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Medicine Sem 4 > Case 4 Anatomy > Flashcards

Case 4 Anatomy Flashcards

1
Q

what does the small intestine extend from and to?

A

pyloric sphincter to the ileocecal junction

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2
Q

what is the function of small intestine?

A

main site of digestion and absorption

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3
Q

what are structural adaptions present in the small intestine to increase surface area for absorption?

A
  1. Plicae circulares = circular folds in the mucosa that can be seen with the naked eye
  2. Villi = finger-like projections of the mucosa
  3. Microvilli = microscopic protrusions from the luminal surface of the intestinal cells
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4
Q

how is most of the small intestine suspended? what does this arrangement ensure?

A
  • from the posterior abdominal wall by the mesentery

- this arrangement ensures that the coils of the jejunum and ileum are freely mobile

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5
Q

which parts of the intestines have a mesentery?

A

the small intestine is differentiated from the large intestine by the presence of a mesentery (exceptions being no mesentery in the duodenum, and presence of a mesentery in the transverse and sigmoid colons)

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6
Q

how long is the root of the mesentery?

A

approx. 15cm long

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7
Q

along what is the root of the mesentery attached to the posterior wall?

A

a Iine that extends from the left side of the 2nd lumbar vertebra to the (right I think) sacroiliac joint

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8
Q

how do blood vessels, lymphatics and nerves supply the small intestine? what is the benefit?

A
  • they enter at the root of the mesentery and pass through it to supply the small intestine
  • this arrangement prevents tangling and trapping of the neurovascular structures
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9
Q

what is the main site of digestion?

A

duodenum

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10
Q

how long is the duodenum and what does extend from and to?

A
  • C-shaped tube
  • approximately 25cm long (12 finer breadths)
  • extends from the pyloric sphincter to the jejunum
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11
Q

what is the duodenum divided into?

A 
divided into four parts (sometimes referred to numerically (first, second, third or fourth) but may be specifically named:
•	First = superior part 
•	Second = descending part 
•	Third = horizontal part 
•	Fourth = ascending part
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12
Q

describe the pancreas’ relation to different parts of the duodenum

A

head of the pancreas sits in the C-shape of the duodenum, it therefore lies inferior to the superior part, medial to the descending part and superior to the inferior part

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13
Q

what are the anterior relations of the duodenum? (each part)

A
  • Superior part = quadrate lobe of liver & gallbladder
  • Descending part = fundus of gallbladder, right lobe of liver, transverse colon, coils of small intestine
  • Horizontal part = root of mesentery, coils of jejunum
  • Ascending part = beginning of root of mesentery and coils of jejunum
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14
Q

what are the posterior relations of the duodenum?

A
  • Superior part = lesser sac, gastroduodenal artery, bile duct, portal vein, inferior vena cava
  • Descending part = hilus of right kidney
  • Horizontal part = right ureter, inferior vena cava, aorta
  • Ascending part = left margin of aorta
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15
Q

what opens into the descending duodenum?

A

minor and major papillae

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16
Q

what is the most distal part of the foregut?

A

descending duodenum

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17
Q

what does the superior duodenum have attached to it?

A

part of the lesser omentum attached to its superior border and part of the greater omentum attached to its inferior border

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18
Q

what is the ascending duodenum supported by?

A

suspensory muscle of the duodenum (ligament of Treitz)

double fold of peritoneum suspending the duodenojejunal flexure from the retroperitoneum

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19
Q

which part of the duodenum is intraperitoneal?

A

superior duodenum has an intraperitoneal section

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20
Q

where is the duodenum continuous with the jejunum?

A

at the duodenojejunal junction

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21
Q

what is the blood supply to the duodenum?

A
  • The first two parts of the duodenum are foregut structures and the third and fourth parts are midgut structures, therefore the duodenum receives arterial blood from both the coeliac trunk and superior mesenteric artery
  • The parts of the duodenum proximal to the major duodenal papilla are supplied by the superior pancreaticoduodenal artery, a branch of the gastroduodenal artery which arises from the coeliac trunk
  • The parts of the duodenum distal to the major duodenal papilla are supplied by the inferior pancreaticoduodenal artery, a branch of the superior mesenteric artery
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22
Q

how long is the jejunum?

A

approx. 2.5m long

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23
Q

what does the ileum extend from and to?

A

from the distal end of the jejunum to the ileocaecal junction

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24
Q

how long is the ileum?

A

approx. 3.6m long (longest section)

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25
Q

what happens in the jejunum?

A

most absorption

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26
Q

however, where is the only site of vitamin B12 absorption?

