GASTRO Flashcards
1
Q
what is the foregut
A
mouth to the proximal 1/2 of the duodenum
2
Q
what is the midgut
A
the distal 1/2 of the duodenum to the right 2/3 of the transverse colon
3
Q
what is the hindgut
A
the left 1/3 of the transverse colon to the anal canal
4
Q
where is the foregut blood and nerve supply from
A
the coeliac trunk and the greater splanchnic nerve T5-9
5
Q
what is the midgut blood and nerve supply
A
the superior mesenteric artery and the lesser splanchnic nerve T10-11
6
Q
what is the hindgut blood and nerve supply
A
the inferior mesenteric artery and the least splanchnic nerve T12
7
Q
what is McBurney’s point
A
it is 2/3 on the way from the umbilicus to the anterior superior iliac spine
8
Q
what is McBurney’s point used to find
A
where the appendix lies in the abdomen
9
Q
what are the horizontal lines used to divide the abdomen
A
the subcostal and intercristal plane
10
Q
what is the vertical line used to separate the abdomen
A
the midclavicular line
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
12
Q
what are the three muscles found in the abdominal wall
A
- external oblique - runs inferomedially
- internal oblique - runs superomedially
- transverse abdominis
13
Q
what do the muscles of the abdomen form at the midline
A
an aponeurosis - forms the rectus sheath
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
15
Q
what are intraperitoneal organs
A
these are organs that care completely surrounded by peritoneum
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
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
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
19
Q
what are the basic features of the large intestine
A
there is the caecum, ascending, transverse, descending, sigmoid colon, rectum and anus.
20
Q
what is the blood supply to the ascending colon
A
the right colic artery from the superior mesenteric artery
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
22
Q
what is the blood supply for the descending colon
A
the left colic artery from the inferior mesenteric artery
23
Q
what is the blood supply for the sigmoid colon
A
the sigmoid arteries from the inferior mesenteric artery
24
Q
what is the epithelia found in the oesophagus
A
stratified squamous epithelium
25
what is the epithelium found in the stomach
simple columnar epithelium
26
what are the three muscle layers of the stomach
longitudinal, oblique and circular
27
how many muscle layers are there in the GI system
there are normally two, longitudinal and circular. the exception for this is in the stomach
28
what are brunners glands and where are they found
they are only found in the duodenum, and they secrete alkaline mucus which neutralises chyme
29
from the top the bottom what are the structures in the GI tract
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
30
what are the three arteries that come off the coeliac trunk
common hepatic, left gastric and splenic
31
what is present on the inside of the stomach
Rugae which are folds in the stomach that increase its surface area. it allows for expansion
32
what are the unique features of the colon
teniae coli, haustra and epiploic appendages
33
what is the epiploic foramen of winslow
it is between the stomach and the liver and it is a pocket into the retroperitoneal space
34
what occurs in the voluntary phase of swallowing
when food is being chewed and then pushed to the back of the oropharynx by the tongue
35
what happens during the first phase of involuntary swallowing
the nasopharynx closes and the hyoid bone elevates. the epiglottis is closed and the pharynx becomes shorter and wider through longitudinal muscle contraction
36
what happens during the second phase of involuntary swallowing
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.
