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ANATOMY 2 > Esophagus, Stomach, Small intestine and Large intestine > Flashcards

Esophagus, Stomach, Small intestine and Large intestine Flashcards

1
Q

Structure of esophagus

A
  • muscular tube
  • 25cm long and 2 cm diameter
  • cervical part: cricoid cartilage to thoracic inlet
  • thoracic part: thoracic inlet to diaphragm
  • abdominal part: diaphragm to cardiac opening in stomach
  • upper 1/3- striated muscle
  • middle 1/3- mixed skeletal and smooth
  • lower 1/3 - smooth muscle
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2
Q

Constrictors of esophagus

A
  1. Cervical constrictor:
    - at pharyngo-esophageal junction
    - caused by cricoid cartilage
    - lower constrictor of pharynx form Upper Esophageal sphincter
  2. Thoracic constrictor:
    - crossed by aortic arch and left main bronchus
  3. Diaphragmatic constrictor:
    - at esophageal hiatus
    - Lower esophageal sphincter- by right crus
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3
Q

Laimer trigone

A
  • triangular V-shaped area on posterior side of esophagus
  • area of weakness due to absence of outer longitudinal muscle layer
  • potential site of herniation or Zener Diverticulum
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4
Q

Z-line

A

where the mucosa abruptly changes from esophageal (stratified non-keratinized squamous) to gastric (simple columnar, glandular) at the cardia

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5
Q

Arterial supply of Esophagus

A
  • Esophageal branch of Inferior Thyroid artery
  • Esophageal branch of Left and Right bronchial a
  • Esophageal branches of Thoracic aorta
  • Left Gastric artery
  • Left Inferior Phrenic artery
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6
Q

Venous drainage of Esophagus

A
  • Left Gastric vein of stomach into Portal system

- Esophageal veins to Azygos and hemiazygos veins

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7
Q

Lymphatic drainage of Esophagus

A
  • Left gastric lymph nodes
  • Inferior Deep cervical lymph nodes
  • Para-tracheal lymoh nodes
  • Posterior mediastinal and intercosal lymph nodes
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8
Q

Innervation of Esophagus

A

Vagal nerves

sympathetic: cervical and thoracic sympathetic chain

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9
Q

Muscular layer of Stomach

A

innermost oblique
inner circular
outer longitudinal

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10
Q

Ligaments of stomach

A
  • Hepatogastric ligament: from liver into lesser curvature, part of lesser omentum, contains left and right gastric artery and vein
  • Gastrocholic ligament: greater omentum to transverse mesocolon, 6 layers, contains left and right gastroepiploic arteries
  • Gastrosplenic ligament: continuation of gastrocolic
  • Gastrophrenic ligament
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11
Q

Arterial supply of stomach

A
  • Left gastric a. (celiac trunk)
  • Right gastric a. (proper hepatic a.)
  • Posterior gastric a. (splenic a.)
  • Short gastric a. (splenic a.)
  • Left Gastro-omental a. (splenic a.)
  • Right Gastro-omental a. (gastro-duodenal a.)
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12
Q

Vanous drainage of Stomach

A
  • Left gastric vein (⇒portal vein)
  • Right gastric vein (⇒portal vein)
  • Left Gastroepiploic vein (⇒splenic vein)
  • Right gastroepiploic vein (⇒sup. mesenteric vein)
  • Prepyloric vein
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13
Q

Lymphatic drainage of Stomach

A
  • sup 1/3: gastric lymph node ⇒ cisterna chyli
  • fundus, corpus: pancreatico-splenic lymph nodes
  • right inf: pyloric and gastroomental lymph nodes
  • left inf: pancreatico-duodenal lymph nodes
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14
Q

Innervation of Stomach

A

parasymp: Anterior /Posterior Vagal trunks + celiac plexus
symp: Th6-Th9⇒ celiac plexus through greater splanchnic nerves

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15
Q

Duodenojejunal junction

A
  • level of L2
  • duodenojejunal flexure
  • fixed by Suspensory ligament of Treitz
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16
Q

