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Phase 1 > Anatomy - GI > Flashcards

Anatomy - GI Flashcards

1
Q

How many vertebrae contribute to the posterior abdominal wall?

A

5 Lumbar vertebrae

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2
Q

What are the 3 functions of the abdominal wall?

A
  • protect the abdominal viscera
  • increase intra-abdominal pressure (eg. for defecation and childbirth)
  • maintain posture and move the trunk
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3
Q

What lines the internal aspect of the abdominal wall?

A

Parietal peritoneum

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4
Q

Where does the subcostal line lie?

A

A horizontal line drawn through the inferior-most parts of the costal margins - through the 10th costal cartilage

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5
Q

Where does the intertubercular line lie?

A

A horizontal line drawn through the tubercles of the L&R iliac crests and the body of L5

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6
Q

What is the transpyloric plane?

A

A horizontal line that passes through the tips of the 9th costal cartilages
(halfway between the top of the manubrium and the pubic symphysis)

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7
Q

What does the transpyloric plane transect?

A
  • pylorus of the stomach
  • gallbladder
  • pancrease
  • hila of the kidneys
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8
Q

What is the transumbilical plane?

A

A horizontal line that lies approximately at the level of L3 but is unreliable as its position depends on the amount of fat present

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9
Q

What is the intercristal plane?

A

A horizontal line drawn between the highest points of the L&R iliac crests
(used to guide procedures on the back)

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10
Q

Where would you find McBurnley’s point?

A

2/3 of the way along a line drawn from the umbilicus to the right anterior superior iliac spine

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11
Q

What surface marking marks the base of the appendix?

A

McBurnley’s point

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12
Q

What four pairs of muscles comprise the anterolateral abdominal wall?

A
  • external oblique
  • internal oblique
  • transverse abdominis
  • rectus abdominis
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13
Q

Where does rectus abdominis attach?

A
  • superiorly attaches to the sternum and costal margin
  • inferiorly attaches to pubis
  • surrounded by aponeurotic rectus sheath
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14
Q

Which way do the fibres of each muscle layer run? Starting with the most superficial.

A
  • External oblique - medially and inferiorly (towards the midline)
  • Internal oblique - medially and superiorly (perpendicular to the external obliques
  • Transverse abdominis - horizontal
  • Rectus abdominis - vertical
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15
Q

What is the linea alba?

A

A rough midline raphe where the fibres of the aponeuroses from the abdominal wall muscles fuse with each other

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16
Q

Where do the rectus abdominis muscles lie?

A

Either side of the linea alba, within the rectus sheath

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17
Q

What lies deep to the transverse abdominis?

A
  • transversalis fascia
  • deep to that lies parietal peritoneum
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18
Q

What are the vessels of the anterior abdominal wall?

A
  • musculophrenic artery - branch of the internal thoracic
  • superior epigastric artery - continuation of the internal thoracic
  • inferior epigastric - branch of the external iliac artery - ascends in rectus sheath and anastomoses with the superior epigastric
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19
Q

How is the anterior abdominal wall innervated?

A
  • Thoraco-abdominal nerves T7-11 - continuation of the intercostal nerves
  • Subcostal nerve - originates from the T12 spinal nerve (runs along the inferior border of the 12th rib)
  • Iliohypogastric & Iliolingual nerves - both branches of teh L1 spinal nerve
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20
Q

What is the difference between parietal and visceral peritoneum?

A

> parietal peritoneum lines the abdominal wall
visceral peritoneum covers the abdominal viscera
parietal peritoneum is innervated by somatic nerves
visceral peritoneum is innervated by visceral sensory nerves
pain from parietal peritoneum is sharp and well localised
pain from visceral peritoneum is dull and diffuse

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21
Q

What lies between the visceral and parietal peritoneum?

A

The peritoneal cavity, in a healthy abdomen a thin film of peritoneal fluid lines the cavity allowing the viscera to slide freely over each other

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22
Q

What words describe the extent to which the abdominal viscera are covered by peritoneum?

