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1 GI and liver > anatomy of the stomach and bowels and peritoneal cavity > Flashcards

anatomy of the stomach and bowels and peritoneal cavity Flashcards

1
Q

what organs are within the foregut?

A 
oesophagus, 
stomach, 
pancreas, 
liver, 
gallbladder
duodenum (proximal to the entrance of the common bile duct)
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2
Q

what organs are within the midgut ?

A 
duodenum (distal to the entrance of the common bile duct) 
jejunum 
ileum 
caecum 
apendix 
ascending colon
 ⅔ proximal transverse colon
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3
Q

what organs are within the hindgut?

A

distal ⅓ transverse colon
descending colon
sigmoid colon
upper part of the anal canal (⅓ rectum)

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4
Q

what is the innervation of the foregut?

A

the greater splanchnic nerve

arises from T5-T9 spinal nerves

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5
Q

what is the innervation of the midgut?

A

the lesser splanchnic nerve
arises from T10-T11

sympathetic, parasympathetic and sensory supply by superior mesenteric plexus

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6
Q

what is the innervation of the hindgut?

A

The Least splanchnic nerve
arises from T12 root

sympathetic, parasympathetic and sensory supply via nerves fromthe inferior mesenteric plexus:

  • Parasympathetic innervation via the pelvic splanchnic nerves
  • Sympathetic innervation via the lumbar splanchnic nerves.
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7
Q

where is pain stimulus in foregut FELT?

A

foregut innervated by T5-T9 greater splanchnic nerve

so pain felt in upper abdomen

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8
Q

where is pain stimulus in midgut FELT?

A

midgut innervated by lesser splanchnic T10-T11

so pain felt around umbilicus

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9
Q

where is pain stimulus in hindgut FELT?

A

hindgut innervated by least splanchnic T12 root

so pain felt in non-hair bearing area immediately above pubis

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10
Q

within which abdominal regions does the stomach lie?

A
  • roughly in the epigastric and umbilical
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11
Q

what are the sections of the stomach?

A
  1. cardiac (T11)
  2. fundus (superior)
  3. body
  4. pylorus (antrum,canal,sphincter)
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12
Q

within which part of the stomach is food stored?

A

the fundus

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13
Q

which is the largest section of the stomach?

A

the body

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14
Q

where is HCl, intrinsic factor and pepsiongen secreted?

A

the body of the stomach

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15
Q

which section of the stomach is involved in grinding solid food and mixing it with secretions?

also the widest, most muscular section

A

the (pyloric) antrum

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16
Q

what is the pyloric sphincter?

A
  • At L1
  • ring of thick smooth muscle
  • controls outflow of gastric contents(chyme) into the duodenum.
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17
Q

which side is the lesser and which side is the greater curve of the stomach?

A

lesser: concave, medial (gastro-oesophagus junction to gastro-duodenum junction)
greater: convex, lateral (cardiac notch to pyloric sphincter)

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18
Q

what 2 structures are attached to the lesser curvature of the stomach?

A
  • the lesser omentum

- the hepatogastric ligament

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19
Q

what structure is attached to the greater curvature of the stomach?

A

the greater omentum

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20
Q

what is the vascular supply to the stomach, on the lesser curvature?

A

lesser:

R&L gastric arteries

(from the celiac trunk)

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21
Q

what is the vascular supply to the stomach, on the greater curvature?

A

greater:

R&L gastro-omental arteries

(from the celiac trunk)

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22
Q

what are the 3 main branched of the celiac trunk

A
  • common hepatic
  • left gastric
  • splenic
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23
Q

explain the veins of the stomach

A

R&L gastric veins (drain into hepatic portal vein)

short gastric vein

R&L gastro-omental veins (drain into superior mesenteric vein )

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24
Q

what are the sphincters of the stomach?

A
  1. Inferior Oesophageal Sphincter

2. Pyloric Sphincter

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25
Q

what level is the Inferior Oesophageal Sphincter at?

what is its function?

A

T11

It allows food to pass from the oesophagus, through the cardiac orifice, and into the stomach

(is under involuntary control)

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26
Q

what level is the Inferior Pyloric Sphincter at?

what is its function?

A

It controls (via smooth muscle contractions) the exit ofchymefrom the stomach into the duodenum

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27
Q

what process forces chyme from the pyloric canal into the duodenum?

A

Gastric peristalsis (overcomes the resistance of the pylorus sphincter)

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28
Q

what are the 3 muscular layers of the stomach?

A
  1. outer longitudinal
  2. inner circular
  3. innermost oblique
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29
Q

what is the parasympathetic innervation of the stomach?

ANS

A
  • vagus nerve
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30
Q

what is the sympathetic innervation of the stomach?

