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AIM 2.2 > Foregut + Midgut > Flashcards

Foregut + Midgut Flashcards

1
Q

accessory digestive organs and their collective general function

A

Pancreas.
Gallbladder.
Liver.

Fxn: assist in digestion of food

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2
Q

main digestive organs and their functions

A

Esophagus (distal 1/3)
Stomach.
Intestines.

Fxn:
Ingestion
Propulsion
mechanical digestion
chemical digestion
absorption
defecation
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3
Q

secondary retroperitoneal organs

A

Originate in peritoneal space, then migrate to retroperitoneal space

Pancreas
Part of duodenum
Ascending/descending colon

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4
Q

primary retroperitoneal organs

A

kidneys

adrenal glands

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5
Q

ascites

A

Accumulation of protein-containing fluid within the abdomen.
Lose appetite, feel SOB, uncomfortable.

Tx: low sodium diet, diuretics

Causes: liver disease, cancer, heart failure, kidney failure, pancreatitis, tuberculosis

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6
Q

foregut

A 
distal 1/3 of esophagus,
1.5 parts of duodenum,
liver,
gallbladder,
pancreas,
spleen

blood supply: celiac trunk

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7
Q

midgut

A 
2.5 parts of duodenum,
jejunum,
ileum,
cecum,
appendix,
ascending colon,
proximal 2/3 transverse colon

blood supply: superior mesenteric artery

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8
Q

hindgut

A 
Distal 1/3 transverse colon,
descending colon,
sigmoid colon,
rectum,
upper 2/3 anal canal

blood supply: inferior mesenteric artery

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9
Q

esophagus passes thru diaphgragm at

A

T10

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10
Q

functions of esophagus

A

Secrete mucus.

Peristalsis

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11
Q

esophagus extends from _________ to _________

A

esophagus extends from pharynx to stomach

begins at level of the cricoid

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12
Q

GERD (general, symptoms, causes, risks)

A

Occurs when stomach acid flows back into esophagus.

Symptoms: heartburn, chest pain, difficulty swallowing, regurgitation of food, lump in throat

Causes: sphincter (LES) relaxes abnormal or weakens

Risks: obesity, hiatal hernial, pregnancy, scleroderma, delayed stomach emptying

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13
Q

complications of GERD

A

Esophageal ulcer.
Esophageal stricture.
Precancerous changes (Barrett’s esophagus)

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14
Q

functions of stomach

A 
Temporary storage (2-4 hours).
Mixing.
Acidic pH.
Mechanical/chemical digestion.
Some nutrient absorption (water, electrolytes, alcohol, NSAIDs)
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15
Q

peptic ulcer disease (general, sx, cause)

A

Open sores that develop on inside of stomach lining (gastric) and upper portion of small intestine (duodenal).

Sx: stomach pain

Cause: H.pylori infection, long term use of aspirin/NSAIDs

stress/spicy foods do NOT cause ulcers, but do exacerbate them

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16
Q

hiatal hernia

A

Occurs when upper stomach bulges thru diaphragm (weakened).

Causes: age, injury, congenitally large hiatus, pressure from coughing/straining/lifting

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17
Q

widest part of small intestine

A

duodenum

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18
Q

location where duodenum becomes jejunum

A

L2

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19
Q

4 parts of duodenum

A

1) superior
2) descending
3) transverse
4) ascending

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20
Q

spleen functions

A

Early hematopoesis.
Mechanical filtration of senescent erythrocytes.
Infection control.

NO role in digestion, but is still intraperitoneal.

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21
Q

splenomegaly

A

Enlargement of spleen.
From disease like portal hypertension or infection

Cannot palpate normally, but can if enlarged.

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22
Q

ligament of Treitz

A

Suspensory ligament of duodenum.

Right crus of diaphragm, and connective tissue to duodenum.

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23
Q

landmarks/directions associated with ligament of Treitz

A

Above: upper GI
Below: lower GI (usually w/ respect to bleeding)

Diagnosis of intestinal malrotation/ partial rotation.

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24
Q

accessory duct of pancreas

A

Duct of Santorini.

Empties directly into duodenum (does NOT combine with common bile duct).

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25
Q

main pancreatic duct

A

Duct of Wirsung.

Combines with common bile duct in ampulla of Vater.

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26
Q

ampulla of Vater

A

Enlargement where pancreatic and bile ducts come together.

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27
Q

major duodenal papilla

A

Sphincter of Oddi.
Releases content from common bile duct and pacreatic duct.

LANDMARK: above is foregut, below is midgut

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28
Q

endocrine function of pancreas

A

Release insulin to blood.
Regulates blood sugar.

Diabetes mellitus

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29
Q

exocrine function of pancreas

A

Release enzymes into pancreatic duct, into small intestine.

Loss = diarrhea, malnutrition.

