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Anatomy > Gastrointestinal > Flashcards

Gastrointestinal Flashcards

1
Q

What is the upper extent of the abdominal cavity?

A

Anteriorly the under surface of the diaphragm reaches the 5th intercostal space

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2
Q

Describe the 9 regions of the abdominal wall.

A

Draw 2 vertical lines down from the midpoint of the clavicles
Draw a horizontal line across the lowest point of the thoracic cage
Draw a horizontal line across the tubercles of the iliac crest

This makes 9 abdominal areas.

R hypochondrium, Epigastric, L hypochondrium
R lumbar, umbilical, L lumbar
R iliac fossa, suprapubic, L iliac fossa

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3
Q

Describe the nerve supply to the skin of the abdominal wall.

A

thoracic 5 - upper epigastrium

thoracic 10 - umbilicus thoracic 12 - just above the lower suprapubic area.

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4
Q

How is the rectus sheath formed?

A

In the upper 2/3 of the abdomen the aponeurosis of the external oblique muscle passes in front of rectus abdominis and the aponeurosis of transversus abdominis passes behind. The aponeurosis of internal oblique sends fibres both in front and behind rectus abdominis.

In the lower 1/3 of the abdomen all three aponeuroses pass in front of rectus abdominis.

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5
Q

What is the surface marking of the aortic bifurcation?

A

The level of the umbilicus

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6
Q

In which regions of the abdomen is pain from the three parts of the bowel felt?

A

Foregut: epigastrium
Midgut: umbilical
Hindgut: suprapubic

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7
Q

Describe the anatomy of a ‘six pack’?

A

The 2 muscles of the rectus sheath run parallel to each other from the pubis to the costal margin separated by the linea alba (aponeurosis). Between the muscles running horizontally are 3 tendons. As the muscle develops, the muscles of the rectus sheath hypertrophy but the tendinous part stays the same. This means the muscles of the rectus abdominis bulge, 3 on each side causing the ‘six pack’ look.

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8
Q

What is the nerve supply to the 3 areas of the abdomen and where would the referred pain be form these areas?

A

Foregut - the foregut is supplied by the greater splanchnic nerve arising from T5-T9 but pain is usually felt anteriorly in the epigastrium.

Midgut - the midgut is supplied by the lesser splanchnic nerve arising from T10 & T11 but pain is felt in the periumbilical area.

Hindgut - the hindgut is supplied by the least splanchnic nerve arising from T12 but pain is felt in the suprapubic area.

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9
Q

Why might kidney pain be felt in the gonads and the other way round?

A

The sensory innervation of the kidney is via the sympathetic plexus (T10,11,12) which accompanies the renal artery. The same plexus also supplies the gonads and therefore, in patients with kidney damage, pain is often radiated down the cutaneous nerves of T10,11,12 and the pain is described as radiating from the loin to the groin. Conversely, gonadal pain can also be felt in the loin.

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10
Q

Where is McBurney’s point? What can we locate here?

A

Locating the appendix and caecum in between the umbilicus and the superior anterior iliac spine. Palpating this region can lead to severe pain and suggest appendicitis.

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11
Q

What are the 3 layers of flat muscles in the abdomen? Which ribs do they span? What is their function?

A

external oblique ribs 5-12 - contralateral rotation of the torso
internal oblique ribs 10-12 - bilateral contraction compresses the abdomen while ipsilateral contraction rotates the torso
transversus abdominis costal cartilages 7-12 - compresses abdominal contents

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12
Q

What are the 2 vertical muscles in the abdomen? what is their function?

A

Rectus abdominis - assists the flat muscles in compressing abdominal contents but also stabilises the pelvis during walking and depresses the ribs
Pyramidalis - tenses the linea alba

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13
Q

Difference between direct and indirect hernia?

A
  • Indirect– where the peritoneal sac enters the inguinal canal through the deep inguinal ring.
  • Direct– where the peritoneal sac enters the inguinal canal though the posterior wall of the inguinal canal.
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14
Q

What is the conjoint tendon made from? Why is the conjoint tendon important?

A

Internal oblique aponeurosis unite with the fibres of transversus abdominis aponeurosis.

The conjoint tendon can predispose to a direct inguinal hernia if it weakens. Young males with well developed abdominal musculature may be presisposed to a direct hernia known as Busoga Hernia.

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15
Q

With the patient in a supine position, where might fluid collect in the abdomen?

A

Fluid can collect posterior to the liver. Fluid can collect in the recesses of the peritoneum in the abdomen. This can lead to ascites (abnormal build up of fluid in abdomen).

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16
Q

What embryological structure forms the ligamentum teres?

A

The ligamentum teres is formed from the remnant of the umbilical vein returning blood from the placenta to the liver.

