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The Gastrointestinal System > Anatomy - Theory > Flashcards

Anatomy - Theory Flashcards

1
Q

What is the term given to the muscles involved in chewing?

A

Muscles of mastication

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2
Q

Which cranial nerve innervates the muscles of mastication?

A

Trigeminal nerve (CN V)

(CN V3 - only the third division is motor and innervates these muscles)

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3
Q

What are the 4 pairs of muscles involved in chewing and what is the role (opening/closing) of each?

A

Masseter - closing

Temporalis - closing

Medial pterygoid - closing

Lateral pterygoid - opening

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4
Q

Where are the attachement sites for the temporalis muscle?

A

Coronoid process of the mandible to the temporal fossa

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5
Q

Where are the attachment sites for the masseter?

A

Angle of the mandible to the zygomatic arch

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6
Q

What are the attachment sites of the lateral pterygoid?

A

Pterygoid plates of the sphenoid bone to the cartilagenous articular disc at the temporal mandibular joint

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7
Q

What are the attachment sites of the medial pterygoid?

A

Angle of the mandible to pterygoid plates of the sphenoid bone

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8
Q

Where does the trigeminal nerve originate and why is this unique?

A

The pons

It is the only cranial nerve to be associated with the pons

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9
Q

Where do the two sensory divisions of the trigeminal nerve travel to after division?

A

Eyes and maxillary region

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10
Q

The 3rd division of the trigeminal nerve heads where?

A

This is the mandibular division and heads straight down out of the cranium

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11
Q

Where does the mandibular division of the trigeminal nerve exit the skull?

A

Foramen ovale

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12
Q

The posterior 1/3rd of the tongue is within the oropharynx so is therefore innervated by which cranial nerve?

A

Glossopharyngeal

CN IX

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13
Q

At which point does the anterior 2/3rd of the tongue begin and what is the name given to the tip of this region?

A

Terminal sulcus

Tip - foramen caecum

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14
Q

Which cranial nerve confers taste to the tongue?

A

Facial nerve

(CN VII)

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15
Q

Which cranial nerve confers general sensation to the tongue?

A

Mandibular division of the trigeminal nerve

(CN V3)

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16
Q

What is the only form of papillae that confers general sensation?

A

Filiform

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17
Q

Where does the facial nerve depart from the CNS?

A

The lateral aspect of the junction between the pons and medulla

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18
Q

The facial nerve exits the cranium via which foramen?

A

Internal acousic meatus, then exits via stylomastoid foramen

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19
Q

What is the name of the branch of the facial nerve that innervates the tongue and provides the sensation of taste?

A

Chorda tympani

(named as it passed through the typanic cavity)

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20
Q

How does the chorda tympani reach the tongue?

A

It exits the middle ear and travels with the lingual nerve to enter the tongue

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21
Q

The superior half of the oral cavity has general sensation due to which cranial nerve?

A

CN V2

(Trigeminal nerve)

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22
Q

The inferior half of the oral cavity has its general sensation due to innervation by which cranial nerve?

A

Trigeminal

(CN V3)

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23
Q

The sensory compinent for a gag reflex is conferred by which cranial nerve?

A

Glossopharyngeal

CN IX

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24
Q

The motor component of the gag reflex is controlled by which cranial nerve(s)?

A

Glosspharyngeal CN IX

Vagus CN X

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25
Q

How does CN V2 exit the cranium?

A

The foramen rotundum in the sphenoid bone

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26
Q

Which modalities does CN V2 confer?

A

Only sensory

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27
Q

Where does the glosspharyngeal nerve exit the CNS?

A

The medulla

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28
Q

How does the glosspharyngeal nerve exit the cranium?

A

Jugular foramen

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29
Q

After exiting the cranial cavity, what path does the glosspharngeal nerve take next?

A

It passes down the back of the neck

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30
Q

What does the glossopharngeal nerve innervate?

A
  • Tongue (posterior 1/3rd)
  • Palate
  • Nasopharynx
  • Posterior wall of oropharynx
  • Parasympathetics to paratid salivary glands

etc.

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31
Q

Which cranial nerve innervates the parotid gland?

A

Glossopharyngeal

CN IX

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32
Q

Which cranial nerve innervates the submandibular glands?

A

Facial nerve

CN VII

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33
Q

Where do the submandibular glands secrete salviva into the mouth?

A

Lingual caruncle

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34
Q

Which cranial nerve innervates the subligual glands?

