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Semester 4: Nutrition and Metabolism > Anatomy Topic 4 Case 4 > Flashcards

Anatomy Topic 4 Case 4 Flashcards

1
Q

How long is the small intestine?

A
  • 6 to 7 m
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2
Q

How long is the duodenum?

A
  • 20 to 25 cm
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3
Q

Is the duodenum retroperitoneal or intraperitoneal?

A
  • Retroperitoneal

- Except for the first part which is connected to the liver by the hepatoduodenal ligament

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4
Q

Identify the four parts of the duodenum

A
  • Superior
  • Descending
  • Inferior
  • Ascending
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5
Q

At what vertebral level is the superior part of the duodenum?

A
  • To the right of L1
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6
Q

The superior part of the duodenum passes anteriorly over which structures?

A
  • Bile duct
  • Gastroduodenal artery
  • Portal vein
  • Inferior vena cava
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7
Q

What is the clinical significance of the superior part of the duodenum?

A
  • Ampulla

- The point of the duodenum at which ulcers are most likely to occur

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8
Q

At what vertebral level does the descending part of the duodenum reach?

A
  • To the right of L3
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9
Q

Identify the structure that passes anterior and the structure that passes posterior to the descending part of the duodenum

A
  • Anterior: Transverse colon

- Posterior: Right kidney

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10
Q

Identify two features of the descending part of the duodenum

A
  • Major duodenal papilla

- Minor duodenal papilla

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11
Q

Identify a structure that passes anterior to the inferior part of the duodenum

A
  • Superior mesenteric artery and vein
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12
Q

At what vertebral level does the ascending part of the duodenum reach?

A
  • To left of L2
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13
Q

What is the duodenojejunal flexure? Identify one feature of it

A
  • Point at which duodenum terminates
  • Surrounded by a fold of peritoneum containing muscle fibres
  • Called the suspensory muscle of duodenum (ligament of Treitz)
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14
Q

Outline the arterial supply to the duodenum

A
  • Gastroduodenal artery (from common hepatic artery)
  • Supraduodenal artery (from gastroduodenal artery)
  • Anterior + posterior superior pancreaticoduodenal arteries (from gastroduodenal artery)
  • Anterior + posterior inferior pancreaticoduodenal arteries (from inferior pancreaticoduodenal artery from superior mesenteric artery)
  • First jejunal branch of superior mesenteric artery
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15
Q

Describe the venous drainage of the duodenum

A
  • Superior pancreaticoduodenal veins drain into portal vein

- Inferior pancreaticoduodenal veins drain into superior mesenteric vein

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16
Q

Describe the lymphatic drainage of the duodenum

A
  • Drains upward via pancreaticoduodenal nodes to gastroduodenal nodes into coeliac nodes
  • Drains downward via pancreaticoduodenal nodes to superior mesenteric nodes
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17
Q

Outline the innervation of the duodenum

A
  • Sympathetic and parasympathetic innervation from coeliac and superior mesenteric plexuses
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18
Q

Describe features of the jejunum

A
  • Proximal 2/5
  • In left upper quadrant
  • Fewer arterial arcades
  • Longer vasa recta
  • Less mesenteric fat
  • More prominent plicae circulares
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19
Q

Describe features of the ileum

A
  • Distal 3/5
  • In lower right quadrant
  • More arterial arcades
  • Shorter vasa recta
  • More mesenteric fat
  • Less prominent plicae circulares
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20
Q

Identify the arterial supply of the jejunum and ileum

A
  • Jejunal and ileal branches of superior mesenteric artery

- Ileum also supplied by ileal branch of ileocolic artery

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21
Q

With regards to Meckel’s diverticulum identify its:

  • Pathology
  • Epidemiology
  • Clinical features
  • Treatment
A
  • Remnant of the yolk sac that lies on the antimesenteric border of the ileum
  • 2% of patients
  • Haemorrhage, diverticulitis, ulceration, obstruction
  • Surgical removal laparoscopically
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22
Q

Describe the features of the mucosa of the duodenum

A
  • Long villi interspersed with crypts of Lieberkuhn

- Brunner’s glands open into muscularis mucosae

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23
Q

Describe the features of the mucosa of the ileum

A
  • Transverse folds (plicae circulares) covered with short villi
  • Peyer’s patches
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24
Q

How does the distribution of plicae circulares change through the small intestine

A
  • Most prominent in jejunum and proximal ileum

- Absent in proximal duodenum and distal ileum

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25
Q

What type of epithelium lines the crypts of Lieberkuhn?

