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Phase 1 Anatomy > GASTROINTESTINAL SYSTEM > Flashcards

GASTROINTESTINAL SYSTEM Flashcards

1
Q

What are aponeuroses

A

Flat tendons

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2
Q

How many lumbar vertebrae contribute to the posterior wall of the abdominal cavity

A

5

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3
Q

The functions of the abdominal wall

A
  • Protect the abdominal viscera
  • Increase intra-abdominal pressure (e.g. for defecation and childbirth)
  • Maintain posture and move the trunk
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4
Q

Bony landmarks which define the boundaries of the abdominal cavity

A
  • Xiphisternum
  • Costal margin
  • Iliac crests
  • Anterior superior iliac spines (ASIS)
  • Pubic tubercles
  • Pubic symphysis (a fibrocartilaginous joint)
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5
Q

What are the 4 quadrants of the anterior abdominal wall

A

right upper and lower quadrants
left upper and lower quadrants

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6
Q

Which lines form the 4 quadrants of the anterior abdominal wall

A

A vertical line that runs down the midline through the lower sternum, umbilicus, and the pubic symphysis
A horizontal line that runs across the abdomen through the umbilicus

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7
Q

What are the 9 regions of the abdominal wall

A

The central regions, from superior to inferior, are the epigastrium, the umbilical region and the hypogastric (suprapubic) region
On the right, the regions from superior to inferior are the right hypochondrium, the right lumbar region and the right iliac fossa (region)
On the left, the regions from superior to inferior are the left hypochondrium, the left lumbar region and the left iliac fossa (region)

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8
Q

Which lines form the 9 regions of the anterior abdominal wall

A

Right and left mid-clavicular lines, down to the mid-inguinal point (halfway between the anterior
superior iliac spine and the pubic tubercle)
The subcostal line - a horizontal line drawn through the inferior-most parts of the right and left costal margins (through the 10th costal cartilage)
The intertubercular line - a horizontal line drawn through the tubercles of the right and left iliac crests and the body of L5

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9
Q

Transpyloric plane

A

Horizontal line that passes through the tips of the right and left ninth costal cartilages.
It transects the pylorus of the stomach, the gallbladder, the pancreas and the hila of the kidneys

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10
Q

Transumbilical plane

A

Horizontal line through the umbilicus approximately at the level of L3, but varies due to subcutaneous fat

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11
Q

Intercristal plane

A

horizontal line drawn between the highest points of the right and left iliac crests

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12
Q

McBurney’s point

A

The surface marking of the base of the appendix. It lies two thirds of the way along a line drawn from the umbilicus to the right anterior superior iliac spine

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13
Q

How is the rectus abdominis orientated and what is it attached to

A

Left and right, lie either side of the midline
Superiorly attached to the sternum and costal margin
Inferiorly attached to the pubis
Surrounded by an aponeurotic rectus sheath

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14
Q

Which 3 muscles are lateral to the rectus abdominis and what directions are their fibres

A
  • External oblique (EO) is most superficial. The fibres of EO run medially and inferiorly, towards the midline.
  • Internal oblique (IO) lies deep to EO. The fibres of IO are orientated perpendicular to those of EO (they run medially and superiorly).
  • Transversus abdominis lies deep to internal oblique. Its fibres are orientated horizontally.
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15
Q

Where do the fibres of the aponeuroses fuse with the aponeuroses of the other side. What is this structure called

A

Forms a tough midline raphe (seam) called the linea alba (‘white line’)

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16
Q

Where do the rectus abdominis muscles lie

A

Either side of the linea alba, comprised of muscle segments interspersed with horizontal tendinous bands

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17
Q

What are the anterior and posterior walls of the rectus sheath formed from

A

The aponeuroses of EO, IO and transversus abdominis.
- As it approaches the midline, the aponeurosis of IO splits into anterior and posterior layers.
- The EO aponeurosis and the anterior layer of the IO aponeurosis form the
anterior wall of the rectus sheath.
- The posterior layer of the IO aponeurosis and the transversus abdominis aponeurosis form the posterior wall of the rectus sheath.

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18
Q

What lies deep to transversus abdominis

A

The transversalis fascia, deep to the fascia lies
the parietal peritoneum

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19
Q

What is the the most inferior part of the external oblique aponeurosis attached to and what does this form

A

Anterior superior iliac spine laterally
Pubic tubercle medially
This forms the inguinal ligament. Just above the inguinal ligament is the inguinal canal.