A

terminal ileum

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27
Q

what is the blood supply of the jejunum and ileum?

A

superior mesenteric artery

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28
Q

how does the SMA supply the jejunum and ileum?

A
  • It enters the mesentery at the root of the mesentery and divides into about 15-18 branches
  • The arteries unite to form loops termed arcades
  • The arcades give rise to straight vessels, vasa recta, which project to the intestinal wall
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29
Q

compare the jejunum and ileum

  • arcades
  • vasa recta
  • vascularity
  • diameter
  • colour
  • fat in mesentery
  • where
  • wall thickness
A 
Jejunum:
•	Fewer, large arcades
•	Long vasa recta  
•	More vascular 
•	Wider in diameter 
•	Redder in colour 
•	Less fat in mesentery
•	Mostly located in left upper quadrant of infracolic compartment 
•	Thicker walled 
Ileum: 
•	Many, short looped arcades 
•	Short vasa recta 
•	Less vascular 
•	Narrower in diameter 
•	Paler in colour
•	More fat in mesentery  
•	Mostly located in right lower quadrant of the infracolic compartment 
•	Thinner walled
(basically less everything but more fat)
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30
Q

where is there the highest abundance of plicae circulares in the small intestine?

A

proximal jejunum

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31
Q

histologically, how can the duodenum be differentiated from other parts of the small intestine?

A
  • the presence of Brunner’s glands

(secrete an alkaline fluid which exerts an anti-acid function by coating the duodenal epithelium, therefore protecting it from the acid chyme of the stomach)

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32
Q

histologically, how can the ileum be differentiated from other parts of the small intestine?

A
  • by the presence of Peyer’s patches

small masses of lymphatic tissue

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33
Q

what are the functions of the large intestine?

A
  • water absorption
  • synthesis of vitamins
  • storage of undigested food
  • formation and excretion of faeces
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34
Q

how does the length and diameter of the large intestine compare to that of the small intestine?

A

large intestine is shorter than the small intestine, but much larger in diameter

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35
Q

what is the large intestine divided into?

A

the caecum, ascending colon, hepatic flexure, transverse colon, splenic flexure, descending colon, sigmoid colon, rectum and anal canal

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36
Q

what is special about the large intestine?

A
  • teniae coli
  • epiploic appendages
  • haustra
  • semilunar folds
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37
Q

what are the teniae coli?

A

three distinct strips of muscle formed from the longitudinal fibres of the muscularis externa

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38
Q

what are the epiploic appendages?

A

small fat-filled sacs that project from the outer wall of the intestine

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39
Q

what are the haustra?

A

sacculations in the wall of the large intestine

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40
Q

what are semilunar folds?

A

folds on the internal wall of the intestine between the haustra

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41
Q

what is the blood supply of the large intestine?

A
  • The regions proximal to the distal third of the transverse colon are midgut structures and therefore supplied by the superior mesenteric artery
  • Those distal to this point are hindgut structures and therefore supplied by the inferior mesenteric artery
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42
Q

what are the arteries supplying the large intestine?

A
  • Superior mesenteric
  • Middle colic
  • Right colic
  • Ileocolic
  • Caecal (anterior & posterior)
  • Appendicular
  • Marginal
  • Inferior mesenteric
  • Left colic
  • Sigmoidal
  • Superior rectal
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43
Q

where is the caecum located?

A

in the right inguinal abdominal region

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44
Q

what lies posterior to the caecum?

A

psoas major

45
Q

what is the arterial supply of the caecum?

A
  • anterior and posterior caecal arteries

- they arise from the ileocolic branch of the SMA

46
Q

what opens into the caecum and where?

A
  • Two orifices open into the posteromedial wall of the caecum
  • One is the ileal orifice and the other is the orifice of the appendix
47
Q

where does the ileal orifice open into the caecum? what does this consist of? what does this do?

A
  • ileocaecal valve
  • consists of two horizontal folds of mucous membrane, one above and one below the ileal orifice
  • it is debatable whether the ileocaecal valve prevents reflux of caecal contents into the ileum but it may control the flow of the contents from the ileum into the colon
48
Q

what does the appendix represent?

A

tip of the caecum that fails to enlarge during development

49
Q

describe the appendix wall

A

it presents the 4 basic layers of the gastrointestinal tract and a lumen of variable diameter

50
Q

what is the lumen of the appendix like throughout life?

A

lumen is wide in young children, obliterated by middle age and narrow in adolescence

51
Q

which age group is most prone to appendicitis?

