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Gross III Exam 2 > Anatomy of Foregut Derivatives > Flashcards

Anatomy of Foregut Derivatives Flashcards

0
Q

What does the esophagus do

A

conveys food from pharynx to stomach via peristalsis

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1
Q

What is the esophagus

A

muscular tube inferior to thoracic diaphragm

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2
Q

What covers the esophagus

A

superior to thoracic diaphragm: adventitia (esophageal plexus)
inferior to thoracic diaphragm: retroperitoneal

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3
Q

What are the 3 areas of constriction exhibited by fluoroscopy following a barium swallow

A

cervical-upper esophageal sphincter
thoracic-aortic arch and left main bronchus
diaphragmatic-lower esophageal sphincter

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4
Q

What issues may arise from the esophageal constrictions

A
  • foreign bodies tend to lodge here
  • swallowed corrosives do greatest damage here
  • carcinomas most frequently occur here
  • damage resulting from edoscopic instruments most likely occur here
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5
Q

What is the esophageal hiatus

A

point of passage through right crus of thoracic diaphragm

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6
Q

What vertebral level is the esophageal hiatus at

A

T10

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7
Q

What are the phrenicoesophageal ligaments

A

attach to thoracic diaphragm at hiatus

  • permit independent movement during respiration and swallowing
  • create seal between thoracic and abdominal cavities
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8
Q

Where is the esophagogastric junction and what are its borders

A

located left of midline at T11(level with xiphoid)

  • right border: continuous with lesser curvature of stomach
  • left border: separated from fundus by cardiac notch
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9
Q

What does the cardiac sphincter do

A

helps prevent gastric reflux

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10
Q

What are the arteries of the esophagus

A

esophageal aa
esophageal branch
left inferior phrenic a

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11
Q

Where do the esophageal aa come from

A

descending thoracic aorta (above diaphragm)

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12
Q

Where does the esophageal branch come from

A

left gastric artery

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13
Q

Where does the left inferior phrenic a. come from

A

abdominal aorta

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14
Q

What are the veins of the esophagus

A

esophageal vv

left gastric v

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15
Q

Where do the esophageal vv drain to

A

superiorly to azygos

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16
Q

Where does the left gastric v drain to

A

inferiorly to hepatic portal v

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17
Q

What are the primary lymphatics of the esophagus

A

left gastric nodes

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18
Q

What are the secondary lymphatics of the esophagus

A

celiac nodes

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19
Q

Where do the lymphatics of the esophagus drain to

A

thoracic duct

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20
Q

What innervates the esophagus

A

parasympathetic and sympathetic blend in esophageal plexus

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21
Q

What is the parasympathetic innervation of the esophagus

A

via vagal trunks

-presynaptic neurons synapse in myenteric and submucosal plexuses

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22
Q

What is the sympathetic innervation of the esophagus

A

presynaptic neurons synapse in celiac ganglion

postsynaptic neurons follow periarterial plexus

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23
Q

What is esophageal varices

A

enlarged submucosal vv associated with portal hypertension

  • submucosal vv dilate as portal venous return is redirected through azygos system
  • rupture is postentially fatal
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24
Q

What is hematemesis

A

vomiting blood due to rupture of esophageal varices

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25
Q

What is esophageal varices associated with

A

cirrhosis of the liver

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26
Q

What is pyrosis

A
  • Burning, substernal pain originating from lower esophagus
  • associated with acid reflux through the cardiac sphincter
  • may be misinterpreted as cardiac pain
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27
Q

What is gastroesophageal reflux disease (GERD)

A
  • Burning, substernal pain, difficulty swallowing, dry cough, hoarseness, lump in throat
  • chronic digestive disease
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28
Q

How is GERD diagnosed

A

if patient has two or more episodes of heartburn or acid reflux per week

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29
Q

What does GERD do

A

acid changes cells in lower part of esophagus

  • damage causes:
  • -narrowing of esophagus from scar tissue resulting in difficulty swallowing
  • -esophageal ulcers which bleed and cause pai
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30
Q

What is Barret’s Esophagus

A
  • precancerous changes to esophageal cells

- -risk of cancer is low but regular endoscopy is recommened

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31
Q

How much food can the adult stomach hold? Newborn?