Superior Horizontal part of Duodenum

A
  • 5cm long
  • anterolateral to L1
  • has ampulla - hepatoduodenal ligament attaches
  • intraperitoneal
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17
Q

Descending part of Duodenum

A
  • 7-10 cm long
  • right side of L1-L3
  • Vater’s papilla + sphincter of Oddi
  • minor duodenal papilla + sphincter of Santorini
  • retroperitoneal
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18
Q

Inferior Horizontal part of Duodenum

A
  • 6-8 cm long, crosses L3

- retroperitoneal

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19
Q

Ascending part of Duodenum

A
  • 5cm long, left side of L3-L2

- retroperitoneal

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20
Q

Arterial supply of Duodenum

A
  • Superior Pancreaticoduodenal a (gastroduodenal)
  • Gastroduodenal a (common hepatic a)
  • Inferior Pancreaticoduodenal a (SMA)

VEINS:
Pancreaticoduodenal veins ⇒ SMV

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21
Q

Lymphatic drainage of Duodenum

A
  • anterior lymph vessels ⇒ pancreaticoduodenal + pyloric lymph nodes
  • posterior lymph vessels ⇒ SMLN
22
Q

Innervation of Duodenum

A

parasymp: Vagus
symp: Lesser/greater Splanchnic nerves

23
Q

Jejunum

A
  • intraperitoneal
  • wider, emptier, thicker walled
  • less fat, less prominent arterial arcades, longer vasa recta
24
Q

Ileum

A
  • longer than jejunum
  • darker, more vertical loops
  • contains Payer’s patches
  • shorter plica circularis, shorter vasa recta, more mesenteric fat, more prominent arcades
25
Q

Meckel’s diverticulum

A

remains of yolk stalk of embryo, which when persistent abnormally as sac or pouch, located 60-90cm orally from ileocecal junction; may be free or attached to umbilicus

26
Q

Blood supply of Jejunum and Ileum

A

ARTERY:
- superior mesenteric artery

VEIN:
- superior mesenteric vein ⇒ splenic vein ⇒ portal vein

27
Q

Lymphatic drainage of Jejunum and Ileum

A
  • Juxta-intestinal lymph nodes
  • mesenteric lymph nodes
  • superior central nodes
28
Q

Innervation of Jejunum and Ileum

A

symp: Th8-Th10 ⇒ lesser/greater splanchnic nerves
parasymp: vagal trunks

29
Q

Teniae coli

A

three bands in which the longitudinal muscular fibers of large intestine, except rectum and anal canal, are collected

  • mesocholic: transverse + sigmoidal mesocolons attach ⇒ posteromedial tenia
  • omental: greater omentum attach to transverse colon ⇒ posterolateral tenia
  • libera: opposite to mesocolic, no attachment ⇒ anterior tenia
30
Q

Cecum

A
  • 7,5 cm
  • semi-intraperitoneal
  • ileocecal junction + ileocecal valve of Bauhin
31
Q

Vermiform Appendix

A
  • blind intestinal diverticulum
  • contain lymphoid tissue
  • has mesoapendix
  • clinically found with McBurney point
  • found where all tenia join
32
Q

Blood supply of Cecum and Appendix

A

ARTERY:
- Ileocolic artery (SME)

VEIN:
- Ileocecal vein (⇒SMV)

LYMPH:
- Ileocecal lymph nodes ⇒ SMLN

33
Q

Ascending colon

A
  • semi-intraperitoneal
  • cecum ⇒ right colic flexure
  • right paracolic gutter ⇒ recess continuous with sub hepatic recess and Morrison’s pouch⇒ infection spread
  • Jackson’s membrane ⇒ thin vascular membrane on anterior surface, may cause obstruction by kinking the bowel
34
Q

Blood supply of Ascending colon

A

ARTERY:
- ileocecal, right colic + middle colic arteries (SMA)
VEIN:
- ileocolic, right colic veins ⇒SMV
LYMPH:
- epicolic, paracolic, right colic lymph nodes ⇒ SMLN

