Bleeding in the GI tract

Question 1

Name three functions of the large intestine?

Answer 1

Defense (commensal bacteria)
Absorption (water and electrolytes)
Excretion (of formed stool)

Question 2

How many “Paracolic Gutters” are there?

Answer 2

2

left and right

Question 3

Where are the 2 paracolic gutters found?

Answer 3

Between the lateral edge of the ascending and descending colon, and the abdominal wall.

Question 4

Which is usually more superior, the splenic flexure or the hepatic flexure?

Answer 4

The splenic felxure.

Question 5

What are the teniae coli?

Answer 5

3 distinct longitudinal bands of thickened smooth muscle, running from caecum to distal end of sigmoid colon.

Question 6

How many distinct longitudinal bands of thickened smooth muscle, run from caecum to distal end of sigmoid colon.

Answer 6

3

teniae coli

Question 7

Which segment (abdominally) do both the caecum and the appendix lie in?

Answer 7

Right iliac fossa

Question 8

Why do some patients present with appendicitis in different ways?

Answer 8

The position of the appendix is variable.

Question 9

Which area of the appendix/caecum has the maximun tenderness in the case of appendicitis?

Answer 9

The appendicieal orifice,

On posteromedial wall of caecum

Question 10

Which segment does the sigmoid colon lie in?

Answer 10

The left iliac fossa.

Question 11

Does the sigmoid colon have a mesentery?

Answer 11

Yes.

Question 12

What is the mesentery of the sigmoid colon called?

Answer 12

Sigmoid mesocolon.

Question 13

What effect does the sigmoid mesocolon have on the sigmoid colon?

Answer 13

Gives it a considerable degree of movement.
HOWEVER:
Sigmoid colon at risk of twisting around itself.
(Sigmoid Volvulus)

Question 14

If the sigmoid colon twists around itself, what is the clinical result?

Answer 14

Bowel obstruction.

Risk if infarction if left untreated.

Question 15

What is a sigmoid volvulus?

Answer 15

When the sigmoid colon twists around itself.

Cause of bowel obstruction.

Question 16

Is the abdominal aorta retroperioneal or intraperitoneal?

Answer 16

Retroperitoneal.

Question 17

The abdominal aorta lies left/right of inferior vena cava.

Answer 17

Left.

Question 18

What are the three midline branches of the abdominal aorta?

Answer 18

Celiac Trunk
Superior Mesenteric Artery
Inferior Mesenteric Artery

Question 19

Which organs are supplied by the celiac trunk?

Answer 19

Foregut organs.

Question 20

Which organs are supplied by the superior mesenteric artery?

Answer 20

Midgut organs.

Question 21

Which organs are supplied by the inferior mesenteric artery?

Answer 21

Hindgut organs.

Question 22

The lateral branches of the abdominal aorta supply:

Answer 22

Kidneys/adrenal glands
Gonads
Body Wall (posterolateral)

Question 23

Which artery supplies the hindgut organs?

Answer 23

The inferior mesenteric artery.

Question 24

Why would a peptic ulcer cause haematemesis?

Answer 24

Peptic ulcer in wall of stomach or duodenum, erodes through the mucosa, stomach or duodenum fills with blood.

Question 25

Why would oesophageal varices cause haematemesis?

Answer 25

Bleeding from oesophageal varices, abnormal dilated veins, thin walled therefore have potential to errupt.
(Formation often due to pathology affecting the portal venous sytem.)

Question 26

What are the two main venous systems?

Answer 26

Hepatic portal venous system

Systemic venous system

Question 27

What does the hepatic portal venous system do?

Answer 27

Drains venous blood from absorptive parts of the GI tract & associated organs to the liver for ‘cleaning’.

Question 28

What does the systemic venous system do?

Answer 28

Drains venous blood from all other organs (not absorptive parts of GI tract and associated organs) and tissues into the superior or inferior vena cavae.

Question 29

What does the inferior vena cava do?

Answer 29

Drains cleaned blood from the hepatic veins into the right atrium.

Question 30

What drains cleaned blood from the hepatic veins into the right atrium?

Answer 30

The inferior vena cava.

Question 31

What does the hepatic portal vein do?

Answer 31

Drains blood from foregut, midgut and hindgut structures to the liver for first pass metabolism.

Question 32

What drains blood from foregut, midgut and hindgut structures to the liver for first pass metabolism?

Answer 32

The hepatic portal vein.

Question 33

What does the splenic vein do?

Answer 33

Drains blood form foregut structures to hepatic portal vein.

Question 34

What drains blood form foregut structures to hepatic portal vein?

Answer 34

The splenic vein.

Question 35

What does the superior mesenteric vein do?

Answer 35

Drains blood from midgut structures to hepatic portal vein.

Question 36

What drains blood from midgut structures to hepatic portal vein?

Answer 36

The superior mesenteric vein.

Question 37

What does the inferior mesenteric vein do?

Answer 37

Drains blood from hindgut structures to splenic vein.

Question 38

What drains blood from hindgut structures to splenic vein?

Answer 38

The inferior mesenteric vein.

Question 39

There are 3 clinically important sites of venous anastomosis between the systemic and the portal venous systems, called ______ _______ _______. These sites are…

Answer 39

There are 3 clinically important sites of venous anastomosis between the systemic and the portal venous systems, called portal systemic anastomoses. These sites are:
The distal end of the oesophagus
The skin around the umbilicus
The rectum/anal canal.

Question 40

What is “portal hypertension”

Answer 40

Increased blood pressure within the portal veins.

Question 41

What can portal hypertension occur as a result of?

Answer 41

Liver pathology (e.g. cirrhosis)

Question 42

What are the clinical presentations of portal hypertension?

Answer 42

Oesophageal varices
Caput medusae
Rectal varices