Gastrointestinal

Question 1

What the two major vessels which supply the duodenum?

Answer 1

Gastroduodenal artery (proximal to the major duodenal papilla)

Inferior pancreaticoduodenal artery (distal to the major duodenal papilla)

Question 2

What forms the rectus sheath?

Answer 2

The aponeurosis (deep fascia) of the transverse abdominal and external and internal oblique muscles

Question 3

What are the anterior and posterior components of the rectus sheath above the costal margin?

Answer 3

Anterior - external oblique

Posterior - costal cartilages

Question 4

What are the anterior and posterior components of the rectus sheath above the arcuate line?

Answer 4

Anterior - external oblique and the anterior portion of the internal oblique

Posterior - posterior portion of the internal oblique and the transverse abdominis

Question 5

What are the anterior and posterior components of the rectus sheath below the arcuate line?

Answer 5

Anterior - tendinous expansions of all three oblique muscles

Posterior - transversalis fascia, peritoneum

Question 10

Where is the arcuate line?

Answer 10

Midway between the umbilicus and pubis

Question 11

Which four arteries supply the stomach?

Answer 11

1. Right gastric
2. Left gastric
3. Right gastro-omental
4. Left gastro-omental

Question 12

What are the borders of Calot’s triangle?

Answer 12

Medial: common hepatic duct

Inferior: cystic duct

Superior: inferior surface of the liver

Question 13

What are the borders of Hesselbach’s triangle?

Answer 13

Medial: lateral border of the rectus abdominus

Lateral: inferior epigastric vessels

Inferior: inguinal ligament

Question 14

What are the boundaries of the femoral ring?

Answer 14

Medial: lacunar ligament

Anterior: medial part of the inguinal ligament

Lateral: femoral vein within the intermediate compartment of the femoral sheath

Posterior: pectineal ligament overlying the pectineus and its fascia covering the superior pubic ramus

Question 15

What are the components of the portal triad?

Answer 15

Hepatic artery

Portal vein

Bile duct

Question 16

What is the lesser sac (omental bursa)?

Answer 16

Potential peritoneal space formed by the greater and lesser omentum

Allows the stomach to move freely against the structures posterior and inferior to it

Question 17

What is the lymphatic drainage of the anterior abdominal wall?

Answer 17

Above the umbilicus: axillary nodes

Below the umbilicus: superficial inguinal nodes

Question 18

What is the lymphatic drainage of the anus?

Answer 18

Above the pectinate line: internal iliac

Below the pectinate line: superficial inguinal

Question 19

What histological changes occur at the gastro-oesophageal junction?

Answer 19

Oesophagus: stratified squamous

Stomach: simple columnar

Question 20

What is the notch on the lesser curvature, separating the body and pyloric antrum of the stomach, called?

Answer 20

The incisura angularis

Question 21

What is biliverdin?

Answer 21

Product of heme catabolism

Responsible for the green colour seen in bruises

Question 22

How does heme become bilirubin?

Answer 22

Heme → biliverdin (heme oxygenase) → bilirubin (biliverdin reductase)

Question 23

What is urobilinogen?

Answer 23

Formed in the intestines from the bacterial breakdown of bilirubin

Question 24

What are the three possible end points for urobilinogen?

Answer 24

1. Urobilin (urine)
2. Stercobilin (faeces)
3. Hepatic reabsorption

Question 25

Which liver enzyme conjugates bilirubin?

Answer 25

UDP-glucuronosyltransferase

Defective in Crigler-Najjar syndrome

Question 26

What is the ligament of Treitz?

Answer 26

Suspensory ligament of the duodenum

Landmark for discriminating upper and lower GI bleeding

Question 28

What does the coeliac artery supply?

Answer 28

Liver, stomach, abdominal oesophagus, spleen, superior duodenum and superior pancreas

Question 29

What does the superior mesenteric artery supply?

Answer 29

Distal duodenum, jejuno-ileum, ascending colon and part of the transverse colon

Question 30

What does the inferior mesenteric artery supply?

Answer 30

Part of the transverse colon to the upper part of the rectum

Question 31

Which arteries supply the stomach?

Answer 31

• *Lesser curvature**
• Right gastric artery
• Left gastric artery

Greater curvature
- Right gastro-omental artery
​- Left gastro-omental artery

Question 32

What are the branches of the coeliac trunk?

Answer 32

Common hepatic artery
Splenic artery
Left gastric artery

Question 33

Which artery is formed by the anastomoses of the SMA and IMA?

Answer 33

Marginal artery (of Drummond)

• Continuous arterial circle along the inner border of the colon*
• Provides colloateral flow*
• From it come straight vessels (vasa recta) that supply the colon*

Question 34

What are the histological layers of the gut wall?

Answer 34

1. Mucosa
2. Submucosa
3. Muscle (muscularis propria)
4. Adentitia