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Phase 1 - Anatomy > Anatomy - The Small and Large Bowels > Flashcards

Anatomy - The Small and Large Bowels Flashcards

1
Q

What are the 3 divisions of the small intestine called?

A
  1. Duodenum. 2. Jejunum. 3. Ileum.
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2
Q

What is the principle function of the small intestine?

A

Digestion and absorption of food.

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3
Q

What are the folds of mucosa inside the small intestine called?

A

Plicae circulares.

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4
Q

What are Peyer’s patches?

A

Large, sub-mucosal, lymph nodules.

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5
Q

Where in the small intestine would you find Peyer’s patches?

A

Ileum.

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6
Q

Is the duodenum intraperitoneal or retroperitoneal?

A

Retroperitoneal.

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7
Q

The first part of the duodenum is prone to peptic ulceration. What artery can this affect?

A

The gastro-duodenal artery. This artery lies in direct contact with the posterior wall of the first part of the duodenum.

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8
Q

Would you describe the jejunum and ileum as intraperitoneal or retroperitoneal?

A

Intraperitoneal.

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9
Q

What part(s) of the small intestine can become twisted? This results in strangulation and ischaemia.

A

Jejunum and ileum.

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10
Q

Which has a thicker intestinal wall, the jejunum or the ileum?

A

Jejunum.

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11
Q

Describe 5 characteristics of the Jejunum.

A
  1. Thick intestinal walls. 2. Longer vasa recta. 3. Less arterial arcades. 4. Pronounced plicae circulares. 5. Red in colour.
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12
Q

Describe 5 characteristics of the Ileum.

A
  1. Thin intestinal walls. 2. Shorter vasa recta. 3. More arterial arcades. 4. Peyer’s patches. 5. Pink in colour.
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13
Q

Where might you find Meckel’s diverticulum?

A

1 meter from the termination of the ileum.

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14
Q

What is Meckel’s diverticulum an embryonic remnant of?

A

The attachment of the mid-gut to the yolk sac.

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15
Q

Where does the mid-gut begin and end?

A

3rd part of duodenum to 2/3 along the transverse colon.

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16
Q

What is the blood supply to the midgut?

A

Superior mesenteric artery (L1).

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17
Q

What is the first branch of the SMA?

A

Inferior pancreaticoduodenal artery?

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18
Q

Name 3 major branches of the SMA.

A
  1. Ileo-colic. 2. Right colic. 3. Middle colic.
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19
Q

What does the right colic artery supply?

A

The ascending colon.

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20
Q

What does the middle colic artery supply?

A

The transverse colon.

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21
Q

Into which vein does blood from the jejunum and ileum drain and what is the final destination of the blood?

A

Drains into the superior mesenteric vein. This vein combines with the splenic vein to form the hepatic portal vein which then goes on to the liver.

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22
Q

Which foodstuffs are absorbed through the lymphatic system?

A

Fats.

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23
Q

What is the innervation of the small intestine?

A

Sympathetic: Lesser splanchnic (T10-11). Parasympathetic: Vagus. No somatic innervation.

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24
Q

Name 4 mechanisms that ensure a high surface area for absorption of nutrients in the intestine.

A
  1. Pliae circularis. 2. Coiled length. 3. Villi. 4. Microvilli.
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25
Q

What is the main function of the large intestine?

A

Water absorption and the formation of faeces.

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26
Q

State whether the caecum is intraperitoneal or retroperitoneal and describe the blood supply and venous drainage.

A
  • Intraperitoneal. - Ileocolic artery. - Ileocolic vein; drains into superior mesenteric vein.
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27
Q

State whether the ascending colon is intraperitoneal or retroperitoneal and describe the blood supply and venous drainage.

A
  • Retroperitoneal. - Ileocolic and right colic arteries. - Ileocolic and right colic veins.
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28
Q

State whether the transverse colon is intraperitoneal or retroperitoneal and describe the blood supply and venous drainage.

