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Jemima Flash Cards > GASTRO > Flashcards

GASTRO Flashcards

1
Q

what is the foregut

A

mouth to the proximal 1/2 of the duodenum

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2
Q

what is the midgut

A

the distal 1/2 of the duodenum to the right 2/3 of the transverse colon

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3
Q

what is the hindgut

A

the left 1/3 of the transverse colon to the anal canal

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4
Q

where is the foregut blood and nerve supply from

A

the coeliac trunk and the greater splanchnic nerve T5-9

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5
Q

what is the midgut blood and nerve supply

A

the superior mesenteric artery and the lesser splanchnic nerve T10-11

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6
Q

what is the hindgut blood and nerve supply

A

the inferior mesenteric artery and the least splanchnic nerve T12

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7
Q

what is McBurney’s point

A

it is 2/3 on the way from the umbilicus to the anterior superior iliac spine

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8
Q

what is McBurney’s point used to find

A

where the appendix lies in the abdomen

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9
Q

what are the horizontal lines used to divide the abdomen

A

the subcostal and intercristal plane

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10
Q

what is the vertical line used to separate the abdomen

A

the midclavicular line

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11
Q

what does the transpyloric plane of addison cross

A

it crosses at the level of T1

crosses the gallbladder, pancreas, pylorus, duodenal-jejunal flexure and kidneys

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12
Q

what are the three muscles found in the abdominal wall

A
  1. external oblique - runs inferomedially
  2. internal oblique - runs superomedially
  3. transverse abdominis
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13
Q

what do the muscles of the abdomen form at the midline

A

an aponeurosis - forms the rectus sheath

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14
Q

what are retroperitoneal organs

A

they sit directly on the posterior abdominal wall and are covered by the peritoneum on its anterior surface only

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15
Q

what are intraperitoneal organs

A

these are organs that care completely surrounded by peritoneum

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16
Q

what is the blood supply of the stomach

A

the greater curvature is supplied by the right and left gastroepiploic artery. the lesser curvature is supplied by the right and left gastric arteries (the left is directly from the coeliac trunk)
short gastric arteries supply the fundus which are branches of the splenic artery

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17
Q

what are the features of the stomach

A

there are two openings, the cardiac and the pyloric orifices
there are two curvatures the greater and lesser
there are two surfaces, the anterior and posterior
there is antrum, body, pylorus, fundus

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18
Q

what are the basic features of the duodenum

A

it is a C shape, and there are 4 parts; the superior, descending, inferior and ascending. the main section is the descending curve where you have bile duct emptying into the duodenum. this is via the major papilla and the flow is controlled by the sphincter of oddi

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19
Q

what are the basic features of the large intestine

A

there is the caecum, ascending, transverse, descending, sigmoid colon, rectum and anus.

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20
Q

what is the blood supply to the ascending colon

A

the right colic artery from the superior mesenteric artery

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21
Q

what is the blood supply for the transverse colon

A

proximal 2/3 is the middle colic from the superior mesenteric. distal 1/3 is from the inferior mesenteric

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22
Q

what is the blood supply for the descending colon

A

the left colic artery from the inferior mesenteric artery

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23
Q

what is the blood supply for the sigmoid colon

A

the sigmoid arteries from the inferior mesenteric artery

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24
Q

what is the epithelia found in the oesophagus

A

stratified squamous epithelium

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25
Q

what is the epithelium found in the stomach

A

simple columnar epithelium

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26
Q

what are the three muscle layers of the stomach

A

longitudinal, oblique and circular

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27
Q

how many muscle layers are there in the GI system

A

there are normally two, longitudinal and circular. the exception for this is in the stomach

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28
Q

what are brunners glands and where are they found

A

they are only found in the duodenum, and they secrete alkaline mucus which neutralises chyme

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29
Q

from the top the bottom what are the structures in the GI tract

A

pharynx (naso/laryngo), upper oesophagel sphincter, Oesophagus, cardiac notch, lower oesophageal sphincter, stomach, pyloric sphincter, duodenum, jejunum, ilium, coecum, ascending colon, transverse colon, descending colon, sigmoid colon, rectum, anus

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30
Q

what are the three arteries that come off the coeliac trunk

A

common hepatic, left gastric and splenic

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31
Q

what is present on the inside of the stomach

A

Rugae which are folds in the stomach that increase its surface area. it allows for expansion

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32
Q

what are the unique features of the colon

A

teniae coli, haustra and epiploic appendages

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33
Q

what is the epiploic foramen of winslow

A

it is between the stomach and the liver and it is a pocket into the retroperitoneal space

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34
Q

what occurs in the voluntary phase of swallowing

A

when food is being chewed and then pushed to the back of the oropharynx by the tongue

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35
Q

what happens during the first phase of involuntary swallowing

A

the nasopharynx closes and the hyoid bone elevates. the epiglottis is closed and the pharynx becomes shorter and wider through longitudinal muscle contraction

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36
Q

what happens during the second phase of involuntary swallowing

A

food passes from the mouth to the oesophagus, and the upper oesophageal sphincter opens. there is sequential movement of food down and there is contractions of the circular muscle.