37
what is the cardiac notch for
it helps to prevent oesophageal reflux of acid
38
what happens in GORD
the epithelium of the lower oesophagus changes from stratified squamous to simple columnar epithelium (metaplasia)
39
what nerves are involved in the gag reflex
CN9 - sensory
| CN10 - causes reflex
40
how much saliva on average does one produce a day
800 - 1500mls
41
what are the functions of saliva
lubrication, taste, cephalic digestion, oral hygiene
42
what are the contents of saliva
water, mucus, antibodies, enzymes (amylase)
43
describe the parotid gland and its secretions
it is the main salivary gland when stimulated. it gives off serous saliva via Stenson's duct
44
what nerve supplies the parotid gland
the glossopharyngeal nerve
45
what structures pass through the parotid gland
the facial nerve and the external carotid artery
46
describe the submandibular gland and its secretions
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
47
what nerve supplies the submandibular gland
the facial nerve
48
describe the sublingual gland
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
49
what nerve supplies the sublingual gland
the facial nerve
50
what secretions do the minor salivary glands produce
mucous secreting except the Von Ebner gland which is serous
51
what is the difference between serous and mucous secretions
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
52
what does parasympathetic innervation of salivary glands do
it stimulates saliva production
53
what are the cell layers in the GI tract
Mucosa
Submucosa - contains the submucosal plexus (ENS)
muscularis externa - myenteric plexus
serosa
54
how many layers are in the muscularis externa
2 layers the inner circular and the outer longitudinal
| - except in the stomach
55
how many muscularis externa layers are there in the stomach
3
| inner oblique, middle circular and outer longitudinal
56
what cells are present at the cardiac notch of the stomach
foveolar cells - mucous producing cells
57
what cells are found in the fundus of the stomach
parietal cells, chief cells and ECL cells
58
what cells are found in the body of the stomach
G cells, D cells and I cells
59
what do parietal cells produce
HCL and intrinsic factor
60
what do chief cells produce
pepsinogen
61
what do ECL cells produce
histamine
62
what do G cells produce (in stomach)
gastrin
63
what do D cells in the stomach produce
somatostatin
64
what do I cells in the stomach/duodenum produce
CCK
65
where are S cells found and what do they produce
they are in the duodenum and produce secretin
66
what are the functions of the stomach
digest and store food, activates enzymes, kills microbes, secretes intrinsic factor needed for B12 absorption
67
how is gastric acid produced in the parietal cells
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
68
what are the phases of gastric acid secretion
1. cephalic phase
2. gastric on phase
3. gastric off phase
4. intestinal phase
69
what happens during the cephalic phase of gastric acid secretion
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
70
what happens during the gastric on phase of gastric acid secretion
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
71
what happens during the gastric off phase of gastric acid secretion
when there is a low stomach pH and large stomach distension it triggers D cells to produce somatostatin which reduces HCL release
72
what happens during the intestinal phase of gastric acid secretion
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
73
what are 4 things that can cause a peptic ulcer
helicobacter pylori, NSAIDS, chemicals and gastroma
74
how does helicobacter pylori cause peptic ulcers
helicobacter produces ammonia from urea which is toxic to the mucosa of the stomach
75
how do NSAIDs cause peptic ulcers
they inhibit COX-1 which is required for prostaglandin production. prostaglandins are needed to make mucous
76
what is the treatment for a peptic ulcer
proton pump inhibitors
| H2 receptor antagonists
77
how is pepsinogen activated
after it is released it is converted into pepsin by itself as well as HCL
78
what is gastric motility
peristaltic waves in the stomach which are slow at the fundus and much harder in the antrum. they are about 3 every minute
79
what causes stomach contractions
interstitial cells of cajal which are in the longitudinal muscle layer
80
what slows down duodenal emptying
low pH, increased fatty acids, increased amino acids, distension, hypertonicity
81
what is gastroparesis
duodenal emptying is too delayed and food rots in the stomach
82
what is the GI water content (on average)
9L
83
what secretions make up for water content in the GI tract
intestines, saliva, bile, stomach juices and pancreatic juices
84
what do the alpha, beta and gamma cells of the pancreas produce
alpha - glucagon
beta - insulin
delta - somatostatin
85
how much water is reabsorbed into the body
98% - about 200mls into the stool
86
how much water is absorbed in the jejunum, ilium and colon
5500mls - jejunum
2000mls - ileum
1300mls - colon
87
what ion is the most abundant in chyme
sodium
88
what vitamins are absorbed in the jejunum
B and C
89
what vitamins are absorbed in the ileum
A, D, E, K, B12
90
what is the process of carbohydrate metabolism
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
91
how are monosaccharides absorbed in the SI
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
92
describe the process of protein metabolism
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
93
how are proteins absorbed in the GI tract
they are absorbed via secondary active transport with sodium (or H+ if the fragments are small enough)
94
describe the process of fat metabolism
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
95
how is fat absorbed in the GI tract
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
96
what are the fat soluble vitamins
A, D, E, K
97
what are the water soluble vitamins
B, C
98
what are the properties of vitamin A and what is it needed for
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
99
what is a source of vitamin A and what happens if you are deficient in it
carrots
| night blindness
100
what are the properties of vitamin D
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
101
how is vitamin D activated in the body
UV converts 7 dehydrocholesterol to cholecalciferol. in the kidney this is converted to vitamin D3
102
what is the form of vitamin D found in supplements
vitamin D2
103
what a source of vitamin D and what does deficiency cause
UVb light
| bone issues such as rickets
104
what are the properties of vitamin E
it is an antioxidant. it is found in nuts and seeds and is stored in the liver
105
what are the properties of vitamin K
it activates clotting factors. it is found in plants as well as in synthetic forms (K3 and 4). deficiency leads to bleeding disorders
106
what are the clotting factors that vitamin K activates
10, 9, 7, 3
| remember 1973
107
what are the properties of vitamin B12
required for cell metabolism and energy. it is indirectly related to DNA synthesis due to folate.