A

Facial nerve

CN VII

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35
Q

What are the four extrinsic muscles of the tongue?

A
  • Genioglossus
  • Hypoglossus
  • Palatoglossus
  • Styloglossus
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36
Q

The extrinsic muscles of the tongue are all innervated by which cranial nerve, and what is the one exception?

A

Hypoglossal nerve

CN XII

(this nerve is exclusively motor)

Palatoglossus - innervated by the vagus nerve (CN X)

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37
Q

The hypoglossal nerves come off the CNS at which point?

A

Medulla

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38
Q

How does the hypoglossal nerve exit the cranial cavity?

A

Hypoglossal foramen

(in anterior wall of foramen magnum)

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39
Q

After exiting the cranial cavity via the hypoglossal foramen, which path does the hypoglossal nerve take next?

A

It descends in the neck lateral to the carotid sheath

At the level of the hyoid bone it will move anteriorly to the lateral aspect of the tongue to supply the musculature

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40
Q

What are the two muscular components of the pharynx?

A
  1. Circular
  2. Longitudinal
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41
Q

What are the three constrictor muscles in the pharynx?

A
  1. Superior
  2. Middle
  3. Inferior
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42
Q

What is the “proper” name for the upper oesophageal sphincter and where eactly is it located?

A

Cricopharyngeus

At the level of the cricoid cartilage

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43
Q

Which cranial nerve innervates all of the muscles of the pharynx?

A

Vagus nerve

CN X

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44
Q

Longitudinal muscles of the pharynx serve what purpose?

A

Pull up the pharynx

(utilised in swallowing)

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45
Q

Describe the process of swallowing

A
  1. Tongue pushes food towards oropharynx - CN XII
  2. Soft palate and larynx elevate - CN IX and CN X
  3. Circular layer of pharyngeal constrictor muscles contract - CN X
  4. The bolus of food enters the oesophagus
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46
Q

At which vertebral level does the oesophagus commence?

A

T6

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47
Q

Laterally to the oesophagus at each side, which cranial nerve will be found?

A

Vagus nerve

CN X

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48
Q

The oesophageal plexus contains which types of nerves?

A

Parasympathetic - can influence smooth muscles in oesophageal wall

Sympathetic - from splanchnic nerves which can influence the enteric nervous system to speed up or slow down peristalisis

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49
Q

The lower oesophageal sphincter is a physiological sphincter

True or false?

A

True

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50
Q

There is a change in the mucosa between the oesophagus and stomach - what is the division line between them called?

A

Z-line

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51
Q

Why may the stomach sag in a lean person?

A

Lack of supportive fat tissue

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52
Q

In which region does the stomach lie?

A

Left hypochondrium

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53
Q

What are rugae?

A

Folds within the stomach that allow for expansion

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54
Q

What is the entrance area of the stomach called?

A

Cardia

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55
Q

What is stored in the pyloric antrum?

A

Chyme

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56
Q

What is the name given to the angle of the lesser curvature of the stomach?

A

Incisura angularis

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57
Q

The small intestine is made up of which three section?

A
  1. Duodenum
  2. Jejunum
  3. Ileum

(DJ Ileum)

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58
Q

What is the caecum?

A

A pouch connecting the small and large intestines

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59
Q

The foregut contains which organs?

A
  • Oesophagus to mid-duodenum
  • Liver and gallbladder
  • Spleen
  • 1/2 of pancreas
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60
Q

The midgut contains which organs?

A
  • Mid-duodenum to proximal 2/3rd of transverse colon
  • 1/2 of pancrease
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61
Q

The hindgut conatins which organs?

A

Distal 1/3 or transverse colon to proximal 1/2 of anal canal

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62
Q

What is abdominal “guarding”?

A

When the abdomnial muscles contract to protect the internal organs after injury or infection

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63
Q

What is the peritoneum and where is it located?

A

It is a thin, transparent, semi-permeable serous membrane

It lines the walls of the abdominopelvic cavity and organs

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64
Q

The peritoneal cavity if formed from what?

A

Visceral and serous peritoneum

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65
Q

Where is the only opening in the human anatomy in the peritoneum?

A

Ovaries

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66
Q

Organs can be classed based on their relationship with the peritoneum. What are these classifications?

A
  • Intraperitoneal
  • Retroperitoneal
  • With a mesentery
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67
Q

What is the mesentery of the small intestine called?

