Foregut, Midgut & Hindgut Flashcards by bob g

Where does the Oesophagus start and end?

Distal laryngopharynx @C6/7

Ends at cardia of stomach @T11

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How long is the Oesophagus?

40cm from incisors to stomach. (Important when inserting tubes)

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Describe the right crus of diaphragm

Loop of muscle; forms lower oesophageal sphincter (Not a ‘true’ anatomical sphincter, because it is not a ring of muscle). @T11-12

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How does the epithelium change between the lower oesophagus and stomach?

Stratified squamous in oesophagus

Columnar epithelium in stomach

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What are mesenteries?

Mesenteries (ventral & dorsal) are double-layered folds of peritoneum attaching the gut tube to the body wall.

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Of the foregut, midgut and hindgut, which have dorsal or ventral mesenteries, or both?

Foregut - Dorsal and Ventral

Mid and Hindgut - Dorsal ONLY

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Describe the lesser omentum

Peritoneum between the stomach & liver

Composed of 2 Ligaments: Hepatoduodenal and Hepatogastric

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Describe the greater omentum

The peritoneum hanging off the greater curvature of stomach

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The Hepatoduodenal ligament contains which 3 structures?

Portal Vein
Hepatic Artery
Common Bile Duct

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Peritoneal folds develop from…

They differentiate into…

Develop from Dorsal and Ventral mesenteries

Omenta, Mesenteries and Ligaments

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Name the omenta of the peritoneal cavity

Greater Omentum 
(From dorsal mesentery)

Lesser Omentum
(From ventral mesentery)

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Name the mesenteries of the peritoneal cavity

Mesentery
(Suspends small bowel)

Transverse Mesocolon
(Suspends transverse colon)

Sigmoid Mesocolon
(Suspends sigmoid colon)

Mesoappendix
(suspends appendix)

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Name the ligaments of the peritoneal cavity

Hepatoduodenal
(Part of lesser omentum)

Hepatogastric
(Part of lesser omentum)

Splenorenal & Gastrosplenic Ligs.
(From spleen to kidney / from stomach to spleen)

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What level does the coeliac trunk come off at?

T12

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What level does the SMA come off at?

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What level does the IMA come off at?

What branches off the coeliac trunk?

Common Hepatic, Left Gastric & Splenic arteries

What could damage the gastroduodenal artery?

Peptic Ulcers

Especially posterior to 1st part of duodenum.

Name the retroperitoneal organs

S: suprarenal (adrenal) gland
A: aorta/IVC
D: duodenum (second and third part)
P: pancreas (except tail)
U: ureters
C: colon (ascending and descending)
K: kidneys
E: (o)esophagus
R: rectum

Name the intraperitoneal organs

S = Stomach
A = Appendix
L = Liver
T = Transverse colon
D = duodenum (only the 1st part)
S = Small intestines
P = Pancreas (only the tail)
R = Rectum (only the upper 3rd)
S = Sigmoid colon
S = Spleen

Describe the duodenum anatomically.

The duodenum is C-shaped and is retroperitoneal (except for the 1st part)
Composed of 4 Parts

What ligament is a useful landmark for the duodeno-jejunal flexure

Ligament of Treitz
Marker point for ‘upper’ vs ‘lower’ GI bleed
Suspends the 4th pt. (ascending part) of the duodenum to the posterior abdominal wall.

Where does the arterial supply for the pancreas and and duodenum come from?

Superior Pancreaticoduodenal artery (from CT)

anastamoses with Inferior Pancreaticoduodenal artery (from SMA).

Where does the caecum sit?

Right Iliac Fossa

What is Teniae Coli?

Longitudinal muscle of colon | Sits in 3 bands that begin at caecum (appendix) and end by covering the rectum

What are the pouches of the large intestine called?

Haustra

What position is the appendix normally in?

Retrocaecal in 60% of people.

What is Intussusception?

Proximal segment of bowel telescopes into an adjacent distal segment Typically in ileocecal junction

Describe the appendix

Blind ended sac | Has own mesentery and artery (SMA -> Ileocolic a. -> Appendicular a.)

Why is the hepatorenal recess important to consider in a supine patient, with peritonitis?

Infections can spread from under the diaphragm to pelvic cavity and vice versa via Paracolic Gutters.

Describe the arterial supply of the hindgut (route).

IMA -> Left colic, Sigmoidal (Join the Marginal A.) and Superior Rectal SMA, IMA and Internal Iliac anastamose (Marginal artery)

Where are the 3 important Portosystemic Anastomoses? What are the clinically significant conditions related to these?

Lower End of the Oesophagus (!Oesophageal Varices) Lower part of Anal Canal (!Anorectal Varices) Umbilical Region of Anterior Abdo Wall (!Caput Medusae)

What are Haemorrhoids?

Prolapsed varicosity of internal venous plexus from excessive straining during defecation. NOT Anorectal Varices!

What positions are Haemorrhoids classically reported on the Anus?

3, 7 and 11 o'clock

Describe what you might see in a barium contract test, if the patient had colon carcinoma?

Apple core sign

Where do GI structures' lymph drain to?

Thoracic duct and cisterna chyli