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20
Q

Which arteries supply the anterolateral abdominal wall

A
  • musculophrenic artery, a branch of the internal thoracic
  • superior epigastric artery, which is the continuation of the internal thoracic artery. It descends in the rectus sheath
  • inferior epigastric artery, a branch of the external iliac artery. It ascends in the rectus sheath and anastomoses with the superior epigastric
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21
Q

Which nerves innervate the muscles and skin of the anterolateral abdominal wall

A
  • Thoraco-abdominal nerves T7 – T11. These are the continuation of the intercostal nerves T7 – T11. These somatic nerves contain sensory and motor
    fibres.
  • The subcostal nerve – this originates from the T12 spinal nerve (so called because it runs along the inferior border of the 12th rib).
  • Iliohypogastric and ilioinguinal nerves – both are branches of the L1 spinal nerve.
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22
Q

What does the parietal peritoneum line

A

Abdominal wall

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23
Q

What type of nerves innervate the parietal peritoneum, what do they effect and how is pain characterised

A

Somatic nerves
Supply the overlying muscles and skin of the abdominal wall.
Pain from the parietal peritoneum is usually sharp, severe, and well localised to the abdominal wall.

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23
Q

What does the visceral peritoneum cover

A

Abdominal viscera

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24
Q

What type of nerves innervate the visceral peritoneum, what do they effect and how is pain characterised

A

Visceral sensory nerves
convey ‘painful’ sensations back to the CNS along the path of the sympathetic nerves that innervate the organ / structure it covers

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25
Q

What lies between the parietal and visceral peritoneum, what does it contain and why

A

Peritoneal cavity
Contains a thin film of peritoneal fluid which allows the viscera to slide freely alongside each other

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26
Q

Intraperitoneal viscera

A

Almost completely covered by peritoneum e.g. the stomach

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27
Q

Retroperitoneal viscera

A

Posterior to the peritoneum, hence only covered by
peritoneum on their anterior surface e.g. the pancreas and abdominal aorta

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28
Q

secondarily retroperitoneal

A

These organs were intraperitoneal in early development but came to be ‘stuck down’ onto the posterior abdominal wall

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29
Q

Mesenteries

A

Folds of peritoneum that contain fat and suspend the small intestine and parts of the large intestine from the posterior abdominal wall

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30
Q

Omenta

A

Folds of peritoneum that are usually fatty and connect the stomach to other organs

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31
Q

Greater omentum

A

Hangs from the greater curvature of the stomach and lies superficial to the small intestine

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32
Q

Lesser omentum and what is embedded within it

A

Connects the stomach and duodenum (the first part of the small intestine) to the liver
The hepatic artery, the hepatic portal vein, and the bile duct (the ‘portal triad’) are embedded within its free edge

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33
Q

Peritoneum ligaments

A

Folds of peritoneum that connect organs to each other or to the abdominal wall

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34
Q

Falciform ligament

A

Connects the anterior surface of the liver to the anterior
abdominal wall

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35
Q

Coronary and triangular ligaments

A

Connect the superior surface of the liver to the diaphragm

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36
Q

Peritoneal folds

A

Raised from internal aspect of the lower abdominal wall and are created by the structures they overlie, like carpet running over a cable

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37
Q

Median umbilical fold

A

Lies in the midline and represents the remnant of the urachus, an embryological structure that connected the bladder to the umbilicus

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38
Q

Medial umbilical folds

A

Lateral to the median umbilical fold
These represent the remnants of the paired umbilical arteries, which returned venous blood to the placenta in foetal life

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39
Q

Lateral umbilical folds

A

Lateral to the medial umbilical folds

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40
Q

Which arteries lie deep to the Lateral umbilical folds and what do they supply

A

Inferior epigastric arteries
Supply the anterior abdominal wall

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41
Q

What 2 regions of unequal size is the peritoneal cavity divided into

A

Smaller lesser sac
Larger greater sac

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42
Q

How do the greater and lesser sacs communicate with each other

A

Via a passageway that lies posterior to the free edge of the lesser omentum, the epiploic foramen (also called the omental foramen)

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43
Q

Where does the gastrointestinal system develop

A

Embryonic gut tube which lies in the midline of the abdominal cavity

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44
Q

What suspends the embryonic gut tube from the posterior abdominal wall

A

Dorsal mesentery

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45
Q

What does the ventral mesentery connect

A

Connects the stomach to the anterior abdominal wall

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46
Q

As the liver grows within the ventral mesentery, what does the ventral mesentery form

A

anterior - falciform ligament
posterior - lesser omentum

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47
Q

What is growth, migration, and rotation of organs responsible for developing

A

Lesser sac and results in some organs being ‘pushed’ onto the posterior abdominal wall and becoming retroperitoneal.