A

Mesentery proper

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68
Q

What is a mesentery?

A

A double layer of peritoneum with a core of blood and lymph vessels

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69
Q

Aside from the mesentery proper, what other mesenteries can be found?

A
  • Transverse and sigmoid mesocolon
  • Mesoappendix
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70
Q

What is the greater omentum?

A

A four layered structure that attaches to the greater curvature of the stomach and hangs down to the transverse colon

It has a role in preventign spread of infection

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71
Q

What is the lesser omentum?

A

A doube layer of peritoneum that extends down from the liver to the lesser curvature of the stomach and the first part of the duodenum

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72
Q

The connection the lesser omentum makes with the liver and lesser curvature of the stomach is called what?

A

Hepatogastric ligament

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73
Q

The connection the lesser omentum makes with the liver and first part of the duodeum is called what?

A

Hepatoduodenal ligament

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74
Q

What is the foramen of Winslow?

A

This is the free edge of the lesser omentum which provides a passage between greater and lesser sacs

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75
Q

In the free edge which structures lie?

A

The portal triad containing:

  • Proper hepatic artery
  • Hepatic portal vein
  • Common bile duct
  • Lymphatic vessels
  • Branch of the vagus nerve
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76
Q

Which ligament joins the stomach and the spleen?

A

Gastrosplenic ligament

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77
Q

Which ligament joins the spleen and kidney?

A

Splenorenal ligament

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78
Q

The peritoneum can drape over the superior aspects of the pelvic organs creating pouches.

What are these pouches in males and females?

A

Males:

  • Rectovesicle pouch

Females:

  • Vesicouterine pouch
  • Rectouterine pouch (pouch of Douglas)
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79
Q

What is acities?

A

Collection of fluid in the peritoneal cavity

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80
Q

What may cause acities?

A
  • Liver cirrhosis
  • Portal hypertension
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81
Q

What is an abdominocentesis?

A

A drainage process for acities

A needle is inserted laterally to the rectus sheath - avoids epigastric artery

Ultrasound guidance may be utilised

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82
Q

Sympathetic nerve fibres for the adrenal gland typically leave the spinal cord at which vertebral level?

A

T10/11

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83
Q

Where is pain felt for the flooing areas:

  1. Foregut
  2. Midgut
  3. Hindgut
A
  1. Epigastric
  2. Umbilical
  3. Pubic
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84
Q

Visceral afferents from:

  • Foregut
  • Midgut
  • Hindut

Enter the spinal cord at which vertebral levels?

A
  1. T6-9
  2. T8-12
  3. T10-L2
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85
Q

Where is the appendix usually located?

A

Right iliac fossa

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86
Q

Where is pain initially felt for apendicitis and why will it move?

A

Initially - umbilical region

Over time the appendix irritates the parietal peritoneum in the right iliac fossa and this is part of the body wall

Pain will now change from dull and aching to sharp and stabbing

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87
Q

What is a laparotomy?

A

A single midline verticle incision used for gastrointestinal and obstetrics surgies.

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88
Q

What does an increase in the blood levels of bilirubin lead to?

A

Yellowing of the sclera (whites of eyes) and skin

This is called jaundice

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89
Q

Where does bilirubin come from?

A

It is a normal breakdown product of red blood cells which ocurs mainly in the spleen

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90
Q

Why is bilirubin required for the body?

A

For the formation of bile

91
Q

Which organ can store bile and therefore regulate the released concentration?

A

Gallbladder

92
Q

In which quadrant is the liver housed?

A

Right upper quadrant

(protected by ribs 7-11)

93
Q

What are the four lobes of the liver?

A
  1. Left
  2. Right
  3. Quadrate
  4. Caudate
94
Q

What is the name of the entrance for portal triad structures in the liver?

A

Porta hepatis

95
Q

Within the potal triad, which three structures are contained?

A
  1. Hepatic portal vein
  2. Hepatic artery proper
  3. Common hepatic bile duct
96
Q

How many functional lobes exist within the liver?

A

8

(there are only 4 anatomical lobes)

97
Q

Each segment in the liver has its own what?

A
  1. Branch of hepatic artery
  2. Brach of hepatic portal vein
  3. Bile drainage to bile duct
  4. Venous drainage to vena cava
98
Q

Why is central venous pressure directed at the liver?

A

The inferior vena cava and hepatic veins lack valves

99
Q

The hepatoduodenal ligament houses which structures?