108
how is vitamin B12 absorbed
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
109
what is a source of vitamin b12 and what happens if you are deficient in it
found in eggs and poultry.
| deficiency leads to pernicious anaemia
110
what are the properties of vitamin C
required for immune system function, Fe absorption and is an antioxidant. found in fresh fruit and veg and a deficiency leads to scurvy
111
what are the two forms of iron found in the body
transferrin - how its transported in the blood
| ferritin - how its stored in the liver
112
where is copper stored
in the liver
113
what is calcium needed for in the body
for muscle contraction and synaptic transmission
114
what is iodine used for in the body and what is its source
used as the thyroid hormone and found in seafood
115
what is BMI and how do you calculate it
body mass index and calculated by dividing weight (kg) by height (M2)
116
what is BMR and what is it measured in
basal metabolic rate and measured in Kcal/Hr/M2
117
what nerve and blood supply does the foregut have
supplied by the T5-9 greater splanchnic nerve
| supplied by the coeliac blood axis
118
does the foregut have a ventral or dorsal mesentery
both
119
does the midgut have a dorsal or ventral mesentery
dorsal
120
does the hindgut have a dorsal or ventral mesentery
dorsal
121
what spinal level is the superior mesenteric artery at
L1
122
what spinal level is the inferior mesenteric artery at
L3/4
123
what is a mesentery
it is a double layered peritoneum with blood vessels and nerves which supplies the abdominal viscera
124
what does a mesentery allow for
it allows for motility as it suspends viscera in the peritoneal cavity
125
what is viscera with a mesentery known as
intraperitoneal
126
what is viscera without a mesentery known as
retroperitoneal
127
what is the difference between primary and secondary peritoneal
secondary peritoneal used to have a mesentery and now doesnt. primary never had a mesentery
128
what embryological layers is the gut derived from
the endoderm (epithelial linings) and mesoderm (connective tissue and muscle)
129
what are the embryological steps involved in midgut (and hindgut) formation
Elongation, herniation, rotation, retraction and fixation
130
what week in development is the primitive gut tube
the 4th week
131
what is formed at the cranial end of the primitive gut tube
the oropharyngeal membrane
132
what week in development does the oropharyngeal membrane burst and what does it form
4th week and forms the mouth
133
what develops at the caudal end of the primitive gut tube
the cloacal membrane
134
at what week in development does the cloacal membrane rupture and what does it form
at the 7th week and forms the anus and urogenital openings
135
how does the foregut form
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
what does the ventral and dorsal mesentery become respectively
the lesser and greater omentum
137
what are the pharyngeal arches - embryology
they arise from the oesophageal membrane and develop in week 4/5. they give rise to components of the larynx and the pharynx
138
what happens to amino acids once they are absorbed
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
what happens to triglycerides after they have been absorbed
they can be stored in adipocytes as monoglycerides. they can be converted into fatty acids. they can be stored in the liver
140
what happens to glucose after it has been absorbed
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
what are the retroperitoneal organs
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
What is the first location that Fat is acted upon by Lipase enzymes when passing through the GI tract
Oral cavity
143
where is the porta hepatis found
on the underside of the liver
144
what is present in the porta hepatis
the hepatic artery proper, portal vein, hepatic bile duct, Vagus nerve branches, sympathetics and lymphatics.
