Anatomy of Foregut Derivatives Flashcards
0
Q
What does the esophagus do
A
conveys food from pharynx to stomach via peristalsis
1
Q
What is the esophagus
A
muscular tube inferior to thoracic diaphragm
2
Q
What covers the esophagus
A
superior to thoracic diaphragm: adventitia (esophageal plexus)
inferior to thoracic diaphragm: retroperitoneal
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
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
5
Q
What is the esophageal hiatus
A
point of passage through right crus of thoracic diaphragm
6
Q
What vertebral level is the esophageal hiatus at
A
T10
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
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
9
Q
What does the cardiac sphincter do
A
helps prevent gastric reflux
10
Q
What are the arteries of the esophagus
A
esophageal aa
esophageal branch
left inferior phrenic a
11
Q
Where do the esophageal aa come from
A
descending thoracic aorta (above diaphragm)
12
Q
Where does the esophageal branch come from
A
left gastric artery
13
Q
Where does the left inferior phrenic a. come from
A
abdominal aorta
14
Q
What are the veins of the esophagus
A
esophageal vv
left gastric v
15
Q
Where do the esophageal vv drain to
A
superiorly to azygos
16
Q
Where does the left gastric v drain to
A
inferiorly to hepatic portal v
17
Q
What are the primary lymphatics of the esophagus
A
left gastric nodes
18
Q
What are the secondary lymphatics of the esophagus
A
celiac nodes
19
Q
Where do the lymphatics of the esophagus drain to
A
thoracic duct
20
Q
What innervates the esophagus
A
parasympathetic and sympathetic blend in esophageal plexus
21
Q
What is the parasympathetic innervation of the esophagus
A
via vagal trunks
-presynaptic neurons synapse in myenteric and submucosal plexuses
22
Q
What is the sympathetic innervation of the esophagus
A
presynaptic neurons synapse in celiac ganglion
postsynaptic neurons follow periarterial plexus
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
24
What is hematemesis
vomiting blood due to rupture of esophageal varices
25
What is esophageal varices associated with
cirrhosis of the liver
26
What is pyrosis
- Burning, substernal pain originating from lower esophagus
- associated with acid reflux through the cardiac sphincter
- may be misinterpreted as cardiac pain
27
What is gastroesophageal reflux disease (GERD)
- Burning, substernal pain, difficulty swallowing, dry cough, hoarseness, lump in throat
- chronic digestive disease
28
How is GERD diagnosed
if patient has two or more episodes of heartburn or acid reflux per week
29
What does GERD do
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
30
What is Barret's Esophagus
- precancerous changes to esophageal cells
| - -risk of cancer is low but regular endoscopy is recommened
31
How much food can the adult stomach hold? Newborn?
Adult: 2-3L of food
Newborn: 30mL of fluid
32
What is the cardia of the stomach
- superior region of stomach where esophagus drains to
| - relatively fixed position 2cm left of midline at 6th costal cartilage(T11)
33
What is the fundus of the stomach
located under the left dome of diaphragm superiorly to left of 5th intercostal space
34
Where is the cardiac notch located in relation to the stomach
between the esophagus and the fundus
35
Where is the body of the stomach
between the fundus and pyloric antrum
36
What makes up the pylorus
pyloric antrum
pyloric canal
pyloric sphincter
37
What is the pyloric antrum
wide funnel shaped extension of the body
38
What is the pyloric canal
narrower region leading to sphincter
39
What is the pyloric sphincter
thick circular muscle-regulates exit from stomach to first part of duodenum
40
What is the lesser curvature of the stomach
shorter, concave border on right side of stomach
41
What is the angular incisure
sharp indentation at junction of pylorus and body in the lesser curvature
42
What is the greater curvature of the stomach
longer, convex border on left side of stomach
43
What is a hiatal hernia
protrusion of part of the stomach into mediastinum via esophageal hiatus
44
What is a sliding hiatal hernia
- esophagus, cardia, and parts of fundus slide through esophageal hiatus
- exacerbated by lying down or bending over
