APE 11: The GI System and the Abdomen

Question 1

What are the 3 different salivary glands?

Answer 1

Submadibular, parotid and sublingual

Question 2

Where is the submandibular gland found?

Answer 2

Under the body of the mandible, floor of the mouth

Question 3

Where is its orifice found?

Answer 3

Under the tongue, in the floor of the mouth

Question 4

Where is the parotid gland found?

Answer 4

Between the ramus of the mandible and the external ear

Question 5

Which muscle is anterior to the parotid gland?

Answer 5

The masseter muscle

Question 6

What is formed at the superior base of the parotid gland?

Answer 6

The external acoustic meatus

Question 7

How is the parotid gland related to the facial nerve?

Answer 7

The parotid gland is the origin of the extracranial part of the facial nerve

Question 8

What is the clinical importance of the relationship between the parotid gland and the facial nerve?

Answer 8

During parotid gland surgery- facial nerve innervate muscles of facial expression so it could be damaged

Question 9

How does the parotid duct run?

Answer 9

It runs anteriorly from the parotid gland to pierce the buccinator muscle

Question 10

Where does the parotid gland enter the mouth?

Answer 10

Adjacent to the crown of the second upper molar tooth

Question 11

Where is the sublingual gland found?

Answer 11

Under the tongue

Question 12

What is the position of the sublingual gland with respect to the submandibular duct?

Answer 12

It is immediately lateral to the submandibular duct

Question 13

Where are the hard and soft palates found?

Answer 13

Both at the roof of the mouth

Hard= more anterior than the soft

Question 14

What are the three papillae found on the tongue and which part?

Answer 14

Fungiform and filiform, on the anterior 2/3 of the tongue

Circumvalate, form a V shape posteriorly

Question 15

What is the purpose of papillae?

Answer 15

They increase the surface area of contact between the surface of the tongue and the contents of the oral cavity

Question 16

What are the boundaries of the nasopharynx?

Answer 16

Posterior to the posterior apertures of the nasal cavity, above level of soft palate

Question 17

What are the boundaries of the oropharynx?

Answer 17

Posterior to oral cavity, inferior to the level of the soft palate and superior to the upper margin of the epiglottis

Question 18

What are the boundaries of the laryngopharynx?

Answer 18

Extends from superior margin of epiglottis to top of oesophagus at C1

Question 19

What is found distally to the epiglottis?

Answer 19

Larynx

Question 20

What must you not do in suspected cases of epiglottitis?

Answer 20

Not attempt to examine child’s throat, not place anything in their mouth, not lay them on their back

Question 21

At which vertebral level does the oesophagus begin?

Answer 21

C6

Question 22

The fibres of which nerve runs to the right and left of the oesophagus?

Answer 22

Vagus nerve initially runs on the right and left, as it passes through the diaphragm:
Left= anteriorly
Right= posteriorly

Question 23

What does the oesophagus pass through?

Answer 23

The oesophageal hiatus

Question 24

What is the vertebral level of the opening of the oesophageal hiatus?

Answer 24

T10

Question 25

What is the common clinical problem associated with the oesophageal hiatus?

Answer 25

Hiatus hernia and heartburn

Question 26

Which plexus surrounds the oesophagus?

Answer 26

The oesophageal plexus

Question 27

What are the two main muscles of mastication?

Answer 27

Temporalis and masseter

Question 28

Which muscle of mastication is the most powerful?

Answer 28

Masseter

Question 29

What is the difference between the masseter and temporalis muscles?

Answer 29

Masseter- only elevates the jaw | Temporalis- elevates and retracts the jaw

Question 30

What is the role of buccinator in chewing?

Answer 30

Holds cheek to the teeth and assists with chewing

Question 31

What is the importance of buccinator in infants?

Answer 31

Sucking reflex

Question 32

What is the transpyloric plane?

Answer 32

The horizontal line halfway between suprasternal notch and pubic symphysis

Question 33

Which vertebral level is the transpyloric plane on?

Answer 33

L1

Question 34

Which other structures are found on the transpyloric plane?

Answer 34

Pylorus, neck of pancreas, hila of both kidneys

Question 35

What are the names of the two horizontal planes of the abdomen?

Answer 35

Subcostal and transtubercular

Question 36

At which vertebral levels are the two horizontal planes found?

