Foregut (stomach and duodenum) Flashcards
what is contained in the foregut
distal oesophagus
stomach
liver
spleen
proximal duodenum
part of pancreas
what is the arterial blood supply of the foregut
blood from branches of coeliac axis (aorta T12)
where is the coeliac axis found on the aorta
anterior branch of abdominal aorta at vertebral level T12
blood from the foregut drains where
hepatic portal vein
lymph from the foregut drains where
local nodes and then into pre-aortic nodes at T12 (coeliac nodes)
where does the digestive system start
in oral cavity
the stomach is ____peritoneal
intra
what are the attachments of the greater and lesser omentum to the stomach
lesser omentum - on lesser curvature
greater omentum - on greater curvature
what lies posterior to the stomach
lesser sac
what allows communicaiton between the greater and lesser sacs
epiploic foramen
why do the muscle layers of the stomach lie in different orientations
to allow stomach to contract and churn food with digestive fluids inside
what is the external surface of the stomach
serosa - gives it a smooth shiny external appearance
describe the layers of the stomach wall from outer to inner
serosa
muscularis externa
submucosa
mucosa
what are the 3 layers of the muscularis externa
outer longitudinal
middle circular
inner oblique
the mucosa of the stomach has folds called
rugae
what is the function of rugae
allows expansion of stomach as it fills with food
what is the name of the sphincter between the stomach and the duodenum
pyloric sphincter
what do you call the part of the stomach that rises above the entrance to the oesophagus
fundus
what part of the stomach fills the left dome of the diaphragm
fundus
what controls outflow of stomach contents to the first part of the duodenum
pyloric sphincter
what forms the main part of the stomach and forms the greater and lesser curvatures
body
what are the 2 notches of the stomach
cardiac notch
angular notch
where does the fundus lie under the diaphragm
as high as 5th - 6th ribs on left side
where does the pyloric valve meet the duodenum
transpyloric plane - vertebral level L1 (rib 8)
what level is the transpyloric plane
L1 (rib 8)
in what regions does the stomach lie
occupies part of the left hypochondrium and epigastric regions
what 3 organs are posterior to the stomach
pancreas and spleen
top pole of left kidney
the coeliac axis (trunk) forms how many branches
3
what are the 3 branches of the coeliac trunk
left gastric artery
splenic artery
common hepatic artery
what is the smallest branch of the coeliac trunk
left gastric
the left gastric artery passes towards…
the lesser curvature of the stomach
what is the largest branch of the coeliac trunk
splenic artery
the splenic artery passes …
along the superior surface of the pancreas
the common hepatic artery passes…
towards the liver
from where does the right gastric artery originate
branch of common hepatic artery
what arteries supply the wall of greater curvature of the stomach and greater omentum
anastomosis of right and left gastro-epiploic (gastro-omental) arteries
describe the blood supply of the lesser curvature
left gastric (from coeliac trunk) and right gastric (from common hepatic) anastomose on lesser curvature and supply wall
what else does the left gastric artery supply
abdominal (distal) part of oesophagus
what is the blood supply of the fundus
short gastric arteries that branch from the splenic artery
the left gastro-epiploic artery is a branch from
splenic artery
the right gastro-epiploic artery is a branch from
gastroduodenal artery
the gastroduodenal artery that gives rise to right gastro-epiploic is a branch from
hepatic artery
blood from the stomach drains where
hepatic portal system
describe the venous drainage of the lesser curvature
left and right gastric veins drain directly into the hepatic portal vein
the left gastro-epiploic vein drains what where
greater curvature
into splenic vein
the short gastric veins drain what where
fundus
into splenic vein
the right gastro-epiploic vein drains what where
greater curvature
into superior mesenteric vein
how does the blood from the stomach eventually end up in the portal system
splenic and superior mesenteric veins unite to form hepatic portal vein
where does lymph from the stomach drain
into small groups of nodes related to stomach and then to pre-aortic coeliac nodes at T12 level (root of coeliac axis)
what is the area called around entrance of oesophagus
cardiac ring
lymph from the coeliac nodes drains where
to cisterna chyli then to thoracic duct
sympathetic innervation of the stomach is from where
greater splanchnic nerves from sympathetic chain in thorax - passes to celiac plexus then to plexuses on gastric and gastroomental arteries
parasympathetic innervation of the stomach is from where
parasympathetic fibres form a plexus over surface of oesophagus and form anterior and posterior vagal trunks that pass through diaphragm with oesophagus