A

adolescents

52
Q

how does the length of the appendix vary between individuals?

A

ranges from 6 - 13cm

53
Q

what is the position of the tip? how can the appendix be located?

A
  • position is also variable – it may coil up behind the caecum, hang down into the pelvis, project up lateral to the caecum or project up anterior or posterior to the ileum
  • this can make it difficult to find during appendicectomy
  • the appendix may be located by following the three bands of the teniae coli as they descend over the caecum and converge at the base of the appendix
54
Q

in relation to surface anatomy, where is the base of the appendix located?

A

at McBurney’s point

55
Q

where is McBurney’s point located?

A

two-thirds of the way along an imaginary line that extends laterally from the umbilicus to that anterior superior iliac spine (the line goes laterally and inferiorly = oblique)

56
Q

what is the mesentery of the appendix like and called?

A

suspended from the mesentery of the small intestine = mesoappendix

57
Q

where are the appendicular artery and vein found?

A

running through the mesoappendix

58
Q

where does the appendicular artery arise from?

A

ileocolic artery (or posterior caecal or ileal artery?)

59
Q

what does the appendicular vein drain via and into what?

A

drains via the ileocolic vein into the superior mesenteric vein

60
Q

what is the lymphatic system of the appendix like? what does lymph drain into? then into what?

A
  • appendix is rich in lymphoid tissue
  • lymph from the appendix drains into the ileocolic nodes
  • efferent vessels from these nodes drain into superior mesenteric nodes
61
Q

what do afferent pain fibres from the appendix accompany and where do they enter the spinal cord?

A
  • accompany the sympathetic (got to be sympathetic because of the pain) fibres
  • enter the spinal cord at the level of T10
62
Q

where is pain from the appendix perceived?

A

in the umbilical abdominal region

63
Q

how long is the ascending colon? what’s its route?

A
  • approx. 13 cm

- it extends upwards through the right lower quadrant and turns as it reaches the liver forming the hepatic flexure

64
Q

what are the anterior relations of the ascending colon?

A
  • greater omentum
  • coils of the small intestine
  • anterior abdominal wall
65
Q

what are the posterior relations of the ascending colon?

A
  • iliac crest
  • iliacus muscle
  • quadratus lumborum
66
Q

what crosses behind the ascending colon?

A
  • ilioinguinal
  • iliohypogastric nerves
    (they arise from L1 spinal segment)
67
Q

what is the largest portion of the colon?

A

transverse colon

68
Q

how long is the transverse colon?

A

approx. 38cm

69
Q

describe the course of the transverse colon

A

extends from the hepatic flexure, hangs down and crosses the abdomen ascends towards the spleen, it turns at the splenic flexure where it leads into the descending colon

70
Q

is the transverse colon intra or retroperitoneal?

A

intraperitoneal

71
Q

what is the transverse colon suspended by from what?

A

by the transverse mesocolon from the anterior border of the pancreas

72
Q

what is attached to the superior and inferior borders of the transverse colon?

A
  • The transverse mesocolon attaches to the superior border of the transverse colon
  • The greater omentum is attached to the lower border of the transverse colon
73
Q

what are the anterior relations of the transverse colon?

A
  • greater omentum

- anterior abdominal wall

74
Q

what are the posterior relations of the transverse colon?

A
  • coils of ileum
  • coils of jejunum
  • head of pancreas
  • second part of duodenum
75
Q

what is the transverse mesocolon?

A

The transverse mesocolon is a broad, meso-fold of peritoneum, which connects the transverse colon to the posterior wall of the abdomen – it’s continuous with the two posterior layers of the greater omentum, which, after separating to surround the transverse colon, join behind it and are continued backward to the vertebral column, where they diverge in front of the anterior border of the pancreas

76
Q

how long is the descending colon?

A

approx. 25cm

77
Q

what is the route of the descending colon?

A

descends from the splenic flexure, passes through the left upper and left lower quadrants and becomes continuous with the sigmoid colon

78
Q

what are the anterior relations of the descending colon?

A
  • greater omentum
  • coils of the small intestine
  • anterior abdominal wall
79
Q

what are the posterior relations of the descending colon?

A
  • iliac crest
  • iliacus muscle
  • lateral border of left kidney
  • quadratus lumborum muscle
  • transversus abdominis muscle
80
Q

what crosses posterior to the descending colon?

A
  • femoral nerve
  • iliohypogastric nerve
  • ilioinguinal nerve
  • lateral cutaneous nerve of the thigh
81
Q

where does the sigmoid colon meet the rectum?