A

The portal triad

  1. Hepatic artery proper
  2. Hepatic portal vein
  3. Common hepatic bile duct
100
Q

The lesser omentum is joined by which two ligaments?

A
  1. Hepatoduodenal ligament
  2. Hepatogastric ligament
101
Q

Which is the first of the three midline branches off from the aorta?

A

Coeliac trunk

102
Q

At which vertebral level does the coeliac trunk leave the aorta?

A

T12

103
Q

Which artery is reponsible for supplying the foregut organs?

A

The coeliac trunk

104
Q

Which branches doe the coeliac trunk divide?

A
  • Splenic artery
  • Common hepatic artery
  • Left gastric artery
105
Q

Which quadrant is the spleen located?

A

Left hypochondrium

(protected by ribs 9-11)

106
Q

Which arteries supply the stomach at the lesser curvature?

A

Right and left gastric arteries (anastomose together)

107
Q

Where does the posterior gastric artery originate?

A

Splenic artery

108
Q

Which arteries supply the stomach at the greater curvature?

A

Right and left gastro-omental arteries (anastomose together)

109
Q

What is the arterial blood supply to the liver and where do these vessels originate?

A

Right and left hepatic arteries

(Comes from common hepatic artery…

…which comes from coeliac trunk)

110
Q

Most of the blood in the liver comes from which vessel?

A

Hepatic portal vein

111
Q

What is the dual blood supply of the liver?

A
  1. Hepatic arteries (left and right)
  2. Hepatic portal vein
112
Q

The peritoneal cavity is related to the liver in which two ways?

A
  1. Hepatorenal recess (Morison’s pouch)
  2. Sub-phrenic recess
113
Q

What is the term given to fluid build-up in the peritoneum?

A

Ascities

114
Q

The hepatic portal vein is formed from which veins?

A
  • Splenic vein
  • Superior mesenteric vein

(the inferior mesenteric vein firstly drains into the splenic vein)

115
Q

Which duct allows for bile to flow in and out of the gallbladder?

A

Cystic duct

116
Q

What is the blood supply to the gallbladder and what is this a branch of?

A

Cystic artery

(branch of right hepatic artery in most people)

117
Q

Where will pain be felt if the gallbladder is the site of injury, and why will pain be felt there?

A

Epigastric region

Visceral afferents enter the vertebral level at T6-9

(pain may be felt in the hypochondrium and it can also radiate to the shoulder)

118
Q

What is the term given to surgical removal of the gallbladder?

A

Cholecystectomy

119
Q

Which part of the duodenum (1, 2, 3 or 4) does the biliary tree enter?

A

2

120
Q

What is formed when the right and left hepatic ducts come together?

A

Common hepatic duct

121
Q

When the common hepatic duct joins with the cystic duct, what duct is formed?

A

Bile duct

122
Q

What are the four parts of the duodenum?

A
  1. Superior
  2. Descending
  3. Horizontal
  4. Ascending
123
Q

Which sphincter muscle signifies the start of the duodenum?

A

Pyloric sphincter

124
Q

Which peptide hormones are released in the duodenum?

A
  • CCK
  • Gastrin
125
Q

Pain from the duodenum presents in which region?

A

Epigastric

126
Q

The pancreas is an intraperitoneal organ.

True or false?

A

False

It is a retroperitoneal organ

127
Q

What are the four parts of the pancreas?

A
  1. Head (and uncinate process)
  2. Neck
  3. Body
  4. Tail
128
Q

The pancreas has two main functions, describe each

A
  1. Endocrine function - blood system - islets of Langerhans - isulin and glucagnon
  2. Exocrine function - duct system - acinar cells - pancreatic digestive enzymes into main pancreatic duct
129
Q

What is the name of the joint between the main pancreatic duct and the the bile duct?

A

Ampulla of Vater

(Hepatopancreatic ampulla)

130
Q

What is the point entry for the Ampulla of Vater into the duodenum called?

A

Major duodenal papilla

131
Q

If there is a minor duodenal papilla, what is this due to?

A

Entry of accessory pancreatic ducts

132
Q

What controls the flow of bile in the biliary system?

A

Sphincter muscles

  • Bile duct sphincter
  • Panceatic duct sphincter
  • Sphincter of Oddi - major duodenal papilla
    *
133
Q

What is ERCP?