Answer 36

``` Subcostal= L3 Transtubercular= L5 ```

Question 37

What are the 4 quadrants of the abdomen?

Answer 37

Right Upper, Right Lower, Left Upper and Left Lower

Question 38

Which organs lie in the Right Upper Quadrant?

Answer 38

Liver, right kidney, colon, pancreas and gall bladder

Question 39

Which organs lie in the Right Lower Quadrant?

Answer 39

Appendix, colon, small intestine and ureter

Question 40

Which organs lie in the Left Upper Quadrant?

Answer 40

Stomach, left kidney, spleen, colon and pancreas

Question 41

Which organs lie in the Left Lower Quadrant?

Answer 41

Colon, small intestine and ureter

Question 42

What are the 9 regions of the abdomen?

Answer 42

Right and left hypochondrion, epigastric, right and left lumbar, umbilical, right and left iliac and hypogastric

Question 43

Where is the parietal peritoneum found?

Answer 43

On the internal aspect of the abdominal wall

Question 44

In cases of peritonitis, which two clinical signs are elicited on palpation?

Answer 44

Abdominal pain/tenderness and distention in abdomen

Question 45

What is continuous with the parietal peritoneum and what does it cover?

Answer 45

Visceral peritoneum, covers the internal organs

Question 46

What is the greater omentum?

Answer 46

A sheath that hangs down over the intestines

Question 47

Why is the greater omentum sometimes referred to as the abdominal policeman?

Answer 47

As it fights 'intra-abdominal' infection

Question 48

What is the peritoneal cavity?

Answer 48

A potential space between the walls of the abdominal cavity and the viscera

Question 49

Where is the lesser omentum found?

Answer 49

The peritoneal fold between the lesser curvature and the porta hepatis

Question 50

Where is the opening to the lesser sac found?

Answer 50

Behind the right edge of the lesser omentum

Question 51

What is the name of the opening of the lesser omentum?

Answer 51

The epiploic foramen (foramen of Winslow)

Question 52

What are the different features of the stomach?

Answer 52

Fundus, body, pyloric antrum, greater and lesser curvature and rugae

Question 53

What is continuous with the pylorus?

Answer 53

The duodenum

Question 54

What is the pyloric sphincter?

Answer 54

The thickening at the junction between the pylorus of the stomach and the duodenum

Question 55

Which trunk supplies the foregut?

Answer 55

Coeliac trunk

Question 56

What are the 3 main branches of the coeliac trunk?

Answer 56

Left gastric, splenic and common hepatic

Question 57

What are the 4 lobes of the liver?

Answer 57

Left, right, quadrate and caudate

Question 58

Which structures enter the porta hepatis?

Answer 58

Bile duct, hepatic portal vein and hepatic artery

Question 59

What are the component parts of the gallbladder?

Answer 59

Neck, body and fundus

Question 60

Where does the peritoneal cavity extend between and what is the name of the cavity?

Answer 60

Between the liver and the diaphragm | Subphrenic space

Question 61

What is the name of the pouch between the liver and the right kidney?

Answer 61

The hepatorenal pouch

Question 62

How would you examine a patient with hepatomegaly?

Answer 62

Palpation and percussion

Question 63

Which two ducts join to form the common bile duct?

Answer 63

The cystic duct and the common hepatic duct

Question 64

Which organ does the common bile duct first enter?

Answer 64

Pancreas

Question 65

What is cholecystitis?

Answer 65

Inflammation of gallbladder

Question 66

What is cholelithiasis?

Answer 66

Formation of gallstones

Question 67

What can happen if a gallstone blocks the common bile duct?

Answer 67

Bile builds up in the liver causing jaundice (yellowing of liver) which develops due to bilirubin in the blood

Question 68

Which is a more serious condition that may block the common bile duct?

Answer 68

Pancreatic cancer

Question 69

What are the ligaments on the spleen on .w.here do they attach?

Answer 69

Spleno-renal/lieno-renal ligament- attachment to the posterior abdominal wall Gastro-splenic ligament- attachment to the stomach

Question 70

Where is the notch of the spleen found?

Answer 70

On the antero-inferior border

Question 71

Where would you begin palpation for an enlarged spleen?

Answer 71

Right lower quadrant

Question 72

Why may the spleen be the cause of a surgical emergency?

Answer 72

If it doesn't work properly it may start to remove healthy blood cells

Question 73

Is the pancreas intra or retro-peritoneal?

Answer 73

Retro-peritoneal

Question 74

What are the 4 components of the pancreas?

Answer 74

Head, neck, body and tail

Question 75

Which artery runs along the superior border of the pancreas?

Answer 75

The splenic artery

Question 76

Which artery is immediately distal to the neck of the pancreas?

Answer 76

Superior mesentric artery

Question 77

Which structure is C shaped?

Answer 77

The duodenum

Question 78

What does the duodenum enclose?

Answer 78

The pancreas

Question 79

What is found on the posterior wall of the the duodenum what does this form a junction between?

Answer 79

Duodenal papilla | Forms a junction between the foregut and midgut

Question 80

What does the duodenum continue to become?

Answer 80

The jejunum

Question 81

What are the 2 junctions of the small intestine?

Answer 81

The duodeno-jejunal junction and the iliocaecal junction

Question 82

What does the jejunum become after the first 3/5 of the small intestine?

Answer 82

Ileum

Question 83

What is the name of the peritoneum that suspends the small intestine?

Answer 83

The mesentery

Question 84

Where do the blood vessels passing the mesentery originate from?

Answer 84

The superior mesenteric artery

Question 85

Which artery supplies the midgut?

Answer 85

The superior mesenteric artery

Question 86

What is the root of the mesentery?

Answer 86

The attachment of the mesentery to the posterior abdominal wall Extends from the duodenojejunal flexure to the ileocoecal junction

Question 87

What are the 4 main parts of the colon?

Answer 87

Ascending, transvere, descending and sigmoid

Question 88

Which parts of the colon are retroperitoneal and don't have a mesentery?

Answer 88

The ascending and descending colon

Question 89

What is the dip in the peritoneum lateral to the ascending and descending colon?

Answer 89

The paracolic gutters

Question 90

What can happen in the paracolic gutters and what can this lead to?

Answer 90

Fluid may collect in and course through these gutter, potentially spreading infection

Question 91

Which artery supplies the splenic flexure and beyond, which part of the gut does this supply?

Answer 91

The inferior mesenteric artery, supplies the hindgut

Question 92

What is the name given to the mesentery of the transverse colon?

Answer 92

Transverse mesocolon

Question 93

What does the descending colon become?

Answer 93

The sigmoid colon and then finally the rectum

Question 94

Do the sigmoid colon and rectum have a mesentery?

Answer 94

Sigmoid colon and upper part of the rectum have a mesentery but the lower part lies below the peritoneum