A

Adult: 2-3L of food
Newborn: 30mL of fluid

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32
Q

What is the cardia of the stomach

A
  • superior region of stomach where esophagus drains to

- relatively fixed position 2cm left of midline at 6th costal cartilage(T11)

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33
Q

What is the fundus of the stomach

A

located under the left dome of diaphragm superiorly to left of 5th intercostal space

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34
Q

Where is the cardiac notch located in relation to the stomach

A

between the esophagus and the fundus

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35
Q

Where is the body of the stomach

A

between the fundus and pyloric antrum

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36
Q

What makes up the pylorus

A

pyloric antrum
pyloric canal
pyloric sphincter

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37
Q

What is the pyloric antrum

A

wide funnel shaped extension of the body

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38
Q

What is the pyloric canal

A

narrower region leading to sphincter

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39
Q

What is the pyloric sphincter

A

thick circular muscle-regulates exit from stomach to first part of duodenum

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40
Q

What is the lesser curvature of the stomach

A

shorter, concave border on right side of stomach

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41
Q

What is the angular incisure

A

sharp indentation at junction of pylorus and body in the lesser curvature

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42
Q

What is the greater curvature of the stomach

A

longer, convex border on left side of stomach

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43
Q

What is a hiatal hernia

A

protrusion of part of the stomach into mediastinum via esophageal hiatus

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44
Q

What is a sliding hiatal hernia

A
  • esophagus, cardia, and parts of fundus slide through esophageal hiatus
  • exacerbated by lying down or bending over
  • often associated with food/acid reflux
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45
Q

What is a paraesophageal hiatal hernia

A
  • esophagus and cardia stay in normal position
  • pouch of peritoneum often containing the fundus extends through the hiatus
  • Acid reflux usually not an issue as cardiac orifice is in its normal position
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46
Q

What are the arteries associated with the stomach

A 
left gastric a
right gastric a
left gastroepiploic a
right gastroepiploic a
short gastric aa
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47
Q

What is the left gastric a a branch of

A

celiac trunk

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48
Q

What is important about the left gastric artery

A

primary arterial supply to lesser curvature of stomach

49
Q

Where does the right gastric artery branch from

A

hepatic a proper

50
Q

What is important about the right gastric a

A

small a that anastomoses with left gastric a. along lesser curvature

51
Q

What does the left gastroepiploic a branch from

A

splenic artery

52
Q

What does the left gastroepiploic supply

A

greater curvature of stomach in greater omentum

53
Q

What is the right gastroepiploic a branch from

A

gastroduodenal a

54
Q

What is supplied by the right gastroepiploic a

A
  • supplies greater curvature of stomach in greater omentum

- anastomoses with left gastroepiploic a along greater curvature

55
Q

What do the short gastric aa branch from

A

splenic a

56
Q

What do the short gastric aa supply

A

4-5 small aa supplying fundus of stomach

57
Q

What do the left and gastric vv drain to

A

Drain to hepatic portal v (HPV)

58
Q

Where do the short gastric and left gastroepiploic vv drain to

A

drain to splenic v

59
Q

Where does the right gastroepiploic v drain to

A

drains to superior mesenteric v

60
Q

What are the primary nodes of the stomach

A

lesser curvature: gastric nodes
greater curvature: gastroepiploic nodes
flow to thoracic duct

61
Q

What is the parasympathetic innervation of the stomach

A

presynaptic neurons via anterior and posterior vagal trunks

  • synapse on postsynaptic neurons in myenteric/submucosal ganglia in stomach
  • -increases acid secretion and rate of emptying
62
Q

What is the sympathetic innervation of the stomach

A
  • presynaptic neurons via greater splanchnic nerve
  • T6-9
  • synapse in celiac ganglion
  • pass in tunica adventitia of arterial vessels in stomach
63
Q