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48
Q

What does the oesophagus pass through within the diaphragm and at what level is this

A

Oesophageal hiatus at T10

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49
Q

How is the reflux of stomach contents into the oesophagus prevented

A

Muscle around the hiatus functions as a sphincter

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50
Q

The branches of what artery supplies the distal oesophagus

A

Left gastric artery

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51
Q

What drains the distal oesophagus

A

Systemic system of veins (via oesophageal veins that drain into the azygos vein)
Portal venous system (via the left gastric veins)

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52
Q

How and what does the stomach break down food into

A

Chemically and mechanically breaks down food into chyme

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53
Q

Which region of the stomach is continuous with the site of at which the oesophagus enters the stomach

A

Cardia

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54
Q

What is the most superior part of the stomach and what does it contain

A

Fundus
Lies superior to the level of entry of the oesophagus and is usually filled with gas

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55
Q

What is the largest part of the stomach

A

The body

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56
Q

What are the regions of the pyloric part which is distal to the body

A

The pyloric antrum is wide and tapers towards the pyloric canal, which is narrow and contains the pyloric sphincter

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57
Q

What is the pyloric sphincter and what is its function

A

Circular smooth muscle
Regulates the passage of chyme into the duodenum

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58
Q

What are the left and right borders of the stomach

A

The right border of the stomach is the lesser curvature. The longer left border is the greater curvature

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59
Q

What are the anatomical relations of the anterior surface of the stomach

A

Related to the anterior abdominal wall, diaphragm, and left lobe of the liver

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60
Q

What does the posterior surface of the stomach form

A

The anterior wall of the lesser sac

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61
Q

Which regions of the anterior abdominal wall does the stomach lie

A

Epigastric and umbilical regions

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62
Q

What lies posterior to the stomach

A

Lesser sac, pancreas, left kidney, left adrenal gland, spleen, splenic artery, transverse mesocolon

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63
Q

What connects the lesser curvature of the stomach to the liver

A

Lesser omentum

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64
Q

What does the free edge of the lesser omentum contain

A

Hepatic artery, hepatic portal vein and the bile duct

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65
Q

Where is the entrance to the lesser sac in relation to the free edge of the lesser omentum

A

Posterior to the lesser omentum

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66
Q

What hangs from the greater curvature of the stomach

A

The greater omentum

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67
Q

Where are the arteries which supply the stomach branched from

A

The coeliac trunk

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68
Q

What does the foregut comprise of

A

The stomach, the first half of the duodenum, the liver, gallbladder, and pancreas

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69
Q

Where does the spleen develop and what is it supplied by

A

develops in the dorsal mesentery, and is supplied by the splenic artery, a branch from the coeliac trunk, but it is mesodermal in origin

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70
Q

What branches arises from the division of the coeliac trunk

A

Left gastric artery
Common hepatic artery
Splenic artery

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71
Q

Which arteries run along the lesser curvature of the stomach

A

The left and right gastric arteries and anastomose with each other
The left gastric artery arises from the coeliac trunk
The right gastric artery usually arises from the common hepatic artery

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72
Q

Which arteries run along the greater curvature of the stomach

A

The left and right gastro-omental (gastroepiploic) arteries and anastomose with each other
The left gastro-omental artery arises from the splenic artery
The right gastro-omental artery arises from the gastroduodenal artery, a branch of the common hepatic artery

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73
Q

What do the right and left gastric veins and right and left gastro-omental veins drain into

A

Hepatic portal vein

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74
Q

Where does the hepatic portal vein carry blood to

A

Carries nutrient-rich venous blood from the GI tract to the liver

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75
Q

Which nerve conveys parasympathetic fibres to the stomach

A

Vagus nerve

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76
Q

Parasympathetic stimulation of the stomach

A

Promotes peristalsis and gastric secretion

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77
Q

How are parasympathetic fibres conveyed to the stomach

A

Via the greater splanchnic nerve
Formed of preganglionic sympathetic fibres that leave spinal cord segments T5-T9 and pass through the sympathetic trunk without synapsing. The fibres synapse in prevertebral ganglia around the coeliac trunk. The postganglionic fibres travel to the stomach and inhibit peristalsis and secretion.

