Anatomy of GI tract bleeding

Question 1

Is the caecum intraperitoneal or retroperitoneal?

Answer 1

intraperitoneal

so quite mobile

Question 2

Is the ascending colon intraperitoneal or retroperitoneal?

Answer 2

secondary retroperitoneal

Question 3

Is the transverse colon intraperitoneal or retroperitoneal?

Answer 3

intraperitoneal

- highly movable, has its own mesentery

Question 4

Is the descending colon intraperitoneal or retroperitoneal?

Answer 4

secondary retroperitoneal

Question 5

Is the sigmoid colon intraperitoneal or retroperitoneal?

Answer 5

intraperitoneal

- has its own mesentery

Question 6

Where are the pancreatic gutters found?

Answer 6

between lateral edge of ascending and descending colon, and abdominal wall
One on the right and left

Question 7

What can commonly collect in pancreatic gutters?

Answer 7

pus

Question 8

What are three distinguishing features of the colon?

Answer 8

Omental appendices
Teniae coli
Haustra

Question 9

What is the role of the teniae coli? What are they?

Answer 9

Facilitate the movement of faeces through the intestine

3 distinct longitudinal bands of thickened smooth muscle, running from caecum to distal end of sigmoid colon
Come together at the appendix

Question 10

Which two flextures are part of the large instestine?

Answer 10

splenic - higher up

hepatic

Question 11

What are ommental appendices?

Answer 11

small, fatty projections

Question 12

What is the most common position of the appendix?

Answer 12

retrocaecal

Question 13

Where do the Caecum and appendix lie?

Answer 13

right illiac fossa

Question 14

What connects the ileum and the caecum?

Answer 14

Ileocaecal orifice

Question 15

What connects the caecum and the appendix?

Answer 15

Appendiceal orifice

Question 16

Where does the sigmoid colon lie?

Answer 16

left iliac fossa

Question 17

What is it called when the sigmoid colon twists around itself?

Answer 17

Sigmoid volvulus

• due to its very flexible mesentery
• results in bowel obstruction
• congeital or acquired

Question 18

What occurs at L4?

Answer 18

aorta bifurcates into the common iliac artery

where the top of the iliac crest

Question 19

What are the 3 midline branches of the abdominal aorta?

Answer 19

Celiac trunk (foregut organs)
Superior mesenteric artery (midgut organs)
Inferior mesenteric artery (hindgut organs)

Question 20

What is the difference between the ileum and jejunums vasculature?

Answer 20

Jejunum

• Longer vasa rectae
• Larger and fewer arcades

Ileum

• Shorter vasa rectae
• Smaller and many arcades

Question 21

What is the marginal artery of drummond?

Answer 21

arterial anastomoses between the branches of the SMA and the IMA

Question 22

What is the blood supply to the rectum and anal canal?

Answer 22

Superior rectal artery, a branch of IMA

Question 23

What supplies the rest of the GI tract? (apart from the rectum and anal canal)

Answer 23

internal iliac artery

Question 24

What is the funciton of the hepatic venous system?

Answer 24

Drains venous blood from absorptive parts of the GI tract & associated organs to the liver for ‘cleaning’

Question 25

What happens when portal veins are blocked?

Answer 25

portal hypertension

Question 26

What drains foregut structures to the hepatic portal vein?

Answer 26

splenic vein

Question 27

What drains midgut structures to the hepatic portal vein?

Answer 27

Superior mesenteric vein

Question 28

What drains hindgut structures to the hepatic portal vein?

Answer 28

Inferior mesenteric vein

Question 29

What are the 3 clinically important sites of venous anastomosis between the systemic and the portal venous systems?

Answer 29

The skin around the umbilicus
Distal end of oesophagus
Rectum/Anal canal

Question 30

Describe the astamoses for the skin around the umbilicus?

Answer 30

Connection between para-umbilical veins and small epigastric veins

Para-umbilical veins to hepatic portal vein along the round ligament of liver

Epigastric veins drain to caval system

Question 31

Describe the astamoses for the distal end of the oesophagus?

Answer 31

Inferior part drains to the hepatic portal vein

Superior part drains to the azygous vein

Question 32

Describe the astamoses for the rectum/anal canal?

Answer 32

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

Question 33

What is portal hypertension? What causes it?

Answer 33

Elevation of blood pressure in the portal system

Can be caused by;
Liver pathology (cirrhosis)
Tumour compressing HPV

Question 34

What are the clinical signs of portal hypertension?

Answer 34

Oesophageal varices
Caput medusa
Rectal varices

Question 35

What is haematemesis?

Answer 35

vomiting up blood