What is stomach cancer

A
  • a bad time
  • tumors in body, or pyloric part may be palpable
  • extensive lymphatic drainage and number of nodes creates surgical issues
64
Q

What is gastrectomy

A
  • total is uncommon
  • partial may be done to remove cancer or ulcer
  • extensive arterial anastomoses provides good vascular support to remaining parts
65
Q

What is a gastric bypass

A

many types
used for rapid weight loss in the morbidly obese
=>BMI greater than 40

66
Q

What is a Roux-en Y

A

most common gastric bypass

  • creates new stomach pouch the size of walnut
  • can have proximal or distal small intestinal attachments
67
Q

What type of bypass allows for more nutrient absorption

A

Proximal

68
Q

What is a adverse side affect of gastric bypass

A

fat in large intestine leads to malodorous dumping syndrome

–patient ends up smelling like Jim Dietrick

69
Q

What causes gastric ulcers

A

90% caused by infection with H. pylori and treatable with antibiotics

70
Q

What happens with a gastric ulcer

A
  • gastric mucous breaks down and acid erodes gastric mucosa

- perforation usually go posteriorly

71
Q

What can happen if gastric ulcer completely perforates the stomach wall

A

leaking acid can cause peritonitis and/or fatal bleeding from damaged arteries in lesser sac

72
Q

How can might a gastric ulcer be treated

A

vagotomy at esophageal hiatus is sometimes done for chronic ulcers

73
Q

What is the duodenum

A

first shortest, widest and most fixed region of the small intestine

74
Q

Where does the duodenum begin

A

begins at pyloric sphincter and ends at duodenojejunal flexure (L2)
-C-shaped around head of pancreas (right side)

75
Q

What are 4 parts of the duodenum

A

superior part
descending part
inferior part
ascending part

76
Q

What is the superior part of the duodenum

A
  • 5cm long, anterolateral to L1 vertebral body
  • Ascends slightly from pylorus
  • Covered anteriorly by parietal peritoneum and posteriorly by adventitia
  • Attached to liver by hepatoduodenal lig
77
Q

What is the descending part of the duodenum

A

-7-10cm long along right sides of L1-3 vertebral bodies
-curves around right side of head of pancreas
contains:
-major duodenal papilla
-hepatopancreatic ampulla
-minor duodenal papilla

78
Q

What is the major duodenal papilla

A

internal opening of common bile duct and main pancreatic duct

79
Q

What is the hepatopancreatic ampulla

A

external union of common bile duct and major pancreatic duct

80
Q

What is the minor duodenal papilla

A

internal opening of accessory pancreatic duct

81
Q

What is the inferior part of the duodenum

A
  • 6-8cm long crossing to left at L3 vertebrae
  • superior mesenteric a,v pass anterior to this part
  • pancreatic head and uncinate process are superior to this part
82
Q

What is the ascending part of the duodenum

A

5cm long rising from L3 vertebrae to superior border L2

83
Q

Where does the ascending part end

A

duodenojejunal flexure

84
Q

What supports the ascending part of the duodenum

A

ligament of trietz- suspensory muscle covered by fold of peritoneum
-contraction widens the angle of duodenojejunal flexure, facilitating movement

85
Q

What are the arteries of the duodenum

A

superior pancreaticoduodenal a

inferior pancreaticoduodenal a

86
Q

What is the superior pancreaticoduodenal a a branch of

A

gastroduodenal a

87
Q

What does the superior pancreaticoduodenal supply

A

duodenum proximal to major duodenal papilla

88
Q

What does the inferior pancreaticoduodenal a branch from

A

branch of superior mesenteric a (SMA)

89
Q

What does the inferior pancreaticoduodenal a supply

A

duodenum distal to major duodenal papilla

90
Q

What do the the superior and inferior pancreaticoduodenal aa form

A

anastomoses between celiac trunk and SMA at the junction of the foregut and midgut