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37
Q

what is the cardiac notch for

A

it helps to prevent oesophageal reflux of acid

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38
Q

what happens in GORD

A

the epithelium of the lower oesophagus changes from stratified squamous to simple columnar epithelium (metaplasia)

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39
Q

what nerves are involved in the gag reflex

A

CN9 - sensory

CN10 - causes reflex

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40
Q

how much saliva on average does one produce a day

A

800 - 1500mls

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41
Q

what are the functions of saliva

A

lubrication, taste, cephalic digestion, oral hygiene

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42
Q

what are the contents of saliva

A

water, mucus, antibodies, enzymes (amylase)

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43
Q

describe the parotid gland and its secretions

A

it is the main salivary gland when stimulated. it gives off serous saliva via Stenson’s duct

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44
Q

what nerve supplies the parotid gland

A

the glossopharyngeal nerve

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45
Q

what structures pass through the parotid gland

A

the facial nerve and the external carotid artery

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46
Q

describe the submandibular gland and its secretions

A

it is a mixed saliva secretion (serous and mucous) via the Wharton’s duct.
It has serous demilunes (serous acini forming crescents around mucous acini)
it is continuously secreting

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47
Q

what nerve supplies the submandibular gland

A

the facial nerve

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48
Q

describe the sublingual gland

A

it is the smallest out of the main glands, and secretes mucous secretions via Wharton’s duct. it is continuously secreting
anterior to the submandibular gland

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49
Q

what nerve supplies the sublingual gland

A

the facial nerve

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50
Q

what secretions do the minor salivary glands produce

A

mucous secreting except the Von Ebner gland which is serous

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51
Q

what is the difference between serous and mucous secretions

A

serous contains water and alpha amylase and histologically looks dark with a small central duct

mucous contains water and mucous and histologically looks light with a large central duct

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52
Q

what does parasympathetic innervation of salivary glands do

A

it stimulates saliva production

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53
Q

what are the cell layers in the GI tract

A

Mucosa
Submucosa - contains the submucosal plexus (ENS)
muscularis externa - myenteric plexus
serosa

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54
Q

how many layers are in the muscularis externa

A

2 layers the inner circular and the outer longitudinal

- except in the stomach

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55
Q

how many muscularis externa layers are there in the stomach

A

3

inner oblique, middle circular and outer longitudinal

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56
Q

what cells are present at the cardiac notch of the stomach

A

foveolar cells - mucous producing cells

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57
Q

what cells are found in the fundus of the stomach

A

parietal cells, chief cells and ECL cells

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58
Q

what cells are found in the body of the stomach

A

G cells, D cells and I cells

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59
Q

what do parietal cells produce

A

HCL and intrinsic factor

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60
Q

what do chief cells produce

A

pepsinogen

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61
Q

what do ECL cells produce

A

histamine

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62
Q

what do G cells produce (in stomach)

A

gastrin

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63
Q

what do D cells in the stomach produce

A

somatostatin

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64
Q

what do I cells in the stomach/duodenum produce

A

CCK

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65
Q

where are S cells found and what do they produce

A

they are in the duodenum and produce secretin

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66
Q

what are the functions of the stomach

A

digest and store food, activates enzymes, kills microbes, secretes intrinsic factor needed for B12 absorption

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67
Q

how is gastric acid produced in the parietal cells

A

In the parietal cell CO2 and H2O combine to make H2CO3. this then dissociates into HCO3- and H+.
HCO3- is basolaterally exchanged for Cl- into the cell. H+ is actively transported out the H+K+ATPase pump apically. Cl- diffuses out the apical side of the cell with K+ where it combines with H+ in the stomach to form HCL

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68
Q

what are the phases of gastric acid secretion

A
  1. cephalic phase
  2. gastric on phase
  3. gastric off phase
  4. intestinal phase
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69
Q

what happens during the cephalic phase of gastric acid secretion

A

this is initiated by sight, smell, thinking of food. Ach via the parasympathetic NS increases gastrin and histamine release as well as directly acting on parietal cells to increase HCL secretion