35
Q

Transverse colon

A
  • right colic flexure ⇒ left colic flexure
  • phrenicocolic ligament attached
  • transverse mesocolon: mesentery of transverse colon. forms inferior border of omental bursa, fuses with greater omentum forming 6 layered gastrocolic ligament
  • L3 vertebral level
36
Q

Blood supply of transverse colon

A 
ARTERY:
- middle colic artery (SMA
- left colic artery (IMA)
⇒ 2nd Riolan anastomosis
VEIN:
- middle colic vein ⇒ SMV
LYMPH:
- middle colic lymph nodes ⇒ SMLN
37
Q

Descending colon

A
  • semi-intraperitoneal
  • left paracolic gutter- closed upward by phrenicocolic ligament
  • thinner than ascending
38
Q

Blood supply of Descending colon

A 
ARTERY:
- left colic artery (IMA)
⇒ Marginal artery of Drummond together with right colic artery
VEIN:
- left colic vein ⇒ IMV
LYMPH:
- left colic lymph nodes ⇒ IMLN
39
Q

Sigmoid colon

A
  • S-shaped loop, 40cm
  • iliac fossa ⇒ S3 vertebra
  • Rectosigmoidal junction: termination of teniae
  • Mesosigmoidum: freely moving
40
Q

Blood supply of Sigmoid colon

A 
ARTERY:
- sigmoidal artery (IMA)
⇒ Sudeck point: anastomosis with superior rectal a
VEIN:
- sigmoidal vein ⇒ IMV
41
Q

Innervation of Colon

A

parasymp: vagus nerve (until 2/3 of transverse colon), sacral plexus (1/3 of transverse colon ⇒ anus)
symp: superior hypogastric plexus

42
Q

Cannon-Böhm point

A

point were innervation changes from vagus to sacral plexus in colon

43
Q

Rectum

A
  • 15-20 cm long, has no omental appendices or haustra
  • sacral flexure + perineal flexure
  • 3 lateral flexures: 2 on left side, 1 right- Kohlrausch’s fold
  • superior 1/3⇒ semi-intraperitoneal, middle 1/3⇒retroperitoneal, inferior 1/3⇒ infra peritoneal
44
Q

Blood supply of Rectum

A

ARTERY:
- superior rectal artery (IMA)
- middle rectal artery (internal iliac artery)
- inferior rectal artery (internal pudendal artery)
VEIN:
- superior rectal vein ⇒ IMV
- middle, inferior rectal veins ⇒ internal iliac vein
- submucosal rectal plexus

45
Q

Innervation of Rectum

A

symp: lumbar part of sympathetic trunk + superior hypogastric plexus
parasymp: pelvic splanchnic nerves

46
Q

Anal canal

A
  • 4cm long, pelvic diaphragm ⇒ anus
  • internal anal sphincter: involuntary, innervated by parasympathetic nerves
  • external anal sphincter: voluntary striated muscle, 3 components⇒ subcutaneous, superficial and deep part
  • anal columns of Morgagni
  • anal valves of Morgagni
  • anal sinuses: pocket like recesses above valves
47
Q

Pectinate line

A

limit of anal valves that indicates the junction of the superior part of anal canal (hindgut) and the inferior part (proctodeum)

48
Q

Zones of mucosa in anal canal

A
  1. Zona columnaris: anorectal junction⇒ pectinate line, simple columnar epith.
  2. Zona Hemorrhagica: pectinate line ⇒ hilton white line, stratified squamous non-keratinized epithelium
  3. Zona cutanea: stratified squamous keratinized non-hairy epithelium
49
Q

Blood supply of Anal canal

A 
ARTERY:
- superior rectal artery
- 2 inferior rectal arteries
- middle rectal artery
VEIN: 
- superior rectal vein
- inferior rectal vein
- middle rectal vein
50
Q

Innervation of Anal canal

A

superior to pectinate line: inferior hypogastric plexus

inferior to pectinate line: inferior anal nerves (pudendal nerve)

ANATOMY 2 (12 decks)

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