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2nd Year - systems 2 > Gastrointestinal Anatomy > Flashcards

Gastrointestinal Anatomy Flashcards

1
Q

Mouth boundaries

A

From lips to palatoglossal arches, cheeks form walls
Floor is mylohyoid muscle

Oral cavity is teeth to oropharynx
Vestibule is between teeth and lips

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2
Q

Teeth

A

Made of dentine (pulp cavity containing nerves and vessels)
Crown covered in enamel
Anchored in sockets by periodontal ligament

Teeth and gums (gingivae) - superior and inferior alveolar nerves and vessels - from maxillary division at top, mandibular at bottom

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3
Q

Numbers of teeth per quadrant

A

Decididuous (milk) - 2 incisors, 1 canine, no premolar, 2 molar
Adult - 2 incisors, 1 canine, 2 premolar, 3 molar

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4
Q

Tongue

A

Made of muscles - intrinsic change shape, extrinsic move tongue
Root is anchored to mandible and hyoid bone
Stratified keratinised squamous epithelia
Covered in papillae - taste buds
Vallate papillae divide body from root of tongue

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5
Q

Nerve supply to tongue

A

All motor - hypoglossal nerve
Posterior 1/3 - sensation and taste from glossopharyngeal
Anterior 2/3 - sensation - mandibular, taste - facial

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6
Q

Looking into mouth

A

Palatoglossal arch in front
Then palatine tonsils
Palatopharyngeal arch

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7
Q

Muscles of mastication

A

Temporalis and massete - superficial
Medial and lateral pterygoid - deep
- supplied by mandibular branch of trigeminal

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8
Q

Deglutition

A

= swallowing

1) VOLUNTARY
- bolus to dorsum of tongue
- up against hard palate as mylohyoid contracts
- bolus to pharynx
- styloglossi and palatoglossi raise posterior part of tongue
2) INVOLUNTARY
- soft palate elevates, sealing off nasopharynx
- long pharyngeal muscles pull larynx upwards
- laryngeal orifice closed by aryepiglottic and oblique arytenoids
- pharyngeal constrictors constrict in sequence
- cricopharyngeus relaxes
3) INVOLUNTARY
- wave of peristalsis moves bolus down oesophagus

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9
Q

Palate

A

Hard palate - palatal processes of maxillae and horizontal plates of palatine bones
Soft palate - 5 muscles - tensor and levator veli palatine, palatoglossus, palatopharyngeus, uvular

Maxillary artery supplies
Sensory - maxillary division of trigeminal
Motor - mainly from pharyngeal plexus

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10
Q

Muscles of pharynx

A

External - constrictors
Internal - palatopharyngeus, salpingopharyngeus (by opening of eustachian tube in nasal cavity), stylopharyngeus (from back of ear)

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11
Q

Suprahyoid muscles

A

Geniohyoid - to chin
Mylohyoid - under tongue, floor of mouth
Digastric - mentum to hyoid to mastoid process
Stylohyoid - to bottom of chin

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12
Q

Infrahyoid muscles

A

Sternohyoid - to sternum
Omohyoid - to scapula
Thyrohyoid
Sternothyroid

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13
Q

Parotid salivary gland

A

Duct pierces buccinator (cheek), enters oral cavity opposite 2nd maxillary molar tooth
Glossopharyngeal nerve innervates
Running through - facial nerve, external carotid, superficial temporal and maxillary artery, retromandibular vein

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14
Q

Submandibular salivary gland

A

Duct opens adjacent to lingual frenulum under tongue

Facial nerve innervates

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15
Q

Sublingual salivary gland

A

Numerous small ducts open into floor of mouth along sublingual folds
Facial nerve innervates

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16
Q

Oesophagus

A

Starts at C6 (cricoid cartilage level), 25cm long
Mucosa stratified squamous epithelium
No serosal layer
Outer longitudinal and inner circular fibres

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17
Q

Four main constrictions of oesophagus

A

1) At C5, cricopharyngeal sphincter
2) At aortic arch
3) At left main bronchus
4) Cardiac sphincter, gastro-oesophageal junction

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18
Q

Arterial supply of oesophagus (and lymph)

A

Upper third - inferior thyroid artery
Middle - branch of thoracic aorta
Bottom third - left gastric artery

Lymph drains to posterior mediastinal nodes, left gastric nodes

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19
Q

Stomach

A

Longitudinal, oblique and circular muscle fibres
Columnar epithelium
Intraperitoneal

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20
Q

Nervous supply to stomach

A

Intrinsic - enteric NS - coordinates contractions and secretions
Extrinsic - autonomic - modify activity (parasymp increases)

Parasympathetic - anterior and posterior vagal trunks
Sympathetic - sympathetic trunks via coeliac plexus

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21
Q

Blood and lymph supply to stomach

A

Veins drain to portal system
Lymph to coeliac nodes

Splenic artery behind stomach to spleen
Gastroepiploic arteries run below to stomach and spleen

