferior mesenteric artery branches superior to inferior
left colic - descending
sigmoid colic
superior rectal (supplies until pectinate line)
214
The distal anal canal starts at the ___ and is supplied from the ___ artery
pectinate line
| internal iliac -> middle and inferior rectal arteries (slightly anastamose with sup. rectal artery
215
anastamosis of the SMA and IMA is predominantly by 1 artery called
marginal artery of Drummond
216
Superior part of oeso usually drains to ___ and distal end drains to ____
Is an anastamosis between systemic and portal systems
```
sup = azygous
inf = HPV
```
217
rectum becomes anal canal just before passing through ___ + anterior to ___
levator ani
| tip of coccyx
218
anal canal and anus lie in pelvic cavity/perineum
perineum
219
at __ level sigmoid becomes rectum
S3
220
rectal ampulla lies superior to ___
levator ani
221
pelvic diaphragm =
levator ani and fascial covering
222
3 main levator ani muscles =
iliococcygeus
pubococcygeus
puborectalis
all = skeletal and voluntary
223
levator ani muscle that slings around rectum and contracts to lower anorectal angle
important in continence
puborectalis
224
Nerves to levator ani =
| cause its and internal anal sphincter contraction
nerve to levator ani mostly - S3+4
| pudendal - S2, 3 and 4
225
internal anal sphincter site =
| contraction is inhibited by ___ when the ampulla is distended
superior 2/3rds of anal canal
| parasympathetics
226
external anal sphincter site =
is continuous superiorly with ___
contraction is stimulated by ___ nerve
inferior 2/3rds of anal canal
puborectalis muscle
pudendal nerve
227
Sympathetic nerves that cause internal anal sphincter to contract and inhibits peristalsis
T12-L2
228
Visceral afferents go to ___ with ___
| sense - stretch and ischaemia of rectum and anal canal
S2-4
| parasympathetics
229
paraympathetic supply to rectum and anal sphincter is from ___
relaxes internal anal sphincter
S2-4
230
Pudendal nerve comes from a branch of the ____
| exits pelvis at ___ and enters via ___ to supply perineum
sacral plexus
greater sciatic foramen
lesser sciatic foramen
231
Embryologically pectinate marks line between __derm and ___ derm derived parts
endoderm and ectoderm
232
nerve, lymphatics, vein and artery for above pectinate line
autonomic NS
IMA
sup. rectal vein >IMV->HPV
internal iliac nodes > inf mes nodes
233
nerve, lymphatics, vein and artery for below pectinate line
somatic and pudendal nerves
internal iliac artery
middle and inf rectal vein >int iliac vein -> systemic veins
superficial inguinal nodes
234
epithelium above and below pectinate line =
```
above = columnar
below = non keratinised stratified squamous
```
235
inferior pelvic structures drain to ____ nodes
internal iliac nodes
236
superior pelvic structures and lower limb drain to ___ nodes
external iliac nodes
237
internal and external iliac nodes drain to ___ nodes to ___ nodes
common iliac nodes
| lumbar nodes
238
Haemorrhoids are caused by ___
| defintion =
raised P
| prolapses of rectal venous plexuses
239
Red horseshoe around anus =
ischioanal abcess
240
ischioanal fossae contains
| R and L communicate ____
fat and loose connective tissue
| posteriorly
241
US is good for imaging ___ organs and free ___
solid eg. biliary tree and urinary tract
| fluid
242
MRI is good for imaging ___ and has no ___
soft tissues
| no radiation
243
Parts of pancreas and duodenum that lie in RUQ
1,2,3rd parts of duodenum
| head of pancreas
244
Duodenal jejunum junction is also called ___
ligament of Treitz
245
scintigraphy =
production of imaging using radioactive compounds to = 2D image
246
cytochemisty =
identifying biochemistry of cell
| eg. Perl's stain for Fe, for enzymes, for leukaemia
247
cytogenetic analysis =
study of chromosomes and their abnormalities
248
immunophenotyping =
investigate the pattern of antigen expression on/in cells through a panel of antibodies
can produce a protein expression profile unique to different cell types eg. T cells
249
First line imaging for biliary colic/cholycystitis=
| and further clarification=
US
| MRCP/ERCP
250
Pancreatitis firstline imaging =
| imaging to show complications after 1wk =
US
| CT/others
251
Firstline imaging for perforation =
| __ shows source and complications
Erect CXR - subphrenic gas
| CT
252
1st line imaging for appendicitis
US
253
Imaging for diverticulitis to see inflammatory change and associted complications =
CT
254
Imaging for distended abdomen (suspected that it's due to bowel gas)
AXR (shows if obstruction/ileus)
| CT
255
Imaging for distended abdomen (suspect fluid)
US
256
1st line investigation for haematemesis/lower GI bleed
| complements it =
endoscopy
| Radiology - CT with IV contrst +/ angiography
257
1st line investigation for dysphagia =
| ___ gives you functional and anatomical/pathological info
endoscopy
| barium/contrast studies
258
Change in bowel habit examination/imaging =
PR
CT colonography if want R colon information
if IBD considered = endoscopy
259
typical appearance of liver met.s on US =
target
260
1st line investigation for jaundice=
biliary cause =>
liver lesions =>
nodular and course contours of liver=>
US ->
M/ERCP
CT (cancer)
US guided biopsy (cirrhosis)