145
What is the action of the proton pump in the parietal cells of the stomach
K+ into cell, H+ out of cell
146
What is the function of the drug ‘Omeprazole’ on the GI tract
Inhibition of Proton Pump to reduce acid secretion
147
How many layers of muscle are present in the stomach wall
3
148
What is the change in cell-type (‘metaplasia’) seen in the lower oesophagus after prolonged reflux of acid
Stratified squamous to columnar
149
what is secreted by ECL cells
Histamine
150
What is the function of Intrinsic Factor produced in the stomach
Allows absorption of Vitamin B12 in the terminal ileum
151
what supplies the jejunum
Superior Mesenteric Artery
152
what is the vagus nerves action on parietal cells
Vagus nerve is part of the parasympathetic system and releases acetylcholine onto parietal cells
153
How do non steroidal anti inflammatory drugs (NSAIDs) irritate the stomach
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
what is the peritoneal cavity
potential space between the parietal and visceral peritoneum
155
what is in the peritoneal cavity
thin film of peritoneal fluid which acts as a lubricant
| - free movement of the abdominal viscera
156
what are the subdivisions of the peritoneal cavity
greater and lesser peritoneal sacs
157
what are the divisions of the greater peritoneal sac
supracolic and infracolic
158
what is in the supracolic compartment of the greater sac
the stomach, liver and spleen
| above the transverse mesocolon
159
what lies in the infracolic compartment of the greater sac
below the transverse mesocolon, it contains the small intestine, ascending and descending colon
160
what is Calot's triangle
it is a small space in the abdomen that is located in the porta hepatis of the liver
161
what are the borders of Calots triangle
medial - common hepatic duct
inferior - cystic duct
superior - inferior surface of the liver
162
what are the contents of Calots triangle
the right hepatic artery, the cystic artery, the lymph node of Lund and the lymphatics
163
what is the peritoneum
it is a continuous membrane which lines the abdominal cavity and covers the abdominal organs
164
what is the cell type of the peritoneum
simple squamous
165
what are the two layers of the peritoneum
parietal (inner) and visceral (outer)
166
what is pain from the visceral peritoneum referred to as
dermatomes/areas of the skin
167
what is a mesentery
it is a double layer of visceral peritoneum
168
what are the properties of the greater omentum
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
what is the inguinal (hesselbach's) triangle
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
what are the boarders of the inguinal triangle
medial - lateral border of the rectus abdominis
lateral - inferior epigastric vessels
inferior - inguinal ligament
171
what are the joints in the lumbar spine
intervertebral discs made from fibrocartilage
172
where does the oesophagus originate
the inferior border of the cricoid cartilage
173
where does the oesophagus end
T11 - cardiac orifice
174
what are the different layers of the oesophagus - outer to inner
adventitia, muscle layer (external longitudinal and internal circular), submucosa and mucosa
175
what is the cell type found in the oesophagus
non keratinised stratified squamous
176
what are the four physiological constrictions in the lumen of the oesophagus
aortic arch, bronchus, cricoid cartilage, diaphragmatic hiatus
177
what is the thoracic oesophagus blood supply
the thoracic aorta and the inferior thyroid artery
178
what is the abdominal oesophagus blood supply
left gastric artery and the left inferior phrenic artery
179
what does the nervous innervation of the oesophagus come from
the oesophageal plexus - vagal trunk. sympathetic comes from the cervical and thoracic sympathetic trunk
180
what spinal level is the pylorus of the stomach
L1
181
what is found anterior to the stomach
diaphragm, greater omentum, left lobe of the liver, gall bladder
182
what is found posterior to the stomach
the lesser sac, pancreas, left kidney, left adrenal, spleen
183
what is the nervous innervation of the stomach
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
where does the small intestine extend from, to
the pylorus of the stomach to the ileocecal junction
185
what are the 4 parts of the duodenum
superior, descending, inferior and ascending
186
what is the spinal level of the superior duodenum
L1
187
what connects the superior duodenum and the stomach
the hepatoduodenal ligament
188
what portion of the duodenum wraps the head of the pancreas
the descending duodenum
189
what portion of the duodenum is the major duodenal papilla present in
the descending duodenum
190
what spinal level is the descending duodenum at
L1 -3
191
what spinal level is the inferior duodenum at
L3
192
what spinal level is the ascending duodenum at
L3 - 2
193
