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Gross III Exam 2 > Anatomy of Midgut and Hindgut > Flashcards

Anatomy of Midgut and Hindgut Flashcards

1
Q

Where does the jejunum begin?

A

At the duodenojejunal flexure (just after SMA/SMV cross over) on Left side of L2 vertebra

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2
Q

About how long is the jejunum?

A

2-3m long

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3
Q

Is the jejunum intraperitoneal or retroperitoneal?

A

intraperitoneal (suspended by mesentery)

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4
Q

What quadrant do you find the jejunum?

A

LUQ

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5
Q

Where does the ileum end?

A

At ileocecal junction

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6
Q

How long is the ilium?

A

About 3-4m long

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7
Q

Is the ileum intraperitoneal or retroperitoneal?

A

intraperitoneal (suspended by mesentery)

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8
Q

What quadrant do you find the ileum?

A

RLQ

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9
Q

What is the primary function of the jejunum and ileum?

A

absorption of food stuffs

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10
Q

T/F - the transition between the ileum and jejunum can be externaly determined.

A

False - no external demarcation

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11
Q

What are the primary lymph nodes of the jejunum and ileum?

A

mesenteric nodes

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12
Q

What are the secondary lymph nodes of the jejunum and ileum?

A

superior mesenteric nodes

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13
Q

Where do the lymphatics from primary and secondary nodes of jejunum and ileum drain?

A

To cisterna chyli then to thoracic duct

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14
Q

Pertaining to the innervation of jejunum and ileum, what nerve plexus surrounds the SMA?

A

perivascular nerve plexus

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15
Q

How does the jejunum and ileum receive sympathetic innervation?

A

Via greater and lesser splanchnic nn (T8-T10); synapse in celiac and superior mesenteric ganglion

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16
Q

What do sympathetic nn. do to jejunum and ileum?

A

Reduce motility and sectretion, vasoconstriction

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17
Q

How does the jejunum and ileum receive parasympathetic innervation?

A

Via posterior vagal trunk; synapse on myenteric and submucosal plexuses

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18
Q

What do parasympathetic nn. do to jejunum and ileum?

A

Increase motility and secretion, vasodilation occurs secondarily

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19
Q

What is the path of the visceral afferents of jejunum and ileum?

A

Visceral afferents (pain) accompany sympathetics to T8-T10 dermatomes

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20
Q

What is ileal (Meckel’s) diverticulum?

A

A rare(er) congenital anomaly; a finger-like pouch that is a remnant of embryonic omphaloenteric duct connecting midgut to umbilical vesicle

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21
Q

Where is an ileal diverticulum found?

A

Its about about 2 inches, seen on anterior ileum about 2 ft (look it up Canadians!) from ileocecal junction

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22
Q

Is an ileal diverticulum symptomatic?

A

Usually asymptomatic, (2% symptomatic)

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23
Q

An ileal diverticulum usually only contains ileal tissue, but what other type of tissue might it contain?

A

acid-producing gastric tissue or pancreatic tissue

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24
Q

What is the most common symptom seen with ileal diverticulum?