A

Intraperitoneal - almost completely covered by peritoneum (eg. stomach)
Retroperitoneal - posterior to the peritoneum, only covered on the anterior surface (eg. pancreas)

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23
Q

What abdominal structures are described as retroperitoneal?

A

Suprarenal glands
Aorta and IVC
Duodenum
Pancreas (except the tail)
Ureter
Colon (ascending and descending)
Kidneys
Esophagus
Rectum

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24
Q

What are mesenteries?

A

Folds of peritoneum that contain fat and suspend the small intestine and parts of the large intestine from the posterior abdominal wall
Embedded in the mesenteries:
- arteries that supply the intestine (from the AA)
- veins that drain the gut (tributaries of the portal system)

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25
Q

What are the greater and lesser omenta?

A

Folds of peritoneum that are usually fatty and connect the stomach to other organs

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26
Q

Where is the greater omentum?

A

The greater omentum hangs from the greater curvature of the stomach and lies superficial to the small intestine

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27
Q

Where is the lesser omentum? And what lies within it?

A

The lesser omentum connects the stomach and duodenum to the liver
Embedded within it is the portal triad:
- hepatic artery
- hepatic portal vein
- bile duct

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28
Q

What are peritoneal ligaments?

A

Folds of peritoneum that connect organs to each other or to the abdominal wall

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29
Q

What are the two main peritoneal ligaments?

A

> falciform ligament - connects the anterior surface of the liver to the anterior abdominal wall
coronary and triangular ligaments - connect the superior surface of the liver to the diaphragm

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30
Q

What is the median umbilical fold?

A

A peritoneal fold lying in the midline that represents the remnant of the urachus
Urachus - embryological structure that connected the bladder to the umbilicus

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31
Q

What are the medial umbilical folds?

A

Peritoneal folds that lie lateral to the median fold representing the remnants of the paired umbilical arteries
Umbilical arteries - returned venous blood to the placenta in foetal life

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32
Q

What are the lateral umbilical folds?

A

Peritoneal folds that lie lateral to the medial umbilical folds, the inferior epigastric arteries and veins lie deep to these folds
They supply the anterior abdominal wall

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33
Q

What are the lesser and greater sacs?

A
  • lesser sac is also called the omental bursa
  • a space that lies posterior to the stomach and anterior to the pancreas
  • greater sac is the remaining part of the peritoneal cavity
34
Q

What is the space between the greater and lesser sacs?

A

Epiploic foramen

It lies posterior to the free edge of the lesser omentum

35
Q

Describe the distal oesophagus

A

> passes through the oesophageal hiatus at the level of T10
muscle around the hiatus functions as a sphincter preventing reflux
abdominal oesophagus is less than 2 cm long

36
Q

Describe the vascular supply to the distal oesophagus

A

> supplied by branches of the left gastric artery
drained by oesophageal veins that drain into the azygous vein
also drained by the left gastric veins which feed into the portal system
therefore a site of portosystemic anastomoses

37
Q

What are the four parts of the stomach?

A

> cardia - where the oesophagus and stomach meet
fundus - most superior part of the stomach, usually filled with gas
body - main part of the stomach
pylorus - distal to the stomach, contains the pyloric sphincter which regulated the passage of chyme into the duodenum

38
Q

What is the blood supply to the stomach?

A
  • Left and right gastric arteries (lesser curvature)
  • Left and right gastro-omental arteries (greater curvature)
  • Veins accompany all the above arteries and drain into the hepatic portal vein
39
Q

What three branches does the coeliac trunk split into?

A
  • Left gastric artery
  • Splenic artery
  • Common hepatic artery
40
Q

How is the stomach innervated?

A

Parasympathetic:
- Vagus nerve
- promotes peristalsis and gastric secretion

Sympathetic:
- Greater splanchnic nerve (from spinal cord segments T5-T9)
- inhibit peristalsis and secretion

41
Q

What are the three parts of the small intestine?

A
  • duodenum
  • jejunum
  • ileum
42
Q

Describe the anatomy of the duodenum

A
  • continuous with the pylorus of the stomach
  • curved into a C-shape around the head of the pancreas
  • most of the duodenum is retroperitoneal
  • halfway along the duodenum is the major duodenal papilla (opening of the bile duct)
43
Q

Where does the duodenum arise from?