- often associated with food/acid reflux
45
What is a paraesophageal hiatal hernia
- 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
46
What are the arteries associated with the stomach
```
left gastric a
right gastric a
left gastroepiploic a
right gastroepiploic a
short gastric aa
```
47
What is the left gastric a a branch of
celiac trunk
48
What is important about the left gastric artery
primary arterial supply to lesser curvature of stomach
49
Where does the right gastric artery branch from
hepatic a proper
50
What is important about the right gastric a
small a that anastomoses with left gastric a. along lesser curvature
51
What does the left gastroepiploic a branch from
splenic artery
52
What does the left gastroepiploic supply
greater curvature of stomach in greater omentum
53
What is the right gastroepiploic a branch from
gastroduodenal a
54
What is supplied by the right gastroepiploic a
- supplies greater curvature of stomach in greater omentum
| - anastomoses with left gastroepiploic a along greater curvature
55
What do the short gastric aa branch from
splenic a
56
What do the short gastric aa supply
4-5 small aa supplying fundus of stomach
57
What do the left and gastric vv drain to
Drain to hepatic portal v (HPV)
58
Where do the short gastric and left gastroepiploic vv drain to
drain to splenic v
59
Where does the right gastroepiploic v drain to
drains to superior mesenteric v
60
What are the primary nodes of the stomach
lesser curvature: gastric nodes
greater curvature: gastroepiploic nodes
flow to thoracic duct
61
What is the parasympathetic innervation of the stomach
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
What is the sympathetic innervation of the stomach
- presynaptic neurons via greater splanchnic nerve
- T6-9
- synapse in celiac ganglion
- pass in tunica adventitia of arterial vessels in stomach
63
What is stomach cancer
- a bad time
- tumors in body, or pyloric part may be palpable
- extensive lymphatic drainage and number of nodes creates surgical issues
64
What is gastrectomy
- total is uncommon
- partial may be done to remove cancer or ulcer
- extensive arterial anastomoses provides good vascular support to remaining parts
65
What is a gastric bypass
many types
used for rapid weight loss in the morbidly obese
=>BMI greater than 40
66
What is a Roux-en Y
most common gastric bypass
- creates new stomach pouch the size of walnut
- can have proximal or distal small intestinal attachments
67
What type of bypass allows for more nutrient absorption
Proximal
68
What is a adverse side affect of gastric bypass
fat in large intestine leads to malodorous dumping syndrome
| --patient ends up smelling like Jim Dietrick
69
What causes gastric ulcers
90% caused by infection with H. pylori and treatable with antibiotics
70
What happens with a gastric ulcer
- gastric mucous breaks down and acid erodes gastric mucosa
| - perforation usually go posteriorly
71
What can happen if gastric ulcer completely perforates the stomach wall
leaking acid can cause peritonitis and/or fatal bleeding from damaged arteries in lesser sac
72
How can might a gastric ulcer be treated
vagotomy at esophageal hiatus is sometimes done for chronic ulcers
73
What is the duodenum
first shortest, widest and most fixed region of the small intestine
74
Where does the duodenum begin
begins at pyloric sphincter and ends at duodenojejunal flexure (L2)
-C-shaped around head of pancreas (right side)
75
What are 4 parts of the duodenum
superior part
descending part
inferior part
ascending part
76
What is the superior part of the duodenum
- 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
What is the descending part of the duodenum
-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
What is the major duodenal papilla
internal opening of common bile duct and main pancreatic duct
79
What is the hepatopancreatic ampulla
external union of common bile duct and major pancreatic duct
80
What is the minor duodenal papilla
internal opening of accessory pancreatic duct
81
What is the inferior part of the duodenum
- 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
What is the ascending part of the duodenum
5cm long rising from L3 vertebrae to superior border L2
83