91
Q

What does the celiac trunk supply

A

supplies from distal esophagus to major duodenal papilla

92
Q

Embryonically what does the celiac trunk supply

A

artery for the foregut

93
Q

What does the superior mesenteric artery supply

A

major duodenal papilla to near left colic flexure

94
Q

Embryonically what does the SMA supply

A

artery to the midgut

95
Q

How do the veins of the duodenum travel

A

follows aa and drains into HPV

96
Q

Where do lymphatics of duodenum drain anteriorly

A

pancreaticoduodenal nodes=>pyloric nodes

97
Q

Where do lymphatics of duodenum drain posteriorly

A

to superior mesenteric nodes

98
Q

What are the secondary nodes for the duodenum

A

celiac nodes

99
Q

How is the duodenum innervated

A

parasympathetic: posterior vagal trunk
sympathetic: greater and lesser splanchnic nn (T8-T10)
Through celiac and superior mesenteric plexuses in walls of arteries

100
Q

What is the liver

A

the largest gland in the body

101
Q

What are the metabolic roles that the liver plays

A
  • carbohydrate metabolism and storage (glyocogen)
  • plasma protein and lipoprotein synthesis and secretion
  • bile formation and secretion
  • drug and alcohol detoxification
102
Q

What is the diaphragmatic surface of the liver

A

mostly anterosuperior convex aspect of liver

103
Q

What is the subphrenic recess of the liver

A

anterosuperior extension of greater sac between liver and diaphragm
–separated into right and left recesses by falciform lig

104
Q

What is the hepatorenal recess of the liver

A

inferior extension of greater sac between liver and right kidney/suprarenal gland

105
Q

What is the coronary ligament

A

anterior and posterior peritoneal reflections from liver to thoracic diaphragm
–outline bare area of liver

106
Q

What are the triangular ligaments of the liver

A

right side: convergence of anterior/posterior coronary ligaments
—->helps anchor right lobe to diaphragm
left side: convergence of anterior/posterior coronary ligaments
—->helps anchor left lobe to diaphragm

107
Q

What is the visceral surface of the liver

A

posteroinferior flat/concave aspect of liver

-covered by visceral peritoneum except under gallbladder and at porta hepatis

108
Q

What is the porta hepatis

A
  • transverse fissure between caudate and quadrate lobes

- entry/exit for HPV, hepatic a proper, common hepatic duct

109
Q

Where is the left lobe of the liver

A

left of falciform lig and ligamentum teres hepatis and ligamentum venosum

110
Q

Where is the right lobe of the liver

A

Right of falciform lig and ligamentum teres hepatis and ligamentum venosum

111
Q

Where is the cuadate lobe

A

between ligamentum venosum and IVC

112
Q

Whats the caudate process

A

extension of caudate lobe connecting it to right lobe

113
Q

Where is the quadrate lobe

A

between the gallbladder fossa and ligamentum teres hepatis

114
Q

How are the functional lobes of the liver divided

A

Right and left separated by vertical line running through IVC and gallbladder fossa
-each has its own blood supply and venous drainage

115
Q

Which functional lobe are the caudate and quadrate lobes located in

A

Functional left lobe

116
Q

What is the ligamentum teres hepatis (round ligament of liver)

A
  • remnant of fetal umbilical v
  • located on free (inferior) edge of falciform lig
  • delivered oxygenated blood and nutrient rich blood from placenta to fetus
117
Q

What is the ligamentum venosum

A
  • remnant of fetal ductus venosus
  • located on visceral surface between caudate lobe and left lobe of liver
  • allowed placental blood to largely bypass liver, shunting it directly to IVC
118
Q

What does the lesser omentum consist of

A

hepatodudenal ligament

hepatogastric ligament

119
Q

What is the hepatoduodenal ligament

A
  • thick free edge surrounding portal triad structures

- from porta hepatis to initial part of duodenum

120
Q

What is the hepatogastric ligament

A

thin, broad sheet form liver to lesser curvature of stomach

Gross III Exam 2 (11 decks)

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