Bleeding in the GI tract and the anatomy of the blood vessels of the abdomen

Question 1

What are the parts of the large intestine in order

Answer 1

caecum
appendix
ascending colon
transverse colon
descending colon
sigmoid colon
rectum
anal canal anus

Question 2

What are the 3 functions of the large intestine

Answer 2

defence
absorption
excretion

Question 3

Where is the colon in relation to the liver and spleen

Answer 3

Inferior to both the liver and the spleen

Question 4

What type of organ is the colon

Answer 4

Intraperitoneal, then retroperitoneal then intraperitoneal

Question 5

Describe the mobility of the intraperitoneal segments of the colon

Answer 5

Quite mobile

Question 6

How many paracolic gutters do we have?

Answer 6

2 (right and left

Question 7

Describe the location of the paracolic gutters

Answer 7

Between the lateral eddge of the ascending and descending colon and the abdominal wall

Question 8

What are the paracolic gutters part of?

Answer 8

The greater sac of the peritoneal cavity

Question 9

What are the paracolic gutters potential sites for

Answer 9

Pus collection

Question 10

How many teniae coli do we have and what are they

Answer 10

3

Longitudinal bands of thickened smooth muscle running from caecum to distal end of sigmoid colon

Question 11

How do we visualise the teniae coli?

Answer 11

Use barium contrast via enema

Question 12

Where do the appendix and the caecum lie?

Answer 12

Right iliac fossa

Question 13

What corresponds to the McBurneys point on the anterior abdominal wall

Answer 13

The appendiceal orifice on the posteromedial wall of the caecum

Question 14

Where is the McBurneys point

Answer 14

A third of the way from the right ASIS to the umbilicus (where pain from appendicitis ends)

Question 15

WHere does the sigmoid colon lie?

Answer 15

In the left iliac fossa

Question 16

What gives rise to the movement of the sigmoid and what is the specific name for this?

Answer 16

Long mesentery - sigmoid mesocolon

Question 17

What is the negative side to the degree of movement of the sigmoid colon?

Answer 17

It can twist around itself and cause a bowel obstruction

Question 18

What is the risk if a bowel obstruction is not treated?

Answer 18

Infarction

Question 19

What does the abdominal aorta branch to supply and what are the names of the branches

Answer 19

The abdominal organs

Right and left common iliac arteries

Question 20

What do the common iliac arteries supply?

Answer 20

The pelvis, perineum and the lower limbs

Question 21

The common iliac arteries bifurcate again to form what?

Answer 21

The external and internal iliac arteries

Question 22

Where does the abdominal aorta lie?

Answer 22

Anterior to the vertebral bodies and to the left of the IVC

Question 23

Name the 3 midline branches of the abdominal aorta

Answer 23

Celiac trunk (foregut)
Superior mesenteric artery (midgut)
Inferior mesenteric artery (hindgut)

Question 24

What are the names of the 6 parts of the SMA arteries from superior to inferior on the right hand side of the body

Answer 24

Inferior pancreatico-duodenal artery
Middle colic artery
Right colic artery
Ileocolic artery
Jejunal and ileal arteries
Appendicular artery

Question 25

What are the names of the 3 parts of the IMA from superior to inferior on the left hand side of the body

Answer 25

Left colic artery
Sigmoid colic artery
superior rectal artery

Question 26

What can help prevent bowel ischaemia

Answer 26

The marginal artery of Drummond

Question 27

Why might a patient present with haematemesis

Answer 27

The stomach has filled with blood due to a peptic ulcer in which the wall of the stomach or the duodenum has been eroded through the mucosa

Question 28

What are varices

Answer 28

Abnormal, dilated veins

Question 29

Why do varices have the potential to rupture

Answer 29

They have such thin walls

Question 30

What causes the formation of oesophageal varices?

Answer 30

A result of pathology affecting the portal venous system

Question 31

How many venous systems does the body have?

Name these

Answer 31

2
Hepatic portal venous system
Systemic venous system

Question 32

What does the hepatic portal venous system do?

Answer 32

Drains venous blood from absorpitve parts of the GI tract and associated organs to the liver for cleaning

Question 33

What does the systemic venous system do?

Answer 33

Drains venous blood from all other organs and tissues into the SVC or IVC

Question 34

What occurs in the liver that requires the hepatic portal system?

Answer 34

First pass metabolism (cleaning)

Question 35

What does the splenic vein do?

Answer 35

Drains the blood form the foregut structures to the hepatic portal vein

Question 36

What does the inferior mesenteric vein do?

Answer 36

Drains the blood from the hindgut structures to the splenic vein

Question 37

What does the superior mesenteric vein do?

Answer 37

Drains the blood from the migut structures to the hepatic portal vein

Question 38

What are the 3 clinically important sites of venous anastomosis between the systemic and the portal venous systems (Portal systemic anastomeses)

Answer 38

Distal end of oesophagus
Skin around umbilicus
Rectum / anal canal

Question 39

What means that blood can flow both ways in the anastomoses ?

Answer 39

The presence of small collateral veins

There are no valves in these veins

Question 40

What would happen to the flow of blood in these collateral veins if the blood pressure within the portal venous system was raised?

Answer 40

Portal Hypertension - blood would be diverted through the collateral veins back to the systemic venous system

Question 41

As a consequence to portal hypertension, what happens to the collateral veins

Answer 41

THey have amuch larger volume of blood through them than they are used to and so dilate, becoming varicose

Question 42

What is a clinical sign of portal hypertension

Answer 42

Dilated collateral veins
Dilated epigastric veins
Dilated submucosal collateral veins
Rectal varices