Where does the ascending part end
duodenojejunal flexure
84
What supports the ascending part of the duodenum
ligament of trietz- suspensory muscle covered by fold of peritoneum
-contraction widens the angle of duodenojejunal flexure, facilitating movement
85
What are the arteries of the duodenum
superior pancreaticoduodenal a
| inferior pancreaticoduodenal a
86
What is the superior pancreaticoduodenal a a branch of
gastroduodenal a
87
What does the superior pancreaticoduodenal supply
duodenum proximal to major duodenal papilla
88
What does the inferior pancreaticoduodenal a branch from
branch of superior mesenteric a (SMA)
89
What does the inferior pancreaticoduodenal a supply
duodenum distal to major duodenal papilla
90
What do the the superior and inferior pancreaticoduodenal aa form
anastomoses between celiac trunk and SMA at the junction of the foregut and midgut
91
What does the celiac trunk supply
supplies from distal esophagus to major duodenal papilla
92
Embryonically what does the celiac trunk supply
artery for the foregut
93
What does the superior mesenteric artery supply
major duodenal papilla to near left colic flexure
94
Embryonically what does the SMA supply
artery to the midgut
95
How do the veins of the duodenum travel
follows aa and drains into HPV
96
Where do lymphatics of duodenum drain anteriorly
pancreaticoduodenal nodes=>pyloric nodes
97
Where do lymphatics of duodenum drain posteriorly
to superior mesenteric nodes
98
What are the secondary nodes for the duodenum
celiac nodes
99
How is the duodenum innervated
parasympathetic: posterior vagal trunk
sympathetic: greater and lesser splanchnic nn (T8-T10)
Through celiac and superior mesenteric plexuses in walls of arteries
100
What is the liver
the largest gland in the body
101
What are the metabolic roles that the liver plays
- carbohydrate metabolism and storage (glyocogen)
- plasma protein and lipoprotein synthesis and secretion
- bile formation and secretion
- drug and alcohol detoxification
102
What is the diaphragmatic surface of the liver
mostly anterosuperior convex aspect of liver
103
What is the subphrenic recess of the liver
anterosuperior extension of greater sac between liver and diaphragm
--separated into right and left recesses by falciform lig
104
What is the hepatorenal recess of the liver
inferior extension of greater sac between liver and right kidney/suprarenal gland
105
What is the coronary ligament
anterior and posterior peritoneal reflections from liver to thoracic diaphragm
--outline bare area of liver
106
What are the triangular ligaments of the liver
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
What is the visceral surface of the liver
posteroinferior flat/concave aspect of liver
| -covered by visceral peritoneum except under gallbladder and at porta hepatis
108
What is the porta hepatis
- transverse fissure between caudate and quadrate lobes
| - entry/exit for HPV, hepatic a proper, common hepatic duct
109
Where is the left lobe of the liver
left of falciform lig and ligamentum teres hepatis and ligamentum venosum
110
Where is the right lobe of the liver
Right of falciform lig and ligamentum teres hepatis and ligamentum venosum
111
Where is the cuadate lobe
between ligamentum venosum and IVC
112
Whats the caudate process
extension of caudate lobe connecting it to right lobe
113
Where is the quadrate lobe
between the gallbladder fossa and ligamentum teres hepatis
114
How are the functional lobes of the liver divided
Right and left separated by vertical line running through IVC and gallbladder fossa
-each has its own blood supply and venous drainage
115
Which functional lobe are the caudate and quadrate lobes located in
Functional left lobe
116
What is the ligamentum teres hepatis (round ligament of liver)
- 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
What is the ligamentum venosum
- 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
What does the lesser omentum consist of
hepatodudenal ligament
| hepatogastric ligament
119
What is the hepatoduodenal ligament
- thick free edge surrounding portal triad structures
| - from porta hepatis to initial part of duodenum
120
What is the hepatogastric ligament
thin, broad sheet form liver to lesser curvature of stomach