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70
Q

what happens during the gastric on phase of gastric acid secretion

A

food in the stomach - stimulatory
the stomach distends and there are amino acids found in the stomach. this triggers an increase in gastrin release. this activates more histamine release as well as acting on parietal cells to increase HCL secretion. there is an increase in H+K+ATPase pumps

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71
Q

what happens during the gastric off phase of gastric acid secretion

A

when there is a low stomach pH and large stomach distension it triggers D cells to produce somatostatin which reduces HCL release

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72
Q

what happens during the intestinal phase of gastric acid secretion

A

there is inhibition due to the presence of fatty acids and amino acids, low pH and high duodenal distension.
this causes enterogastrone release which induces secretin and CCK to be released

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73
Q

what are 4 things that can cause a peptic ulcer

A

helicobacter pylori, NSAIDS, chemicals and gastroma

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74
Q

how does helicobacter pylori cause peptic ulcers

A

helicobacter produces ammonia from urea which is toxic to the mucosa of the stomach

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75
Q

how do NSAIDs cause peptic ulcers

A

they inhibit COX-1 which is required for prostaglandin production. prostaglandins are needed to make mucous

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76
Q

what is the treatment for a peptic ulcer

A

proton pump inhibitors

H2 receptor antagonists

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77
Q

how is pepsinogen activated

A

after it is released it is converted into pepsin by itself as well as HCL

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78
Q

what is gastric motility

A

peristaltic waves in the stomach which are slow at the fundus and much harder in the antrum. they are about 3 every minute

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79
Q

what causes stomach contractions

A

interstitial cells of cajal which are in the longitudinal muscle layer

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80
Q

what slows down duodenal emptying

A

low pH, increased fatty acids, increased amino acids, distension, hypertonicity

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81
Q

what is gastroparesis

A

duodenal emptying is too delayed and food rots in the stomach

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82
Q

what is the GI water content (on average)

A

9L

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83
Q

what secretions make up for water content in the GI tract

A

intestines, saliva, bile, stomach juices and pancreatic juices

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84
Q

what do the alpha, beta and gamma cells of the pancreas produce

A

alpha - glucagon
beta - insulin
delta - somatostatin

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85
Q

how much water is reabsorbed into the body

A

98% - about 200mls into the stool

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86
Q

how much water is absorbed in the jejunum, ilium and colon

A

5500mls - jejunum
2000mls - ileum
1300mls - colon

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87
Q

what ion is the most abundant in chyme

A

sodium

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88
Q

what vitamins are absorbed in the jejunum

A

B and C

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89
Q

what vitamins are absorbed in the ileum

A

A, D, E, K, B12

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90
Q

what is the process of carbohydrate metabolism

A

starts in the mouth with alpha amylase.
it continues in the duodenum with pancreatic amylase were about 95% starch broken down. this makes oligo/disaccharides. there are membrane bound oligo/disaccaridases which break them down to monosaccharides - glucose, galactose and fructose

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91
Q

how are monosaccharides absorbed in the SI

A

glucose and galactose via a glucose sodium symporter - SGLT1
fructose is absorbed via facilitated diffusion - GLUTs
all three leave the basolateral side of cells via GLUT2

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92
Q

describe the process of protein metabolism

A

digestion starts in the stomach with pepsin. most occurs in the duodenum. the pancreas secreted inactive endo and exopeptidases (trypsinogen, chymotryposinogen and carboxypeptidase) which are activated in the duodenum. these then cut peptides mid chain and end of chain respectively.
membrane bound aminopeptidases break down the smaller chains

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93
Q

how are proteins absorbed in the GI tract

A

they are absorbed via secondary active transport with sodium (or H+ if the fragments are small enough)

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94
Q

describe the process of fat metabolism

A

starts in the mouth. in the duodenum they are emulsified by bile salts, preventing reaggregation. lipase and colipase bind to the droplets converting the triglycerides to monoglycerides and fatty acids. with the bile salts these are packaged into micelles and transported to the intestinal cell membrane

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95
Q

how is fat absorbed in the GI tract

A

micelles break down at the cell membrane and the monoglycerides and fatty acids diffuse into the cell. once in the cell they reaggregate into vesicles called chylomicrons. these get exocytosed into lacteals of the lymphatic system

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96
Q

what are the fat soluble vitamins

A

A, D, E, K

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97
Q

what are the water soluble vitamins

A

B, C

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98
Q

what are the properties of vitamin A and what is it needed for

A

called retinol or rhodopsin it is absorbed as a lipid and stored in the liver in ITO cells or in the space of disse. it is needed for night vision

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99
Q

what is a source of vitamin A and what happens if you are deficient in it

A

carrots

night blindness

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100
Q

what are the properties of vitamin D

A

known as calciferol. it is required for calcium and phosphate intestinal absorption. it is stored in the liver
- active form of vitamin D is Vitamin D3

