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GI Midterm > Blood and Nerve supply to Abdominal Organs > Flashcards

Blood and Nerve supply to Abdominal Organs Flashcards

1
Q

Where does the abdominal aorta start?

A

T12

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2
Q

Is the abdominal aorta intra-, extra- or retroperitoneal?

A

Retroperitoneal

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3
Q

Where does the abdominal aorta bifurcate?

A

L4

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4
Q

Is the abdominal aorta to the right or left of the thoracic duct and cisterna chyli

A

to the left

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5
Q

What are you likely to find on the anterior surface of the abdominal aorta?

A

Duodenum
pancreas,
root of the mesentery

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6
Q

A pts CT shows a balloon-like dilation in midline of the abdomen around L2-L3. Pt presents with extreme hypotension, pain in lower back, stomach, and groin. On physical exam patient was plae, diaphoretic, femoral pulse +1. What is a likely diagnosis?

A

abdominal aortic aneurysm rupture.

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7
Q

what is the primary cuase of AAA/

A

atherosclerosis

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8
Q

What nerve provides parasympathetic innervation to foregut and midgut and Hindgut?

A

Foregut and midgut = vagas

hindgut = pelvic splanchnic.

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9
Q

What nerve provide sympathetic innervation to foregut, midgut and hindgut?

A 
Foregut = greater splanchnic n. (T5-T9
Midgut = lesser splanchnic n. (T10-T11)
Hindgut = least splanchnic n.  (T12-T13)
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10
Q

What organs make up the midgut?

A

3rd and 4th part of the duodenum to proximal 2/3 of the transverse colon

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11
Q

What makes up the hindgut?

A

distal 1/3 of transverse colon to upper portion of rectum

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12
Q

At what vertebral level does the celiac trunk come off the abdominal aorta?

A

T12-L1

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13
Q

What are the three main branches of the celiac trunk?

A
  1. left gastric a
  2. common hepatic a
  3. splenic a.
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14
Q

What branches does the left gastric a give off, along what does it course and what does it anastomose with?

A

Gives of esophageal branch. Follows the lesser curvature of stomach and anastomoses with right gastric.

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15
Q

In what mesentery does the splenic a. run?

A

Splenorenal ligament.

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16
Q

What are the branches of splenic a. ?

A
  1. Short gastric a.
  2. pancreatic artery
  3. Left gastro-omental a.
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17
Q

What mesentery does the short gastric a run within?

A

Gastrosplenic ligament.

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18
Q

What are the branches of the common hepatic a.?

A
  1. Proper hepatic

2. Gastroduodenal

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19
Q

Where does the Right gastric a come off of?

A

It comes off of the proper hepatic artery.

20
Q

Where does the cystic artery come off of?

A

It comes off the right hepatic artery

21
Q

What does the gastroduodenal artery branch into?

A
  1. Right gastroomental a

2. Superior pancreaticoduodenal a. which bifurcates into anterior and posterior branches

22
Q

Where is the bile duct located in the portal hepatis?

A

To the right

23
Q

What mesentery (ligament) surrounds the portal hepatis?

A

Hepatoduodenal Ligament.

24
Q

WHat must be ligated BEFORE cholecystectomy?

A

the cystic artery

25
Q

What makes up the Calot’s Triangle?

A

Laterally = cystic duct
Medially = common hepatic duct
Superiorly = edge of liver.
Cystic artery crosses the middle of the triangle.

26
Q

What is the main route of lymphatic drainage of the gallbladder?

A

Calot’s node.

27
Q

What are the branches off the SMA?

A
  1. Inferior pancreaticoduodenal artery which gives of anterior and posterior branches.
  2. Middle colic artery
  3. right colic artery
    jejunal artery
  4. ileal artery
  5. Iliocolic artery which then gives off appendicular artery, ascneding right colic branch, anterior and posterior cecal artery
28
Q

What are the blood supply to the pancreas?

A

From the celiac trunk via the superior pancreatiogoduodnel artery (posterior and anterior); pancreatic artery from the splenic branch.
From the SMA: inferior pancreaticoduodenal artery (anterior and posterior branches)

29
Q

What is the distinctive feature of the jejunal blood supply?

A

Simple arcade and long vasa recta

30
Q

What is the distinctive feature of ileal blood supply?

A

Complex arcades, short vasa recta.

31
Q

What branches of the superior mesenteric artery supply the large intestine?

A
  1. Ileocolic artery and it’s branches (ileal branch, colic branch, anterior/posterior cecal branch, appendicular branch)
  2. right colic artery
  3. middle colic artery
32
Q

An overweight female presents with intense abdominal cramping, pain 8/10 sharp. Sensation is on the LLQ, no radiation. Normal bowel movements and no blood in stool. Patient has hypercholesterolemia and hypertension. On PE she is noted to have tenderness in the LLQ, decreased bowel sounds and no rebound tenderness or guarding. CT was normal. Colonoscopy showed some irritation of the descending colon. What is the likely diagnosis?

A

ischemia colitis.

33
Q

Where does the superior rectal veins drain into?

A

Inferior mesenteric vein

34
Q

Where does the middle rectal veins drain into?

A

Internal iliac vein

35
Q

Where does the inferior rectal vein drain into?

A

internal pudendal veins

36
Q

Where do sympathetic preganglion fibers arise from/ and where do they synapse?

A

Arises from T5-L1 and travels in respeictive splanchnic nerves; synapse in prevertebral sympathetic ganglia.

37
Q

Where do parasympathetic preganglionic fibers synapse?

A

They synapse in nerve plexi of enteric (intrinsci) nervous system contained in the gut wall.

38
Q

What nerve provides parasympathetic innervation to the stomach and up to the proximal 2/3 of transverse colon?

A

Vagus nerve.

39
Q

What parasympathtic nerve innervates the distal 1/3 transverse colon and proximal rectum?

A

pelvic nerves from S2-S4.

40
Q

Where are the parasympathtic ganglionic nerve plexi located in the gut?

A
  1. Submucosal (meissner’s) plexus is located in the submucosal layer.
  2. Myenteric (auerbach’s) is located in the muscularis layer between the circular muscle and longitudinal muscles
41
Q

In Hirschsprung’s disease, which which layer of the intestine must be biopsied and what are the pathologist looking for?

A

Must biopsy the muscularis mucosa and looking to for absence of the Myenteric plexus.

42
Q

What is the cause of Hirshchsprung disease?

A

Failure of neural crest cells to migrate during intestinal development.
-No myenteric plexus.

43
Q

How does Hirshchsprung disease present?

A

No parasympathetics so the gut cannot relax, causing constriction and megacolon of the proixmal colon segment.

44
Q

Most cases of the presentation of Hirschsprung disease occur what specific part of the GI?

A

rectosigmoidal junction.

45
Q

What microorganism is responsible for the megacolon presentation seen in Chagas disease?

A

T. Cruzi

46
Q

How does the T. Cruzi cause megacolon?

A

Destroys autonomic nervous system mainly the myenteric plexus of the GI.

47
Q

Where do the preganglionic sympathetic nerve fibers of the superior mesenteric plexus synapse?

A

On the superior mesenteric ganglia.

GI Midterm (11 decks)

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