Anatomy wk 2 Flashcards
How long is the oesophagus + where does it begin and end
25cm
From pharynx to stomach
Name the 3 areas where there are constrictions in the oesophagus
Cervical
Thoracic
Diaphragmatic
What is the vertebral level of the oesophageal opening in the diaphragm
T10
Name 4 things that traverse the oesophageal opening in the diaphragm
Oesophagus
Vagus nerve
Oesophageal arteries
Lymphatic vessels
Blood supply of the abdominal part of the oesophagus
Branches of left gastric artery
Venous drainage of the abdominal part of the oesophagus
Left gastric vein
Lymphatic drainage of the abdominal part of the oesophagus
Left gastric lymph nodes
The lower end of the oesophagus is a site of portosystemic anastamosis, therefore in portal hypertension, what condition can you get at this site
Oesophageal varices
Major symptom of oesophageal varices
Haematamesis
How many orifices, curvatures and surfaces does the stomach have
2 - cardiac orifice + pyloric orifice
2 - greater + lesser
2 - anterior + posterior
What orifice connects the oesophagus and stomach
Cardiac
What orifice connects the stomach and duodenum
Pyloric
What is the most superior part of the stomach called
Fundus
What is the pyloric sphincter
Smooth muscle controlling gastric connects entering duodenum
Pyloric sphincter is formed from the thickening of which histological layer of the gut tube
Circular layer of muscularis externa
What are the gastric folds (rug) formed from
Folded mucosa and submucosa
7 structures forming the stomach bed (below + behind stomach)
Left dome of diaphragm Left kidney Spleen Pancreas Left adrenal gland Colon Mesocolon
Name the artery coming off the aorta at T12 and the 3 branches it gives not long after branching off the aorta, that goes on to supply the stomach
Coeliac trunk
Common hepatic artery
Left gastric artery
Splenic artery
Name 4 arterial branches that supply the stomach
Right gastric artery
Left gastric artery
Left gastro-omental artery (branch of splenic artery)
Right gastro-omental artery (branch of gastroduodenal artery which is branch of common hepatic a)
Venous drainage of the stomach (name the 5 veins and where they drain into each)
Right and left gastric veins –> hepatic portal v
Right and left gastro-omental veins –> superior mesenteric v
Short gastric vein –> superior mesenteric v
What group of lymph nodes does the stomach drain into
Coeliac lymph node
Gastric carcinoma usually occurs along which curvature of the stomach
Greater
What cranial nerve innervates the stomach and controls gastric motility
CN X
Increased vagal stimulation of the stomach causes what 2 things
Relaxes pyloric sphincter to allow more gastric contents into duodenum
Increases gastric secretion (HCl)
Where does the small intestine begin and end
Pylorus of stomach to ileocaecal junction
Which part of the small intestine receives the opening of the common bile and pancreatic duct + the specific name of the area that the ducts enter and the sphincter controlling this area
2nd part of duodenum
Enters at the major duodenal papilla controlled by the sphincter of oddi
Foregut/midgut boundary
Proximal half of duodenum
Describe how the duodenum is peritonised (2)
1st part intraperitoneal
2nd - 4th part retroperitoneal
Which part of is shortest and widest
Duodenum
Describe the jejunum in terms of: Colour Wall Vascularity Vasa recta Arcades Fat in mesentery Circular folds
Deep red Thick + heavy Greater vascularity than ileum Long vasa recta Few large loops Little fat in mesentery compared to ileum Large, tall and closely packed
Describe the ileum in terms of: Colour Wall Vascularity Vasa recta Arterial arcades (loops) Fat in mesentery Circular folds
Pale pink
Thin + light
Less vascularity than jejunum
Short vasa recta
Many short loops
More fat in mesentery compared to jejunum
Small, short + sparse folds; absent in distal ileum
Which organ sits in the curve of the duodenum and capable of compressing the common bile and pancreatic duct if there’s a tumour of this organ
Pancreas (specifically the head)
3 features that distinguish large intestine from small
Omental appendices (yellow fatty tissue)
Haustra
Teniae coli
How is the caecum peritonised
Intraperitoneal
How is the ascending colon peritonised
Retroperitoneal
How is the descending colon peritonised
Retroperitoneal
How is the transverse colon peritonised
Intraperitoneal
How is the sigmoid colon peritonised
Intraperitoneal
Midgut/hindgut boundary
Hindgut begins distal 1/3rd transverse colon
What abdominal region is the caecum and appendix in
Right iliac
What 2 structures open into the cavity of the caecum
Appendix
Ileum
Normal position of appendix
Retrocaecal
What is the McBurney’s point (clinical definition and anatomical definition)
Point of max tenderness in appendicitis
Point of right side of abdomen that’s 1/3 of the way from the anterior superior iliac spine to the umbilicus
3 parts of the rectum
Superior 1/3
Middle 1/3
Inferior 1/3
Arterial supply of superior 1/3 rectum