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30
Q

blood supply of pancreas

A

HEAD:
anastamoses from branches of celiac trunk (foregut) and superior mesenteric (midgut). —- anterior/posterior superior pacreaticoduodenal AND anterior/posterior inferior pancreaticoduodenal [celiac > common hepatic > gastroduodenal].

Body: greater pancreatic a., dorsal pancreatic a. (both from splenic a.)

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31
Q

lymphatic drainage of pancreas

A

MAJOR:
celiac lymph nodes
superior mesenteric lymph nodes

MINOR:
superior pancreatic LN
pancreaticoduodenal LN
pyloric LN

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32
Q

clinical significance of head of pancreas

A

Common site for carcinoma.
Close to duodenum.
Numerous ducts/blood vessels.

Enlargement due to carcinoma can put pressure on duodenum (intestinal obstruction).
Jaundice due to pressure on bile duct (bilirubin flows back to liver, re-enters circulation).
Carcinoma erodes local vessels causing bleeding.

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33
Q

mucosal folds

A

In jejunum and ileum.

Increase surface area.

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34
Q

ileocecal junction

A

sphincter between ileum and cecum.

Endoscope here for gold standard diagnosis of Crohn’s disease.

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35
Q

large intestine

A

extends from ileocecal junction to upper part of anal canal

site where water, electrolytes, vitamin K is absorbed

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36
Q

cecum

A

large pouch forming the beginning of large intestine

connected to cecum is small blind tube or diverticulum (appendix)

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37
Q

colon

A

4 segments:

ascending
transverse
descending
sigmoid

38
Q

rectum

A

pelvic pt of large intestine

39
Q

anal canal

A

last subdivision of large intestine

40
Q

vermiform appendix

A

contains lymphoid tissue, neutralizes pathogens

variable anatomical position, base of the appendix is attached to the cecum

41
Q

most common cause of surgery in the abd

A

appendicitis (pain felt in periumbilical region T10)

42
Q

perforation of inflamed appendix leads to

A

peritonitis (nflammation and infection of the peritoneum)

43
Q

physical indications of appendicitis

A

pain worsened by pressure over the McBurney Point

+ Blumberg sign (REBOUND tenderness when palpating abd)

+ posas sign (irritation to illopsoas due to inflammed appendix)

44
Q

external features of the large intestine (3)

A

omental (epiploic) appendices

taenia coli

haustra

45
Q

omental (epiploic) appendice

A

small, fat filled pouches along large intestine

46
Q

taenia coli

A

3 longitudinal smooth muscle bands (*not in rectum or anal canal)

47
Q

haustra

A

sacculations of the colon from tightening of teniae coli

48
Q

mass movements (peristaltic contractions)

A

circular muscles contract simultaneously w/ teniae coli of colon wall to move colon contents twd anus

49
Q

dilatation at end of rectum

A

rectal ampulla

50
Q

After the rectosigmoid junction, 3 transverse folds are found in the rectum

A

superior rectal fold
middle rectal fold
inferior rectal fold

51
Q

anorectal junction

A

between rectum and anus

52
Q

puborectalis m.

A

wraps around the posterior aspect of the rectum forming a sling that holds the rectum forward in the pelvis

53
Q

celiac trunk

landmark, supplying…?

A

T12

foregut

54
Q

superior mesenteric a.

landmark, supplying…?

A

L1

midgut

55
Q

inferior mesenteric a.

landmark, supplying…?

A

L3

hindgut

56
Q

Foregut blood supply comes from which branches of the celiac trunk?

A
  1. L gastric a.
  2. Splenic a.
  3. Common hepatic a.
    - proper hepatic
    - gastroduodenal
57
Q

Midgut blood supply comes from which branches of superior mesenteric a.?

A
  1. Ileocolic a.
  2. R colic a.
  3. Middle colic a.
58
Q

terminal end arteries of the superior mesenteric artery that reach the intestinal wall

A

vasa rectae (straight arteries)

59
Q

Hundgut blood supply comes from which branches of the inferior mesenteric a.?

A

marginal artery (artery of Drummond)

L colic a.

sigmoid arteries

60
Q

marginal artery (artery of Drummond)

A

formed by anastomosing ends of the branches of the superior and inferior mesenteric arteries

61
Q

venous drainage of abd cavity

A

all drains into hepatic portal v. which accepts drainage from

superior mesenteric v.
inferior mesenteric v. (via splenic v.)