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101
Q

how is vitamin D activated in the body

A

UV converts 7 dehydrocholesterol to cholecalciferol. in the kidney this is converted to vitamin D3

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102
Q

what is the form of vitamin D found in supplements

A

vitamin D2

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103
Q

what a source of vitamin D and what does deficiency cause

A

UVb light

bone issues such as rickets

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104
Q

what are the properties of vitamin E

A

it is an antioxidant. it is found in nuts and seeds and is stored in the liver

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105
Q

what are the properties of vitamin K

A

it activates clotting factors. it is found in plants as well as in synthetic forms (K3 and 4). deficiency leads to bleeding disorders

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106
Q

what are the clotting factors that vitamin K activates

A

10, 9, 7, 3

remember 1973

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107
Q

what are the properties of vitamin B12

A

required for cell metabolism and energy. it is indirectly related to DNA synthesis due to folate.

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108
Q

how is vitamin B12 absorbed

A

it initially binds to the R protein of transcobalamin 1 in the stomach. in the duodenum it dissociates from this and binds to intrinsic factor

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109
Q

what is a source of vitamin b12 and what happens if you are deficient in it

A

found in eggs and poultry.

deficiency leads to pernicious anaemia

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110
Q

what are the properties of vitamin C

A

required for immune system function, Fe absorption and is an antioxidant. found in fresh fruit and veg and a deficiency leads to scurvy

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111
Q

what are the two forms of iron found in the body

A

transferrin - how its transported in the blood

ferritin - how its stored in the liver

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112
Q

where is copper stored

A

in the liver

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113
Q

what is calcium needed for in the body

A

for muscle contraction and synaptic transmission

114
Q

what is iodine used for in the body and what is its source

A

used as the thyroid hormone and found in seafood

115
Q

what is BMI and how do you calculate it

A

body mass index and calculated by dividing weight (kg) by height (M2)

116
Q

what is BMR and what is it measured in

A

basal metabolic rate and measured in Kcal/Hr/M2

117
Q

what nerve and blood supply does the foregut have

A

supplied by the T5-9 greater splanchnic nerve

supplied by the coeliac blood axis

118
Q

does the foregut have a ventral or dorsal mesentery

A

both

119
Q

does the midgut have a dorsal or ventral mesentery

A

dorsal

120
Q

does the hindgut have a dorsal or ventral mesentery

A

dorsal

121
Q

what spinal level is the superior mesenteric artery at

A

L1

122
Q

what spinal level is the inferior mesenteric artery at

A

L3/4

123
Q

what is a mesentery

A

it is a double layered peritoneum with blood vessels and nerves which supplies the abdominal viscera

124
Q

what does a mesentery allow for

A

it allows for motility as it suspends viscera in the peritoneal cavity

125
Q

what is viscera with a mesentery known as

A

intraperitoneal

126
Q

what is viscera without a mesentery known as

A

retroperitoneal

127
Q

what is the difference between primary and secondary peritoneal

A

secondary peritoneal used to have a mesentery and now doesnt. primary never had a mesentery

128
Q

what embryological layers is the gut derived from

A

the endoderm (epithelial linings) and mesoderm (connective tissue and muscle)

129
Q

what are the embryological steps involved in midgut (and hindgut) formation

A

Elongation, herniation, rotation, retraction and fixation

130
Q

what week in development is the primitive gut tube

A

the 4th week

131
Q

what is formed at the cranial end of the primitive gut tube

A

the oropharyngeal membrane

132
Q

what week in development does the oropharyngeal membrane burst and what does it form

A

4th week and forms the mouth

133
Q

what develops at the caudal end of the primitive gut tube

A

the cloacal membrane

134
Q

at what week in development does the cloacal membrane rupture and what does it form

A

at the 7th week and forms the anus and urogenital openings

135
Q

how does the foregut form

A

at he 4th week a fusiform dilation forms. at week 7 there is a 90 degree clockwise longitudinal rotation which creates the lesser sac. at week 8 there is ventrodorsal rotation forming stomach

136
Q

what does the ventral and dorsal mesentery become respectively

A

the lesser and greater omentum

137
Q

what are the pharyngeal arches - embryology

A

they arise from the oesophageal membrane and develop in week 4/5. they give rise to components of the larynx and the pharynx

138
Q

what happens to amino acids once they are absorbed

A

they are either stored as protein in muscle or go to the liver. here they are turned into alpha keto acids. from here they can go onto make fatty acids or enter into oxidative phosphorylation

139
Q

what happens to triglycerides after they have been absorbed

A

they can be stored in adipocytes as monoglycerides. they can be converted into fatty acids. they can be stored in the liver