A
  • Simple columnar epithelium
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26
Q

Identify 5 cell types that line the crypts of Lieberkuhn and their function

A
  • Enterocytes: Absorption
  • Goblet cells: Mucus production
  • Paneth cells: Defensive function (eosinophilic granules
  • Neuroendocrine cells: Motility (hormones)
  • Stem cells: Replenish all of the above cells
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27
Q

Identify two features of enterocytes that protect the small intestine from auto-digestion

A
  • Goblet-cell derived mucus

- Glycocalyx

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28
Q

What is responsible for absorption of pancreatic enzymes from small intestine?

A
  • Glycocalyx
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29
Q

Where are lacteals located and what is their role?

A
  • Run through centre of villi
  • Drain tiny lymphatic vessels
  • Transport absorbed lipid into circulatory system via lymphatic duct
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30
Q

Describe two additional protective mechanisms of the small intestine

A
  • T lymphocytes are scattered among enterocytes

- Plasma cells secrete IgA

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31
Q

How long is the large intestine?

A
  • 1.5 m
32
Q

Identify four characteristics of the large intestine

A
  • Larger diameter than small intestine
  • Peritoneal-covered accumulations of fat (omental appendices)
  • Segregation of longitudinal muscle into three narrow bands (taeniae coli)
  • Sacculations known as haustrations
33
Q

In which abdominal region is the cecum located?

A
  • Right iliac fossa
34
Q

Is the cecum intraperitoneal or retroperitoneal?

A
  • Intraperitoneal

- Because of its mobility not because of its suspension by mesentery

35
Q

What is the appendix?

A
  • Narrow, hollow, blind-ended tube connected to the cecum
36
Q

Identify two functions of the mesoappendix

A
  • Suspends appendix form terminal ileum

- Contains appendicular vessels

37
Q

Identify four possible locations of the appendix

A
  • Retrocecal
  • Retrocolic
  • Subcecal
  • Preileal
  • Postileal
38
Q

Identify the surface projection of the appendix

A
  • One third the distance from the ASIL to the umbilicus
39
Q

Identify the arterial supply to the cecum and appendix

A
  • Anterior cecal artery
  • Posterior cecal artery
  • Appendicular artery
  • All of which are from the ileocolic artery
  • A branch of the superior mesenteric artery
40
Q

Identify the pathology of appendicitis

A
  • Obstruction from fecalith or enlargement of lymphoid nodules
  • Causing proliferation of bacteria
  • Resulting in invasion of appendix wall, which becomes damaged by pressure necrosis
41
Q

Outline the clinical features of appendicitis

A
  • Periumbilical pain that becomes localised to right iliac fossa
  • Associated with fever, vomiting and nausea
42
Q

Outline the investigation and treatment of appendicitis

A
  • Ultrasound scan

- Appendectomy

43
Q

Identify the parts of the colon

A
  • Ascending colon
  • Hepatic flexure
  • Transverse colon
  • Splenic flexure
  • Descending colon
  • Sigmoid colon
44
Q

What are the paracolic gutters?

A
  • Formed between lateral margins of ascending and descending colon and posterolateral abdominal wall
  • Through which material can pass through peritoneal cavity
  • Which is free of vessels and lymphatics allowing for mobilisation of the ascending and descending colons
45
Q

To which vertebral level does the sigmoid colon descend to?

A
  • S3
46
Q

Identify the arterial supply to the ascending colon

A
  • Colic branch from ileocolic artery
  • Anterior cecal artery
  • Posterior cecal artery
  • Right colic artery
  • All of which arise from the superior mesenteric artery
47
Q

Identify the arterial supply to the transverse colon

A
  • Right colic artery (SMA)
  • Middle colic artery (MSA)
  • Left colic artery (IMA)
48
Q

Identify the arterial supply to the descending colon

A
  • Left colic artery

- From inferior mesenteric artery

49
Q

Identify the arterial supply to the sigmoidal colon

A
  • Sigmoid arteries

- From inferior mesenteric artery

50
Q

How is the perineal flexure (anorectal junction) formeD?

