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LC Gastroenterology Week 4 > Clinical Anatomy of Bleeding in the GI Tract > Flashcards

Clinical Anatomy of Bleeding in the GI Tract Flashcards

1
Q

What is the large intestine made up of?

A 
Colon
- caecum 
- appendix 
- ascending colon 
- transverse colon 
- defending colon 
- sigmoid colon 
rectum 
anal canal 
anus
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2
Q

What parts of the colon are retroperitoneal?

A

Ascending and descending colon (secondary retroperitoneal)

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3
Q

What are the Paracolic gutters?

A

The paracolic gutters (paracolic sulci, paracolic recesses) are spaces between the colon and the abdominal wall.

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4
Q

Where are the paracolic gutters exactly?

A

between the lateral edge of the ascending and descending colon and the abdominal wall

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5
Q

What are the paracolic gutters part of?

A

The greater sac of the peritoneal cavity

- potential site for pus collection

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6
Q

What are 3 distinguishing features of the colon?

A
  1. oMental appendices
  2. Teniae coli
  3. Haustra
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7
Q

What are mental appendices?

A

They are small fatty projections that are on the large intestine

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8
Q

Describe the teniae coli?

A

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

Come together at the appendix

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9
Q

Describe the haustra?

A

Formed by the tonic contraction of the teniae coli

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10
Q

Which flexure usually lies more superior than the other?

A

The splenic flexure usually lies more superior than the hepatic flexure

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11
Q

Where is the caecum and appendix located?

A

In the right iliac fossa

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12
Q

What is the position of the appendix usually?

A

Most often is it retroceacal

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13
Q

What is the orifice called that joins the caecum and appendix?

A

The appendices orifice

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14
Q

Where is McBurney’s point?

A

1/3 of the way between the right ASIS to umbilicus

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15
Q

Where does the sigmoid colon lie?

A

In the left iliac fossa

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16
Q

What does the sigmoid colon had in terms of mesentery?

A

A long mesentery - giving it a considerable degree of movement

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17
Q

What is bad about the sigmoid colon having a long mesentery?

A

The sigmoid colon is at risk of twisting around itself

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18
Q

What is it called when the sigmoid twists round on itself?

A

Sigmoid Volvulus

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19
Q

What does sigmoid volvulus usually resit in?

A

Bowel obstruction (bowel at risk of infarction if left untreated)

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20
Q

What are the 3 branches of the abdominal aorta?

A

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

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21
Q

At what level does the Celiac trunk branch off the aorta?

A

T12

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22
Q

At what level does the SMA branch off the aorta?

A

L1

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23
Q

At what level does the IMA branch off the aorta?

24
Q

What are the lateral branches of the abdominal aorta?

A 
Kidneys/adreanl glands 
Gonads (testes/ovaries)
Body wall (posterolateral)
25
When does the abdominal aorta bifurcate and what does it bifurcate into?
Bifurcates at L4 into the common iliac artery These further bifurcate into the internal and external iliac
26
What branches come off the SMA?
``` Inferior pancreatico-duodenal artery Jejunal and ileal arcades Ileo-colic artery Right colic artery Middle colic artery ``` Appendicular (runs within the mesoappendix)
27
Describe the jejunal arteries?
Longer vasa rectae | Larger and fewer arterial arcades
28
Describe the ileal arteries?
Shorter vasa rectae | Smaller and many arterial arcades
29
What are vasa rectae?
Vasa recta are straight arteries coming off from arcades in the mesentery of the jejunum and ileum, and heading toward the intestines.
30
What are arterial arcades?
The arcades are anastomoses of the jejunal and ileal arteries, branches of superior mesenteric artery.
31
What are the branches of the inferior mesenteric artery?
Left colic artery Sigmoid arteries (multiple) Superior rectal artery
32
Describe what exists between the branches of the SMA and IMA?
An arterial anastomoses - The marginal artery of Drummond These anastomoses can help to prevent intestinal ischaemia by providing an arterial (collateral) route by which the blood can travel
33
What is the marginal artery of drummond?
The marginal artery of Drummond, also known as the marginal artery of the colon, is a continuous arterial circle or arcade along the inner border of the colon formed by the anastomoses of the terminal branches of the superior mesenteric artery (SMA) and inferior mesenteric artery (IMA).
34
What branch of the IMA supplies blood to the rectum and anal canal?
The superior rectal artery - off the IMA
35
How is the rest of the Gi tract supplied with blood? (the hindgut only extends to the proximal half of the anal cancel - the pectate line)
The rest of the GI tract is supplied by the internal iliac artery (gives off the middle and inferior rectal artery) - there is an anastomoses between these vessels (Internal iliac and the superior rectal artery)
36
What are the 2 venous systems of the body?
Hepatic portal system | Systemic venous system
37
Describe the hepatic portal venous system?
Drains venous blood from absorptive parts of the GI tract and associated organs to the liver for 'cleaning'
38
Describe the systemic venous system?
Drains venous blood from all other organs and tissues into the superior or inferior vena cava
39
Is the IVC intra or retroperitoneal and describe its function?
Retroperitoneal - drains cleaned blood from the hepatic veins into the right artrium
40
Describe the hepatic portal vein?
Drains blood from the foregut, midgut and hindgut structures to the liver for first pass metabolism
41
Describe the splenic vein?
Drains blood from the foregut structures to hepatic portal vein
42
Describe the superior mesenteric vein?
Drains blood from the midgut structures to hepatic portal vein
43
Describe the inferior mesenteric vein?
Drains blood from the hindgut structures to the splenic vein
44
What are the portal system anastomosis?
They are clinically important sites of venous anastomosis between the systemic and the portal venous system At these sites the presence of small collateral veins means blood can flow both ways either into the systemic or portal venous system
45
Are there valves in the portal systemic anastomosis?
No valves
46
How much blood flow is there in the collateral veins?
Usually very little blood flow
47
What are the 3 portal systemic anastomosis?
Distal end of the oesophagus Skin around the umbilicus Rectum/anal cancel
48
Describe the anastomosis at the distal end of the oesophagus?
Inferior part drains to the hepatic portal vein Superior part drains to the azygous vein
49
Describe the anastomosis at the skin around the umbilicus?
Connection between para-umbilical veins and small epigastric veins Para-umbilical veins to hepatic portal vein along the round ligament of liver Epigastric veins drain to caval system (systemic bood flow - vena cava)
50
Describe the anastomosis at the rectum/anal canal?
Rectum and superior anal canal drains to inferior mesenteric vein Inferior part of the GI tract drains to the internal iliac veins
51
Describe the venous drainage from the rectum and anal canal?
Inferior rectal vein - drains to the internal iliac vein Middle rectal vein - drains to the internal iliac vein Superior rectal vein - drains to inferior mesenteric vein (there is a venous plexus in the anal canal)
52
What is portal hypertension?
Elevation of blood pressure in the portal system
53
What can portal hypertension by caused by?
``` Liver pathology (cirrhosis) Tumour compressing HPV (hepatic portal vein) ```
54
What does portal hypertension lead to?
Reversal of blood flow There is also a larger volume of blood flow to these anastomotic (collateral) areas causing them to become varicose
55
What is the clinical presentation of portal hypertension?
Oesophageal varices Caput medusa Rectal varices

LC Gastroenterology Week 4 (9 decks)

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