Foregut

Question 1

Foregut Basics

• Consists of
• Blood supply
• Lymphatics

Answer 1

• Distal oesophagus, stomach, liver, spleen, proximal duodenum, pancreas
• Branches of coeliac axis (aorta at T12). Drains to portal vein
• Pre-aortic nodes at T12 (coeliac nodes)

Question 2

Stomach

• What and where is it?
• Greater and lesser omentum
• Wall morphology
• Notches and rugae

Answer 2

• Intra-peritoneal muscular bag
• Lesser from lesser curvature, greater from greater curvature
• Serosa, muscularis externa, submucosa and mucosa are layers in wall
• Angular and cardiac notches. Rugae are folds which are visible when stomach is empty.

Question 3

Surface Anatomy of Stomach

• Fundus
• Pyloric valve
• Trans-pyloric plane

Answer 3

• Rises under left hemi-diaphragm. Can go as high as 5th or 6th rib
• Quite fixed positionally
• @ L1

Question 4

Stomach Arteries

• Coeliac axis and branches
• Gastric arteries
• Splenic vein
• Greater curvature

Answer 4

• Very short. Comes off abdominal aorta and immediately divides into splenic, left gastric and common hepatic arteries. All of these contribute to stomach supply.
• Right comes from hepatic artery, left from coeliac axis. Both supply lesser curvature. Short gastric supplies fundus of stomach.
• Bendy vessel along top of pancreas, heading to supply spleen
• Supplied by gastro-omental artery, which comes from the hepatic on the right and the splenic on the left.

Question 5

Stomach Veins

• Gastric veins
• Left gastro-epiploic and short gastric
• Right gastro-epiploic

Answer 5

• Left and right both into hepatic portal vein
• Into splenic vein and then into portal vein
• Into superior mesenteric vein and then into portal

Question 6

Stomach Lymph

• Coeliac nodes
• Cisterna cyhli

Answer 6

• Nodes in stomach drain to coeliac nodes @ coeliac axis root (T12)
• Move from coeliac nodes to cisterna chyli and then on to thoracic duct.

Question 7

Stomach Innervation

• Autonomic
• Parasympathetic
• Sympathetic

Answer 7

• Coeliac plexus
• From anterior and posterior vagal trunks
• Fibres carried by the greater splanchnic nerve to the coeliac plexus

Question 8

Duodenum

• 1st Part
• 2nd Part
• 3rd Part
• 4th Part
• Plicae Circularis
• Blood supply

Answer 8

• Duodenal cap - first part of intestine
• Descending entrance of bile and pancreatic ducts
• Transverse
• Ascending to jejunum
• Folds on the inside of the duodenum
• Part coeliac axis and part superior mesenteric - is junction of foregut and midgut.

Question 9

Liver Morphology

• What is shown by the arrows?

Answer 9

• As shown

Question 10

Posterior Liver

• What is shown by the arrows?

Answer 10

• As shown

Question 11

Peritoneum

• Falciform and R&L triangular ligaments
• Coronary and left triangular ligament

Answer 11

• Made by peritoneum folding back on itself
• Created by right layer of falciform

Question 12

Lymphatic Drainage of Liver

• Where does the lymph go?
• How much lymph?

Answer 12

• To nodes at the porta hepatis and then the coeliac nodes
• 1/3 to 1/2 of entire body lymph

Question 13

Gall Bladder

• What is shown by F, B and N?
• What is shown by the arrows?

Answer 13

• Fundus, body and neck
• As shown

Question 14

Pancreas

• Splenic artery and vein
• Lymphatic drainage
• Innervation

Answer 14

• Artery along the top, vein posterior
• Coeliac (T12) or superior mesenteric (L1) pre-aortic nodes
• Coeliac and superior mesenteric plexuses