A
  • By action of the puborectalis muscle

- So the anal canal moves in a posterior direction as it passes through the pelvic floor

51
Q

Identify the three lateral curvatures of the

A
  • Upper and lower curvatures on the right

- Middle curvature on the left

52
Q

What is the rectal ampulla?

A
  • Expanded lower part of the rectum
53
Q

What are anal columns / columns of Morgagni?

A
  • Longitudinally oriented folds

- Which are united inferiorly by crescentic folds termed anal valves

54
Q

What is the pectinate line?

A
  • Circle formed around the anal canal by the anal valves

- Marks position of the anal membrane in the foetus

55
Q

What is the anal pecten?

A
  • Transition line lined by non-keratinised stratified squamous epithelium.
  • Ending inferiorly as the anocutaneous line (white line)
56
Q

Outline the arterial supply to the rectum and anus

A
  • Superior rectal artery (from inferior mesenteric artery)
  • Middle rectal artery (from internal iliac artery)
  • Inferior rectal artery (from internal pudendal artery from internal iliac artery)
57
Q

What is the arterial supply to the hindgut?

A
  • Inferior mesenteric artery
58
Q

At which vertebral level does the inferior mesenteric artery arise?

A
  • L3
59
Q

Identify the branches of the inferior mesenteric artery

A
  • Left colic artery
  • Sigmoid arteries
  • Superior rectal artery
60
Q

Identify the part of the vascular supply of the hindgut that is vulnerable to ischaemia

A
  • Watershed area between superior mesenteric and inferior mesenteric artery at splenic flexure
61
Q

Which structures are drained by the inferior mesenteric vein?

A
  • Rectum
  • Sigmoid colon
  • Descending colon
  • Splenic flexure
62
Q

Outline the course of the inferior mesenteric vein

A
  • Beings as superior rectal vein
  • Which receives tributaries from sigmoid veins and left colic vein
  • It passes posterior to body of pancreas
  • To join splenic vein (though it can join superior mesenteric vein)
63
Q

What are Peyer’s patches?

A
  • Lymphoid tissue

- Found in the mucosa of the ileum and ileocecal junction

64
Q

Identify the two cell types of the colon and their arrangement

A
  • Absorptive and goblet cells
  • Arranged in closely packed straight tubular glands
  • Which extend down to muscularis mucosae
65
Q

What fills the space between the glands of the large intestine?

A
  • Lamina propria

- Containing blood vessels into which water is absorbed

66
Q

Outline the defence mechanisms of the colon

A
  • Lamina propria contains collagen, lymphocytes (lymphoid aggregates) and plasma cells
67
Q

How does the mucosa of the rectum differ to that of the rest of the colon?

A
  • Contains more goblet cells
68
Q

Identify the epithelial transitions through the rectum and anus

A
  • Columnar (colon and rectum) to stratified squamous epithelia from the anorectal junction
69
Q

Identify the two haemorrhoidal plexuses of the anus

A
  • Internal plexus in the submucosa above the pectinate line

- External plexus in the submucosa between the anal canal and perianal skin

70
Q

Which artery supplies the midgut?

A
  • Superior mesenteric artery
71
Q

At which vertebral level is the superior mesenteric artery located?

A
  • Lower part of L1
72
Q

What crosses the anterior surface of the superior mesenteric artery?

A
  • Splenic vein

- Neck of pancreas

73
Q

What crosses the posterior surface of the superior mesenteric artery?

A
  • Left renal vein
  • Uncinate process
  • Inferior part of duodenum
74
Q

Identify the branches of the superior mesenteric artery

A
  • Inferior pancreaticoduodenal artery
  • Jejunal arteries
  • Ileal arteries
  • Ileocolic artery
  • Right colic artery
  • Middle colic artery
75
Q

What do the jejunal and ileal arteries pass through?

A
  • Mesentery

- Forming arcades as they pass outward to supply the small intestine

76
Q

What does the middle colic artery pass through?

A
  • Transverse mesocolon where it divides into left and right branches

Semester 4: Nutrition and Metabolism (17 decks)

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