A
  • Intraperitoneal. - Middle colic artery. - Superior mesenteric vein.
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29
Q

State whether the descending colon is intraperitoneal or retroperitoneal and describe the blood supply and venous drainage.

A
  • Retroperitoneal. - Left colic and superior sigmoid arteries. - Inferior mesenteric vein.
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30
Q

State whether the sigmoid colon is intraperitoneal or retroperitoneal and describe the blood supply and venous drainage.

A
  • Intraperitoneal. - Sigmoid arteries. - Inferior mesenteric vein.
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31
Q

What is the marginal artery of Drummond?

A

An artery that forms important anastomosis between SMA and IMA. It extends the length of the colon.

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32
Q

What vertebral level is the inferior mesenteric artery found at?

A

L3.

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33
Q

Name 3 characteristic features of the large intestine that allow it to be distinguished from other abdominal organs.

A
  1. Haustrations. 2. Tenia coli. 3. Appendices epiploicae.
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34
Q

What are appendices epiploicae?

A

Small pouches of peritoneum filled with fat. They mark where blood vessels enter the bowel to supply the mucosa.

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35
Q

What are tenia coli?

A

3 strips of longitudinally running muscle on the outer surface of the large intestine.

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36
Q

What are haustrations?

A

Sacculations produced from where the tenia coli contract to shorten the wall of the bowel.

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37
Q

Where does the hind gut begin and end?

A

Distal 1/3 of the transverse colon to the anal canal.

38
Q

What is the innervation of the hind gut?

A

Sympathetic: least splanchnic nerve (T12). Parasympathetic: S2-4. No somatic innervation.

39
Q

What artery normally supplies the descending colon?

A

The left colic artery.

40
Q

What is the importance of the marginal artery of Drummond?

A

If there is an occlusion to the IMA, blood can still be supplied to the large intestine via the SMA through this artery.

41
Q

Give 4 locations where the distal end of the appendix may lie.

A
  1. In the pouch of Douglas. 2. Behind the caecum. 3. Behind the umbilicus. 4. Below the liver.
42
Q

Name the intraperitoneal parts of the large intestine.

A

Caecum, transverse colon, sigmoid colon.

43
Q

Describe the anatomy of the duodenum?

A
  • most proximal portion of the small intestines
  • runs from the pylorus of the stomach to the duodenojejunal junction
  • Can be divided into four parts: superior, descending, inferior, and Ascending
  • forms a C shape, 25cm, wraps around the head of the pancreas
44
Q

Describe the superior section of the duodenum?

A
  • known as the cap
  • Ascends upwards from the pylorus of the stomach
  • Connected to the liver by the hepato-duodenal ligament
  • Most common site of duodenal ulceration
  • initial 3cm is covered by the visceral peritoneum, and the remainder is retroperitoneal
45
Q

Describe the descending section of the duodenum?

A
  • curves inferiorly around the head of the pancreas
  • lies posterior lead to the transverse colon and interiorly to the right kidney
  • internally marked by the major duodenal papilla - where bile and pancreatic secretions enter the ampulla of Vater
46
Q

Describe the inferior section of the duodenum?

A
  • travels laterally to the left, crossing over the inferior vena cava and aorta
  • located inferiorly to the pancreas and posteriorly to the superior mesenteric artery and vein
47
Q

Describe the ascending section of the duodenum?

A
  • after crossing the aorta, it ascends and curves anteriorly
  • joins jejunum at sharp turn known as the duodenojejunal flexure
48
Q

How does the duodenojejunal junction work?

A
  • the suspensory muscle of the duodenum contracts
  • widens the angle of the flexure
  • Leads movement of the intestinal contents into the jejunum
49
Q

How are the jejunum and ileum Related to the posterior abdominal wall?

A
  • intraperitoneal
  • attached to the posterior abdominal wall by mesentery ( double layer peritoneum)
50
Q

Describe the anatomy of the jejunum and ileum?