A

S3

  • forms an S-shaped loop as it extends between the descending colon and the rectum
82
Q

what attaches the sigmoid colon to where?

A

sigmoid mesocolon to the posterior pelvic wall

83
Q

how is the junction (rectosigmoid junction) between the sigmoid colon and the rectum marked?

A
  • by changes in the muscle layer

- the teniae coli disappear and are replaced by a complete layer of longitudinal muscle

84
Q

how long is the rectum?

A

approx. 13cm

85
Q

what does the rectum pass down in front of?

A

S3-S5 and coccyx

86
Q

what happens to the rectum at the level of the tip of the coccyx?

A

it pierces the pelvic diaphragm and becomes continuous with the anal canal

87
Q

the rectum is not straight, what flexures are apparent?

A
  • sacral flexure of the rectum
  • anorectal flexure
  • superior and inferior lateral flexures
  • intermediate lateral flexure
88
Q

what is the sacral flexure?

A

this flexure follows the curve of the sacrum and coccyx

89
Q

what is the anorectal flexure? what important for?

A

the sharp postero-inferior angle where the rectum pierces the pelvic diaphragm – important in maintaining faecal continence

90
Q

where are the superior and inferior lateral flexures located?

A

on the left side of the rectum

91
Q

where is the intermediate lateral flexure located?

A

on the right side of the rectum

92
Q

where is the rectum in terms of the peritoneum?

A

partially retroperitoneal and partially below the level of the peritoneum (subperitoneal)

93
Q

what are the anterior relations of the rectum?

A
  • Vagina (females)
  • Prostate (males)
  • Seminal vesicles (males)
  • Base of bladder (males)
  • Coils of intestine
94
Q

what are the posterior relations of the rectum?

A
  • Sacrum
  • Coccyx
  • Median sacral artery
95
Q

what is the dilated distal end of the rectum called?

A

rectal ampulla (bigger area than would expect)

96
Q

what does the puborectalis do?

A

is the portion of the levator ani muscle that forms a sling around the rectoanal junction, pulling it forward and forming the anorectal flexure

97
Q

what are the transverse folds of the rectum? how formed?

A
  • on the inside of the rectum a number of permanent semi-circular folds are evident
  • these are made from folds in the mucosa and circular muscle layers
98
Q

how long is the anal canal?

A

approx. 4cm

99
Q

in which direction does the anal canal extend from the rectal ampulla?

A

downward and backward

100
Q

what is the anococcygeal body?

A

fibrous structure that lies posterior to the anus

101
Q

what lies lateral to the anus?

A

ischioanal fossa

102
Q

what is the perineal body?

A

fibrous structure that lies anterior to the anus

103
Q

what is the pectinate line?

A

(dentate line) demarcates where the upper half of the anus joins the lower half (not only in structure but also in neurovascular supply (reflecting the differing embryological origin)) (above the dentate line the epithelium is a mucous membrane like the rest of the gastrointestinal tract and below the dentate line the epithelium is considered cutaneous) (the dentate line is formed by the anal columns, which consists of a series of anal sinuses (which drain anal glands))

104
Q

upper half of the anal canal

  • lymph drainage
  • arterial supply
  • venous drainage
A
  • Lymph drains to inferior mesenteric nodes via lumbar nodes
  • Arterial supply – superior rectal branch of IMA
  • Superior rectal vein drains to portal system via IMV and splenic
105
Q

lower half of anal canal

  • lymph drainage
  • arterial supply
  • venous drainage
A
  • Lymph drains to superficial inguinal nodes
  • Supplied by inferior rectal branch of pudendal artery
  • Inferior rectal vein drains to internal iliac via pudendal vein
106
Q

upper half of anal canal

  • are anal columns present
  • what epithelium
  • what derivative
A
  • Anal columns present
  • Columnar epithelium
  • Hindgut derivative
107
Q

lower half of anal canal

  • are anal columns present
  • what epithelium
  • what derivative
A
  • No anal columns present
  • Stratified squamous epithelium
  • Derived from proctodeum
108
Q

upper half of anal canal

  • what innervation
  • where nerve fibres from
  • what sensitive to
A
  • Innervated by ANS
  • Nerve fibres from hypogastric plexus (the superior hypogastric plexus receives contributions from the two lower lumbar splanchnic nerves L3-L4?)
  • Sensitive to stretch
109
Q

lower half of anal canal

  • what innervation
  • what sensitive to
A
  • Innervated by inferior rectal branch of pudendal nerve

* Sensitive to pain, temperature, touch and pressure

Medicine Sem 4 (23 decks)

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