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78
Q

What are the 3 regions of the small intestines

A

Duodenum, jejunum, and ileum

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79
Q

Which region of the stomach is the duodenum continuous with

A

Pylorus of the stomach

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80
Q

What shape is the duodenum and why

A

C-shaped around the head of the pancreas
Most of the length of the duodenum is retroperitoneal

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81
Q

What is the major duodenal papilla and where is it located

A

Opening of the bile duct and the main pancreatic duct into the duodenum
Bile and pancreatic juice enters the duodenum here
Approximately halfway along the internal wall of the duodenum

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82
Q

What supplies the first half of the duodenum and why

A

Arterial branches from the coeliac trunk as the first half develops from the embryological foregut

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83
Q

What supplies the second half of the duodenum and why

A

Branches from the superior mesenteric artery as the second half develops from the embryological midgut

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84
Q

What suspends the jejunum and ileum from the posterior abdominal wall

A

The mesentery of the small intestine

85
Q

What does the midgut comprise of

A

Second half of the duodenum, jejunum, ileum, cecum, appendix, ascending colon and the first 2/3’s of the transverse colon

86
Q

How is the jejunum and ileum specialised for nutrient absorption

A

Vast surface area: the small intestine is long, the mucosa is folded (plicae circulares), the mucosal folds bear villi and there are microvilli on the luminal surface of each epithelial cell

87
Q

What are the internal differences of the jejunum and ileum

A

The plicae are more pronounced in the jejunum
The internal ileum is characterised by Peyer’s patches, which are large submucosal lymph nodules

88
Q

What is Meckel’s diverticulum

A

A blind-ended diverticulum approximately one meter from the ileum’s termination
The embryological remnant of the connection that was present between the midgut loop to the yolk sac. If it becomes inflamed, it may mimic an appendicitis (inflammation of the appendix)

89
Q

What is the caecum, what is it continuous with and how are they connected

A

Distended, blind-ended ‘pouch’ which is covered by peritoneum but doesn’t have a mesentery
Continuous with the terminal ileum via the ileocaecal junction in the right iliac fossa

90
Q

What is the function of the large intestine

A

Reabsorbs water from faecal material to form semi-solid faeces

91
Q

What is the large intestine composed of

A

Caecum, appendix, ascending colon, transverse colon, descending colon, sigmoid colon, rectum, and anal canal

92
Q

What is the taeniae coli

A

The outer longitudinal smooth muscle layer organised into 3 bands

93
Q

What are the bands of the taeniae coli

A

mesocolic, free and omental coli

94
Q

What is a haustra (or haustrations)

A

Bulges or sacculations due to contraction of the inner circular muscle layer of the taeniae coli

95
Q

What are epiploic appendages (appendices epiploicae)

A

Fatty tags in the large intestines which mark the point at which blood vessels penetrate the intestinal wall

96
Q

What is the appendix

A

Small diverticulum that arises from the caecum and contains lymphoid tissue

97
Q

How is the appendix attached to the cecum

A

By a small mesentery, the mesoappendix

98
Q

What is the 90° turn left of the ascending colon in the right upper quadrant, becoming continuous with the transverse colon

A

Hepatic flexure (sometimes called the right colic flexure)

99
Q

Where does the ascending colon lie

A

Runs vertically on the right side of the posterior abdominal wall in the right paracolic gutter

100
Q

Is the ascending colon retroperitoneal or intraperitoneal

A

It is retroperitoneal (it is an example of a secondarily retroperitoneal organ)

101
Q

Mesocolon

A

The part of the mesentery that attaches the colon to the abdominal wall

102
Q

What is the 90° turn inferiorly of the transverse colon in the left upper quadrant, becoming continuous with the descending colon

A

Splenic flexure (sometimes called the left colic flexure)

103
Q

How is the splenic flexure tethered to the diaphragm

A

By the phrenicocolic ligament

104
Q

What does the hindgut compose of

A

Distal third of the transverse colon, descending colon, sigmoid colon and proximal third of the rectum

105
Q

Where does the transverse colon lie

A

Runs vertically on the left side of the posterior abdominal wall in the left paracolic gutter

106
Q

Is the descending colon retroperitoneal or intraperitoneal

A

It is retroperitoneal (also secondarily retroperitoneal)

107
Q

Is the transverse colon retroperitoneal or intraperitoneal

A

Intraperitoneal

108
Q

What is the 90° turn inferiorly into the pelvis of the sigmoid colon

A

Rectosigmoid junction

109
Q

Which mesentery connects the sigmoid colon to the pelvic wall

A

Sigmoid mesocolon, and so is intraperitoneal

110
Q

Function of the rectum

A

Stores feaces until it is convenient to defecate

111
Q

Which arteries supply the gastrointestinal tract and which regions do they supply

