Anatomy of Bleeding in GI Tract

Question 1

mobility of caecum

Answer 1

intraperitoneal - quite mobile

Question 2

membrane of ascending colon

Answer 2

secondarily retroperitoneal

Question 3

mobility of transverse colon

Answer 3

highly mobile, has its own mesentery

intraperitoneal

Question 4

membrane of descending colon

Answer 4

secondarily retroperitoneal

Question 5

mobility of signoid colon

Answer 5

intraperitoneal - quite mobile

has its onw mesentery

Question 6

location of paracolic gutters

Answer 6

left and right (2 in total)

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

Question 7

what are paracolic gutters potential sites for

Answer 7

pus collection

Question 8

describe paracolic gutters

Answer 8

part of greater sac of peritoneal cavity

similar to subphrenic or hepatorenal recesses

Question 9

where does teniae coli run

Answer 9

caecum to distal end of sigmoid colon

Question 10

describe the splenic flexure

Answer 10

lies more superior than hepatic flexure

Question 11

how is haustra formed

Answer 11

formed by tonic contraction of teniae coli

Question 12

where does caecum and appendix lie

Answer 12

right iliac fossa

Question 13

position of appendix

Answer 13

variable (accounts for different ways appendicitis presents);
most often retrocaecal

Question 14

where is appendices orifice located

Answer 14

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

Question 15

where is maximum tenderness felt in appendicitis

Answer 15

appendices orifice

Question 16

where does sigmoid colon lie

Answer 16

left iliac fossa

Question 17

describe mesentery of sigmoid colon

Answer 17

it is long;

allowing considerable degree of movement

Question 18

what is sigmoid volvulus

Answer 18

signed colon can twist around itself due to its great mobility
results in bowel obstruction

Question 19

risks of bowel obstruction

Answer 19

bowel infarction in untreated

Question 20

describe the abdominal aorta

Answer 20

midline, retroperipotneal structure

Question 21

where does abdominal aorta lie

Answer 21

anterior to vertebral bodies and left of IVC

Question 22

midline branches of abdominal aorta

Answer 22

3;
celiac trunk
superior mesenteric artery
inferior mesenteric artery

Question 23

what do lateral branches of abdominal aorta supply

Answer 23

kindeys/adrenal glads
gonads
body wall (posterolateral)

Question 24

bifurcation of lateral branches of abdominal aorta

Answer 24

bifurcate into common iliacs

further bifurcate into internal and external iliac

Question 25

branches of superior mesenteric artery

Answer 25

appendicular 
ileocolic 
right colic
middle colic
inferior pancreaticduodenal 
superior mesenteric
jejunal and iliac

Question 26

branches of inferior mesenteric artery

Answer 26

inferior mesenteric
left colic
sigmoid colic
superior rectal

Question 27

where is arterial anastomoses of mesenteric artery located

Answer 27

one artery between branches of superior mesenteric artery and inferior mesenteric artery

Question 28

name of arterial anastomses

Answer 28

the marginal artery of Drummond

Question 29

role arterial anastomoses of mesenteric artery

Answer 29

helps prevent intestinal ischaemia by providing collateral route which blood travels

Question 30

artery supplying distal half of anal canal

Answer 30

internal iliac artery (with a degree of anastomoses)

Question 31

what is haematemesis

Answer 31

patient vomiting blood

Question 32

where does haematemesis come from

Answer 32

usually the upper GI tract

Question 33

describe hepatic portal venous system

Answer 33

drains venous blood from absorptive parts of gI tract and associated organs to liver for cleaning

Question 34

drainage of hepatic portal vein

Answer 34

drains blood from foregut, midgut and hindgut to liver for first pass metabolism

Question 35

venous anastomoses between systemic and portal venous systems

Answer 35

portal systemic anastomoses

Question 36

describe portal systemic anastomoses

Answer 36

presence of small collateral veins - allowing blood to flow both ways;
either into the systemic or portal venous system
no valves in these veins
very little blood flow within these collateral veins

Question 37

sites of portal-systemic anastomoses

Answer 37

distal end of oesophagus
skin around umbilicus
rectum/anal canal

Question 38

drainage of distal end of oesophagus portal-systemic anastomoses - inferior part

Answer 38

drains to hepatic portal vein

Question 39

drainage of distal end of oesophagus portal-systemic anastomoses - superior part

Answer 39

drains to azygous vein

Question 40

drainage of skin around umbilicus portal-systemic anastomoses

Answer 40

normally the ligamentum teres remains closed throughout adult life and blood flows from the skin around the umbilicus via inferior epigastric veins to the IVC

Question 41

drainage of rectum/anal canal portal-systemic anastomoses

Answer 41

rectum and superior anal canal drains to inferior mesenteric vein
most inferior part of GI tract drains to the internal iliac veins

Question 42

diversion of blood in the event of portal hypertension

Answer 42

blood will be diverted through the collateral veins back to the systemic venous system
collateral veins consequently have larger volume of blood -
dilate, becoming varicose