are the jejunum and ileum retroperitoneal or intraperitoneal
intraperitoneal
194
what is the duodenal blood supply
proximal to the major duodenal papilla is supplied by the gastroduodenal. the distal portion is supplied by the superior mesenteric
195
what is the blood supply to the jejunum and the ileum
superior mesenteric artery
196
what is the blood supply of the jejunum and ileum
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
what is the difference between the vasa recta of the jejunum and ileum
the jejunum vasa recta is long and the ileum ones are shorter
198
what is the difference between arcades in the jejunum and ileum
in the jejunum there less arcades than in the ileum
199
is the ascending colon intraperitoneal or retroperitoneal
retroperitoneal
200
what connects the transverse colon to the diaphragm
phrenoicocolic ligament
201
what is the least fixed part of the colon
the transverse colon
202
what are the teniae coli of the large intestine
three longitudinal strips of muscle on - mesencolic, free and omental coli
203
what are omental appendices
small pouches of peritoneum filled with fat
204
what spinal level does the rectum begin with
S3
205
what are the two major flexures of the rectum
the sacral flexure and the anorectal flexure (puborectalis muscle)
206
what are the other flexures that are in the rectum
superior, middle and inferior flexures what are formed due to the transverse folds in the internal rectum wall
207
where is the rectum is faeces stored
the ampulla
208
what is the rectal blood supply
the superior, middle and inferior rectal artery
209
what is the nervous supply of the rectum
innervated by the lumbar splanchnic plexus (and hypogastric plexus), it also has supply from the S2-4 via the pelvic splanchnic nerves
210
what are the anatomical relations of the gall bladder
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
what is surrounding the gallbladder
it is entirely surrounded by peritoneum and is in direct relation to the visceral surface of the liver
212
what is the anatomical structure of the gall bladder
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
what is the pathway of the biliary tree
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
what is the arterial supply of the gallbladder
cystic artery
215
what is the anatomical position of the pancreas
it is positioned at the transpyloric plane which is at L1
216
what is the relations of the pancreas to other structures around it
stomach - anterior
duodenum - pancreas head is wrapped round
transverse mesocolon - attached to anterior surface of the pancreas
spleen - posterior and lateral
217
what are the 5 parts of the pancreas
the head, uncinate process, neck, body and tail
218
what is the internal structure of the pancreas like
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
what artery that supplies the pancreas
the splenic artery
220
what is the head of the pancreas also supplied by (blood)
the superior and inferior pancreaticoduodenal arteries which are branched of the gastroduodenal and superior mesenteric arteries
221
where is the abdomen is the spleen located
the upper left quadrant of the abdomen
222
what connects the spleen to the greater curve of the stomach
the gastric ligament
223
what connects the hilum of the spleen to the left kidney
the splenorenal ligament
224
what are the borders of the spleen
anterior - stomach
posterior - diaphragm, left lung, ribs 9-11
inferior - left colic flexure/splenic flexure
medial - left kidney and tail of the pancreas
225
what is the spleen vascularized by
the splenic artery (arises from the coeliac trunk)
226
where is the root of the mesentery
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
what is the mesentery of the small intestine like
it connects the jejunum and the ileum to the posterior abdominal wall
228
where is the right mesocolon
it is flattened against the posterior abdominal wall
229
where is the transverse mesocolon found
it is a mobile structure that lies between the colic flexures
230
there is the left mesocolon found
flattened against the posterior abdominal wall
231
where is the mesosigmoid found
medial portion is flattened against the posterior abdominal wall, where as the region of the mesentery associated with the sigmoid colon itself is mobile
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where is the mesorectum found
it assists in anchoring the rectum through the pelvis
233
what spinal level does the superior mesenteric artery arise from
L1
234
what are the branches that the superior mesenteric artery gives off
inferior pancreaticoduodenal artery, jejunal and ileal arteries, right colic arteries, middle colic artery
235
what are the three major branches that arise from the inferior mesenteric artery
the left colic artery, the sigmoid artery and the superior rectal artery
236
what are the three lateral abdominal muscles