A

Coeliac trunk - Foregut
Superior mesenteric artery - Midgut
Inferior mesenteric artery - Hindgut

112
Q

At what level does the coeliac trunk leave the abdominal aorta

A

T12

113
Q

At what level does the superior mesenteric artery leave the abdominal aorta

A

L1

114
Q

At what level does the inferior mesenteric artery leave the abdominal aorta

A

L3

115
Q

What are the major branches of the superior mesenteric artery

A

Jejunal branches – several branches to the jejunum
Ileal branches – several branches to the ileum
Ileocolic artery – supplies the caecum, appendix, and ascending colon
Right colic artery – supplies the ascending colon
Middle colic artery – supplies the transverse colon

116
Q

What are the jejunal and ileal branches embedded in

A

The mesentery of the small intestine

117
Q

What forms when the jejunal and ileal branches anastomose

A

‘Loops’ of arteries called arcades. From these arcades run the vasa recta (‘straight’ vessels), which supply the intestinal wall.

118
Q

What are the major branches of the inferior mesenteric artery

A

Left colic artery – supplies the transverse colon and the descending colon
Sigmoid branches – supply the sigmoid colon
Superior rectal artery – the terminal branch of the IMA, which supplies the upper rectum

119
Q

What is the marginal artery

A

The anastomose of the branches of the middle colic artery and left colic artery, along the distal third of the transverse colon and the splenic flexure

120
Q

What is the function of the inferior mesenteric vein and where does it lie

A

Drains the hindgut.
Ascends on the left side of the abdomen and typically drains into the splenic vein from the spleen

121
Q

What is the function of the superior mesenteric vein and where does it lie

A

Drains the midgut.
Ascends and unites with the splenic vein close to the liver (posterior to the neck of the pancreas) to form the hepatic portal vein

122
Q

Function of the hepatic portal vein

A

Supplies the liver with nutrient rich blood from the gut, as the splenic, superior mesenteric and inferior mesenteric veins join together.

123
Q

Function of the small hepatic veins and what do they form

A

Carries blood which has had its nutrients removed from the liver.
They unite within the liver to form 2 or 3 large hepatic veins that enter the inferior vena cava

124
Q

What innervates the foregut and midgut

A

Parasympathetic fibres from the vagus nerve

125
Q

What innervates the hindgut

A

Parasympathetic fibres via the pelvic splanchnic nerves

126
Q

What are the pelvic splanchnic nerves formed from

A

The axons of parasympathetic neurons that lie in the sacral spinal cord
The cell bodies of preganglionic parasympathetic neurons lie in S2 – S4
The axons of these neurons leave the spinal cord and form the pelvic splanchnic nerves
The preganglionic axons synapse with a second neuron in a ganglion. The parasympathetic ganglia are located very close to, or even within, the walls of the viscera

127
Q

What fibres pass through the sympathetic trunk (without synapsing) via the greater, lesser, and least splanchnic nerves

A

Preganglionic sympathetic fibres from T5 – T12

128
Q

Which fibres do the greater, lesser, and least splanchnic nerves carry and what do they innervate

A

The greater splanchnic carries fibres from T5 – T9 and innervates the foregut.
The lesser splanchnic carries fibres from T10 – T11 and innervates the midgut.
The least splanchnic carries fibres from T12 and innervates the hindgut.

129
Q

How do parasympathetic fibres innervate the midgut and hindgut

A

Stimulate peristalsis and secretions

130
Q

The preganglionic fibres in splanchnic nerves synapse within ganglia that lie where

A

In the abdomen, clustered around the aorta and the coeliac trunk, SMA and IMA

131
Q

What do the postganglionic sympathetic fibres of the splanchnic nerves form and how do they innervate the gut

A

Form visceral nerves that innervate the gut
They inhibit peristalsis and secretions

132
Q

How do visceral sensory fibres from the gut travel to the CNS

A

Alongside the sympathetic fibres that innervate that part of the gut

133
Q

Painful sensations from the gut enter what spinal chord segments

A

Foregut enter spinal cord segments T5 - T9
Midgut enter spinal cord segments T10 – T11
Hindgut enter spinal cord segment T12

134
Q

T5-12 of the spinal cord also receive somatic sensory information, from which dermatomes

A

The region of the dermatome is consistent with the region of the spinal cord
T5 – T9 (upper abdomen and epigastrium)
T10 – T11 (the umbilical region)
T12 (the suprapubic region)
Epigastric pain suggests foregut pathology
Central abdominal / umbilical pain suggests midgut pathology
Lower abdominal / suprapubic pain suggests hindgut pathology.