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22
Q

Lesser omentum

A

Two layers of peritoneum extending between liver and lesser curvature of stomach

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23
Q

Lesser sac

A

Between lesser and greater omentum
Subsection of peritoneal cavity, posterior to lesser omentum and stomach, anterior to retroperitoneal organs of posterior abdominal wall

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24
Q

Greater omentum

A

Two layers of peritoneum laying together -> 4 layers
Between greater curvature of stomach and transverse colon
Hangs like apron over intestines
Contains adipose tissue

Omental foramen is communication between lesser and greater omentum

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25
Endoscopy
OGD = oesophagogastroduodenoscopy - lie on left side, swallow tube TOE = transoesophageal echocardiography - ultrasound probe through oesophagus to view heart Indicated after upper GI bleed, foreign body, gastric cancer, GORD
26
Oesophagus histology
Stratified squamous epithelia, to protect from acid reflux Peristalsis mediated by muscularis externa Submucosal glands, especially in lower oesophagus ``` Epithelia Lamina propria - not much, mainly gastric glands Muscularis mucosa Submucosa Circular muscle Longitudinal muscle (NO Serosa) ```
27
Gastro-oesophageal sphincter
LES has no marked thickening of circular muscle, so physiological NOT anatomical sphincter
28
Stomach cell types
PARIETAL - dominant cell type, large cells with bright pink cytoplasm and central dark nucleus CHIEF - light grey cytoplasm, nucleus at base of cell, abundant in gastric glands ENDOCRINE - light grey cytoplasm (look very similar to chief), but less abundant MUCOUS NECK - empty spaces in surface epithelium, found at bottom of gastric pits and scattered SURFACE EPITHELIAL - dominant type lining gastric pits, columnar epithelial, nucleus at base
29
Histology of duodenum
Abundant tall villi separated by crypts Brunner's glands (submucosal) Paneth cells found here in crypts - prominent apical eosinophilic granules, for host defence as secrete anti-microbial factors
30
Ileum histology
Abundant smaller villi separated by crypts | Peyer's patches (lymph) pack mucosa, covered by flattened epithelium with less obvious villi
31
Large intestine histology
No villi, just crypts Mucosa has crypts filled with mucus-secreting goblet cells Loose connective tissue forms submucosa Crypts of Lieberkuhn - crypts packed with mucus-secreting goblet cells, for salt and water secretion
32
Duodenum
In epigastric region 1st part at L1, intraperitoneal Rest is retroperitoneal as forms C shape around pancreas Simple columnar epithelium with villi and circular folds (pilicae circulares) Secretion stimulated by secretin - local hormone, and vagus nerve Dual blood supply and lymph drainage - 1st 1/3rd is foregut (coeliac), then midgut (superior mesenteric). Major duodenal papilla marks change
33
Pancreas
In epigastric region Retroperitoneal, but tip of tail intraperitoneal Duct opens at major duodenal papilla Endo and exocrine gland Secretion stimulated by cholecystokinin and vagus nerve
34
Blood supply to pancreas
Splenic artery runs along top of body Superior and inferior pancreaticoduodenal arteries run around head Corresponding veins drain to portal system - splenic vein biggest, posterior
35
Spleen
Red and white pulp For removal of old RBCs from blood, largest lymphoid organ Sits under 9th-11th ribs on left - left hypochondriac region Intraperitoneal Splenic artery and vein supply Superior/anterior - stomach Inferior - left colic flexure, left kidney DELICATE and vulnerable to injury - if rupture by blunt trauma, significant bleeding, left flank pain
36
Foregut surface anatomy
Liver - deep to ribs 5-11 on right, crosses midline Gallbladder - behind tip of 9th costal margin Pancreas - neck overlies L1-2, body and tail left and superior Spleen - 9-11th ribs on left (only palpable at 3x normal size)
37
Referred pain by region
Foregut -> epigastric Midgut -> umbilical Hindgut -> hypogastric Retroperitoneal refer to back
38
Liver
Largest gland in body - 1.5kg in adult Right hypochondriac region, extending to epigastric Intraperitoneal, covered in visceral peritoneum apart from bare area where joins to diaphragm Right, left, caudate (top) and quadrate (bottom) lobes Falciform ligament across front, attaches to abdominal wall at front and diaphragm above Lymph to coeliac nodes
39
Porta
In porta hepatis, fissure Carries hepatic portal vein (80% blood to liver), L + R hepatic arteries, bile duct Hepatic portal vein - SMV (midgut), IMV (hindgut) and splenic vein (foregut) all feed in
40
Functions of liver
METABOLIC - fats, proteins, carbs PRODUCTION - bile, plasma proteins, albumin, clotting factors, urea STORAGE - glycogen, vitamins, minerals IMMUNITY - produce immune factors and remove bacteria HOMEOSTASIS - regulates glycogen release in response to glucagon or insulin from pancreas, produces heat for body temperature control
41
Embryological remnants in liver
