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Gastrointestinal System Flashcards

1
Q

Which organs make up the foregut?

A

Oesophagus

Stomach

First half of the duodenum

Liver

Gallbladder

Spleen

Half of pancreas

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2
Q

Which organs make up the midgut?

A

Second half of duodenum

Jejunum

Ileum

Ascending colon

Proximal 2/3 of transverse colon

Half of pancreas

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3
Q

Which organs make up the hind gut?

A

distal 1/3 of the transverse colon

descending colon

sigmoid colon

proximal half of the anal canal

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4
Q

Which nerves are involved in the gag reflex?

A

Glossopharyngeal - sensory & motor

Vagal - motor

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5
Q

Which nerve provides sensory and special sensory (taste) innervation to the posterior 1/3 of the tongue?

A

Glossopharyngeal

CN IX

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6
Q

Which nerves provide sensory innervation to the anterior 2/3rds of the tongue?

A

Mandibular branch of trigeminal (CN V3) - sensory

Facial nerve (CN VII) - chorda tympani - special sensory (taste)

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7
Q

Which parasympathetic nerves innervate the salivary glands?

A

Parotid - glossopharyngeal (CN IX)

Submandibular - facial nerve (CN VII)

Sublingual - facial nerve (CN VII)

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8
Q

Which sympathetic nerve fibres innervate the salivary glands?

A

Post-ganglionic neurons of the

superior cervical ganglia

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9
Q

What are the features of intraperitoneal organs?

A

Almost completely covered with visceral peritoneum

Minimally mobile

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10
Q

Give examples of retroperitoneal organs.

A

Kidneys

Pancreas

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11
Q

What are the features of organs with a mesentery?

A

Covered in visceral peritoneum and suspended from posterior abdominal wall by mesentery

Highly mobile

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12
Q

What is a mesentery?

A

Double layer of visceral peritoneum

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13
Q

What procedure is performed to drain the peritoneal cavity of ascites?

A

Paracentesis

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14
Q

What should the needle placement be for paracentesis?

A

lateral to rectus sheath to avoid inferior epigastric vessels

(running deep to rectus abdominus)

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15
Q

Where does the inferior epigastric artery arise?

A

from the external iliac

just medial to the deep inguinal ring

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16
Q

Which two organs are attached by the lesser omentum?

A

Liver and stomach

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17
Q

Which two organs are attached by the greater omentum?

A

Stomach and transverse colon

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18
Q

Which structure attaches the liver to the anterior abdominal wall?

A

Falciform ligament

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19
Q

Where does the portal triad lie?

A

Within the free edge of the lesser omentum

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20
Q

How do the omenta divide the peritoneal cavity?

A

Into a greater sac and a lesser sac, which communicate via the omental foramen

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21
Q

In the male, what pouch is formed by the inferior aspect of the peritoneum?

A

Rectovesical pouch - between bladder and rectum

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22
Q

In the female which pouches are formed by the inferior aspect of the peritoneum?

A

Uterovesical pouch

Rectouterine pouch

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23
Q

How does the autonomic nervous sytem influence peristalsis?

A

parasympathetic - speed up peristalsis

sympathetic - slow down peristalsis

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24
Q

Where do the sympathetic nerve fibres supplying the abdominal organs leave the spinal cord?