ANS

A
  • T6-T9 spinal cord segments
  • coeliac plexus (via the greater splanchnic nerve)
  • some pain transmitting fibres.
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31
Q

describe the lymphatic drainage of the stomach

A

gastric lymphatic vessels -> gastricandgastro-omentallymph nodes -> coeliac lymph nodes

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32
Q

describe the shape and location of the duodenum

A
  • C shaped tube
  • first part of small intestine (from pylorus of stomach to duodenojejunal junction)
  • wraps around the head of pancreas
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33
Q

what are the 4 sections of the duodenum?

A

D1 - superior (the cap)
D2 - descending
D3 - inferior
D4 - ascending

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34
Q

is the duodenum a intraperitoneal or retroperitoneal structure?

A

D1 - intraperitoneal

rest is retroperitoneal

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35
Q

how can you tell the duodenum has become the jejunum?

A

once a mesentery develops

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36
Q

describe the spinal level and pathway of the first part of the duodenum

A

D1 - superior (the cap)

  • at L1
  • ascends from the pylorus
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37
Q

to what organ is the D1 duodenum attached to?

A

the liver

via the hepatoduodenal ligament

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38
Q

describe the spinal level and pathway of the second part of the duodenum

A

D2, descending

  • from L1 to L3
  • curves inferiorly around head of pancreas
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39
Q

is the second part of duodenum anterior or posterior to:

a. the transverse colon
b. the right kidney

A

D2

  • posterior to transverse colon
  • anterior to right kidney
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40
Q

what structure does D2 contain that allows bile and pancreatic secretions in?

A

major duodenal papilla

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41
Q

describe the spinal level and pathway of the third part of the duodenum

A

D3, inferior

  • L3
  • travels laterally to the left
42
Q

is the third part of duodenum anterior or posterior or inferior to:

a. the aorta & IVC
b. the superior mesenteric artery and vein
c. the pancreas

A
  • crosses over the IVC and aorta (anterior)
  • posterior to superior mesenteric artery and vein
  • inferior to pancreas
43
Q

describe the spinal level and pathway of the fourth part of the duodenum

A

D4, ascending

  • L3 to L2
  • curves anteriorly upwards, has a sharp flexure, where it joins the jejunum (duodenojejunal flexure)
44
Q

how is the D4 duodenum adapted to allow the movement of duodenal contents into the jejunum ?

A

has the suspensory muscle of the duodenum

which contracts and widen angle at duodenojejunal flexure

45
Q

which parts of the small intestine are intraperitoneal and which are retroperitoneal

A

intraperitoneal

  • the cap of the duodenum
  • jejunum
  • ileum

retroperitoneal
- rest of duodenum

46
Q

where does jejunum begin?

A

duodenojejunal flexure.

47
Q

where does ileum begin and end?

A
  • no clear external demarcation between the jejunum and ileum
  • ileum ends at the ileocaecal junction
48
Q

what is the ileocecal valve? what is its function ?

A
  • invagination of ileum into the caecum
  • at the ileocaecal junction
  • can prevent reflux of material back into the ileum
49
Q

what are the major duodenal papilla/papilla of vater?

A

point where the dilated junction of the pancreatic duct and the bile duct (ampulla of Vater) enter the duodenum

presence of these marks junction between proximal and distal duodenum

50
Q

what is the arterial supply to duodenum?

A

proximal

  • gastroduodenal artery
  • from coeliac trunk (common hepatic)

distal

  • inferior pancreaticduodenal artery
  • from SMA
51
Q

where does the venous drainage of duodenum drain into?

A

the hepatic portal vein

52
Q

what is the arterial supply to jejunum and ileum?

A

branches from SMA (L1)

53
Q

what are the 3 main branches of the SMA?

A

right colic
ileocolic
middle colic

54
Q

what are arcades?

A
  • in small intestine

- loops formed from the branches of the SMA linking via anastomosis

55
Q

what level does the SMA branch off the aorta?

A

L1

56
Q

describe the veinous drainage of the jejunum and ileum

A
  • drained by superior mesenteric vein

- drains into hepatic portal vein

57
Q

what is the first part of the large intestine? in what section if the abdomen is this found?

A
  • the caecum

- right iliac fossa

58
Q

what is the first part of the large intestine? in what section if the abdomen is this found?

A
  • the caecum

- in right iliac fossa

59
Q

what parts of the large intestine are intraperitoneal and retroperitoneal?

A

intraperitoneal

  • caecum
  • transverse colon
  • signmoid colon

retroperitoneal

  • ascending colon
  • descending colon
  • rectum (not LI)
60
Q

what is the innervation of the caecum?

A

superior mesenteric plexus

61
Q

where is the appendix located?

A
  • at base of caecum
62
Q

what is the role of the colon?

A
  • to receive digested food from theSI
  • from which it absorbs water and electrolytes
  • toformfaeces
63
Q

which parts of the colon are covered by the greater omentum?

A

ascending
transverse
descending

64
Q

where does the ascending colon become the transverse colon?

A

at the 90 degrees right colic (aka.hepatic ) flexure

where the ascending colon meets the right lobe of the liver

65
Q

where does the ascending colon become the transverse colon?