A
  • first half -> develops from the embryological foregut and is supplied by branches from the coeliac trunk
  • second half -> develops from the embryological midgut and is supplied by the superior mesenteric artery
44
Q

How are the jejunum and ileum adapted for nutrient absorption?

A
  • small intestine is long
  • mucosa is folded (plicae circulares)
  • villi (on mucosal folds)
  • microvilli (on luminal surface of each epithelial cell)
45
Q

Describe the anatomy of the jejunum and ileum

A
  • duodenum, jejunum, ileum all continuous with each other
  • both intraperitoneal
  • both suspended from the posterior abdominal wall by the mesentery of the small intestine
  • blood vessels from the superior mesenteric are embedded in the mesentery
46
Q

How do the jejunum and ileum differ?

A
  • plicae are more pronounced in the jejunum
  • internal ileum is characterised by Peyer’s patches (large submucosal lymph nodules)
47
Q

What is Meckel’s diverticulum?

A
  • Only present in some people
  • A blind ended diverticulum approximately one meter from the termination of the ileum
  • Embryological remnant of the connection between the midgut loop and the yolk sac
48
Q

Where does the small intestine meet large intestine?

A

> Ileocaecal junction where the terminal ileum is continuous with the caecum
In the right iliac fossa

49
Q

What parts compose the large intestine?

A
  • caecum
  • appendix
  • ascending colon
  • transverse colon
  • descending colon
  • sigmoid colon
  • rectum
  • anal canal
50
Q

How is the large intestine distinguished from the small intestine?

A
  • Taeniae coli - outer longitudinal muscle layer is organised into three bands
  • Haustra - inner circular muscle layer forms bulges
  • Epiploic appendages - fatty tags that mark the point at which blood vessels penetrate the intestinal wall
51
Q

Where does the ascending colon run?

A
  • right side of the posterior abdominal wall
  • in the right paracolic gutter
  • makes a 90 degree turn called the hepatic flexure
52
Q

Where does the transverse colon run?

A
  • horizontally in the upper abdomen, often hangs down
  • suspended from the posterior abdominal wall by the transverse mesocolon
  • makes a 90 degree turn called the splenic flexure
  • splenic flexure tethered to the diaphragm by the phrenicocolic ligament
53
Q

Where does the transverse colon arise from?

A

> first 2/3 - embryological midgut
last 1/3 - embryological hindgut

54
Q

Where does the descending colon run?

A
  • left side of the posterior abdominal wall
  • in the left paracolic gutter
55
Q

Where does the sigmoid colon run?

A
  • in a sinuous shape
  • 90 degree turn inferiorly into the pelvis called the rectosigmoid junction
  • has a mesentery called the sigmoid mesocolon
56
Q

What does the superior mesenteric artery supply?

A

Midgut structures
Second half of the duodenum, small intestine, caecum, ascending colon and first 2/3 of the transverse colon

57
Q

What does the inferior mesenteric artery supply?

A

Hindgut structures
Last 1/3 of the transverse colon, descending colon, sigmoid colon, rectum and upper anal canal

58
Q

What level does the superior mesenteric artery leave the aorta?

A

L1

59
Q

What level does the inferior mesenteric artery leave the aorta?

A

L3

60
Q

What level does the coeliac trunk leave the aorta?

A

T12

61
Q

What main veins form the portal venous system?

A
  • Inferior mesenteric vein - runs with the IMA, drains the hindgut, joins the splenic vein
  • Superior mesenteric vein - runs with the SMA, drains the midgut, unites with the splenic vein to form the hepatic portal vein
  • Hepatic portal vein - enters the liver and nutrients are removed
62
Q

Describe the parasympathetic innervation of the gut

A

Foregut and midgut:
Innervated with parasympathetic fibres by the vagus nerve

Hindgut:
Innervated with parasympathetic fibres by the pelvic splanchnic nerves

63
Q

Describe the sympathetic innervation of the gut

A

Foregut: Greater splanchnic nerve carries sympathetic fibres from T5-T9

Midgut: Lesser splanchnic nerve carries sympathetic fibres from T10-T11

Hindgut: Least splanchnic nerve carries sympathetic fibres from T12

64
Q

Where does the liver lie in the abdomen?