what contributes fibres to the coeliac plexus
posterior vagal trunk and greater splanchnic nerves
the duodenum is _ shaped and _ cm long
C shaped
25cm
the duodenum surrounds the head of what organ
pancreas
how many named parts are there of the duodenum
4
the duodenum is ____peritoneal
partially retroperitoneal
what are the 4 parts of the duodenum
1st - duodenal cap
2nd - descending
3rd - transverse
4th - ascending
the duodenal cap is suspended by what
on a dorsal mesentery
what parts of the duodenum are retroperitoneal
2nd 3rd 4th
what part of the duodenum has the entrance of the bile and pancreatic ducts
2nd part (descending)
which part of the duodenum is crossed by the superior mesenteric vessels
3rd - transverse
what is the course of the 4th part of the duodenum
ascends to the root of the mesentery to join the jejenum
what is the name of the folds on the inner surface of the duodenum
plicae circulares
describe the wall of the duodenum
smooth outer wall and folded inner surface
describe the mucous membrane of the duodenum
thick
inner surface forms many folds - plicae circulares
the 2nd part of the duodenum communicates with the bile and pancreatic ducts via the
the bile and main pancreatic ducts unite to form the hepatopancreatic ampulla (of Vater) and enter the posteromedial wall of the descending duodenum at an eminence called the major duodenal papilla
what is the hepatopancreatic ampulla
union of common bile duct and main pancreatic duct
the hepatopancreatic ampulla opens into the duodenum where
beneath a small mound on inner surface called the major duodenal papilla
how is the flow of pancreatic and bile fluids into the duodenum controlled
hepatopancreatic spinchter (sphincter of Oddi) at the hepatopancreatic ampulla
bile is made in the ___ and passes into the ____ ___
liver
biliary tree
the sphincter of Oddi at the end of the biliary tree is normally closed so the bile backs up the biliary tree and into the gall bladder via the _____ ____
cystic duct
bile is stored where
in the gall bladder
how does bile enter the duodenum
sphincter of Oddi opens and biliary tree contracts to expel bile into duodenum
the sphincters are made of
smooth muscle
where does the duodenum lie
between vertebral levels L1-L3 in umbilical region
the duodenum begins where
just above transpyloric plane
the duodenum ends where
below transpyloric plane approx. 2-3cm to left of midline
where is the duodenal-jejunal junction
3cm left of midline
what are the relations of the 1st part of the duodenum
liver
gall bladder
bile duct
portal vein
IVC
what is the course of the 2nd part of the duodenum
descends towards the right kidney and wraps around the head of pancreas
what are the relations of the 2nd part of the duodenum
transverse colon
right kidney
ureter
pancreas
what are the relations of the 3rd part of the duodenum
superior mesenteric vessels
jejenum
right ureter
right psoas
IVC
aorta
pancreas
the 3rd part of the duodenum lies ____ to the superior mesenteric vessels
inferior
what are the relations of the 4th part of the duodenum
root of mesentery
jejenum
aorta
left psoas
the 4th part of the duodenum passes ____ to the left psoas and aorta
anterior
the 4th part of the duodenum joins the jejenum at the
root of the mesentery
the duodenum receives blood from
coeliac axis and superior mesenteric vessels
the proximal part of the duodenum is supplied by the
celiac axis –> common hepatic artery –> gastroduodenal artery –> superior pancreaticoduodenal artery
the superior pancreaticoduodenal artery comes from
gastro-duodenal artery from hepatic artery from coeliac axis
the distal part of the duodenum is supplied by the
inferior pancreaticoduodenal artery
the inferior pancreaticoduodenal artery comes from
superior mesenteric artery
the duodenum is said to lie at junction of what
foregut and midgut
the venous drainage of the superior part of the duodenum drains
into the hepatic portal system
the venous drainage of the inferior part of duodenum drains
into hepatic portal system via superior mesenteric vein
the sympathetic supply of the duodenum is from
greater and lesser splanchnic nerves via celiac and superior mesenteric plexuses
the parasympathetic supply of the duodenum is from
vagus nerves
pain from duodenum is referred where
epigastric region
what nerve plexuses supply the duodenum
coeliac and superior mesenteric plexuses
lymph from the duodenum drains where
local nodes then to pre-aortic nodes at both the coeliac axis and superior mesenteric artery
why does the duodenum have dual lymph drainage
it as dual arterial supply and as a general rule lymph drainage follows arterial supply
lymph from the proximal parts of the duodenum follow
pancreaticoduodenal, gastroduodenal and pyloric nodes to pre-aortic coeliac axis at T12
lymph from the distal parts follow
pancreaticoduodenal nodes to pre-aortic superior mesenteric nodes at L1
level of pre-aortic superior mesenteric nodes
L1
