Anatomy - Foregut Flashcards
What structures make up the foregut?
Stomach
Liver
Gallbladder
Pancreas
First part duodenum

What structures make up the midgut?
Second - fourth parts duodenum
jejunum
ileum
cecum
appendix
ascending colon
first 2/3 transverse colon

What structures make up the hindgut?
Last 1/3 transverse colon
descending colon
sigmoid colon
rectum

What is the blood supply to the foregut?
Celiac trunk (superior branch of abdominal aorta)
What is the blood supply to the midgut?
Superior mesenteric artery (middle branch off abdominal aorta)
What is the blood supply to the hindgut?
Inferior mesenteric artery (inferior branch off abdominal aorta)
What are the structures and blood supply to the foregut, midgut and hindgut?


What is the sympathetic and parasympathetic innervation to the foregut?
Sympathetic: greater splanchnic nerves synapse on celiac ganglion
Parasympathetic: vagus
What is the sympathetic and parasympathetic innervation to the midgut?
Sympathetic: Lesser splanchnic nerve synapse on superior mesenteric ganglion
Parasympathetic: vagus
What is the sympathetic and parasympathetic innervation to the hindgut?
Sympathetic: lumbar splanchnic nerves synapse on inferior mesenteric ganglion
Parasympathetic: Pelvic splanchnic nerves (S2-S4)
What is the sympathetic and parasympathetic innervation to the kidneys?
Sympathetic: least splanchnic nerve synapse on aorticorenal ganglion
Parasympathetic: vagus


The greater splanchnic nerve arises from spinal levels […] - […]
T5 - T9
The lesser splanchnic nerve arises from spinal levels […] - […]
T10 - T11
The lumbar splanchnic nerve arises from spinal levels […] - […]
L1 - L2


Describe the development of the GI tract.
- Developing liver and stomach. Pancreas develops from two buds – a dorsal and a ventral bud. The SMA is visible in the dorsal mesentery.
- Midgut begins to lengthen, and because the abdominal cavity is too small to hold it, the entire gut tube begins to herniate out through the umbilicus. Notice that at this stage, the gut is still a simple, untwisted tube, supplied by the SMA.
- At this stage, the midgut has already rotated once – the cecum is now superior.
- Now, the small intestine is going to expand, and thus need to start coiling up. You can see that the greater omentum is starting to descend from the inferior border of the stomach.
- At this point, the midgut is starting to retract back into the abdominal cavity. The cecum is still superior, just under the liver.
- But here, you can see it has descended and is in the lower right quadrant where it will remain in adults. You can also see the greater omentum, opened for illustration. This is a great place to see that the greater omentum is actually a four-layered structure, because it represents a two-layer structure that was folded in half.
- This is a similar stage as the previous slide, but without the umbilicus and yolk stalk pictured.
- And finally, we can see the greater omentum in all of its glory



What is the transpyloric plane?
Approximately through the middle of a typical stomach, located just superior to the subcostal plane
What is the angle of his?
How is it different in infants?
The acute angle helps keep the gastro-esophageal sphincter closed, which helps keep gastric juices in the stomach as they are irritating to the esophagus.
In infants, this angle is much more obtuse, which contributes to the high rate of GERD in babies
What other organs does the stomach border?
Stomach borders the liver, diaphragm, spleen, left kidney and adrenal, pancreas, and colo





What is the function of the rugal folds?
The inner layer is very bumpy, increasing the surface area available for digestion


- Attaching the lesser curvature of the stomach to the liver is the […].
- Hanging from the greater curvature of the stomach is the […]
- The entrance to the lesser sac or omental bursa is between the […] and the […], an opening called the […].
- lesser omentum
- greater omentum
- pyloric region of the stomach; gallbladder; epiploic foramen
Label image. Also:
- inferior-most aspects of the lungs lie posterior to the […], […], and […]

- stomach, spleen, and liver



What are the 3 direct branches off of the celiac trunk?
Left gastric artery
Common hepatic artery
Splenic artery
left gastric artery provides blood supply to much of the […]
lesser curvature of the stomach
Splenic artery provides blood to much of the […] and the […]
greater curvature
spleen
hepatic artery provides blood to the […] and […]
pylorus and liver
- This branch of the splenic artery supplies the stomach along the greater curvature
- This branch of the splenic artery supply the fundus
the left gastro-omental artery
short gastric arteries