A
  • jejunum begins at the duodenojejunal flexure
  • there is no clear external demarcation between them, but they are microscopically different
  • The ileum ends at the ileocecal junction
51
Q

Describe the ileocecal junction’s anatomy?

A
  • The ileum invaginates into the caecum To form the ileocecal valve
  • it can only prevent reflux material back into the ileum
52
Q

What are the five things that you are able to distinguish between the jejunum and ileum during surgery?

A
  • jejunum located in the upper left quadrant, ileum Located in the lower right quadrant
  • jejunum has thick intestinal walls, ileum has thinner intestinal wall
  • jejunum has longer Vasa recta, ileum has shorter Vasa recta
  • jejunum has less arcades (Arterial loops), has more arcades
  • jejunum is red in colour, ileum is pink in colour
53
Q

What are the two arterial sources that supply the duodenum?

A
  • Proximal to the major duodenal papilla - gastroduodenal Artery ( branch of the common hepatic artery from the coeliac trunk)
  • Distal to the major duodenal papilla - inferior pancreaticoduodenal artery (branch of the superior mesenteric artery)
  • Marks a change of foregut to the midgut
54
Q

Where the veins of the duodenum drain into?

A

hepatic portal vein

55
Q

Where does the lymphatic drainage of the duodenal drain in to?

A

pancreatoduodenal and superior mesenteric nodes

56
Q

Describes the arterial supply to the jejunum and ileum?

A
  • superior mesenteric artery
  • arises from the aorta at L1, immediately inferior to the coeliac trunk
  • splits into 20 branches, forming loops called arcades
    • long straight arteries arise called vasa recta
57
Q

Where does the venous drainage of the jejunum and ileum drain into?

A
  • via the superior mesenteric vein
  • unites with the splenic vein at the neck of the pancreas to form the hepatic portal vein
58
Q

Where does the lymphatic drainage of the jejunum and ileum drain into?

A

superior mesenteric nodes

59
Q

Describe the major duodenal papillae?

A
  • nipple shaped lump on the inside of the duodenum, where the common bile duct and pancreatic duct open
  • between the second and third parts of the duodenum
  • marks the end of the Foregut and the start of the midgut
60
Q

Describe the ampulla of Vater?

A
  • Small channel formed inside the major duodenal papilla
  • where the common bile duct and pancreatic duct merge, just before they release their juices into the duodenum
61
Q

Describe the sphincter of Oddi?

A
  • controls the release of bile and pancreatic juices from the ampulla of Vater into the duodenum
62
Q

Describe plicae circularis? Where are they most pronounced?

A
  • Internal folds of the mucosa, increase the surface area
  • also known as valavulae conniventes
  • Most pronounced in the jejunum
63
Q

Name the large submucosal lymph nodes found in the ileum?

A

Peyer’s patches

64
Q

What is Meckel’s diverticulum?

A
  • blind-ended diverticulum about 1m from ilium termination
  • Embryonic remnant of the attachment of the midgut loop to the yolk sac
65
Q

Where is there more fat deposited in the mesentery?

A
  • Increasing amounts towards ilium end
66
Q

What 4 anatomical features ensure the small bowel has a high surface area for absorption of nutrients?

A

Length, mucosal folds (plicae circularis), villi and micro-villi

67
Q

Name and describe the first part of the colon?

A
  • Ascending colon
  • the retroperitoneal structure which ascends superiorly from the cecum
  • Turns the right colic flexure (or hepatic flexure) the right lobe of the liver
    • marks the start of the transverse colon
68
Q

Name and describe the second part of the colon?

A
  • the transverse colon
  • extends from the right colic flexure to the spleen
  • turns 90° to point inferiorly, known as the left colic flexure (or splenic flexure)
  • Least fixed part of the colon, variable in position
69
Q

How is the transverse colon attached to the diaphragm?

A

phrenicocolic ligament

70
Q

How does the transverse colon differ from the ascending and descending colon in terms of it’s positioning?

