General GI tract anatomy

Question 1

What does the peritoneal cavity normally contain?

Answer 1

A small amount of lubricating fluid

Question 2

What is the relation of ‘intra-peritoneal’ organs to the peritoneal cavity?

Answer 2

They are enveloped in the cavity but not inside of it

Question 3

What is the relation of ‘retro-peritoneal’ organs to the peritoneal cavity?

Answer 3

Their anterior surfaces are in contact with the cavity but they lie posterior to it

Question 4

What is pneumo-peritoneum and what can cause it?

Answer 4

When air or gas gets into the peritoneal cavity. This can be a pathological process or as a result of laraposcopy when the cavity is inflated with CO2 so that they can see what they are doing

Question 5

What significant artery can be damaged if a duodenal ulcer perforates?

Answer 5

gastro-duodenal artery which lies behind the first part of the duodenum

Question 6

What are the clinical consequences of a damaged gastro-duodenal artery from duodenal ulcer perforation?

Answer 6

Severe bleeding and often massive haematemesis (vomiting up blood)

Question 7

Blockage of what veins can cause portal hypertension?

Answer 7

Hepatic veins (which drain into the inferior vena cava) as they are distal to the portal vein and so would limit the flow through the portal vein and cause a rise in portal pressure

Question 8

What forms the anterior border of the lesser sac?

Answer 8

1. Posterior surface of stomach
2. Lesser omentum
3. Part of the greater omentum

Question 9

What forms part of the posterior border of the lesser sac?

Answer 9

1. Diaphragm

2. Pancreas

Question 10

What is a porto-systemic anastomosis?

Answer 10

A part of the body which normally drains into the portal system but which has the facility to drain blood into the systemic system

Question 11

In oesophageal varices how does the blood drain into the systemic system?

Answer 11

Systemic drainage - via the azygous vein

Portal drainage - via the left gastric vein

Question 12

In the porto-systemic varices that present as the caput medusae, which veins are involved?

Answer 12

para-umbilical veins - veins which carry oxygenated blood from the mother to the fetus in utero and are noramally closed within one week of birth but can become re-canalised due to portal hypertension

Question 13

What branch of the coeliac trunk gives rise to the left gastroepiploic artery (also called gastro-omental artery)

Answer 13

Splenic artery

Question 14

Where does the left gastroepiploic artery travel after it has branched off of the splenic artery?

Answer 14

It travels along the greater curve of the stomach (about a cm away from it) to anastomise with the right gastroepiploic artery.

Question 15

What are the three main structures that lie in the free edge of the lesser omentum?

Answer 15

Hepatic artery
Hepatic portal vein
Common bile duct

Question 16

What is the ligamentum teres?

Answer 16

A remnant of the foetal umbilical vein, found in the falciform ligament

Question 17

The gastro-duodenal artery branches off which artery to make its way down past the posterior of the first part of the duodenum?

Answer 17

Commonly the common hepatic artery

Question 18

When does the common hepatic artery become known as the proper hepatic artery?

Answer 18

After the gastro-duodenal artery branches off of the common hepatic artery

Question 19

The greater sac is divided into supracolic and infracolic compartments. What structure forms the physical divide between these compartments?

Answer 19

Transverse mesocolon (mesentery of the transverse colon)

Question 20

Where is the gastrocolic ligament attached?

Answer 20

To the greater curve of the stomach and the transverse colon

Question 21

What divides the infracolic compartment into right and left infracolic spaces?

Answer 21

The mesentery of the small intestine (holding it to the posterior abdominal wall)

Question 22

The paracolic gutters are channels within the peritoneal cavity which connect the supracolic and infracolic compartments. Where do they lie?

Answer 22

Lateral to the ascending and descending colon (between the lateral aspect of the ascending and descending colon and the lateral abdominal wall)

Question 23

What two compartments is the greater sac divided into?

Answer 23

Supracolic and infracolic compartments

Question 24

Where is the pouch of Douglas found?

Answer 24

Beween the rectum and uterus (in females!). It is also called the rectouterine pouch

Question 25

Below the arcuate line, what is the posterior surface of the rectus abdominis muscle in contact with?

Answer 25

The aponeurosis of the transverse abdominis

Question 26

At what spinal level does the oesophagus pierce the diaphragm?

Answer 26

T10

NB: there are ten letters in the word ‘oesophagus’

Question 27

At what spinal level does the vena cava pierce the diaphragm?

Answer 27

T8

NB: there are eight letters in the word ‘vena cava’

Question 28

At what spinal level does the aorta pierce the diaphragm?

Answer 28

T12

NB: aortic hiatus has 12 letters in it

Question 29

What structure lies around the oesophageal hiatus (where the oesophagus pierces the diaphragm) and helps prevent reflux of the stomach contents into the oesophagus?

Answer 29

Right crus of the diaphragm (a tendinous structure) which helps prevent reflux by tightening around the lower oesophagus

Question 30

What structure of the diaphragm does the vena cava pass through?

Answer 30

Central tendon of the diaphragm

Question 31

Which part of the pancreas does the portal vein originate behind?

Answer 31

Neck - at the confluence of the splenic and superior mesenteric veins

Question 32

What is the name of the artery that supplies blood to the lesser curve of the stomach?

Answer 32

Left gastric artery - which anastomoses with the right gastric artery (along the lesser curve of the stomach)

Question 33

What are the three main branches of the coeliac trunk?

Answer 33

Left gastric artery
Splenic artery
Common hepatic artery

Question 34

What is the name of the small lobe of the liver that lies in close approximation to the gallbladder?

Answer 34

Quadrate lobe

Question 35

What is the name of the small lobe of the liver that lies very close to the vena cava at the posterior aspect of the liver?

Answer 35

Caudate lobe

Question 36

What structures lies in the free edge of the lesser omentum?

Answer 36

The hepatic artery, portal vein and common bile duct

Question 37

What artery does the gastroduodenal artery branch off of?

Answer 37

Common hepatic artery - it then descends down the posterior surface of the duodenum

Question 38

What are the names of the sphincters which control the input and output of food into the stomach?

Answer 38

Superior sphincter - lower oesophageal sphincter

Inferior sphincter - pyloric sphincter

Question 39

Where are the subphrenic spaces found?

Answer 39

Recesses in the greater sac between the anterosuperior face of the liver and the diaphragm

Question 40

What divides the subphrenic spaces into left and right?

Answer 40

Falciform ligament

Question 41

Where can the lymph nodes be found near the stomach?

Answer 41

the gastric lymphatic vessels travel with the arteries along the greater and lesser curvatures of the stomach. Lymph fluids drain into the gastric and gastroepiploic lymph nodes found at these curvatures. Efferent lymphatic vessels from these nodes connect to the coeliac lymph nodes

Question 42

What is the anatomical relationship between the duodenum and the pancreas?

Answer 42

The ucinate process, head and neck of the pancreas are nestled in the C shape of the duodenum

Question 43

What is the relationship between the spenic blood vessel and the tail of the pancreas?

Answer 43

The splenic artery and vein travel along behind the posterior surface of the pancreas’ tail

Question 44

Where do the superior mesenteric vein and splenic vein meet?

Answer 44

neck of pancreas

Question 45

What is the relationship between the superior mesenteric vessel (artery and vein) and the third part of the duodenum?

Answer 45

The superior mesenteric vessel pass over the anterior surface of the third part of the duodenum