135
Q

Where does the liver lie

A

Upper right quadrant and epigastric region
Predominantly in the right hypochondrium and epigastric areas, and extends into the left hypochondrium

136
Q

Which products of digestion from the gut are transported to the liver and how

A

All products, except lipids, via the hepatic portal vein

137
Q

What is the function of bile and where is it stored

A

Produced in the liver and is transported to the gallbladder for storage
Bile emulsifies lipids in the chyme entering the duodenum from the stomach

138
Q

What are the 2 surfaces of the liver

A

Diaphragmatic surface - Lies anterosuperior and is related to the inferior surface of the diaphragm.
Visceral surface - Lies posteroinferior and is related to other organs.

139
Q

Which regions of the liver are not covered by visceral peritoneumeum

A

-Bare area of the liver – A region on the posterior surface that lies in contact with the diaphragm
-The region where the gallbladder lies in contact with the liver
-Region of the porta hepatis – where hepatic blood vessels and ducts of the biliary system enter and exit the liver (the equivalent of the hilum of the lung)

140
Q

What is the falciform ligament

A

A ligament which separates the small left lobe and the large right lobe
It connects the anterior surface of the liver to the internal aspect of the anterior abdominal wall

141
Q

What are the accessory lobes of the liver and where are they located

A

The caudate and quadrate lobes, located on the posteroinferior surface
These lobes do not represent the internal, functional organisation of the liver

142
Q

How many functional segments are in the liver

A

8 functional segments
Each segment is served by its own branch of the hepatic artery and portal vein, and by its own hepatic duct

143
Q

What arteries supply the liver and how do these arteries arise

A

The right and left hepatic arteries
The common hepatic artery, which arises from the coeliac trunk, becomes the hepatic artery proper after the gastroduodenal artery branches off.
The hepatic artery proper bifurcates into right and left hepatic arteries, which enter the liver at the porta hepatis.

144
Q

What is the liver connected to and how

A

-Diaphragm by the coronary and triangular ligaments
-Anterior abdominal wall by the falciform ligament
-Stomach and duodenum by the lesser omentum

145
Q

Where does the liver grow from

A

A tissue bud that develops in the ventral mesentery – a peritoneal fold in the upper abdomen that connects the stomach to the anterior abdominal wall

146
Q

What do the remains of the ventral mesentery form

A

The lesser omentum and the falciform ligament

147
Q

What does the free edge of the falciform ligament contain

A

The round ligament of the liver (the ligamentum teres)
It is the remnant of the umbilical vein, which, in the foetus, carries oxygenated blood from the placenta to the foetus

148
Q

What is the embryological remnant, the ligamentum venosum

A

It is the remains of the ductus venosus, which in foetal life diverts blood from the umbilical vein to the IVC, thus shunting oxygen-rich blood to the heart and bypassing the liver.
Lies on the posterior surface of the liver, in the groove between the caudate lobe and the left lobe of the liver.

149
Q

What is the function of the gallbladder

A

Stores and concentrates bile

150
Q

Where does the gallbladder lie and what are its 3 main parts

A

Lies on the posteroinferior (visceral) surface of the liver and lies close to the duodenum
Fundus, the body, and the neck

151
Q

What is the body of the gallbladder

A

Main part of the gallbladder which sits in the gallbladder fossa on the visceral surface of the liver and tapers towards the neck

152
Q

What is the neck of the gallbladder

A

Communicates with the cystic duct

153
Q

What is the fungus of the gallbladder

A

The rounded end of the gallbladder, which typically extends to the inferior border of the liver

154
Q

What is the surface marking of the fundus of the gallbladder

A

Tip of the 9th costal cartilage, at the point where the right midclavicular line intersects the right costal margin

155
Q

What cells produce bile

A

Hepatocytes in the liver

156
Q

How does bile reach the duodenum from the liver

A

First excreted into small channels called bile canaliculi, which drain into bile ducts of increasing which converge to form right and left hepatic ducts that exit the liver at the porta hepatis.
These converge to form the common hepatic duct
Common hepatic duct receives the cystic duct from the gallbladder, the duct is now called the bile duct which runs in the free edge of the lesser omentum
It lies posterior to the superior part of the duodenum and posterior to the
head of the pancreas
The bile duct enters the duodenum

157
Q

How and when does bile enter the gallbladder from the liver

A

When bile is not needed for digestion, it enters the gallbladder via the cystic duct

158
Q

Where is the spiral fold (spiral duct)