A

T5 to L2

abdominopelvic splanchnic nerves

synapse at prevertebral ganglia

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25
How do postsynaptic sympathetic nerve fibres reach the abdominal organs?
travel from prevertebral ganglia on the surface of arterial branches in periarterial plexuses
26
What is unique about the sympathetic nerve supply to the adrenal glands?
Leave the spinal cord at T10 - L1 with abdominopelvic splanchnic nerves but **do not synapse at prevertebral ganglia** carried within perarterial plexuses to adrenal gland where they synapse directly onto cells
27
How do vagus nerve fibres travel to the foregut and midgut organs?
Enter the abdominal cavity on the surface of the oesophagus - vagal trunks travel along periarterial plexuses on abdominal aorta Synapse in ganglia on organ walls
28
How do parasympathetic nerve fibres travel to the hind gut organs?
Pelvic splanchnic nerves S2 - S4
29
Where do pain fibres from the foregut enter the spinal cord?
T6 - T9
30
Where do pain fibres from the midgut enter the spinal cord?
T8 - T12
31
Where do pain fibres from the hindgut enter the spinal cord?
T10 - L2
32
Where does pain from the liver and gallbladder tend to refer to?
Right shoulder
33
Where does pain from the stomach, duodenum and pancreas tend to refer to?
Back
34
Where does pain from the kidney and ureter tend to refer to?
Back Groin
35
What structures are supplied by the thoracoabdominal nerves?
Abdominal body wall
36
From which intercostal nerves do the thoracoabdominal nerves arise?
7 - 11
37
What is the course of the thoracoabdominal nerves through the abdominal wall?
Between the internal oblique and transversus abdominus
38
At which ramus does the subcostal nerve arise?
T12 anterior ramus
39
Which nerves supplying the abdominal wall arise from the L1 anterior ramus?
Iliohypogastric nerve Ilioinguinal nerve
40
Which vessels are found in the portal triad?
hepatic artery hepatic portal vein common bile duct (nerves and lymphatics)
41
Which branches of the abominal aorta serve the abdominal organs?
celiac trunk - foregut superior mesenteric artery - midgut inferior mesenteric artery - hindgut
42
What are the three branches of the celiac trunk?
hepatic artery splenic artery left gastric artery
43
Which ribs protect the spleen?
9 - 11
44
What is the blood supply to the stomach?
**lesser curvature** right gastric artery - branch of the hepatic artery left gastric artery **greater curvature** ** **left gastro-omental artery - branch of the splenic artery right gastro-omental artery - branch of the hepatic artery
45
Why does a rise in central venous pressure transmit directly to the liver?
Neither the IVC nor the hepatic veins have valves
46
What is the supply and drainage to a liver lobule?
interlobular portal triad at each corner ## Footnote biliary duct hepatic portal vein hepatic artery central vein in the middle
47
Where is the quadrate lobe of the liver found?
Posterior surface Inferior, next to gall bladder
48
Where is the caudate lobe of the liver found?
Posterior surface Superior to the gall bladder
49
What are the two recesses around the liver?
Subphrenic recess Hepatorenal recess (Morison's pouch) the latter is one of the lowest parts of the peritoneal cavity when a patient is supine
50
What are the normal bounds of the liver?
ribs 7 to 11
51
Which ligaments attach the liver to the diaphragm?
Coronary ligaments
52
Which ligament is found inferior to the liver, and is a remnant of the embryological umbilical vein?
Ligamentum teres | (round ligament)
53
Which veins supply the portal vein?
foregut - splenic vein midgut - superior mesenteric vein hindgut - inferior mesenteric vein - splenic vein
54
Which artery supplies the gall bladder?
cystic artery usually a branch of the right hepatic artery
55
What are the parts of the gallbladder?
body and neck
56
Which artery supplies the pancreas and duodenum?
Gastroduodenal which branches into the right gastro-omental and superior pancreatico-duodenal
57
Into which part of the duodenum do the bile duct and pancreatic duct drain?
Second part
58
Through which orifice do the bile duct and main pancreatic duct drain?
Major duodenal papilla via the ampulla of Vater
59
Which sphincters control the drainage of bile and pancreatic juices?
bile duct sphincter (controls flow of bile) pancreatic duct sphincter (prevents reflux of bile into pancreatic duct) sphincter of Oddi
60
What are the parts of the pancreas?
Head Uncinate process Neck Body Tail
61
Where does the uncinate process lie?
Posterior to the superior mesenteric vessels
62
What is the blood supply to the pancreas?
splenic artery superior pancreatico-duodenal artery inferior pancreatico-duodenal artery superior mesenteric artery