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17
Q

Where does the base of the appendix lie (surface marking and internally)?

A

2/3 of the way from the umbilicus to the ASIS. On the surface, it lies at McBurnies point.

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18
Q

Which parts of the bowel have a mesentery?

A

The 1st cm of the duodenum, all of the jejeunum and ilium, the transverse and sigmoid colon and the appendix.

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19
Q

What structures form the portal triad?

A

hepatic portal vein, hepatic artery and bile duct.

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20
Q

What is the (greater and lesser) omentum?

A

Omentum are sheets of tissue covered on both surfaces with peritoneum. They contain blood vessels, lymphatics, fat and nerves.

The greater omentum spans between the greater curvature of the stomach and the posterior abdominal wall.
The lesser omentum spans the lesser curvature of the stomach and the liver. The lesser omentum also contains the portal triad entering the porta hepatis.

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21
Q

Describe the location of the small bowel in the abdomen

A

The small bowel is connected via the duodenum from the stomach. It is made up of the duodenum, jejenum and ileum. It lies centrally and is often separated from the anterior abdominal wall by the greater omentum.

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22
Q

What is the relationship of the inferior epigastric artery as applied to direct and indirect hernia

A

Hernia medial to the inferior epigastric artery is direct

Hernia lateral to the inferior epigastric artery is indirect

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23
Q

Blood supply to and from the gut

A
  1. Coeliac trunk (T12/L1)- foregut
  2. Superior mesenteric artery (L1) - midgut
  3. Inferior mesenteric artery (L3) - hindgut

Venous drainage of the gut
- splenic vein and superior mesenteric vein form the hepatic portal vein which drains into the portal vein. From the liver, hepatic veins take blood into the IVC.

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24
Q

What is an omenta? Where do the greater and lesser omenta attach to?

A

Omenta is double layered folds of peritoneum between the stomach and other viscera.

The lesser omenta is attached from the lesser curvature of the stomach to the porta hepatis of the liver. It spans the space between the liver and the stomach.

The greater omenta is attached to the greater vasculature of the stomach. It loops down over the small intestine and back up on itself to attach to the transverse colon.

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25
Q

What is a mesentry?

A

Mesentry are double layered folds of peritoneum which cover and connect the viscera to the posterior abdominal wall. Some parts of the GI tract are suspended in mesentry and are able to move around freely. There is mesentry of the small intestine, transverse mesocolon and sigmoid mesocolon.

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26
Q

What do we mean by retroperitoneal Name some retroperitoneal organs

A 
Retroperitoneal organs are located between the parietal peritoneum and posterior abdominal wall which are not suspended by a mesentery. These only have peritoneum on the anterior surface.
Suprarenal glands
Pancreas
Ureters
Ascending and descending colon
Rectum
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27
Q

Name the ligaments of the liver and where they run

A

coronary ligament - attaches the liver to the inferior of the diaphragm and posterior abdominal wall. This creates a bare area of the liver.

triangular ligament - continuations of the coronary ligament helping to hold the liver in place

falciform ligament - separates the large right and smaller left lobe of the liver. Attaches the liver to the posterior abdominal wall.

ligamentum teres - remnant of the umbilical vein and courses the inferior border of the falciform ligament

ligamentum venosum - ductus venosum would shunt blood from left portal vein to left hepatic vein bypassing hepatic circulation in the foetus, this then degenerates to form the ligamentum venosum.

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28
Q

At what vertebral level does the oesophagus, vena cava and aortic hiatus pass through the diaphragm?

A
  • Vena Cava (8 letters) – Passes through the diaphragm at T8.
  • Oesophagus (10 letters) – Passes through the diaphragm at T10.
  • Aortic Hiatus (12 letters) – Descending aorta passes through the diaphragm at T12
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29
Q

Which structures pass through the diaphragm alongside the oesophagus?

A

Vagul trunks, inferior oesophageal artery and vein

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30
Q

From where does the stomach receive it’s nerve supply?

A

Sympathetic - greater splanchnic nerve (T5-9)

Parasympathetic - vagal nerve (Cranial nerve X)

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31
Q

What structure attaches the stomach to the liver?

A

lesser omentum

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32
Q

Which structures lie in front of the stomach?

A

left lobe of liver, anterior abdominal wall

33
Q

Which structures lie behind the stomach?

A

the lesser sac, behind the lesser sac is the pancreas and diaphragm

34
Q

What is porto-systemic anastomosis?

A

The venous blood from the bowel flowing up into the veins of the oesophagus and into the superior vena cava rather than going into the portal vein (bypassing the liver to return blood to the heart).

35
Q

Which vein drains blood from the colon and where does it flow to?