140
Q

what happens to glucose after it has been absorbed

A

can be stored as glycogen in the muscles. it can be stored in adipocytes as alpha glycerol phosphate or fatty acids, both of which can form triglycerides. it can be taken up by the liver, stored as glycogen, fatty acids or alpha glycerol phosphate

141
Q

what are the retroperitoneal organs

A

Remember SAD PUCKER
suprarenal glands, aorta/IVC, second and third part of duodenum, tail of pancreas, ureters, colon (ascending and descending), kidneys, (o)esophagus, rectum

142
Q

What is the first location that Fat is acted upon by Lipase enzymes when passing through the GI tract

A

Oral cavity

143
Q

where is the porta hepatis found

A

on the underside of the liver

144
Q

what is present in the porta hepatis

A

the hepatic artery proper, portal vein, hepatic bile duct, Vagus nerve branches, sympathetics and lymphatics.

145
Q

What is the action of the proton pump in the parietal cells of the stomach

A

K+ into cell, H+ out of cell

146
Q

What is the function of the drug ‘Omeprazole’ on the GI tract

A

Inhibition of Proton Pump to reduce acid secretion

147
Q

How many layers of muscle are present in the stomach wall

A

3

148
Q

What is the change in cell-type (‘metaplasia’) seen in the lower oesophagus after prolonged reflux of acid

A

Stratified squamous to columnar

149
Q

what is secreted by ECL cells

A

Histamine

150
Q

What is the function of Intrinsic Factor produced in the stomach

A

Allows absorption of Vitamin B12 in the terminal ileum

151
Q

what supplies the jejunum

A

Superior Mesenteric Artery

152
Q

what is the vagus nerves action on parietal cells

A

Vagus nerve is part of the parasympathetic system and releases acetylcholine onto parietal cells

153
Q

How do non steroidal anti inflammatory drugs (NSAIDs) irritate the stomach

A

NSAIDs inhibit COX-1 and COX-2 (COX = cyclo-oxygenase).
COX-2 is the target enzyme and blockade of this will inhibit production of inflammatory and nociceptive-enhancing prostaglandins.
Inhibition of COX-1 will prevent production of gastro-protective prostaglandins

154
Q

what is the peritoneal cavity

A

potential space between the parietal and visceral peritoneum

155
Q

what is in the peritoneal cavity

A

thin film of peritoneal fluid which acts as a lubricant

- free movement of the abdominal viscera

156
Q

what are the subdivisions of the peritoneal cavity

A

greater and lesser peritoneal sacs

157
Q

what are the divisions of the greater peritoneal sac

A

supracolic and infracolic

158
Q

what is in the supracolic compartment of the greater sac

A

the stomach, liver and spleen

above the transverse mesocolon

159
Q

what lies in the infracolic compartment of the greater sac

A

below the transverse mesocolon, it contains the small intestine, ascending and descending colon

160
Q

what is Calot’s triangle

A

it is a small space in the abdomen that is located in the porta hepatis of the liver

161
Q

what are the borders of Calots triangle

A

medial - common hepatic duct
inferior - cystic duct
superior - inferior surface of the liver

162
Q

what are the contents of Calots triangle

A

the right hepatic artery, the cystic artery, the lymph node of Lund and the lymphatics

163
Q

what is the peritoneum

A

it is a continuous membrane which lines the abdominal cavity and covers the abdominal organs

164
Q

what is the cell type of the peritoneum

A

simple squamous

165
Q

what are the two layers of the peritoneum

A

parietal (inner) and visceral (outer)

166
Q

what is pain from the visceral peritoneum referred to as

A

dermatomes/areas of the skin

167
Q

what is a mesentery

A

it is a double layer of visceral peritoneum

168
Q

what are the properties of the greater omentum

A

there are four layers of visceral peritoneum and it descends from the greater curvature of the stomach and the proximal part of the duodenum to the liver

169
Q

what is the inguinal (hesselbach’s) triangle

A

it is a region in the anterior abdominal wall, it contains no clinically significant structures, however it can be weak and herniation can occur

170
Q

what are the boarders of the inguinal triangle

A

medial - lateral border of the rectus abdominis
lateral - inferior epigastric vessels
inferior - inguinal ligament

171
Q

what are the joints in the lumbar spine

A

intervertebral discs made from fibrocartilage

172
Q

where does the oesophagus originate

A

the inferior border of the cricoid cartilage

173
Q

where does the oesophagus end

A

T11 - cardiac orifice

174
Q

what are the different layers of the oesophagus - outer to inner

A

adventitia, muscle layer (external longitudinal and internal circular), submucosa and mucosa