Arterial supply of middle 1/3 rectum
Arterial supply of inferior 1/3 rectum
Superior rectal artery (branch of IMA)
Middle rectal artery (branch of internal iliac a)
Inferior rectal artery (branch of internal iliac a)
What is the superior rectal artery a branch of
IMA
What is the middle and inferior rectal artery a branch of
Internal iliac a
Venous drainage of the
- superior 1/3 rectum
- middle 1/3 rectum
- inferior 1/3 rectum
Superior rectal vein
Middle rectal vein
Inferior rectal vein
How is the rectum peritonised:
Retroperitoneal
What 2 other things are involved in faecal continence apart from pelvic floor muscles
External and internal anal sphincter
What is the purpose of both somatic and visceral (autonomic) innervation to the anal canal
Somatic motor innervation of the external anal sphincter
Autonomic innervation for the smooth muscle of the anal canal
Arterial supply of proximal duodenum (1st and 2nd part)
Coeliac artery/trunk
Venous drainage of duodenum
Portal system (–> portal vein –> hepatic veins –> IVC)
Lymphatic drainage of duodenum
Coeliac group of lymph nodes
Arterial supply of distal duodenum (3rd and 4th part)
Superior mesenteric artery
Arterial supply of jejunum and ileum
Superior mesenteric artery
Venous drainage of jejunum and ileum
Portal system
Lymphatic drainage of jejunum and ileum
Superior mesenteric group lymph nodes
Arterial supply of caecum
Superior mesenteric artery
Venous drainage of caecum
Portal system
Lymphatic drainage of caecum
Superior mesenteric group lymph nodes
Arterial supply of ascending colon
Superior mesenteric artery
Venous drainage of ascending colon
Portal system
Lymphatic drainage of ascending colon
Superior mesenteric group lymph nodes
Arterial supply of proximal 2/3 transverse colon
Superior mesenteric artery
Venous drainage of proximal 2/3 transverse colon
Portal system
Lymphatic drainage of proximal 2/3 transverse colon
Superior mesenteric group lymph nodes
Arterial supply of distal 1/3 transverse colon
Inferior mesenteric artery
Venous drainage of distal 1/3 transverse colon
Portal system (vein corresponds to artery so in this case inferior mesenteric vein –> portal vein –> hepatic vein –> IVC)
Lymphatic drainage of distal 1/3 transverse colon
Inferior mesenteric group lymph nodes
Arterial supply of sigmoid colon
Inferior mesenteric a
Venous drainage of sigmoid colon
Portal system
Lymphatic drainage of sigmoid colon
Inferior mesenteric lymph nodes
Lymphatic drainage of majority of rectum
Inferior mesenteric group lymph nodes
Lymphatic drainage of lower rectum
Internal iliac lymph nodes
Superior rectal vein drains into what system vs middle/inferior rectal veins drain into what system
Superior rectal v –> portal system
Middle/inferior –> systemic venous system (IVC)
Nerve supply of the rectum (3 fibre types)
ALL AUTONOMIC:
Sympathetic - lumbar splanchnic nerves, Superior and inferior hypogastric plexuses
Parasympathetic - pelvic splanchnic nerves (S2-S4)
Visceral sensory - follows the parasympathetic supply
Nerve supply of the anal canal (2 types)
Autonomic - inferior hypogastric plexus
Somatic motor - inferior rectal nerves
What is the falciform ligament
Separates right and left lobe of liver and joins the liver to the anterior abdominal wall
What lies within the free border of the falciform ligament
Round ligament of liver
What is the round ligament of the liver an embryological remnant of
Left umbilical vein
What is an omentum (omenta)
Double fold of peritoneum connecting the stomach with other abdominal organs or the body wall
What is a mesentery
Double fold of continuous peritoneum that attaches your intestines (and other abdominal organs) to the posterior abdo wall
What is a ligament in terms of abdominal cavity
Double layers of peritoneum which span between organs and organs or body wall
How many layers of peritoneum present in greater omentum
4
What are the paracolic gutters
Spaces between the surface of the colon and posterolateral abdo wall
Clinical significance of paracolic gutters
Passage for infectious fluids that leak in the abdomen
List 3 abdominal structures which lie in the free edge of a mesentery
Jejunum
Ileum
Transverse colon
What 2 layers of muscle are present in the muscularis externa
Circular and longitudinal
Which third of the oesophagus has skeletal muscle and what muscle type are the other two thirds made of
Upper 1/3 skeletal
Other 2/3 are smooth muscle
What epithelium lines oesophagus
Stratified squamous
What type of muscle is the musclaris mucosae in the mucosal layer
Smooth
What are the large folds called present inside the stomach wall
Rugae
What 3 cell types are in the gastric pits
Mucus neck
Parietal
Chief
What are the large folds called extending into the lumen of the small intestine
Villi
What are superimposed on each villi of the small intestine
Microvilli
What type of epithelium lines the small intestine
Simple columnar
What 2 parts of the GI tract do you find glands in the submucosa as well as the lamina propria
Oesophagus and duodenum
