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Anatomy - Abdomen and Pelvis > Chapter 5 - Small Intestines > Flashcards

Chapter 5 - Small Intestines Flashcards

1
Q

Extent and length of SI

A

From pylorus to ileoceacal junction
6m long
Longer in males

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2
Q

Divisions of SI

A
  1. Upper fixed duodenum
  2. Lower mobile tube
    - upper 2/5 - jejunum
    - lower 3/5 - ileum
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3
Q

Large surface area of SI by

A
  1. Length
  2. Circular mucous folds
  3. Villi
  4. Microvilli
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4
Q

Circular mucous folds of SI

A
  • called plicae circulares or valves of Kerckring
  • form complete or incomplete circles
  • folds are permanent
  • begin in 2nd part of duodenum
  • become large and closely set below level of duodenal papilla and through jejunum
  • diminish in size and no. in distal jejunum and proximal ileum
  • absent in distal ileum
    Facilitate absorption by slowing down passage of contents
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5
Q

Intestinal villi

A
  • finger like projections of mucous membrane
  • large and many in duodenum and jejunum
  • small and few in ileum
  • inc. surface area by 8 times
  • villi covered by absorptive columnar cells
  • Columnar cells have microvilli
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6
Q

Intestinal glands of SI

A
  • tubular glands
  • on mucous membranes of jejunum and ileum
  • open by circular apertures between villi
  • epithelial cells in crypts show high mitotic activity
  • proliferated cells move to surface and shed from tips of villi
  • complete epithelial lining of villi replaced every 2-4 days
    Brunners glands in submucosa - compound tubuloacinar glands - secrete mucous
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7
Q

Lymphatic follicles of SI

A

2 types - solitary and aggregated
-Solitary - 1-2mm in dia
-Aggregated - Peyers patches - 2-10cm - max in ileum
Both are numerous at puberty, diminish later
Peyers patches ulcerated in typhoid fever

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8
Q

Arterial supply of SI

A

Jejunum and ileum - jejunal and ileal branches of superior mesenteric A

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9
Q

Nerve supply of SI

A

Symp - T9-T11
Parasymp - Vagus
Both pass through coeliac and superior mesenteric plexuses
- Myenteric plexus and submucosal plexus has parasymp. ganglia
- Symp. nerves are motor to sphincters and muscularis mucosae and inhibitory to peristalsis
- Parasymp. stimulate peristalsis and inhibit sphincters

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10
Q

Location of duodenum

A

Shortest, Widest, Most fixed part of SI

  • from pylorus to duodenojejunal flexure
  • curves around head of pancreas to form C
  • above level of umbilicus
  • opp L1, L2, L3 vertebrae
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11
Q

Parts of duodenum

A
  1. Superior - 2in.
  2. Descending - 3in.
  3. Horizontal - 4in.
  4. Ascending - 1in.
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12
Q

Location of 1st part of duodenum

A
  • Starts at pylorus

- passes back, up, right to meet 2nd part

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13
Q

Peritoneal relations of 1st part of duodenum

A

Proximal 2.5cm
- movable
- attached to greater omentum above, lesser omentum below
Distal 2.5cm
- fixed
- retroperitoneal. peritoneum only on anterior side

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14
Q

Visceral relations of 1st part of duodenum

A

Ant: Quadrate lobe of liver, Gallbladder
Post: Gastroduodenal A, Bile duct, Portal V
Sup: Epiploic foramen
Inf: Pancreas

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15
Q

Location of 2nd part of duodenum

A
  • starts at superior duodenal flexure
  • passes down
  • reaches L3
  • curves to left at inf. duodenal flexure
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16
Q

Peritoneal relations of 2nd part of duodenum

A

Retroperitoneal and fixed

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17
Q

Anterior relations of 2nd part of duodenum

A
  1. Liver
  2. Transverse colon
  3. Transverse mesocolon
  4. SI
18
Q

Posterior relations of 2nd part of duodenum

A
  1. Right kidney
  2. Right renal vessels
  3. Right edge of IVC
  4. Right psoas major
19
Q