175
Q

what is the cell type found in the oesophagus

A

non keratinised stratified squamous

176
Q

what are the four physiological constrictions in the lumen of the oesophagus

A

aortic arch, bronchus, cricoid cartilage, diaphragmatic hiatus

177
Q

what is the thoracic oesophagus blood supply

A

the thoracic aorta and the inferior thyroid artery

178
Q

what is the abdominal oesophagus blood supply

A

left gastric artery and the left inferior phrenic artery

179
Q

what does the nervous innervation of the oesophagus come from

A

the oesophageal plexus - vagal trunk. sympathetic comes from the cervical and thoracic sympathetic trunk

180
Q

what spinal level is the pylorus of the stomach

A

L1

181
Q

what is found anterior to the stomach

A

diaphragm, greater omentum, left lobe of the liver, gall bladder

182
Q

what is found posterior to the stomach

A

the lesser sac, pancreas, left kidney, left adrenal, spleen

183
Q

what is the nervous innervation of the stomach

A

parasympathetic arises from the anterior and posterior vagal trunks. the sympathetic innervation comes from T6-9 spinal nerves, passes to the coeliac plexus via the greater splanchnic nerve

184
Q

where does the small intestine extend from, to

A

the pylorus of the stomach to the ileocecal junction

185
Q

what are the 4 parts of the duodenum

A

superior, descending, inferior and ascending

186
Q

what is the spinal level of the superior duodenum

A

L1

187
Q

what connects the superior duodenum and the stomach

A

the hepatoduodenal ligament

188
Q

what portion of the duodenum wraps the head of the pancreas

A

the descending duodenum

189
Q

what portion of the duodenum is the major duodenal papilla present in

A

the descending duodenum

190
Q

what spinal level is the descending duodenum at

A

L1 -3

191
Q

what spinal level is the inferior duodenum at

A

L3

192
Q

what spinal level is the ascending duodenum at

A

L3 - 2

193
Q

are the jejunum and ileum retroperitoneal or intraperitoneal

A

intraperitoneal

194
Q

what is the duodenal blood supply

A

proximal to the major duodenal papilla is supplied by the gastroduodenal. the distal portion is supplied by the superior mesenteric

195
Q

what is the blood supply to the jejunum and the ileum

A

superior mesenteric artery

196
Q

what is the blood supply of the jejunum and ileum

A

from the superior mesenteric artery. It moves between the layers of the mesentery and splits into branches. these anastomose to form loops called arcades. from arcades there are long straight arteries called vasa recta

197
Q

what is the difference between the vasa recta of the jejunum and ileum

A

the jejunum vasa recta is long and the ileum ones are shorter

198
Q

what is the difference between arcades in the jejunum and ileum

A

in the jejunum there less arcades than in the ileum

199
Q

is the ascending colon intraperitoneal or retroperitoneal

A

retroperitoneal

200
Q

what connects the transverse colon to the diaphragm

A

phrenoicocolic ligament

201
Q

what is the least fixed part of the colon

A

the transverse colon

202
Q

what are the teniae coli of the large intestine

A

three longitudinal strips of muscle on - mesencolic, free and omental coli

203
Q

what are omental appendices

A

small pouches of peritoneum filled with fat

204
Q

what spinal level does the rectum begin with

A

S3

205
Q

what are the two major flexures of the rectum

A

the sacral flexure and the anorectal flexure (puborectalis muscle)

206
Q

what are the other flexures that are in the rectum

A

superior, middle and inferior flexures what are formed due to the transverse folds in the internal rectum wall

207
Q

where is the rectum is faeces stored

A

the ampulla

208
Q

what is the rectal blood supply

A

the superior, middle and inferior rectal artery

209
Q

what is the nervous supply of the rectum

A

innervated by the lumbar splanchnic plexus (and hypogastric plexus), it also has supply from the S2-4 via the pelvic splanchnic nerves

210
Q

what are the anatomical relations of the gall bladder

A

inferior border of the liver and anterior abdominal wall, posterior to it is the transverse colon and proximal duodenum. inferior to it is the biliary tree and remaining bit of duodenum

211
Q

what is surrounding the gallbladder

A

it is entirely surrounded by peritoneum and is in direct relation to the visceral surface of the liver

212
Q

what is the anatomical structure of the gall bladder

A

storage of about 30-50ml and lies anterior to the first part of the duodenum. it is divided into three parts: fundus, body and neck

213
Q

what is the pathway of the biliary tree

A

bile is initially secreted by hepatocytes and drains into the intrahepatic ducts. this then drains into the left and right hepatic ducts. these then join to form the common hepatic duct. this then joins the cystic duct. this joins to form one common bile duct. it descends and is joined by the pancreatic duct, these then form the hepatopancreatic ampulla and empties into the duodenum via the major duodenal papilla