What secretory cells are found the small intestine
Goblet - secrete mucous
Where do you find Peyer’s patches the most
Ileum
What is the predominant cell present in the surface epithelium of the colon
Goblet cells
What is the epithelium transition from rectum to anal canal
Simple columnar –> stratified squamous in anal canal
What is the transpyloric plane
Transverse line halfway between jugular notch and pubic symphysis at L1 level
What vertebral level and costal cartilage level is the transpyloric plane
L1
8th costal cartilage
List 6 structures present in the transpyloric plane
Pylorus of stomach 1st part of duodenum Hilum of kidneys Neck of pancreas 8/9th costal cartilage Gallbladder
What costal cartilage level is the gallbladder
9th
Name 6 imaging procedures used to investigate GI diseases
Barium study Endoscopy CT MRI USS XR
What organ is a barium meal used for
What organ is a barium swallow used for
Stomach
Oesophagus
Name the 4 types of barium studies
Barium swallow
Barium meal
Barium follow through
Barium enema
What organ is a barium follow through used for
SI
What organ is a barium enema used for
LI
Kidneys vertebral level range
T12 - L3
Name 5 accessory organs of the GI tract
Liver
Gallbladder
Kidneys
SpleenPANCREAS
How is the spleen peritonised
Intraperitoneal
Does the spleen move with respiration + what other abdo organ moves with respiration
Yes
Liver
Name 3 structures present in the hilum of the spleen
Splenic artery
Splenic vein
Lymphatic vessels and nerves
The tail of which organ is closely related to the hilum of the spleen
Pancreas
4 functions of the spleen
Storage/production of RBCs
Blood filtration
Storage of WBCs
Phagocytosis
What type of gland is the pancreas
BOTH exocrine + endocrine
What does the exocrine part of the pancreas do + what does the endocrine pancreas do
Secrete digestive enzymes
Secrete hormones
4 components of the pancreas
Head
Neck
Body
Tail
How is the pancreas peritonised
Retroperitoneal
Which vein is posterior to the neck of the pancreas
Portal v
What quadrant is the liver in
RUQ
How many lobes does the liver have + name them + which is the biggest
Right - biggest
Left
Caudate
Quadrate
What ligament connects the liver to the undersurface of the diaphragm
Coronary ligament
Which lobe of the liver has the bare area + what is it
Right
Area not covered by peritoneum, directly contacts diaphragm
What is the porta hepatis
Area of the liver where structures enter and leave
Name 3 structures in the porta hepatis
Hepatic artery
Portal vein
Bile duct
What ligament is wrapped around the 3 structures in the porta hepatis
Hepatoduodenal ligament
Extrahepatic biliary apparatus consists of what 5 things
L & R hepatic ducts Common hepatic duct Gallbladder Cystic duct Common bile duct
Common bile duct is formed by the union of what 2 ducts
Cystic and common hepatic
What organ produces bile + what stores bile
Liver
Gallbladder
Where does bile enter the gut tube
Major duodenal papilla in the 2nd part of duodenum
Bile function
Emulsify fats
What do the common bile duct and the main pancreatic duct join to form
Hepatopancreatic duct
What is biliary obstruction + potential causes
When passage of bile into duodenum is partially or completely blocked
Gallstones
Cancer of head of pancreas
What is calot’s triangle
Triangular space formed by cystic duct, common hepatic duct and inferior surface of liver
3 histological features of pancreas
Islets of langerhans - clumps of poorly stained cells
Pure serious acini - large strongly stained cells
Small lobules surrounded by connective tissue septa
How to differentiate between exocrine and endocrine pancreas on histology
Endocrine pancreas will have small clumps of lightly stained cells (islets of langerhans)
Exocrine pancreas more strongly stained because they secrete enzymes which are protein which is strongly stained
2 histological features of liver
Cells arranged in sheets and converging towards the centre (central vein in centre)
At the corners of a lobule, connective tissue encloses the vessels of the portal triad
Spleen is covered by what
Dense fibromuscular capsule formed of collagen and elastic fibres
What is the parenchyma of the spleen called
Pulp
What is the red pulp of the spleen
Made up of sinusoids (large wide capillaries filled with blood) where most blood filtration occurs
What is the white pulp of the spleen
Made up of plasma cells and lymphocytes
Surface anatomy position of gallbladder
9th costal cartilage
Surface anatomy position of the spleen
9th - 11th ribs
Which abdominal plane crosses the pancreas + which part of the pancreas does it pass through
Transpyloric
Neck of pancreas
What imaging modality can be used to view the arteries coming off the abdominal aorta
Abdominal arteriography
What nerve is secretomotor to stomach
Vagus
What parts of the GI tract are goblet cells found more in
Distal ileum + LI
Does LI have villi
No
What vein drains the liver
Hepatic vein
NOT PORTAL - PORTAL V IS ACTUALLY A BLOOD SUPPLY OF LIVER