A

Right upper quadrant and epigastrium

65
Q

What are the two surfaces of the liver?

A

Diaphragmatic surface lies anterosuperior, related to the inferior surface of the diaphragm

Visceral surface lies posteroinferior, related to other organs

66
Q

What are the regions of the liver not covered in visceral peritoneum called?

A
  • Bare area - a region on the posterior surface that lies in contact with the diaphragm
  • Porta hepatis - where the portal triad enters/exits the liver
  • Gallbladder area - where the gallbladder lies in contact with the liver
67
Q

Describe the lobes of the liver

A

Anatomical left and right lobes separated by the falciform ligament
Accessory caudate and quadrate lobes located on the posteroinferior surface

68
Q

Do the lobes of the liver represent the internal function?

A

No the liver is divided internally into 8 function segments each with their own vascular and biliary branches

69
Q

Describe the blood supply to the liver

A

Coeliac trunk -> common hepatic artery -> hepatic artery proper -> left/right hepatic arteries

70
Q

Describe the venous drainage of the liver

A
  • Blood exits the liver by two or three large hepatic veins that lie within the liver (not visible externally)
  • They unite with the IVC as it passes posterior to the liver
71
Q

Describe the innervation of the liver

A

Hepatic nervous plexus, which runs alongside the portal triad
Parasympathetic fibres from the vagus nerve
Sympathetic fibres from the coeliac plexus

72
Q

What is the liver anatomically related to? And how?

A

> diaphragm by the coronary and triangular ligaments
anterior abdominal wall by falciform ligament
stomach and duodenum by lesser omentum

73
Q

What are the two recesses related to the liver?

A

> hepatorenal recess - between the right kidney and posterior surface of the right side of the liver
L/R subphrenic recesses - either side of the falciform ligament between the diaphragm and the anterosuperior surface of the liver

74
Q

What is the ligamentum teres?

A
  • Remnant of the umbilical vein
  • Which in foetal life carries oxygenated blood from the placenta to the foetus
  • Contained in the free edge of the falciform ligament
75
Q

What is the ligamentum venosum?

A
  • Remains of the ductus venosus
  • Which in foetal life diverts blood from the umbilical vein to the IVC, shunting O2 rich blood to the heart bypassing the liver
  • Lies on the posterior surface of the liver in the groove between the caudate lobe and the left lobe
76
Q

What are the three parts of the gallbladder?

A

Neck - tapered end that communicates with the cystic duct
Body - main part
Fundus - rounded end

77
Q

What is the surface marking of the fundus of the gallbladder?

A

The tip of the 9th costal cartilage, at the point where the right midclavicular line intersects the right costal margin

78
Q

Describe the biliary tree

A

> bile made by hepatocytes in the liver
excreted into small channels called bile canaliculi of increasing calibre
converge to form left and right hepatic ducts
common hepatic duct
joined by cystic duct to form (common) bile duct
enters the duodenum at the major duodenal papilla

79
Q

What happens to bile if it is not needed for digestion?

A
  • Enters the gallbladder via the cystic duct
  • When needed it flows out via the cystic duct to the duodenum
  • The spiral fold lies at the junction between the gallbladder neck and the cystic duct
80
Q

Describe the vascular supply to the gallbladder

A
  • Blood supplied by the cystic artery, a branch of the right hepatic artery
  • Blood drained by the cystic veins that pass directly into the river or join the hepatic portal vein
81
Q

Where might gallbladder pain be felt?

A

> Epigastrium - visceral pain enters spinal cord levels T5-T9 so referred to epigastrium
Right shoulder - if gallbladder irritates the diaphragm because it is innervated by the phrenic nerve and spinal cord segments C3-C5 also receive somatic sensory information from the skin of the right shoulder
Right hypochondrium - if pathology irritates the parietal peritoneum, innervated by somatic nerves

82
Q

What are the three branches of the

A

Phase 1 (4 decks)

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