``` Ligamentum teres (round at bottom of falciform) - old umbilical vein Ligamentum venosum (between left and caudate lobes) - old ductus venosus, shunt ```
42
Gallbladder
In right hypochondriac region Intraperitoneal Arterial supply from branch of right hepatic artery To store and concentrate bile made by liver Secretion stimulated by cholecystokinin, into duodenum
43
Biliary tree
Left and right hepatic ducts Common hepatic duct + cystic duct from gall bladder -> common bile duct
44
Gallstones
Form from bile pigments, cholesterol crystals so don't show up on X rays If dislodge -> pain and jaundice Cholecystitis = acute inflammation Biliary colic = cystic duct blocked, pain but no jaundice
45
Laporascopic cholescystectomy
= Lap chole Scope in port superior to umbilicus Inflate abdominal cavity with CO₂ to create space Insert other ports Isolate cystic duct and cystic artery Make small cut, insert contrast, choleangiogram Cut and clip cystic duct and artery Cut through fat and fascia attached to posterior wall to liver Insert bag, put gallbladder in Saline solution into cavity to ensure no bleeding
46
Arcuate line
Half way between umbilicus and pubic symphysis | No posterior rectus sheath below
47
Inguinal canal
From ASIS to pubic tubercle Anterior - skin, superficial fascia, external oblique aponeurosis Posterior - medial - conjoint tendon (where transverse abdominus and internal oblique fuse at pubic tubercle) - lateral - transversalis fascia Roof - lower edge of internal oblique and transverse abdominus Floor - inguinal ligament
48
Inguinal ring
Deep - opening in transversalis fascia lateral to lateral to pubic tubercle Superficial - above and lateral to pubic tubercle Contains spermatic cord and inferior epigastric vessels to testes in men Or round ligament of uterus to anchor to abdominal wall in women Below midinguinal ligament - femoral nerve Below midinguinal point - femoral artery
49
Acute appendicitis
Interpreted as midgut pain as refers to umbilical region initially - as inflammation just in viceral peritoneum and appendix wall As develops, pain localises to right iliac fossa McBurney incision to remove
50
Hernias
The protrusion of tissue or an organ from the confines of its normal cavity to outside of that cavity Inguinal hernia - above inguinal ligament Femoral hernia - below inguinal ligament to exit abdominal cavity
51
Blood and lymph to small intestines
Blood supply from jejunal and ileal branches of superior mesenteric artery Corresponding veins drain to portal system Lymph drains along arteries to superior mesenteric lymph nodes
52
Features of jejunum
Larger, densely packed circular folds, larger villi Deep red Thicker mucosal wall Few Peyer's patches (lymphoid tissue) More vascular - longer vasa recta, less arcades Less fat in mesentery Upper left quadrant, umbilical region Intraperitoneal Mesentery attaches to left of aorta to posterior abdominal wall
53
Features of ileum
``` Smaller, fewer, sparser circular folds Pale pink Thinner mucosal wall Many Peyer's patches (lymphoid tissue) Less vascular - shorter vasa recta, more arcades More fat in mesentery Lower right quadrant, hypogastric region Intraperitoneal Mesentery attaches to right of aorta to posterior abdominal wall ``` - terminal ileum is site for absorption of vitamin B12 with intrinsic factor from stomach
54
Location of branching of aorta
``` Passes into abdomen at T12 Coeliac trunk arises at L1 (high) SMA arises at L1 (low) Renal arteries arise at L2 IMA arises at L3 Bifurcation to form common iliac arteries at L4 ```
55
Structure and function of large intestine
Principle function to absorb water Venous drainage via SMV and IMV to portal vein Ileocaecal valve prevents reflux from caecum to ileum Ascending and descending colon - retroperitoneal Transverse and sigmoid colon - intraperitoneal
56
Taeni coli
Thickened bands of muscle in large intestine, don't go complete width of colon Gives sacculated appearance Free taeni coli - ascending colon Omental taeni coli - transverse colon Mesocolic taeni coli - descending colon
57
Rectum
Dilatable holding area in pelvis, above levator ani Upper part - superior rectal artery from IMA, lymph to inferior mesenteric nodes Lower part - middle rectal artery from internal iliac, lumph to internal iliac nodes Anal canal is 4cm long tube, from anorectal ring to anus
58
Upper anal canal
``` Above pectinate line Derived from endoderm Simple columnar epithelium Stretch sensors - inferior hypogastric plexuses Superior rectal artery from IMA supplies Superior rectal vein to IMV drains Lymph to internal iliac nodes ```
59
Lower anal canal
Below pectinate line Derived from ectoderm Stratified squamous epithelium Pain, temperature, pressure receptors - inferior rectal nerve Inferior rectal artery supplies Inferior rectal vein drains Lymph to superficial inguinal group nodes
60
Anal pathology
Weakness in levator ani muscles -> incontinence or prolapse of rectum (and uterus in women) Infection may seed next to anal canal at ischioanal fossa -> abscess formation Potential portosystemic anastamoses site as dual system of blood drainage

2nd Year - systems 2 (7 decks)

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