214
Q

what is the arterial supply of the gallbladder

A

cystic artery

215
Q

what is the anatomical position of the pancreas

A

it is positioned at the transpyloric plane which is at L1

216
Q

what is the relations of the pancreas to other structures around it

A

stomach - anterior
duodenum - pancreas head is wrapped round
transverse mesocolon - attached to anterior surface of the pancreas
spleen - posterior and lateral

217
Q

what are the 5 parts of the pancreas

A

the head, uncinate process, neck, body and tail

218
Q

what is the internal structure of the pancreas like

A

there are clusters of cells called acini which are connected via duct. These intercalated ducts then unite with those that drain adjacent lobules and drain into intralobular collecting ducts which drains into the main pancreatic duct

219
Q

what artery that supplies the pancreas

A

the splenic artery

220
Q

what is the head of the pancreas also supplied by (blood)

A

the superior and inferior pancreaticoduodenal arteries which are branched of the gastroduodenal and superior mesenteric arteries

221
Q

where is the abdomen is the spleen located

A

the upper left quadrant of the abdomen

222
Q

what connects the spleen to the greater curve of the stomach

A

the gastric ligament

223
Q

what connects the hilum of the spleen to the left kidney

A

the splenorenal ligament

224
Q

what are the borders of the spleen

A

anterior - stomach
posterior - diaphragm, left lung, ribs 9-11
inferior - left colic flexure/splenic flexure
medial - left kidney and tail of the pancreas

225
Q

what is the spleen vascularized by

A

the splenic artery (arises from the coeliac trunk)

226
Q

where is the root of the mesentery

A

the root of the mesentery is the point where the bare area attaches to the posterior abdominal wall, the root is long and has an oblique origin (L2)

227
Q

what is the mesentery of the small intestine like

A

it connects the jejunum and the ileum to the posterior abdominal wall

228
Q

where is the right mesocolon

A

it is flattened against the posterior abdominal wall

229
Q

where is the transverse mesocolon found

A

it is a mobile structure that lies between the colic flexures

230
Q

there is the left mesocolon found

A

flattened against the posterior abdominal wall

231
Q

where is the mesosigmoid found

A

medial portion is flattened against the posterior abdominal wall, where as the region of the mesentery associated with the sigmoid colon itself is mobile

232
Q

where is the mesorectum found

A

it assists in anchoring the rectum through the pelvis

233
Q

what spinal level does the superior mesenteric artery arise from

A

L1

234
Q

what are the branches that the superior mesenteric artery gives off

A

inferior pancreaticoduodenal artery, jejunal and ileal arteries, right colic arteries, middle colic artery

235
Q

what are the three major branches that arise from the inferior mesenteric artery

A

the left colic artery, the sigmoid artery and the superior rectal artery

236
Q

what are the three lateral abdominal muscles

A

the external oblique, the internal oblique and the transversus abdominis

237
Q

what are the 9 anatomical regions of the stomach

A

three central regions - epigastric, umbilical and suprapubic
three lateral regions - hypochondrium, flank and iliac fossa

238
Q

what is the intertubercular plane

A

level of the tubercles of the iliac crests and marks the position of the bifurcation of the abdominal aorta

239
Q

why does appendicitis pain ‘move’

A

there is a vague abdominal pain due to the lesser splanchnic nerve (supplies dermatome in middle of stomach), however when the inflammation of the appendix is more, it rubs on the inside of the abdominal wall and the pain is relayed by cutaneous nerves and the pain is felt directly over the appendix

240
Q

what is the abdominal cavity lined by

A

simple squamous epithelia

241
Q

what is the right gastro-epiploic artery a branch of

A

the gastroduodenal artery

242
Q

where does the left gastroepiploic artery come from

A

the splenic artery

243
Q

where does the right gastric artery come from

A

the hepatic artery

244
Q

are plicae circularis more pronounced in the jejunum or the ilium

A

more pronounced in the jejunum

245
Q

what are plicae circularis

A

the numerous permanent crescentic folds of mucous membrane found in the small intestine especially in the lower part of the duodenum and the jejunum

246
Q

where are peyer’s patches found in the small intestine

A

in the ilium

247
Q

what are the superior mesenteric arteries to the colon

A

ileo-colic, right colic and middle colic branches

248
Q

where does the large intestine start

A

at the ileo-caecal valve in the right iliac fossa

249
Q

what is the taenia coli

A

it is the outer longitudinal muscle layer of the large intestine, forming three bands

250
Q

what forms haustrations on the large intestine

A

between the tenia coli, the circular inner layer bulges repeatedly between them

251
Q

What is a Merkel’s deviation

A

in embryology the yolk sac is attached to the bowel half way along its length. In 2% of adults this connection persists, which can contain gastric mucosa and can be a sight for peptic ulcers

252
Q

what is the embryological derivative of the liver

A

the foregut

253
Q

what is the quadrate lobe of the liver

A

area of the liver situated on the undersurface of the medial segment left lobe, bounded in front by the anterior margin of the liver, behind by the porta hepatis, on the right by the fossa for the gall-bladder, and on the left by the fossa for the umbilical vein.

