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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
main pancreatic duct
Duct of Wirsung. | Combines with common bile duct in ampulla of Vater.
26
ampulla of Vater
Enlargement where pancreatic and bile ducts come together.
27
major duodenal papilla
Sphincter of Oddi. Releases content from common bile duct and pacreatic duct. LANDMARK: above is foregut, below is midgut
28
endocrine function of pancreas
Release insulin to blood. Regulates blood sugar. Diabetes mellitus
29
exocrine function of pancreas
Release enzymes into pancreatic duct, into small intestine. Loss = diarrhea, malnutrition.
30
blood supply of pancreas
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.)
31
lymphatic drainage of pancreas
MAJOR: celiac lymph nodes superior mesenteric lymph nodes MINOR: superior pancreatic LN pancreaticoduodenal LN pyloric LN
32
clinical significance of head of pancreas
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.
33
mucosal folds
In jejunum and ileum. | Increase surface area.
34
ileocecal junction
sphincter between ileum and cecum. Endoscope here for gold standard diagnosis of Crohn's disease.
35
large intestine
extends from ileocecal junction to upper part of anal canal site where water, electrolytes, vitamin K is absorbed
36
cecum
large pouch forming the beginning of large intestine connected to cecum is small blind tube or diverticulum (appendix)
37
colon
4 segments: ascending transverse descending sigmoid
38
rectum
pelvic pt of large intestine
39
anal canal
last subdivision of large intestine
40
vermiform appendix
contains lymphoid tissue, neutralizes pathogens variable anatomical position, base of the appendix is attached to the cecum
41
most common cause of surgery in the abd
appendicitis (pain felt in periumbilical region T10)
42
perforation of inflamed appendix leads to
peritonitis (nflammation and infection of the peritoneum)
43
physical indications of appendicitis
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
external features of the large intestine (3)
omental (epiploic) appendices taenia coli haustra
45
omental (epiploic) appendice
small, fat filled pouches along large intestine
46
taenia coli
3 longitudinal smooth muscle bands (*not in rectum or anal canal)
47
haustra
sacculations of the colon from tightening of teniae coli
48
mass movements (peristaltic contractions)
circular muscles contract simultaneously w/ teniae coli of colon wall to move colon contents twd anus
49
dilatation at end of rectum
rectal ampulla
50
After the rectosigmoid junction, 3 transverse folds are found in the rectum
superior rectal fold middle rectal fold inferior rectal fold
51
anorectal junction
between rectum and anus
52
puborectalis m.
wraps around the posterior aspect of the rectum forming a sling that holds the rectum forward in the pelvis
53
celiac trunk | landmark, supplying...?
T12 | foregut
54
superior mesenteric a. | landmark, supplying...?
L1 | midgut
55
inferior mesenteric a. | landmark, supplying...?
L3 | hindgut
56
Foregut blood supply comes from which branches of the celiac trunk?
1. L gastric a. 2. Splenic a. 3. Common hepatic a. - proper hepatic - gastroduodenal
57
Midgut blood supply comes from which branches of superior mesenteric a.?
1. Ileocolic a. 2. R colic a. 3. Middle colic a.
58
terminal end arteries of the superior mesenteric artery that reach the intestinal wall
vasa rectae (straight arteries)
59
Hundgut blood supply comes from which branches of the inferior mesenteric a.?
marginal artery (artery of Drummond) L colic a. sigmoid arteries
60
marginal artery (artery of Drummond)
formed by anastomosing ends of the branches of the superior and inferior mesenteric arteries
61
venous drainage of abd cavity
all drains into hepatic portal v. which accepts drainage from superior mesenteric v. inferior mesenteric v. (via splenic v.)
62
celiac lymph nodes receive lymph from
``` gallbladder duodenum pancreas spleen stomach ```
63
superior mesenteric lymph nodes receive lymph from
cecum ascending and R half of transverse colon jejunum ileum
64
inferior mesenteric lymph nodes receive lymph from
hindgut
65
cisterna chyli
lowest portion of thoracic duct all three lymph groups drain here (celiac, superior mesenteric, inferior mesenteric)
66
innervation from foregut to descending colon
visceral afferent pain fibers SYMPATHETIC fibers (thoracic and lumbar splanchnic nerves T6-T12)
67
innervation from sigmoid to upper part of rectum and anal canal
visceral afferent pain fibers PARASYMPATHETIC fibers (pelvic splanchnic nervers S2-S4)
68
sympathetic innervation of abd acts to
dec motility and secretions/contract sphincters
69
parasympathetic innervation of abd acts to
inc motility and secretions/relax sphincters
70
greater, lesser, least splanchnic n. nerve roots? ganglion? paths of postsynaptic fibers?
T5-T12 synapse on celiac, superior mesenteric ganglion postsynaptic fibers travel thru aortic and periarterial plexuses to viscera (foregut and midgut)
71
lumbar splanchnic n. nerve roots? ganglion? paths of postsynaptic fibers?
L1-L2 synapse on inferior mesenteric, superior hypogastric ganglion travel thru aortic and periarterial plexuses to viscera (hindgut)
72
vagus CNX paths of presynaptic fibers? ganglion? paths postsynaptic fibers?
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
pelvic splanchnic n. nerve roots? paths of presynaptic fibers? ganglion? paths postsynaptic fibers?
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
pectinate line
anatomic anorectal junction remnant of anal membrane (during development) above pectinate line --> endoderm (hindgut) below pectinate line --> ectoderm
75
external anal sphincter
voluntary control relaxation --> defecation constriction --> maintains fecal continence
76
internal anal sphincter
involuntary control modified extension of circular m. of rectum relaxation --> defecation constriction --> maintains fecal continence
77
above pectinate line, anal canal is receiving blood from
superior rectal a. (br. of inferior mesenteric a.)
78
below pectinate line, anal canal is receiving blood from
middle rectal a. inferior rectal a. (br. of internal iliac a.)
79
above pectinate line, anal canal venous drainage goes to
inferior mesenteric v. (to portal v.)
80
below pectinate line, anal canal venous drainage goes to
common iliac v. (to inferior vena cava)
81
venous blood from lower anal canal dumps into ________, while venous blood from upper anal canal (hindgut) goes __________.
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
at anorectal junction, what time of anastomoses are present?
portacaval anastomosis | anastomoses between portal and systemic circulation
83
portacaval anastamoses locations
esophageal veins retroperitoneal veins anorectal veins paraumbilical veins
84
hemorrhoids
normally, external/internal venous plexuses are cushions that help w/ stool control disease when swollen or prolapsed
85
lymphatic drainage of the anal canal
above pectinate line --> inferior mesenteric nodes, cisterna chyli below pectinate line --> superficial inguinal nodes
86
anal canal innervation above pectinate line
hindgut innervation (autonomic and visceral sensory) to mucosa and internal anal sphincter
87
anal canal innervation below pectinate line
somatic motor to external anal sphincter and somatic sensory to skin around anal region
88
Diverticulosis
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
volvulus of sigmoid colon
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
colorectal cancers
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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