the external oblique, the internal oblique and the transversus abdominis
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what are the 9 anatomical regions of the stomach
three central regions - epigastric, umbilical and suprapubic
three lateral regions - hypochondrium, flank and iliac fossa
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what is the intertubercular plane
level of the tubercles of the iliac crests and marks the position of the bifurcation of the abdominal aorta
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why does appendicitis pain 'move'
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
what is the abdominal cavity lined by
simple squamous epithelia
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what is the right gastro-epiploic artery a branch of
the gastroduodenal artery
242
where does the left gastroepiploic artery come from
the splenic artery
243
where does the right gastric artery come from
the hepatic artery
244
are plicae circularis more pronounced in the jejunum or the ilium
more pronounced in the jejunum
245
what are plicae circularis
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
where are peyer's patches found in the small intestine
in the ilium
247
what are the superior mesenteric arteries to the colon
ileo-colic, right colic and middle colic branches
248
where does the large intestine start
at the ileo-caecal valve in the right iliac fossa
249
what is the taenia coli
it is the outer longitudinal muscle layer of the large intestine, forming three bands
250
what forms haustrations on the large intestine
between the tenia coli, the circular inner layer bulges repeatedly between them
251
What is a Merkel's deviation
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
what is the embryological derivative of the liver
the foregut
253
what is the quadrate lobe of the liver
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
what is the caudate love of the liver
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
what are the three main branches of the coeliac trunk
the left gastric artery, the common hepatic artery and the splenic artery
256
what does the left gastric artery supply
the lesser curvature of the stomach and the lower third of the oesophagus
257
what does the common hepatic artery supply
the liver, the gall bladder, the stomach, the duodenum and the pancreas
258
what does the splenic artery supply
the pancreas, the spleen and the stomach
259
what is the posterior attachment of the tongue
it is attached to the ramus of the mandible and hyoid bone
260
what nerve supplies taste sensation to the anterior 2/3 of the tongue
the facial nerve
261
what nerve supplies taste sensation to the posterior 1/3 of the tongue
the glossopharyngeal nerve
262
what nerve gives general sensation to the anterior 2/3 of the tongue
the trigeminal nerve - mandibular
263
what nerve supplies general sensation to the posterior 1/3 of the tongue
glossopharyngeal
264
what nerve are the muscles of the tongue supplied by
the hypoglossal nerve
265
what structures make up the soft palate
tensor, palatine, levator palatine, musculus uvuli, palatoglossus and palatopharyngeus
266
what is the function of the soft palate
it controls the orifice between the nasal and oral parts of the pharynx
267
what happens when the tensor and levator palatine muscle contracts
contraction of these opens the eustachian tube and allows air to enter the middle ear from the naso-pharynx
268
what is the bulla ethmoidallis
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
what is the hiatus semilunaris
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
what are bruners glands and where are they found
glands that secrete bicarb rich secretion of mucus and are found in the duodenum
271
what are crypts of lieberkuhn
the lie between bases of villi and contain stem cells, enteroendocrine and paneth cells
272
what are paneth cells
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
what are peyers patches
this is lymphoid tissue found in the submucosa of the ileum (mostly)
274
what are plicae circulares
these are vascular flaps projecting into the small intestine lumen - duplications of the mucus membrane
275
what is the function of gastric inhibitory peptide
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
what is the action of vasoactive intestinal peptide
it stimulates secretion from intestinal glands, dilates regional capillaries and inhibits acid secretion. it causes more effective absorption
277
what ions are pancreatic juices rich in
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
what cells produce pancreatic enzymes
acinar cells
279
what cells in the pancreas release HCO3- and Na+
Centro acinar cells
280
what pancreatic cells exchange HCO3- for CL-
ductable cells
281
what channel does chloride ions move through
CFTR channel