- This branch of the hepatic artery supplies the duodenum
- This branch of the hepatic artery supllies the lesser curvature of the stomach
- gastroduodenal artery
- right gastric artery


This branch of the GDA supplies the right greater curvature of the stomach.
right gastro-omental artery


Of the many subdivisions that arise originally from the celiac trunk, which have anastamoses?
Left gastric —- right gastric
Left gastro-omental —- right gastro-omental








The celiac trunk comes off the aorta in the […], which lies deep to the […], which stretches between the […] and the […]
lesser sac
lesser omentum
lesser curvature of the stomach and the liver
the hepatoduodenal ligament contains the […]
portal triad
The foramen deep to the hepatoduodenal ligament leading into the lesser sac is called the […]
epiploic foramen




The duodenum lies at approximately the level of […], and curves from left to right
L2-L4


The first part of the duodenum is […] while the other parts are […]
intraperitoneal
retroperitoneal


- The fourth portion of the duodenum is attached to the esophagus by a ligament called the […]
- What is its clinical significance?
- duodenal suspensory ligament, or the ligament of Treitz
- The ligament helps surgeons find the division between the duodenum and jejunum


Blood supply to the first part of the duodenum comes from branches of the […]
celiac trunk
- What are the 3 branches of the GDA?
- What organs do they supply?
- Supraduodenal
- superior duodenum
- Anterior superior pancreaticoduodenal artery
- Anterior and superior duodenum and pancreas
- Posterior superior pancreaticoduodenal artery
- Posterior and superior duodenum and pancreas
posterior and anterior inferior pancreaticoduodenal arteries are branches of the […] and supply the […]
Superior mesenteric artery
More distal portions of the duodenum that are considered part of the midgut
- The superior border of the liver is at approximately […], just below the […]
- Its left-most corner nearly reaches the […]
- Its lower corner is palpable inferior to the […]
- The liver lies just inferior to the […] and superior to the […]
- The level of the sixth rib; nipples
- left nipple
- Costal margin
- diaphragm; stomach
The […] divides the right and left lobes of the liver and is attached to the […]
Falciform ligament
Anterior abdominal wall


What are the 2 additional divisions of the right lobe of the liver?
The quadrate lobe anteriorly and the caudate lobe posteriorly
What is the portal triad?
Where is it?
Common bile duct, portal vein, and hepatic artery
Run in the hepatoduodenal ligament, the right border of the lesser omentum


Liver is connected to lesser curvature of stomach and first part duodenum by the […].
Sheet of peritoneum called the lesser omentum
What are the 2 parts of the lesser omentum?
The flat, thin, sheet called the hepatogastric ligament, and the right edge of the omentum through which vessels run, called the hepatoduodenal ligament
What are the contents of the lesser sac?
Celiac trunk and its branches, the IVC, and the pancreas


- Each segment of the liver is served by tertiary branches of the […]
- All blood filtered by the liver then drains into the […]
- Hepatic artery, the portal vein, and the common hepatic duct
- IVC





Once the GDA branches off of the common hepatic, the artery changes names to the […], which divides into the […] which supply the […].
Hepatic artery proper
Left and right hepatic arteries
Liver
The cystic artery is a branch of the […] and supplies the […]
Right hepatic artery
Gallbladder


The […] system drains the GI tract
The […] system drains the abdominal wall and lower limbs
Portal
Caval














Describe how pancreatic secretions enter the duodenum.
Pancreatic duct joins with the common bile duct. The combined bile and pancreatic enzymes then enter the duodenum via the major duodenal papilla. The pancreas also has an accessory pancreatic duct, which enters the duodenum via the minor duodenal papilla.
- The neck, body, and tail of the pancreas get blood supply from the […]
- The head of the pancreas gets blood supply from the […]
- Celiac trunk
- Superior mesenteric artery and celiac trunk






How does bile enter GI tract?
- From liver: collects in the right and left hepatic ducts, which join to form the common hepatic duct.
- From gallbladder: bile stored in the gallbladder exits via the cystic duct and joins with the common hepatic duct to form the common bile duct.
- The common bile duct joins with the main pancreatic duct, which dumps combined bile and pancreatic enzymes into the duodenum through the hepatopancreatic ampulla.