A

It is intraperitoneal and is enclosed by the transverse mesocolon

71
Q

Describe the descending colon?

A
  • moves inferiorly towards pelvis
  • retroperitoneal, but is located anteriorly to the left kidney passing over its lateral border
  • when it turns medially it becomes a sigmoid colon
72
Q

Describe the location of the sigmoid colon?

A
  • located in the lower left quadrant of the abdomen
  • extending from the left iliac fossa to the level of the S3 vertebrae
73
Q

How does the sigmoid colon attach the posterior pelvic wall?

A
  • via the sigmoid mesentery
  • The long length of the mesentery allows it to be particularly mobile
74
Q

What are the Paracolic gutters?

A
  • Two spaces between the ascending and descending colon and the postero-lateral abdominal wall
  • Allow material that is been released from inflamed or infected abdominal organs to accumulate elsewhere in the abdomen
75
Q

What are omental appendices?

A

small pouches of peritoneum filled with fat

76
Q

What are the teniae coli? name them? What do they cause?

A
  • Muscles longitudinally running along the surface of the colon
  • mesocolic, free and omental coli
  • produces sacculations called haustra
  • Play a role in peristalsis
  • broadened out to form a continuous layer at the recto sigmoid junction
77
Q

What part of the colon is part of the midgut and what is its arterial supply?

A
  • ascending colon, and proximal two-thirds of the transverse colon
  • supplied by the superior mesenteric artery
    • 3 branches called the ileocolic, middle and right colic artery
78
Q

What part of the colon is part of the hindgut and what is its arterial supply?

A
  • Distal one third of the transverse colon, descending colon and sigmoid colon
  • supplied by a single branch of the inferior mesenteric artery - the left colic artery and superior rectal arteries
  • sigmoid colon receives arterial supply via the sigmoid arteries
79
Q

Describe the venous drainage of the Midgut and hindgut?

A
  • midgut - superior mesentery vein
  • hindgut - inferior mesentery vein, drains into the splenic vein
  • both empty into the hepatic portal vein, allows toxins to be absorbed from the colon to be processed by the liver for detoxification
80
Q

How is the midgut innervated?

A

Sympathetic, parasympathetic and censoring supply via nerves from the superior mesenteric plexus

81
Q

How is the hindgut innervated?

A
  • Sympathetic, parasympathetic and sensory supply via the inferior mesenteric plexus (Sacral nerves 2,4,5)
    • parasympathetic via pelvic splanchnic nerves
    • sympathetic via the lumbar splanchnic nerves
82
Q

How is the Lymphatics of the midgut drained?

A
  • into the superior mesenteric nodes
  • passes into the intestinal lymph trunks, and into the cisterna chyli and thoracic duct
83
Q

How is the lymphatics of the hindgut drained?

A
  • inferior mesenteric nodes
  • passes into the intestinal lymph trunks, and into the cisterna chyli
84
Q

What protrudes from the external wall of the caecum inferiorly?

A

the appendix

85
Q

What is the mesorectum?

A

perirectal fat that surrounds the rectum

86
Q

What are the 3 major branches of the Coeliac trunk?

A

The left gastric, the splenic and the common hepatic.

87
Q

What does the left gastric artery supply?

A

The lesser curvature of the stomach and lower oesophagus.

88
Q

What branches does the splenic artery give off?

A
  • The short gastric arteries. - The pancreatic arteries. - The left gastroepiploic artery. - 5 branches just before it reaches the Spleen.
89
Q

What do the short gastric arteries supply?

A

The greater curvature of the stomach.

90
Q

What does the left gastroepiploic artery supply? What does anastomose with?

A

It supplies the greater curvature of the stomach. It anastomoses with the right gastroepiploic artery.

91
Q

Name the 2 branches of the common hepatic artery.

A
  1. Proper hepatic artery. 2. Gastroduodenal artery.
92
Q

What is the appendicular artery a branch of?

A

The ileocolic artery (branch of SMA).

Phase 1 - Anatomy (29 decks)

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