A

Inferior mesenteric vein and drains into the splenic vein.

36
Q

Where does lymph from the small bowel drain?

A

Into the cisterna chyli and to the thoracic duct

37
Q

Which foodstuffs are absorbed through the lymphatic system?

A

lipids

38
Q

What 4 anatomical features ensure the small bowel has a high surface area for absorption of nutrients?

A

length, mucosal folds (plicae circularis), villi and microvilli

39
Q

Where is the junction between the mid gut and the hind gut?

A

2/3 of the way along the transverse colon

40
Q

How do you distinguish a loop of large intestine from that of small intestine?

A
  • Large intestine has epiploic appendages, haustra (outpouchings protruding into the lumen) and tenea coli (long muscular stripe)
  • The small bowel is located centrally whereas the large intestine goes around the sides.
41
Q

Which part of the bowel is supplied by sacral nerves 2, 3 and 4?

A

The hind gut

42
Q

What does the lesser omentum contain?

A
  • hepatic artery
  • hepatic portal vein
  • bile duct
43
Q

What 3 structures make up the ‘gastric bed’

A

Splenic artery, pancreas and part of the duodenum - they lie behind the lesser sac.

44
Q

Describe the position of the liver in the abdomen

A

The liver is found mainly in the right hypochondrium of the abdomen with the left lobe extending into the epigastrium, underneath the diaphragm. Its upper surface is related to the diaphragm and it’s lower border follows the contour of the right costal margin.

45
Q

The liver is covered in a fibrous layer known as?

A

Glissons capsule

46
Q

What accessory lobes arise from the right lobe? What runs between these 2 lobes?

A

caudate (in the upper aspect) and quadrate lobe (in the lower aspect)
The porta hepatic runs between these 2 lobes which transmits all the vessels, nerves and ducts entering or leaving the liver (except hepatic veins)

47
Q

Blood supply to the liver? Venous drainage from the liver?

A

Dual blood supply
Majority = hepatic portal vein (75%)
Lesser = hepatic artery proper (25%) derived from the common hepatic artery

Venous drainage: hepatic veins which drain into IVC.

48
Q

Nerve supply to liver?

A

Hepatic plexus contains sympathetic (coeliac plexus) and parasympathetic (vagus) these enter at the aorta hepatica

49
Q

Where does the lymph from the anterior and posterior liver drain?

A

Anterior: Hepatic lymph nodes which lie in the lesser momentum and empty into the cistern chill

Posterior: phrenic and posterior mediastinum nodes which join the right lymphatic and thoracic ducts

50
Q

Describe where the gallbladder is found in the abdomen

A

The gall bladder is found in the right hypochondrial region of the abdomen, in the midclavicular line on the lower edge of the 9th costal cartilage. It is anterior to the first part of the duodenum and closely applied to the surface of the liver.

51
Q

Describe the biliary tree

A

Bile is initially secreted from hepatocytes and drain from both lobes via canaliculi, interlobular ducts and collecting ducts into left and right hepatic ducts.
Right and left hepatic ducts join to form the common hepatic duct
The cystic duct from the gallbladder joins the common hepatic to form the common bile duct.
The common bile duct descends and passes posteriorly to the first part of the duodenum and the head of the pancreas where it is joined by the pancreatic duct forming the hepatopancreatic ampulla which empties into the duodenum via duodenal papilla.

52
Q

Blood supply to and from the gallbladder? Innervation of gallbladder? Does sympathetic or parasympathetic cause contraction of the gallbladder? What else controls contraction of the gallbladder?

A

Cystic artery which is a branch of the right hepatic artery (derived from common hepatic artery)

Venous drainage = cystic veins which drain into portal vein

Innervation: coeliac plexus + vagus nerve.

Parasympathetic stimulation causes contraction of the gallbladder and secretion into the duodenum of bile is due to relaxation of sphincter of Oddi.
Contraction is mainly controlled by cholecystokinin.

53
Q

What are these conditions?

  • cholelithiasis
  • biliary colic
  • cholecystitis
  • choledocholithiasis
  • cholangitis
A
  • Cholelithiasis – uncomplicated gallstones
  • Biliary colic– typically right upper quadrant pain following a fatty meal as gallstones obstruct the cystic duct during contraction of the gallbladder. Not associated with systemic upset
  • Cholecystitis– inflammation of the gallbladder. Pain is often associated with nausea, vomiting or fever
  • Choledocholithiasis– gallstone within the common bile duct. Often causes deranged liver function tests.
  • Cholangitis– infection of the common bile duct often secondary to choledocholithiasis. Typically presents with right upper quadrant pain, fever and jaundice (Charcot’s Triad)
54
Q

At what level does the coeliac trunk arise?

