Anatomy Review

Question 1

What vertebral levels does the esophagus span?

Answer 1

CVI to TXI.

Question 2

At what level does the esophagus pass through the diaphragm?

Answer 2

TX.

Question 3

What four places can the esophagus be compressed?

Answer 3

1) Junction of esophagus and pharynx in the neck
2) Arch of the aorta
3) Left main bronchus
4) Esophageal hiatus in diaphragm

Question 4

Arterial Supply of the Esophagus

Answer 4

Esophageal arteries arising from the aorta, bronchial arteries, left inferior phraneic, and left gastric artery

Question 5

Venous Drainage of Esophagus

Answer 5

Small vessels returning to the azygos vein, hemiazygos vein, and esophageal branches to the left gastric vein.

Question 6

Lymphatic Drainage of the Esophagus

Answer 6

Posterior mediastinal and left gastric nodes

Question 7

Innervation of the Esophagus

Answer 7

Muscle - branchial efferents of vagus nerves
Smooth muscle - parasympathetic efferents from vagus nerves; synapse in myenteric and submucosal plexi
Sensory (visceral) efferents from vagus

Question 8

What do the ventral and dorsal vagal trunks correspond to?

Answer 8

The left and right vagus nerves, respectively.

Question 9

Esophageal Cancer

Answer 9

Tumor location determines where cancer will spread
Spreads quickly to lymphatics, draining to lymph nodes in the neck and around the celiac artery
Dx by barium swallow/endoscopy

Question 10

Esophageal Rupture

Answer 10

Fatal if untreated.
Usually occurs in lower 1/3 with a rise in interluminal pressure caused by vomiting secondary to failure of cricopharyngeal muscle to relax
Tears typically occur on the left and are associated with a large left pleural effusion that contains gastric contents
Tx: surgery

Question 11

Innervation of the Parietal Peritoneum

Answer 11

Somatic afferents of associated spinal nerves; sensitive to well-localized pain

Question 12

Innervation of the Visceral Peritoneum

Answer 12

Visceral afferents that accompany autonomic nerves back to CNS; activation can result in poorly localized, referred pain.

Question 13

Boundaries of the Omental (Epiploic) Foramen

Answer 13

Portal Triad (Hepatic artery, bile duct, portal vein) anteriorly and IVC posteriorly.

Question 14

Effects of Large Surface Area of the Peritoneum

Answer 14

1) Facilitates the spread of disease to bowels

2) Can be used for certain treatments

Question 15

Ventriculoperitoneal Shunts

Answer 15

Used to treat obstructive hydrocephalus (blockage of lateral, 3rd, or 4th ventricles and increased ICP).
Placement of a fine bone catheter through the skull into the ventricles and placing the extracranial part of the tube beneath the scalp and skin of the chest wall and then passing it into the parietal cavity. CSF drains into the parietal cavity, where it can be absorbed.

Question 16

Dialysis

Answer 16

Tx of renal failure

Question 17

Peritoneal Dialysis

Answer 17

Peritoneum is used as a dialysis membrane for fluid and electrolyte exchange.
A small tube is inserted through the abdominal wall and dialysis fluid is injected into the peritoneal cavity. Fluid is drained once dialysis is complete.

Question 18

Peritoneal Spread of Disease

Answer 18

Malignancies and infections can spread throughout the abdomen.
However, intra-abdominal infection tends to remain below the diaphragm.

Question 19

Perforated Bowel

Answer 19

Can lead to release of gas into peritoneal cavity.

Question 20

Greater Omentum

Answer 20

“Policeman of the abdomen” - migrates to any area of inflammation to wall it off. Adheres to diseased organs.
Ovarian carcinoma can spread via the greater omentum.

Question 21

Four Anatomic Divisions of the Stomach

Answer 21

1) Cardia
2) Fundus (above cardiac oriface)
3) Body
4) Pyloris

Question 22

Greater Curvature

Answer 22

Attachment of the gastrosplenic ligament and greater omentum

Question 23

Lesser Curvature

Answer 23

Attachment point of lesser omentum

Question 24

Arterial Supply of the Stomach

Answer 24

Left gastric from celiac trunk
R. gastric from hepatic artery
R. gastro-omental from the gastroduodenal
L. gastro-omental from the splenic
Posterior gastric from the splenic

Question 25

Venous Drainage of the Stomach

Answer 25

R. & L. gastric veins drain the lesser curvature Short gastric veins to the splenic vein drain the fundus and l. greater curvature L. gastro-omental drains the greater curvature

Question 26

Lymphatic Drainage of the Stomach

Answer 26

Celiac nodes

Question 27

Where do most duodenal ulcers occur?

Answer 27

The superior part (duodenal cap)

Question 28

Descending Duodenum

Answer 28

Crossed by the transverse colon R. kidney is posterior to it Contains major duodenal papilla (common entrance of the bile/pancreatic ducts)

Question 29

3rd part of duodenum

Answer 29

Anterior to IVC, aorta, and vertebral column

Question 30

4th Part of Duodenum

Answer 30

Can pass upward on aorta

Question 31

Arterial Supply of Duodenum

Answer 31

Gastroduodenal (From hepatic) Supraduodenal artery from the gastroduodenal duodenal branches from the posterior superior pancreaticoduodenal artery (from gastroduodenal) Duodenal branches from the anterior inferior pancreaticoduodenal (SMA)

Question 32

Important Takehome on Duodenal Blood Supply

Answer 32

DUAL BLOOD SUPPLY from Celiac and SMA; good for surgeries if one needs clamped off.

Question 33

Venous drainage of Duodenum

Answer 33

SMA

Question 34

Lymphatic Drainage Duodenum

Answer 34

Celiac/SM nodes

Question 35

Blood Supply of Jejunum/Ileum

Answer 35

Superior Mesenteric Artery gives off jejunal/ilial branches | Lymph drains here too.

Question 36

Duodenal Ulceration

Answer 36

``` Occur anteriorly (can affect periotneum and show subdiaphragmatic gas) or posteriorly (gastroduodenal or posterior superior pancreaticoduodenal artery). Can be caused by Heliobacter pylori. Tx:H2-receptor antagonists to reduce H+ production; may need surgical intervention ```

Question 37

Meckel's Diverticulum

Answer 37

Remnant of the vitelline duct which extends into the umbilical cord of an embryo. Sx: ulceration and bleeding 2% of the population, 2 inches, 2x more likely in boys, 2 years old, 2 tissue types (Stomach and pancreas).

Question 38

Carcinoma of the Stomach

Answer 38

Chronic gastric inflammation, pernicious anemia, and polyps predispose someone to it. Sx: vague epigastric pain, early fullness with eating, obstruction, bleeding. Dx: barium and radiology or endoscopy; US for spread to liver Tx: surgery

Question 39

Blood Supply to Large Intestine

Answer 39

Ascending and 1st 2/3 of transverse: SMA branches (R. colic, middle colic, ileocolic) Last 1/3 of transverse and descending: IMA (left colic, sigmoid)

Question 40

Lymphatic Drainage of Large Intestine

Answer 40

Ascending and 1st 2/3 of transverse - SMA nodes | Rest - IMA

Question 41

McBurney's Point

Answer 41

Line between ASIS and umbilicus; indicative of appendictis

Question 42

Appendicitis

Answer 42

An abdominal emergency. Occurs when the appendix is obstructed by enlarged lymph nodes; bacteria proliferate and invade the appendix wall. Sx: tenderness in R. groin (pain at McBurney's), fever, nausea, vomiting Tx: appendectomy