63
Where is the duodenal cap?
Initial section of the 1st part of the duodenum
64
What are the four parts of the duodenum?
superior (part intraperitoneal) descending (retroperitoneal) horizontal (retroperitoneal) ascending (retroperitoneal)
65
Which lymph nodes drain the kidneys, posterior abdominal wall, pelvis and lower limbs?
lumbar
66
Where are the paracolic gutters found?
Between the lateral edge of the ascending and descending colon and the abdominal wall
67
How is the colon identified radiologically?
haustra, formed by the teniae coli | (3 longitudinal bands of smooth muscle)
68
What is the location of McBurney's point?
1/3 of the way from ASIS to the umbilicus
69
What are the branches of the superior mesenteric artery supplying the large intestine?
middle colic artery right colic artery ileocolic artery appendicular artery jejunal artery ileal artery
70
What are the branches of the inferior mesenteric artery?
left colic artery sigmoid artery superior rectal artery
71
What is the marginal artery of Drummond?
arterial anastomoses between branches of the SMA and IMA
72
Which artery supplies the distal end of the anal canal?
Internal iliac artery
73
Where are the important sites of venous anastomosis between the system and portal nevous systems?
distal end of oesophagus - oesophageal varices (hepatic portal vein/azygous) around the umbilicus (inferior epigastric veins \> IVC) rectum/anal canal (IVC, internal iliac)
74
Which muscle
75
At which vertebra does the sigmoid colon become the rectum?
anterior to S3
76
At which point does the rectum become the anal canal?
anterior to the tip of the coccyx, just prior to passing through the levator ani muscle
77
In which part of the body are the rectum, anal canal and anus found?
rectum - pelvis anal canal & anus - perineum
78
What is the name of the mesentary to which the sigmoid colon is attached?
Sigmoid mesocolon
79
What is the name of the dilated distal part of the rectum?
Rectal ampulla | (immediately superior to levator ani)
80
When does the levator ani muscle contract and relax?
tonically contracted most of the time reflexively contracts further during situations of increased intra-abdominal pressure (coughing, sneezing) relaxes to allow defecation & urination
81
How is the levator ani muscle innervated?
Nerve to levator ani branch of sacral plexus
82
Which muscle of the levator ani is particularly important for maintain faecal continence?
**Puborectalis muscle** It has two attachments to the pubic bone, either side of the pubic symphesis and loops around the back of the rectum at the **anorectal angle**. Contraction decreases the anorectal angle, relaxation allows defecation.
83
Where is the internal anal sphincter located? How is it innervated?
superior 2/3rds of the anal canal contraction stimulated by sympathetic nerves contraction inhibited by parasympathetic nerves contracted all the time - relaxed reflexively in response to distension of rectal ampulla
84
Where is the external anal sphincter located? How is it innervated?
Inferior 2/3rds of anal canal - superior part of sphincter continous with puborectalis muscle. Contraction stimulated by **pudendal nerve**. Voluntarily contracted (with puborectalis muscle) in response to rectal ampulla distension and internal sphincter relaxation.
85
Which somatic nerve fibres make up the pudendal nerve?
S2, S3, S4
86
Which line of the anal canal marks the end of the hind gut? What is its significance?
Pectinate line embryologically - endoderm vs ectoderm visceral (superior) and parietal (inferior) have different arterial supply, venous drainage and nerve supply
87
What is the lymphatic drainage of the visceral anal canal?
internal iliac nodes \> inferior mesenteric nodes
88
What is the lymphatic drainage of the parietal anal canal?
superficial inguinal nodes
89
What is the difference in nerve supply between the visceral and parietal anal canal?
visceral - autonomic nerve supply parietal - somatic nerve supply (pudendal)
90
What is blood supply and drainage of the parietal anal canal?
Internal iliac artery Internal iliac vein
91
What is the functional difference between the blood drainage of the visceral and parietal anal canal?
visceral - portal system parietal - systemic circulation
92
What are rectal varices?
Dilation of collateral veins between portal and system venous circulations, formed in relation to portal hypertension
93
What is the cause of haemorrhoids?
Prolapse of internal rectal venous plexus (anal cushions) external rectal venous plexus
94
Where are the ischioanal fossae?
Either side of the anal canal, medial to the ischium Filled with fat and connective tissue

Anatomy (10 decks)

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