Medial relations of 2nd part of duodenum

A
  1. Pancreas head

2. Bile duct

20
Q

Lateral relations of 2nd part of duodenum

A

Right colic flexure

21
Q

Features of interior of 2nd part of duodenum

A
  1. Major duodenal papilla: hepatopancreatic ampulla opens at summit of papilla
  2. Minor duodenal papilla: opening of accessory pancreatic duct
  3. Below major duodenal papilla, longitudinal fold called plica longitudinalis is seen
22
Q

Course of 3rd part of duodenum

A
  • from inf. duodenal flexure
  • passes horizontally in front of IVC
  • joins 4th part in front of abdominal aorta
23
Q

Peritoneal relations of 3rd part of duodenum

A

Retroperitoneal and fixed

Crossed by superior mesenteric vessels in median plane

24
Q

Anterior relations of 3rd part of duodenum

A
  1. Superior mesenteric vessels

2. Root of mesentery

25
Q

Posterior relations of 3rd part of duodenum

A
  1. Right ureter
  2. Right psoas major
  3. Right testicular/ovarian vessels
  4. IVC
  5. Abdominal aorta
26
Q

Superior relations of 3rd part of duodenum

A
  1. Head of pancreas

2. Uncinate process

27
Q

Inferior relations of 3rd part of duodenum

A

Jejunum

28
Q

Course of 4th part of duodenum

A

Runs up till L2

Turns forward becomes cont. with jejunum at duodenojejunal flexure

29
Q

Peritoneal relations of 4th part of duodenum

A

Retroperitoneal

Terminal part is mobile

30
Q

Anterior relations of 4th part of duodenum

A
  1. Transverse colon
  2. Transverse mesocolon
  3. Lesser sac
  4. Stomach
31
Q

Posterior relations of 4th part of duodenum

A
  1. Left sympathetic chain
  2. Left renal A
  3. Left gonadal A
  4. Inf. mesenteric V
32
Q

Side relations of 4th part of duodenum

A

Right: Root of mesentery
Left: Left kidney and ureter
Sup: Body of pancreas

33
Q

Suspensory Ligament of Duodenum

A

Ligament of Treitz
- fibromuscular band
- suspends and supports duodenojejunal flexure
- arises from right crus of diaphragm
- attaches to post. surface of duodenojejunal flexure and part 3 and 4 of duodenum
Made of:
- Striped muscles in upper part
- Elastic M in middle
- Smooth M in lower
Its contraction inc. angle to DDJ flexure

34
Q

Arterial supply of duodenum

A

Upto opening of bile duct - from foregut - superior pancreaticoduodenal A
After opening - from midgut - inferior pancreaticoduodenal A
1st part addiotionally from:
1. Right gastric A
2. Supraduodenal A of Wilkie
3. Gastroduodenal A
4. b. of Right gastroepiploic A

35
Q

Venous drainage of duodenum

A

Drain into:
Splenic
Superior mesenteric
Portal V

36
Q

Lymphatic drainage of duodenum

A

Pancreaticoduodenal nodes
Hepatic nodes
Coeliac nodes

37
Q

Nerve supply of duodenum

A

Sympathetic - T9-T10

Parasymp - Vagus through Coeliac plexus

38
Q

Blood supply of jejunum and ileum

A

Superior mesenteric A and V

39
Q

Nerve Supply of jejunum and ileum

A

Sym - T9-T11

Parasym - Vagus

40
Q

Things that differentiate jejunum from ileum

A

Jejunum has:

  1. Thicker, more vascular walls
  2. Wider lumen
  3. Lesser fat in mesentery
  4. Longer and fewer vasa recta
  5. Large, closely set circular mucosal folds
  6. More abundant villi
  7. Fewer lymph follicles
41
Q

Meckel’s diverticulum

A
  • Persistant proximal part of vitellointestinal duct.
  • Normally disappears during 6th wk of IUL
  • 2in long
  • Situated close to ileocaecal valve, attached to antimesenteric border of ileum
  • Apex may be free or attached to other structures

Anatomy - Abdomen and Pelvis (8 decks)

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