62
Q

celiac lymph nodes receive lymph from

A 
gallbladder
duodenum
pancreas
spleen
stomach
63
Q

superior mesenteric lymph nodes receive lymph from

A

cecum
ascending and R half of transverse colon
jejunum
ileum

64
Q

inferior mesenteric lymph nodes receive lymph from

A

hindgut

65
Q

cisterna chyli

A

lowest portion of thoracic duct

all three lymph groups drain here (celiac, superior mesenteric, inferior mesenteric)

66
Q

innervation from foregut to descending colon

A

visceral afferent pain fibers

SYMPATHETIC fibers (thoracic and lumbar splanchnic nerves T6-T12)

67
Q

innervation from sigmoid to upper part of rectum and anal canal

A

visceral afferent pain fibers

PARASYMPATHETIC fibers (pelvic splanchnic nervers S2-S4)

68
Q

sympathetic innervation of abd acts to

A

dec motility and secretions/contract sphincters

69
Q

parasympathetic innervation of abd acts to

A

inc motility and secretions/relax sphincters

70
Q

greater, lesser, least splanchnic n.

nerve roots?
ganglion?
paths of postsynaptic fibers?

A

T5-T12

synapse on celiac, superior mesenteric ganglion

postsynaptic fibers travel thru aortic and periarterial plexuses to viscera (foregut and midgut)

71
Q

lumbar splanchnic n.

nerve roots?
ganglion?
paths of postsynaptic fibers?

A

L1-L2

synapse on inferior mesenteric, superior hypogastric ganglion

travel thru aortic and periarterial plexuses to viscera (hindgut)

72
Q

vagus CNX

paths of presynaptic fibers?
ganglion?
paths postsynaptic fibers?

A

presynaptic fibers travel thru aortic and periarterial plexuses

synapse on enteric ganglion on the viscera (foregut and midgut)

postsynaptic fibers are lying on or w/i the abd viscera (foregut and midgut)

73
Q

pelvic splanchnic n.

nerve roots?
paths of presynaptic fibers?
ganglion?
paths postsynaptic fibers?

A

S2-S4

presynaptic fibers travel through inferior hypogastric plexuses

synapse on enteric hanglion in the viscera (hindgut)

postsynaptic fibers are lying on or within the abd viscera (hindgut)

74
Q

pectinate line

A

anatomic anorectal junction

remnant of anal membrane (during development)

above pectinate line –> endoderm (hindgut)
below pectinate line –> ectoderm

75
Q

external anal sphincter

A

voluntary control

relaxation –> defecation
constriction –> maintains fecal continence

76
Q

internal anal sphincter

A

involuntary control

modified extension of circular m. of rectum

relaxation –> defecation
constriction –> maintains fecal continence

77
Q

above pectinate line, anal canal is receiving blood from

A

superior rectal a. (br. of inferior mesenteric a.)

78
Q

below pectinate line, anal canal is receiving blood from

A

middle rectal a.
inferior rectal a.
(br. of internal iliac a.)

79
Q

above pectinate line, anal canal venous drainage goes to

A

inferior mesenteric v. (to portal v.)

80
Q

below pectinate line, anal canal venous drainage goes to

A

common iliac v. (to inferior vena cava)

81
Q

venous blood from lower anal canal dumps into ________, while venous blood from upper anal canal (hindgut) goes __________.

A

venous blood from lower anal canal dumps into systemic circulation directly, while venous blood from upper anal canal (hindgut) goes to hepatic system first.

82
Q

at anorectal junction, what time of anastomoses are present?

A

portacaval anastomosis

anastomoses between portal and systemic circulation

83
Q

portacaval anastamoses locations

A

esophageal veins
retroperitoneal veins
anorectal veins
paraumbilical veins

84
Q

hemorrhoids

A

normally, external/internal venous plexuses are cushions that help w/ stool control

disease when swollen or prolapsed

85
Q

lymphatic drainage of the anal canal

A

above pectinate line –> inferior mesenteric nodes, cisterna chyli

below pectinate line –> superficial inguinal nodes

86
Q

anal canal innervation above pectinate line

A

hindgut innervation (autonomic and visceral sensory) to mucosa and internal anal sphincter

87
Q

anal canal innervation below pectinate line

A

somatic motor to external anal sphincter and somatic sensory to skin around anal region

88
Q

Diverticulosis

A

false diverticula (external evaginations of mucosa of colon) develop along intestine

commonly found in sigmoid colon

infection/rupture –> diverticulitis (can erode arteries, cause hemorrhage)

tx: supportive, treat inflammation, surgery

middle-aged and elderly affected

89
Q

volvulus of sigmoid colon

A

rotations/twisting of the mobile loop of sigmoid colon

result: obstruction of lumen of descending colon proximal to twisted segment

leads to…
constipation (may progress to fecal impaction)
ischemia/necrosis if untreated

tx: decompression or resection of the sigmoid

90
Q

colorectal cancers

A

risk fx: FHx, IBD, old age, African American, low-fiber diet, alcohol, smoking, obesity

signs/sx: 
change in bowel habits
rectal bleeding
persistent abd discomfort
pain
weakness/fatigue
unexplained weight loss

most cases begin as small, benign clumps of cells –> “adenomatous polyps”

dx: colonoscopy

3 primary tx: surgery, chemo, radiation

AIM 2.2 (26 decks)

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