A

Endoscopic Retrograde Cholangiopancreatography

The endoscope enters through the oral cavity, into the stomach and duodenum

It is sued to study the pancreas and biliary tree

A camera can even be instered into the major duodenal papilla

134
Q

What may be the cause of jaundice in relation to the biliary tree?

A
  • Obstruction in the biliary tree (gallstones, carcinoma)
  • Physiological jaundice in newborn infants
135
Q

By which other name is jaundice known?

A

Icterus

136
Q

Where does the blood supply for the pancreas originate?

A

Coeliac trunk

Superior mesenteric artery

137
Q

Which two vessels anastomose when supplying the pancreas?

A

Coeliac trunk and SMA

The superior pancreaticoduodenal artery comes from the coeliac trunk and the inferior pancreaticoduodenal artery comes from the SMA - it is these vessels which anastomose directly

Both vessels split into anterior and posterior portions to sandwich the pancreas

138
Q

How does the splenic artery contribute to pancreatic blood supply?

A

Dorsal pancreatic arteries supply the pancreas

These are branches from the splenic artery

139
Q

Where will pancreatic pain be felt?

A

Epigastric region

(potentially umbilical region)

Pain can radiate to the back

140
Q

Blockage of the ampulla of Vater by a gallstone will result in what?

A

Bile will be diverted to the pancreas

This can cause acute pancreatitis as bile reflux and pancreatic juice enters into the main pancreatic duct

141
Q

In severe cases of pancreatitis what can occur and what signs can show this?

A

Vascular haemorrhage

Blood travels into the retroperitoneal space and manifests at the two signs below

142
Q

Which parts of the duodenum are foregut?

A

1 and 2

143
Q

Where does the jejunum begin?

A

Duodenaljejunal flexure

144
Q

Where does the ilieum end?

A

Ileocaecal junction

145
Q

How does the jejunum differ from the ileum in terms of colour?

A

Jejunum - deep red

Ileum - lighter pink

146
Q

How does the jejunum differ from the ileum in terms of their walls?

A

Jejunum - thicker and heavier

Ileum - thinner and lighter

147
Q

How does the jejunum differ from the ileum in terms of vascularity?

A

Jejunum - more vascular

Ileum - less vascular

148
Q

How does the jejunum differ from the ileum in terms of the amount of mesenteric fat?

A

Jejunum - less mesenteric fat

Ileum - more mesenteric fat

149
Q

How does the jejunum differ from the ileum in terms of the circular folds in the lumen?

A

Jejunum - large, tall and closely packed folds

Ileum - low and sparse folds which becoem absent distally

150
Q

How does the jejunum differ from the ileum in terms of lymphoid tissue?

A

Jejunum - Peyer’s patches present

Ileum - Peyer’s patches not present

151
Q

How does the jejunum differ from the ileum in terms of absorptive function?

A

Jejunum - most absorptive function

Ileum - less absorptive function

152
Q

What is the blood supply to the jejunum and ileum?

A

Superior mesentic artery

(Via jejunal and ileal arteries)

153
Q

What is the venous drainage from the jejunum and ileum?

A

Jejunal/ileal veins to superior mesenteric vein

154
Q

What is the name given to the loops of arteries around the jejunum and ileum?

A

Arterial arcades

(intermesenteric arterial anastomoses or Riolan arcades)

155
Q

At which vertebral level does the superior mesenteric artery leave the aorta?

A

L1

156
Q

Describe the path of the superior mesenteric artery

A

It travels posterior to the neck of the pancreas, and anterior to the uncinate process of the pancreas

It can then enter the mesentery proper

157
Q

What is a lacteal?

A

A specialised lymph vessel in the small intestine to pick up chylomicrons

158
Q

What are the main lymph nodes associated with the abdomen?

A
  • Celiac - forgut
  • Superior mesenteric - midgut
  • Inferior mesenteric - hindgut
  • Lumbar - kidneys, posterior abdomen wall, pelvis and lower limbs
159
Q

The left venous angle is associate with lymphatic drainage from the ___________ _____

A

Thoracic duct

160
Q

The right venous angle is associated with lymphatic drainage from the _______ ___________ ________

A

Right lymphatic duct

161
Q

What are the three main functions of the large intestine?

A
  1. Defence - commensal bacteria
  2. Absorption - H2O and electrolytes
  3. Excretion - of formed stool
162
Q

The caecum is retroperitoneal

True or false?

A

False

The caecum is intraperitoneal

163
Q

What are paracolic gutters and where do they lie?