A

T12

55
Q

What are the 3 major branches of the coeliac trunk?

A

Left gastric, splenic and common hepatic artery.

56
Q

The left gastric artery id the largest branch of the coeliac trunk, where does it course and what does it supply?

A

It ascends across the diaphragm, giving rise tooesophageal branches,before continuing anteriorly along the lesser curvature of thestomach. It then anastomoses with the right gastric artery.

57
Q

Describe the course of the splenic artery from the coeliac trunk and what it supplies.

A

It travels towards the spleen running posterior to the stomach and along the superior margin of thepancreas.
It terminates into five branches whichsupply the segments of the spleen.
The splenic artery also gives rise to the left gastroepiploic which supplies the greater curvature of the stomach and anastomoses with the right gastroepiploic artery, the short gastric which supply the fungus of the stomach and the pancreatic branches which supply the body and tail of the pancreas.

58
Q

Describe the course of the common hepatic artery and what it supplies.

A

The common hepatic artery is the only branch of the coeliac artery to pass to the right. It travels past the superior aspect of the duodenum + divides into its 2 terminal branches: proper hepatic and gasproduodenal arteries.

59
Q

What are the branches from the proper hepatic artery + what do they supply?

A

The proper hepatic artery ascends through the lesser omentum towards the liver. It gives rise to:

  • Right gastric:supplies the pylorus and lesser curvature of the stomach.
  • Right and left hepatic:divide inferior to the porta hepatis and supply their respective lobes of the liver.
  • Cystic:branch of the right hepatic artery – supplies the gall bladder.
60
Q

What are the branches from the gasproduodenal artery + what do they supply?

A
  • Right gastroepiploic:supplies the greater curvature of thestomach. Found between the layers of the greater omentum, which it also supplies.
  • Superior pancreaticoduodenal:divides into an anterior and posterior branch, which supplies the head of thepancreas
61
Q

If a peptic ulcer erodes through the duodenal wall, what artery can it erode into?

A

Gastroduodenal artery

62
Q

Which part of the duodenum does the major duodenal papilla (opening where bile and pancreatic secretions enter the from the ampulla of Vater) enter?

A

Descending duodenum

63
Q

Where in the duodenum are ulcers most likely to occur?

What are common causes of duodenal ulcers?

A

Superior portion

H pylori infection and chronic NSAID therapy are common causes.

64
Q

What are the 5 parts of the pancreas?

A

Tail - left end near spleen
Head - widest part
Neck
Body - centrally located crossing midline of body
Uncinate process - projection arising from the lower part of the head & extending medially to lie beneath the body of the pancreas

65
Q

Is the whole pancreas retroperitoneum?

A

All of it except the tail.

66
Q

What structure separates the stomach from the pancreas?

A

the lesser sac

67
Q

Describe the pancreas in relation to vessels around it.

A
  • The aorta and inferior vena cava pass posteriorly to the head of the pancreas.
  • The superior mesenteric artery lies behind the neck of the pancreas and anterior to the uncinate process.
  • Posterior to the neck of the pancreas, the splenic and superior mesenteric veins unite to form the hepatic portal vein.
68
Q

Which artery supplies the pancreas? Venous drainage of the pancreas?

A

pancreatic branches of the splenic artery
the head is additionally supplied by the superior and inferior pancreaticoduodenal arteries
Venous drainage: superior mesenteric branches of the hepatic portal vein.

69
Q

Which artery is the cystic artery a branch of?

A

usually right hepatic artery but it can be a branch of the left hepatic artery or the hepatic artery

70
Q

What structure degenerates to form the ligamentum venosum?

A

ductus venosum

71
Q

Where is the bare area of the liver?

A

Under the central tendon of the right side of the diaphragm.
- Between the anterior and posterior surface of the coronary ligament, covered by no peritoneum, posterior surface of liver

72
Q

What is the surface marking of the fundus of the gall bladder?

A

Tip of the 9th costal cartilage

73
Q

What vessel supplies the majority of oxygen to the liver?

A

Portal vein = 70%

74
Q

Which of these is not a branch of the coeliac trunk: left gastric, common hepatic, right gastric, splenic?

A

Right gastric - comes off the hepatic artery proper (sometimes common hepatic)

75
Q

What marks the end of the foregut?

A

2nd part of the duodenum

76
Q

Can the spleen by palpated during normal abdominal examination?

A

No unless it is considerably enlarged or displaced by a mass

77
Q

What structures might a tumour of the head of the pancreas involve?

A

The hepatic portal vein, bile duct or pancreatic duct

78
Q

How many pancreatic ducts are there?

A

2 - one from the ventral pancrearic bud and one from the dorsal pancreatic bud

Anatomy (7 decks)

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