A

at the 90 degrees right colic (aka.hepatic ) flexure

where the ascending colon meets the right lobe of the liver

66
Q

what is the name of the mesentery covering the transverse colon?

A
  • the transverse mesocolon
67
Q

where does the transverse colon become the descending colon?

A
  • at spleen,

- 90 degree turn inferiorly (left colic/splenic flexure)

68
Q

does the transverse colon travel anteriorly or posteriorly to the left kidney?

A
  • is retroperitoneal

- but travels anteriorly over left kidney

69
Q

where does the descending colon become the sigmoid colon?

A
  • as It starts to turn medially
70
Q

in what abdominal section is the sigmoid colon?

A

left iliac fossa

71
Q

which parts of the colon have their own mesenteries?

A

transverse : the transverse mesocolon

sigmoid: the sigmoid mesocolon

allow for mobility

retro or peri?

72
Q

describe the arterial supply for the ascending colon

A

SMA

  • the ileocolic → colic, anterior cecal, posterior cecal (all 3 branches supply ascending)
  • the right colic arteries
73
Q

describe the arterial supply for the transverse colon

A

proximally - SMA

  • right colic
  • middle Colic

distally - IMA
-left colic

74
Q

describe the arterial supply for the descending colon

A

IMA

- left colic

75
Q

describe the arterial supply for the sigmoid colon

A

IMA

-sigmoid arteries

76
Q

which sections of the colon drain into the superior mesenteric vein?

A

the ascending and transverse

(midgut)

then goes into hepatic portal

77
Q

which sections of the colon drain into the inferior mesenteric vein?

A

the descending and sigmoid

(hindgut)

then goes into hepatic portal

78
Q

what are the 2 portions of the peritoneal cavity ?

A

greater sac

lesser sac

79
Q

what are the 2 parts of the greater sac?

A

superacolic compartment
- ABOVE transverse mesocolon

infracolic compartment
- BELOW the transverse mesocolon

80
Q

what does the supra colic compartment contain?

A
  • stomach
  • liver
  • spleen
81
Q

what does the infracolic compartment contain?

A
  • small intestine

- ascending and descending colon

82
Q

where is the lesser sac?

A

ie. omental bursa

posterior to stomach and lesser omentum

83
Q

how are the greater and lesser sac connected?

A

via the epiploic foramen of Winslow

84
Q

where is the epiploic foramen of Winslow ?

A

posterior to free edge of lesser omentum

```
hepatoduodenal ligament
between liver and duodenum
~~~

85
Q

is the peritoneal cavity completely closed?

A

males - yes

females - no (uterine tubes keep it open)

86
Q

what is the double folding of peritoneam between the rectum and bladder in males called?

A

the rectovesical pouch

87
Q

name the double folding of the peritoneum between the rectum and the posterior wall of the uterus (in females)

A

the Rectouterine pouch (of Douglas)

88
Q

name the double folding of peritoneum between the anterior surface of the uterus and the bladder (in females)

A

the Vesicouterine pouch

89
Q

what is the role of the mucous plug?

A

in the external opening of the uterus in females
which prevents the passage of pathogens
but allows sperm to enter the uterus.

90
Q

what are the main differences between the small and large intestine?

A
  1. SI is longer, has a narrower diameter, and is more mobile
  2. SI has villi, circular folds, peyers patches
  3. LI has taeniae coli, haustra, omental appendices
91
Q

what are the omental appendices?

A

pouches of peritoneum

filled with fat

only in large intestine

92
Q

what are the Taenia Coli ?

A
  • smooth muscle of the colom
  • longtiguinal
  • 3 strips that run along outer surface
  • they contract to shorten the bowel
93
Q

what are the haustra?

A

Pouches along the colon caused by taeniae coli being too short

94
Q

what are the crypts of lieberkuhn?

A
  • found in both SI+LI
  • are intestinal glands
  • found in between villi in epithelium
95
Q

what are Paneth cells?

A
  • specialised secretory epithelial cells
  • located in the bases of the crypts of Lieberkühn in the SI only
  • produce antimicrobial peptides
96
Q

what are Peyer’s patchers?

A
  • Aggregations of lymphoid tissue

- in ilium of SI

97
Q

what are the plicae circulares?

A
  • circular folds
  • in SI only
  • increase SA
98
Q

what are the Brunner’s glands ?

A
  • tubular mucus glands

- secrete mucus with an alkaline pH, which serves to neutralize chyme from the stomach.

99
Q

how do you tell the duodenum from the jejunum/ileum?

A
  • only one that contains Brunner’s glands

- broad short villi

100
Q

how do you tell the jejunum and ileum apart?

A

jejunum:
- upper left (Ileum is lower right quadrant)
- thicker intestinal wall
- longer vasa recta
- less arcades
- darker red
- way less Peyers patches

1 GI and liver (6 decks)

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