A

They form part of the greater sac of the peritoneal cavity

They lie between the lateral edge of the ascending and descending colon and the abdoninal wall

164
Q

What are the small fatty deposits on the wall of the colon called?

A

Omental appendices

165
Q

The three longitudinal muscle bands on the large intestine have what collective name?

A

Teniae coli

166
Q

What is the name of the individual pouches that make up the colon and how are they formed?

A

Haustra

Formed due to contraction of the teniae coli

167
Q

Where do the caecum and appendix lie?

A

Right iliac fossa

168
Q

Where is the most common location for the appendix?

A

Retrocaecal

(there are many variations for its location)

169
Q

What is the point at which the appendix joins the caecum?

A

Appendiceal orifice

170
Q

How is the ileocaecal valve distinguishable within the caecum?

A

It is invaginated within the caecum giving a lipped appearance on the inside

171
Q

Which surface anatomy point corresponds to the location of the appendiceal orifice?

A

McBurney’s point

172
Q

How is McBurney’s point found?

A

It is 2/3rd of the way from the umbilicus to the anterior superior iliac spine

173
Q

Where does the sigmoid colon lie?

A

Left iliac fossa

174
Q

The sigmoid colon has a mesentery which can potentially cause what?

A

A sigmoid volvulus

This is twisting of the sigmoid colon causing bowel onstruction and potentially infarction

175
Q

What are the three midline branches of the abdominal aorta?

A
  1. Coeliac artery
  2. Superior mesenteric artery
  3. Inferior mesenteric artery
176
Q

What are the lateral branches of the abdominal aorta?

A
  • Renal arteries
  • Gonadal arteries
  • Lumbar arteries
177
Q

Which vessels doe the abdominal aorta bifurcate to create?

A

Common iliac arteries

(which bifurcate further to produce the internal and external iliac arteries)

178
Q

Name the branches of the superior mesenteric arteries and the areas they provide

A
  1. Inferior pancreaticoduodenal artery - pancreas and duodenum
  2. Middle colic artery - transverse colon
  3. Right colic artery - ascending colon
  4. Ileocolic artery
  5. Jejunal and ileal arteries
179
Q

How does the structure of the blood vessel supply to the jejunum and ileum differ?

A
  • The jejunum has longer vasa rectae and larger and fewer arcades
  • The ileum has shorter vasa rectae and many arcades
180
Q

The inferior mesenteric artery is given of at which vertebral level?

A

L3

181
Q

Which branches does the inferior mesenteric artery give off?

A
  • Left colic artery
  • Sigmoidal artery - supplies sigmoid colon
  • Superior rectal artery
182
Q

What is the name of the anastomosis formed between the SMA and IMA branches?

A

The marginal artery of Drummond

183
Q

Why is the marginal artery of Drummond useful?

A

In the case of blockage, it provides many alternative routes for blood to take preventing ischaemia

184
Q

The hindgut extends to which anatomical line?

A

Pectinate line

185
Q

If the ther superior rectal artery supplies down to the pectinate line, which vessel(s) suupply the area below the pectinate line?

A

Middle and inferior rectal arteries

(these are branches of the internal iliac artery)

186
Q

Where are the 3 main portal-systemic anastomosis

A
  1. Oesophagus (distal end)
  2. Skin around umbilicus
  3. Rectum/anal canal
187
Q

What allows for the anastomosis between portal and systemic circulations?

A

Small collateral vessels that can flow in both directions due to the absence of valves

188
Q

Describe the venous drainage of the rectum

A

Above pectinate line:

Superior rectal vein to IMV

Below pectinate line:

Middle and inferior rectal veins to internal iliac vein

189
Q

Why can the portal-systemic anastomoses become varicosed?

A

Portal hypertension

190
Q

What is the term given to the dilation of para-umbilical and epigastric veins called?

A

Caput medusa

191
Q

Haematemesis occurs as a result of what?

A

Peptic or duodenal ulcers that erode through the mucosa causing the stomach to fill with blood

(varices may also cause this due to their thin walls)

192
Q

The pelvic cavity lies between which two things?

A

Pelvic inlet and pelvic floor

193
Q

Which muscle helps form the pelvic floor?

A

Levator ani muscle

194
Q

At which vertebral level does the sigmoid colon become the rectum?

A

S3

195
Q

What is the rectal ampulla?

A

Dilated section of the rectum immediately superior to the levator ani muscle and anal canal

196
Q

What is the purpose of the rectal ampulla?