A

rectal bleeding

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25
What might the pain of an ileal diverticulum mimic?
when inflammed, the pain of appendicitis
26
What are the main function of the colon?
Completing absorption (mostly water) and compacting/storing feces
27
What are the regions of the colon?
Cecum (with appendix), ascending, transverse, descending and sigmoid colon, rectum, anal canal
28
What are the external characteristics of the large intestine?
Teniae coli, haustra, and epiploic appendages
29
What are teniae coli?
3 bands of longitudinal smooth muscle in outer layer of muscularis externa beginning at appendix and broadening/merging at longitudingal layer around rectum
30
What happens when teniae coli contract?
tonic contraction shortens the walls of colon
31
What are haustra
sacculations in wall of colon between teniae coli
32
What are epiploic appendages?
Small fatty projections on outside of large intestine
33
What is the function of epiploic appendages?
unknown
34
Where is the cecum located?
Beginning of large intestine, RLQ
35
What is the cecum?
A blind puch at inferior portion of ascending colon, inferior to ileocecal junction
36
Is the cecum palpable?
Palpable through anterolateral abdominal wall, only when distended
37
Is the cecum intraperitoneal or retroperitoneal?
intraperitoneal (but no mesentery)
38
What is the function of the ileocecal valve?
To prevent reflux from cecum into ileum
39
What is the appendix of the cecum?
A blind intestinal diverticulum that is retrocecal; contains much GALT
40
What is the mesoappendix?
A short, triangular mesentery of appendix between cecum and proximal appendix
41
What is an inflammation of the appendix producing severe abdominal pain?
Appendicitis
42
When does appendicitis occur in young and old people respectively?
Due to hyperplasia of lymph tissue occluding lumen; occurs due to fecalith (a stone turd)
43
Normally, pain due to appendicitis is due to swelling/stretching of tissue; what makes that pain more severe?
When parietal peritoneum is also irritated.
44
What are the symptoms of a ruptured appendix?
Peritonitis, increased pain, and nasea
45
What is a surgical removal of the appendix called?
Appendectomy
46
What are the arteries of the cecum and appendix?
Ileocolic a. from SMA and the appendicular a. (of ileocolic a.)
47
What vein drains the cecum and appendix?
Ileocolic v. draining to SMV
48
What are the primary lymph nodes of the cecum and appendix?
Ileocecal nodes
49
What are the secondary lymph nodes of the cecum and appendix?
superior mesenteric nodes
50
Where do the lymphatics from primary and secondary nodes of cecum and appendix drain?
To cisterna chyli then to thoracic duct
51
What are the sympathetic innervations to the cecum and appendix?
Via lesser splanchnic n. (T10); synapse on superior mesenteric ganglion
52
What are the parasympathetic innervations to the cecum and appendix?
Via vagal trunks; synapse on myenteric and submucosal plexuses
53
What do the visceral afferent innervations from cecum and appendix accompany?
(Pain) - accompany sympathetics to T10 dermatome (at level of umbilicus)
54
Where is the ascending colon positioned?
Passing superiorly on right side of the abdominal cavity from cecum to liver
55
Describe the right colic (hepatic) flexure
Leftward bend of colon at liver, transition to transverse colon
56
Is the ascending colon intraperitoneal or retroperitoneal?
Retroperitoneal on right side of posterior abdominal wall, covered by parietal peritoneum anteriorly
57
What are the main arteries of the ascending colon?
Right colic a. and ileocolic a.
58
Where do the right colic and ileocolic aa. branch from?
SMA
59
What does the ileocolic a. supply?
terminal ileum, cecum, appendix, and inferior ascending colon
60
What does the right colic a. supply?
Passes retroperitonealy, gives an ascending and descending branch
61
What does the right colic a. anastomose with?
Marginal a.
62
What are the 2 main veins of the ascending colon?
Ileocolic and right colic vv.
63
Where do the ileocolic and right colic vv. drain?
SMV
64
What are the primary nodes of the ascending colon?
paracolic, ileocolic, right colic nodes
65
What are the secondary nodes of the ascending colon?
superior mesenteric nodes
66
What are the sympathetic innervations to the ascending colon?
Via lesser splanchnic n. (T10); synapse on superior mesenteric ganglion
67
What are the parasympathetic innervations to the ascending colon?
Via vagal trunks; synapse on myenteric and submucosal plexuses
68
What do the visceral afferent innervations from ascending colon accompany?
Sympathetics; refer to T10 dermatome
69
What is the largest and most moble part of the large intestine?
Transverse colon
70
What is the position of the transverse colon?
Crosses abdomen from right colic flexure to left colic flexure
71
Which colic flexure is normally located higher and less mobile
left colic flexure
72
How is the transverse colon suspended in the abdomen?
By transverse mesocolon, hangs to level of umbilibus
73
What is the main branch of the transverse colon and where is it from?
Middle colic a. from SMA, shares common branch with right colic a.
74
Where does the middle colic a. run?
passes through transverse mesocolon where it devides into right and left branches
75
What other artery does the middle colic a. anastomose with?
Marginal a.
76
What is the main vein of the transverse colon and where does it drain?
Middle colic v. to SMV
77
What are the primary nodes of the transverse colon?
middle colic nodes
78
What are the secondary nodes of the transverse colon?
superior mesenteric nodes
79
What are the sympathetic innervations to the transverse colon?
Via lesser splanchnic n. (T11) and superior mesenteric plexus
80
What are the parasympathetic innervations to the transverse colon?
Via vagal trunks and superior mesenteric plexuses
81
Where does the hindgut begin?
Descending colon
82
From where does the descending colon travel?
From left colic flexure to left iliac fossa where it transitions to sigmoid colon.
83
Is the descending colon intraperitoneal or retroperitoneal?
retroperitoneal
84
Where is the left paracolic gutter present?
lateral to the left of descending colon
85
From where does the sigmoid colon travel?
S-shaped segmend connection descending colon to rectum
86
Where do the tenia coli stop?
About 15 cm from the anus, broaden and merge to form longitudinal layer of rectum
87
Is the sigmoid colon intraperitoneal or retroperitoneal?
intraperitoneal with long mesentery, adds to mobility
88
Where does the mesentary dissapear from the sigmoid colon?
At transition to rectum (S2)
89
What is the main vascular supply to descending and sigmoid colon and what is it a branch of?
IMA, branch of abdominal aorta just superior to its bifurcation
90
What are the branches of the IMA that supply the descending and sigmoid colon?
Left colic a. and sigmoidal aa., terminating as superior rectal a.
91
What does the left colic a. supply and what does it anastomose with?
supplys descending colon; anastamoses between SMA and IMA via marginal a.
92
What does the sigmoidal aa supply?
About 2-4 aa in sigmoid mesocolon, supply sigmoid colon
93
What is the main vein of the descending and sigmoid colons?
IMV, drains to splenic vein (most common), SMV, or junction between splenic v. and SMV.
94
What are the primary nodes of the descending and sigmoid colons?
paracolic or left colic nodes
95
what are the secondary nodes of the descending and sigmoid colons?
Either inferior or superior mesenteric nodes
96
What are the sympathetic innervations to the descending and sigmoid colon?
Via least and lumbar splanchnic nn. (T12-L3), synapse in superior mesenteric and inferior mesenteric ganglia respectively
97
What are the parasympathetic innervations to the descending and sigmoid colon?
Via pelvic splanchnic n. (S2-4), pass through inferior hypogastric plexus
98
What do the proximal visceral afferents to descending and sigmoid colons accompany?
Proximal (orad) accompany sympathetics (pain); those for reflexes follow parasympathetics
99
What do the distal visceral afferents to descending and sigmoid colons accompany?
Distal (aborad) accompany parasympathetics (pain and reflexes)

Gross III Exam 2 (11 decks)

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