254
Q

what is the caudate love of the liver

A

The caudate lobe is situated upon the posterosuperior surface of the liver on the right lobe of the liver, opposite the tenth and eleventh thoracic vertebrae.

The caudate lobe of the liver is bounded below by the porta hepatis, on the right by the fossa for the inferior vena cava, and on the left by the fossa for the ductus venosus and the physiological division of the liver, called the ligamentum venosum

255
Q

what are the three main branches of the coeliac trunk

A

the left gastric artery, the common hepatic artery and the splenic artery

256
Q

what does the left gastric artery supply

A

the lesser curvature of the stomach and the lower third of the oesophagus

257
Q

what does the common hepatic artery supply

A

the liver, the gall bladder, the stomach, the duodenum and the pancreas

258
Q

what does the splenic artery supply

A

the pancreas, the spleen and the stomach

259
Q

what is the posterior attachment of the tongue

A

it is attached to the ramus of the mandible and hyoid bone

260
Q

what nerve supplies taste sensation to the anterior 2/3 of the tongue

A

the facial nerve

261
Q

what nerve supplies taste sensation to the posterior 1/3 of the tongue

A

the glossopharyngeal nerve

262
Q

what nerve gives general sensation to the anterior 2/3 of the tongue

A

the trigeminal nerve - mandibular

263
Q

what nerve supplies general sensation to the posterior 1/3 of the tongue

A

glossopharyngeal

264
Q

what nerve are the muscles of the tongue supplied by

A

the hypoglossal nerve

265
Q

what structures make up the soft palate

A

tensor, palatine, levator palatine, musculus uvuli, palatoglossus and palatopharyngeus

266
Q

what is the function of the soft palate

A

it controls the orifice between the nasal and oral parts of the pharynx

267
Q

what happens when the tensor and levator palatine muscle contracts

A

contraction of these opens the eustachian tube and allows air to enter the middle ear from the naso-pharynx

268
Q

what is the bulla ethmoidallis

A

The ethmoid bulla (or ethmoidal bulla) is an elevation on the lateral wall of the middle meatus of the nose. It is produced by middle ethmoidal cells

269
Q

what is the hiatus semilunaris

A

The hiatus semilunaris is a semicircular shaped opening located on the lateral wall of the nasal cavity. It is a component of the ostiomeatal complex and serves as the opening for the frontal and maxillary sinuses and the anterior ethmoid air cells

270
Q

what are bruners glands and where are they found

A

glands that secrete bicarb rich secretion of mucus and are found in the duodenum

271
Q

what are crypts of lieberkuhn

A

the lie between bases of villi and contain stem cells, enteroendocrine and paneth cells

272
Q

what are paneth cells

A

they are secretory cells that secrete lysozyme which destroys peptidoglycan bonds. they also secrete defensins which increase ion channels in bacteria. finally they secrete TNF-alpha which increases inflammation

273
Q

what are peyers patches

A

this is lymphoid tissue found in the submucosa of the ileum (mostly)

274
Q

what are plicae circulares

A

these are vascular flaps projecting into the small intestine lumen - duplications of the mucus membrane

275
Q

what is the function of gastric inhibitory peptide

A

it is secreted when fats and carbs enter the duodenum and its action increases insulin release (also increases lipid synthesis and increase glucose use by muscles)

276
Q

what is the action of vasoactive intestinal peptide

A

it stimulates secretion from intestinal glands, dilates regional capillaries and inhibits acid secretion. it causes more effective absorption

277
Q

what ions are pancreatic juices rich in

A

Na+ and HCO30 if there is a fast flow rate

Na+ and CL- if the flow rate is slow as there is time for exchange

278
Q

what cells produce pancreatic enzymes

A

acinar cells

279
Q

what cells in the pancreas release HCO3- and Na+

A

Centro acinar cells

280
Q

what pancreatic cells exchange HCO3- for CL-

A

ductable cells

281
Q

what channel does chloride ions move through

A

CFTR channel

Jemima Flash Cards (9 decks)

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