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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?

A

L3

24
Q

What are the lateral branches of the abdominal aorta?

A 
Kidneys/adreanl glands 
Gonads (testes/ovaries)
Body wall (posterolateral)
25
Q

When does the abdominal aorta bifurcate and what does it bifurcate into?

A

Bifurcates at L4 into the common iliac artery

These further bifurcate into the internal and external iliac

26
Q

What branches come off the SMA?

A 
Inferior pancreatico-duodenal artery
Jejunal and ileal arcades
Ileo-colic artery
Right colic artery
Middle colic artery

Appendicular (runs within the mesoappendix)

27
Q

Describe the jejunal arteries?

A

Longer vasa rectae

Larger and fewer arterial arcades

28
Q

Describe the ileal arteries?

A

Shorter vasa rectae

Smaller and many arterial arcades

29
Q

What are vasa rectae?

A

Vasa recta are straight arteries coming off from arcades in the mesentery of the jejunum and ileum, and heading toward the intestines.

30
Q

What are arterial arcades?

A

The arcades are anastomoses of the jejunal and ileal arteries, branches of superior mesenteric artery.

31
Q

What are the branches of the inferior mesenteric artery?

A

Left colic artery
Sigmoid arteries (multiple)
Superior rectal artery

32
Q

Describe what exists between the branches of the SMA and IMA?

A

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
Q

What is the marginal artery of drummond?

A

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
Q

What branch of the IMA supplies blood to the rectum and anal canal?

A

The superior rectal artery - off the IMA

35
Q

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)

A

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
Q

What are the 2 venous systems of the body?

A

Hepatic portal system

Systemic venous system

37
Q

Describe the hepatic portal venous system?

A

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

38
Q

Describe the systemic venous system?

A

Drains venous blood from all other organs and tissues into the superior or inferior vena cava

39
Q

Is the IVC intra or retroperitoneal and describe its function?

A

Retroperitoneal - drains cleaned blood from the hepatic veins into the right artrium

40
Q

Describe the hepatic portal vein?

A

Drains blood from the foregut, midgut and hindgut structures to the liver for first pass metabolism

41
Q

Describe the splenic vein?

A

Drains blood from the foregut structures to hepatic portal vein

42
Q

Describe the superior mesenteric vein?

A

Drains blood from the midgut structures to hepatic portal vein

43
Q

Describe the inferior mesenteric vein?

A

Drains blood from the hindgut structures to the splenic vein

44
Q

What are the portal system anastomosis?

A

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
Q

Are there valves in the portal systemic anastomosis?

A

No valves

46
Q

How much blood flow is there in the collateral veins?

A

Usually very little blood flow

47
Q

What are the 3 portal systemic anastomosis?

A

Distal end of the oesophagus
Skin around the umbilicus
Rectum/anal cancel

48
Q

Describe the anastomosis at the distal end of the oesophagus?

A

Inferior part drains to the hepatic portal vein

Superior part drains to the azygous vein

49
Q

Describe the anastomosis at the skin around the umbilicus?

A

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
Q

Describe the anastomosis at the rectum/anal canal?

A

Rectum and superior anal canal drains to inferior mesenteric vein

Inferior part of the GI tract drains to the internal iliac veins

51
Q

Describe the venous drainage from the rectum and anal canal?

A

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
Q

What is portal hypertension?

A

Elevation of blood pressure in the portal system

53
Q

What can portal hypertension by caused by?

A 
Liver pathology (cirrhosis)
Tumour compressing HPV (hepatic portal vein)
54
Q

What does portal hypertension lead to?

A

Reversal of blood flow

There is also a larger volume of blood flow to these anastomotic (collateral) areas causing them to become varicose

55
Q

What is the clinical presentation of portal hypertension?

A

Oesophageal varices
Caput medusa
Rectal varices

LC Gastroenterology Week 4 (9 decks)

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