A

Lies at the junction between the gallbladder neck and the cystic duct

159
Q

Which artery supplies the gallbladder

A

Cystic artery, which typically arises from the right hepatic artery

160
Q

How is the gallbladder drained of blood

A

By cystic veins that pass directly into the liver or join the hepatic portal vein

161
Q

Visceral afferents from the gallbladder return to the CNS via what type of fibres

A

Sympathetic fibres

162
Q

Visceral pain from the gallbladder enters which spinal cord levels

A

T5 – T9
Therefore referred to (i.e. felt in) the epigastrium

163
Q

Why might gallbladder pain also be referred to the right shoulder

A

If gallbladder pathology (e.g. inflammation) irritates the diaphragm
The diaphragm is innervated by the phrenic nerve which originates at spinal segments C3-5, which also receives somatic sensory information from the skin over the shoulder

164
Q

If gallbladder pathology irritates the parietal peritoneum, where is pain felt

A

Pain is well localised to the right hypochondrium
The parietal peritoneum is innervated by somatic nerves

165
Q

What is hepatomegaly and what causes it

A

Enlargement of the liver
Causes include hepatitis (inflammation of the liver from various causes), malignancy, and heart failure
When the liver is enlarged, its inferior border becomes palpable inferior to the right costal margin

166
Q

Why do cancers often metastasise to the liver

A

Venous blood from the gut passes through the liver, bowel cancers often metastasize to the liver, via the portal vein

167
Q

What is cirrhosis of the liver and what causes it

A

Scarring of the liver, where hepatocytes are destroyed and replaced with fibrous tissue
Can impair liver function and cause failure due to less hepatocytes
The liver becomes shrunken, hard, and nodular
Caused by chronic excess alcohol consumption, chronic infection with hepatitis B or C, or a build-up of fat in the liver

168
Q

What is portal hypertension and what causes it

A

High blood pressure in the portal venous system
Caused when blood flow through the liver and portal vein is obstructed (e.g. in cirrhosis of the liver)

169
Q

What are portosystemic anastomoses

A

Communications between veins draining to the systemic circulation and veins draining to the portal circulation
In the distal oesophagus, venous blood drains into both the systemic veins (via the azygos) and into the portal system (via the gastric veins)

170
Q

If flow in the portal system is obstructed, where does the blood go

A

Pressure in the portal system increases and blood is diverted from the portal veins into the systemic veins
Systemic veins become distended and varicose (in the oesophagus these are called oesophageal varices) and prone to rupture, which can result in catastrophic bleeding

171
Q

What are gallstones mostly composed of

A

cholesterol

172
Q

Where are gallstones lily to be present if the patient is asymptomatic

A

Within the gallbladder

173
Q

What is biliary colic

A

Severe pain when the gallbladder contracts with gallstones lodged within the cyst duct

174
Q

What happens if a gallstone gets stuck in the biliary tree

A

Results in the accumulation of bile.
If it gets stuck in the cystic duct, flow of bile into the cystic duct and the gallbladder becomes inflamed (cholecystitis)

175
Q

What is a cholecystectomy

A

Removal of the gallbladder

176
Q

What are the 4 parts of the duodenum

A

The superior (first), descending (second), the inferior (third) and the ascending (fourth) parts

177
Q

Where do the bile duct, gastroduodenal artery and the hepatic portal vein lie in relation to the pancreas

A

Posterior to the first part of the duodenum

178
Q

Where does the superior mesenteric artery lie in relation to the pancreas

A

Anterior to the third (anterior) part

179
Q

Arterial branches that supply the duodenum are derived from what arteries

A

Gastroduodenal artery (from the common hepatic artery and hence the coeliac trunk)
Inferior pancreaticoduodenal arteries (from the superior mesenteric artery)
Veins follow the arteries and are tributaries of the hepatic portal vein

180
Q

Where does the pancreas lie

A

Horizontally on the posterior abdominal wall at the level of L1, behind the stomach
Forms part of the posterior wall of the lesser sac

181
Q

Is the pancreas intraperitoneal or retroperitoneal

A

Retroperitoneal
It does not have a capsule so in the cadaver its surface appears ‘bumpy’ rather than smooth

182
Q

How does the pancreas develop

A

Forms from dorsal and ventral pancreatic buds which fuse

183
Q

What are the 4 parts of the pancreas

A

The head, the neck, the body, and the tail

184
Q

What is the uncinate process

A

A hook-like projection of the head of the pancreas

185
Q

Where does the tail of the duodenum extend to

A

The hilum of the spleen

186
Q

How does the splenic artery and vein interact with the pancreas

A

Splenic artery runs towards the spleen embedded in the upper border of the pancreas
Splenic vein lies posterior to the pancreas