A

Its walls can relax to hold faeces

Sphincter muscles can hold faeces here until it is appropriate to defecate

197
Q

Which folds does the rectum have?

A
  • Superior
  • Middle
  • Inferior
198
Q

Which muscles make up the levator ani?

A
  1. Iliococcygeus
  2. Pubococcygeus
  3. Puborectalis
199
Q

Why are pelvic organs continually supported?

A

The muscles of the levator ani continually support the pelvic organs due to tonic contraction

200
Q

Which nerve innervates the levator ani muscle?

A

Nerve to levator ani

This is a branch of the sacral plexus combines with the pudendal nerve (S2, 3 and 4)

201
Q

Which type of muscle is the levator ani composed of?

A

Skeletal muscle

202
Q

What role does the puborectalis have?

A

It maintains continence by looping round the anal canal creating a kink and decreasing the anal angle

203
Q

How mnay anal sphincters exist?

A

2

  • Internal
  • External
204
Q

The pectinate line is an embrylogical remnant of what?

A

Where the endoderm and ectoderm came together

205
Q

What stimulates contraction/relaxation of the internal anal sphincter?

A

The autonomic nervous system

206
Q

Contraction of the external anal sphincter is conferred by which nerve?

A

Pudendal

207
Q

How does the nerve supply vary between the pelvic cavity and perineum?

A

Pelvic cavity - within a body cavity - ANS, visceral afferent

Perineum - within body wall - somatic motor and sensory

208
Q

Where does sympathetic thoracolumbar outflow come from (for rectum/anal canal), and what influence does it have?

A

T12-L2

Travels to inferio mesenteri ganglia, then via periarterial plexuses around the branches of the IMA

It allows for the contraction of the internal anal sphincter and inhibition of peristalsis

209
Q

Where does parasympthic sacral outflow come from (for rectum/anal canal), and what influence does it have?

A

S2-S4

Nerves synapse in the walls of the rectum

It allows for the inhibition of the internal anal sphincter and allows for the stimulaion of peristalsis

210
Q

Where do visceral afferents travel to from (for rectum/anal canal), and what influence does it have?

A

S2-S4

They run with parasympathetics

They allow for sensation of stretch, ischaemia etc to be transmitted

211
Q

Where do somatic motor nerve come from (for rectum/anal canal), and what influence does it have?

A

Pudendal nerve (S2-S4) and nerve to levator ani (S3 and S4)

It allows for the contraction of the external anal sphincter and puborectalis

212
Q

How does the pudendal nerve enter the pelvis?

A

Via the greater sciatic foramen

213
Q

How does the pudendal nerve enter the perineum?

A

Via the lesser sciatic foramen

214
Q

During childbirth, which two structures are most likely to be damaged?

A
  • Pudendal nerve
  • Puborectalis
215
Q

How does arterial supply differ above the pectinate line and below it?

A

Above - IMA

Below - Internal iliac artery

216
Q

How does venous drainage differ above the pectinate line and below it?

A

Above - IMV (then to portal system)

Below - Internal iliac vein (then to systemic system)

217
Q

How does lymphatic drainage differ above the pectinate line and below it?

A

Above - Inferior mesenteric nodes

Below - Superficial inguinal nodes

218
Q

What are the main groups of lymph nodes in the pelvis?

A

Internal iliac - inferior pelvic structures

External iliac - lower limb and more superior pelvic structures

Common iliac - drains external and internal iliac nodes to lumbar nodes

219
Q

Describe the difference between rectal varices and haemorrhoids

A

Rectal varices - form due to portal hypertension - they are the dilaatation of collateral veins between the portal and systemic systems

Haemorrhoids - prolapses of rectal venous plexuses

220
Q

What causes haemorrhoids?

A

Raised intra-abdominal pressure

e.g. chronic consipation, pregancy etc

221
Q

Which type of haemorrhoids, internal or external, are more painful and why?

A

External

They have somatic innervation

222
Q

What is an ischioanal fossa?

A

A fat filled space with loose connective tissue that allows for expansion during defecation, it also provides protection for nerves

223
Q

What is most important during a digital rectal examination

A
  • To assess anal tone
  • Palpate prostate - should not feel
  • Palpate cervix - should not feel
224
Q

What is a proctoscopy?

A

A technique to view the interior of the rectum using an endoscope

The Gastrointestinal System (27 decks)

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