187
Q

Function of the pancreas

A

Endocrine - Synthesizes and secretes insulin and glucagon
Exocrine - Produces pancreatic juice that contains digestive enzymes

188
Q

How is pancreatic juice transported to the duodenum

A

Via the main pancreatic duct which merges with the bile duct at the hepatopancreatic ampulla which opens into the second part of the duodenum at the major duodenal papilla
Via the accessory pancreatic duct, which empties pancreatic juice into the duodenum at the minor duodenal papilla, which lies just proximal to the major duodenal papilla

189
Q

What is the sphincter of Oddi and what is it’s function

A

The smooth muscle around the hepatopancreatic ampulla
Contraction of the sphincter prevents reflux of duodenal contents into the bile and main pancreatic ducts

190
Q

Where does the accessory pancreatic duct empty pancreatic juice in the duodenum

A

At the minor duodenal papilla
Lies just proximal to the major duodenal papilla

191
Q

What blood vessels supply the pancreas

A

-The splenic artery runs along the upper border of the pancreas and gives rise to pancreatic arteries
-The superior pancreaticoduodenal arteries which arise from the gasproduodenal artery from the common hepatic artery and hence the coeliac trunk
-Inferior pancreaticoduodenal arteries derived from the superior mesenteric artery

192
Q

Which veins drain the pancreas

A

Veins follow the arteries
The splenic vein drains the pancreas and unites with the superior mesenteric vein to form the hepatic portal vein posterior to the neck of the pancreas

193
Q

What is the spleen and what are its functions

A

A haematopoietic and lymphoid organ.
It has several functions that include the breakdown of old red blood cells, the storage of red blood cells and platelets, and various immune responses, including production of IgG

194
Q

What are the 2 surfaces of the spleen

A

The diaphragmatic surface
The visceral surface lies in contact with the stomach, left kidney and colon. The splenic vessels enter and exit the spleen at the hilum on the visceral surface

195
Q

What are the 4 borders of the spleen

A

The anterior and superior borders are typically notched
The posterior and inferior borders are smooth

196
Q

What vessel supplies the spleen

A

The splenic artery which runs along the superior border of the pancreas, embedded within it
The artery divides into approximately five branches at the hilum

197
Q

How is the pancreas drained of blood

A

Via the splenic vein, which runs posterior to the pancreas
It unites with the superior mesenteric vein to form the hepatic portal vein

198
Q

What is a duodenal ulcer and what can it result in

A

Sores, mostly found in the first half of the duodenum
May erode the duodenal wall and gastroduodenal artery, which lies posterior to the first part of the duodenum, resulting in severe intra-abdominal bleeding

199
Q

What is pancreatitis

A

Inflammation of the pancreas which may be chronic or acute
Acute pancreatitis is a life- threatening condition

200
Q

What are the main causes of pancreatitis

A

Excess alcohol intake
Impaction of the gallstone prevents pancreatic juice from leaving the pancreas and it starts to break down the pancreas - Autolysis

201
Q

How can pancreatic cancer result in bile pigments in the blood and jaundice (yellowing of the skin)

A

When it affects the head of the pancreas, it can obstruct flow of bile in the bile duct

202
Q

What is diabetes mellitus

A

When the insulin-producing cells (β cells) of the pancreas no longer produce insulin or not enough
High blood glucose levels
Some patients develop diabetes secondary to pancreatitis

203
Q

What is splenomegaly and what can cause this

A

Enlargement of the spleen towards the midline, in the
direction of the right iliac fossa, because the phrenicocolic ligament prevents its direct descent towards the left iliac fossa
Infection (e.g. infectious mononucleosis, malaria), haematological malignancy (e.g. leukaemia) and portal hypertension

204
Q

Why is the spleen prone to rupture or blunt abdominal trauma

A

Its soft and highly vascular

205
Q

What is the long-term risk after a splenectomy

A

More prone to some bacterial infections

206
Q

Which part of the nasal cavity contains olfactory receptors

A

Mucosa in the upper part of the nasal cavity

207
Q

What form the olfactory nerves

A

The axons of these receptors

208
Q

How are the left and right nasal cavities separated

A

Thin midline septum, formed of cartilage and bone
The oral cavity inferiorly by the hard palate
The brain superiorly by bone

209
Q

What are paranasal sinuses

A

Cavities within the skull bones

210
Q

What forms the midline nasal septum

A

Cartilage anteriorly and two thin plates of bone posteriorly

Phase 1 Anatomy (4 decks)

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